Spinal/Epidural Blocks

Question 1

Where is CSF contained?

Answer 1

B/w the Pia and arachnoid maters in the subarachnoid space

Question 2

The spinal cord normally extends from ______ to the level of ___ in adults

Answer 2

foramen magnum; L1

Question 3

In children, the spinal cord ends at ___ and moves up with age

Answer 3

L3

Question 4

Lower spinal nerves form the _____

Answer 4

cauda equina

Question 5

One of the radicular arteries is typically large, the _______, or ______, arising form the aorta

Answer 5

artery of Adamkiewicz; arteria radicularis magna

Question 6

Absolute contraindications for neuraxial anesthesia

Answer 6

infxn at site of injection
lack of consent
coagulopathy or other bleeding diathesis
severe hypovolemia
increase ICP

Question 7

Relative C/I for neuraxial anesthesia

Answer 7

sepsis
uncooperative pt
preexisting neurological deficits
demyelinating lesions
stenotic valvular heart lesions
LV outflow obstruction (Hypertrophic obstructive CM)
severe spinal deformity

Question 8

Controversial C/I for neuraxial anesthesia

Answer 8

prior back sx at the site of injection
complicated surgery
prolonged operation
major blood loss
maneuvers that compromise respiration

Question 9

Rivaroxaban should be discontinued ____ before a neuraxial block

Answer 9

72 hrs

Question 10

Rivaroxaban should be administered at least ______ hours after catheter removal

Answer 10

22-26

Question 11

Dabigatran requires a _____ discontinuation period prior to neuraxial anesthesia

Answer 11

96 hr

Question 12

Hold subQ heparin for ___ hrs for catheter removal

Answer 12

12

Question 13

___ & ____ do NOT increase the risk of spinal hematoma from neuraxial anesthesia or epidural catheter removal

Answer 13

aspirin & NSAIDs

Question 14

Waiting period for ticlopidine

Answer 14

10 days

Question 15

Waiting period for clopidogrel

Answer 15

5-7 days

Question 16

Waiting period for prasugrel

Answer 16

7-10 days

Question 17

Waiting period for ticagrelor

Answer 17

5-7 days

Question 18

Waiting period for abciximab

Answer 18

24-48 hrs

Question 19

Waiting period for eptifibatide

Answer 19

4-8hrs

Question 20

The _____ the dosage or more _____ the site of injection, the more cephalad the level of anesthesia that will be obtained

Answer 20

larger; cephalad

Question 21

When a pt is in a head-down position, a hyperbaric solution spreads ______, and a hypobaric solution moves ______

Answer 21

cephalad; caudad

Question 22

A head-up position causes a hyperbaric solution to ____ and a hypobaric solution to _____

Answer 22

settle caudad; ascend cephalad

Question 23

When a pt remains in a lateral position, a hyperbaric spinal solution will have a greater effect on the _____ side whereas a hypobaric solution will achieve higher levels on the _____ side.

Answer 23

dependent (down); nondependent (up)

Question 24

An _____ solution tends to remain at the level of injection

Answer 24

isobaric

Question 25

Only what type of local anesthetic solutions are used for spinal anesthetics?

Answer 25

preservative-free

Question 26

What is the hallmark of postdural puncture headache?

Answer 26

its association with body position. (increased by sitting or standing, relieved by lying down flat)

Question 27

________ needles are a/w a higher incidence of PDPH than ______ needles of the same gauge

Answer 27

cutting-point; pencil-point

Question 28

Tx for PDPH

Answer 28

laying flat, dark room, Tylenol, NSAIDs, caffeine, opioids, epidural patch