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Anesthesia Foundations II Exam 2 > Spinal, Epidural, Caudal (week 7) > Flashcards

Spinal, Epidural, Caudal (week 7) Flashcards

1
Q

How many cervical vertebrae are there?

A

7

Torabi’s Panopto 1

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2
Q

How many thoracic vertebrae are there?

A

12

Torabi’s Panopto 1

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3
Q

How many Lumbar vertebrae are there?

A

5

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4
Q

How many Sacral “vertebrae” are there?

A

5

Torabi’s Panopto 1

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5
Q

How many coccygeal “vertebrae” are there?

A

4

Torabi’s Panopto 1

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6
Q

Total vertebrae within the spinal column?

A

33

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7
Q

Where does the adult spinal cord extend from/to?

A

From: the Medulla oblongata
To: the spinal foramen @ the level of L1-L2

Torabi’s Panopto 1

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8
Q

Where does the pediatric spinal cord extend to?

A

About the level of L3

Torabi’s Panopto 1

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9
Q

What is the Cauda Equina’s function

A

Send/Receive messages from the lower limbs/pelvic organs

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10
Q

What organ(s) does the Cauda equina innervate?

A
  • Bladder
  • Rectum
  • Internal Genital organs

Torabi’s Panopto 1

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11
Q

When performing a caudal epidural block, what two landmarks are you palpating for?

A
  • Sacral Hiatus
  • Sacral Cornua

Torabi’s Panopto 1

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12
Q

What happens to isobaric solutions after injected into the CSF?

A

Baricity = 1
They remain & act in the location

Spinal Anesthetic Baricity PPT, slide 3

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13
Q

What happens to hypobaric solutions after injected into the CSF?

A

Solutions rise to the highest anatomical level
Baricity <0.999

Spinal Anesthetic Baricity PPT, slide 3

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14
Q

What happens to hyperbaric solutions after injected into the CSF?

A

Baricity >1.015
Solutions sink to lowest anatomical position

Spinal Anesthetic Baricity PPT, slide 3

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15
Q

What do you mix with a LA to create an isobaric solution?

A

Sterile/preservative free Normal Saline

Spinal Anesthetic Baricity PPT, slide 5 & Nagelhout pg. 1122

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16
Q

What do you mix with a LA to create a hypobaric solution?

A

Sterile/preservative free Water

Spinal Anesthetic Baricity PPT, slide 5 & Nagelhout pg. 1122

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17
Q

What do you mix with a LA to create a hyperbaric solution?

A

Sterile/preservative free 5-8% Dextrose solution

Spinal Anesthetic Baricity PPT, slide 5 & Nagelhout pg. 1122

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18
Q

How long are patients required to be supine after a blood patch?

A

30 min - 1 hr

Nagelhout 7th ed., Ch. 49, pg. 1126

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19
Q

Absolute contraindications for central neuraxial blockade?

A
  • Pt refusal
  • Blood coagulopathies/dyscrasias
  • A./M. stenosis
  • Increased ICP
  • severe hypovolemia

Nagelhout 7th ed., Ch. 49, pg. 1114

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20
Q

Sympathetic blockade can be how many dermatome levels higher than sensory?

A

6 or more

Nagelhout 7th ed., Ch. 49, pg. 1113

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21
Q

What doses of opioids can be added to prolong spinal anesthesia?

A
  • 10 - 25 mcg Fentanyl
  • 100 - 250 mcg Morphine
  • 2.5 - 10 mcg Sufentanil

Nagelhout 7th ed., Ch. 49, pg. 1122

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22
Q

What doses of alpha-2 adrenergic agonists can be added to prolong spinal anesthesia?

A
  • 150mg Clonidine
  • 5 mcg Precedex

Nagelhout 7th ed., Ch. 49, pg. 1122

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23
Q

Examples of surgeries at the T4 level?

A
  • Upper abdominal surgery
  • C-section
  • Cystectomy
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24
Q

Examples of surgeries at the T6-7 level?

A
  • Appendectomy
  • Lower abdominal surgeries
25
Examples of surgeries at the T10 level?
* Total hip arthroplasty * TURP * Vaginal delivery
26
Examples of surgeries at the L1-L3 level?
* Lower extremity surgeries
27
Examples of surgeries at the L2-L3 level?
* Foot surgeries
28
Examples of surgeries at the S2-S5 level?
* Hemorroidectomy
29
Order of sensory/motor loss?
1. Pre-ganglionic sympathetic 2. Temp 3. Fast pain 4. Touch 5. Deep Pressure 6. Motor ## Footnote Miller's 8th Ed. pg. 1688 + Torabi PPT
30
What is cauda equina syndrome?
Exposure of the Lumbosacral trunk to high-concentrations of LA, or long exposure via catheter, causing permanent neurologic injury ## Footnote Miller's 9th ed. Ch 45,
31
Which drug/tool has been implicated in Cauda equina syndrome?
* 5% Lidocaine * Spinal micro-catheters ## Footnote Miller's 9th ed. Ch 45,
32
Needles used for Spinal/Epidural Anesthesia?
* Spinal - 25g Whitacre * Epidural - 17g Touhy
33
Risk factors for PDPH | Post-dural puncture headache
* Female * Less than 40 y/o * Multiple punctures * Hx of PDPH * Use of a cutting needle ## Footnote Nagelhout 7th ed, Ch. 49, pg. 1125
34
Description of a PDPH?
* Mild-incapacitating * Frontal radiating behind the eyes * To the Occiput * Down to Neck/shoulders * Relieved when supine *Tinnitis ## Footnote Nagelhout 7th ed, Ch. 49, pg. 1125
35
Tx for PDPH?
* Supine * Hydration * Oral analgesics * 500mg IV Caffeine * **Theophylline 150mg q12hr** * Sphenopalantine Ganglion block * Epidural blood patch ## Footnote Nagelhout 7th ed, Ch. 49, pg. 1126
36
Other S/Sx of PDPH?
* N/V & Appetite loss * Blurred vision * Plugging of ears/hearing loss * Tinnitus * Vertigo * Depression ## Footnote Nagelhout 7th ed, Ch. 49, pg. 1125
37
What interventions can be used with unilateral epidural blocks?
* Unblocked side dependent * Withdraw catheter 1-2cm * Take it out and do it again, higher * Give 5mL bolus (based on our review on V-day) ## Footnote Nagelhout 7th ed, Ch. 49, pg. 1135
38
Depth of epidural space from skin?
3.5 - 6cm ## Footnote Miller's 9th ed. Ch. 45, pg. something
39
How much catheter should be threaded into the epidural space?
3-5 cm ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1128
40
In what order do you penetrate tissue during an Epidural/Intrathecal puncture with a median approach?
1. Subq tissue 2. Supraspinous ligament 3. Interspinous ligament 4. Ligamentum Flava 5. Dura (Intrathecal only... unless you suck) 6. Arachnoid Mater ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1110
41
What is the concentration of drugs in a test dose for Epidural anesthesia?
* 1.5% Lidocaine (15mg/mL) * 1:200,000 Epinephrine (5mcg/mL) * (3mL total) ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1130
42
What do the ingredients in the test dose... test for?
* Intrathecal * Intravascular placement ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1130
43
How will you know an epidural test dose is intravascular?
* 20% increase in HR from Epi * Tinnitus, Metallic taste, circumoral numbness, rushing sound in ears from Lido ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1130
44
How will you know an epidural test dose is intrathecal?
Warmth/Weakness in LE, Spinal anesthesia within 3 min **Stop**, do it somewhere else ## Footnote Nagelhout 7th ed., Ch. 49, pg. 1130, Torabi Neuraxial/Epidural PPT slide 81
45
Absolute CI to Caudal Anesthesia?
* Spina Bifida * Meningocele * Meningitis ## Footnote Apex
46
Sensory block is how many dermatomes higher than motor block?
2 Levels ## Footnote Torabi Neuraxial/Epidural PPT slide 18
47
How long should you hold IV Heparin before/after a neuraxial block?
Before: 2-4 hours After: 1 Hour ## Footnote Torabi Neuraxial/Epidural PPT slide 26
48
How long should you hold Lovenox before/after a neuraxial block?
Once daily dosing Before: ≥12 hrs Twice daily dose Before: ≥24 hrs All doses after: 4 ## Footnote Torabi Neuraxial/Epidural PPT slide 27's website
49
What lab values would you question if neuraxial is appropriate?
> 2x the normal range of * PT/INR: (9-11 sec) * aPTT: (25-38 sec) * Bleeding time: 3-7 min * PLts: <100,000
50
What drug can you give to prevent Spinal induced hypotension?
Ondansetron 4-8mg
51
What is the medication used for hyperbaric subarachnoid block?
Bupivicaine 0.75% w/ 8.25% Dextrose (2mL) ## Footnote Torabi Neuraxial/Epidural PPT slide 51
52
What is the principle site of action of spinal anesthesia?
Nerve roots of spinal cord ## Footnote Torabi Neuraxial/Epidural PPT slide 52
53
What is the principle site of action for Epidural anesthesia?
Dural cuff ## Footnote Torabi Neuraxial/Epidural PPT slide 52
54
Describe briefly the Taylor approach?
* Paramedian approach * @ the L5 to S1 interspace
55
Since spread of epidural LA is greater with age and in pregnancy, how much LA should be limited per desired level of block?
0.5 to 1 mL per segment ## Footnote Torabi Neuraxial/Epidural PPT slide 78
56
Common side effects of neuraxial opioids?
* **Pruritis (most common)** * Respiratory depression (most severe) * Urinary retention * N/V ## Footnote Torabi Neuraxial/Epidural PPT slide 82
57
How would you select a site for the epidural blood patch
Choose a site **at or below** the previous insertion ## Footnote Torabi Neuraxial/Epidural PPT slide 93
58
A patient has redness, irritation, or an infection at your desired epidural site, would you give it?
No cause it is contraindicated you moron. | The creator of the card, not you, innocent study friend ## Footnote Torabi Neuraxial/Epidural PPT slide 84
59
What is the specific gravity of CSF?
1.004 - 1.009 ## Footnote Nagelhout 7th ed. Ch. 49, p. 1121

Anesthesia Foundations II Exam 2 (6 decks)

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