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Principles of Anesthesia 1 - (Summer 2024) > Spinal & Epidural Part 2 ( Tubog) Exam 1 > Flashcards

Spinal & Epidural Part 2 ( Tubog) Exam 1 Flashcards

1
Q

Which meningeal layer is the outermost?

A. Arachnoid mater
B. Dura mater
C. Pia mater
D. Subdural space

A

B. Dura mater

Slide 29

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2
Q

What mengieal layer is considered the middle layer surrounding the spinal cord?

A. Epidural mater
B. Subarachnoid space
C. Subdural space
D. Arachnoid mater

A

D. Arachnoid mater

Slide 29

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3
Q

What structure directly covers the spinal cord?

A. Dura mater
B. Arachnoid mater
C. Pia mater
D. Epidural veins

A

C. Pia mater
Innermost layer

Slide 29

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4
Q

Which statements are true about the epidural space? Select 3

A. It is located outside the dura mater
B. It contains fat
C. It contains large blood vessels
D. It is filled with cerebrospinal fluid (CSF)
E. It contains small blood vessels
F. It is between the arachnoid mater and pia mater

A

A. It is located outside the dura mater
B. It contains fat
E. It contains small blood vessels

Slide 30

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5
Q

Features of the subdural space include:
Select 2

A. Located between the dura mater and arachnoid mater
B. A potential space
C. Filled with cerebrospinal fluid (CSF)
D. Contains fat and small blood vessels
E. Located between the dura mater and epidural space

A

A. Located between the dura mater and arachnoid mater
B. A potential space

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6
Q

The subarachnoid space: (select 2)

A. Is located between the arachnoid mater and pia mater
B. Is located between the dura mater and the arachnoid mater
C. Contains epidural veins
D. Is filled with cerebrospinal fluid (CSF)
E. Is a potential space

A

A. Is located between the arachnoid mater and pia mater
D. Is filled with cerebrospinal fluid (CSF) -CSF cushions and protects the spinal cord

Slide 30

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7
Q

Where is the cranial border of the epidural space located?

A. Near the ligament connected to the coccyx
B. At the foramen magnum
C. Along the vertebrae
D. Framed by the bony plates of the vertebrae

A

B. At the foramen magnum At the top, (base of the skull)

slide31

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8
Q

What forms the caudal border of the epidural space?

A. The posterior longitudinal ligament
B. Ligamentum flavum
C. The sacrococcygeal ligament
D. The vertebral pedicles

A

C. The sacrococcygeal ligament - it’s at the bottom where the ligament is connected to the coccyx

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9
Q

What marks the anterior border of the epidural space?

A. Ligamentum flavum
B. The anterior longitudinal ligament
C. The bony projections of the vertebrae (vertebral pedicles)
D. The posterior longitudinal ligament

A

D. In the front, lined by the posterior longitudinal ligament along the vertebrae

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10
Q

What forms the lateral borders of the epidural space?

A. The posterior longitudinal ligament
B. The bony projections of the vertebrae
C. The sacrococcygeal ligament
D. Ligamentum flavum

A

B. The bony projections of the vertebrae on the sides (verterbral pedicles)

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11
Q

The posterior borders of the epidural space are at the back, framed by __________ and the bony plates of the vertebrae __________.
A. ligamentum flavum, vertebral lamina
B. posterior longitudinal ligament, vertebral pedicles
C. sacrococcygeal ligament, vertebral lamina
D. arachnoid mater, intervertebral discs

A

A. ligamentum flavum, vertebral lamina

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12
Q

The epidural space contains nerves, __________, lymphatics, and blood vessels.

A. epithelial tissue
B. interstitial fluid
C. fatty tissue
D. connective tissue

A

C. fatty tissue

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13
Q

How does the fatty tissue in the epidural space affect drug absorption?

A. It has no effect on drug absorption
B. It absorbs and increases the availability of drugs
C. It absorbs and decreases the availability of certain drugs
D. It only affects the absorption of morphine

A

C. It absorbs and decreases the availability of certain drugs
(e.g., bupivacaine is absorbed more than lidocaine or fentanyl or morphine).

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14
Q

What is a characteristic of epidural veins?

A. They have valves
B. They form a plexus
C. Their density decreases laterally
D. They are unaffected by obesity or pregnancy

A

B. They form a plexus (Batson’s Plexus) -draining blood from the cord and its linings

Slide 32

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15
Q

Functions and features of epidural veins (Batson’s Plexus) include: Select 3

A. Valveless structure
B. A plexus returning blood to the cord
C. Density increases laterally
D. Engorge during pregnancy
E. Decrease the risk of puncture

A

A. Valveless structure
C. Density increases laterally
D. Engorge during pregnancy

increasing the risk of puncture during needle procedures in this area.

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16
Q

True or False

The presence of this Plica Mediana Dorsalis is controversial but has been definitively confirmed.

A

FALSE
The presence of this structure is controversial and not definitively confirmed.

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17
Q

Where is the plica mediana dorsalis thought to be located?

A. Between the spinal cord and the pia mater
B. Between the ligamentum flavum and the dura mater
C. Between the arachnoid mater and pia mater
D. Between the spinal cord and the epidural space

A

B. Between the ligamentum flavum and the dura mater

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18
Q

The plica mediana dorsalis might have clinical relevance by: Select 3

A. Facilitating catheter insertion
B. Acting as a barrier within epidural space
C. Increasing the spread of medications
D. Playing a role in complications
E. Possibly causing unilateral blocks

A

B. Acting as a barrier within epidural space
D. Playing a role in complications during epidural catheter placement
E. Possibly causing unilateral blocks

Medication spread - This barrier could affect how medications spread when injected into the epidural space

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19
Q

Where is the subarachnoid space located?

A. Superficial to the arachnoid mater
B. Deep to the arachnoid mater
C. Superficial to the dura mater
D. Deep to the pia mater

A

B. Deep to the arachnoid mater

Slide 34

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20
Q

The subarachnoid space: (select 2)

A. Is located superficial to the arachnoid mater
B. Contains cerebrospinal fluid (CSF)
C. Contains nerve roots
D. Contains fat and small blood vessels

A

B. Contains cerebrospinal fluid (CSF)
C. Contains nerve roots
Contains the spinal cord itself

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21
Q

What is the primary target when performing a spinal anesthetic procedure?

A. Epidural space
B. Subdural space
C. Subarachnoid space
D. Ligamentum flavum

A

C. Subarachnoid space

Slide 34

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22
Q

If the needle is advanced too far anteriorly during a spinal anesthetic procedure, it could pass through several layers before reaching bone, EXCEPT this one:

A. Pia mater
B. Spinal cord
C. Posterior longitudinal ligament
D. Anterior longitudinal ligament

A

D. Anterior longitudinal ligament

Slide 34

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23
Q

During spinal anesthesia, a characteristic “pop” is often felt when the needle passes through this outer membrane:

A. pia mater
B. arachnoid mater
C. dura mater
D. ligamentum flavum

A

C. dura mater

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24
Q

Where is the subdural space located?

A. Between the pia mater and arachnoid mater
B. Between the dura mater and arachnoid mater
C. Between the dura mater and ligamentum flavum
D. Between the pia mater and spinal cord

A

B. Between the dura mater and arachnoid mater

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25
Q

What can happen if local anesthetic is inadvertently injected into the subdural space during an epidural?

A. It can have no effect
B. It can only affect the area of injection
C. It can cause a “low spinal” effect
D. It can cause a “high spinal” effect

A

D. It can cause a “high spinal” effect
meaning the medication affects a larger area than intended.

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26
Q

What can result from an accidental injection in the subdural space during spinal anesthesia?

A. Increased effectiveness of the spinal block
B. A failed spinal block
C. A “high” spinal block
D. Enhanced spread of medication

A

B. A failed spinal block

Slide 35

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27
Q

Which meningeal layer is a tough fibrous shield that protects the spinal cord?

A. Arachnoid mater
B. Pia mater
C. Dura mater
D. Epidural space

A

C. Dura mater
The first meningeal layer encountered after advancing through epidural space

Slide 36

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28
Q

Where does the dura mater start and extend to?

A. From the foramen magnum to the dural sac
B. From the spinal cord to the pia mater
C. From the arachnoid mater to the pia mater
D. From the epidural space to the dural sac

A

A. From the foramen magnum to the dural sac

Slide 36

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29
Q

Which meningeal layer is directly beneath the dura mater and acts as a protective middle layer?

A. Pia mater
B. Epidural space
C. Subdural space
D. Arachnoid mater

A

D. Arachnoid mater
*A thin layer of connective tissue *

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30
Q

What is the innermost meningeal layer that directly covers the spinal cord?

A. Dura mater
B. Arachnoid mater
C. Pia mater
D. Subdural space

A

C. Pia mater

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31
Q

The pia mater: (pick 3)

A. Is a highly vascular structure
B. Is the delicate outermost layer that directly covers the spinal cord
C. Is the delicate innermost layer that directly covers the spinal cord
D. Should never be punctured during a spinal
E. Is punctured during a spinal
F. Lies directly beneath the dura mater

A

A. Is a highly vascular structure
C. Is the delicate innermost layer that directly covers the spinal cord
D. Should never be punctured during spinal

Slide 36

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32
Q

How many pairs of spinal nerves does the spinal cord have?

A. 21 pairs
B. 25 pairs
C. 31 pairs
D. 35 pairs

A

C. 31 pairs

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33
Q

Which nerve is an exception by exiting below its corresponding vertebra?

A. C1 nerve
B. C5 nerve
C. C7 nerve
D. C8 nerve

A

D. C8 nerve
C8 Nerve: This nerve is an exception as it exits below the C7 vertebra.

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34
Q

How many pairs of cervical nerves are there?

A. 5 pairs
B. 8 pairs
C. 12 pairs
D. 31 pairs

A

B. 8 pairs

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35
Q

Matching

A

A. Cervical - 8
B. Thoracic - 12
C. Lumbar - 5
D. Sacral - 5
E. Coccyx - 1

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36
Q

Each nerve is formed by the joining of two different nerve roots: the anterior (ventral) nerve root and the __________ (dorsal) nerve root.

A. lateral
B. medial
C. superior
D. posterior

A

D. posterior

Slide 37

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37
Q

What type of information does the anterior (ventral) nerve root carry?

A. Sensory information
B. Motor and autonomic information
C. Both sensory and motor information
D. Only autonomic information

A

B. Motor and autonomic information
information from the spinal cord to the body.

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38
Q

The posterior (dorsal) nerve root brings __________ information from the body back to the spinal cord.

A. sensory
B. autonomic
C. motor
D. mixed

A

A. sensory
information from the body back to the spinal cord.

Slide 37

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39
Q

A dermatome is an area of skin that receives sensory nerves from a __________ spinal nerve root.

A. single
B. double
C. multiple
D. complex

A

A. single

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40
Q

True or False

Even though a dermatome may physically appear to align with a certain part of the spine, it is actually connected to a different spinal nerve root.

A

True
The umbilicus (belly button) looks like it should be served by the L3 nerve, but it’s actually served by the T10 nerve.

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41
Q

Dermatome time…

Matching

A

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42
Q

more..matching

Matching

A

Slide 39

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43
Q

another one..

Matching

A

you did it!

Slide 39

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44
Q

True or False

The sensory information from the face is conducted by spinal nerves.

A

FALSE. NO. WRONG
The sensory information from the face is not conducted by spinal nerves.

Instead, the face’s sensations are transmitted through the trigeminal nerve (Cranial Nerve V)

Slide 40

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45
Q

Which branch of the trigeminal nerve handles sensation from the forehead, scalp, and upper eyelids?

A. Ophthalmic (V1)
B. Maxillary (V2)
C. Mandibular (V3)
D. Ophthamadibullary (V)

A

A. Ophthalmic (V1)

Slide 40

46
Q

Which nerve is responsible for sensory input from the lower eyelids, cheeks, nostrils, upper lip, and upper teeth?

A. Ophthalmic (V1)
B. Maxillary (V2)
C. Mandibular (V3)
D. Trigeminal (X)

A

B. Maxillary (V2)

Slide 40

47
Q

Which branch of the trigeminal nerve is responsible for conveying sensations from the lower jaw, lower teeth, lower lip, and part of the tongue?

A. Ophthalmic (V1)
B. Maxillary (V2)
C. Mandibular (V3)
D. Mandooobular (V3)

A

C. Mandibular (V3)

..will there be test questions on the final.. maybe..

Slide 40

48
Q

Matching the dermatome with surgery

A

…tourniquet..T10!!!!!

Slide 41

49
Q

Which of the following is the location for spinal anesthesia?

A. Epidural space
B. Subarachnoid space
C. Paravertebral area
D. Dural cuff

A

B. Subarachnoid space

Slide 43

50
Q

What is the primary target of local anesthetics in spinal anesthesia?

A. Sympathetic chain
B. Preganglionic neurons
C. Myelinated preganglionic fibers of the spinal nerve roots
D. Postganglionic neurons of the spinal nerve roots

A

C. Myelinated preganglionic fibers of the spinal nerve roots

Slide 43

51
Q

In epidural anesthesia, local anesthetics diffuse through the ____ to reach nerve roots.

A. Pia mater
B. Dural cuff
C. Subarachnoid space
D. Intervertebral foramen

A

B. Dural cuff

Slide 43

52
Q

Which of the following processes occur in epidural anesthesia?

A. Local anesthetics act on myelinated preganglionic fibers.
B. Local anesthetics end in the subarachnoid space
C. Local anesthetics leak through the intervertebral foramen.
D. Local anesthetics inhibit neural transmission in the superficial layers of the spinal cord.

A

C. Local anesthetics leak through the intervertebral foramen *into the paravertebral area *

Green area

Side 43

53
Q

Which of the following factors is controllable and affects the spread of local anesthetic in spinal anesthesia?

A. Volume of CSF
B. Increased intra-abdominal pressure
C. Age (elderly)
D. Patient position

A

D. Patient position

Slide 44

54
Q

For hyperbaric solutions, the relative density of the spinal anesthetic to CSF is crucial in determining how it:

A. Is absorbed
B. Spreads
C. Metabolizes
D. Excretes

A

B. Spreads
this is a controllable factor

Slide 44

55
Q

Which of the following does NOT affect the spread of local anesthetic in spinal anesthesia?

A. Dose
B. Baricity
C. Site of injection
D. Speed of injection

A

D. Speed of injection

Slide 44

56
Q

Which of the following factors is non-controllable and affect the spread of local anesthetic in spinal anesthesia? (Select 3)

A. Volume of CSF
B. Increased intra-abdominal pressure
C. Age (elderly)
D. Speed of Injection
E. Orientation of Bevel

A

A. Volume of CSF - Low CSF volume correlates to extensive spread of LA in intrathecal space

B. Increased intra-abdominal pressure - this can include with pregnancy and obesity

C. Age (elderly) -With advanced age, neural nerves are vulnerable to LA and CSF volume decreases.

Slide 44

57
Q

What is the most reliable factor affecting how far and wide the anesthetic spreads in spinal anesthesia when using a hypo- or isobaric solution?
A. Patient position
B. Baricity
C. Speed of injection
D. Dose

A

D. Dose
Dose is Crucial: It’s the most reliable factor affecting how far and wide the anesthetic spreads when using a hypo- or isobaric solution.

slide 44

58
Q

Which of the following does NOT influence the spread of local anesthetic in spinal anesthesia?
Select 2

A. Patient position
B. Baricity
C. Addition of vasoconstrictor
D. Age (elderly)
E. Barbotage

A

C. Addition of vasoconstrictor
E. Barbotage -(repeated aspiration and reinjection of CSF)

slide 44

59
Q

Which factor does not contribute to the spread of local anesthetic in spinal anesthesia?

A. Volume of CSF
B. Increased intra-abdominal pressure
C. Orientation of bevel
D. Site of injection

A

C. Orientation of bevel

Slide 44

60
Q

True or False

Gender affects the spread and block height of local anesthetic in Spinal anesthesia?

A

False

Slide 44

61
Q

Which of the following is the most important drug-related factor significanly affecting the spread of local anesthetic in epidural anesthesia?

A. Level of injection
B. Local anesthetic volume
C. Patient position
D. Orientation of bevel

A

B. Local anesthetic volume

Slide 45

62
Q

What is the most important procedure-related factor significantly affecting the spread of local anesthetic in epidural anesthesia?

A. Local anesthetic dose
B. Patient position
C. Level of injection
D. Speed of injection

A

C. Level of injection

Slide 45

63
Q

Which of the following factors are non-controllable and significantly affect the spread of local anesthetic in epidural anesthesia? (Select 2)

A. Local anesthetic volume
B. Level of injection
C. Local anesthetic dose
D. Pregnancy
E. Old age

A

D. Pregnancy
E. Old age

Slide 45

64
Q

Which of the following controllable factors have a small effect on the spread of local anesthetic in epidural anesthesia? (Select 2)

A. Local anesthetic concentration
B. Patient position
C. Volume of local anesthetic
D. Height

A

A. Local anesthetic concentration
B. Patient position

Slide 45

65
Q

Which of the following non-controllable factors has a small affect the spread of local anesthetic in epidural anesthesia?

A. Age
B. Height
C. Gender
D. Pregnancy

A

B. Height

Slide 45

66
Q

Which of the following factors does NOT affect the spread of local anesthetic in epidural anesthesia?

A. Local anesthetic volume
B. Additives in the anesthetic
C. Level of injection
D. Patient position

A

B. Additives in the anesthetic

Slide 45

67
Q

Which of the following factors do NOT affect the spread of local anesthetic in epidural anesthesia? (Select 2)
A. Site of injection
B. Direction of the bevel of the needle
C. Speed of injection
D. Local anesthetic concentration

A

B. Direction of the bevel of the needle
C. Speed of injection

Slide 45

68
Q

In the lumbar region, the spread of local anesthetic when injected during epidural anesthesia is mostly:

A. Caudad
B. Cephalad
C. Balanced
D. Lateral

A

B. Cephalad

Slide 45

69
Q

In the mid-thoracic region, the spread of local anesthetic in epidural anesthesia is:

A. Mostly cephalad
B. Mostly caudad
C. Balanced both cephalad and caudad
D. Only caudad

A

C. Balanced both cephalad and caudad

Slide 45

70
Q

In the cervical region, the spread of local anesthetic in epidural anesthesia is primarily:

A. Caudad
B. Cephalad
C. Balanced
D. Lateral

A

A. Caudad

Slide 45

71
Q

Which type of nerve fiber has the heaviest myelination and is involved in skeletal muscle motor function and proprioception?

A. Aα (alpha)
B. Aβ (beta)
C. Aγ (gamma)
D. Aδ (delta)

A

A. Aα (alpha)
4th/Last to be blocked, large diameter

Slide 46

72
Q

Which type of nerve fiber is responsible for fast pain, temperature, and has medium myelination?

A. Aα (alpha)
B. Aβ (beta)
C. Aγ (gamma)
D. Aδ (delta)

A

D. Aδ (delta)
Third thing to be blocked

Slide 46

73
Q

Which type of nerve fiber has the earliest block onset during anesthesia?

A. Aα (alpha)
B. Aβ (beta)
C. B fibers
D. C fibers

A

C. B fibers
1st thing to be blocked
autonomic preganglionic fibers (venodilation-hypotension)

Slide 46

74
Q

Which type of blockade occurs at even lower concentrations of local anesthetics, affecting neither sensory nor motor neurons, and leads to the highest level of blockade?

A. Sensory blockade
B. Autonomic blockade
C. Motor blockade
D. Proprioceptive blockade

A

B. Autonomic blockade

Slide 46

75
Q

What does differential blockade refer to?

A. The uniform sensitivity of all nerve fibers to local anesthetics
B. The same level of block achieved in all types of nerve fibers
C. The varying sensitivities of different types of nerve fibers to local anesthetics
D. The selective blockade of motor neurons only

A

C. The varying sensitivities of different types of nerve fibers to local anesthetics

slide 46

76
Q

Which of the following statements about sensory blockade are true? (Select 3)
A. Occurs at lower concentrations of local anesthetics
B. Does not affect motor neurons
C. Results in a lower block level compared to motor block
D. Results in a higher block level compared to motor block

A

A. Occurs at lower concentrations of local anesthetics
B. Does not affect motor neurons
D. Results in a higher block level compared to motor block

Slide 46

77
Q

The sensory level of blockade is how many levels higher than the motor level?

A. 1 level
B. 2 levels
C. 3 levels
D. 4 levels

A

B. 2 levels

Slide 48

78
Q

The sympathetic level of blockade is how many levels higher than the sensory level?

A. 1-3 levels
B. 3-5 levels
C. 2-6 levels
D. 5-7 levels

A

C. 2-6 levels

Slide 48

79
Q

Match the onset of block, with the function and nerve fiber type. Yay

A

Slide 49

80
Q

Which sense is the first to be blocked when monitoring a sensory block?

A. Pain
B. Temperature
C. Touch
D. Pressure

A

B. Temperature
*the patient may not feel cold from an alcohol pad.
*

Slide 50

81
Q

What is the second sense to be assessed using stimuli like a pinprick during monitoring of a sensory block?

A. Pain
B. Temperature
C. Touch
D. Pressure

A

A. Pain

Slide 50

82
Q

Which sense is the last to be blocked during a sensory block?

A. Temperature
B. Pain
C. Touch or Pressure
D. Vibration

A

C. Touch or Pressure

Slide 50

83
Q

Which region’s function is specifically evaluated by the Modified Bromage Scale?

A. Cervical nerves
B. Thoracic nerves
C. Lumbosacral nerves
D. Cranial nerves

A

C. Lumbosacral nerves
which are the lower spine and sacral nerve areas, and does not assess movement above these regions.

Slide 50

84
Q

Match the description of the Modified Bromage Scale with the description

A

Slide 50

85
Q

What effect does Neuraxial Anesthesia
have if there is a Sympathectomy (T1-T4 block) on preload?

A. Increases preload
B. Decreases preload
C. No change in preload
D. Initially increases, then decreases preload

A

B. Decreases preload

Slide 51

86
Q

How does Neuraxial Anesthesia
sympathectomy (T1-T4 block) decrease preload?

A. By increasing heart rate
B. By increasing systemic vascular resistance (SVR)
C. By causing veins to dilate
D. By enhancing myocardial contractility

A

C. By causing veins to dilate
block of cardio-accelerator nerves) causes veins to dilate, leading to blood pooling in the periphery and reducing the blood returning to the heart.

Slide 51

87
Q

What effect does Neuraxial Anesthesia
sympathectomy have on afterload?

A. Increases afterload
B. Decreases afterload
C. No change in afterload
D. Initially decreases, then increases afterload

A

B. Decreases afterload
Sympathectomy partially dilates arterial circulation.

Slide 51

88
Q

In healthy patients, what is the approximate decrease in systemic vascular resistance (SVR) caused by a T1-T4 block?

A. 10%
B. 25%
C. 15%
D. 5%

A

C. 15%

Slide 51

89
Q

What is the effect on cardiac output (CO) due to a decrease in venous return and systemic vascular resistance (SVR) from neuraxial anesthesia? (select 2)

A. Increases CO
B. Decreased CO
C. Reduced stroke volume
D. No change in CO
E. Increases SVR and CO

A

B. Decreased CO
C. Reduced stroke volume

Side 51

90
Q

*What is the initial response of cardiac output (CO) to neuraxial anesthesia?

A. Decreases initially and then increases
B. May initially increase, then decrease
C. Remains constant
D. Decreases over time

A

B. May initially increase, then decrease
CO may initially increase, then decrease over time due to changes in blood vessel dilation speeds.

Slide 51

91
Q

What are the reasons for a decrease in heart rate due to neuraxial anesthesia? (Select 2)

A. Blockade of Cardiac Accelerator Fibers
B. Increase in sympathetic tone
C. Activation of Bezold-Jarisch Reflex
D. Increase in venous return

A

A. Blockade of Cardiac Accelerator Fibers -*Reduces SNS tone, leading to decreased heart rate.
*
C. Activation of Bezold-Jarisch Reflex

Slide 51

92
Q

Which receptors mediate the Bezold-Jarisch Reflex?

A. β1 receptors
B. α1 receptors
C. 5-HT3 receptors
D. Muscarinic receptors

A

C. 5-HT3 receptors
Bezold-Jarisch Reflex is mediated by 5-HT3 receptors in the vagus nerve and ventricular myocardium

Slide 51

93
Q

What is the Bezold-Jarisch Reflex?

A. Response to increased venous return
B. Response to ventricular underfilling
C. Response to increased heart rate
D. Response to atrial stretching

A

B. Response to ventricular underfilling

Slide 51

94
Q

True or False

Bezold-Jarisch Reflex: Response to ventricular underfilling, potentially leading to a significant bradycardia and asystole.

A

True

slide 51

95
Q

What triggers the Reverse Bainbridge Reflex?

A. Increased venous return
B. Reduced stretching of the heart’s right ventricular
C. Reduced stretching of the heart’s right atrium
D. Increased arterial pressure

A

C. Reduced stretching of the heart’s right atrium
controversial

Slide 51

96
Q

In which patient population is sudden cardiac arrest due to high parasympathetic tone more likely to be seen?

A. Elderly patients with low parasympathetic tone
B. Young adults with high parasympathetic tone
C. Patients with chronic hypertension
D. Patients with diabetes

A

B. Young adults with high parasympathetic tone

Slide 52

97
Q

Sudden cardiac arrest during neuraxial anesthesia is associated with which of the following conditions? Select 2.

A. Large blood loss
B. Hypothermia
C. Orthopedic cement placement
D. Hypercalcemia

A

A and C
Orthopedic cement placement and large amounts of blood loss

Slide 52

98
Q

What can unopposed parasympathetic tone to the cardioaccelerator fibers result in? (Select 3)
A. Hypertension
B. Profound bradycardia
C. Hypotension
D. Sudden cardiac arrest
E. Increased cardiac output
F. Enhanced sympathetic tone

A

B. Profound bradycardia
C. Hypotension
D. Sudden cardiac arrest

Slide 52

99
Q

What is the approximate incidence of sudden cardiac arrest in patients receiving spinal anesthesia?

A. 1:1,000
B. 1:5,000
C. 7:10,000
D. 3:10,000

A

C. 7:10,000

Slide 52

100
Q

What is the approximate incidence of sudden cardiac arrest in patients receiving epidural anesthesia?

A. 3:1,000
B. 5:5,000
C. 1:10,000
D. 7:10,000

A

C. 1:10,000

Slide 52

101
Q

What is the typical time frame after the onset of spinal anesthesia when sudden cardiac arrest can occur?

A. 10-20 minutes
B. 30-90 minutes
C. 20-60 minutes
D. 5-15 minutes

A

C. 20-60 minutes

Slide 52

102
Q

Which of the following medications is used preventatively to maintain blood pressure by constricting blood vessels during spinal anesthesia?

A. Ondansetron
B. Phenylephrine
C. Lidocaine
D. Midazolam

A

B. Phenylephrine

slide 53

103
Q

Which preventative drug can mitigate reflexes that cause hypotension, such as the Bezold-Jarisch reflex, during spinal anesthesia?

A. Epinephrine
B. Ondansetron
C. Fentanyl
D. Atropine

A

B. Ondansetron

Slide 53

104
Q

What is the recommended fluid management strategy immediately after a spinal block to prevent drops in blood pressure?

A. Co-loading
B. Pre-block hydration
C. Postoperative fluid restriction
D. Excessive fluid administration

A

A. Co-loading with intravenous fluids (around 15 mL/kg)

Slide 53

105
Q

Why is pre-block hydration not routinely recommended for preventing hypotension during spinal anesthesia?

A. It causes hypertension
B. It is difficult to administer
C. It has minimal impact
D. It increases the risk of infection

A

C. It has minimal impact on preventing hypotension
Also consider too much fluid and overloading patients with heart conditions

slide 53

106
Q

What positioning adjustment can help optimize blood flow and reduce risks during spinal anesthesia in Obstetric cases?

A. Elevating the head
B. Slight pelvic tilting
C. Lying flat on the back
D. Raising the legs

A

B. Slight pelvic tilting
takes pressure off the vena cava from the baby squishing it

Slide 53

107
Q

Which vasopressor is the preferred treatment if there is symptomatic bradycardia during spinal anesthesia?

A. Phenylephrine
B. Ephedrine
C. Dopamine
D. Norepinephrine

A

B. Ephedrine
Vasopressors: Such as ephedrine and epinephrine are used based on the patient’s heart rate and symptoms

Slide 54

108
Q

Which fluids are recommended to maintain adequate blood volume during spinal anesthesia?

A. Whole blood
B. Crystalloids
C. Dextrose solutions
D. Lactated Ringer’s only

A

B. Crystalloids* or colloids*

Slide 54

109
Q

What type of medication is atropine, and what complication can it treat during spinal anesthesia?

A. Anticholinergic; used for hypotension
B. Anticoagulant; used for blood thinning
C. Anticholinergic; used for bradycardia
D. Analgesic; used for pain relief

A

C. Anticholinergic; used for bradycardia

Slide 54

110
Q

What is a potential risk of using a Trendelenburg position greater than 20 degrees during spinal anesthesia?

A. Increased venous return
B. Enhanced cerebral perfusion
C. Reduced cerebral perfusion
D. Improved oxygenation

A

C. Reduced cerebral perfusion
the tilt can reduce venous brain drainage .

Slide 54

111
Q

If the block is not set yet, the block height can ____________ due to gravity?

A. Decrease
B. Slightly increase
C. Increase
D. Not move

A

C. Increase

Slide 54

Principles of Anesthesia 1 - (Summer 2024) (24 decks)

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