Spinals and epidurals Flashcards
1
Q
2 different types of needles
A
- pencil point (less pain and trauma)
- cutting
2
Q
sizes of spinal needles
A
- 22-27 gauge
- 90-145 mm
3
Q
absolute contraindications
A
- patient refusal
- lack of cooperation
- uncorrected coagulopathies
- infection at the site of block
- hypovolemia
- increased ICP
4
Q
factors that effect uptake and spread from subarachnoid space
A
- concentration of LA in CSF
- surface area of nerve exposed
- lipid content of nerve tissue
- blood flow to nerve tissue
5
Q
factors effecting distribution of spinals
A
- baricity
- position
- dose
6
Q
factors that effect the level of a spinal
A
- baricity
- position
- dose
- site of injection
- age
- speed of injection
- volume
- concentration
7
Q
CV changes with spinal
A
- sympathectomy dependent on block height
- hypotension and bradycardia
- veno and arterial dilation
- treat with fluids, ephedrine, neo
- bradycardia is usually first
8
Q
GI changes with spinal
A
- sympathetic innervation from T6- L2
- increased secretions
- sphincters relax
- bowel constricts
- N&V in about 20%
- atropine to treat after high spinal
9
Q
what to do when you encounter paresthesia during catheter insertion
A
- stop advancing
- remove stylet and check for CSF flow
10
Q
where is the catheter positioned when doing the paramedian approach
A
- 1 cm lateral and 1 cm inferior to space
- angle needle medially and cephalad
11
Q
incidence of neurological injury
A
- 0.03% 1:240,000
12
Q
signs of cauda equina syndrome
A
- loss of perianal sensory loss
- decreased rectal motor tone and lower extremity weakness
- high posts-void residual
13
Q
post dural puncture headache (PDPH) S&S
A
- 25% incidence
- worse when head is up, relief when supine
14
Q
treatment of PDPH
A
- fluids
- caffeine (500mg)
- bed rest
- analgesics
- sumatriptan
- blood patch
15
Q
epidural levels
A
- usually L2-L4
- can use adult levels after age 8
