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KLowe-Advanced Anes 2 (Rachel's Class) > Spinals and Epidurals > Flashcards

Spinals and Epidurals Flashcards

1
Q

What are (2) types of spinal needles?

A
  • Pencil point

- Cutting

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2
Q

___ (pencil point/cutting) needles have a better feel and cause less trauma

A

Pencil point needles have a better feel and cause less trauma

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3
Q

___ (pencil point/cutting) needles should be placed longitudinally

A

Cutting needles should be placed longitudinally

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4
Q

Use of stylet with needle prevents introduction of ___ cells, thus preventing ___ spinal cord tumor

A

Use of stylet with needle prevents introduction of dermal cells, thus preventing dermal spinal cord tumor

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5
Q

Sizes of spinal needles–___-___ gauge, ___-___ mm

A

22-27 gauge, 90-145 mm

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6
Q

(4) absolute contraindications to spinal–1) patient ___; 2) lack of ___; 3) uncorrected ___; 4) ___ at the site of block

A

1) patient refusal
2) lack of cooperation
3) uncorrected coagulopathies
4) infection at the site of block

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7
Q

Patient refusal is a ___ (absolute/relative) contraindication to spinal anesthesia

A

Patient refusal is an absolute contraindication to spinal anesthesia

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8
Q

Sepsis at the site of injection is ___ (absolute/relative) contraindication to spinal anesthesia

A

Absolute

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9
Q

Hypovolemia is ___ (absolute/relative) contraindication to spinal anesthesia

A

Absolute

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10
Q

Coagulopathy is ___ (absolute/relative) contraindication to spinal anesthesia

A

Absolute

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11
Q

Indeterminate neurologic disease is ___ (absolute/relative) contraindication to spinal anesthesia

A

Absolute

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12
Q

Increased intracranial pressure is ___ (absolute/relative) contraindication to spinal anesthesia

A

Absolute

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13
Q

Infection distant from site of injection is ___ (absolute/relative) contraindication to spinal anesthesia

A

Relative

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14
Q

Unknown duration of surgery is ___ (absolute/relative) contraindication to spinal anesthesia

A

Relative

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15
Q

Factors affecting uptake/spread from subarachnoid space–___ of LA in CSF; ___ of nerve tissue exposed; ___ content of nerve tissue; ___ flow to nerve tissue

A

Concentration of LA in CSF; surface area of nerve tissue exposed; lipid content of nerve tissue; blood flow to nerve tissue

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16
Q

(3) factors affecting distribution of spinal

A
  • Baricity
  • Position
  • Dose
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17
Q

Factors affecting level of spinal–___ity; ___ion; ___; ___ of injection; ___?; ___ of injection; ___ume; ___tion

A

baricity; position; dose; site of injection; age? speed of injection; volume; concentration

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18
Q

What is the specific gravity of CSF?

A

1.0069

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19
Q

If MAP is maintained during spinal anesthesia, there are no physiologic changes to the liver?–T/F?

A

True

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20
Q

CV effects of spinal anesthesia–___thectomy, dependent on block height

A

Sympathectomy

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21
Q

___tension and ___cardia are most common effects of sympathectomy that occurs with spinal

A

Hypotension and bradycardia

Occur d/t venodilation and arterial dilation

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22
Q

How should you treat sympathectomy from spinal?

A

Fluids and vasopressors

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23
Q

Spinal has little effects on those with normal lung physiology–T/F?

A

True

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24
Q

Major respiratory effects may occur with ___ spinal–feeling of ___ related to inability to feel chest move

A

Major respiratory effects may occur with high spinal–feeling of dyspnea related to inability to feel chest move

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25
Q

GI–sympathetic innervation from __-__

A

T6-L2

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26
Q

GI effects of spinal–___ (increased/decreased) secretions; sphincters ___ (contract/relax); bowel ___ (constricts/dilates); nausea/vomiting occurs in about __%, use ___ to treat after high spinal

A

GI effects of spinal–increased secretions; sphincters relax; bowel constricts; nausea/vomiting occurs in about 20%, use atropine to treat after high spinal

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27
Q

Review slide 17 suggested LA doses for spinals (suggestions that are not currently approved by FDA)

A

.

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28
Q

Prone position for spinal–use ___baric or ___baric solutions

A

Use isobaric or hyperbaric solutions

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29
Q

When going to place spinal, you should first identify the ___

A

iliac crests–L4-L5

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30
Q

(3) approaches to spinal

A
  • Median
  • Paramedian
  • Taylor
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31
Q

Midline approach for spinal anesthesia–introducer should be placed slightly ___ (cephalad/caudal) __-__ degrees

A

Midline approach for spinal anesthesia–introducer should be placed slightly cephalad 10-15 degrees

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32
Q

When spinal needle is placed through introducer, resistance will be met at all levels, most likely at ___, then pop through ___

A

When spinal needle is placed through introducer, resistance will be met at all levels, most likely at ligamentum, then pop through dura

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33
Q

After you pop through the dura, remove stylet and check for ___ flow

A

After you pop through the dura, remove stylet and check for CSF flow

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34
Q

What should you do if there’s no CSF flow?

A

If there’s no CSF flow, rotate needle (it may be up against something)

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35
Q

After free flow of CSF, attach ___, aspirate ___, ___ (slow/fast) injection of __ml/sec

A

After free flow of CSF, attach syringe, aspirate CSF, slow injection of 0.5 ml/sec

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36
Q

Complications during placement of spinal needle–___ contacted, ___thesia, ___, ___ of patient

A

Complications during placement of spinal needle–bone contacted, paresthesia, blood, position of patient

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37
Q

If bone is contacted during spinal needle placement, you should ___ needle and stylet to skin and re___

A

If bone is contacted during spinal needle placement, you should withdraw needle and stylet to skin and redirect

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38
Q

If patient experiences paresthesia during spinal needle placement, ___ (continue/stop) advancing; remove stylet and check for ___

A

If patient experiences paresthesia during spinal needle placement, stop advancing; remove stylet and check for CSF

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39
Q

If blood is encountered during spinal placement, it is usually not a problem (unless excessive); you should reattempt–T/F?

A

True

40
Q

Paramedian approach is good for ___ intraspinous ligament or difficult ___

A

Paramedian approach is good for calcified intraspinous ligament or difficult positioning

41
Q

For paramedian approach, needle is inserted 1 cm ___ and 1 cm ___ to space; angle needle ___ (laterally/medially) and ___ (caudal/cephalad)

A

For paramedian approach, needle is inserted 1 cm lateral and 1 cm inferior to space; angle needle medially and cephalad

42
Q

For paramedian approach, what is the 1st resistance?

A

Ligamentum flavum

43
Q

Complications with spinal anesthesia–___ injury; ___ syndrome; ___ditis; ___itis; post dural ___; spinal ___; ___ spinal; ___ collapse

A

Complications with spinal anesthesia–neurologic injury; cauda equina syndrome; arachnoiditis; meningitis; post dural puncture headache (PDPH); spinal hematoma; high spinal; CV collapse

44
Q

Neurologic injury from spinal may result from needle introduction to ___ or ___; can result in spinal cord ___; bacterial ___; ___oma

A

Neurologic injury from spinal may result from needle introduction to nerve or cord; can result in spinal cord ischemia; bacterial contamination; hematoma

45
Q

Cauda Equina Syndrome results from micro___; 5% ___ and repeated dosing

A

Cauda Equina Syndrome results from micocatheters; 5% lidocaine and repeated dosing

46
Q

Treatment of arachnoiditis includes ___ interventions and intrathecal ___

A

Treatment of arachnoiditis includes surgical interventions and intrathecal steroids

47
Q

How can you prevent meningitis? Use strict ___ technique

A

Can prevent meningitis by using strict sterile technique

48
Q

PDPH has up to ___% incidence

A

PDPH has up to 25% incidence

49
Q

PDPH is worse when head is ___, relief when ___

A

PDPH is worse when head is up, relief when supine

50
Q

What (5) things can be used to treat PDPH?

A
  • Fluids
  • Caffeine (500 mg 1-2 doses)
  • Bed rest
  • Analgesics
  • Sumatriptan
51
Q

May take up to __-__ weeks for PDPH to resolve

A

May take up to 1-6 weeks for PDPH to resolve

52
Q

What is the mainstay of invasive treatment for PDPH?

A

Epidural blood patch

53
Q

What patient factors contribute to spinal hematoma?–anti___; ___ (increased/decreased) age; ___ (male/female); history of ___ bleed; length of therapy

A

Patient factors that contribute to spinal hematoma–anticoagulation; increased age; female; history of GI bleed; length of therapy

54
Q

Spinal hematoma is a medical ___

A

Spinal hematoma is a medical emergency!

Need immediate neuro consult/MRI

55
Q

If patient experiences high spinal, you should monitor and treat appropriately with ___ and ___ support

A

If patient experiences high spinal, you should monitor and treat appropriately with airway and pressor support

56
Q

CV collapse from spinal–what is usually first sign?

A

Bradycardia–treat aggressively

57
Q

Absolute contraindications for epidural–patient ___, uncorrected ___volemia, ___ ICP, ___ at site

A

Absolute contraindications for epidural–patient refusal, uncorrected hypovolemia, increased ICP, infection at site

58
Q

Relative contraindications for epidural–___pathy, fixed ___ defect, anatomic ___, unstable ___ disease

A

Relative contraindications for epidural–coagulopathy, fixed cardiac defect, anatomic abnormalities, unstable neurologic disease

59
Q

Epidurals are usually done at what levels?

A

L2-L4

60
Q

You can use adult levels after age ___

A

8

61
Q

Physiological effects of epidurals are similar to spinal–T/F?

A

True

62
Q

Effects below T4–vasomotor tone is controlled by __-__; effects = ___ (increased/decreased) venous return, and subsequent ___ (increased/decreased) CO

A

Effects below T4–vasomotor tone is controlled by T5-L1; effects = decreased venous return and subsequent decreased CO

63
Q

Effects above T4–__-__ = cardiac sympathetic fibers; effects = profound ___tension and ___cardia

A

Effects above T4–T1-T4 = cardiac sympathetic fibers; effects = profound hypotension and bradycardia

64
Q

Respiratory effects of epidurals are minimal in midthoracic region–T/F?

A

True

65
Q

Respiratory arrest from epidural is likely d/t ___tomy and brainstem ___

A

Respiratory arrest from epidural is likely d/t sympathectomy and brainstem ischemia

66
Q

Lower concentration for epidural = ___ (sensory/motor) block

A

Lower concentration for epidural = sensory block

67
Q

Higher concentration for epidural = ___ (sensory/motor) block

A

Higher concentration for epidural = motor blocker

68
Q

What is a key factor affecting coverage for epidurals?

A

VOLUME!

69
Q

For epidurals in adults, you need __-__ ml for each level to be blocked

A

For epidurals in adults, you need 1-2 ml for each level to be blocked

70
Q

Lumbar level gets more spread ___ (cephalad/caudal) than ___ (cephalad/caudal)

A

Lumbar level gets more spread cephalad than caudal

71
Q

Thoracic level has even spread up and down–T/F?

A

True

72
Q

How does age affect epidural dosing? Increased age = ___ (increased/decreased) dose

A

Increased age = decreased dose

73
Q

How does height affect epidural dosing? If < 5’2”, use ___ ml per level; if > 5’2”, increase dose by ___ ml for every 2 inches

A

If < 5’2”, use 1 ml per level

If > 5’2”, increase dose by 0.1 ml for every 2 inches

74
Q

How do pregnancy and obesity affect epidural dosing? ___ (increased/decreased) dose d/t epidural vein ___ and increased ___ tissue

A

Decreased dose d/t epidural vein engorgement and increased adipose tissue

75
Q

What are (3) approaches for epidural?

A

Same as spinal

  • Median
  • Paramedian–start 1.5-2 cm laterally
  • Taylor
76
Q

What is (1) different technique for epidural?

A

-Caudal

77
Q

How can you identify the epidural space?

A

Loss of resistance technique

78
Q

Hanging drop technique is used mostly for ___ epidurals

A

Hanging drop technique is used mostly for thoracic epidurals

79
Q

What is another way you can identify the epidural space?

A

Ultrasound

80
Q

For caudal block, sacral ___ is identified by sacral ___

A

For caudal block, sacral hiatus is identified by sacral Cornu

81
Q

Caudal block–needle is inserted at ___ degree angle; distinct pop or snap when you go through the ___ membrane; when you pass through membrane, lower angle to ___ degrees; advance for adults no more than ___ cm, for children no more than ___ cm; aspirate for blood or CSF, insert catheter or inject

A

Caudal block–needle is inserted at 45 degree angle; distinct pop or snap when you go through the sacrococcygeal membrane; when you pass through membrane, lower angle to 160 degrees; advance for adults no more than 1.5 cm, for children no more than 0.5 cm; aspirate for blood or CSF, insert catheter or inject

82
Q

When placing epidural catheter, you should withdraw catheter through needle–T/F?

A

FALSE–NEVER WITHDRAW EPIDURAL CATHETER THROUGH NEEDLE

83
Q

When dosing epidural catheter, always ___ prior to injection

A

When dosing epidural catheter, always aspirate prior to injection

84
Q

Lumbar dosing–__-__ ml per segment; give in __ ml increments q __-__ min

A

Lumbar dosing–1-2 ml per segment; give in 5 ml increments q 3-5 minutes

85
Q

Thoracic dosing–__ ml per segment; __-__ ml q __ min

A

Thoracic dosing–0.7 ml per segment; 3-6 ml q 30 min

86
Q

Caudal dosing–__ ml per segment

A

Caudal dosing–3 ml per segment

87
Q

Continuous infusion–__-__ ml/hr

A

Continuous infusion–4-15 ml/hr

88
Q

Complications from epidurals include–__tension; ___lateral block; ___ block

A

Complications from epidurals include–hypotension; unilateral block; inadequate block

89
Q

If patient has inadequate block with epidural, ___ (raise/lower) head and redose with ___ (lower/higher) concentration; can also add ___

A

If patient has inadequate block with epidural, raise head and redose with higher concentration; can also add fentanyl

90
Q

If patient’s epidural is questionable quality and you need to go to the OR…in OR, ___ catheter; do ___ with new catheter placement

A

If patient’s epidural is questionable quality and you need to go to the OR…in OR, remove catheter; do CSE with no catheter placement

91
Q

If patient’s block is dissipating–requires more or doesn’t last…check for ___ placement; rebolus with ___ (lower/higher) concentration and ___ (increase/decrease) rate; add ___

A

If patient’s block is dissipating–requires more or doesn’t last…check for intravascular placement; rebolus with higher concentration and increase rate; add opioid

92
Q

Minor back pain has 20-30% incidence with epidural placement–T/F?

A

True

93
Q

Back pain from epidural is usually self limiting; can use NSAIDs, Tylenol, heat to treat–T/F?

A

True

94
Q

PDPH from epidural is most common in ___; usually expected after ___

A

PDPH from epidural is most common in younger female; usually expected after wet tap

95
Q

Accidental subdural injection with epidural has a delayed response of __-__ minutes; get ready for ___

A

Accidental subdural injection with epidural has a delayed response of 5-10 minutes; get ready for high spinal

96
Q

Subarachnoid injection of epidural dose will result in ___ (fast/slow) high spinal

A

Subarachnoid injection of epidural dose will result in fast high spinal

97
Q

Meningitis symptoms–non-positional ___ache; ___; ___gy; ___ion; and classic ___ rigidity; emergent ___ therapy; ___ CT, ___ puncture, neuro consult to diagnose

A

Meningitis symptoms–non-positional headache; fever; lethargy; confusion; and classic nuchal rigidity; emergent antibiotic therapy; head CT, lumbar puncture, neuro consult to diagnose

KLowe-Advanced Anes 2 (Rachel's Class) (16 decks)

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