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Advanced Anesthesia 2 > Spinals and Epidurals - Quiz 6 > Flashcards

Spinals and Epidurals - Quiz 6 Flashcards

1
Q

Label 1-9 of the Vertebra

A
  1. Spinous Process
  2. Transverse Process
  3. Vertebral Arch Lamina
  4. Pedicle
  5. Body
  6. Head of Rib
  7. Superior Articular Process
  8. Vertbral Foramen
  9. Spinal Cord
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2
Q

Which part of the vertebra allows for the passage of nerves?

A

Lateral Notches

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3
Q

What angle should the needle be when placing in Cervical & Thoracic Vertebrae?

A

Cephalad Angle

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4
Q

What makes Lumbar Vertebrae easier to place needles?

A

Larger with Less Overlap & Larger Gaps

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5
Q

Label 1 - 15 of the Sacral Vertebra

A
  1. Sacral Canal
  2. Superior Sacral Notch
  3. Auricular Surface
  4. Sacral Tuberosity
  5. Posterior Sacral Foramina
  6. Sacral Hiatus
  7. Sacroccocygeal Notch
  8. Apex of Coccyx
  9. Transverse Process of Coccyx
  10. Cornua of Sacrum & Coccyx
  11. Inferolateral Angle
  12. Lateral Crest
  13. Intermediate Crest
  14. Median Crest
  15. Superior Articular Facet
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6
Q

What was the 3 Intervertebral Ligaments from Superficial to Deep?

A

Supraspinous Ligament

Intraspinous Ligament

Ligamentum Flavum

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7
Q

Which Intervertebral Ligament is strong, connects the apices of the spinous processes, and is the major ligament of Cervical and Upper Thoracic Regions?

A

Supraspinous Ligament

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8
Q

Which Intervertebral Ligament is Absent or Poor Quality in the Cervical Region and Thin, especially in the Lumbar?

A

Intraspinous Ligament

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9
Q

Which Intervertebral Ligament is the Strongest and looks like a contiguous ligament?

A

Ligamentum Flavum

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10
Q

The Ligamentum Flavum is _____ on the lateral edge, ______ midline, like a V

A

The Ligamentum Flavum is THIN on the lateral edge, THICK midline, like a V

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11
Q

At the L2 - L3 level, the Ligamentum Flavum measures _______ thick

A

At the L2 - L3 level, the Ligamentum Flavum measures 3 - 5 mm thick

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12
Q

Which Ligaments of the Spine covers the Anterior & Posterior parts of the Vertebra?

A

Anterior & Posterior Longitudinal Ligaments

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13
Q

Where is the Epidural Space located?

A

Between Ligamentum Flavum & Dura Mater

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14
Q

Where does the Epidural Space Originate and End?

A

From Base of Cranium to Sacral Sulcus

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15
Q

How far is the Epidural Space from the Skin?

A

Varies - From 2.5 - 8 cm

Average is about 5 cm from Skin

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16
Q

How far does the Spinal Cord extend for Adults & Kids?

A

Adults: Medulla to L2

Kids: Medulla to L3

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17
Q

Which Layer of the Spinal Cord contains CSF?

A

Arachnoid Mater

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18
Q

How are the 31 Pairs of Spinal Nerves distributed?

A

8 Cervical

12 Thoracic

5 Lumbar

1 Coccygeal

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19
Q

Where do Thoracic Nerves run along in relation to the Ribs?

A

Inferior Margin of Rib

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20
Q

Slide 18 - Levels

A
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21
Q

How far along the Spinal Cord is the Brachial Plexus?

A

C4 - T1

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22
Q

How far along the Spinal Cord is the Lumbar & Sacral Plexus?

A

L2 - S3

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23
Q

How far along the Spinal Cord is the Cauda Equina?

A

L1 - S5

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24
Q

Which part of the Spinal Cord is the entering Sensory Root and which is the outgoing Motor Root?

A

Dorsal - Entering Sensory

Ventral - Outgoing Motor

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25
What is the Laminae II called?
Substanca Gelatinosa - Where IV & Neuraxial Opioids work
26
What are the Afferent & Ventral Tracts of Grey Matter?
**Afferent:** I - VI **Ventral:** VII - IX
27
Which part of the highly organized White Matter is exclusively Ascending Sensory Fiber Tracts?
Dorsal White Matter
28
What do the Lateral & Ventral White Matter do?
Descending Motor Tract Ascend to Brain Reflex - Start and End w/in Spinal Cord
29
Where are the Sensory/Afferent Receptors location?
**Epidermis & Dermis**: Pain & Temp **Dermis**: Pressure, Touch, Vibration, Proprioception
30
What are the 2 Classifications of Sensory Receptors?
Extroceptors - Near Suface of Skin & Proprioceptors - Deeper than Skin Surface
31
How do peripheral sensory signals travel to the Thalamus with the Dorsal Medial Lemniscus tract?
Dorsal Root --\> Cross over Medulla (1st to 2nd Order) --\> Goes up Medial Lemiscus Tract via Brainstem (2nd Order) --\> Thalamus (3rd Order Neuron)
32
How do peripheral sensory signals travel to the Thalamus with the Anterolateral Pathway?
Dorsal Horn --\> Laminae I, IV, V, VI --\> Crossover at Anterior Commissure --\> Anterolateral White Columns --\> Associated Tract (Spinothalmic) --\> Thalamus --\> Interpretation in Brain
33
What are the differences b/t the Dorsal Medial Lemnisucus versus the Anterolateral System?
**Dorsal Medial Lemniscus**: Large, Myelinated, High Spacial Orientation with a 30-110 m/sec conduction speed - Descrete Senses **Anterolateral**: Small, Myelinated, Low Spacial Orientation with a 40 m/sec conduction speed - Broad Senses
34
What kind of sensations does the Dorsal Medial Lemniscal system transmit?
Touch Vibrations Skin Movement Joint Position Fine Pressure
35
What kind of sensations does the Anterolateral system transmit?
Pain Thermal Crude Touch Tickle Itch Sexual
36
Where do Preganglionic B Fibers Originate and Exit?
Originates in Tnermediolateral Gray Horn T1 - L2/L3 & Exits via Ventral Nerve Root - Whtie Rami Cummincans
37
What does _stimulation_ of the SNS fiber in the Superior Cervical Ganglia cause?
Midrasis - Pupil Dilation & Blood Vessel Constriction in Head
38
What happens when the Superior Cervical Ganglia, Central SNS, or Paravertebral Ganglia is damaged?
**Horners Syndrome**: Miosis - Small Pupil Ptosis Anhydrosis - No Sweat
39
What are the 4 Stages of Pain Transmssion?
1. Tranduction 2. Transmission 3. Modulation 4. Perception
40
How do motor signals travel through the Corticospinal Tract?
Precentral Gyrus --\> Crosses Medulla --\> Form Pyramids --\> Leave Spinal Cord or Enter Ventral Horn to Synapse w/ Lower Motor Neurons
41
What happens if damage occurs to the Neurons of the Corticospinal Tract that have inhibitory effects on the Lower Motor Neurons?
Hyperreflexia & Spasticity
42
What happens with Upper Motor Neuron Paralysis?
Hyperreflexia d/t Impeded Suppressor fibers
43
What happens when Lower Motor Neurons are damaged?
Flaccid Paralysis
44
How are Cutting Epidural/Spinal needles placed?
Longitudinal
45
What is the purpose of the Stylet regarding Epidural/Spinal Needles?
Prevents introduction of Dermal Cells, leading to Dermoid Spinal Cord Tumor
46
What are absolute contraindications to Spinals?
Patient Refuse Lack of Cooperation Coagulopathy Infection at Site Hypovolemia Neuro Disease Increased ICP
47
What factors affect the Uptake & Spread regarding Spinals?
Local Anesthetic Concentration Nerve Surface Area Lipid Content of Nerve Blood Flow to Nerve
48
What factors affect distribution regarding Spinals?
Baricity Position Dose
49
What factors affect the Level regarding Spinals?
Baricity Position Dose Site of Injection Age Speed of Injection Volume Concentration
50
Which Local Anesthetics are Isobaric & Hyperbaric?
Tetracaine Lidocaine Bupivacaine
51
What kind of Baricity does Tetracaine & Lidocaine have?
Hypobaric Isobaric Hyperbaric
52
What are the main cardiovascular side affects of Spinals?
**Hypotension & Bradycardia** - treat w/ Fluids or Vasopressors
53
What are the GI effects from Spinals?
**T6 - L2 Sympathetic Innervation** ↑Secretions Relaxed Sphincters Bowel Constriction N/V
54
What is the LA Spinal dose suggestion for Lidocaine?
25-50 mg (25-100 mg)
55
What is the recommended LA Spinal dose for Tetracaine & Bupivacaine?
5 - 20 mg
56
What baricity should the LA be if the patient is getting a Spinal in the prone position?
Iso or Hypobaric
57
What are the different approaches for placing a Spinal?
Median Maramedian Taylor
58
What should be done if bone is felt when placing a Spinal?
Withdraw both needle & stylet to skin & Redirect
59
What should be done if the patient experiences paresthesia during Spinal placement?
Stop Advancing, Remove Stylet, Check for CSF
60
What is a Paramedian approach good for when placing a Spinal?
Calcified Intraspinous Ligaments or Difficult Positioning
61
How is the needle inserted with a Paramedian approach?
1 cm Lateral & 1 cm Inferior to Space w/ a Medial & Cephelad angle
62
Which ligament is first to give resistance with a Paramedian Spinal approach?
Ligamentum Flavum
63
What are the complications r/t Spinals?
Cauda Equina Syndrome Arachnoiditis Meningitis PDPH Hematoma High Spinal CV Collapse
64
With PDPHm the headache is worse when when the patient is \_\_\_\_\_\_\_\_, and gets relief when the patient is \_\_\_\_\_\_\_\_\_
With PDPH the headache is worse when when the patient is **UPRIGHT**, and gets relief when the patient is **SUPINE**
65
How are PDPHs treated?
Epidural Blood Patch - Mainstay Fluids Caffeine Bedrest Pain Meds Sumatriptan
66
Spinal Hematomas are considered an \_\_\_\_\_\_\_\_, and requires immediate Neuro Consult & MRI
Spinal Hematomas are considered an **EMERGENCY**, and requires immediate Neuro Consult & MRI
67
What are absolute contraindications for Epidurals?
**Patient Refuse** **Hypovolemia** **Increased ICP** **Infection at Site**
68
What are the effects of an Epidural below T4?
Vasomotor Tone Effected ↓Venous Return & CO
69
What are the effects of Epidurals Above T4?
Cardiac Sympathetic Fibers Effected Profound HYPOtension & Bradycardia
70
What factors affect Epidural Coverage?
**\*\* ​VOLUME \*\*** Site Concentration Age Height Pregnancy Obesity
71
Regarding Epidurals, what is the volume needed for each level of block?
1 - 2mL per level
72
Regarding Epidurals, the Lumbar gets more spread \_\_\_\_\_\_\_\_, while the Thoracic gets and _____ spread
Regarding Epidurals, the Lumbar gets more spread **CEPHALAD**, while the Thoracic gets and **EVEN** spread
73
Pregnant & Obese patients require a ________ dose for an Epidural d/t Vein Engorgement & Increased Fat Tissue
Pregnant & Obese patients require a **DECREASED** dose for an Epidural d/t Vein Engorgement & Increased Fat Tissue
74
When should each Epidurally injected Local Anesthetic be redosed? * Chloroprocaine * Lidocaine * Mepivacaine * Bupivacaine * Ropivacaine
* **Chloroprocaine**: 45 min * **Lidocaine**: 60 min * **Mepivacaine**: 90 min * **Bupivacaine**: 120 min * **Ropivacaine**: 120 min
75
How is the Epidural Space identified with the Loss of Resistance technique?
Once in the Intraspinous Ligament, advance syringe slowly while tapping or placing continuous pressure until LOR.
76
How is the Epidural Space identified with the Hanging Drop technique?
Once in Intraspinous Ligament, place syringe with a lil fluid in the hub and advanced until drop sucks into needle
77
What are the complications of an Epidural?
Hypotension Unilateral Block Inadequate Block Back Pain PDPH Subdural/Subarachnoid Injection Meningitis Arachnoiditis Nerve Injury
78
What should be done if there is a Unilateral Block from an Epidural?
Pull Catheter Back Unaffected side Down Redose Replace
79
What should be done if there is an Inadequate Epidural Block?
Raise Head Redose w/ Higher Concentration Add Fentanyl
80
A Subdural Epidural Injection will elicit a response after _________ and can lead to a High Spinal
`A Subdural Epidural Injection will elicit a response after **10 - 15 minutes** and can lead to a High Spinal
81
A Subarachnoid Epidural Injection leads to a \_\_\_\_\_\_\_\_
A Subarachnoid Epidural Injection leads to a **FAST HIGH SPINAL**
82
What are signs of Meningitis from an Epidural?
Non-Positional Headache Fever Lethargy Confusion Nuchal Rigidity
83
What should be done if Meningitis is suspected?
Head CT Lumbar Puncture Neuro Consult Antibiotics
84
How long should anticoagulants such as Warfarin be discontinued before placing an Epidural/Spinal?
4 - 5 Days & PT/INR \< 1.5
85
How should Heparin be managed regarding Epidurals/Spinals?
**Sub Q**: Hold until after Block **IV**: Hold 1 Hour after Block & Remove 2-4 Hours after last Dose
86
How long should Herbal supplements that cause bleeding be held before Epidurals/Spinals?
5 - 7 Days
87
When should Ticlopidin & Clopidogrel be discontinued for Epidurals/Spinals?
**Ticlopidine**: 14 days **Clopidogrel**: 7 days
88
When should Abciximab be discontinued for Epidurals/Spinals?
Avoid Epidural/Spinal if patient is on Abciximab
89
How should LMWH/Lovenox be mangaged regarding Epidurals/Spinals?
Place Block 10-12 Hrs after last dose 24 hrs if High Dose

Advanced Anesthesia 2 (8 decks)

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