TEST - in general from PRODIGY Flashcards
MILLILITER dose range for LA dosing for caudal anesthesia
0.5-1.0mL / kg
define ‘field block’
injection of large amount of LA into SQ to block cutaneous nerves
popliteal blocks disrupt transmission in the _____ n.
sciatic
popliteal block and ______ n. blocks will provide complete anesthesia below knee.
saphenous
After spinal, pt. has RR 16bpm, SpO2 100%, c/o dyspnea… where is block level?
T2-T4 blocks indicate sensory loss to chest wall movement = dyspnea despite WNL RR… C2-C3 will result in denervation to phrenic nerve and intercostal muscles = hypoxia, hypercarbia, respiratory arrest
spinal epidurals occur in this order: the _______ is inserted first then the ________ is performed 2 interspaces below
epidural, spinal
ANTERIOR border of epidural space? POSTERIORLY?
believe it or not, ANT. is posterior longitudinal segment and POS. is vertebral lamina and ligamentum flavum
lumbar spinal peaks at which interspace?
L3
INJECTION of hyperbaric spinal @ L3 means the drug will spread which direction?
caudal and cephalad since L3 is the peak
what nerve fibers/ spinal column level innervate urinary bladder tone
S2-S4
caudal anesthesia is good below whiche level?
level of umbilicus
spinal-epidural rationale for labor pain… which is first?
spinal for early, epidural for active labor
what cardiac condition is C.I. for neuraxial anesthesia
aortic stenosis
pregnant patients receive what fraction of spinal anesthetic than non-pregnant patients?
1/3 less
epidural blood patch: how much autologous blood and where?
15mL one interspace below level of dural puncture
epidural opioids exert effects on receptors at which LAMINA (2) aka the ___________ ___________.
II and III aka substantia gelatinosa
epinephrine, clonidine, and phenylephrine dosing to prolong spinal
epi = 0.1-0.2ml 1:1000 clonidine = 75-100mcg phenylephrine = 2-5mg (no way but this is from PRODIGY)
appropriate opioid dosing for morphine, fentanyl and sufenta in spinal blocks
FENTANYL = 10-25 mcg
SUFENTA = 10mcg
preservative free MORPHINE = 250mcg
epidural catheter needle placement (BL and unilateral)
cephalad for BL, 45 towards side you wish to blck
epidural DC’d ___ hours prior LMWH dosing
2
SAS (subarachnoid space) extends to __-___ in adults and __-___ in kiddos
S2-S3, L1-L3
SPINAL-epidural blocks: injection of epidural anesthetic does what to your previously doses spinal anesthetic?
increases block height
which areas/level of spinal column are MOST dependent when supine
T4-T8
SCIATIC nerves divides into which two n.? Superior or inferior to popliteal fossa?
tibial & common peroneal n. and superior to knee
popliteal artery lateral to semiTENDONosis tendon? T or F
True dat
PDH relieved in which posish’
supine
is patient age a C.I. for spinal anesthesia?
nope
primary innervation of PENIS
PUDENDAL
SCIATIC nerve roots are
L4-S3
spinal anesthesia DURATION determined by
dose and LA chosen (opioids increase duration too)
caudal anesthesia: more likely to have intrathecal anesthesia in kiddos or adults? why?
kids, d/t epidural sac extension to S3 in kids
caudal anesthesia covers
procedures below diaphragm - rectal, inguinal, lower extremity surgery
sacral hiatus is insertion point for CAUDAL anesthesia… it’s location is b/t
S4 and S5
epidural space is largest at what level of spinal column (general)
LUMBAR
PABA is? found in what LA?
PARA-aminobenzoic acid in ESTER local anesthetics
femoral n. block which is most lateral? n., artery, vein?
n.
first pop in spinal is? second?
ligamentum flavum, dura mater
cardiac arrest s/p spinal indicated by what symptoms? caused by a blockade of which fibers at T1-T5
bradycardia & hypotension, cardioacceleratory
things that increase likelihood of PDPH… list em’
young females, multiple attempts, large gauge needle use
insertion of needle 2cm medial and caudal to anterior iliac spine and injecting 10-15mL LA after entering fascia lata you are blocking which n.?
lat. femoral cutaneous n.
hyperbaric spinal is placed @ L3, which direction will it travel if patient remains sitting position? Caudal, cephalad, both?
caudal for a ‘saddle block’
paramedian approach - which part of vertebrae would you likely encounter first? Pedicle? spinous process, lamina, or transverse process?
lamina
most common pediatric neuroaxial anesthetic?
caudal
most common SE of epidural anesthetics?
urinary retention
most common SE for morphine epidural anesthetic? bupivicaine?
MORPHINE - pruritis
BUPIVICAINE - hand weakness followed by hypotension
which n. prevents ADDUCTION of legs?
obturator
which position is best for a combined spinal/epidural technique? sitting, standing on head, lateral, prone?
SITTING
popliteal n. located __________ (in space) to popliteal artery?
laterally
which n. block in combo w/ popliteal fossa n. block would completely (when done right) would completely anesthetize the foot?
SAPHENOUS n. - remember, we are blocking the SCIATIC n. prior to jump off point of TIBIAL and PERONEAL branches… what remain is the terminal branch of the femoral n.
which spinal needle is a ‘cutting’ needle?
Quincke
IMPORTANT PENIS INNERVATION STUFF B/C WE HAVE PENISES : What n. block the penis?
pudendal, genitofemoral, and ilioinguinal
saphenous n. can be blocked posterior to to medial malleolus? TRUE or FALSE
FALSE - anterior
epidural segmental spread is directrly related to _______ (DOSE, POSITION, VOLUME, or BARICITY)
VOLUME - REMEMBER, spinals are DOSE dependent
how much epinephrine is in an epidural test dose lidocaine?
EPI - 15mcg
lido - 45 mcg
or 3ml of 1.5% lido (15mgml) and 1:200,000 epi
3 part question on spinal blockade sympathectomy.
1. What levels block cardioaccelatory fibers? 2. What does cardioaccelatory blockade cause? 3. A sensory block at T6 means autonomic (sym) block at T_ and motor at T_.
spinal anesthesia cause sympathomemectomy which causes venous pooling via dilation of venous capitance vessels (minimal arterial dilation) AKA: venodilation.
Cardioaccelatory blockade occurs b/t T1-T4 - so watch out for BRADYcardia and decreased contractility.
T4 and T8 respectively
SYMPATHECTOMY is results in
unopposed VAGAL activity (parasympathetic),
SLUDGE is the handy acronym for crazy PNS crap what does it mean?
Salivation: stimulation of the salivary glands
Lacrimation: stimulation of the lacrimal glands
Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles
Defecation: relaxation of the internal anal sphincter
Gastrointestinal upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea
Emesis: Vomiting
sympatholysis d/t neuroaxial anesthetics do what to the GI tract?
peristalsis = generalized constriction of bowel, increased bloodflow, increased intralumen pressure
Tip of the scapula (shoulder blade duh) corresponds w/ which thoracic vertebrae?
T7
most prominent cervical vertebrae is?
C7
tip of twelfth rib corresponds w/ which thoracic vertebrae?
L1
iliac crest corresponds w/ which thoracic vertebrae?
L4
sacral cornua, coccyx, and pos. sup. iliac spines are all good surface anatomy markers for?
caudal anesthesia
Caudal anesthesia: are paresthesias, and ‘fullness’ normal senstations w/ injection?
yep
What is the cause of APNEA w/ spinal anesthesia? treatment?
from the lack of perfusion to brainstem… corrected w/ hemodynamic resuscitation
