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Reproductive & Sexual Health > The Anatomy of Anaesthesia for labour > Flashcards

The Anatomy of Anaesthesia for labour Flashcards

1
Q

Above the levator ani muscle = _____
Below the levator ani muscle= _________

A

Above the levator ani muscle = pelvic
Below the levator ani muscle= perineum

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2
Q

Which nerve fibre types are found in the perineum?

A

Body wall

Somatic motor and somatic sensory

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3
Q

How do fibres responsible for uterine ‘cramping’ (e.g. menstruation) get from CNS to organs?

A

Hormonal (sympathetic/parasympathetic)

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4
Q

How do fibres responsible for uterine contraction (e.g. during labour) get from CNS to organs?

A

Hormonal (sympathetic/parasynpathtic)

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5
Q

How do fibres responsible for pelvic floor muscle contraction (e.g. during sneezing) get from CNS to organs?

A

Somatic motor

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6
Q

How do fibres carrying pain from adnexae (ovaries and fallopian tubes) get to the CNS?

A

Visceral afferents

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7
Q

How do fibres carrying pain from uterus get to the CNS?

A

Visceral afferents

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8
Q

How do fibres carrying pain from vagina get to the CNS?

A

Visceral afferents (pelvic part)/somatic sensory (perineum)

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9
Q

How do fibres carrying pain from perineum get to the CNS?

A

Somatic sensory

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10
Q
  • Superior aspect of pelvic organs / touching the peritoneum
    • Visceral afferents
    • Run alongside _________ ______
    • Enter spinal cord between levels _____
    • Pain is perceived by patient as ________
A
  • Superior aspect of pelvic organs / touching the peritoneum
    • Visceral afferents
    • Run alongside sympathetic fibres
    • Enter spinal cord between levels T11-L2
    • Pain is perceived by patient as suprapubic
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11
Q
  • Inferior aspect of pelvic organs / not touching peritoneum
    • Visceral afferents
    • Run alongside ______________ _____
    • Enter spinal cord at levels __, __, __
    • Pain perceived in __, __, __ ________ (________)
A
  • Inferior aspect of pelvic organs / not touching peritoneum
    • Visceral afferents
    • Run alongside parasympathetic fibres
    • Enter spinal cord at levels S2, S3, S4
    • Pain perceived in S2, S3, S4 dermatome (perineum)
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12
Q

How do structures crossing from the pelvis to the perineum e.g. urethra, vagina: above the levator ani sense pain?

A

Via visceral afferents

Parasympathetic

Spinal cord levels S2, S3, S4

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13
Q

How do structures below the levator ani sense pain?

A

Somatic sensory

Pudendal nerve

Spinal cord levels S2, S3, S4

Localised pain within perineum

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14
Q

Describe the autonomic sympathetic nerves of the pelvis?

A

Sacral sympathetic trunks

T11-L2

Superior hypogastric plexus

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15
Q

Describe the autonomic parasympathetic nerves of the pelvis?

A

Sacral outflow (S2, 3, 4)

Pelvic splanchnic nerves

Emerge from spinal roots

Mixes with sympathetics in inferior hypogastric plexus

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16
Q

Which pelvic organs touch the peritoneum?

A

Uterine tubes, uterus, ovaries

17
Q

Which organs are inferior to peritoneum?

A

Cervix and superior vagina

18
Q

Which organs are within the perineum

A

Inferior vagina, perineal muscles, glands, skin

19
Q

What are the various types of anesthesia used in labour?

A

Spinal anaesthetic

Epidural anesthetic

Pudendal nerve block

20
Q

At what level does spinal cord become cauda equina?

A

L2 vertebra

21
Q

What level does subarachnoid space end at?

A

S2

22
Q

Where is spinal and epidural anaesthetic injected into?

A

L3-L4 (L5) region

23
Q

What does the needle pass though in epidural anesthetic?

A

Supraspinous ligament

Interspinous ligament

ligamentum flavum

Epidural space (Fat and veins)

24
Q

What does needle pass through in spinal anaesthetic?

A

Supraspinous ligament

Interspinous ligament

Ligamentum flavum

Epidural space (Fat and veins)

Dura mater

Arachnoid mater

Finally reaches subarachnoid space (contains CSF)

25
Q

Sympathetic outflow originates from _______ centres in the _____

Sympathetic nerves exit spinal cord with__-__ _____ nerves

Travel to _________ chains running the length of the ________ ______

A

Sympathetic outflow originates from autonomic centres in the brain

Sympathetic nerves exit spinal cord with T1-L2 spinal nerves

Travel to sympathetic chains running the length of the vertebral column

26
Q

After sympathetic chains sympathetic outflow passes into …..

A

Spinal nerves (anterior and posterior rami/named nerves)

27
Q

How does sympathetic outflow happen below level L2?

A

Sympathetic ganglia recieve fibres from L2 level via the sympathetic chain and distrubite tham via connections with lumbar, sacral and coccygeal spinal nerves

28
Q

All spinal nerves and their named nerves contain ______ ______; including femoral, sciatic, obturator, pudendal

A

All spinal nerves and their named nerves contain sympathetic fibres; including femoral, sciatic, obturator, pudendal

29
Q

What does blockade of sympathetic tone cause due to spinal anaesthetic?

A

Block of sympathetic tone to all arterioles in lower limb;

Vasodilatation

  • skin looks flushed
  • warm limbs
  • reduced sweating
30
Q

What does the pudendal nerve supply?

A

Nerve of the perineum

Somatic motor and somatic sensory to structures of the perineum

31
Q

What does pudendal nerve block cause?

A

Anaesthesia of majority of perineum

32
Q

The pudendal nerve;

Exits pelvis via ______ ____ ______

Passes posterior to _________ _______

Re-enters pelvis/perineum via ______ _____ _______

A

The pudendal nerve;

Exits pelvis via greater sciatic foramen

Passes posterior to sacrospinous ligament

Re-enters pelvis/perineum via lesser sciatic foramen

33
Q

What does the pudendal nerve travel within and with?

A

Passageway within obturator fascia

With internal pudendal artery and vein (and nerve to obturator internus)

34
Q

What can be used as a landmark to administer pudendal nerve block?

A

Ischial spine

35
Q

When can pudendal nerve block be used during labour?

A
  • forceps delivery
  • painful vaginal delivery
  • episiotomy incision
36
Q

How is pudendal nerve anaesthetised in perineal suturing after delivery?

A

LA is injected along site of tear/episiotomy to anesthetise branches of pudendal

37
Q

What can be stretched and torn during labour?

A
  • pudendal nerve
  • fibres within the levator ani
  • external anal sphincter
38
Q

How is episiotomy performed?

A

Posterolateral (mediolateral incision)

  • made into the relatively ‘safe’ fat filled ischianal fossa and avoids the incision extending into the rectum

Reproductive & Sexual Health (54 decks)

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