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APA Fundamentals > Types of Regional/Conduction Anesthesia > Flashcards

Types of Regional/Conduction Anesthesia Flashcards

1
Q

T/F: Post op mortality and morbidity is increased with neuraxial blockade?

A

False

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2
Q

Into what space is LA injected for spinal anesthesia?

A

Into the subarachnoid/intrathecal space.

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3
Q

What are three indications for spinal?

A
  1. Surgery of lower abdomen.
  2. Surgery of lower extremities.
  3. Surgery on perineum.
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4
Q

What must be done prior to considering spinal anesthesia?

A

Preoperative assessment:

  • Note baseline neuro deficits.
  • Bacteremia/abcess/infection.
  • Check for anticoagulant use.
  • Cardiac disease (specifically AS).
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5
Q

What is the only true absolute contraindications to spinal?

A

Patient refusal.

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6
Q

What are “relative” contraindications to spinal?

A
  • Lack of cooperation (ex: MRDD).
  • Increased ICP.
  • Significant coagulopathies.
  • Skin infection at site.
  • Hypovolemia.
  • Fixed cardiac state
  • Difficult airway.
  • Existing neuropathy.
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7
Q

How long should plavix be discontinued prior to spinal anesthesia?

A

7 days prior

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8
Q

T/F: Aspirin must be stopped 7 days prior to spinal anesthesia?

A

False: no contraindication

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9
Q

What are a couple examples of herbal supplements that are potential contraindications for spinal anesthesia?

A

Ginko.
Ginseng.
Fish oil.

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10
Q

How long should spinal anesthesia typically last?

A

1-4hours.

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11
Q

If spinal anesthesia is lasting longer than expected, what could potentially be a risk?

A

Spinal or epidural hematoma.

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12
Q

What are signs of spinal or epidural hematoma?

A

Prolonged spinal effect.
New onset weakness.
New onset back pain.
New onset bowel/bladder dysfunction.

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13
Q

Spinal or epidural hematomas must be surgically decompressed within how many hours?

A

8 hours

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14
Q

What are risks of permanent neurologic injury with spinal anesthesia?
Epidural anesthesia?

A

Spinal 1-4.2:10,000

Epidural 0-7.6:10,000

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15
Q

The anatomy of the vertebral column is broken down into categories, what are they?

A 
7 Cervical vertebra.
12 Thoracic
5 Lumbar.
5 Sacral.
4 Coccygeal.
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16
Q

What are the three intralaminar ligaments in order?

A
  1. Surpaspinous ligament
  2. Interspinous ligament.
  3. Ligamentum flavum.
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17
Q

Which intralaminar ligament connects the apices of spinous processes?

A

Supraspinous ligaments

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18
Q

Which intralaminar ligament connects the caudal edge of the vertebra above to the cephalad edge of the lamina below?

A

Ligamentum flavum.

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19
Q

While advancing a spinal needle, which intralaminar ligament would your needle first pass through?

A

Supraspinous ligament.

(Skin, subcutaneous, supraspinous, interspinous, ligamentum flavum).

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20
Q

The spinal cord ends at what position in a new born (under 2 years)? In an adult?

A

Under 2 yrs: L3.

Adult: L1.

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21
Q

Where are spinal needles placed to ensure spinal cord is not damaged?

A

Below L2

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22
Q

What are the 3 meninges covering the spinal cord?

A
  1. Dura mater.
  2. Arachnoid.
  3. Pia mater
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23
Q

What meninge is closest to the spinal cord?

A

Pia Mater

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24
Q

What meninge is in between the pia mater and the dura mater?

A

Arachnoid

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25
Q

What is the anatomically proper word that spinal needles are placed into below the spinal cord?

A

Cauda equina.

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26
Q

What is the conus medullaris?

A

The spinal cord begins to taper into a cone shape between T12 and L1.

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27
Q

Where is the CSF located?

A

Subarachnoid space

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28
Q

What is the volume of total CSF? CSF in spinal canal?

A

Total=140ml

Spinal canal 30-80ml

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29
Q

How much CSF is produced daily?

30
Q

What is the specific gravity of CSF at 37C?

A

1.004-1.009

31
Q

What are the 6 things that affect level of spinal blockade?

A
  1. Drug dose.
  2. Drug volume.
  3. Turbulence of CSF.
  4. Increased IAP.
  5. Spinal curvatures.
  6. Baricity of LA
32
Q

Does IAP increase or decrease the level of the spinal?

A

Can increase because the pressure creates a thinner vessel for the volume to spread over.

33
Q

T/F: While laying supine, the LA will settle away from the lumbar region?

A

False: Laying supine, the LA settles in lumbar region.

If laying prone, the LA will settle away from lumbar region.

34
Q

What are examples of things that increase the turbulence of the CSF?

A
  1. Coughing.
  2. Barbotage.
  3. Rapid injection.
  4. Patient movement
35
Q

What is the most common LA solution for spinal anesthesia, isobaric, hypobaric, or hyperbaric?

A

Hyperbaric

36
Q

How can the baricity of a LA be increased?

A

By added dextrose

37
Q

How can a LA be made into a hypobaric solution?

A

By adding sterile water.

38
Q

What is the purpose of a pencil point spinal needle?

A

Trying not to cut fibers.

trying to just spread the fibers apart without causing damage.

39
Q

Describe a Touhy needle?

A

Typically used to epidurals, Bevel is very flat with slight curve in it.
Also, typically very large needles (17gauge).

40
Q

While laying lateral, would the affected side be placed up while using a hypobaric LA? Hyperbaric LA?

A

Affected side up with hypobaric.

Affected side down with hyperbaric

41
Q

Is the sitting or lateral position preferred for obese patients?

A

Sitting to assist in identification of midline.

42
Q

Describe needle technique with midline approach?

A

Right in the middle, straight with the needle, maybe 10degree cephalad angle.

43
Q

Describe needle technique with paramedian approach?

A

Needle placed 1-1.5cm lateral to midline. Aimed medially and slightly cephalad. Passed lateral to the supraspinous ligament.

44
Q

In what situation would the paramedian needle approach be warranted?

A

Useful in patient who cannot be maximally flexed or whose intrapspinous ligaments are ossified.

45
Q

What lumbar vertebra does the iliac crests intersect?

A

L4 or the L3-L4 interspace.

46
Q

Why is contamination of spinal kit with antiseptic solution specifically avoided?

A

It is potentially neurotoxic (arachatinitis).

47
Q

What direction should the bevel be facing upon insertion of the spinal needle?

A

Bevel should be parallel to the fibers that run longitudinal.

48
Q

Which ligament creates a sudden “pop” once entered?

A

Ligamentum flavum.

49
Q

How is correct placement of spinal needle confirmed?

A

Free flow of CSF into the hub of the needle.

50
Q

Describe the steps of administering the spinal anesthetic into the subarachnoid space:

A
  1. Syringe with appropriate dose is filled.
  2. CSF confirmed free flow.
  3. Aspiration
  4. Slow injection of drug.
  5. Re-aspiration at end of injection.
  6. Needle gently removed
  7. Patient placed in desired position.
51
Q

What will happen upon aspiration with a hyperbaric solution? Isobaric solution?

A

Hyperbaric solution: will see swirl.

Isobaric: will only see volume change.

52
Q

How long does fixation of LA take?

A

Approx 20 minutes

53
Q

How is any ascending anesthetic level assessed?

A

Pinprick or alcohol swab.

54
Q

How should vital signs be monitored followed after spinal anesthesia?

A

BP/HR/RR at least once every minute until deemed stable.

55
Q

If sensory blockade is confirmed at the T7 level, at what level would sympathetic and motor be blocked?

A

Sympathetic is 2 above (T5).

Motor is 2 below (T9).

56
Q

Do younger or older patients have more profound hypotension from spinal anesthesia?

A

Younger because the vessels are very elastic and not athersclerosed.

57
Q

T/F: Heart rate is effected significantly in most patients following a spinal?

A

False:

only 10-15% have significant bradycardia.

58
Q

What is treatment for CV response to spinal anesthesia?

A 
Fluid load (can preload).
Oxygen mask.
Vasopressors.
Atropine.
Epi/NE.
CPR.
59
Q

Should CV effects be anticipated with spinal?

A

Yes; and steps should be taken to minimize the degree of hypotension and bradycardia via preload of fluids and pretreatment of vasopressors.

60
Q

T/F: The diaphragm is typically the effected muscle following spinal anesthesia?

A

False. Diaphragm involvement would be rare.

61
Q

What two things are effected in relation to breathing following a spinal?

A
  1. Blocked ability to use accessory muscles (no effective cough, forced exhale.
  2. No sensation of breathing.
62
Q

What are the complications of spinal anesthesia?

A
  1. Failure of block.
  2. Spinal headache.
  3. High spinal (treat all symptoms).
  4. Nausea.
  5. Urinary retention.
  6. Hypoventilation.
  7. Backache.
63
Q

Which vertebral region has a wider epidural space?

A

Lumbar region 5-6mm wide.

Mid-thoracic region 3-5mm wide.

64
Q

T/F: Spinal anesthesia develops in a segmental manner and selective blockade can be achieved?

A

False; Epidural blockade can .

65
Q

Is the site of action for an epidural different than a spinal anesthetic?

A

No; works on the same place, but we just don’t put it in the same place.

66
Q

Which anesthetic approach has a slower onset and lower intensity, epidural or spinal?

67
Q

Which way will an epidural spread in the thoracic region? Lumbar region?

A

Thoracic region= both up and down.

Lumbar region= Only up (no where to go down).

68
Q

What is the technique that should be used to locate the epidural space for lumbar epidural placement?

A

Loss of resistance technique

69
Q

What technique should be used to locate the epidural space for thoracic epidural placement?

A

Hanging drop technique.

70
Q

Which ligament must be punctured in order to enter the “potential” epidural space?

A

Ligamentum Flavum

71
Q

If correctly placed in the epidural space, a test dose of epi/LA should have what effect on HR?

A

No effect; however, if injected into an epidural vein, a 20-30% increase in HR will be seen.

72
Q

Does position have an effect on epidural level?

A

No; because it is not “floating” in the CSF

APA Fundamentals (10 decks)

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