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APEX > Unit 8 - Neuraxial Anesthesia Pt 2 > Flashcards

Unit 8 - Neuraxial Anesthesia Pt 2 Flashcards

1
Q

coagulopathic states that make neuraxial anesthesia contraindicated

A
  • Plt < 100,000
  • PT, aPTT, or bleeding time 2x normal value
  • Risk epidural or spinal hematoma
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2
Q

why is increased ICP a potential contraindication to neuraxial anesthesia

A
  • increased chance of brain herniation with sudden change in CSF pressure
  • Sudden change in CSF pressure by passing a needle through dura
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3
Q

why is sepsis a relative contraindication to neuraxial anesthesia

A
  • Introduction of contaminated blood beyond blood-brain barrier
  • Worsening hypotension d/t neuraxial sympathectomy
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4
Q

valvular lesions with fixed SV that may make neuraxial contraindicated

A
  • severe AS
  • severe MS
  • HOCM
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5
Q

why is difficult airway a relative contraindication to neuraxial anesthesia

A
  • block failure may require rapid conversion to GA
  • RAS depression is common and may cause sedation
  • Supplementation with IV sedatives may lead to airway obstruction or collapse
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6
Q

why is a full stomach a relative contraindication to neuraxial anesthesia

A
  • hypotension & brainstem hypoperfusion r/t sympathectomy can cause N/V
  • Can lead to aspiration if sedated patient has full stomach
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7
Q

why is neuraxial anesthesia often avoided in patients with peripheral neuropathy

A
  • theory that these patients are more susceptible to injury
  • Slower to recovery from injury

Data lacking but legal word has a strong opinion

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8
Q

neuraxial considerations in pts with multiple sclerosis

A
  • epidural is safe, spinal might exacerbate s/s
  • if spinal would benefit pt, inform about small risk of exacerbation
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9
Q

why should lower dose and concentration of LA be used for neuraxial if pt has multiple sclerosis

A

Demyelinated fibers may be more susceptible to LA-induced neurotoxicity with spinal

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10
Q

neuraxial considerations in pts with spina bifida

A
  • Increased risk for traumatic injury during needle placement depending on extend of defect
  • Greatest risk: neural tube defects, tethered cord
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11
Q

is previous back surgery a contraindication to neuraxial

A

nope

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12
Q

is a lower back tattoo a contraindication to neuraxial

A

theoretical concern of introducing neurotoxic compounds into body (no data to justify)

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13
Q

cutting tip spinal needles

A

Quincke
Pitkin

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14
Q

pros and cons of cutting tip spinal needles

A

pros: requires less force

cons:
* Higher risk PDPH
* Less tactile feel
* Needle more easily deflected
* More likely to injure cauda equina

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15
Q

non-cutting tip spinal needles - pencil point

A

Sprotte
Whitacre
Pencan

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16
Q

rounded bevel tip spinal needle

A

Greene

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17
Q

pros of non-cutting tip spinal needles

A
  • Lower risk PDPH
  • More tactile feel
  • Needle less likely to deflect
  • Less likely to injure cauda equina
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18
Q

needle angles of epidural needles

A

Crawford = 0 degrees
Hustead = 15 degrees
Tuohy = 30 degrees

19
Q

why is aortic stenosis a relative contraindication for neuraxial anesthesia

A

fixed afterload makes CO highly dependent on preload, which decreases with sympathectomy

20
Q

distance from epidural space to skin in lumbar region of most adults

A

3-5 cm

Distance ↑ in pregnant & obese patients: skin to epidural space up to 9 cm

21
Q

optimal depth of epidural catheter insertion

A

3-5 cm inside epidural space

22
Q

consequences of epidural catheter depth too shallow vs. too deep

A

o Too shallow = higher incidence of inadequate analgesia (epidural failure)
o Too deep = catheter may enter epidural vein or exit through intervertebral foramen

23
Q

distance from ligamentum flavum to dura

A

~7 mm

(can range from 2 mm – 2.5 cm)

24
Q

distance from ligamentum flavum to dura

A

~7 mm

(can range from 2 mm – 2.5 cm)

25
Q

how does Tuohy needle decrease risk of dural puncture

A

30 degree curvature + blunt tip

26
Q

distance from skin to ligamentum flavum

A

~ 4-6 cm

27
Q

dermatomes blocked with caudal approach to epidural space

A

sacral, lumbar, & lower thoracic dermatomes

28
Q

use of caudal blocks

A
  • Useful for procedures requiring up to a T10 sensory block
  • Most commonly used in pediatrics
  • Procedure examples: hemorrhoidectomy, labor pain, anal fistula
29
Q

absolute contraindications to caudal block

A

spina bifida, meningomyelocele of sacrum, meningitis

30
Q

relative contraindications to caudal block

A

pilonidal cyst, abnormal superficial landmarks, hydrocephalus, intracranial tumor, progressive degenerative neuropathy

31
Q

why are caudal blocks infrequently used after childhood

A

sacral anatomy more difficult to identify & lumbar approach to epidural space is easier & equally effective

32
Q

positions for caudal block placement

A
  • Simm’s position (lateral, hips flexed, top leg flexed > bottom)
  • prone (small roll under iliac crests, legs in frog position)
33
Q

landmarks for caudal block

A

Use posterior superior iliac spines & sacral hiatus as landmarks to envision equilateral triangle with apex of triangle at sacral hiatus

34
Q

needles used for caudal block

A

22g needle
25g needle
20g IV catheter

35
Q

needle insertion for caudal block

A

bevel up through sacral hiatus at 45-degree angle aiming cephalad

36
Q

what signifies entry into epidural space with caudal block

A

advance until you feel a pop

From here, drop angle and advance into epidural space

37
Q

ligament punctured in caudal block

A

sacrococcygeal ligament

38
Q

what increases risk of dural puncture with caudal block

A

Placing needle tip beyond S2-S3

39
Q

should LOR with air be used for caudal block?

A

not in children - increases risk of air embolism

40
Q

what does resistance to injection suggest with caudal block

A

needle tip in subperiosteal area

41
Q

Which spinal ligament must be breached regardless of approach or type of neuraxial block being performed?

A

ligamentum flavum

42
Q

—left off on dosing for caudal block pg 18–

A
43
Q

nerve roots that are most resistant to effects of LAs

A

L5
S1

44
Q

largest spinal nerves

A

L5
S1

APEX (54 decks)

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