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Levi's Class 2014 > Week 11 Spinal and Epidural > Flashcards

Week 11 Spinal and Epidural Flashcards

1
Q

When was the first spinal done and with what drug?

A
  • 1885 to 1890

- Cocaine

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2
Q

What would your assessment of the patient be before a spinal or epidural?

A
  • History
  • Medication
  • Surgical History
  • INFORMED CONSENT
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3
Q

What equipment would be needed for resuscitation of a epidural or spinal patient?

A
  • Monitor
  • IV
  • Midication
  • O2
  • Sedation
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4
Q

How would you place a cutting spinal/epidural needle?

A

-Longitudinal

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5
Q

What would happen if dermal cells were introduced epidural space or sub-arachnoid space?

A

Dermoid spinal cord tumor

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6
Q

What are absolute contraindications for a spinal or epidural?

A
  • PATIENT REFUSAL
  • Lack of cooperation
  • Uncorrected coagulopathies
  • Infection
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7
Q

What effects the uptake and spread of a spinal?

A
  • Concentration of LA in CSF
  • Surface area of nerve tissue exposed
  • Lipid content of nerve tissue
  • Blood flow to nerve tissue
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8
Q

What effect the distribution of a spinal?

A
  • Baricity
  • Position
  • Dose
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9
Q

What are hypObaric drugs for a spinal?

A
  • Tetracaine

- Lidocaine

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10
Q

What are isbaric drugs for a spinal?

A
  • Tetracaine
  • Lidocaine
  • Bupivacaine
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11
Q

What are the hyperbaric drugs for a spinal?

A
  • Tetracaine
  • Lidocaine
  • Bupivicaine
  • Bupivicaine

DEXTROSE is usually used for the mixture

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12
Q

T/F: If MAP is unchanged to the liver the liver will have no changes.

A

TRUE

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13
Q

What would be a sign of a high spinal?

A

-Dyspnea

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14
Q

At what level would you see the GI affected by a spinal?

A

T6 to L2

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15
Q

What would be the S/S of a sympathetic innervation to the GI?

A
  • Increased secreation
  • Sphincters relax
  • Bowel constricts
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16
Q

What would you use to treat for N/V of a high spinal?

A

-Atropine

17
Q

What local anesthetic is currently not approved by the FDA for a spinal?

A

2-Chloroprocaine

18
Q

List the onset, duration, and Dose of Lidocaine?

A
  • 3 to 5 minutes
  • 60 to 90 minutes
  • 25 to 50 (25 to 100)
19
Q

List the onset, duration, and dose of Tetracaine?

A
  • 3 to 6 minute
  • 70 to 180 minutes
  • 5 to 20 mg
20
Q

List the onset, duration, and dose of bupicicaine?

A
  • 5 to 8 minutes
  • 90 to 150 minutes
  • 5 to 20 mg
21
Q

What is the segment of the back at the iliac crest?

A

-L4 to L5

22
Q

Where would you feel the pop when placeing the spinal?

A

-Dura

23
Q

How fast should solute be injected into the spinal?

A

0.5 mL/sec

24
Q

When would you use a paramedian approach?

A

-Calcified intraspinous ligament

25
Q

What is the treatment for PDPH?

A
  • Fluids
  • Caffeine
  • bed rest
  • Sumatriptan
26
Q

What increases the chance of a spinal hematoma?

A
  • Anticoagulation
  • increased age
  • female
  • Hx GI bleeds
  • length of therapy
27
Q

T/F: A lower LA concentration may block motor more than sensory.

A

FALSE

28
Q

What is a key factor for spread of an epidural?

A

VOLUME

29
Q

If the epidural is placed in the lumbar region which way would the LA spread go?

A

More cephalad

30
Q

If the epidural is placed in the thoracic area which way would the LA spread?

A

EVEN spread up and down

31
Q

T/F: Position is not considered a factor in epidural coverage.

A

TRUE

32
Q

What would decrease the dose of an epidural?

A
  • Pregnancy

- Obesity

33
Q

What block would be changed for a epidural than a spinal?

A

-Caudal block

34
Q

What is the test dose for an epidural?

A
  • 3 mL of 1.5 % Lidocaine

- 15 mcg of Epinephrine

35
Q

What is the correct epidural dose for lumbar, thoracic, caudal, continuous infusion (per segment)?

A
  • Lumbar 1-2 mL
  • Thoracic 0.7 mL
  • Caudal 3 mL
  • Continuous infusion 4 -15 mL/hr
36
Q

What could be done if an epidural is inadequate?

A
  • Raise head
  • redose with higher concentration
  • fentanyl
37
Q

What could you do for a unilateral block for a epidural?

A
  • Pull the catheter back
  • Unaffected side down
  • Redose
38
Q

What kind of response would you get for an epidural that is placed in subarachnoid injection?

A

-fast high spinal

39
Q

What kind of response would you get for an epidural that is placed in SUBDURAL injection?

A
  • Delayed by 10 to 15 minutes

- high spinal

Levi's Class 2014 (16 decks)

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