week 3 Flashcards
in adults where does the spinal cord end
L1-L2
in pediatrics where does the spinal cord end
L3
In adults where does the dura sac end
S2
in pediatrics where does the dura sac end
S4
Name the largest interspace
L5-S1
name L Site placement for following surgeries
Hip surgery
lower extremity surgery
obstetric analgesia
lumbar l2-L5
draw imaginary line between the iliac crests
Nipple:
Xiphoid:
Umbilicus:
Cardioacceleators
T4
T6
T10
T 4 - 5
Characteristics of patient affecting level of spinal anesthesia
height position gender
other factors affecting level of spinal anesthesia
Type of needle, site of injection, and the direction of the needle
Dosage amount (most influential factor)
Characteristics of the local anesthetic (baricity):
hypobaric, isobaric, hyperbaric
Volume of CSF in the spinal canal
position for broken hip
TURN THEM OVER ON THE SIDE THAT THEIR HIP IS BROKEN.
Advantages of Spinal Over General Anesthesia
Reduced stress response to surgery
Less blood loss (hip surgery)
Less incidence of DVT
Pulmonary complications appear to be less
Possible less cardiac complications
Better in obstetrics (less medications are administered to mother and fetus)
level of insertion for colectomy, anterior resection, upper abdominal surgery
lower thoracic t6-t8
thoracic surgery level of insertion
t2-t6
What is the purpose of doing neuraxial regional anesthesia
A neuraxial regional anesthetic (spinal, epidural, caudal) is selected when maintenance of consciousness during surgery is desirable
spinal anesthesia advantages.
Takes less time to perform
Produces a more rapid onset of better-quality sensory and motor anesthesia
Is associated with less pain during surgery.
Unlike epidural anesthesia, a continuous spinal technique is rarely used because of post spinal headache and concern about the proper maintenance of the catheter in the subarachnoid space.
Epidural anesthesia
A lower risk for post–dural puncture headache
Less chance of systemic hypotension if epinephrine is added to the local anesthetic solution,
The ability to prolong or extend the anesthesia through an indwelling epidural catheter
The option of using the epidural catheter to provide postoperative analgesia.
Skeletal muscle relaxation and contraction of the gastrointestinal tract are also produced by a regional anesthetic.
Modified Bromage Scale
0 no motor block
1 can’t lift legs but can move knees and feet
2 can’t life legs can’t move knees but can move feet
3 complete block of motor limb