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Principles 2 SAB Slides 18-31
here we go again...
19
Nursing
Graduate
09/02/2009

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Cards

Term

What is a nerve plexus?

What are some examples?

Definition

A group of nerve fibers that intertwine to supply an area.

Cervical, brachial, lumbar

Term

The area of cutaneous sensation supplied by a spinal nerve is known as what?

How is this helpful for practice?

Definition

Dermatomes.

If you know the dermatomes you can estimate the level of your block.

Term

Are lateral and midline dermatone levels equal?

Identify the following sensory levels:

C4

T2

T4

T6

T10

S3

Definition

No, especially when checked caudad to T10.

C4 = clavicles

T2 = 2nd rib

T4 = nipple line

T6 = xyphoid process

T10 = umbilicus

S3 = saddle block

 

Term

When was the earliest SAB done?

Who did this?

Definition
1921, August Bier
Term
What is the order a SAB spreads?
Definition

1.  SAS

2.  Nerves of the cauda equina

3.  Laterally to the nerve rootlets

4.  Laterally to the nerve roots

5.  Into the spinal cord

Term
What are some advantages of using a SAB?
Definition

Less toxic to major organ systems

Preserves spontaneous respiration

Decreased risk of aspiration

Less N/V

Mental Alertness (TURP)

Wound bleeding reduced

Decreased incidence of DVT

Term
What are some disadvantages of SAB?
Definition

More strain on CV system (quicker progression of hypotension)

Awareness

Post dural puncture headaches

Does not decrease incidence of post-op pulm. complications

Does not make a difference re: post-op outcomes!

Term
When are some situations to consider a SAB?
Definition

Vascular, lower extrem. 

Lower abdominal (below T8)

Extremity procedures

C sections

TURP

Pts with renal, hepatic, or metabolic disease

Higher risk for DVT

Term
Besides procedure type, what should be considered before using a  SAB?
Definition

Will the pt cooperate?

Can they remain in the same position?

Length of procedure

Outpatient vs inpatient

Surgeon preference

Term
What should be done preoperatively before SAB?
Definition

Informed consent: risks, benefits, potential complications, alternatives

Patient prep: assessment, chart review, reassurance, NPO

Term

Besides pain pathways, what else does SAB block?

What happens?

Definition

Sympathetic autonomic pathways

Vasodilation in the periphery

Term

What should be done to reduce the risk of a drop in BP in someone receiving a SAB?

When is this done?

Definition

Fluids!

NPO deficit is often replaced in the pre-op area.

Term

What patients (according to age) with have the most profound response to autonomic block?

 

What if the patient can't tolerate a large volume load?

Definition

Younger patients

 

Use of pressors, may want to avoid SAB

Term

What must be available before attempting spinal anesthesia?

 

Definition
Emergency equipment
Term

What are the 2 types of needles used in SAB?

How are they different?

Which type shows a decreased incidence of post dural puncture headaches?

Definition

Cutting bevel tips and pencil point.  Bevel tips cut through structures, whereas pencil points separate fibers.

Pencil point

Term

What is Tuffier's line?

 

What is the largest laminar space?

Definition

AKA intercristal line, plane formed along the iliac crest, contiguous with L4. (although this is not always L4--can range from L3 to L5)

 

L5

Term
What position is used for spinals?  Why?
Definition
Sitting position, with the shoulders relaxed and the back pushed out.  This opens the vertebral spinous processes and helps identify spaces.
Term
In terms of monitors, what is minimum with spinals?
Definition
A baseline BP, often a pulse ox.
Term
What are tricks to help with patient positioning?
Definition

Have them hug a pillow

Have the shoulders relaxed and dropped

Place the feet on a chair or stool

Ideally have someone in front of them giving them support.

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