Term
| caudal anesthesia involves injecting local into ___ and accessing this space via what part of the body |
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Definition
| Caudal anesthesia involves local administration into the epidural space through the sacral hiatus. |
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Term
| the spinal cord and nerve roots are contained within the |
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Definition
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Term
| the vertebral canal extends from the ____ to the ____ |
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Definition
| vertebral canal extends from the foramen magnum to sacral hiatus. |
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Term
| The two major curvatures of the spine are referred to as? located where |
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Definition
1. kyphosis: convex. at the thorax
2. lordosis: concave. lumbar |
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Term
| can all people be accessed for caudal anesthesia |
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Definition
| NO. 8% have fused sacral hiatus. |
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Term
| the ____ mater provides an impregnable barrier to drugs or other thigns from getting to the spinal cord |
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Definition
arachnoid mater.
B/c you wouldn't want blood getting past it since CSF is in the sub-arachnoid space. |
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Term
| the highly vascular mater is the |
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Definition
|
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Term
| the arachnoid space is bordered by the ___ mater on the inner side and the ___ mater on the outer side |
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Definition
| pia mater on the inside and arachnoid mater on outer side |
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Term
| there are __ pairs of spinal nerves |
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Definition
| 31 pairs of spinal nerves |
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Term
| There are how many paried coccygeal nerves |
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Definition
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Term
| which fibers in a supine patient are more susceptible to hyperbaric solutions of local in spinals.. why |
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Definition
| the sensory afferent nerve fibers enter the posterior aspect of the spine. Therefore if the patient is supine that posterior side is dependent. Therefore a heavy solution (hyperbaric) will settle dependent and sit and influence the sensory the most. |
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Term
| the cervical nerves pass above or below their corresponding cervical vertebrae |
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Definition
| Above..above the posterior notch arch. But there are 8 cervical nerves so the 8th cervical nerve passes over T1 |
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Term
| for thoracic nerves they leave the vertebrae via? |
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Definition
| thoracic nerve passes through the inferior notch |
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Term
| blood supply for the spinal cord arises from? 3x |
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Definition
| single anterior and two paired posterior |
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Term
| which part of the spine is more at risk for ischemia the anterior or posterior |
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Definition
| ANTERIOR! only one artery compared to the posterior which has two and between both are collateral vessels. |
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Term
| artery of adamkieqicz is located |
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Definition
| enters vertebral canal through the L1 intervertebral foramen |
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Term
| what artery supplies blood to the lower 2/3 of the spinal cord |
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Definition
|
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Term
| vertebral canal is drained via ___ which drains into the ___ veins |
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Definition
| internal vertebral venous plexus which drain into the azygos venous system |
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Term
| the azygos venous system drains what? into what? In what area of the body |
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Definition
| The azygos venous system is the final vneous drainage system for the vertebral canal. It is found in the chest and drains into the superior vena cava over the right upper lung. |
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Term
| patients with increased abdominal pressure, or tumors that compress their vena cava may have issues with epidurals why? |
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Definition
| compression of the vena cava causes back pressure buildup that goes all the way back to the veins in the epidural space of the spinal cord. That results in more engorged veins that can be more easily pierced during epidural placement or insertion |
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Term
| absolute contraindications for neuraxial anesthesia are 4x |
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Definition
1. pt refuses
2. infection at site
3. elevated ICP
4. bleeding diathesis |
|
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Term
| can patients with Multiple sclerosis get neuraxial anesthesia |
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Definition
| Yes. They are not on the contraindications list. But only give to them if benefit outweighs risks |
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Term
| What kind of patients with cardiac issues should we be careful with when placing a neuraxial block... what does nueraxial anesthesia greatly affect |
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Definition
| Neuraxial anesthesia causes large decrease in systemic vascular resistance. Any cardiac disease which are use to higher SVR will not respond well. Be very cautious with patients who have AS, mitral stenosis and idiopathic hypertorphic subaortic stenosis. |
|
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Term
| absolute contraindications for neuraxial anesthesia are 4x |
|
Definition
1. pt refuses
2. infection at site
3. elevated ICP
4. bleeding diathesis |
|
|
Term
| can patients with Multiple sclerosis get neuraxial anesthesia |
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Definition
| Yes. They are not on the contraindications list. But only give to them if benefit outweighs risks |
|
|
Term
| What kind of patients with cardiac issues should we be careful with when placing a neuraxial block... what does nueraxial anesthesia greatly affect |
|
Definition
| Neuraxial anesthesia causes large decrease in systemic vascular resistance. Any cardiac disease which are use to higher SVR will not respond well. Be very cautious with patients who have AS, mitral stenosis and idiopathic hypertorphic subaortic stenosis. |
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Term
| which position for inserting a spinal is associated most with the potential to vasovagal them |
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Definition
| sitting,, as soon as the spinal eliminates the SNS they are now sitting and can't compensate. |
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Term
| spinal cord in an adult normally lies between L ? and L ? |
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Definition
| L1-L2 is the termination of the spinal cord |
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Term
| In what percentage of adults does the spinal cord potentially extend to the third interspace of the lumbar spine |
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Definition
| 2% may extend to third interspace of L2-L3. |
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Term
| The incidence of a spinal headache is dependent on |
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Definition
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Term
| normal size range for a spinal needle is |
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Definition
|
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Term
| the interlaminar space is slightly _____ to the interspinous space |
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Definition
| caphald. So start medial over the lower spinous process and angle cephald. |
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Term
| Name the path of the spinal needle as it enters the body |
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Definition
| Skin, sub Q, supraspinous ligament, interspinous ligament, ligamentum flavum, epidrual space, dura mater, sub arachnoid space. |
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Term
| describe the Taylor approach for spinal anesthesia and when would it be useful |
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Definition
| the Taylor approach is best used when patients cannot bend their backs to open up their interspaces. The approach is done at L5-S1. The needle is inserted 1 cm median and 1 cm caudal from the posterior superior iliac spine. The needle is inserted at a 55 degree angle. |
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Term
| What part of the lumbar anatomy when the needle punctures it gives the provider a feeling of a POP |
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Definition
| dura mater (touch mother) |
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Term
| If a patient develops parathesia during the insertion of the spinal needle what do you do |
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Definition
| STOP. this is not good. Terminate the procedure. |
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Term
| the distribution of local anesthetic solution in the CSF is decided by what factos 3x |
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Definition
1. baricity of the solution
2. contour of the spinal canal
3. position of hte patient in the first few minutes after the injection of local. |
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Term
| what is the most common baricity of spinal anesthesia |
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Definition
|
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Term
| what is added to make a solution of local hyperbaric |
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Definition
|
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Term
| A hyperbaric solution administered to a supine patient will travel towards what |
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Definition
Towards the kyphotic position on the patients spine which is around T6/T7. This is the area of most dependency
Also the sacrum has an area of kyphosis wher eit will also go. |
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Term
| what is a saddle block and why is it important |
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Definition
| A saddle block takes advantage of the patients anatomy and characteristics of local anesthesia. Buy injecting a spinal solution caudal into the lumbosacral peak thus keepingt he hyperbaric solution below the peak of the sacral |
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Term
| when would a hypobaric solution be used |
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Definition
| not often. Its used for procedures in the jack knife position or for operation on the non-dependent side since it will float up |
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Term
| how is hypobaric solution made |
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Definition
| adding 10% local with sterile water |
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Term
| Can gravity effect the spread of locals |
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Definition
|
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Term
| When would you consider isobaric solutions for a spinal |
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Definition
| isobaric solutions are made from a local combined with NS. Since gravity has no influence on local spread this type of solution stays exactly where it is. The lack of spread is ideal when wanting a more dense block! |
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Term
| you add how much epi to a local solution for an epidural |
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Definition
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Term
| you add how much neo to a spinal to prevent spread of the local |
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Definition
|
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Term
| if i want 2-5 mg of a drug that comes in a 1% solution then how many mL do I need |
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Definition
|
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Term
| adding an opioid to a spinal solution physiologically works how |
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Definition
| the opioid mimics enkephalin and acts on the dorsal horn |
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Term
| first nerve fibers to be effected from spinal injection are? How soon after injection |
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Definition
| within 30-60 seconds after injection you will have effects on A delta fibers and C fibers. |
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Term
| the first ___ minutes after spinal anesthesia are critical for getting anesthesia in areas you want it throgugh positioning. It is also critical because if patient crashes they will now |
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Definition
|
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Term
| what position for epidural anesthesia is associated with less of a chance of venous cannulation |
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Definition
|
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Term
| What age group is it common to place epidurals after general anesthesia |
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Definition
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Term
| the most common epidural needles is known as? |
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Definition
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Term
| for a thoracic epidural is a midline or paramedian approach easier |
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Definition
| here it may be easier for a paramedian appropach since the thoracic spinous process is angled much more therefore limiting interlaminar space. |
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Term
| is onset of local more rapid in spinal or epidural |
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Definition
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Term
| in continuous epidural anesthesia the catheter is advanced how far into the epidural space |
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Definition
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Term
|
Definition
|
|
Term
| caudal anestehsia is performed in what two positions |
|
Definition
|
|
Term
| Two variants in anatomy to be aware of when performing caudal anesthesia |
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Definition
1. 10% of individuals dural sac extends beyond S2.
2. 10% of individuals the sacral hiatus is closed. |
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Term
| describe the spread patterns of epidurals in the lumbar and thoracic injection areas |
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Definition
| In the lumber area spread of epidural LA tends to favor cephald. While in thorax due to its smaller epidural space likes to spread evenly caudal and cephald. |
|
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Term
| how much epi do you add to your epidural LA |
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Definition
|
|
Term
| what happens when you add bicarb to local |
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Definition
| It causes more local to go into the non-ionized form thereby increasing the onset. |
|
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Term
| why is chloroprocaine so rapidly borken down |
|
Definition
| hydrolyzed plasma esterases |
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Term
| if an epidural hematoma occurs in a pt after a epidural catheterizatoin what will most significantly change outcomes in motor recovery |
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Definition
| time to decompression by a surgeon! |
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Term
| an accidental dural puncture during a epidural procedure is known as |
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Definition
|
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Term
| does a spinal or epidural have a higher incidence of systemic absorption and why |
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Definition
| Epidurals have a higher incidence of systemic absorption due to the larger volume of LA required and the fact that the epidural space contains numerous venous plexuses |
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|
Term
| mild central nervous system toxicity form LA has sx of |
|
Definition
1. restlessness
2. slurred speech
3. tinnitus |
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Term
| moderate to severe central nervous system toxicity from LA overdose has sx such as |
|
Definition
1. seizures
2. coma
3. CV collapse |
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Term
| what sign can you look for in the unconscious anesthetized patient that your epidural injection actually went into the subarachnoid space |
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Definition
| Eyes dilate and do not react to light. BADD |
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Term
| What has happen if you have patchy sensory anesthesia and unilateral dominance?? |
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Definition
| You somehow injected local anesthetic into the subdural space which is normally very small due to close adherence of the arachnoid mater and dura mater. |
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Term
| Does baracity effect epidurals and spinals |
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Definition
| FALSE only effects spinals not epidurals |
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Term
| Injection of LA in the lumbar or thoracic EPIDURAL space will favor a cephald spread |
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Definition
| lumbar favors cephald spread while thoracic will be symmetrical |
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Term
| spread of spinal is direct or inverse to height |
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Definition
|
|
Term
| T/F you have to be careful when positioning a patient for an epidural |
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Definition
| FALSE! ITS NOT A SPINAL. It will not have as significant of a effect. But maybe some |
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Term
| Onset and duration of lidocaine |
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Definition
| onset 10-15 minutes, duration 60-120 minutes |
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|
Term
| onset and duration of chloroprocaine |
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Definition
| onset 5-10 minutes and duration 45-60 minutes |
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|
Term
| is lidocaine short acting or medium acting |
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Definition
|
|
Term
| onset and duration of bupivcaine |
|
Definition
| onset 15-20 minutes, duration 120-200 minutes |
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|
Term
| is bupivicaine short, medium or long acting |
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Definition
|
|
Term
| most highly vascular meninge is |
|
Definition
|
|
Term
| male or female more at risk for postdural headache |
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Definition
|
|
Term
| which needle type less risk for postdural headache |
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Definition
|
|
Term
| where does the anterior spinal artery originate from? |
|
Definition
|
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Term
| where do the posterior arteries for spinal cord branch from |
|
Definition
| the posteiror and inferior cerebellar arteries |
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Term
| artery of adamkiewicz supplies what portion of the spinal cord |
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Definition
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|
Term
| to promote blood flow to a compromised spinal cord we can drain CSF but should not exceed how many mL/hour |
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Definition
| no more than 20 mL / hour |
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Term
| The landmark for lumbar spinal is called |
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Definition
|
|
Term
| obesity may raise or lower the conus medullaris? |
|
Definition
| lowers it!! Risk for hitting it with spinal. Maybe lower than L2! |
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|
Term
| dermatones S3,4,5 are limited to? |
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Definition
|
|
Term
| the posterior part of your legs are what dermatones |
|
Definition
|
|
Term
| the major dermatone of the back of your head is |
|
Definition
|
|
Term
| what is the order for local anesthetics effect on sensation |
|
Definition
STP-TP-MVP
Sympathectomy - temp - pain - touch - pressure - motor - vibration - proprioception |
|
|
Term
| absolute contraindications for neuraxial |
|
Definition
1. pt refusal
2. increase ICP
3. infection at site
4. hypovolumia
5. coagulopathy |
|
|
Term
| Epidural space is approximately how deep on a normal body habitus patient |
|
Definition
|
|
Term
| The largest interspinous space for spinal needle to transverse is found wherer |
|
Definition
|
|
Term
| name two manufactorers of pencil tip spinal needles |
|
Definition
|
|
Term
| name manufacturer of open tip, cutting needle |
|
Definition
|
|
Term
| never put more than __ mL of LA in spinal canal |
|
Definition
|
|
Term
| how long will morphine added to spinal help with pain |
|
Definition
|
|
Term
| all opioid added spinal anesthesia will cause |
|
Definition
|
|
Term
| why is demerol a good drug for spinals |
|
Definition
| can treat shakes and highly specific affinity for substantia gelantonsa. but still worry about cholinergic effects and active metabolites |
|
|
Term
| are locals weak bases or acids |
|
Definition
|
|
Term
| can you add bicarb to spinals and epidurals |
|
Definition
| NOOOOOOOOO. NEver to spinals. |
|
|
Term
| which local do you avoid with epidural catheters |
|
Definition
| avoid chlorprocaine b/c it has an unk effect on future opioid dosing |
|
|
Term
| bupivicaine has more sensory or motor blockade while tetracaine is the opposite |
|
Definition
| Bupivicaine has more sensory than motor! while tetracaine has more motor than sensory. |
|
|
Term
| heparin gtt should be off for how long prior to epidural since epidural is most risk for bleeding |
|
Definition
|
|
Term
| test dose for epidural catheter is |
|
Definition
|
|
Term
| epidural catheter sits how far in epidural space |
|
Definition
|
|
Term
| there is greater control of sensory and motor blockade with epidurals or spinals |
|
Definition
|
|
Term
| degree of hypotension from spinal anesthesia directly correlates to what |
|
Definition
|
|
Term
| what is the bezold-jarisch reflex |
|
Definition
| decrease venous return from sympathetcomy cuases asytole due to lack of blood to right heart. |
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|
Term
| when would you expect to see a post dural headache develop |
|
Definition
| 12-48 hours after a spinal or wet-tap |
|
|
Term
| whos at risk for a post-dural headache |
|
Definition
| 1. pregnant woman 2. young people 3. hisotry of it 4. large diameter needle 5. cutting needle |
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