Regional Anesthesia

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  1. With a spinal what is the principle site of action?
    The nerve root
  2. How many vertebrae total?
    How many cervical?
    Fused sacral?
    • 33 total
    • 7 cervical
    • 12 thoracic
    • 5 lumbar
    • 5 fused sacral
    • 4 coccygeal
  3. What vertebral level do the scapula correspond to?
  4. What vertebral level does the iliac crest correspond to?
  5. Where does the spinal cord end in adults?  In kids?
    • Adults L1
    • Kids L2 or L3
  6. At what levels are spinals usually performed at?
    Below L1 (below the level of the spinal cord)
  7. Cauda equina
    • Free flowing nerve fibers in CSF 
    • Begin after spinal cord ends
  8. Where does the CSF extend to?
  9. 3 levels of vertebral ligaments from superficial to deep
    supraspinous, interspinous, ligamentum flavum
  10. Where is spinal anesthesia performed?
    Subarachnoid space, AKA intrathecal space
  11. Between what membranes is a spinal located?
    Arachnoid and pia mater
  12. T or F, free flowing CSF is indicative of epidural placement?
    F, this is indicative of spinal placement
  13. What are the 3 membranes surrounding the spinal cord from superficial to deep?
    Dura mater, arachnoid mater, pia mater
  14. Between what two membranes is a epidural placed?
    ligamentum flavum and dura mater
  15. What artery and how many arteries supply the dorsal portion of the spinal cord?
    • Posterior spinal arteries
    • 2
  16. Is the dorsal portion of the spinal cord sensory or motor?
  17. What artery and how many arteries supply the ventral portion of the spinal cord?
    • artery of Adamkiewicz
    • 1
  18. Is the ventral portion of the spinal cord sensory or motor?
  19. 2 types of spinal needles
    cutting (cuts thru the dura) and non cutting (spreads the dura)
  20. What size and type of spinal needle is least likely to cause a post dural puncture headache?
    smaller non cutting needle
  21. What 2 approaches are used to perform a spinal
    midline (straight in) or paramedian (enter laterally)
  22. Type of block produced with a spinal
    • -dense blockade (high concentration of LA at the nerve root)
    • -complete blockade (sympathetic and motor)
  23. What is the principle site of action of neuraxial blockade?
    nerve root
  24. differential blockade
    smaller sympathetic nerves (pain and temperature) are more easily blocked than larger motor nerves
  25. CV effects of a spinal
    sudden hypotension and bradycardia (sympathectomy)
  26. GI effects of a spinal
    increased peristalsis, decreased sphincter tone (due to sympathectomy)
  27. Where do the sympathetic nerves exit the spinal cord from?  How does this affect hypotension?
    • Thoracolumbar area
    • The higher the sympathetic block, the more hypotensive the pt will be
  28. Urinary tract effects of a spinal
    urinary retention and loss of bladder control
  29. endocrine effects of a spinal
    blocks stress response of surgery
  30. dermatome
    section of skin innervated by that spinal nerve
  31. spinal level / sympathetic level
    boundary of where the pt is able to feel sensation
  32. T4 dermatome
    nipple line
  33. T10 dermatome
  34. T or F, a spinal uses a small amount of LA injected directly into the CSF to produce high levels of sensory and motor blockade
  35. Does an epidural usually produce a sympathectomy?
    No, only if it's a thoracic epidural
  36. What is the most important factor affecting the level of spinal anesthesia?
    • -Baricity (heaviness of the solution in relation to CSF)
    • -Pt position is also important and is related to baricity
  37. If a pt is supine where will a hyperbaric solution accumulate?
    thoracic and sacral spine as both are convex
  38. Is a higher dose of a LA needed to achieve a T4 or T10 blockade?
  39. For what types of surgeries is a  T4 level of spinal desired?
    Upper abdominal
  40. For what types of surgeries is a T10 level of spinal desired?
    TURP, vaginal delivery, hip surgery
  41. Are spinal needles larger or smaller than epidural needles?
    Smaller as with a spinal you are not inserting a catheter
  42. 2 techniques to verify that you are in the epidural space
    • 1) loss of rx 
    • 2) hanging drop
  43. Is a spinal inserted with the pt awake or asleep?
  44. Is an epidural inserted with the pt awake or asleep?
    Either, however awake is preferred so the pt can communicate pain or paresthesias
  45. Absolute contraindications to neuraxial blockade
    • -pt refusal
    • -infection at injection site
    • -severe hypovolumia
    • -coagulapathy
    • -increased ICP
    • -severe AS or MS
  46. Recommendations re: neuraxial blockade with ASA and NSAIDs
    No contraindication
  47. Are pts taking NSAIDs or SQ heparin at increased risk for spinal hematoma?
  48. Are pts taking plavix, fibrinolytic therapy, LMWH, or fully anticoagulated on heparin at increased risk for spinal hematoma?
    Yes!  Insertion and removal both pose a risk for spinal hematoma
  49. Is PDPH related to timing of ambulation?
  50. What factors lead to increased incidence of PDPH?
    younger age, female, larger needle size, pregnant, multiple punctures
  51. What 4 factors influence the affect of LA on nerve fibers?
    • 1) myelinated or not
    • 2) size of nerve fibers
    • 3) concentration of LA at nerve fiber
    • 4) duration of LA at nerve fiber
Card Set
Regional Anesthesia
regional anesthesia
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