List 3 factors that affect the level and duration of spinal anesthesia
patient position
volume of anesthetic
rate of injection
site of injection
baricity of the local
use of epinephrine
What additive prolongs the duration of spinal?
a) epinephrine
b) ephedrine
c) atropine
epinephrine
When is hypobaric local anesthetic indicated in a spinal?
- head down procedures (eg rectal surgery)
- procedures where patient lies on the opposite side (eg nephrectomy)
When are isobaric solutions indicated in spinal anesthetic
- lower extremity and urologic procedures
- tends to stay at the site of injection
How long after the injection and positioning of the patient is the spinal level 'fixed'?
a) 5 minutes
b) ten to fifteen minutes
c) 30 minutes
ten to 15 minutes
Describe the progression of ONSET of nerve blockade in a spinal - sensory;motor and autonomic
first is autonomic then sensory then motor
Describe the progression of OFFSET of nerve blockade in a spinal - sensory; motor and autonomic
first motor then sensory then autonomic
What dermatome levels are the autonomic and motor functions compared to sensory?
motor is 2 dermatomes lower
autonomic is 2 dermatomes higher
Anatomically - where is the dermatome T4?
nipple
Anatomically - where is the dermatome T6?
xiphoid
Anatomically - where is the dermatome T10?
navel
Anatomically - where is the dermatome L1?
groin
Anatomically - where is the dermatome L4?
knees
How much does adding epinephrine to the local anesthetic, extend the duration of a spinal?
a) doubles
b) triples
c) quadruples
doubles
What is the duration of a spinal using lidocaine
- a) 1-1.5 hours
- b)1.5 - 3 hours
- c) 2-3 hours
- d) 2-4 hours
1 to 1.5 hours
What is the duration of a spinal using tetracaine
- a) 1-1.5 hours
- b)1.5 - 3 hours
- c) 2-3 hours
- d) 2-4 hours
2-3 hours
What is the duration of a spinal using bupivicaine
- a) 1-1.5 hours
- b)1.5 - 3 hours
- c) 2-3 hours
- d) 2-4 hours
1.5 - 3 hours
List 5 complications from spinal anesthesia?
mild temperature loss
N & V
urinary retention
hypotension
high spinal
bradycardia
temporary mild hearing loss
dural puncture headache
hematoma formation
backache
List cause and treatment for the following complication of spinal anesthesia?
mild temperature loss
Cause: vasodilation (ANS block)
Tx warm blankets
List cause and treatment for the following complication of spinal anesthesia?
N & V
Cause: usually hypotension, possibly from unopposed vagal stimulation (ANS block)
Tx
- monitor for nausea
- meds
- monitor and maintain BP
List cause and treatment for the following complication of spinal anesthesia?
Urinary retention
Cause:
- decreased sensation and muscle tone of bladder (sensory and motor block)
Tx
- assess for distention
List cause and treatment for the following complication of spinal anesthesia?
hypotension
Cause: autonomic block impairs vasoconstriction
Tx
- IV crystalloid
- possibly ephedrine
List S &S and treatment for the following complication of spinal anesthesia?
high spinal (above T4)
S & S
- whispering speech,
- weak upper extremities;
- loss of sensation along chest
- resp failure from hypotension; diaphragm paralysis; IC muscle paralysis
Tx intubation may be necessary
What should the nurse suspect if she sees the following?
- whispering speech,
- weak upper extremities;
- loss of sensation along chest
- resp failure
What are S & S of a high spinal blockade
high spinal
List cause and treatment for the following complication of spinal anesthesia?
bradycardia
- develops if cardiac accelerating fibres (T1-4) are blocked
Tx - atropine
How does taking beta blockers affect a patient post-spinal?
not able to produce compensatory tachycardia in the presence of hypovolemia thus more likely to have hypotension
List cause and treatment for the following complication of spinal anesthesia?
hearing loss
possibly from temporary decrease is CSF
usually more frequent with larger needles
Tx - transient
List S & S, cause and treatment for the following complication of spinal anesthesia?
Dural puncture headache
cause:
- persistent leak of CSF
S & S:
- occiptal h/a that is worse when sitting
- usually on day 2
Tx
- blood patch
What is the cause of the following complication of spinal anesthesia?
- unusually long duration of spinal;
- complains of back pain;
- persistant hypotension
hematoma
- rare but disastrous
- hematoma compresses spinal cord and nerve
- Tx - surgical decompression - 50% success
List cause and treatment for the following complication of spinal anesthesia?
Backache
traumatic insertion or stretching of ligaments with muscle relaxation
Tx analgesics
Testing of cold perception post-spinal tests what type of nerve fibre?
autonomic
What level of nerve function does plantar flexion of toes indicate (dermatome)
S1-2
What level of nerve function does dorsal flexion of toes indicate (dermatome)
L4-5
What level of nerve function does raising the knees indicate (dermatome)
L2-3
What is the duration of Morphine in a spinal?
- a) 1-2 hours
- b) 2-3 hours
- c) 4-6 hours
- d) 8-24 hours
8-24 hours
What is the duration of Fentanyl in a spinal?
- a) 1-2 hours
- b) 2-3 hours
- c) 4-6 hours
- d) 8-24 hours