Anesthesia Blocks Subarachnoid (Spinal)

Front 1

Indication for giving a subarachnoid block?

Back 1

Anesthesia for any surgical procedure below the level of T4 requiring sensory loss with or without motor blockade not requiring a secured airway or mechanical ventilation

Anesthesia for a vaginal or cesarean delivery

Front 2

Briefly describe three approaches for spinal anesthesia.

Back 2

1. Median Approach. The most common approach, the needle or introducer is placed midline, perpendicular to spinous processes, aiming slightly cephalad.

2. Paramedian Approach. The spinal needle is placed 1.5 cm laterally and slightly caudad to the center of the selected interspace. The needle is aimed medially and slightly cephalad and passed lateral to the supraspinous ligament. If the lamina is contacted, the needle is redirected and "walked off" in a medial and cephalad direction.

3. Taylor or Lumbosacral Approach. The injection site is 1cm medial and 1cm caudad of the posterior iliac spine. The needle is directed 45 degrees medial and 45 degrees caudad, after contacting the lamina the needle is walked upward and medially to enter the L5-S1 interspace.

Front 3

List the two ways the subarachnoid block can be assessed.

Back 3

Alcohol swab to test for temperature sensation loss.

Pin pricks moving from nipple line down for numbness.

Front 4

List 3 common complications following Spinal Anesthesia.

Back 4

Postdural Puncture Headache

Transient Radicular Syndrome

Backache

Hypotension

Itching

Front 5

What are the Factors Affecting the Spread of the Local Anesthetic Solution?

Back 5

the baricity of the local anesthetic solution

the position of the patient

the concentration and volume injected

the level of injection

the speed of injection

Front 6

What are the landmarks for the subarachnoid block (spinal)?

Back 6

Superior Iliac crests palpated and L4 is identified.

Front 7

Spinal block...Insertion of the 17G introducer into the spine angled slightly cephalad is in what order of tissue layers?

Back 7

epidermis,
dermis,
sub Q,
supraspinous ligament, interspinous ligament,
stopping in the ligamentum flavum.

Front 8

During the insertion of a spinal block...A 25G choice needle is inserted into the introducer and thru what layers in the spine?

Back 8

passing through the epidural space,
dura, and
arachnoid to the
sub arachnoid space stopping when the presence of CSF is determined.

Front 9

Benefits of the Pencil Point Needles (Sprotte)?

Back 9

Designed to spread the dural fibers and help reduce the occurrence of post dural puncture headache

Yields a distinct "pop" as the pencil point penetrates the dura

Offers increased "tip strength" to minimize bending or breakage

Precision-formed side hole enables directional flow of anesthetic and reduces the possibility of straddling the dura

Tracks straight when advancing through ligaments toward the dura

Front 10

What are the concerns of using the Cutting Needle (Quincke)

Back 10

Dural "pop" is less likely to be appreciated due to the sharper tip

Increased risk of Postdural Puncture Headache due to increased trauma to the dura

Introducer may not be necessary depending on patient size