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13 Cards in this Set
- Front
- Back
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What are the two methods of neuraxial (central) blockade?
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Epidural and spinal (intrathecal)
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When attempting an epidural, where are you trying to insert the catheter and deliver the anesthetic?
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Epidural space
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The epidural space is found is found between which two layers?
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Externally: ligamentum flavum
Internally: spinal dura mater |
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What lies within the epidural space?
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Fat and blood vessels (epidural plexus)
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From superficial to deep, name the layers through which a needle placed in the epidural space would have to pass.
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1) Skin and subcutaneous fat
2) Supraspinous ligament 3) Interspinous ligament 4) Ligamentum flavum |
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Where does the supraspinous ligament run?
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The supraspinous ligament runs longitudinally along the posterior surface (apices) of the spinous processes from C7 to the sacrum.
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Where do the interspinous ligaments run?
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Between the spinous processes
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Where is the ligamentum flavum situated?
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Posterior aspect of the spinal canal
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How does injecting agents into the epidural space cause anesthesia?
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The anesthetic agents are slowly absorbed into the subarachnoid space where they act on the spinal cord and nerve roots.
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Which two parameters determine the height or level of the nerve block in an epidural?
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1) The site where the catheter is placed
2) The volume of anesthetic delivered |
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Describe the technique for the insertion of an epidural catheter.
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The insertion is done strictly under sterile fashion.
A 17 or 17 gauge needles is inserted into the spinous interspace. A syringe filled with air or saline is attached to the needle. A sudden loss of resistance will be felt as the needle enters the space. The catheter is threaded through the needle into the space. The catheter is tested to ensure that no CSF or blood can be aspirated from it, indicating placement of the catheter into the subarachnoid space or into a blood vessel. LA is delivered in small 3 mL aliquots, while observing for signs or symptoms of incorrect catheter placement (e.g. systemic signs of toxicity indicating you're in a blood vessel or rapid onset nerve block indicating you're in the subdural space). In the absence of any signs or symptoms of incorrect catheter placement, the full dose of LA is delivered over 10-20 minutes. |
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When inserting an epidural catheter, how will you know when you've reached the epidural space?
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The epidural space is a potential space filled with fat, and you will feel a sudden loss of resistance as you pass through the ligamentum flavum into the fat.
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Name two ways you test the catheter to ensure you're in the epidural space.
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1) Apirate
-is there blood or CSF? 2) Deliver little amounts of LA -systemic signs of LA toxicity could indicate that you're in a blood vessel -rapid onset of sensory/motor block could indicate you're in the subdural space |
