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29 Cards in this Set
- Front
- Back
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List some risk factors for infectious complications after regional anesthetic technique.
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underlying sepsis
diabetes depressed immune status diabetes steroid therapy localized bacterial colinization infection chronic catheter maintenance |
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Is dural puncture considered a risk factor in the pathogenesis of meningitis?
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Yes
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According to Barash and M&M, when you inject into the epidural space each ml of local anesthetic will anesthetize how many segments?
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1 segment
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Origin of Artery of ADamkiewicz
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T9-T12 in 60% of cases
T5-T8 in 14% of cases Below L1 in 20% of cases Baby Miller says it enters at L1 interspace and is highly variable. |
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EXAM QUESTION
Has Bupivacaine and lidocaine been shown to inhibit the growth of a variety of microorganisms in culture? |
Yes
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Do opioids inhibit the growth of a variety of microorganisms in culture?
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No
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What are 3 major routes of entry for microorganisms into the epidural space?
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Catheter hub
Catheter insertion site Hematogenous spread |
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What major route of entry for microorganisms account for nearly half of the sources?
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Catheter hub
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Is the use of bacterial filters alone efficacious in preventing epidural colinization and infection?
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No- need to pay attention to aseptic technique.
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Should you provide a central neuraxial block in a patient with untreated systemic infection?
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No- only do it in the most extraordinary circumstances.
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EXAM QUESTION
Data suggest that patients with systemic infection have what done to safely undergo spinal anesthesia? |
Patient is provided appropriate antibiotic therapy is initiated
AND response to therapy elicited (dec. in fever) |
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List the 5 nerves that are superficial to the level of the ankle and easy to block for a foot block.
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sural nerve-superficial
superficial pernoeal-superficial saphenous nerve-superficial & only one not a branch of the sciatic- it is a branch of the femoral nerve deep peroneal- deep posterior tibial- deep & most difficult to block |
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How does meningitis usually present?
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fever
severe headache altered level of consciousness meningismus |
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How do you diagnose meningitis?
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Diagnosis confirmed with a lumbar puncture
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Should lumbar puncture be performed if epidural abscess is suspected?
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No-
because contamination of the intrathecal space may result. |
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CSF examination in patient with meningitis reveals what?
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Leukocytosis
glucose level <30 mg/dl protein level >150 mg/dl |
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A delay in diagnosis and treatment of major CNS infections of even a few hours will significantly worsen neurologic outcome.
True or False |
True
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EXAM QUESTION
How does a classic course of epidural abscess progress? |
Neuraxial discomfort (back pain)
radicular symptoms root pain weakness (including bowel and bladder symptoms) eventually paralysis Onset of weakness often progresses to complete paralysis within 24 hours |
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EXAM QUESTION
What is the currently recommended method to diagnose an epidural abscess? |
noncontrast MRI
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What was the old method used to diagnose an epidural abscess?
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myelogram
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when MRI capabilities are not available, what test can be used to diagnose epidural abscess?
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computed tomography myelography
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What is the treatment of choice for epidural abscess?
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Antibiotics
and surgical drainage |
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Rare or Common
serious central neuraxial infections such as arachnoiditis, meningitis, and abscess after spinal or epidural anesthesia |
Rare
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Epidural catheters should be removed in the presence of what?
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local erythema and/or discharge
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How long does it take for an epidural abscess formation to present after neural block?
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days to weeks after the neural block
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What are the clinical signs of an epidural abscess?
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severe back pain
local tenderness fever associated with leukocytosis |
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What is the most sensitive modality for evaluation of the spine when infection is suspected?
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MRI without contrast
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Name 2 of the most commonly identified pathogens in epidural infections.
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1) S. aureus
2) coagulasenegative staphylococcus |
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Growth of pathogens in epidural infections are inhibited at higher concentrations of local anesthetic such as....
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2% Lidocaine
0.5% Bupivacaine |
