Bb Spinal And Epidural Anesthesia

Front 1

How does obesity affect spread of hyperbaric intrathecal local anesthetics?

Back 1

increases the cephalad spread

Front 2

Xiphhoid is what dermatome?

Back 2

T6

Front 3

Where does the spinal cord and subarachnoid space end in adults and pediatrics?

Back 3

adults: spinal cord L2, subarachnoid space S2
pediatrics: spinal cord L3, subarachnoid space S3

Front 4

What controls the extent of spread of spinal analgesia?

Back 4

specific gravity(density) of anesthetic solution, volume and concentration of anesthetic solution, site of injection, position of patient during injection and after, barbotage, force and rate of injection, addition of vasoconstrictors, alterations in CSF pressure, temperature of local anesthetic solution, elimination of lumbar lordotic curve

Front 5

What factors increase epidural spread of local anesthetic?

Back 5

Major: age, site; Minor: weight, height, position; Min: speed of injection, direction of bevel, pregnancy

Front 6

What are risk factors for post-spinal headaches?

Back 6

younger patients, female, larger needle, transverse needle cut, pregnant, multiple needle punctures

Front 7

What factors do not affect the incidence of post-spinal headaches?

Back 7

continuous spinals, timing of ambulation

Front 8

What is treatment of spinal headaches?

Back 8

bedrest, hydration, analgesics, after 24-36 hours blood patch should be considered

Front 9

What are characteristics of spinal headache?

Back 9

occipital, not present in supine position, present in the standing position, often associated with 6th nerve palsy

Front 10

What are risks of spinal or epidural anesthesia?

Back 10

hypotension, n/v, total spinal, headache, local anesthetic toxicity, nerve injury, infection, failed spinal

Front 11

What should you consider with neurologic symptoms following neuraxial anesthesia?

Back 11

epidural hematoma, direct trauma to the spinal cord, epidural abcess, adhesive arachnoiditis, cauda equina, anterior spinal artery syndrome

Front 12

What is adhesive arachnoiditis?

Back 12

proliferative overgrowth of the pia that potentially can obliterate the subarachnoid space

Front 13

What is the symptoms of adhesive arachnoiditis?

Back 13

gradual onset of symptoms(weeks to months after spinal), chronic sensory loss and paresis of the lower extremities

Front 14

Why is subarachnoid steroid injections not recommended?

Back 14

risk of adhesive arachnoiditis, probably due to the preservative ethylene glycol

Front 15

What is the largest factor controlling the spread of local anesthetic in the subarachnoid space?

Back 15

baricity

Front 16

How can you make a local anesthetic solution hypo, iso, or hyperbaric for injection in the subarachnoid space?

Back 16

hypobaric: mix with sterile water
isobaric: mix with CSF
hyperbaric: mix with 10% dextrose

Front 17

How should you adjust the dose of local anesthetic given intrathecally if the patient is under 5 feet or over 6 feet?

Back 17

alter dose by 1-2mg

Front 18

How do high thoracic spinals affect the ABG?

Back 18

do not change the ABG, they do diminish coughing

Front 19

How can high thoracic spinals lead to respiratory arrest and how should you treat this?

Back 19

causing medullary ischemia secondary to hypotension which can lead to respiratory arrest; early recognition and treatment with epinephrine

Front 20

What spinal levels are the cardioaccelerator nerves?

Back 20

T1-4

Front 21

What are the cardiovascular effects of blocking the cardioaccelerator nerves with a high spinal?

Back 21

hypotension and bradycardia

Front 22

When doing spinal anesthesia what should you always have available?

Back 22

resuscitative skills and equipment(drugs, monitors, O2)

Front 23

What are the respiratory affects of high spinals?

Back 23

decrease expiratory reserve, ERV decreased 20% with total thoracic block, inspiratory capacity is a function of diaphragmatic function and is minimally affected, closing capacity is a function of intrinsic lung mechanisms and is minimally affected

Front 24

What are the benefits of bupivacaine versus tetracaine for spinal anesthesia?

Back 24

bupivacaine provides less motor block, bupivicaine may provide better relief of tourniquet pain

Front 25

What are the advantages of vasoconstrictors for spinal anesthesia?

Back 25

decrease uptake of local anesthetic, increase the duration of the block, increase the effectiveness or density of the block

Front 26

What are characteristics of tourniquet pain?

Back 26

ill-defined, occurs 45-60 minutes after tourniquet inflation, dull

Front 27

How can you decrease the incidence of tourniquet pain when using epidural or spinal anesthesia?

Back 27

intrathecal or epidural opioids, bupivicaine in spinal anesthesia is more effective than tetracaine for lower extremity tourniquet pain

Front 28

What is the definitive treatment of tourniquet pain?

Back 28

releasing the tourniquet,

Front 29

What are the cardiovascular effects of epidural anesthesia to the T5 level without epi?

Back 29

MAP, SV, CO and SVR are all decreased

Front 30

What are the cardiovascular effects of epidural anesthesia to the T5 level with epi?

Back 30

MAP and SVR are decreased, SV, CO are increased

Front 31

What are contraindications to spinal and epidural anesthesia?

Back 31

HIICCCC: Hypovolemia, History of allergy to local anesthetics, Increased ICP, Infection locally, Coagulopathy, Consent problems, Cardiac lesions(AS, IHSS, intracardiac right to left shunt, Certain conditions of pregnancy(abruptio placenta, placenta previa, severe eclampsia-preeclampsia)

Front 32

How does the sympathetic block correlate to the sensory block for spinal or epidural anesthesia?

Back 32

sympathetic block is from two to six dermatomes higher than the sensory block and sympathetics are usually blocked first

Front 33

What are cardiovascular benefits of epidural or spinal anesthesia?

Back 33

decreased venous thromboembolism, less blood loss(decrease in MAP), decreased afterload results in decreased myocardial oxygen consumption, the heart rate can tolerate a lower BP because NVO2 is reduced

Front 34

During neuraxial anesthesia above what MAP is renal autoregulation maintained?

Back 34

MAP> 80 torr

Front 35

How does neuraxial anesthesia effect the GI system?

Back 35

intestines contract and peristalsis increases following sympathectomy

Front 36

How does epinephrine effect the epidural block?

Back 36

increases the density of the block and decreases the risk of systemic toxicity

Front 37

Why is tetracaine not used in the epidural space?

Back 37

because is spreads poorly

Front 38

Why is chloroprocaine not used more often with neuraxial anesthesia?

Back 38

increased risk of adhesive arachnoiditis(especially subarachnoid, likely due to preservative, sodium bisulfite)

Front 39

What areas are frequently spared with epidural anesthesia?

Back 39

frequently spares lower lumbar and sacral segments, caudal supplements

Front 40

What are tests for the presence of CSF?

Back 40

CSF is warm, contains glucose, will not cause thiopental to precipitate(local anesthetics do)

Front 41

What are boundaries of the epidural space?

Back 41

foramen magnum, sacral hiatus, dura, and ligamentum flavum

Front 42

What structures are traversed with the paramedian approach for epidural needle placement?

Back 42

ligamentum flavum, dura, and arachnoid

Front 43

What property of opioids best predicts their behavior in the CSF?

Back 43

lipid solubility

Front 44

Why do the least lipid soluble drugs produce the longest acting effects in the epidural or intrathecal space?

Back 44

the greater the lipid solubility the faster the systemic absorption and the greater the dural penetration

Front 45

What are typical opioid effects in the intrathecal space?

Back 45

respiratory depression(rare, biphasic with first peak within the first hour and the second up to 24 hours), nausea, pruritus, sedation, urinary retention

Front 46

What is the typical dose of epidural and intrathecal duramorph?

Back 46

epidural: 4-6mg; intrathecal: 0.5mg

Front 47

What are the benefits of epidural as opposed to intrathecal narcotics?

Back 47

better postop analgesia, higher postop PO2, lower incidence of pulmonary complications

Front 48

Lack of fusion of what vertebra leads to the sacral hiatus?

Back 48

S5

Front 49

What is the sacral hiatus covered by?

Back 49

sacrococcygeal ligament

Front 50

What are the most common complications of a caudal?

Back 50

intravascular injection, subarachnoid injection