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54 Cards in this Set

  • Front
  • Back
How many spinal curves are there
4
Cervical C7, thoracic T7, lumbar L3-4, sacral
When pt is supine what is the highest and lowest point of the spine
T5 is the lowest
L4 is the highest
Ligaments of the vertebral column
supraspinous
interspinous
lig flavum
name the 3 maters
dura, arachnoid, pia
Where is the epidural space
foramen magnum to caudal canal
Epidural space (not really an open space) contains
lymphatics, adipose tissue, veins
Spinal cord ends at
L2
the dural sac ends at
S2
How many arteries supply the spinal cord & location
3
one ant
two post
What is the major art of the spinal cord
artery of adamkiewcz)
CSF Composition
Clr colorless
Contains gluc, pro, elytes
SP grav = 1.003-1.009 (r/t baricity of spinal anesth)
CSF volume
120-150ml
20-80ml in spinal arach space (varies per person, obese<,)
Fluid ossilates vigorously w/ art pulsations
CSF volume
Rate of formation/day
150ml/day up to .35ml/min
Dermatomes
Definition
cutaneous area innerv. primarily by a single nerve root
Dermatomes
Significance
guide for required anesthetic
level for intended surg
estimates physio changes
Deramtome Landmarks
L1
immediately above genitalia
Deramtome Landmarks
L1O
Umbilicus
Deramtome Landmarks
T8
lower Costal margin
Deramtome Landmarks
T6
xiphoid
Deramtome Landmarks
T4
nipple line
Deramtome Landmarks
C8
little finger
Deramtome Landmarks
C6
thumb
Spinal Anesthesia
Zones of differnetial blkade
T2 =
Sympathectomy level (sm amt blk
Spinal Anesthesia
Zones of differnetial blkade
T4 =
Sensory level (alittle more blk)
Spinal Anesthesia
Zones of differnetial blkade
T6=
Sensory level (sufficient blk)
Epidural Anesthesia
Zones of Differential Blkade
C8
Sympathectomy level
Epidural Anesthesia
Zones of Differential Blkade
T4
Sensory level
Epidural Anesthesia
Zones of Differential Blkade
T8
Sensory level
Differential Blkade
Clinical Signs
Small fibers : B&C (pain 1st blk (feel warm, dec pain
-A-delta (pain) gamma,beta (loss sens pain, pressure, touch
-A-alpha loss of motor & propriocep
-Return of funct (motor, prop, press, touch, pain, sympathetics)
Differential Blkade Reasons
Spinal
-Cephalad spread diluts LA
-In Vivo diff sensitivity to local anesth
-sympathetics most sens
-sensory intermediate
-motor least sens
Differential Blkade Reasons
Epidural
Wider spread of zones w/ epidural d/t diff
-site of action
-how Local anesth (LA) reaches sites of actions
Deramtomes
Estimating Physiologic Change
L1
Minimal physio change
Deramtomes
Estimating Physiologic Change
T10
low ext venous pooling, mild dec in BP
Deramtomes
Estimating Physiologic Change
T6
splanchinic bed vasodilat, dec exp manuerveres
Deramtomes
Estimating Physiologic Change
T4
above plus frequent C-A blkade
Deramtomes
Estimating Physiologic Change
C8 (phrenic nerve)
above plus OCC phrenic nerve
epiural blk at T1-T4 (Cardiac accelator) results in
parasympathetic response
Physiology: T5 Level of Spinal Anest Blk
Cardiovasc changes MAP
MAP dec by 15-20%
-loss of symp tone, arteriole dilate, dec 15-20% SVR
-Intrinsic mus tone further dec
-dec sympath tone, some dec in cardiac contract
Physiology: T5 Level of Spinal Anest Blk
Cardiovasc changes in C.O.
C.O. = venous return dependent
-if maintained, little or no chng
-if not, mod to sev hypotension
Physiology: T5 Level of Spinal Anest Blk
Cardiovasc chng HR
Stable or slight dec unless
-t1-T4 cardioaccelerators blkd
-dec ven return -> non stretch of RA/Great Vein Stretch Recpt -> Brady
Physiology: T5 Level of Spinal Anest Blk
Cardiovasc changes to myocardium
dec coronary bld flow w/ dec mean aortic press
-dec HR + LV work contrib to lower cardiac O2 demand
Physiology: T5 Level of Spinal Anest Blk
Cerebral Circulation changes
-dec in MAP compensated by autoreguation -> no chng in CBF
-HTN PT autoreg shift to right -> tx aggressive, to maintain BP at 20-30% from baseline
Physiology: T5 Level of Spinal Anest Blk
Pulmonary Changes
Expiratory changes (dec FVC,FEV1 & cough d/t paralysis of IC/ABD musc
-Insp chng minimal: VT, MV unchg
-PaO2, PaCO2 nrml
Physiology: T5 Level of Spinal Anest Blk
Few Pulmonary Changes
-Phrenic nerves C3-5
-Zones of diff blkade
-Resist of motor nerves to locals
Physiology: T5 Level of Spinal Anest Blk
Hepatic Circ
-reduce in hepatic bld w/ dec MAP
-Post-op dysfunct check other causes, surg site, bld transfus, drugs
Physiology: T5 Level of Spinal Anest Blk
Renal effects
-slight reduc in GFR & renal funct.
-R/T dec MAP
Physiology: T5 Level of Spinal Anest Blk
GI
-T5-L1 symp fibers inhibit motility
-sympathectomy unopposed vagal tone -> inc peristalisis
-NV w/ nrml VS: tx w/ atropine or glycopyrrolate
Physiology: T5 Level of Spinal Anest Blk
Endocrine effects
-No increase in stess horomones (hi spinal)
-probably beneficial, outcomes controversial
Physiology: T10 or lower
Saddle blk or Low SAB (most previous effects of T5 don't occur)
-Low SAB very safe even in sick pts (hips, turp)
-Safer than gen anest agents less use of high SAB
Physiology: T5 Epidural
-all previous effects of SAB apply
-most difference r/t systemic effects of Locals
Physiology: T5 Epidural
Cardiovasc changes
-same as SAB as long as Locals serum levels are low
-toxic levels-> myocard dep
-use of EPI: lowers BP,SVR, Inc SV & CO
Physiology: T5 Epidural
Pulmonary effects
-Sim to SAB
-harder to obtain resp paralysis (wider band of zones of differential blk(
Physiology: T5 Epidural
Other Physilogic effects
-poss cardioproctective effects
-improve global cardiac funct
-reduce thromoembolic comp
-reduce bld loss
-thoracic epi more favorable that lumbar
Physiology: Epidurals
-slower onset
-easier to manage
-solid motor blk difficult
-fewer resp complaints