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79 Cards in this Set
- Front
- Back
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What are the types of neuraxial blocks?
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spinal; epidural; caudal.
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What is the neuraxis?
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It is an imaginary line drawn through the spinal cord through the front of the brain.
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What does rostral mean in reference to neuraxial planes?
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towards the beak or towards the nose (rostral spread- pretty much means up towards the head or towards the front of the face (modern term is cephalic or high spinal).
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What is the vertebral body facing towards?
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the belly/abdomen.
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What is the spinous process facing towards?
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the back.
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The size of the area between the bone on the spine is dependent on what?
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the location of where you are at on the spine.
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Where does the spinal cord begin and end in the adult patient?
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Begins at the foramen magnum and ends at L1.
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Where does the spinal cord begin and end in newborns?
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begins at foramen magnum and ends at L3.
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What is the most prominent vertebrae?
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C7
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What is the first vertebrae that you can feel and count?
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C2.
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If you draw a line under that bottom of the scapula; what vertebrae would you be at?
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T7.
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What is tuffier’s line?
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a line drawn across the top of iliac crest.
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What is important to know about the cauda equine?
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It is at the end of the spinal cord; called horses tail of nerve that free float in fluid.
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What is the spinal cord innervated by?
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Innervated by 31 pair of spinal nerves that carry both motor and sensory information.
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How many cervical nerves are there?
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8 cervical nerves.
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How many thoracic nerves are there?
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12 throacic nerves.
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How many lumbar nerves are there?
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5 lumbar nerves.
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How many sacral nerves are there?
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5 sacral nerves.
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How many coccygeal nerves are there?
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1 coccygeal nerve.
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What is the spinal canal?
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Spinal canal is the space in the vertebra where the spinal cord lives and passes through & runs from the foramen magnum to the sacral hiatus.
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What is the role of the gray matter in the spinal cord?
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Gray matter is composed of neuronal cells and unmyelinated fibers. It contains a large number of connecting or interneurons.
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What is the role of the white matter in the spinal cord?
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contains the ascending & descending tracts (Dorsal tract is sensory; Lateral and ventral tract are motor tracts).
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What are the 3 ligaments of the spinal cord?
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supraspinous ligament, intraspinous ligament, & ligamentum flavum.
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What is important to know about epidural veins?
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Runs along the sides; in most ppl its not a big deal but they don’t have valves so they are very reactive to increased intra-thoracic and intra-abdominal pressure so they then get distended and engorged (makes them easier to hit with needle entry).
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What are the 3 layers around the spinal cord?
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from inside out; pia mater, arachnoid mater, dura mater.
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What does the dorsal root do?
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Dorsal Root; carries all afferent signals TO the spinal cord & brain (sensory).
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What does the ventral root do?
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Ventral Root; carries all efferent signals AWAY from the spinal cord & brain to the periphery.
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What is the primary site of action where the local anesthetic will work for spinal and epidural?
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The nerve root.
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Where can a generated stimulus travel?
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It can go to the brain or it can be a reflex and travel back out to the periphery.
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Where are mantle bundles located in the nerve trunk?
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Mantle- the outside or periphery of the nerve.
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Where are core bundles located in the nerve trunk?
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core- the center portion of the nerve.
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What order are nerves blocked with anesthesia?
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SNS/PNS; sensory; motor.
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Which blockade is usually blocked higher?
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sympathetic nervous system blockade; it is usually 2-6 dermatomes higher then sensory & motor is usually 2 dermatomes below sensory.
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Where do cardiac accelerator fibers originate?
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originate at T1-T4.
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What will happen if you block T4 & how do you treat it?
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you may lose the effect of the cardiac accelerator fibers and have bradycardia; treat with atropine (severe –epinephrine).
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When you do a spinal; what is the first thing to get numb?
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The toes (onset moves upward); wearing off moves downward (the last sensation to return is the toes).
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What dermatomes/nerves keep the diaphragm alive?
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C3, 4, 5 keep the diaphragm alive.
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What is a good test to perform to make sure you have not blocked the diaphragm?
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Ask the patient to move their thumbs (C6); if they can then the diaphragm is not blocked.
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The nipple line is a reference point for what?
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reference for T4; want a c section patient numb to there.
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The umbilicus is a reference point for what?
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Reference for T10.
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What are the 3 approaches to spinal anesthesia?
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Midline, paramedian (lateral), lumbosacral (taylor –uncommon).
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The imaginary line drawn across the top of the iliac crest corresponds to what?
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the level L4.
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What anatomic landmarks must be identified prior to performing midline technique procedure?
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the spinous processes and the iliac crest.
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Position is key to spinal insertion; what should you have the patient do?
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sit on the bed with legs dangled & round out their back & push back out towards you.
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What is the importance of rounding out the back?
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rounding out the back opens up the entry space.
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What patient population is least likely to get a post puncture spinal headache?
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elderly men bc thick fibrous ligaments.
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Are insertion lengths the same for all needles & why?
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No, bc they all have opens in different positions on the needle.
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What should you have the patient do after you finish placing the spinal?
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have them lay down bc local anesthetic is heavier then CSF.
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What is the difference b/w the midline and the lateral spinal approaches?
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The difference between the Lateral and the Midline is in its insertion site of the needle and the angle of approach.
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How long does it take for an epidural to take effect?
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15-20 minutes.
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What are the different epidural locations?
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cervical, thoracic, lumbar, caudal.
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What should you know about the anatomy of the epidural space?
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It Extends from the foramen magnum to the sacral hiatus & It Is segmented and discontinuous (not uniform).
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What should you do if a patient develops an epidural hematoma?
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Consult a neurosurgeon; this is caused by trauma to the epidural artery!!.
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What is different about epidural fat from other fat?
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It is very vascular and has a venous plexus.
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What are the layers you go through for an epidural?
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Skin; SubQ; Supraspinous ligament; Intraspinous ligament; Ligamentum Flavum; Epidural Space.
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Relatively LARGE volumes of local anesthetic are needed to achieve a block that spans several dermatomes for epidurals; why is that?
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Because epidurals are largely dependent on diffusion.
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Which type of spinal anesthesia is volume dependent?
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an epidural.
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What are the 2 types of epidural techniques used?
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Air and saline.
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How do you identify the epidural space?
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By a loss of resistance with the air and saline in a syringe (its negative pressure).
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What is a result of large amounts of air being pushed in with the air technique?
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HUGE headache.
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How can you create a walking epidural?
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Put narcotics in the epidural and no local anesthetic until ready to lay down and not move.
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If one side is numb and not the other; what should you do to try and fix it?
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You can lay them on the side that is not numb and/or redoes them and lay them on the side that’s not numb yet.
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What landmarks are important to thoracic epidurals?
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C2, C7, T7.
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What is a benefit of the combined spinal epidural technique?
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The patient can get immediate and continuing pain relief.
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What is a disadvantage of the combined spinal epidural technique?
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Once you have dosed the patient for a SAB; you can’t give a test dose for the epidural to check position bc they are already numb.
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What is an indication for a caudal block?
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a surgery below the umbilicus.
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What patient population do you use a caudal block in more often?
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children.
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What type of block is the caudal?
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It is still an epidural bc it goes into the epidural space; so its dependent on diffusion.
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Where is the point of entry for the caudal block?
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the caudal epidural space accessed through the sacral hiatus.
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What should you do if you ever get blood on any type of block?
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Withdraw the needle and start all over.
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What are the different types of baricity?
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Hyperbaric Solutions; Hypobaric Solutions; Isobaric Solutions.
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All solutions are compared to what to determine their baricity?
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All solutions are compared to CSF & CSF has a baricity (specific gravity) of 1.003-1.008 at normal body temperature.
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What is a hyperbaric solution?
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LA mixed with dextrose 7 has a higher baricity than CSF so it sinks & can cause a saddle block if left sitting up.
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What is hypobaric solution?
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Prepared by adding 6 to 8cc of sterile water to the LA & The LA “Floats up” since it is now lighter than the CSF.
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What is a isobaric solution?
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With isobaric mix CSF with LA (Useful if you do not want the block to rise above the level of the hips); the CSF and solution have the same baricity.
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Which baricity solution is most commonly used?
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Hyperbaric solutions.
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Which baricity solution an more easily create a high spinal?
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Hypobaric solutions.
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Why should you use preservative free local anesthetics?
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preservatives around spinal nerve roots can be toxic to them.
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Which way should the needles bevel be facing?
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The bevel should be anterior? is this for all insertions???
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