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16 Cards in this Set
- Front
- Back
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AKA neuraxial anesthesia
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*spinal
*epidural *caudal blocks |
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how can neuraxial anesthesia be performed
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as single injection or with catheter to allow intermittent boluses or continuous infusion
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how is potential needle trauma to cord avoided during spinal
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performing lumbar puncture below L1 in adults and L3 in child
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what is the principle site of action for neuraxial blockade
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nerve root
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what does differential blockade result in
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sympathetic blockade (by using temp sensitvity) that may be 2 segments igher than the sensory block (pain, light touch) which is in turn is usually 2 segments higher than motor blockade
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what can produce smpathetic and some parasympathetic blockade
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interruption of efferent autonomic transmission at the spinal nerve roots
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what is typical side effect produced by neuraxial blockade
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variable decreases in BP
may be accompanied by decrease HR and cardiac cotractility |
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what should always be anticipated with neuraxial blockade and what steps should be taken
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deleterious cardio effects
take steps to minimize degree of hypotension by volume loading with 10-20mL/kg of IVF for healthy pt to compensate for venous pooling |
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how should bradycardia and hypotension be treat
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brady: atropine
hypotension:vasopressors |
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what are the major contraindications to neuraxial anesthesia
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*pt. refusal
*bleeding diathesis *severe hypovolemia *elevated ICP *infection at site of injection *sever stenotic valvular disease *ventricular outflow obstruction |
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what is clinical sign that epidural space has been reached
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loss of resistance as needle penetrates ligaummentuatum flavum and enter epidural space
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what is clinical sign that spinal needle is in right place
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penetration of dura-subarachnoid membranes as signaled by free flowing cerebrospinal fluid
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advantages of epidural
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wider range of applications
can be performed at lumbar, thoracic or cervical level |
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differences between epidural and SAB
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*epidural is slower onset (10-20 min) and may not be as dense as SAB
*volume and concentration of local needed for epidural is very large compared with spinal *significant toxicity can occur if lg amt injected intrathecally or intravascualrly |
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what precautions are taken to avoid complications of epidural
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test dose
incremental dosing |
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what is the most commonly used regional technique in peds cases
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caudal epidural anesthesia
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