Neuraxial Complications

Front 1

Order that functions go after LA injection

Back 1

Autonomic
Temperature
Pain
Touch
Pressure
Motor
Vibration
Propriception

Front 2

Landmarks for sacral block

Back 2

PSIS, sacral hiatus

Front 3

HEELP syndrome

Back 3

hemolysis elevated liver enzymes, low platelets

Front 4

Is it better to do a spinal or epidural for a pt with MS?

Back 4

epidural...less concentration of LA in white matter of spinal cord

Front 5

why is doing neuraxial anesthesia a problem in pts with MS?

Back 5

LA toxicity more likely in demylenated neurons

Front 6

Brain tumors, masses, lesions...why could they complicate neuraxial anesthesia?

Back 6

they can increase ICP, and neuraxial anesthesia may cause brain herniation

Front 7

Hydrocephalus: what should you do before doing a spinal/epidural? (2 things)

Back 7

get radiologic exam to make sure shunt is working
give abx bc increased risk of shunt infection

Front 8

hydrocephalus shunt failure vs PDPH

Back 8

shunt failure causes global neurological problems

Front 9

half life of plavix, heparin

Back 9

plavix: 7-36 days
heparin: 3-6 hours

Front 10

how does warfarin work?

Back 10

blocks vit K dependent clotting factors- leads to inability of clotting factors to bind vit K, so decreased formation of thrombin

Front 11

how long before a procedure should you d/c warfarin? heparin? TPa?

Back 11

warfarin 5 days
heparin 6-12 hours (or at least 4)
TPa wait 10 days and check labs

Front 12

how does TPa work?

Back 12

degrades fibrin into FSP

Front 13

What is the cutoff level for platelet count and neuraxial anesthesia?

Back 13

must be >70

Front 14

What should you do different for a pt with Von Willebrand's dx? What is this dx?

Back 14

Have blood products in the room before you do a spinal/epidural. It is a platelet impairment characterized by epistaxis, mucoutaneous bleeding, easy bruising.

Front 15

Hemophilia A and B- which factors are deficient?

Back 15

A- VIII
B-IX

Front 16

What means you might have lasting radiculopathies?

Back 16

If you have sustained, persistant paresthesias during injection.

Front 17

If the pt has aortic stenosis, what should you do when doing a spinal?

Back 17

avoid tachycardia, avoid decreasing preload, slowly titrate LA's

Front 18

What drug is good to use to increase BP in a pt with AS getting a spinal?

Back 18

neo (want to restore SVR)

Front 19

incidence of persistant neurological complications from neuraxial anesthesia

Back 19

.01-.03%

Front 20

backache is more common with spinals or epidurals?

Back 20

epidurals

Front 21

why does bradycardia happen following neuraxial anesthesia?

Back 21

normal compensatory mechanism- arterial and venous baroreceptors

Front 22

risk factors for bradycardia after spinal/epidural

Back 22

baseline bradycardia, male, >37 y/o, non-emergency, long case

Front 23

what can you give if your spinal/epidural pt becomes bradycardic?

Back 23

atropine .4mg

Front 24

Risk factors of getting hearing loss after neuraxial anesthesia

Back 24

spinal, larger needle, younger age

Front 25

incidence of hearing loss after neuraxial anesthesia

Back 25

.4-40%, but <25% is clinically noticable

Front 26

How long does hearing loss after neuraxial anesthesia usually last, and what is one treatment for it?

Back 26

less than 1 week, blood patch

Front 27

S/S of horner syndrome (4)

Back 27

ptosis, miosis, anhydrosis, enophtalmos

Front 28

How does Horner syndrome occur? Which vertebral levels are involved?

Back 28

usually from thoracic epidurals, or high spinal/epidural- T3-T5

Front 29

what is Horner syndrome caused by

Back 29

blockage of preganglionic sympathetic fibers

Front 30

Incidence of Horner syndrome

Back 30

1-4% of epidurals

Front 31

2 main mechanisms for hypotension

Back 31

decreased SVR (from vasodilation)
decreased venous return and decreased CO

Front 32

Risk factors for n/v

Back 32

female, non-smoker, anxiety, pain, hx of PONV or motion sickness, gastric distension, hypoglycemia, hypotension, hypovolemia

Front 33

what is droperidol? dose?

Back 33

anti-dopamine antiemetic. 0.625mg

Front 34

S/S of pneumocephalus

Back 34

generalized HA immediatly following injection or after changing to upright position, n/v, change in LOC

Front 35

incidence and onset of PDPH

Back 35

3%, occurs 12-72 hours after injection

Front 36

is puritis more common with spinals or epidurals?

Back 36

spinals

Front 37

incidence and onset of shivering

Back 37

20-60%, onset less than 1 min

Front 38

treatment for shivering

Back 38

meperidine, clonidine, doxapram, alfentanil

Front 39

risk factors for urinary retention after neuraxial anesthesia

Back 39

male, old age, long surgery, overdistension of bladder, increased SNS stimulation (pain and anxiety)

Front 40

incidence of cardiac arrest after neuraxial anesthesia

Back 40

6:10,000

Front 41

what is anterior spinal artery syndrome?

Back 41

caused by hypotension, it is a thrombosis in the blood supply of the spinal cord. Causes loss of motor and pain/temperature sensation below the level of injury, but preservation of proprioception and vibration

Front 42

incidence of epidural and spinal hematomas

Back 42

epidural: 1:150,000
spinal: 1:220,000

Front 43

S/S of spinal cord compression from hematoma

Back 43

progressive motor/sensory blockade
back pain/pressure
bowel/bladder probs
radicular pain (along dermatome)

Front 44

S/S of subdural anesthesia

Back 44

high, patchy block, mild/moderate decrease in BP, dyspnea, Horner's sx, facial anesthesia

Front 45

Transient neurologic syndrome: s/s, duration

Back 45

pain in low back/butt with/without radiation to one or both legs
lasts 1 week, resolves spontaneously

Front 46

Arachnoiditis s/s

Back 46

thickening and fibrosis of arachnoid membrane
back pain, leg pain
poor outcome

Front 47

Transverse Myelitis s/s

Back 47

pain, motor weakness, bowel/bladder probs, allodynia