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68 Cards in this Set
- Front
- Back
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What types of blocks are known as neuroaxial anesthesia?
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Spinal, Epidural, and Caudal
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What location for an LP usually avoids potential needle trauma to the cord?
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L1-L2 interspace in adults, L2-L3 interspace in peds, L4-L5 interspace in infants
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What is the principle site of action for neuraxial blockade?
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The nerve root.
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How is sympathetic blockade assessed?
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Temp. sensitivity.
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How is sensory blockade assessed?
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Pain, Pressure, light touch
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What CV manifestations indicate a sympathectomy?
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Decreased HR & possible decreased contractility, Decrease BP
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What preoperative intervention can minimize the effect of venous pooling?
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Fluid loading of 10-20 ml/kg in the healthy patient
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How shoud symptomatic or excessive bradycardia be treated?
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Atropine
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How shoud hypotension be treated?
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Vasopressors
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What are the major contraindications to neuraxial anesthesia?
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Pt. refusal
Coagulopathy Severe hypovolemia Elevated ICP Infection @ injection site Severe stenotic valvular heart disease or ventricular outflow obstruction |
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Order of tissue penetration for midline approach?
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Skin
Fascia Supraspinous Interpinous Lig.Flavum "POP" Epidural Space-Epidurals here Dura Arachnoid space-Spinals here |
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Signal that you are in the Arachnoid space?
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Free flowing CSF
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What is differential blockade?
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Sympathetic blockade 2 segments higher than sensory block, and motor block 2 segments lower than sensory block
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How do spinals and epidurals differ in application?
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Epidurals can be performed at any level, and offer incremental dosing.
Spinals are typically all-or-nothing |
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What are the safeguards against toxicity with epidural blocks?
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Test dose to prevent intravascular injection and incremental dosing
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How does the volume and concentration of anesthetic differ between spinal and epidural anesthesia?
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Spinal anesthetics are more concentrated and of lower volume. The concentration is the key.
Epidural anesthetics are volume based and have greater volumes although the block may be less dense as compared with spinal anesthesia |
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What approach is most common in pediatric patients?
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Caudal epidural anesthesia is one of the most common techniques in pediatric patients
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What space does a midline aproach pass through?
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Oval space between the bony lamina and the spinous process of the adjacent vertebra
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Where do the dural sac, epidural and subarachnoid spaces end?
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S2 in adults and S3 in children
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Where are the curves located?
High points? Low Points? |
C5, T5, L4, S4
C5, L4 T5, S4 |
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C7 landmark
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Most prominent spinal process
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T7 landmark
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Inferior tip of scapula
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Tuffier's line
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L4
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S2 Landmark
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Posterior Superior Iliac Spine
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L1
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End of cord in adult
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What nerves compose the Lateral cord?
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C5,6,7
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What nerves compose the Posterior Cord?
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C5-8 & T1
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What nerves compose the Medial Cord?
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C7 & T1
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What nerves compose the musculocutaneous nerve?
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C5,6,7
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What nerves compose the axillary nerve?
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C5,6
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What nerves compose the radial nerve?
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C5-8 & T1
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What nerves compose the medial nerve?
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C6-8 & T1
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What nerves compose the ulnar nerve?
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C8 & T1
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What nerves compose the Superior trunk?
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C5,6
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What nerves compose the Medial trunk?
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C7
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What nerves compose the inferior trunk?
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C8 & T1
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What is the motor innervation of the musculocutaneous nerve?
Sensory? |
Biceps flex
Lat. forearm |
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What is the motor innervation of the axillary nerve?
Sensory? |
Deltoid
Lat. upper arm |
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What is the motor innervation of the radial nerve?
Sensory? |
Triceps extension, supinator/extensor of forearm
Post. arm & forearm, thumb/dorsal hand |
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What is the motor innervation of the medial nerve?
Sensory? |
Flexor/pronator muscles of forearm
Palmar surface of hand, index & middle fingers |
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What is the motor innervation of the ulnar nerve?
Sensory? |
Flexor carpi ulnaris (abduct fingers)
Little finger & medial ring finger |
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What nerves contribute to Lat. Femoral Cutaneous nerve?
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L2,3
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What nerves contribute to Femoral nerve?
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L2,3,4
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What nerves contribute to Obturator nerve?
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L2,3,4
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What nerves contribute to Sciatic nerve?
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L4,5 S1,2,3
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Motor Innervation of Lat. Femoral Cutaneous nerve?
Sensory? |
None. Sensory only on leteral thigh
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Motor Innervation of Femoral nerve?
Sensory? |
Quadriceps femoris
Ant. thigh and knee |
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Motor Innervation of obturator nerve?
Sensory? |
Adduction of leg
Post. medial thigh |
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Motor Innervation of sciatic nerve?
Sensory? |
Splits into peroneal and tibial nerves
Sensory is the posterior leg & foot |
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Motor Innervation of common peroneal nerve?
Sensory? |
Dorsiflex foot
Lateral calf |
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Motor Innervation of Tibial nerve?
Sensory? |
Plantar flex foot
Heel |
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Sensory innervation of superficial and deep peroneal nerves?
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Superficial: front of lower leg
Deep: Between great and 2nd toe |
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What wavelength of light does oxyhemoglobin absorb?
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940nm
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What wavelength of light does deoxyhemoglobin absorb?
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660nm
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What causes pulse ox to stay at 85% despite change in FiO2?
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Methhemoglobinemia
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Tx for methemoglobinemia?
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Methylene blue
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Cause of methhemoglobinemia?
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Benzocaine
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What causes false high sat?
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Carboxyhemoglobin
CO poisoning |
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What is the termination of the femoral nerve?
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Saphenous nerve
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What is the termination of the sciatic nerve?
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The superficial and deep peroneal nerves and the sural nerve
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At the post. politeal fossa, the sciatic nerve splits into what nerves?
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The peroneal and tibial nerves
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Which fibers carry pain impulses?
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A gamma and C dorsal root fibers
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Which fibers carry postganglionic sympathetic fibers?
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C sympathetic fibers
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Which fibers carry non-noxious stimul?
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A alpha, A beta
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Which fibers carry preganglionic autonomic fibers?
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B fibers
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Which fibers have the fastest conduction velocities?
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A fibers, then B, then C
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Which fibers are the largest?
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A alpha (motor) fibers
Largest take longest to block |
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Which fibers are the 1st to be blocked?
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C sympathetic fibers
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