Valley Regional

Front 1

High points =

Back 1

C3 and L3

Front 2

Low points =

Back 2

T6 and S2

Front 3

Spinal cord
o Extends from _______ to _______

Back 3

to lumbar level one (L1) in the
adult and ranges from 42-45 cm, and to lumbar level three
(L:) in the newborn.

Front 4

Spinal cord

o Cord terminates

Back 4

o Cord terminates at conus medullaris and the filum terminale
extends down and anchors in the lower sacral region.

Front 5

__________ pairs of spinal nerves.

Back 5

Thirty one

Front 6

Cauda equina (horses tail) is

Back 6

is the nerve group in lower dural sac (L1 to S5).

Front 7

Supraspinous ligament
3 points

Back 7

o Strong fibrous cord.
O Sacrum to C7.
o Thickest and broadest in lumbar region.

Front 8

Interspinous ligament

3 points

Back 8

o Thin membranous ligament.
o Thickest and broadest in lumbar region.
o Full length of column.

Front 9

Ligamentum Flavum (yellow ligament)
lacation

Back 9

Short segments between spinous processes.

FYI Ligamentum Flq.vum
o Widest at level L2(5-6 rnm).
o Narrowest at level C5 (1.0 - 1.5 mm).

Front 10

Epidural space Extends from

Back 10

from foramen magnum to sacral hiatus.

Front 11

cerebrospinal fluid is contained between

Back 11

the pia and the arachnoid maters in the subarachnoid space; the mater and CSF protect the spinal cord from traumatic shock injuries and are the medium for drugs during spinal anesthesia.

Front 12

the epidural space is a potential space
that is bound by

Back 12

the dura and the ligamentum
flavum.

Front 13

blood supply to the spinal cord and nerve roots is derived from

Back 13

from a single
anterior spinal artery and paired posterior
spinal arteries.

Front 14

The principle site of action for neuraxial
blockade is the

Back 14

the nerve root.

Front 15

determines the duration of spinal anesthesia.

Back 15

Rate of elimination

Front 16

Bainbridge reflex

Back 16

If the sympathetic
outflow from Tl to T4 is blocked by local anesthetic, unopposed vagal stimulation will produce
bradycardia-this is called the Bainbridge reflex

Front 17

Bradycardia is
associated with 2X

why?

Back 17

blockade of cardioaccelerator fibers, but also with decreased venous return

"With a decrease in venous return and a corresponding reduction in right atrial filling, the frequency
of action potentials from stretch receptors to the right atrium and great veins is diminished, which
leads to a reflex decrease in heart rate."

Front 18

Volume for initial treatment of hypotension is

why?

Back 18

is from balanced salt solutions that do not contain glucose.
Administer volume in increments of 5 ml/kg. 'Why no glucose in the IV solution? Glucose can act as a
diuretic and worsen the situation (hypotension).

Front 19

In patients where symptomatic bradycardia is present the drug of choice is

Back 19

is a mixed alpha and beta agonist.
Ephedrine will increase heart rate and increase peripheral vascular resistance

Front 20

As the level of the block moves cephalad, the abdominal muscles, followed by the intercostal muscles,
become paralyzed. If the block is at ___________, phrenic nerve paralysis and loss of accessory muscles of ventilation increase the potential for hypoxia.

Back 20

C2-C3

Front 21

Apnea, if it occurs, is due to

Back 21

hypoperfusion of the respiratory centers in the medulla secondary to
severe hypotension.

Front 22

advantage of spinal over epidural anesthesia is

2X

Back 22

the ability to control the spread of the anesthetic by
controlling the specific gravity of the solution and the position of the patient.

Front 23

Patients receiving NSAIDs, includir-rg aspirin, may receive neuraxial anesthesia WHEN?

Back 23

regardless of when they
received the last dose. Herbal therapy alone does not seem to be a particular concern.

Front 24

Patients receiving intravenous hcparin therapy before surgery sl-rould not receive neuraxial anesthesia
until

Back 24

until a normal aPTT can be documented.