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Apex Review > Neuraxial blocks section 2 > Flashcards

Neuraxial blocks section 2 Flashcards

1
Q

Transection of the C6 posterior nerve root will cause:
A. diaphragmatic paralysis
B. impaired sympathetic outflow to the C6 distribution
C. Sensory block of the thumb
D. Motor deficit of the middle finger

A

C. sensory block of the thumb

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2
Q

Posterior nerve roots are

A

sensory

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3
Q

Anterior nerve roots are

A

motor and autonomic

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4
Q

_______ is an area of skin that’s innervated by a dorsal nerve root (sensory) from the spinal cord

A

A dermatome

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5
Q

Key dermatome: C6

A

thumb

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6
Q

Key dermatome: C7

A

2nd and 3rd digits

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7
Q

Key dermatome: C8

A

4th and 5th digits

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8
Q

Key dermatomes: T4

A

nipple line

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9
Q

Key dermatomes: T6

A

Xiphoid process

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10
Q

Key dermatomes: T10

A

umbilicus

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11
Q

Key dermatomes: L4

A

anterior knee

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12
Q

The spinal cord has ____ paired spinal nerves

A

31

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13
Q

A sensory level of T4 is needed for the following surgical procedures:

A

upper abdominal surgery
C-section
cystectomy

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14
Q

A sensory level of T6-T7 is needed for the following surgical procedures:

A

lower abdominal surgery
appendectomy

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15
Q

A sensory level of T10 is needed for the following surgical procedures:

A

Total hip arthroplasty, vaginal delivery, TURP

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16
Q

A sensory level of L1-L3 (inguinal ligament) is needed for the following surgical procedures:

A

lower extremity surgery

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17
Q

A sensory level of L2-L3 is needed for the following surgical procedures:

A

foot surgery

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18
Q

A sensory level of S2-S5 is needed for the following surgical procedures:

A

hemorrhoidectomy

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19
Q

Describe the dosing guidelines for a epidural catheter placed at T2-T6 (upper thoracic).

A

5-10 mL local anesthetic

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20
Q

Describe the dosing guidelines for an epidural catheter placed at T6-L1 (lower thoracic)

A

10-20 mL

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21
Q

Describe the dosing guidelines for an epidural catheter placed at L2-L5

A

20 mL local

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22
Q

Key benefits of a well-executed thoracic epidural technique (compared to a lumbar epidural) include:

A

superior analgesia
minimizes the surgical stress response
reduces the incidence of postoperative pulmonary complications
can spare the nerves that innervate the legs, which will allow for postoperative ambulation

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23
Q

When a thoracic epidural is combined with GA, cardiopulmonary considerations include a higher risk of:

A

bradycardia (blockade of cardioaccelerator nerves T1-T4)
Hypotension (decreased cardiac output & vasodilation)
changes in airway resistance (increased vagal influence on airways)

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24
Q

In the subarachnoid space, the primary site of local anesthetic action is on the

A

myelinated preganglionic fibers of the spinal nerve roots

25
Q

Describe the order in which fibers are blocked.

A

Autonomic, then sensory, then motor neurons last

26
Q

Autonomic blockade is __________ than sensory blockade, and sensory blockade is _______ than motor blockade

A

2-6 dermatomes higher than sensory and sensory is 2 dermatomes higher than motor blockade

27
Q

Controllable factors that meaningfully affect spread of local anesthetic include

A

the dose and baricity of the local anesthetic, site of injection, and patient position

28
Q

Factors that don’t meaningfully affect the spread include

A

barbotage, speed of injection, bevel orientation, body habitus, and gender

29
Q

Local anesthetics in the epidural space must first diffuse through _________ before they can block the nerve roots

A

dural cuff

30
Q

The primary determinants of spread for epidural anesthesia are

A

volume and level of injection

31
Q

Describe the autonomic, sensory, and motor block with epidural anesthesia

A

Sensory blockade is 2-4 dermatomes higher than the motor block; there’s no autonomic differential blockade with epidural anesthesia

32
Q

__________ is the most reliable determinant of intrathecal spread when using a hypo- or isobaric solution

A

Dose

33
Q

______ is the most reliable determinant of intrathecal spread when using a hyperbaric solution

A

Baricity

34
Q

Describe how the level of injection affects spread in the epidural space of the lumbar region

A

spread is mostly cephalad

35
Q

Describe how the level of injection affects spread in the epidural space of the midthoracic region

A

spread is equally cephalad and caudad

36
Q

Describe how the level of injection affects spread in the epidural space of the cervical region

A

spread is mostly caudad

37
Q

Describe the order in which we can test a differential blockade

A

first- sense of temperature
second- pain
third- sense of light touch or pressure

38
Q

The _______ can be used to assess the degree of motor block

A

Modified Bromage Scale

39
Q

The Modified Bromage Scale can only evaluate the

A

lumbosacral nerves (nothing more cephalad)

40
Q

Describe the degrees (0-3) of the Modified Bromage Scale

A

0= no motor block
1= patient cannot raise an extended leg but can move the knees and feet
2= patient cannot raise an extended leg or move the knee but can move the feet
3= complete motor block

41
Q

Describe the block onset for peripheral nerves

A

B- first
C- second
A gamma & delta- third
A alpha & beta- fourth

42
Q

What is the MOST appropriate spinal dose of 3% 2-chloroprocaine to achieve for a T10 level?
a. 5 mg
b. 20 mg
c. 30 mg
d. 50 mg

A

c. 30 mg
the dose range needed to achieve a T10 level is 30-40 mg

43
Q

When dosing a spinal anesthetic, the most important controllable factors affecting block height include

A

dose, baricity, and patient postion

44
Q

When dosing an epidural anesthetic, the primary drug-related determinant of block height is

A

LA volume

45
Q

When dosing an epidural anesthetic, the primary procedure-related determinant of block height is

A

the level of injection

46
Q

When dosing an epidural anesthetic, the primary determinant of block density is

A

local anesthetic concentration

47
Q

Describe the necessary dosing for spinal anesthesia using Bupivacaine 0.5-0.75% for a T10 and T4 level to be achieved

A

T10: 10-15 mg
T4: 12-20 mg

48
Q

Describe the onset of action of spinal anesthesia for bupivacaine 0.5-0.75%

A

4-8 min

49
Q

Describe the dosing for a T10 & T4 level of levobupivacaine 0.5% for spinal anesthesia

A

T10- 10-15 mg
T4- 12-20 mg

50
Q

Describe the onset of action for spinal anesthesia of levobupivacaine 0.5%

A

4-8 min.

51
Q

Describe the duration of action of bupivacaine 0.5-0.75%

A

130-220 min.

52
Q

Describe the dosing needed to achieve spinal anesthesia of T10 & T4 using ropivacaine 0.5-1%

A

T10- 12 -18 mg
T4- 18-25 mg

53
Q

Describe the onset of action of ropivacaine 0.5-1%

A

3-8 min

54
Q

Describe the duration of action of 0.5-1% ropivacaine

A

80-210 min.

55
Q

Describe the needed dosing for T10 & T4 spinal anesthesia using 2-chloroprocaine 3%

A

T10- 30-40 mg
T4- 40-60 mg

56
Q

Describe the onset of action of 2-chloroprocaine 3%.

A

2-4 min.

57
Q

Describe the duration of action of 2-chloroprocaine 3%.

A

40-90 min.

58
Q

Describe the dosing of 0.5-1% tetracaine for T10 and T4 spinal anesthesia

A

T10- 6-10 mg
T4- 12- 16 mg

59
Q

Describe the onset of action for tetracaine 0.5-1%

A

3-5 minutes

Apex Review (224 decks)

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