Combined Spinal & Epidural

Question 1

Bupivacaine Dose

Answer 1

Epidural: 0.0625 - 0.125%
Spinal: 1.25 - 2.5 mL

Question 2

Ropivacaine Dose

Answer 2

Epidural: 0.08 - 0.2%
Spinal: 2.5 - 4.5 mL

Question 3

Lidocaine w/ epi Dose

Answer 3

Epidural: 2% in 5 mL bolus

Question 4

Fentanyl Dose

Answer 4

Epidural: 50 - 100 mcg
Spinal: 10 -25 mcg

Question 5

Sufentanil Dose

Answer 5

Epidural: 5 - 10 mcg
Spinal: 1.5 - 5 mcg

Question 6

Morphine Dose

Answer 6

Spinal: 0.1 - 0.2 mg

Question 7

LAST Treatment

Answer 7

Intralipid 20% IV
Bolus: 1.5 mL/kg over 1 min
Drip rate: 0.25 mL/kg/min (inc to 0.5 if BP declines)

Max total dose 8 mL/kg

Question 8

Hypobaric

Answer 8

Mixed w/ Sterile Water

Floats up

Question 9

Isobaric

Answer 9

Mixed w/ NS

Stays where injected

Question 10

Hyperbaric

Answer 10

Mixed w/ Dextrose

Sinks

Question 11

Progression of Blockade

Answer 11

B: sympathetic
C + A (delta): Pain & Touch
A (gamma): Motor tone
A (beta): Touch and Pressure
A (alpha): Motor Function & Proprioception

Top (first) to Bottom: Onset of Block
Bottom (first) to Top: Recovery of Block

Question 12

Highest Point/Apex of Spine

Answer 12

C3 & L3

Question 13

Lowest Point/Trough of Spine

Answer 13

T6 & S2

Question 14

Important Dermatome Levels

Answer 14

T4 - Nipple
T6 - Xiphoid
T10 - Umbilicus
C6 - Thumb
C7 - middle finger
C8 - Pinky & ring finger

Question 15

Loss of Resistance

Answer 15

Average: 4 -6 cm

Thin: 3 cm
Obese: 8 cm

Question 16

S/S of LAST

Answer 16

Analgesia
Lightheadedness
Tinnitis
Tongue/ circumoral numbness/ tingling/ funny taste
Seizure
Unconsciousness
Respiratory arrest
CV arrest