30. Spinal Anesthesia Flashcards
(105 cards)
1
Q
cervical vertebrae
A
7
2
Q
thoracic
A
12
3
Q
lumbar
A
5
4
Q
sacrum
A
5
5
Q
coccyx
A
4
6
Q
spinal tissue encounter order
A
skin
supraspinous
interspinal
ligamentum flavum
dura matter
subarachnoid space
7
Q
adult spinal cord end
A
L1-2
8
Q
peds spinal cord end
A
L2-3
9
Q
what does the dural sheath innervate
A
bladder
GU
10
Q
conus medullaris
A
end of spinal cord
11
Q
cauda equina
A
nerve fibers extending caudally from spinal cord
12
Q
filum terminale
A
fibrous tissue that connects conus medullaris to periosteum of coccyx
13
Q
faster blockade
A
smaller
myelinated
proximity to injection
14
Q
easiest to hardest to block
A
autonomic>sensory>motor
15
Q
spinal can be the primary anesthetic for which cases
A
lower abdominal
inguinal
urogenital
rectal
lower extremity
16
Q
spinal: absolute CI
A
infection
lack of consent
coagulopathy
severe hypovolemia
incr ICP
aortic/mitral stenosis
sepsis
17
Q
warfarin: neuraxial
A
normal PT/INR
or
discontinue for 1 wk
18
Q
rivaroxaban: neuraxial
A
discontinue 72 hrs prior
19
Q
apixaban: neuraxial
A
discontinue 72 hrs prior
20
Q
NSAIDS: neuraxial
A
no need to delay
21
Q
clopidogrel: neuraxial
A
discontinue 5-7 days prior
22
Q
clopidogrel AKA
A
plavix
23
Q
anticoags
A
warfarin
rivaroxaban
apixaban
24
Q
anticoags
A
NSAIDS
clopidogrel
25
low-dose SC heparin: neuraxial
delay 4-6 hrs after 5000 units
26
systemic heparin: neuraxial
delay 4-6 hrs and correct PTT
wait 1 hr after neuraxial event to admin
27
low dose LMWH: neuraxial
delay 12 hrs from admin
28
high dose LMWH: neuraxial
delay 24 hrs from admin
29
when would lateral positioning for a spinal be beneficial?
hip fractures
30
spinal kit
spinal needle
3mL syringe w/18ga needle
5mL syringe
18g introducer
25g skin local needle
filter tube or needle
0.75% hyperbaric bupivacaine
lidocaine
needle holder
sterile drape
sterila paper towel
iodine w/sponges
gauze
***epi
31
cutting needle
better for calcified ligaments
32
pencil point
better tactility
less incidence of PDPH
33
standard spinal needle size
25g 3.5"
34
a longer needle means
longer time for CSF to return
35
tuffiers line
body of L4
sometimes L4-L5 interspace
36
what should you mark on spinal pt
superior aspect of inferior spinous process
inferior aspect of superior spinous process
37
what do you use to localize in spinal
25g needle
3mL syringe
1% lidocaine
38
where should you insert needle for spinal
inferior aspect of the interspaceq
39
os
bone
40
os shallow
midline but need to redirect cephalad
41
os deep
off midline
42
heme
blood
43
what happens when you pass through the dura
pop
44
barbotage
CSF swirl when you aspirate CSF into local
45
barbotage only occurs with
hyperbaric medication
46
what can happen if you inject air into spinal
pnemocephalis
47
paramedian spinal indications
severe arthritis
kyphoscoliosis
previous spinal surgery
thoracic epidural placement
48
how do you insert needle for paramedian spinal
15 degrees to midline
49
most dependent part of spine
T4
50
most non-dependent part of spine
L2-L4
51
does the spine have dependent parts when pt is laying in lateral decubitus?
no
52
which block is preferrential for sacral nerves
saddle block
53
what type of solution is used for saddle block
hyperbaric
54
what influences spread of local anesthetic
baricity
pt position
orifice orientation
medication temp
faster injection
pt height
CSF volume
55
higher medication temp
more spread
56
faster injection
more spread
57
taller patient
less spread
58
decr CSF volume
more spread
59
what causes decreased CSF volume?
gravid uterus
ascites
tumor
engorged epidural veins
kyphosis/lordosis
advanced age (**intrinsic)
60
how long after injection of spinal does spread stop?
20-25 mins
61
sympathetic blockade travels the most
cephalad
62
sensory blockade is
2 levels caudal to sympathetic level
63
motor blockade is
2 levels caudal to sensory level
64
sympathetic blockade is tested by
temperature
65
sensory blockade is tested by
pain
light touch
66
T4
nipples
67
T10
umbilicus
68
typical surgeries that require spinal
C section
lower limb
TURP
69
surgery:
esophagus
lung
upper abdomen
block up to T1
70
C section
block up to T4
71
lower abdominal surgery
block up to T6
72
lower limb surgery
block up to L1-2
73
cardiac accelerator fibers
T1-T4
74
lumbar spinal will result in sympa or parasympa flow
uninhibited parasympathetic flow
75
spinal SE: CV
hypotension
- N/V
- dizzy
- dyspnea
variable HR
76
spinal CV: treatment
fluids
direct alpha antagonist
beta-antagonist
77
what pts dont tolerate fluid well
poor pulmonary status
ESRD
CHF
78
spinal SE: respiratory
decr coughing
79
minimize respiratory complications from spinal
proper positioning
supportive airway measures
80
what should you check if pt says they cant breathe?
SpO2 - 100%
hand squeeze
alert/oriented
81
spinal GI SE
peristaltic/contracted gut
decr hepatic BF
82
spinal GU SE
renal BF mx'd
urinary retention
83
spinal endocrine SE
neuroendocrine stress response
84
what causes neuroendocrine stress response
somatic and visceral afferents
85
what happens during neuroendocrine stress response
release of ACTH, corisol, epi, NE
activates RAAS
86
spinal complications
high neural block
cardiac arrest
urinary retention
meningitis/arachnoiditis
TNS
neurologic injury
pruritis
shivering
87
high spinal symptoms
unconsciousness
apnea
hypotension
88
total spinal
high spinal
cranial nerve blockade
seizures
89
treatment
supportive measures
ABC
90
typical pts who go into cardiac arrest during spinal
young
healthy
91
cardiac arrest spinal presentation
bradycardia
bradyarrythmias
hypotension
92
spinal cardiac arrest treatment
HR correction
BP correction
-- fix preload/afterload
93
what causes urinary retention
afferent muscle block of sacral nerves inhibits bladder constriction
94
what makes urinary retention worse
narcotics
95
what treats urinary retention post-spinal
time
bethanechol (muscarinic)
prazosin (a1 blocker)
catheter
96
what pts are at a higher risk of meningitis/arachnoiditis
epidural or spinal catheters
97
TNS aka
transient radicular irritation
98
TNS symptoms
back pain radiating to legs w/o sensory or motor deificit
99
primary cause of TNS
hyperbaric lidocaine spinal
100
what % of pts get pruirius with a spinal
>30% of pts who get neuraxial opioids
101
treatment for pruritius
naloxone
naltrexone
ondansatron
diphenhydramine
102
what % of pts get shivering?
55%
103
is shivering more prevalent in spinals or epidurals?
epidurals due to larger volume of injectate
104
what reduces shivering
neuraxial opioids
active warming
105
Spinal benefits compared to general
decr resp complications
decr cardiac complications
less PONV
earlier ambulation
decr DVT
lower infection
better analgesia
faster GI function recovery
cheaper
