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AP II Test 2 > Neuraxial Anesthesia > Flashcards

Neuraxial Anesthesia Flashcards

1
Q

History of the spinal

___64 - Cerebral spinal fluid was first
identified by Cotugno
18__ - Corning was the first documented
individual to inject into the intraspinous space
18__ - Quincke used spinal needles to
relieve elevated ICP in patients with
tubercular meningitis

A

1764

1885

1891

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2
Q

Cervical and thoracic spinals are less popular because:

A

accidentally injecting into the spinal cord, a syrinx can form that will grow and grow until it leads to death

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3
Q

Entire gut arises embryologically from what dermatome and indicates the entire abdomen is anesthetized?

A

T10

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4
Q

Where do you block during labor? There are 2 stages and two dermatome ranges.

A

1st stage: T8-T10 for uterus contraction

2nd stage: T10-L1, L3 during delivery

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5
Q

What dermatome innervates kidneys and uterus?

A

T10

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6
Q

What dermatomes innervate the vaginal introitis?

A

S2-S3

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7
Q

What dermatome innervates the anus?

A

S4

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8
Q

Sensory pathways can ascend as much as two levels higher. In other words, Uterine pain can be felt as high as T8. True or false?

A

True

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9
Q

Things that you can alter in an epidural: (5)

A

location of needle–center of LA action

infusion rate

drug

concentration

other adjuncts

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10
Q

A L5/S1 epidural requires a rate of ____
cc/hr to achieve a T10 block

A

14+

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11
Q

A T10 epidural requires a rate of ___ cc/hr to
provide adequate labor analgesia

A

4

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12
Q

The rate of infusion is equal to the _____ of your anesthetic.

A

Rate = Distribution
Rate = Distribution
Rate = Distribution

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13
Q

What are the signs of systemic toxicity? (3)

A

ringing in ears

funny taste in the mouth

numbness around the mouth

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14
Q

What LA has a fast onset?

A

chloroprocaine

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15
Q

What LA has intermediate onset?

A

lidocaine

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16
Q

What LA has a slow onset?

A

bupivicaine (4-6 minutes)

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17
Q

Nerves affected in what order?

A

Sympathetics first

sensory

motor

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18
Q

What is a downside to using chloroprocaine? (2)

A

tachyphlaxis

interferes with opioid effectiveness

Not recommended for surgergy > 1 hour

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19
Q

Procaine onset?

Duration?

A

3 minutes

30-40 minutes

20
Q

Lidocaine onset?

Duration?

Problems?

A

4-5 minutes

45-60 minutes

tachyphlaxis

21
Q

The lower the pKA, how is the onset affected?

A

faster onset

22
Q

_____ affects what you feel and wheter you retain motor function.

A

Concentration

Thus adjust concentration not rate when making adjustments!

23
Q

How does epinepherine increase effectiveness of local? (2)

A

decreased uptake

increased duration

24
Q

What are several adjucts to LA to lower concentration of anesthetic administered? (3)

A

epi

clonidine

opioid like Duramor, is a preservative-free one

25
Q

How do we prepare for an epidural? (3)

A

get consent

give lots of fluids to prevent hypotension, prefer coload

get position

26
Q

Goal of epidural for labor and delivery rate:

A

T8 - L3, min 14+ cc/hr

27
Q

What approach do we prefer for elderly pts?

A

paramedian because of calcified supraspinous ligament

28
Q

What position is better during an emergency?

A

lateral decubitus because pt can’t fall and fetus will not be distressed if pregnant patient

29
Q

What position is technically more difficult?

A

lateral decubitus

30
Q

Where do we want to place a spinal needle?

A

around L2

31
Q

Preload is the act of administering a bolus
of ___-___ L immediately prior to placing a
neuraxial block.

Coload is the administration of ___-___ L fluid
as a block is in the process of setting up

A

1-2

32
Q

Air vs. Normal Saline

Downside of ___ : it can track around nerve
roots and prevent exposure to local
anesthetics

A

air

33
Q

What is the test dose of lidocaine and epinepherine?

A

45 mg at 1.5% lidocaine

and 15mcg of epi at 1/200,000

34
Q

How much should we thread the catheter?

A

3-5 cm is ideal

35
Q

What do you look for in the test dose to indicate that you are in the right epidural space?

A

tachycardia

HTN

perioral numbness

hearing changes

metallic taste

profound numbness

36
Q

What are some troubleshooting issues? (4)

A

inadequate analgesia: no block, one-sided, patchy, or wears off too quickly

puritis

hypotension

too dense

37
Q

What should you document when removing epidural catheter?

A

blue tip intact

38
Q

What if you determine there is no block? What do you do?

A

start over

39
Q

If patient complains that they are only feeling it on one side. What may have happened? (2) What do you do?

A

Catheter may be in too far, or pt was lying on the side for too long

Septated epidural space

Replace it

40
Q

What may have occurred in a patchy block? What is it called?

A

a window

It can be caused by air around the nerve root.

It is also possible that a certain nerve may be repeatedly stimulated.

41
Q

How do you treat a patchy block? (4)

A

volume bolus

withdraw the catheter 1-2 cm

lie the patient “window” side down

small bolus of higher concentration LA vs. opioid bolus

42
Q

The patient appears to have a complete motor
block of the left leg but not the right. There is a
sensory block T10 bilaterally. The left side has no
sensory block above T10. Horner’s Syndrome has
appeared on the right.

A

Remove and start over

numb skull!

Give ventilatory support!

43
Q

Block that “wears off”

What is the solution? (2)

A
  • You forgot to start the infusion
  • The infusion isn’t connected/set up properly

The patient’s block is actually working but

they aren’t as numb… which is appropriate

The patient is ready to push

The patient has developed a comorbidity

(chorio vs. uterine rupture vs. something else)

44
Q

How do you treat hypotension?

A

Left or right uterine displacement

fluid bolus 500cc-1L

ephedrine 10 mg

phenylephederine is better! Less fetal acidosis

check for bradycardia/dysrhythmias

check for alternative causes: Mg, hemmorhage, vagal

45
Q

Can a paraplegic deliver a baby vaginally?

A

yes!

46
Q

If the patient is “too numb” or “can’t push”.

You are called because the patient can’t feel her legs and the OBs are concerned that she won’t be able to push.

A

DECREASE CONCENTRATION in the epidural

Inject 5-10 cc NS through catheter

47
Q

The ___ receptor is THE cause of pruritis?

What is the treatment?

A

mu

mu antagonist!

AP II Test 2 (7 decks)

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