Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

8362 T&T Exam1 > Mod3: Spinal Anesthesia Part 2 > Flashcards

Mod3: Spinal Anesthesia Part 2 Flashcards

1
Q

Spinal Anesthesia: Assessment of Block

The skin area innervated by a given spinal nerve and its corresponding cord segment is also know as:

A

Dermatome

Corresponds to a portion of the spinal cord that gives rise to all nerve rootlets of a single spinal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Required Block Levels

What’s the Dermatomal block Level for Upper Abd/C-Section procedures?

A

T4 = nipple line

[Dermatomal block Level]

“Upper Abd/C-Section procedures”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Required Block Levels

What’s the Dermatomal block Level for GYN/Urological procedures?

A

T6: Xiphoid level

“GYN/Urological procedures”

XX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Required Block Levels

What’s the Dermatomal block Level for Hip Surgery?

A

T10 = Umbilicus

“Hip Surgery”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Required Block Levels

What’s the Dermatomal block Level for Upper Leg procedures?

A

L1 = Upper Anterior Thigh

“Upper Leg procedures”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Required Block Levels

What’s the Dermatomal block Level for Foot & Ankle procedures?

A

L2 = Mid Anterior Thigh

“Foot & Ankle procedures”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Required Block Levels

What’s the Dermatomal block Level for Perineal procedures?

A

L1-L2 or

S2 w/saddle block

“Perineal procedures”

Sacral nerves are larger and harder to block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Spinal Anesthesia: Assessment of block

How do we assess that our blocks are working?

A

Assess progress of block level q 2-3 minutes initially

Asseess until desired level is attained

Fast onset, usually

Takes ~10 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Spinal Anesthesia: Assessment of block

Once block established, reassess block level every

A

30-45 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spinal Anesthesia - Physiology of local anesthetic neural blockade

Local anesthetics block conduction of:

A

Electrical impulses along nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Spinal Anesthesia - Physiology of local anesthetic neural blockade

Local anesthetics block conduction of Impulses along nerves. However, exact location of action is:

A

Unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Spinal Anesthesia: Neurophysiological effects - Differential Blockade

Different nerve fibers serving different functions display varying sensitivity to LA blockade. What’s the order of sensitivity? in other words, what the first thing to be blocked? what’s the last thing to be blocked?

A

ANS>Pain>Temperature>Touch>Motor

“A PTT M”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spinal Anesthesia: Neurophysiological effects - Differential Blockade

The mechanism of action of differential blockade is:

A

Not clearly known!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spinal Anesthesia: Neurophysiological effects - Differential Blockade

Which factors affect the mechanism of action of LA?

A

Nerve fiber diameter is one factor but not the only

Decrease in LA concentration in CSF as function of distance from injection site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Spinal Anesthesia: Neurophysiological effects

Differential Blockade manifests as a spatial separation in sensations blocked. How does Sympathetic block extend in reference to sensory block?

A

2 dermatomes higher than sensory block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Spinal Anesthesia: Neurophysiological effects

Differential Blockade manifests as a spatial separation in sensations blocked. Where is Sensory block localized in reference to Motor block?

A

2 dermatomes higher than Motor block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Spinal Anesthesia: Neurophysiological effects

Patients & surgeons can appreciate the differential blockade and can find it worrisome. This could be evidenced by which statement from a pt?

A

“Don’t let him start. I can still move my foot!!!”

The pt fail to recognize the difference between sensory and motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Spinal Anesthesia: Assessment of block

Which three methods are used to assess differing blockade?

A

Autonomic nervous system response

Sensory response

Motor response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Spinal Anesthesia: Assessment of block

Autonomic nervous system blockade manifest as:

A

Skin flushing

Warm skin

Vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Spinal Anesthesia: Assessment of block

Which object/instruments could be used to assess Sensory nerves blockade?

A

Broken tongue blade

works well to determine sensory block level

Alcohol swab to detect temp response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Spinal Anesthesia: Assessment of block

Methods to assess differing blockade: How do you assess Motor nerves?

A

Ask patient to move lower extremities to assess motor block level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Spinal Anesthesia: Cardiovascular Physiology

Blockade of SNS efferent fibers to vascular smooth muscle could cause:

A

Hypotension (40% ± incidence)

Hypotension is the most common side effect encountered

Bradycardia (10-15%)

2nd and 3rd degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Spinal Anesthesia: Cardiovascular Physiology

Hypotension caused by Blockade of SNS efferent fibers to vascular smooth muscle is the result of:

A

Arterial dilation (decreased SVR)

Venous dilation (decreased preload=decreased CO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Spinal Anesthesia: Cardiovascular Physiology

Which block factor determines Extent of Hypotension caused by blockade of SNS efferent fibers to vascular smooth muscle?

A

Level of block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Spinal Anesthesia: Cardiovascular Physiology

Which factors may amplify Effect of Hypotension caused by Blockade of SNS efferent fibers to vascular smooth muscle?

A

Age > 50

Concurrent GA

Obesity

Hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Spinal Anesthesia: Cardiovascular Physiology

Effect of Hypotension caused by Blockade of SNS efferent fibers to vascular smooth muscle may be worse in patients on which drugs?

A

ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Spinal Anesthesia: Cardiovascular Physiology

Bradycardia caused by Blockade of SNS efferent fibers to vascular smooth muscle is the result of:

A

Blockade of sympathetic cardioaccelerator fibers originating from T1-T4

Bradycardia starts to be seen with T6 sensory level blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Spinal Anesthesia: Cardiovascular Physiology

Bradycardia caused by Blockade of SNS efferent fibers to vascular smooth muscle is the result of Blockade of sympathetic cardioaccelerator fibers originating from T1-T4. Why is it noted with T6 sensory level blocks?

A

Sympathetic block level is 2 dermatomes higher than sensory level block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Spinal Anesthesia: Cardiovascular Physiology

How does Bradycardia caused by Blockade of SNS efferent fibers to vascular smooth muscle manifest?

A

Diminished venous return and associated decreased stretch of intracardiac stretch receptors

Severe bradycardia/asystole reported

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Spinal Anesthesia: Cardiovascular Physiology

What are risk factors for Bradycardia caused by Blockade of SNS efferent fibers to vascular smooth muscle?

A

Age < 50

Any ASA

Use of beta blockers

31
Q

Spinal Anesthesia: Cardiovascular Physiology

What’s the treatment for Bradycardia caused by Blockade of SNS efferent fibers to vascular smooth muscle?

A

Epinephrine

32
Q

Spinal Anesthesia: Cardiovascular Physiology

What’s the major risk factor for 2nd and 3rd degree heart block caused by Blockade of SNS efferent fibers to vascular smooth muscle?

A

Preexisting 1st degree heart block

33
Q

Spinal Anesthesia: Treating CV hemodynamic changes

When is it recommended to initiate treatment for CV hemodynamic changes?

A

BP is decreased more than 25-30% baseline

SBP<90 in normotensive pt

HR falls below 50-60 beats/min

Pt becomes symptomatic

34
Q

Spinal Anesthesia: Treating CV hemodynamic changes

Which vasopressors are used to treat CV hemodynamic changes from spinal blockade?

A

Ephedrine

Phenylephrine

35
Q

Spinal Anesthesia: Treating CV hemodynamic changes

What’s the dose and and what are the effects of Ephedrine when used to treat CV hemodynamic changes from spinal blockade?

A

5-10mg Ephedrine (IV)

Alpha and beta adrenergic activity (inc HR)

Increases CO (venous return) and SVR

36
Q

Spinal Anesthesia: Treating CV hemodynamic changes

Dose and effects of Phenylephrine when used to treat CV hemodynamic changes from spinal blockade?

A

50-100 mcg Phenylephrine (IV)

Primary alpha-agonist activity

Increases SVR (may decrease CO)

37
Q

Spinal Anesthesia: Treating CV hemodynamic changes

Fluid Administration when used to treat CV hemodynamic changes from spinal blockade. Prehydration with:

A

Crystalloid solution

500-1000 mL

38
Q

Spinal Anesthesia: Treating CV hemodynamic changes

When treating CV hemodynamic changes from spinal blockade, why must we be cautious placing in head up position to decrease cephalad spread?

A

Exaggerates decreased BP by decreasing venous return

39
Q

Spinal Anesthesia: Treating CV hemodynamic changes

NYSORA Recommendations in the treatment of CV hemodynamic changes from spinal blockade

A

NYSORA Recommendations

40
Q

Spinal Anesthesia

Complications:

A

Postdural puncture headache (PDPH)

Backache

Total spinal

Neurologic Injury

Transient neurologic syndrome (TNS)

Spinal hematoma

41
Q

Spinal Anesthesia: Complications

Causes of Postdural puncture headache (PDPH):

A

Loss of CSF through meningeal needle hole (?)

“Saggy Brain”

42
Q

Spinal Anesthesia: Complications

Characteristics of Postdural puncture headache (PDPH):

A

Bilateral in the frontal-occipital region

Worsens with upright position

Improves in supine position

Photophobia

Tinnitus

N/V

43
Q

Spinal Anesthesia: Complications

Incidence of Postdural puncture headache (PDPH):

A

Increased in young patients, women, and parturient

Decreases with increasing age

Decreases with use of smaller diameter (larger gauge) spinal needle with noncutting tips

Remaining supine does not decrease incidence

44
Q

Spinal Anesthesia: Complications

How should the cutting needles be inserted to decrease incidence of Postdural puncture headache (PDPH)?

A

With bevel aligned parallel to long axis of dural fibers

45
Q

Spinal Anesthesia: Complications

Treatment of Postdural puncture headache (PDPH):

A

Usually resolves over 48hr without invasive therapy

Bedrest/fluids/analgesics/caffeine

Epidural blood patch

46
Q

Spinal Anesthesia: Complications

When is backache a common complication?

A

After general anesthesia, but

More common after spinal (11%)

47
Q

Spinal Anesthesia: Complications

Causes of Backache after spinal anesthesia?

A

Needle trauma

Local anesthetic irritation

Ligament strain secondary to muscle relaxation

48
Q

Spinal Anesthesia: Complications

The complication from spinal anesthesia that manifest as “Blockade of entire spinal cord and occasionally brain stem” is also known as:

A

Total spinal

49
Q

Spinal Anesthesia: Complications

Which pt’s populations are more susceptible to “Total spinal”, and why?

A

Obese & Parturients

Relative decreased CSF volume a/w Obesity & Pregnancy

LA spreads more

50
Q

Spinal Anesthesia: Complications

When does “Total spinal” occur?

A

Immediately or

up to 60 mins after injection

51
Q

Spinal Anesthesia: Complications

Symptoms of “Total spinal”:

A

Profound hypotension and bradycardia

Apnea/respiratory arrest (phrenic nerve paralysis)

52
Q

Spinal Anesthesia: Complications

Treatment of “Total spinal”:

A

Protect the airway

Vasopressors

Anticholinergics

Fluids

Oxygen with controlled ventilation

53
Q

Spinal Anesthesia: Complications

T/F

If managed appropriately, “Total spinal” will resolve without sequelae

A

True

54
Q

Spinal Anesthesia: Complications

Incidence of Neurologic Injury:

A

Rare (0.03-0.1% incidence) but

Widely feared!!!

55
Q

Spinal Anesthesia: Complications

Causes of Neurologic Injury:

A

Direct needle trauma to spinal cord or nerves

Spinal cord ischemia

Introduction of bacteria or neurotoxic chemicals (prep solution) into SAS

Toxic LA buildup “Cauda Equina Syndrome”

56
Q

Spinal Anesthesia: Complications

The condition that occurs when the bundle of nerves below the end of the spinal cord called cauda equina is damaged is known as:

A

Cauda Equina Syndrome

Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control

57
Q

Spinal Anesthesia: Complications

T/F

“Cauda Equina Syndrome” is the Result of subarachnoid injection through microbore, high resistant catheters

A

True

Catheters produce little turbulence and the undiluted solution pools around cauda equina nerve roots

58
Q

Spinal Anesthesia: Complications

The painful condition of the buttocks and thighs with possible radiation to the lower extermities, beginning as soon as a few hours after spinal anesthesia and lasting as long as ten days is also known as:

A

Transient Neurologic Syndrome (TNS)

Pain in buttocks or leg (posterior thigh usually)

Pain can be mild to severe

59
Q

Spinal Anesthesia: Complications

What differentiates Transient neurologic syndrome (TNS) from “Cauda equina syndrome”?

A

TNS is exclusively a pain syndrome

There is no bowel or bladder dysfunction

Neurologic, MRI , and Electrophysiologic examinations are normal

60
Q

Spinal Anesthesia: Complications

All local anesthetics are implicated in Transient neurologic syndrome (TNS), except:

A

Chloroprocaine

Risk > with lidocaine

61
Q

Spinal Anesthesia: Complications

Which condition increase the risk of Transient neurologic syndrome (TNS)?

A

Lithotomy position

Obesity

62
Q

Spinal Anesthesia: Complications

Pain from Transient neurologic syndrome (TNS) resolves in:

A

72hrs

63
Q

Spinal Anesthesia: Complications

What’s the incidence of “Spinal hematoma”?

A

Rare (<1 in 150,000)

64
Q

Spinal Anesthesia: Complications

How does “Spinal hematoma” manifest?

A

Lower extremity numbness

Lower extremity weakness

65
Q

Spinal Anesthesia: Complications

Why is early detection “Spinal hematoma” critical?

A

Delay >8hrs in decompressing spinal cord

Could lead to decreases chance of neurologic recovery

66
Q

Spinal Anesthesia: Anticoagulated Patients

Which anticoagulants present a very low risk in spinal anesthesia?

A

ASA

NSAIDS

SQ heparin

67
Q

Spinal Anesthesia: Anticoagulated Patients

After low dose low-molecular-weight heparin (LMWH) administration, delay spinal anesthesia for:

A

12 hrs

68
Q

Spinal Anesthesia: Anticoagulated Patients

After high dose low-molecular-weight heparin (LMWH) administration, delay spinal anesthesia for:

A

24hrs

69
Q

Spinal Anesthesia: Anticoagulated Patients

If taking twice daily, Post-op delay LWMH for:

A

24 hrs

70
Q

Spinal Anesthesia: Anticoagulated Patients

If taking once daily, Post-op delay LWMH for:

A

6-8 hrs

71
Q

Spinal Anesthesia: Anticoagulated Patients

After the last dose of Ticlopidine (Ticlid), avoid spinal anesthesia for how long?

A

14 days

Ticlopidine (Ticlid) is a blood thinner

72
Q

Spinal Anesthesia: Anticoagulated Patients

After the last dose of clopidogrel (Plavix), avoid spinal anesthesia for how long?

A

7 days

73
Q

Spinal Anesthesia: Anticoagulated Patients

For reference, consult:

A

American Society of Regional Anesthesia (ASRA)

8362 T&T Exam1 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions