Anaatomy of Anaesthesia for Labour Flashcards
(41 cards)
What motor functions are involved in the female reproductive system?
- uterine cramping (menstruation)
- uterine contraction (labour)
- pelvic floor muscle contraction (during sneezing)
Sensory pains from the reproductive system?
- pain from the adnexae, uterus, vagina, perineum
What separates the pelvis from the perineum?
- Levator Ani Muscle
Structures in the pelvis?
- body cavity (organs: uterus, bladder, rectum)
- sympathetic, parasympathetic and visceral afferent
Structures in the perineum?
- body WALL
- somatic MOTOR and sensory
What motor function in the reproductive system is controlled hormonally?
- uterine cramping and contraction
What are the sources of visceral afferent pains?
-pain from the adnexae, uterus, vagina (pelvic part)
What parts of the reproductive system are under somatic sensory ?
- perineum part of the vagina
- pain from the perineum
How different is the sensory nerve supply between the superior aspect of the pelvic organs and the inferior aspect?
- pelvic organs in contact with peritoneum: VISCERAL afferents (run alongside sympathetic fibres)
- inferior aspect of pelvic organs: also VISCERAL afferent (runs along PARASYMPATH.)
Where does the sensory supply enter at the spinal cord in the superior aspect of the pelvic organs vs the inferior?
- superior: T11-T12
- Inferior: S2-S4
Where is the pain perceived to be with regards to whether it’s the superior or inferior aspect of the pelvic organs?
- Pain of the superior aspect: SUPRAPUBIC area
- pain from the inferior aspect: S2-S4 dermatome (perineum)
Distinct nerve supply for structures that cross over from the pelvis to the perineum.
- above the L.ani: visceral afferents/parasympa/S2-S4
- Below the L.ani: somatic sensory / PUDENDAL nerve/ S2-S4 —–pain localized to perineum
Where do the sympathetics arise from in spinal cord?
- sacral sympathetic trunks
- T11-L2
- Superior Hypogastric Plexus
Where do the parasympathetics arise from?
- sacral outflow (S2-s4)
- pelvic splanchnic nerves ; from spinal roots
- —-mixes with sympathetics in the inferior hypogastric plexus
What pelvic organs touch the peritoneum?
Spinal cord levels?
- uterine tubes
- uterus- ovaries
- —T11 -L2
INferior aspect, pelvic organs?
- cervix
- superior vagina
Structures within the perineum somative nerve supply and to which spinal level?
- Pudendal nerve back to S2-S4
- —–inferior vagina, perineal muscles, glands and skin
Where is the spinal anaesthetic given at and when?
- spinal block via Lumbar Puncture (anesthetisizes from waist down - intra+subperitoneal + somatic areas)
When is the caudal epidural nerve block given?
- anesthetisize areas innervated by the pudendal nerve + subperitoneal areas
Pudendal nerve block is specifically to block
—pudendal nerve supply to the majority of the PERINEUM
Site for injection of the spinal and epidural anaesthetic?
- L3-L4 (L5)
TRANSVERSE line from the superior points of the iliac crests
When does the spinal cord become the cauda equina?
- L2
When does the subarachnoid space end?
S2
What does the epidural anaesthetic pass through?
- supraspinous Ligament
- interspinous ligament
- ligamentum flavum
- epidural space
