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Flashcards in Anatomy of Anaesthesia in Labour Deck (22)
1

Define the distinction between the pelvis and the perineum

above levator ani = pelvis
below= perineum

2

How do visceral afferents from superior pelvic organs/those touching the peritoneum enter the spinal cord

run alongside SYMPATHETIC NERVE fibres
enter at T11-L2

3

where is pain felt from the superior pelvic organs

as suprapubic

4

How do visceral afferents from the inferior pelvic organs enter the spinal cord

run alongside PARASYMPATHETICS
enter spinal cord at S2, 3, 4

5

how is pain from the inferior pelvic organs felt

in a dermatomal distribution S2, 3, 4

6

How does pain from structures below the levator ani i.e. in the perineum enter the spinal cord

Somatic sensory - via the pudendal nerve
levels S2, 3, 4

7

how is pian below the levator ani felt as

localised to the area within the perineum

8

At what level does the spinal cord become the cauda equina

L2

9

When does the subarachnoid space end

S2

10

At what level of the spinal cord is anaesthesia usually injected into

L3-L4

11

Name all the ligaments that the needle passes through in either a spinal or epidural

Supraspinous ligament
Interspinous ligament
Ligamentum flavum

12

What is the difference between a spinal and epidural

Spinal - into subarachnoid space
Epidural - epidural space

13

Where do sympathetic nerves exit the spinal cord

T1-L2

14

What effect does the anaesthetic have on the arterioles

Affects sympathetic fibres - which supply all arterioles
results in vasodilation

15

What can happen in a spinal/epidural due to vasodilation

skin of lower limbs looks flushed
warm lower limbs
reduced sweating
HYPOTENSION

16

What does the pudendal nerce supply

the perineum

17

what is the routes of the pudendal nerve

branch of sacral plexus S2, 3, 4

18

When is a pudendal nerve block used

Episiotomy
Forceps use
Perineal stitching post delivery

19

Describe the course of the pudendal nerve

exits pelvis via greater sciatic foramen
Passes posterior to sacrospinous ligament
Re-enters pelvis/perineum via the lesser sciatic foramen
Travels in pudendal canal
To supply the perineum

20

where is the pudendal canal

a passageway within the obturator fascia (also contains internal pudendal artery and vein and nerve to obturator internus)

21

How is the location to inject anaestetic for a pudendal nerve block determined

The ischal spine is palpated transvaginally and used as a landmark
The pudendal nerve crosses the lateral aspect of the sacrospinous ligamnent

22

Why is an episiotomy done

a posteriolaterl incision into the ischioanal fossa - prevents tearing into the anal spincter and anus/rectum.