Flashcards in centroneuraxial Deck (61):
how many vertebrae in cervical
how many vertebrae in thoracic
how many vertebrae in lumbar
how many vertebrae in sacral
how many vertebrae in coccygeal
what are the high points?
what are the low points
the spinal cord extends to __ in the adult and __ in the newborn
the lateral approach DOES NOT pass through which two structures?
supraspinous and interspinous ligaments
the spinal cord is enlarged in two sections, one is called the cervical enlargement but actually forms the Brachial plexus (from __ to __), the other is the lumbosacral enlargement forms the lumbosacral plexus (from __ to __)
brachial plexus C5-T1
name the three meninges from outside in
the distance from the skin to epidural space using a midline approach is __ to __ cm, with an average of 5 cm
2.5 - 8 cm
a 3.5" epidural needle is 8.9 cm long
the principal site of action for neuraxial block is the __
scoliosis is a __ curvature
kyphosis is a __ curvature
"hump" in thoracic region
lordosis is __ of the back due to obesity or pregancy
what level for a c-section?
belly button is at level
inguinal is at level __
what is the first fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?
B, autonomic, to blockages.
what is the second fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?
type C, pain, 0.4-12 microns, NO myelin, 0.5-2.3 m/s, ++++ sensitive
If I was on Hep "C" precautions "secondary" to a needle stick, even if it only penetrated 0.4-12 microns, I could have "NO" sex for 1/2 to 2.3 years and would have "++++" pain.
what is the third fiber type to be blocked? what is its function? how big? myelinated? conduction velocity? sensitivity?
type A, many functions, 2-20 microns, heavy myelin, 12-120 m/s, increasing sensitivity.
Three type A people I know do almost everything from age 2-20, even lifting heavy weights 12-120 pounds with increasing sensitivity
type A alpha
type A beta
type A gamma
type A delta
how to remember the type A fibers in order
I knew the car was motoring too fast, so I first touched then put pressure on the brakes, then muscled it as much as I could, but I crashed and now have a lot of pain and a fever.
what happens when you block B fibers?
venodilation and hypotension
your *B*lood pressure drops when you block your *B* fibers
what happens when you block your C and A-delta fibers?
loss of pain and temp
remember, if I get a needlestick and am on Hep C precautions, or if I wreck my car, it's going to be very painful and my temp will go up
what happens when you block type A-gamma fibers
loss of muscle
remember, you're muscling the brakes as much as you can to prevent a crash
what happens when you block type A-beta fibers
touch and pressure
remember, you first touch then apply pressure to the brake
what happens when you block type A-alpha fibers
loss of motor and proprioception
you "knew" the car was "motoring" too fast
where are your cardiac accelerator fibers?
Motor block occurs __ segments __ than sensory block
2-3 segments LOWER
sympathetic block occurs __ segments __ than sensory block
2-6 segments HIGHER
INR 1.2-1.5 = __
Aspirin and NSAIDs
not a problem
need normal PTT, can heparinize 1 hour post catheter removal
need INR less than 1.5 to perform or remove
report new lower limb weakness, sensory deficit, bladder/bowel dsfxn, back pain
need surgical decompression of hematoma!
most common complication?
second most common complication?
etiology of post dural puncture headache
decreased CSF drops brain into foramen magnum, stretches meninges and vessels on top, leading to HA
treatment for PDPH as evidenced by bilateral FRONTAL pain from eyes posterior to occiput then caudad down neck
caffeine, fluids, bed rest, NSAIDs, epidural blood patch, DON'T LET THEM GO HOME!!
how to prevent PDPH
smallest pencil point needle, bevel sideways, straight in, avoid young or females, don't dull needle on bone, use weak anesthetic, preferably tetra over bup
where would you give an epidural blood patch?
one level LOWer because blood will spread rostrally (cephalad)
tell me about the intercristal line
the plane across the top of the iliac crests, usually intersects L4-L5
taylor's approach- _ cm medial and _ cm caudad to posterior superior iliac spine, angle medially and cephalad 55* toward L5 interspace
how much CSF do adults make each day?
normal CSF pressure
how much CSF in the subarachnoid space, central canal, and brain at any given time?
how much in spinal canal only?
spec grav of CSF
HYPERbaric solutions have a spec grav __ than CSF and will thus sink to the lowest point
HYPObaric solutions have a spec grav __ than CSF and thus float or rise to the top
how to make a HYPERbaric solution- dissolve in __, makes a baricity > 1
how to make a HYPObaric solution- dissolve in __ water, makes a baricity < 1
how to make an isobaric solution
dissolve in CSF or NS
Highly protein bound drugs such as __ and __ last longer than those that aren't like lidocaine
tetra and marcaine
distribution of local anesthetic in CSF is influenced by 4 things
*B*e*C*ause *P*osition *C*ounts
dysfunction of bowel or bladder, think
severe back pain think
transient neurological symptoms