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SRNAClinical Practicuum Prep > EPIDURAL ANESTHESIA > Flashcards

EPIDURAL ANESTHESIA Flashcards

(60 cards)

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1
Q

Risk factor for cauda equina usually with undiagnosed?

A

Undiagnosed spinal stenosis (detected during

evaluation of the new neurologic deficits) was a risk factor for cauda equina syndrome

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2
Q

Cutaneous Landmarks : Fifth finger
Segmental level is ____
significance________

A

Fifth finger
C8
All cardioaccelerator fibers (T1-T4) blocked

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3
Q

Cutaneous Landmarks : Nipple line
Segmental level is ____
Type of operation_______
Significance______

A

T4-T5
Upper abdominal
Possibility of cardio-accelerator blockade

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4
Q

T4-T5 is at the

A

nipple line

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5
Q

Cutaneous Landmarks : Tip of xiphoid
Segmental level is ____
Type of operation_______
Significance_____

A

T6
Lower Abdominal
Splanchnics (T5-L1) blocked

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6
Q

Cutaneous Landmarks : Umbilicus
Segmental level is ________
Type of operation_______
Significance________

A

T10
Hip
Sympathetic blockade to lower extremities

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7
Q

Cutaneous Landmarks : Lateral aspect of foot
Segmental level is ________
Type of operation_______
Significance________

A

S1
Leg and foot
No lumbar sympathectomy

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8
Q

Cutaneous Landmarks : Lateral aspect of foot
Segmental level is ________
Type of operation_______
Significance________

A

Perineum S2-S4 Hemorrhoidectomy

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9
Q

Termination of the spinal cord in adult is

A

L1

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10
Q

The dural sac terminates at

A

S2

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11
Q

When is paramedian approach recommended for Epidural anesthesia?

A

When at the THORACIC level T1 - T7 to bypass ANGLED spinous process

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12
Q

At levels below T7_________

A

Needle insertion becomes similar to L2-L3

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13
Q

Lumbar Spine The epidural space is________

A

widest, i.e., 5-6 mm.

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14
Q

Lumbar Spine Needle insertion below

A

L1 (in adults) avoids the spinal cord.

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15
Q

Lumbar Spine The ligamentum flavum is

A

thickest in the midline in the lumbar area.

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16
Q

Lumbar Spine: The spinous processes

A

have only slight downward angulation.

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17
Q

Lumbar Spine The epidural veins are

A

prominent in the lateral portion of the epidural space.

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18
Q

Thoracic Spine

The epidural space is__________

A

3-5 mm in the midline, narrow laterally.

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19
Q

Thoracic Spine The ligamentum flavum is

A

thick but less so than in the midlumbar region.

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20
Q

Thoracic Spine The spinous processes have

A

extreme downward angulation; the paramedian

approach is recommended.

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21
Q

Cervical Spine
The epidural space is_______
The ligamentum flavum is_____
The spinous process at C7 is

A

narrow, only 2 mm at C3-6
thin.
almost horizontal.

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22
Q

Vertebra prominens level

A

C7

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23
Q

Root of scapular spine level

A

T3

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24
Q

Inferior angle of scapula level

A

T7

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25
Intercristal line level
L3, 4
26
Posterior superior iliac spine
S2
27
The major sites of action of epidurally injected local anesthetics are
The spinal nerve roots, where the dura is relatively thin.
28
How does the addition of vasoconstriction help local anesthetics?
The addition of vasoconstricting agents reduces blood flow in the richly vascularized epidural space, reducing systemic absorption; because more of the drug remains in Close to the nerve, the onset of block is quicker and the duration of action is longer.
29
Complications of Epidural
Spinal hematomas, Cauda Equina, meningitis, epidural abscess.
30
Local anesthetic dose may be calculated by the following formula:
dose equals 1 to 1.5 mL of local anesthetic agent per segment blocked
31
When Epidural start regressing
A second dose of approximately 50% of the initial dose will maintain the original level of anesthesia if injected when the blockade has regressed 1 or 2 dermatomes
32
How to give a 2nd dose?
A second dose of approximately 50% of the initial dose will maintain the original level of anesthesia if injected when the blockade has regressed 1 or 2 dermatomes
33
The addition of epinephrine can prolong the duration of lidocaine nerve block by
up to 50%.
34
Epidural Space | The epidural space may be approached using a_____or _______insertion.
midline or a paramedian needle
35
How do you identify the EPIDURAL SPACE?
The epidural space is identified by the passage of the | needle from an area of high resistance (ligamentum flavum) to an area of low resistance (epidural space).
36
After the needle is positioned in the ligamentum flavum,
a syringe with a freely movable plunger is attached, and continuous pressure is applied to the plunger.
37
If the needle is positioned correctly in the ligament, | the syringe
should not inject when pressure is applied to the plunger.
38
As the needle passes into the epidural space,
a sudden loss of resistance in the plunger will be felt, and the air or fluid will easily inject. At this point, a flexible nylon catheter may be advanced 3 to 4 cm through the needle into the epidural space to allow repeated and incremental injections.
39
Accurately identify the level of the vertebrae as well as to estimate the depth of the epidural space
Pre-insertion ultrasound imaging has been demonstrated
40
A test dose of is then injected, An
3 mL of local anesthetic solution (typically lidocaine, 1.5%) containing 1:200,000 epinephrine and the patient is observed for signs of intravascular, subdural, or subarachnoid injection.
41
After the test dose inserted How do you assess intravascular, subdural or subarachnoid?
increase in systolic blood pressure of at least 15 mm Hg or an increase in heart rate of at least 10 beats/min represents intravascular injection, whereas a change in lower extremity sensation (with or without a decrease in blood pressure) denotes subdural or subarachnoid injection.
42
Extreme upward angulation required for
Midthoracic region
43
What is the widest part of the epidural space?
L2 is thought to be the widest part of the epidural space, measuring 5 to 6 mm at this level.
44
The spinal cord begins at the level of the foramen
magnum and ends below as the conus medullaris.
45
At birth, the cord extends to
L3, but it moves to its adult position at the lower border of L1 by age 1 year.
46
The spinal meninges are three individual membranes that surround the spinal cord
Dura, Arachnoid, Pia
47
The dura is a ______layer
Tough
48
THin and AVASCULAR
ARACHNOID
49
MIddle membrane closely attached to the dura
Arachnoid
50
Thin Layer and HIGHLY VASCULAR
PIA
51
The space between the arachnoid and pia is the
subarachnoid space.
52
Meninges layer from outer to inner
Dura, Arachnoid, Pia
53
From closer to spinal cord to out
Pia - Arachnoid - Dura
54
SIFED-ASP order of ligaments
Supraspinal -> Interspinal --> Flavum , ligamentum --> Epidural -> Dura --> Arachnoid --> Subarachnoid --> Pia
55
The strongest of the ligaments
The ligamentum flavum,
56
Blood Supply | The spinal cord is supplied by Throughout their length,
one anterior spinal artery and two posterior | spinal arteries.
57
Blood Supply | The three spinal arteries receive contributions from
radicular branches of intercostal arteries.
58
The most caudal medullary artery is usually ______
the largest, the arteria medullaris magna anterior (artery of Adamkiewicz).
59
The MEDULLARY MAGNA ANTERIOR (artery of Adamkiewicz) artery has a variable origin along the spinal cord, arising in__________15% of patients, in _________60%, and in _________ 25%.
between T5 and T8 between T9 and T12 between L1 and L5
60
Primary ligaments that provide vertebral column stability by binding the vertebral bodies.
The anterior and posterior longitudinal ligaments

SRNAClinical Practicuum Prep (21 decks)

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