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Flashcards in epidural, combined spinal/epidural Deck (28):
0

LA spreads __ for epidural

cephalad

1

what determines the level of anesthesia with an epidural?

VOLUME, no such thing as overdosing an epidural

diffusion dependent

2

T/F - any procedure that can be done with a spinal can also be done with epidural

true

3

What's special about a Touhy?

has the most curvature 30*, therefore less likely to pierce arachnoid and enter subarachnoid

4

What size catheter should you use in the epidural?

2 sizes SMALLER than the needle

5

the majority of the population have loss of resistance between __ - __ cm

4-6 cm

6

the paramedian/lateral approach does not have to pass through what two layers?

supraspinous ligament
intraspinous ligament

7

epidural insertion site for TAH and low abdominal surg

L2-L3

2-3 kids is just about right

8

epidural insertion site for upper abdominal surg

T8-T10

ribs 8-10 are the "false" ribs in humans

9

epidural insertion site for thoracic surg

T4-T5

"Thora" has five letters

10

epidural insertion site for chronic pain therapy or surgery of the arms, shoulders, or upper chest

C7-T1

11

__ affects the density of the block

concentration

12

__ affects the spread of LA throughout the epidural space

volume

13

do blocks occur faster in cephalad or caudad direction?

cephalad

14

what is the "take home" volume per dermatomal segment?

1-2 ml per dermatome

15

where are the opioid receptors in the spinal cord?

substantia gelatinosa

16

how much more opioid must you give epidural vs. IV?

spinal vs. Epidural

Epidural = IV dose

10x epidural compared to intrathecal

morphine 200 mcg spinal, but 2000 mcg epidural or IV

17

the time of maximum spread of LA for epidural?

10-25 minutes

18

when sensory regression of 1-2 dermatomes occurs, give a dose of __ - __ the initial dose

30-50%

19

number one complication of epidural

backache

20

when should you give epidural morphine?

AFTER BABY DELIVERED AND CORD CLAMPED due to resp depression

21

after age __, anatomy changes make caudal site identification difficult and spread of LA less reliable

12

slide 30

22

how much volume for caudal anesthesia for sacrum?

how much volume for caudal for T10?

10-15 ml

20-30 ml

23

what is in your test dose for an epidural?

3 ml's of 1.5% lido and 1:200,000 epi
equals 45 mg lido and 15 mcg epi total

24

Epidural final site of action

Ventral and dorsal rootlets, cord

25

Protein binding gives you

Longer duration

26

In adults the dura ends around

In peds the dura ends around

L2 aduLts

S4 pedS

27

Why does the caudal approach have such a high failure rate?

False passages