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Anesthesia Prinicples > Exam 1 Neuraxial Anesthesia (5/29/25) > Flashcards

Exam 1 Neuraxial Anesthesia (5/29/25) Flashcards

(62 cards)

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1
Q

What is the most important drug related factor of epidural LA spread?

A

Local Anesthetic Volume

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2
Q

What is the most important procedure related factor of epidural LA spread?

A

Level of injection

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3
Q

Controllable factors that significantly affect epidural spread

A

LA Volume
Level of injection
LA dose

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4
Q

Non-controllable factors that significantly affect epidural spread

A

Pregnancy
Old Age

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5
Q

Controllable factors that have a small effect epidural spread

A

LA concentration
Patient position

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6
Q

Non-controllable factors that have a small effect epidural spread

A

Height

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7
Q

factors that don’t affect epidural spread

A

Additives to the LA
Direction of bevel
Speed of injection

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8
Q

Which way does the epidural LA spread in the following regions?

Lumbar:
Mid-Thoracic Region:
Cervical:

A

Lumbar: Mostly cephalad
Mid-Thoracic Region: balanced between cephalad and caudad
Cervical: spreads caudad

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9
Q

The sensory level is __________than motor level

A

2 levels higher

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10
Q

The sympathetic level is ________ than sensory level

A

2-6 levels higher

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11
Q

List the order in which nerves are affected by LA and what those nerve fibers affect?

A

B= SNS
C & A-Delta=loss of pain and temperature
A-gamma= loss of motor tone
A-Beta=loss of touch and pressure
A-alpha= loss of motor unction and proprioception

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12
Q

Differential Blockade

A

Refers to how different types of nerve fibers have varying sensitivities to LA, affecting the level o block achieved

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13
Q

What nerve fiber is affected the longest?

A

B

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14
Q

True or false: nerves recover in the same order they are blocked

A

False, they recover in the opposite direction

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15
Q

Plica Mediana Dorsalis

A

Connective tissue that divides the right and left epidural space

*can be a cause of unilateral blocks

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16
Q

What is contained within the subarachnoid space?

A

CSF
Nerve Roots
Spinal cord

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17
Q

Compare the subudural and epidural spaces

A

They are both potential spaces, but the subdural space does not contain any veins

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18
Q

Where is the subdural space located?

A

Between the dura mater and arachnoid mater

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19
Q

List the meningeal layers starting with the outermost layer

A

Dura mater
Arachnoid mater
Pia Mater

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20
Q

The pia mater is attached _________ and plays a role in ________

A

directly to the spinal cord
reabsorbing some of the LA

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21
Q

A decrease in CSF is usually secondary to what factor?

What is the clinical significance of lower CSF volume?

A
  • Abdominal pressure (ascites, obesity, pregnancy)
  • The pressure will disperse the CSF volume
  • Clinical Significance: Lower CSF volume = small amount of LA
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22
Q

Dermatome region related to T10.

A
  • Umbilicus
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23
Q

The area of cutaneous sensation supplied by a spinal nerve is anatomically identified as it passes through an intervertebral foramen.

A
  • Dermatome
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24
Q

Dermatome region related to T4.

A
  • Nipple Line
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25
Dermatome region related C6.
* Thumb
26
Dermatome region related C6, C7, and C8.
* Hand
27
Where is the Tuffier's (Intercristal) Line?
* A horizontal line that connects the highest points of the iliac crests that serve as an important marker to determine the puncture level * This will indicate that you are between L3 and L4
28
How many pairs of spinal nerves are there? How many in each section of the vertebrae?
31 C: 8 T: 12 L: 5 S: 5 Coccyx: 1
29
What nerve provides sensory innervation of the face and what is it's clinical significance?
CN V (trigeminal nerve) important for airway blocks
30
Which dermatome level do you block for vaginal delivery, uterine, hip procedure, tourniquet, TURP?
T10
31
Which dermatome level do you block for C-section and upper abdominal surgery?
T4
32
Which dermatome level do you block for urological/gynecological/ lower abdominal procedures? (hysterectomy)
T6
33
Which dermatome level do you block for peri-anal and anal sugeries?
S2-S5
34
Which dermatome level do you block for foot/ankle surgery?
L2
35
Which dermatome level do you block for thigh/lower leg/knee?
L1
36
Which dermatome level do you block for scrotal procedures?
S3
37
Which dermatome level do you block for a penis surgery?
S2
38
Which dermatome level do you block for a testicular procedure?
T8
39
What are the controllable factors the affect the spread (height) of a spinal block?
Baricity Patient position Dose Site
40
What are the non-controllable factors the affect the spread (height) of a spinal block?
Volume of CSF Inc. intra-abdominal pressure Age
41
What factors do not affect the spread of a spinal block?
Barbotage Speed of injection Orientation of bevel Gender Addition of vasoconstricor
42
What is the most reliable factor affecting how far and wide the anesthetic spreads when using a hypo or isobaric solution in a spinal block?
Dose
43
The ______ the CSF volumes, the higher the spinal block will go
lower
44
List the order of senses that are blocked
Temperature Pain Touch or pressure
45
Modified Bromage Scale
A scale used to monitor the lumbosacral nerves motor block with 0 being no block and 3 being complete block
46
CV effects of neuraxial anesthesia on Preload: Afterload: CO: HR:
Preload: decrease due to sympathectomy Afterload: decrease due to sympathectomy CO: Decrease **may initially increase HR: Decrease
47
Why does HR decrease with neuraxial anesthesia?
Blockade of cardiac accelerator fibers Activation of Bezold-Jarisch reflex and reverse bainbridge reflex
48
Bezold-Jarisch reflex
Response to ventricular underfilling potentially leading to severe bradycardia and asystole *mediated by 5-HT3 receptors in the vagus nerve and ventricular myocardium
49
Reverse Bainbridge reflex
Triggered by reduced stretching of heart's right atrium
50
What is a major complication of neuraxial anesthesia?
Sudden cardiac arrest from unopposed parasympathetic tone seen 20-60 minutes after onset of spinal **can be seen in young adults with high parasympathetic tone
51
True or false: failure or delay to treat spinal induced hypotension will increase mortality
True
52
Ways to prevent spinal anesthesia induced hypotension
Vasopressors (ephedrine or phenylephrine) 5-HT3 antagonists (zofran 8mg) Fluids: warmed and isotonic * avoid preloading and excess fluids Positioning (tilt pregnant pts to the left)
53
What is the dose of fluids for Co-loading to prevent spinal anesthesia induced hypotension?
15mL/kg
54
Treatment for spinal anesthesia induced hypotension
Vasopressors Anticholinergics (glycopyrolate) Fluids Positioning
55
How does neuraxial anesthesia affect our pulmonary system?
ERV decreased small decrease in VC
56
Which patient populations do we use caution in with neuraxial anesthesia due to pulmonary effects?
COPD Pickwickian syndrome
57
GI Parasympathetic innervation is via ______ Afferent transmits: Efferent Transmits:
Vagus nerve sensations of satiety, distension, and nausea sphincter relaxation, peristalsis, and secretion
58
GI sympathetic innervation stems from ______ Afferent transmits: Efferent Transmits:
T5-L2 visceral pain inhibit peristalsis and gastric secretion and cause sphincter contraction
59
What are the results of unopposed vagal tone in the GI system due to neuraxial anesthesia
-Relax sphincters -Increase peristalsis -Increased GI blood flow -20% incidence of N/V -**Reduces postop incidence of ileus in abdominal surgery
60
GU effects from neuraxial anesthesia
-No change in renal blood flow as long as MAP is maintained -addition of neuraxial opioids decrease detrusor contraction and increase bladder capacitance
61
At what level is urinary sphincter tone relaxed?
Sympathetic block above T10 which would mean sensory block at T12-L4
62
How does neuraxial anesthesia affect endocrine system?
it can partially suppress or totally block (lower extremity) neuroendocrine response of elevated cortisol, epi, norepi, vaso, and RAAS activation

Anesthesia Prinicples (4 decks)

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