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Regional Anesthesia > LA - Epidural > Flashcards

LA - Epidural Flashcards

1
Q

Which has a higher incidence of PDPH: spinal or epidural?

A

spinal

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2
Q

Cause of PDPH

A

Leakage of CSF from dura/arachnoid

-needle size correlated w/ incidence/intensity of HA

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3
Q

Wet tap

A

epidural inserted too far

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4
Q

Which has lower incidence hypotension: epidural or spinal? Why?

A

Epidural

  1. strength of autonomic blockade not as strong
  2. spinal has higher autonomic blockade than sensory (epidural is same level)
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5
Q

Main site of action for epidural LA

A

nerve root

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6
Q

Which has slowest onset: SAB or Epidural?

A

Epidural

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7
Q

Why does epidural have slower onset?

A

LA has to diffuse accross dura (meninges) to reach nerve root

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8
Q

Important characteristic of epidural veins

A

valveless

  • located lateral to midline, anterior
  • higher risk of hitting w/ paramedial approach
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9
Q

Pregnant individuals + those with increased intra-abdominal pressure have what alteration in epidural area

A

Engorged epidural veins, decreased epidural volume

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10
Q

How far in should epidural catheter be secured?

A

Additional 5cm from where loss of resistance is felt.

i.e. Catheter says 5 when loss of resistance felt: secure at 10 cm

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11
Q

Epidural catheter should be positionef

A

bevel UP

-so catheter migrates cephalad

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12
Q

primary limiting membrane for epidural

A

arachnoid mater

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13
Q

Epidurals cause what type of blockade?

A

Segmental

-nerve roots closest to site of injection are blocked/anesthetized best

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14
Q

Spread of spinal anesthetic is dependent on

A
  1. baricity
  2. position of patient
  3. dose (not as much)
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15
Q

Spread of epidural anesthesia is dependent on

A

volume

*only isobaric LA

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16
Q

2 main differences between spinal and epidural

A

Epidural:

  1. onset of sympathetic block is slower (less likely to have abrupt HOTN)
  2. Sympathetic block @ same level as sensory, motor block = 4 levels below
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17
Q

Sequence of blockade

A
  1. peripheral vasodilation + HOTN
  2. Loss of pain + temp
  3. Loss of proprioception
  4. Motor weakness
  5. Paralysis
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18
Q

Peripheral vasodilation + HOTN occurs d/t blockade of which fibers?

A

B Fibers

19
Q

Loss of pain + temp occurs d/t blockade of which fibers?

A

A-delta + C fibers

20
Q

Loss of proprioception occurs d/t blockade of which fibers?

A

A-alpha

21
Q

Motor weakness occurs d/t blockade of which fibers?

A

A gamme

22
Q

Paralysis occurs d/t blockade of which fibers?

A

A-beta

23
Q

How do you know you’re in the epidural space?

A

Loss of resistance
“LOR”
(past Ligamentum Flavum)

24
Q

How far in should catheter be placed for epidural?

A

10 cm

  • Epidural space: 4-6cm from skin
  • want 3-5 cm catheter inside epidural space
25
Q

After LOR felt, describe next steps of epidural placement

A
  1. Remove stylet from needle
  2. Attach syringe, verify no blood/CSF
  3. Note distance on needle - insert catheter 1 cm at a time
  4. Resistance felt at tip of needle, continue 3-5cm
  5. Withdraw needle, maintain catheter at insertion site
26
Q

After epidural catheter is placed, what must be done?

A

Tape catheter over shoulder to confirm no movement of catheter even if patient is moved

27
Q

Unable to thread catheter - what to do

A

Rotate needle, try to advance catheter again

28
Q

If epidural placed, aspiration shows blood - what is happening?

A

Epidural is in vein - remove! Try again

29
Q

What must be done every time epidural catheter is accessed?

A

Aspirate for minimum 5 seconds
Good = nothing seen
Bad = blood (vein) or CSF (SA space)

30
Q

What is done to confirm placement of epidural?

A

Epidural test dose

31
Q

Why is an epidural test dose performed?

A

To confirm placement

-aspiration may apply negative pressure + result in false negatives

32
Q

Epidural test dose consists of

A

3mL 1.5% Lidocaine + 5mcg/mL Epi (1:200,000)

33
Q

After test dose - what is seen if catheter is intravascular?

A

HR increases 10-15% within 1 min

*pt having contractions: perform after contraction

34
Q

After test dose - what is seen if catheter is intrathecal?

A

Sacral anesthesia develops w/in 3-5min tested by pin prick

35
Q

Epidural dosing may begin when?

A

After test-dose administered + verified catheter is in epidural space

36
Q

Epidurals should be administered how

A

Dose in 3-5 cc increments

-intermittent injection or continuous infusion

37
Q

Key determinant for height (spread) of epidural block

A

Volume of LA given

38
Q

Key determinant for density/completeness of block

A

Concentration of LA

39
Q

Tx: High/total spinal

A

supportive, 100% fiO2, intubate, fluids, pressors

  • avoid vasopressin
  • avoid more LA (Lido) obvi
40
Q

Epidural hematoma - s/s

A

sudden onset**
bilateral complaints (chief sign)
leg/back pain
lower extremity weakness

41
Q

Epidural hematoma dx

A

CT scan

42
Q

Epidural hematoma Tx

A

surgical decompression w/in 12h

43
Q

most common cause of PDPH

A

dural puncture “wet tap”

44
Q

PDPH Tx

A

Epidural blood patch

Regional Anesthesia (4 decks)

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