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Regional Anesthesia > LA - Neuraxial/Subarachnoid > Flashcards

LA - Neuraxial/Subarachnoid Flashcards

1
Q

Total number of vertebrae

A

33

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2
Q

Types of vertebrae

A
  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacral (5)
  • Coccygeal (4)
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3
Q

How many pairs of spinal roots are there?

A

31

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4
Q

Spinal portions - convex anteriorly

A

Cervical + Lumbar

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5
Q

Spinal portions - convex posteriorly

A

Thoracic + Sacral

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6
Q

Spinal cord ends at

A

Adults - L1

Infants - L3

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7
Q

Conus medullaris

A

where SC terminates

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8
Q

Horses tail

A

cauda equina

-lumbar + sacral roots from L2-coccygeal region

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9
Q

end of epidural space

A

sacral hiatus

-5th sacral vertebra not fused dorsally

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10
Q

How to identify sacral hiatus?

A

Sacral cornu - 2 bony prominences on both sides of hiatus

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11
Q

All vertebrae except 1 have____

Which vertebrae does not have the above?

A
  • anterior body
  • 2 pedicles that project posteriorly
  • 2 lamina that connect pedicles
  • C1
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12
Q

Where is the spinal cord located?

A

spinal canal

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13
Q

what forms the spinal canal?

A

2 lamina that connect pedicles

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14
Q

Where is the supraspinous Ligament thickest and broadest?

A

Upper Lumbar region

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15
Q

What is after the Ligamentum flavum?

A

Epidural Space

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16
Q

What is the epidural space bound to posteriorly?

A

Ligamentum Flavum

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17
Q

Where is a spinal placed?

A

Subarachnoid

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18
Q

Where is CSF located?

A

Subarachnoid space

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19
Q

Where does SC end in adult?

A

L1

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20
Q

Arachnoid/subarachnoid space ends at

A

S2

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21
Q

Spinal nerves - how many pairs?

A

31

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22
Q

Where do spinal nerves exit the spine?

A
  • C1-C7 exit above respective vertebra
  • C8 exits below C7 vertebra
  • All other spinal nerves (T1 and below) exit below respective vertebra
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23
Q

How many cervical spinal nerves are there?

A

8 pairs

despite only 7 cervical vertebra

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24
Q

Cervical spinal nerves exit

A
  • C1-C7 nerves exit above body of corresponding vertebrae

- C8 nerve exits below C7 body

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25
Q

Blood supply to spinal cord is supplied via

A

1 anterior spinal artery

2 (paired) posterior artires

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26
Q

The anterior spinal artery supplies

A

anterior 2/3 of cord

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27
Q

The posterior spinal arteries supply

A

posterior 1/3 of cord

28
Q

Additional blood supply to spinal cord is supplied via

A

radicular arteries

29
Q

Biggest radicular artery

A

Artery of Adamkiewicz

arteria radicularis magna

30
Q

Artery of Adamkiewicz

(arteria radicularis magna) supplies which portion of spinal cord?

A

anterior lower 2/3

31
Q

injury or hypoperfusion of Artery of Adamkiewicz

(arteria radicularis magna) can result in

A

anterior spinal artery syndrome

32
Q

principle site of action for neuraxial anesthesia

A

nerve root

33
Q

During a spinal, where does sensory/autonomic blockade occur?

A
  • Sympathetic fibers more easily blocked so segmental blockade occurs
  • sympathectomy is 2 vertebral spaces above point where sensory blockade occurred
34
Q

Diaphragm is innervated by which nerve?

A

C3, 4, 5 (phrenic nerve exits)

“keep the diaphragm alive”

35
Q

Cardiac accelerator fibers are innervated by which nerve?

A

T1-T4

36
Q

CVS side effects during spinal

A
  1. decreased BP (T5-L1) - peripheral pooling

2. decreased HR (T1-T4: cardioaccelerator fibers) - inhibits compensatory vasoconstriction above blockade

37
Q

Tx: hypotension d/t spinal

A
  1. Fluids (peripheral pooling)

2. Phenylephrine (sympathectomy)

38
Q

1st sign of hypotension

A

N/V

39
Q

Neuroendocrine effects of neuraxial block

A

Blunts stress response (attenuates surgical stimulation)

-evidenced by cortisol levels

40
Q

Spinal Blockade: Location of Sympathetic, motor, sensory

A

Motor block: T-8
Sensory: T-6
Sympathetic: T-4

41
Q

Epidural Blockade: Location of Sympathetic, motor, sensory

A

Sympathetic/Sensory = same level
Motor block: T-10
Sensory + Sympathetic: T-6

42
Q

Biggest hematologic risk of neuraxial anesthesia

A

epidural hematoma

43
Q

Contraindications to neuraxial anesthesia

A 
CHIN
Coagulopathy
Hypotension
Infxn/Increased ICP
No
44
Q

Coagulopathic - contraindications

A

INR < 1.5

Platelets 50-100

45
Q

Which anticoagulants should be held prior to neuraxial?

A

Heparin IV
Warfarin
Plavix
Eliquis

46
Q

Which anticoagulants do not need to be held prior to neuraxial?

A

ASA, NSAIDs, Heparin SubQ

47
Q

Heparin IV - how does this effect neuraxial?

A

hold 4-6h prior to insertion of catheter

Resume 1h after removal

48
Q

Warfarin - how does this effect neuraxial?

A

INR < 1.5 prior to placement of catheter

49
Q

Plavix - how does this effect neuraxial?

A

Clopidogrel

Hold 7d prior

50
Q

Eliquis - how does this effect neuraxial?

A

Apixiban
Hold 26-30h prior
Resume 4-6h after
*monitor Anti-Factor Xa

51
Q

What should be available prior to starting neuraxial?

A

Airway management

Resuscitation: IV, IVF, ACLS Rx, pressors

52
Q

Hyperbaric LA

  • depends on
  • drug moves
A

Higher specific gravity (denser) than CSF

Drug moves caudad (to “down” side)

53
Q

How to make LA hyperbaric

A

+ glucose/dextrose (8.25% dextrose)

54
Q

Hypobaric LA

  • depends on
  • drug moves
A

Lower specific gravity than CSF (lighter)

Drug moves cephalad (“up” side)

55
Q

How to make LA hypobaric

A

Add sterile H2O

56
Q

Which baricity is preferred?

A

More common: hyperbaric

57
Q

CSF specific gravity

A

1.003-1.008

58
Q

Isobaric

A

same specific gravity as CSF

-stays where you inject

59
Q

Pt laying down, hyperbaric neuraxial injected, where will LA go?

A

Cephalad because pt laying down, going “down” is actually towards head

60
Q

Pt with broken hip - which hip is placed onto operating table?

A

broken hip down onto OR table

61
Q

How to block unilaterally

A

Operative side down + hyperbaric LA

62
Q

Midline approach for SA block passes thru

A 
Skin
SubQ
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural space ** 
Dura Mater 
Arachnoid mater
Subarachnoid Space**
63
Q

Paramedium Approach

A 
*miss supra/interspinous ligaments
Skin 
SubQ
Ligamentum flavum
Epidural space ** 
Dura Mater 
Arachnoid mater
Subarachnoid Space**
64
Q

L4 anatomical landmark

A

iliac crest

65
Q

1st resistance felt in paramedian approach

A

Ligamentum Flavum

66
Q

PDPH is related to

A

larger needles

-also cutting needles, more common w/ epidural

Regional Anesthesia (4 decks)

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