Define neuraxial anesthesia
A local anesthetic placed anywhere in the spinal column
What is intrathecal
The fluid filled space immediately surrounding the spinal column
When was cerebral spinal fluid first identified?
1764 by Cotugno
A fluid filled pocket inside the spinal cord is also known as what?
Syrinx
What provides stability to the spine when bending over?
Ligamentum flavum
What is the dermatome at the level of the nipple?
T4
What is the dermatome at the level of the kidneys and uterus?
T10
What is the dermatome at the level of the vaginal introitus?
S2/S3
True or false: sensory pathways can ascend up to two levels higher than the organ there innervating
True
Name the five factors that you can alter in an epidural?
Location Rate Drug Concentration Adjuncts
What is the therapy index?
When more anesthesia is required to have a complete motor and sensory block instead of just finding the comfort zone
Rate of infusion is determined by what?
Distribution of the local!
In what order do local anesthetics affect the nerves?
Sympathetic
Sensory
Motor
The patient is complaining that they are too numb and cannot move, which should you address? the concentration or the rate?
Concentration
What is preload?
The act of administering a bolus of 1 to 2 L immediately prior to placing a neuraxial block
What is coload?
The administration of 1 to 2 L of fluid as a block is in the process of setting up
What is the purpose of coload?
It lowers the rate of hypotensive events
What type of needle is used for epidurals?
Touhy needle
What is the difference between a cutting needle and a splitting needle?
A cutting needle creates space via a semi-lunar cut
A splitting needle is more of a “shotgun” approach and creates an inflammatory response
The loss of resistance method is used for epidurals or spinals?
Epidurals
What do you do when you’ve dosed the catheter and no block is seen?
Replace it
The patient is complaining that they’re only feeling the block on one side what may have happened?
The catheter may be in too far
Patient may have been lying on one side too long
They may have a septated epidural space
What are some possible causes of a patchy block?
There is a window caused by air around the nerve root
There could be an anomaly in the epidural space preventing local anesthetic penetration
The malpresentation could be resulting in compression of a single nerve root
Following the placement and bolus of the epidural the patient’s blood pressure has fallen to 80s / 30s. What should you do?
Check for decreased fetal heart tones and other signs of inadequate perfusion
Left uterine displacement
Pressers and a fluid bolus
True or false: Both ephedrine and phenylepherine cross the fetal blood barrier
False only ephedrine crosses the fetal blood barrier
What is the Valsalva maneuver?
The act of “pushing” the baby out
Which receptor is the cause of pruritis?
μ receptor
What are some possible treatments for post opioid pruritus?
Zofran can possibly reduce
Nubain
Narcan drip
