Neuraxial Anesthesia and Local Anesthetic Flashcards Preview

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Flashcards in Neuraxial Anesthesia and Local Anesthetic Deck (230)
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1

Where does the spinal cord end in adults?

L1-L2

2

Where does the dural sac end in adults?

S2

3

Where does the spinal cord end in children?

L2-L3

4

Where does the dural sac end in children?

S3

5

Name the 7 layers of the spine from skin to CSF

1. Skin
2. Supraspinous ligament
3. Interspinous ligament
4. Ligamentum flavum
5. Epidural space
6. Dura mater
7. Subarachnoid space (contains CSF)

6

the epidural space extends superiorly to the _____ and inferiorly to the _____

foramen magnum

sacral hiatus

7

____ cervical vertebrae
____ thoracic vertebrae
____ lumbar vertebrae
____sacral vertebrae
____ coccyx vertebrae
___ total vertebrae

7
12
5
5
4
33

8

__pair of cervical nerve roots
__ pair of thoracic nerve roots
__ pair of lumbar nerve roots
__ pair of sacral nerve roots
__ pair of coccygeal nerve roots
__total spinal nerve roots

8
12
5
5
1
31

9

As nerve roots exit the spinal canal they are covered by dural sheath.
1.. Roots close to the spinal cord tend to float in the dural sac, and are thus usually (pushed away/ pierced) by an advancing needle
2. Nerve blocks close to the intervertebral foramen carry a risk of ____

1. pushed away

2. subdural injection

10

For adults, what interspace is the most common starting insertion site for a spinal or a lumbar epidural?

L3-L4

11

If an L3-L4 spinal/epidural fails, what interspace should be the next option?

L4-L5

12

If an L3-L4 AND L4-L5 spinal/ epidural fails, what interspace should be the next option?

L2-L3

13

an imaginary line that is drawn between the superior aspects of the iliac crests

Tuffier's line

14

What interspace does Tuffier's line estimate?

L4-L5 interspace
-In order to find L3-4, the anesthetist simply palpates the superior aspects of the iliac crests, and moves up one interspace above Tuffier’s line

15

What does the T10 dermatome represent?

umbilicus

16

What 3 surgeries is a T10 level of analgesia needed for?

1. Spontaneous vaginal delivery
-T10-L1 is the goal dermatome level of a block for laboring patients planning on regular vaginal delivery

2. Inguinal surgery
3. Testicular surgery

17

What does the T4 dermatome represent?

Nipple

18

What dermatome level is needed for a C-section

T4

19

What dermatome level is the most dependent area of the spine when the patient is supine?

T4

20

Why is having the T4 dermatome as the most dependent area of the spine conveneint?

1. if we lay patients supine after a spinal block it will USUALLY go to the perfect height necessary for analgesia for a C-section (T4)

2. It helps prevent the spread of local anesthetic above T4, which helps prevent high spinal or total spinal anesthesia

21

What dermatomes represent vasomotor tone?

T5-L1

22

When ___ nerves are blocked with a spinal or epidural, it causes a sympathectomy

T5-L1

Because spinal blocks will typically settle at T4 in supine patients, virtually all patients laid in the supine position after a spinal block will have some degree of sympathectomy

23

What is the earliest sign of an intense sympathectomy?

nausea and vomiting
-profound hypotension causes nausea

24

how is nausea in a sympathectomy best treated?

by raising the patient's blood pressure

25

sympathectomies are more severe with (spinal/ epidural)

spinal
-Epidural boluses can still produce a sympathectomy (if they happen to rise above T1

26

What dermatomes represent the cardiac accelerator fibers?

T1-T4

27

What happens if the neuraxial block rises above the T4 dermatome?

the patient can have significant bradycardia

28

What dermatome represents the phrenic nerve?

C3-C5

29

What happens if the neuraxial block gets to C3-C5 dermatome level?

the phrenic nerve will be knocked out and the patient will go apneic

30

What dermatomes represent the hands/fingers?

C6-C8