Neuraxial Anesthesia - Exam 1 Flashcards
(30 cards)
Neuraxial anesthesia is beneficial because it reduces these 6 things
-Postoperative ileus
-Narcotic usage
-Thromboembolic events
-Bleeding
-PONV
-Respiratory complications
T or F: Neuraxial anesthesia blunts the stress response from surgery and Neuraxial anesthesia has quicker PACU discharge times
True
Relative contraindications for Neuraxial anesthesia
-Deformities of Spinal Column
-Preexisting disease of the spinal cord
-Chronic headache / backache
-Inability to perform SAB /Epidural after 3 attempts
If you are unable to perform the SAB / Epidural after ___ attempts, stop
3
7 Absolute Contraindications to Neuraxial anesthesia
-Coagulopathy (risk of epidural hematoma)
-Patient refusal
-Evidence of dermal site infection
-Severe or critical valvular heart disease
-HSS (idiopathic hypertrophic subaoeric stenosis)
-Increased ICP
-Severe CHF
Neuraxial anesthesia is contraindicated with a(n):
INR > ____
Platelets < _______
Nagelhouts x ___ (PT, aPTT, bleeding time)
Known coagulation disorder or taking ______
- INR > 1.5
- Platelets < 100,000; consider trends
- Nagelhout x2
- Taking anticoagulants
Normal PT is __ to ___ seconds
12 to 14
Normal INR is __ to ___
0.8 to 1.1
Normal aPTT is __ to __ seconds
25 to 32
Normal bleeding time is ___ to ___ minutes
3 to 7
Normal platelet count is __ to ___
150,000 to 300,000
If you have AS =/< __ cm2 or MS < __ cm2 this is a contraindication to neuraxial anesthesia
- 1
- 1
What is the “death spiral” with aortic stenosis?
-Hypotension causes myocardial ischemia
-Ischemic contractile dysfunction occurs
-Cardiac output decreases
-Hypotension worsens
All of this leads to increased ischemia
Your patient is scheduled for a 1 hour knee replacement. They have CHF with an EF of 25% and exhibit preload dependent HF. Are they a good candidate for neuraxial anesthesia?
NO! Severe CHF with EF <30-40% and preload dependence are absolute contraindications
Spinal vs. Epidural
Onset?
Give times as well
Spinal: Rapid; 5 min
Epidural: Slow; 10-15 min
Spinal vs. Epidural
Spread?
Spinal: Higher than expected; may extend extracranially
Epidural: as expected, can be controlled with volume of LA
Does a spinal or epidural exhibit a dense block, in reference to the nature of the block?
Spinal is dense!
Does a spinal or epidural exhibit a segmental block, in reference to the nature of the block?
Epidural is segmental
Spinal vs. Epidural
Motor block?
Spinal: Dense
Epidural: Minimal
Is hypotension more likely in spinal or epidural anesthesia?
Spinal!!
This is due to sympathectomy; T1-T4 are accelerators
The duration of a ___ block is limited and fixed (spinal or epidural?)
Spinal
Epidural is unlimited
What are the locations the needle can go with a spinal block?
-L3-4
-L4-5
-L5-S1
What level in the spine can an epidural go?
Any!
Are you more likely to have local anesthetic toxicity with a spinal or epidural?
Epidural!
Lots of veins in there
