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Principles of Anesthesia I (Updated Summer 2025) > Neuraxial Complications- ChatGPT > Flashcards

Neuraxial Complications- ChatGPT Flashcards

(53 cards)

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1
Q

What causes a postdural puncture headache?

A

Persistent CSF leak from a punctured dura lowers intracranial pressure, leading to traction on pain-sensitive structures in the brain.

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2
Q

What are the hallmark features of PDPH?

A

Worse when sitting or standing, relieved when lying down
Starts 2–3 days post-puncture
Frontal to occipital distribution
May be accompanied by nausea, photophobia, diplopia, tinnitus

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3
Q

What factors increase the risk of PDPH?

A

Young age
Female sex
Pregnancy
Use of cutting-tip needle
Larger needle diameter
Use of air for LOR
Needle inserted perpendicular to spine

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4
Q

What are conservative treatments for PDPH?

A

Bed rest
NSAIDs
Caffeine
Hydration

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5
Q

What is the gold-standard treatment for severe PDPH?

A

Epidural blood patch (10–20 mL autologous blood)

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6
Q

When is a blood patch generally avoided?

A

Within 24 hours of dural puncture. Optimal timing is 48 hours post-puncture.

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7
Q

What is the success rate of an epidural blood patch?

A

~90%

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8
Q

What is the SPG block and when is it used?

A

Sphenopalatine ganglion block — a noninvasive, intranasal lidocaine-soaked swab used for PDPH relief when a blood patch isn’t ideal.

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9
Q

What should be done if paresthesia occurs during needle advancement?

A

Stop, redirect the needle — do not inject through paresthesia.

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10
Q

When is nerve injury most likely during neuraxial procedures?

A

In uncooperative or moving patients
When paresthesia is ignored
With CSE techniques

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11
Q

What documentation should be included if paresthesia occurs?

A

Level, laterality, and the response taken (e.g., redirection)

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12
Q

What is the definition of a failed spinal block?

A

No adequate block within 15–20 minutes of administration.

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13
Q

What are causes of failed or patchy spinal anesthesia? (5)

A

Wrong interspace
Inadequate dosing
CSF dilution/bleeding
Equipment malfunction
Anatomic variation

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14
Q

What should be done if a spinal fails completely?

A

Consider redoing the block or converting to general anesthesia.

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15
Q

What are risks of repeating a spinal?

A

Neurotoxicity and high spinal — caution is advised.

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16
Q

What should be done for unilateral block?

A

Reposition patient, then consider IV sedation or conversion to general anesthesia if unresolved.

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17
Q

What are major sources of contamination that can lead to meningitis?

A

Lack of mask
Poor hand hygiene
Failure to follow aseptic technique

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18
Q

What is the most common organism in post-spinal meningitis?

A

Streptococcus viridans (oral flora)

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19
Q

What is the recommended skin prep to reduce meningitis risk?

A

Alcohol + chlorhexidine, allowing full drying to prevent arachnoiditis.

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20
Q

What causes cauda equina syndrome from neuraxial anesthesia?

A

High-concentration LA (esp. 5% lidocaine)
Microcatheters
Direct neurotoxicity

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21
Q

What are clinical features of cauda equina syndrome?

A

Bowel/bladder dysfunction
Saddle anesthesia
Sensory deficits
Back pain, sexual dysfunction, paralysis

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22
Q

What is the treatment for cauda equina syndrome?

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A

Supportive care
Urgent imaging
If compressive lesion: laminectomy within 6 hours

23
Q

What causes TNS after spinal anesthesia?

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A

Sciatic nerve stretch
Lidocaine 5% use
Lithotomy or hyperflexed positioning

24
Q

What are signs and symptoms of TNS?

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A

Severe radicular pain in back, buttocks, and both legs
Onset within 6–36 hours
Resolves in 1–7 days

25
What does NOT increase TNS risk?
Early ambulation LA baricity or concentration
26
What is the treatment for TNS?
NSAIDs Opioids Trigger point injections if needed
27
How should an epidural catheter be removed?
Simultaneously with the needle to prevent shearing.
28
What should be done if the catheter is difficult to remove?
Reposition patient to original insertion position Apply gentle traction Consider tape traction
29
What if a catheter fragment is retained in the body?
Inform patient Monitor if asymptomatic If neurologic symptoms develop: consider surgical removal
30
What does blood in the epidural needle usually indicate?
Lateral placement; redirect toward midline
31
How to manage blood aspiration from catheter?
Slightly withdraw catheter Flush with saline If persistent, replace catheter
32
What increases the risk of epidural vein cannulation?
Multiple attempts Pregnancy Use of stiffer catheters Trauma during placement
33
What are common causes of a unilateral block?
Catheter exiting through intervertebral foramen Tip too close to one-sided nerve root
34
What are solutions to a unilateral epidural block?
Pull catheter back 1–2 cm Reposition patient with the non-blocked side down Inject diluted LA Replace catheter if unresolved
35
What is the most common cause of LAST?
Inadvertent intravascular injection of local anesthetic.
36
What is the most common initial symptom of LAST?
Seizure — though cardiac arrest may occur first with bupivacaine.
37
Why is bupivacaine more cardiotoxic than other agents?
High affinity for voltage-gated Na⁺ channels Slow dissociation from channels during diastole Difficult to resuscitate from bupivacaine-induced cardiac arrest
38
What physiologic factors increase the risk of CNS LAST?
Hypercarbia: ↑ brain delivery & ↓ protein binding Hyperkalemia: ↑ neuronal excitability Acidosis: ↓ seizure threshold & ↑ ion trapping
39
What conditions decrease CNS LAST risk?
Hypocarbia: ↓ cerebral perfusion Hypokalemia: ↓ neuron excitability Use of CNS depressants (e.g., benzos/barbiturates)
40
What are the cardiac effects of LAST?
↓ automaticity, conduction, AP duration Myocardial depression via impaired calcium handling
41
What is the first step in managing LAST?
Airway management with 100% oxygen to prevent hypoxia/acidosis.
42
What is the preferred agent to treat seizures in LAST?
Benzodiazepines (avoid high-dose propofol due to cardiac depression)
43
What modification to ACLS is recommended in LAST?
Use low-dose epinephrine (<1 mcg/kg) Avoid vasopressin Use amiodarone for arrhythmias
44
What is the role of lipid emulsion therapy in LAST?
Sequesters local anesthetic ('lipid sink') Enhances cardiac metabolism and inotropy Inhibits LA binding to sodium channels
45
What is the lipid therapy protocol per 2020 ASRA guidelines for patients >70 kg?
Bolus: 100 mL over 2–3 min Infusion: 250 mL over 15–20 min Repeat bolus if unstable Max dose: 12 mL/kg
46
When should you escalate to cardiopulmonary bypass in LAST?
If lipid therapy and modified ACLS fail.
47
What is the estimated incidence of epidural hematoma?
Rare — ~1:200,000
48
What are risk factors for epidural hematoma?
Coagulopathy or anticoagulation Traumatic/difficult placement Indwelling catheters + anticoagulation
49
What is the key to preventing permanent injury from hematoma?
Prompt diagnosis and laminectomy within 8 hours
50
Why might hematoma symptoms be confused with local anesthetic effects?
Both may cause numbness or weakness — but progressive pain is more specific for hematoma.
51
What causes arachnoiditis in the context of neuraxial anesthesia?
Injection of non-approved substances Preserved or contaminated solutions (e.g., betadine) Chlorhexidine not allowed to dry
52
What are the clinical consequences of arachnoiditis?
Inflammation and fibrosis of the meninges Constricted vasculature → chronic pain, neurologic dysfunction
53
What is the key prevention strategy for arachnoiditis?
Use preservative-free drugs Allow chlorhexidine to fully dry Avoid introducing toxic agents into CSF

Principles of Anesthesia I (Updated Summer 2025) (34 decks)

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