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

Neuraxial Procedure- ChatGPT Flashcards

(42 cards)

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1
Q

What must you always be prepared to do with any neuraxial case?

A

Convert to general anesthesia if:

  • Block fails
  • High spinal develops
  • LAST occurs
  • Anaphylaxis or CV collapse
  • Case outlasts block duration
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2
Q

What key items are included in a spinal kit?

A
  • 3.5” spinal needle (styleted)
  • Introducer
  • Skin LA (1% lidocaine)
  • SAB medication (usually 2 mL)
  • Prep supplies (chlorhexidine or betadine)
  • Drapes
  • Sterile gloves, mask, hat
  • Filter needle
  • 18G and 22G needles
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3
Q

What is the purpose of the filter needle in SAB prep?

A

To draw up spinal medications and prevent contamination/particles from entering the syringe.

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4
Q

What are the three baricity types and their behavior in CSF?

A
  • Isobaric: stays at injection site
  • Hyperbaric: sinks
  • Hypobaric: rises
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5
Q

What are cutting spinal needle types?

A

Quincke, Pitkin

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6
Q

What are non-cutting (pencil-point) spinal needle types?

A

Sprotte, Whitacre, Pencan, Greene, Gertie Marx

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7
Q

What are the advantages of pencil-point needles?

A
  • Lower PDPH risk
  • “Click” or “pop” sensation
  • Less tissue coring/trauma
  • ~<1% PDPH risk
  • ~5% failure rate
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8
Q

What is the correct patient position for spinal block?

A

“Mad cat” — full spinal flexion in sitting or lateral decubitus position.

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9
Q

What confirms needle entry into subarachnoid space?

A

Feeling a ‘pop’ and visualization of free-flowing CSF.

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10
Q

What does the “swirl” test verify?

A

Confirms CSF in syringe after mixing with hyperbaric local anesthetic.

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11
Q

What should you do immediately after SAB injection?

A
  • Lay patient flat
  • Assess BP/HR
  • Monitor dermatome level
  • Reposition early to prevent high spinal
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12
Q

What are common SAB issues? (6)

A
  • No CSF flow
  • No swirl
  • Resistance to injection
  • Paresthesia
  • Blood return
  • Failed or partial block
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13
Q

What does the epidural kit typically contain?

A
  • Prep (chlorhexidine/betadine)
  • Drapes
  • Lidocaine (1% and 1.5% with epi for test dose)
  • Tuohy needle (17–18G)
  • Filter needle
  • LOR syringe
  • Epidural catheter
  • epidural catheter filter
  • Syringes (3, 5, 20 mL)
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14
Q

What are the common epidural needle types and their characteristics?

A
  • Tuohy: 30° curve, blunt tip
  • Hustead: 15° curve
  • Crawford: 0°, for thoracic
  • Weiss: 15° curve + wings
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15
Q

What is the optimal catheter depth in the epidural space?

A

3–5 cm

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16
Q

What are advantages of multi-orifice epidural catheters?

A
  • Better drug spread
  • Lower failure rate
  • Slightly increased IV placement risk
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17
Q

What is the main concern with stiffer plastic catheters?

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A

Easier threading, but higher risk of SAB puncture or trauma.

18
Q

What is the correct direction for Tuohy needle bevel?

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A

Cephalad (upward)

19
Q

How is the epidural space identified?

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A

Loss of resistance (LOR) to air, saline, or both

20
Q

What is the test dose used for epidural placement?

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A

3 mL of 1.5% lidocaine with 1:200,000 epinephrine

21
Q

What indicates intravascular test dose injection?

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A

HR ↑ by 20%, tinnitus, metallic taste, perioral numbness

22
Q

What indicates subarachnoid test dose injection?

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A

Dense motor block within 5 minutes

23
Q

In OB patients, when should the test dose be given?

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A

After a contraction ends for accurate assessment.

24
Q

What is the general epidural loading dose?

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A

1–2 mL per dermatome, given in 5 mL increments

25
When should a top-up dose be given?
Before 2-dermatome regression to maintain block.
26
What is the top-up dose volume relative to the initial dose?
50–75% of the original dose
27
What is the recommended top-up interval for epidural agents?
- Lidocaine: 60 min - 2-chloroprocaine: 45 min - Mepivacaine: 60 min - Bupivacaine/Ropivacaine: 120 min
28
What are common epidural problems?
- Wet tap (CSF) - Paresthesia - Inability to thread catheter - Positive test dose - False positives
29
How is a CSE performed?
- Tuohy needle enters epidural space - Spinal needle passes through Tuohy - Inject spinal dose after CSF confirmed - Hold spinal needle still to avoid dural tear - Thread epidural catheter
30
What is a risk if the spinal sets up too fast before epidural catheter is threaded?
Sacral-only spread or poor cephalad distribution
31
What is a rare complication of CSE?
Epidural catheter may enter the dural puncture site, causing high spinal or total spinal.
32
What are the steps to prepare for a spinal block?
Gather and open spinal kit Apply monitors, oxygen if needed Assist patient into sitting or lateral flexed position ("mad cat") Don sterile gloves, hat, mask Prep and drape the back using chlorhexidine or betadine
33
After skin prep, what are the next steps in spinal block placement?
Infiltrate skin with 1% lidocaine Identify landmarks (L3–L4 or L4–L5 interspace) Advance introducer needle to interspinous ligament
34
How is the spinal needle advanced?
Insert through introducer Advance until "pop" is felt or CSF is seen Confirm free-flowing CSF before injecting drug
35
What is done after CSF confirmation in SAB?
Perform the “swirl” test if using hyperbaric LA Slowly inject drug over 10–15 seconds Remove needle and reposition patient immediately supine
36
What are immediate post-SAB priorities?
Monitor BP, HR, oxygenation Assess block level regularly Be ready to treat hypotension or high spinal
37
What are the steps to prepare for an epidural block?
Open sterile epidural kit Apply monitors and oxygen if needed Assist patient into sitting or lateral flexed position Don hat, mask, sterile gloves Prep and drape back with chlorhexidine or betadine
38
After sterile prep, what comes next in an epidural procedure?
Infiltrate skin with 1% lidocaine Identify desired interspace (commonly L3–4) Insert Tuohy needle midline with bevel cephalad
39
How is the epidural space identified?
Use loss of resistance (LOR) to air or saline while advancing through ligamentum flavum.
40
What is done after LOR confirms epidural space?
Remove syringe Thread epidural catheter 3–5 cm into space Remove Tuohy needle carefully over catheter
41
What is done after catheter placement?
Aspirate for blood or CSF Inject test dose (3 mL of 1.5% lidocaine with epi) Observe for signs of intravascular or subarachnoid injection
42
What should be done if test dose is negative?
Inject initial loading dose in 3–5 mL increments Secure catheter at appropriate depth Monitor block level, BP, HR, and symptoms

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

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