Regional Exam II Flashcards by Jenn Weinschenk

Injection location

(spinal vs. epidural)

spinal - lumbar only

epidural - anywhere

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duration of block

(spinal vs. epidural)

spinal - brief

epidural - longer

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Which has a better quality of block, spinal or epidural?

spinal

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sacral hiatus

unfused opening between S4 and S5

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T₇-T₈ Landmark

lower limits of scapulae

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C₇ landmark

bony knob at base of neck

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L₂ Landmark

terminal point of 12^th ribs

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L₄ Landmark

Iliac crest

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S₂ Landmark

posterior iliac spines

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what connects the epidural space with the paravertebral space?

foraminae

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Maximal depth of epidural space

6 mm at L₂

(only 4-5 mm in the midthoracic area)

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plica mediana dorsalis

connect dura mater to the ligamentum flavum

(may not even exist)

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(5) complications to discuss with patient

nerve damage
bleeding
infection
headache
failed block

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Which type of block would be performed in a perineal surgery?

spinal

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One should probably not attempt a spinal above _____

L₃ - L₄ interspace

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Which type of needles are more likely to cause PDPH?

beveled

(Quincke)

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Two types of Pencil-point Spinal Needles

Whitacre and Sprotte

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Which spinal approach is independent of patient flexion?

Taylor

star 1 cm medial and caudal to PSIS
advance cephalad at 55^o with medial orientation

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Which spinal approach is best suited for narrow interspaces or difficulty with flexion?

Paramedian

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Level and duration of spinal are primarily determined by _____

baricity, contour of spinal canal, and patient position

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Epinephrine in spinals

vasoconstricts, decreasing the spread, and has some alpha-2 analgesia

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Tetracaine in spinals

major vasodilation

(vasopressors have a profound effect)

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Bupivacaine in spinals

decreases spinal and dural blood flow

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Dose of Lidocaine for spinals

60-75 mg

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Dose of Chloroprocaine for Spinals

40-60 mg

Dose of Bupivacaine for spinals

5 - 20mg

Which one is more profoundly affected by vasoconstrictors? Tetracaine or Bupivacaine

Tetracaine

Opiates in spinals

affect the dorsal horn usually 25 ug of Fentanyl

Dose of Tetracaine for spinals

5 - 20 mg

Sensory level for Hemorrhoidectomy

S₂ - S₅

Sensory level for Foot surgery

L₂ - L₃

Sensory level for lower Extremities

L₁ - L₃

Sensory level for Hip, TURP, or vaginal delivery

T₁₀

Sensory level for Lower abdomen or Appendectomy

T₆ - T₇

Sensory level for upper abdomen or C-section

T₄

Anything above ____ inhibits SNS to the GI tract

First-line drug to treat hypotension in Spinals

Ephedrine

Blood Patch

15 - 20 mL injected at or below the site, as the blood will travel cephalad

Warning sign of hypotension and stroke during spinal

nausea

Hypotension in Spinals

occurs in ¹/₃ of patients initially due to decreased SVR

Most common epidural needle

Tuohy

Most common approach for lumbar epidural

midline

Two techniques to identify epidural space

loss of resistance or hanging drop

Test dose

3 cc of 1.5% lidocaine with 1:200,000 Epi

Caudal blocks

epidural injections placed through the sacrococcygeal ligament and sacral hiatus

Sacral Hiatus is absent in \_\_\_\_% of patients

Difference between Lumbar and Thoracic epidurals

Lumbar tends to flow cephalad due to negative intrathoracic pressure, whereas thoracic stays in place

What will cause spread of local in epidurals?

negative intrathoracic pressure

Intermediate duration LA

lidocaine

Which LA is not effected by Epinephrine?

Bupivacaine

Epinephrine in Epidurals

prolongs duration (especially if chloroprocaine or lidocaine) * may accentuate the fall in blood pressure

Sodium Bicarbonate with Epidurals

promotes more rapid onset

If epidural anesthesia has "partially failed, " consider \_\_\_\_

injecting small doses of chloroprocaine

Which LA has a higher risk of absorption or intravascular injection?

Bupivacaine

Major site of action for an epidural

nerve roots

Neuraxial blocks results in a sympathectomy ____ dermatomes above the sensory block

2 - 6

Bainbridge Reflex

stimulation of right atrial stretch receptors leads to vagal afferent stimulation of medulla and subsequent inhibition of parasympathetic activity (increase HR)

(3) mechanisms that effect heart rate

* bainbridge reflex * direct effect on the SA node elicited by atrial stretching * anesthesia of T_1-4 cardioaccelerator fibers

Cardiovascular effects of Neuroaxial Anesthesia

arterial and venous dilation and decreased preload and HR

Which drug should be considered in parturients instead of Epi or ephedrine

phenylephrine

Risk of headache after accidental dural puncture with an epidural needle is \_\_\_\_

about 50%

(6) Risk Factors for PDPH

* beveled needle (quinke) * larger needle * female * pregnant * young * history of headaches

Order of block sensitivty

temperature \> SNS \> pain \> touch \> motor (first to last to go)

Anesthetic effects of central blocks

* decrease MAC * produce sedation * potentiate hypnotics

location of cardioaccelerators

T_1-4

Epidural with epinephrine seems to cause _____ hypotension than without Epi

What are two major factors affecting block height?

baricity and patient position

Spinal blocks wear off in a ______ direction

cephalad to caudad (thus sacral lasts longer than thoracic)

Higher blocks usually wear off _____ than lower blocks

faster

\_\_\_\_\_ agonists can prolong a spinal block

adrenergic

Reduce anesthetic dose by _____ if working on upper dermatomes

30-50% | (rksk of cephalad spread is increased)

Caudal is more similar to an epidural or spinal?

epidural

Spinal is injected into the \_\_\_

subarachnoid space

subarachnoid space is a continuous space that contains \_\_\_\_\_

CSF, spinal cord, and conus medullaris

Where does the subarachnoid space end?

conus medullaris at the sacral hiatus

termination of spinal cord

usually at L1 | (L3 in pediatrics)

Dorsal (posterior) roots are responsible for \_\_\_\_

sensory blockade

Anterior (ventral) roots are responsible for \_\_\_\_\_

motor blockade

total CSF in adults

100 - 150 mL

CSF volume in subarachnoid space

25 - 35 mL

specific gravity of CSF

1.0003 - 1.0006

Supraclavicular Nerves

branches of the superficial cervical plexus (C₃-C₄) * provides cutaneous innervation at the shoulder

Suprascapular Nerves

C₅ and C₆ provides sensory innervation to posterior/superior shoulder and anterior axilla

Intercostobrachial Nerves

T₂ * often used to treat tourniquet pain

Axillary Block

Infraclavicular Block

Interscalene Block

Supraclavicular Block

Regional Exam II Flashcards

(89 cards)