Regional- Spinal (subarachnoid) Neural Blockade Flashcards Preview

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Flashcards in Regional- Spinal (subarachnoid) Neural Blockade Deck (91)
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1

what is the front of the spinal cord called?

Anterior

Ventral

2

what is the back of the spinal cord called

Posterior

Dorsal

3

what is the area where the spinal nerves exit called 

Facet joint

4

cervical nerves exit where?

above the vertebrae

5

all other nerves exit where?

below the vertebrae

6

what is the 1st and 2nd cervical vertebrae

  1. Atlas
  2. Axis

Remember "t" comes before "x"

7

In a supine pt where are the high points of the spine

C3

L3

8

In the supine pt where are the low spots of the spine

 

T6

S2

 

9

the spinal cord extends from the ____ _____ to the Lumbar level ___ in the adult and ____ in the newborn

Foramen Magnum

L1 (adult)

L3 (newborn)

10

by what age should the newborns Spinal cord be at the adult level 

2 yo

11

the cord terminates where?

conus medullaris

12

how many cervical vertebrae are there?

7

13

how many thoracic vertebrae are there?

12

14

how many lumbar vertebrae are there?

5

15

how many sacral vertebrae are there?

5

16

how many coccygeal vertebrae are there?

4

17

how many pairs of spinal nerves are there

31

18

where is the spinal cord the wideest

L2

19

where is the spinal cord the narrowest

C5

20

what is the nerve group in the lower dural sac L1- S5 termed

Cauda Equiuna (horses Tail)

21

what is the area between S4 and S5 termed and what do we use it for?

Sacral Hiatus

Caudal Block

22

is a caudal block grouped as a spinal or epidural?

Epidural

23

what is total CSF volume

100-150ml (go with 150mL)

24

how much CSF is in the subarachnoid

25-30mL (1/5)

25

How much CSF is produced daily?

500mL

26

what is normal CSF pressure?

10-20 cmH20

27

what are the layers of the spinal meninges form outer to inner?

Dura matter

Arachnoid matter

Pia matter

28

what 2 things absorb CSF

arachnoid villi

arachnoid granuloma

29

the subarachnoid space lies where?

between the arachnoid and pia matter

30

the principle site of actin for neuraxial blockade is where

the nerve root

31

where is CSF found

the subarachnoid space (b/t the arachnoid matter and pia matter)

32

the sacral coccygeal membrane is an extension of what?

ligamentum flavum

33

pic of the layers of the meninges

 

34

vasoconstrictors prolong duration of spinal block how? who's law?

decreased absorption

ficks law

35

what are 10 factors that effect the distribution of the drug in a spinal 

  • Site
  • Anatomical shape of spinal column
  • Height
  • Angilation of needle
  • Volume of CSF
  • LA (dnesity/specific gravity/baracity)
  • Dose
  • Volume
  • Position of pt during injection
  • position of pt after injection

 

 

36

so volume of CSF affects the distribution of spinal anesthesia.. what happens to speed with inccreased CSF? and Decreased CSF

Increased CSF = Decreased speed

Decreased CSF= Increased speed

37

what is the specific gravity of CSF

1.004 - 1.009

think of james bond 007 (and your in the middle)

38

SG of CSF is 1.004-1.009

what is isobaric?

Hyperbaric?

Hypobaric?

Iso- SG = CSF SG

Hyper SG > CSF SG (follows gravity)

Hypo SG

39

what % of the bodies blood is in the venous side? arterial side?

75% venous

25% arterial

40

with a spinal you get venodilation... what does that do to preload?

decreases it 

41

although sympathetic preganglionic neurons send signals to smooth muscles of both arteries and veins, the predomiant action of sympathetic blockade d/t LA is what?

Venodilation

42

if the sympathetic outflow from T1- T4 is blocked by LA, unapposed vagus stimulation will produce what? and what is this reflex termed?

bradycardia

Bainbridge reflex

43

the best means for treating hypotension during spinal anesthesia is what

physiologic not pharmacologic

AKA give fluids

44

if pt is normovolemic and still has hypotension what is the best pressor

ephedrine

45

volume for initail treatment of hypotension is from balanced salt solutions that do NOT contain glucose. administer volume in increments of how much?

5 mL/kg

46

why would you not want to replace volume with glucose in the hypovolemic hypotensive pt

glucose is a diuretic and can worsen the hypovolemia

47

if apnea occurs with a high spinal it is often d/t hypoperfusion of the repiratory centers in the medulla secondary to severe hypotension. what should u do?

treat the pressure and usually it will fix it self

48

what are the 3 groups with the least reserve and at the highest risk for hemodynamic compromise with regional anesthesia?

peds

elderly

Very sick

49

what are 3 symptoms of cauda equina syndrome?

lower extremity weakness

bowel and bladder dysfunction

50

what are the 2 cutting needles used

QuinKe BadcocK

PitKin

"k" for th C sound in Cutting

51

Picture of cutting needles

 

52

what are 3 non cutting needles for spinals

Greene

whitacre

sprotte

(Pecan also used  not shown here)

53

picture of NON cutting

 

54

how should you inseert the needle with a cutting needle

Turn tip paralle to fibers

never caudal or cephalad

55

how long should a pt be off ASA before getting a spinal

no need to be off ASA for spinal! 

56

Pts receiving heparin IV before sx should not receive spinal untill what?

normal aPTT documented

57

when using a spinal and intraop heparin will be used . how long post spinal should u wait until you should give heparin

1 hour

58

what is the magical number for INR with coumadin therapy to either place a spinal or remove a catheter?

59

pts receiving fibrinolytics or thrombolytic drug therapy should not receive neuraxial for how many days

10 days

60

Anterior dermatome: name landmark

C4

 

clavicle

 

61

Anterior dermatome: name landmark

T4-T5

 

Nipples

 

62

Anterior dermatome: name landmark

T6 (to T8)

Xiphoid

63

Anterior dermatome: name landmark

T8

Lower border of rib cage

64

Anterior dermatome: name landmark

T10

Umbilicus

65

Anterior dermatome: name landmark

L1

inguinal ligament

66

Anterior dermatome: name landmark

L2-L3

Knee and below

67

Anterior dermatome: name landmark

S2-S5

Perineal

68

Posterior dermatome: name landmark

C7

most prominant cerivial spinous process

69

Posterior dermatome: name landmark​

T7

inferior boarder of scapula (lower tip)

70

Posterior dermatome: name landmark​

L4

Iliac crest (superior)

Tuffier's line

Intercristal line

71

Posterior dermatome: name landmark​

S2

Posterior superior iliac spine

72

Name Indications for spinal anesthesia

  • Full stomach
  • Anatomic distortions of upper airway
  • TURP
  • OB
  • Decreased Post op pain
  • Continuous infusion

 

73

Name some ABSOLUTE contraindications to spinal

  • Infection at site of injection
  • Patient Refusal
  • Severe Aortic stenosis
  • Dematologic conditions
  • Shock or severe hypovolemia
  • Increased ICP
  • Blood clotting abnormalites

74

name all the structures the needle passes through for a Subarachnoid block (midline) from posterior to interior

  • ​Skin
  • subcutaneous tissue
  • SupraSpinous Ligament
  • Intraspinous ligament
  • Ligamentum Flavum
  • (epidural space)- not a real space
  • Dura matter
  • arachnoid matter

75

the lateral approach for a SA block will not pass through what 2 structures just listed for the midline approach?

Supraspinous ligament

intraspinous ligament

76

how many vertebraes does the spinal column have

33

77

what is the purpose of the stylet in the spinal needle

gives structure

does NOT allow tracking of cells from skin into CSF

78

what is the most common complication of Spinal

back ache

79

what is the 2nd most common complication of spinal

headache

80

whendoes the spinal headache usually set up

12-72 hours later

81

what are some of the risk factors for spinal headache

Large needles

Cutting needles

Female

Young

OB

Bevel perpendicular

82

Complications w/ spinal: infection

what are some predisposing factors to infectio

advanced age

DM

Alcoholism

Cancer

AIDS

83

Complications w/ spinal: infection

what are the classic signs of infection

High fever

nuchal rigidity

Severe Headache

84

Complications w/ spinal: infection

what does the s/s of infection from spinal resemble

Meningitis

85

Complications w/ spinal: infection

what is the most common causative organism 

staphylococcus aureus

86

Complications w/ spinal: infection

with a PDPH why do you get diplopia

d/t traction on cranial nerves

87

what are s/s of PDPH

  • nausea (loss of appetite)
  • Photophobia
  • Changes in auditory acuity
  • tinnitus
  • Depression
  • "feel miserable"
  • tearful
  • bed-ridden
  • diplopia
  • cranial nerve palsies

88

what causes a PDPH

decreased amount of CSF in SA space, causes medulla and brainstem to drop into the foramen magnum, stretching the menengies, vessels, and nerves

89

what is a fix for PDPH

Blood patch

90

what comfirms PDPH versus all other potential diagnosis

the postural element

91

what is conservative therapy for PDPH?

Caffeine (cerebral vasoconstriction)

Lying flat

Hydration

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