Regional Techniques Overview 27 May 25 Flashcards
(88 cards)
1
Q
What are the three central neuraxial techniques focused on in this course?
A
Spinal anesthesia, epidural anesthesia, combined spinal and epidural anesthesia (CSE)
2
Q
What is the main goal of using epidural anesthesia as an adjunct to general anesthesia in thoracic surgery?
A
Optimize post-operative pain management
3
Q
List some common clinical indications for spinal anesthesia.
A
- Orthopedic surgery (e.g., knee replacement, hip arthroplasty)
- Vascular surgery on the legs
4
Q
True or False: Regional anesthesia can increase the incidence of post-operative illness.
A
False
5
Q
What are some benefits of regional anesthesia?
A
- Decreases post-operative illness
- Reduces thrombotic events
- Decreases opioid use
- Reduces itching and respiratory complications
- Less urinary retention
- Quicker PACU discharge time
6
Q
Fill in the blank: A relative contraindication is one that __________.
A
depends
7
Q
What are some relative contraindications for regional anesthesia?
A
- Scoliosis
- Pre-existing diseases of the spinal cord (e.g., multiple sclerosis)
- Chronic headache and chronic back pain
8
Q
What is the importance of informed consent in anesthesia?
A
It clarifies potential complications and ensures patient understanding
9
Q
What should be done if a patient refuses regional anesthesia?
A
Respect the refusal as an absolute contraindication for neuroaxial anesthesia
10
Q
What is the maximum number of attempts recommended for administering spinal or epidural anesthesia?
A
Three attempts
11
Q
List some absolute contraindications for regional anesthesia according to the American Society of Regional Anesthesia.
A
- INR greater than 1.5
- Platelet count less than 100,000
12
Q
What is the normal bleeding time range?
A
Three to seven minutes
13
Q
What can chronic back pain lead to when considering spinal anesthesia?
A
Post-dural puncture headache
14
Q
In what scenario might general anesthesia be preferred over regional anesthesia?
A
When it is easier to perform and quicker to manage post-operatively
15
Q
What is the significance of trends in laboratory values for anesthesia?
A
Trends help assess the patient’s risk and suitability for anesthesia procedures
16
Q
Why might a patient with chronic headaches be cautious about receiving spinal anesthesia?
A
Risk of exacerbating their headaches
17
Q
What is the main substance sought during spinal anesthesia administration?
A
Cerebrospinal fluid (CSF)
18
Q
What is a potential complication of opioid use in anesthesia?
A
Increased risk of postoperative nausea and vomiting (PONV)
19
Q
True or False: Epidural anesthesia is usually quicker to administer than spinal anesthesia.
A
False
20
Q
What is the preferred method for anesthesia in most hospitals?
A
General anesthesia
21
Q
What does PT stand for in the context of bleeding time assessment?
A
Prothrombin Time
PT is used to assess blood coagulation, particularly in patients on Coumadin or warfarin.
22
Q
What is the normal range for bleeding time?
A
3 to 7 minutes
Prolonged bleeding time is considered to be 7 to 14 minutes.
23
Q
What does APTT measure?
A
Activated Partial Thromboplastin Time
APTT is primarily used to monitor patients on heparin.
24
Q
What are absolute contraindications for spinal anesthesia?
A
- Severe aortic stenosis
- Severe mitral stenosis
- Length of surgery exceeding safe limits
Aortic stenosis is a critical condition where the diameter is less than 1.0 cm.
25
What are the clinical manifestations of aortic stenosis?
* Angina
* Syncope
* Heart failure
## Footnote
These symptoms are critical in assessing the severity of aortic stenosis.
26
How does hypotension affect patients with aortic stenosis?
It can lead to severe complications
## Footnote
Hypotension is especially dangerous for patients with aortic stenosis.
27
What is a relative contraindication in anesthesia?
A condition that may allow for anesthesia but requires careful consideration
## Footnote
Unlike absolute contraindications, these may be evaluated on a case-by-case basis.
28
What is the maximum duration of surgery for spinal anesthesia?
Typically not advisable for surgeries longer than 2-4 hours
## Footnote
Spinal anesthesia is often limited to shorter procedures due to its single administration nature.
29
What is the difference in action between spinal and epidural anesthesia?
* Spinal anesthesia acts quickly and is dense
* Epidural anesthesia allows for controlled dosing over time
## Footnote
Spinal anesthesia is a single shot, while epidurals can be topped off.
30
What is the typical EF range considered very low?
Less than 30%
## Footnote
An EF (Ejection Fraction) of 10% indicates severe cardiac dysfunction.
31
What is a common effect of spinal anesthesia on heart rate?
Bradycardia
## Footnote
Bradycardia often accompanies hypotension during spinal anesthesia.
32
What is the 'walking epidural'?
An epidural that allows patients to move during labor
## Footnote
This technique is more common in Europe than in the US due to legal concerns.
33
What is a 'wet tap' in the context of epidural anesthesia?
Accidental puncture of the dura mater during placement
## Footnote
This can lead to complications such as post-dural puncture headaches.
34
What factors influence the dosing of local anesthesia in epidurals?
Patient size and length of procedure
## Footnote
Dosing is tailored based on the individual needs of the patient and the type of surgery.
35
What is the typical concentration range for local anesthesia used in epidurals?
0.125% to 0.5%
## Footnote
This is generally lower than concentrations used for spinal anesthesia.
36
What is the primary goal of spinal anesthesia in terms of patient positioning?
Patient should be laid flat after administration
## Footnote
This helps facilitate the spread of the anesthetic.
37
What is the primary use of the PT test?
To monitor patients on anticoagulant therapy
## Footnote
It is crucial for assessing coagulation status preoperatively.
38
What is the typical concentration of local anesthesia for epidural anesthesia?
0.125% to 0.25%
## Footnote
Local anesthesia concentrations vary, with epidural anesthesia being lower than local anesthesia injections.
39
What is a test dose in the context of local anesthesia?
A small initial dose administered to check for correct placement and avoid systemic toxicity
## Footnote
It helps ensure that the local anesthetic is not inadvertently injected into a vein.
40
Why is baricity not an issue in epidural anesthesia?
There is no cerebrospinal fluid (CSF) in the epidural space
## Footnote
Epidural space is a potential space filled with fat and engorged veins.
41
What is the goal of positioning the patient in spinal anesthesia?
To influence the height of local anesthesia spread
## Footnote
For example, positioning can help achieve the desired sensory level for procedures.
42
What are the two segments of each vertebra?
Anterior segment and posterior segment
## Footnote
Understanding these segments is crucial for performing spinal and epidural anesthesia.
43
What should be the approach when inserting the needle for spinal anesthesia?
Always go midline to avoid hitting bone
## Footnote
Being midline ensures proper needle placement and reduces complications.
44
What is the significance of the spinous process in spinal anesthesia?
It serves as a landmark for needle insertion
## Footnote
Proper identification of the spinous process is critical for accurate needle placement.
45
What is the typical volume of local anesthesia administered in an epidural?
12 cc
## Footnote
The volume may be given in incremental doses to ensure safety.
46
What is the purpose of aspirating before administering epidural anesthesia?
To check for placement in a vein and avoid systemic toxicity
## Footnote
This step is crucial to ensure the catheter is in the right space.
47
What anatomical landmark is used for spinal anesthesia?
The two Pierce line or intercristal line
## Footnote
This line is identified using the superior aspects of the iliac crest.
48
What does hyperbaric mean in the context of local anesthesia?
It sinks in relation to CSF
## Footnote
Hyperbaric solutions are used to control the spread of anesthesia.
49
True or False: In spinal anesthesia, sensory and pain travel together with temperature.
True
## Footnote
This relationship is important for assessing the effectiveness of anesthesia.
50
What is the typical sensory target level for a C-section under spinal anesthesia?
T4
## Footnote
Achieving the correct sensory level is crucial for effective anesthesia during surgery.
51
Fill in the blank: The epidural space is a _______ space.
potential
## Footnote
Understanding the nature of the epidural space is essential for safe anesthesia administration.
52
What is the role of the posterior superior iliac crest in anesthesia procedures?
It serves as a landmark for needle insertion
## Footnote
Identifying this landmark helps in accurate placement for spinal anesthesia.
53
What happens if the needle is not positioned midline during spinal anesthesia?
It may hit bone and cause complications
## Footnote
Proper technique is critical to avoid unnecessary pain and injury.
54
What should be done if difficulties arise in finding the right needle entry point?
Readjust the position slightly and reattempt
## Footnote
A small adjustment can significantly affect needle placement.
55
What is the landmark used for spinal anesthesia?
Intercristal line (also known as two Pierce line)
## Footnote
This is the traditional term used in spinal anesthesia.
56
Where do the S5 vertebrae of the sacrum fuse?
The S5 vertebrae are not fused
## Footnote
This is important for understanding the anatomy during anesthesia.
57
What is the landmark for caudal anesthesia?
Sacral Cornu
## Footnote
The needle is inserted at the center of the sacral hiatus.
58
What is the difference between spinal anesthesia and caudal anesthesia?
Spinal anesthesia involves CSF; caudal anesthesia is an epidural technique
## Footnote
Caudal anesthesia is performed below S2 where CSF is not present.
59
What is the typical ending point of the spinal cord?
Conus medullaris, usually between L1 and L2 vertebrae
## Footnote
This is clinically significant for administering spinal anesthesia.
60
What is the cauda equina?
A bundle of nerve roots extending from L2 to S5
## Footnote
It resembles a horse's tail.
61
How many nerves are associated with each vertebral level?
Two nerves per level (right and left)
## Footnote
This is important for understanding nerve distribution.
62
What is the blood supply to the spinal cord?
One anterior spinal artery and two posterior spinal arteries
## Footnote
The anterior artery supplies motor function; the posterior arteries supply sensory function.
63
What ligaments does the needle traverse during spinal or epidural anesthesia?
Anterior longitudinal ligament and posterior longitudinal ligament
## Footnote
These ligaments are traversed from the back during the procedure.
64
What does the ligamentum flavum feel like when traversed by a needle?
Greasy texture
## Footnote
This sensation indicates proximity to the epidural or subarachnoid space.
65
What approach is used for spinal or epidural anesthesia?
Midline approach
## Footnote
It is essential for proper needle placement.
66
True or False: Epidural anesthesia is performed in the subarachnoid space.
False
## Footnote
Epidural anesthesia is performed in the epidural space, not the subarachnoid space.
67
What is the relationship between spinal anesthesia and the epidural space?
Spinal anesthesia passes through the epidural space to reach the subarachnoid space
## Footnote
This is important for understanding the technique.
68
What is the significance of the dural sac in relation to CSF?
The dural sac ends at S2 in adults and S3 in infants
## Footnote
CSF is not found below S2.
69
Fill in the blank: The sacral hiatus is located at the _______.
Center of the sacral Cornu
70
What is the typical clinical use of caudal anesthesia?
Pain management during procedures like hemorrhoidectomy
## Footnote
It can be used as an alternative to general anesthesia.
71
What happens to sensory or motor function if there is a problem with the anterior spinal artery?
Sensory or motor problems may occur
## Footnote
This is particularly relevant in surgeries involving the aorta.
72
What mnemonic can help remember the structures traversed in a midline approach?
Skin, Subcutaneous tissue, Ligamentum flavum, Dura mater, Subarachnoid space
## Footnote
Creating mnemonics can aid in memorizing the sequence.
73
What is the difference in anesthesia technique for patients with scoliosis?
Needle placement is adjusted due to spinal curvature
## Footnote
This requires careful consideration in the procedure.
74
What is the difference between spinal anesthesia and epidural anesthesia in terms of the space they target?
Spinal anesthesia targets the subarachnoid space, while epidural anesthesia targets the epidural space.
## Footnote
Spinal anesthesia is also known as intrathecal anesthesia.
75
What is the anatomical landmark that indicates the transition from epidural to spinal anesthesia?
The dura mater, which is penetrated during spinal anesthesia but not during epidural anesthesia.
76
Which space is referred to as a potential space that can expand?
Epidural space.
77
What sensation indicates that the needle has reached the subarachnoid space during spinal anesthesia?
A 'pop' sound when the dura is penetrated.
78
What should you do if you hear a pop sound while performing an epidural?
You should stop because it indicates you have gone too far and are in the subarachnoid space.
79
Fill in the blank: The epidural space contains _______ and fatty tissues.
[air]
80
What are the signs that spinal anesthesia may not be working?
* No hypotension
* No sensory blockade
* No motor blockade
* No numbness after 10 minutes
81
What is the typical dose of lidocaine with epinephrine?
7 mg per kg.
82
What should be prepared at the bedside when performing spinal or epidural anesthesia?
General anesthesia setup, including drugs and equipment.
83
What is the clinical significance of knowing that veins are located on the lateral side of the epidural space?
If blood is aspirated during needle insertion, it indicates the needle is on the lateral side and should be repositioned to midline.
84
True or False: The epidural space is filled with cerebrospinal fluid (CSF).
False.
85
What is the term used to describe veins that drain blood from the spinal cord?
Bat's flexes.
86
What should you do if you aspirate blood while performing an epidural?
Pull the needle out and go midline.
87
What type of anesthesia is used when the medication is delivered in the intrathecal space?
Spinal anesthesia.
88
What is the potential consequence of administering an epidural anesthetic too deep?
It may result in a spinal anesthesia effect, leading to unintended side effects.
