Spinal & Epidural Anesthesia

Question 1

Mechanism(s) of local anesthetic action in epidural anesthesia:
A) direct local anesthetic action on nerve roots and spinal cord following local anesthetic diffusion across the dura
B) diffusion of local anesthetic into paravertebral regions through the intervertebral foramina
C) both
D) neither

Answer 1

C. both

Question 2

what are the absolute indications for spinals or epidurals?

Answer 2

none

Question 3

what is the purpose of spinals and epidurals?

Answer 3

Blunt the “stress response” to surgery
Decreases intraoperative blood loss
Lower incidence of postoperative thromboembolic events
Decreased morbidity and mortality in high-risk surgical patients

Question 4

which patient type has instability at the C1 level?

Answer 4

Down’s syndrome

Question 5

what is the first prominent spinous process?

Answer 5

C7

Question 6

At what level does the Illiac Crest cross?

Answer 6

L5

Question 7

what level is the bottom of the scapulae?

Answer 7

T 6-8

Question 8

list the 5 ligaments that support the spine

Answer 8

Supraspinous
Ligamentum Nuchae
Interspinous ligament
Ligamentum Flavum
Longitudinal ligaments

Question 9

Into what space is a spinal inserted?

Answer 9

Subarachnoid

Question 10

The epidural space is superficial or deep to the spinal?

Answer 10

Superficial

Question 11

What are the three layers of protective meninges?

Answer 11

Dura mater
arachnoid mater
Pia mater

Question 12

What effect does the epidural fat have on opioids and lipid soluble local anesthetics?

Answer 12

Reduces the bioavailability

Question 13

At what level does the dura mater terminate?

Answer 13

S2 at Filum terminale

Question 14

What is the purpose of the dentate ligaments?

Answer 14

Anchor the cord in the meninges

Question 15

At what level does the spinal cord terminate in adults? At birth?

Answer 15

L1 in adults

L3 at birth

Question 16

What are the two approaches to spinal anesthesia?

Answer 16

Midline and paramedian

Question 17

What does the paramedian approach bypass?

Answer 17

Supraspinous ligament

Question 18

What can happen if you inject drugs into an epidural too fast?

Answer 18

It may go too high causing respiratory depression and blunting the cardiac accelerator fibers

Question 19

What is the technical term for aspiration before injection into an epidural?

Answer 19

Barbitage

Question 20

What is the treatment for a high spinal?

Answer 20

Supportive and give Epinepherine

Question 21

Why is there a longer sensory than motor block?

Answer 21

Fiber diameter

motor fibers are thicker and have a longer onset and faster offset

Question 22

Why do we check coags before performing a spinal?

Answer 22

Because of the risk of a spinal hematoma

Question 23

Adding epinephrine to a local anesthetic for a spinal would prolong or shorten the duration of action?

Answer 23

Prolong

Question 24

True or false half of you probably will not look at all of these cards

Answer 24

True