spinal and epidural part 1

Question 1

what is regional anesthesia divided into

Answer 1

spinal
epidural
caudal
combined spinal and epidural

Question 2

what 2 meds discussed in lecture CANNOT be given via spinal

Answer 2

zofran
reglan

Question 3

what are clinical indications of regional

Answer 3

sx involving lower abdomen, perineum, lower extremities
orthopedic surgery
vascular surgery on legs
thoracic surgery -epidural
c-section

Question 4

neuraxial anesthesia reduces

Answer 4

narcotic usage
post op ileus
thromboembolic events
bleeding
PONV
respiratory complications
urinary retention

Question 5

benefits of neuraxial anesthesia

Answer 5

great mental alertness
quicker to eat, void, and ambulate
avoid unexpected overnight admission from complications of general anesthesia
quicker PACU discharge
blunts stress response from surgery

Question 6

relative contraindications of neuraxial anesthesia

Answer 6

deformities of spinal column
preexisting disease of spinal cord (MS, post polio)
chronic headache/backache
inability to perform SAB/ epidural after 3 attempts

Question 7

absolute contraindications of neuraxial anesthesia

Answer 7

INR>1.5
plts <100,000 (trends)
nagelhout 2x normal
coagulation disorders or anticoagulants
pt refusal
evidence of dermal site infection
severe or critical valvular heart disease
HSS
operation>duration of LA
increased ICP
severe CHF

Question 8

normal PT and what pathway

Answer 8

12-14 seconds
extrinsic

Question 9

normal INR and pathway

Answer 9

0.8-1.1
extrinsic

Question 10

aPTT normal and pathway

Answer 10

25-32 seconds
intrinsic

Question 11

bleeding time normal

Answer 11

3-7 minuets
plt function

Question 12

when would valvular heart disease be considered severe? critical?

Answer 12

severe- valve area 0.7-1.0 cm2
critical- valve area <0.7cm2

Question 13

why is aortic stenosis a absolute contraindication for regional

Answer 13

decrease in SVR

Question 14

in valvular aortic stenosis what is the life expectancy for a patient with angina? syncope? failure?

Answer 14

5 years
3 years
2 years

Question 15

what is the death spiral

Answer 15

hypotension causes myocardial ischemia
ischemic contractile dysfunction
decreased CO
worsening hypotension
increased ischemia

Question 16

severe CHF contraindication for regional would be when EF is

Answer 16

<30-40%
normal is 60

Question 17

what is the onset for spinal? epidural?

Answer 17

spinal-rapid (5 min)
epidural-slow(10-15min)

Question 18

what is the spread for spinal? epidural?

Answer 18

spinal- higher than expected may extend extracranially
epidural- as expected can be controlled with volume of LA

Question 19

what is the nature of block for spinal? epidural?

Answer 19

spinal-dense
epidural-segmental

Question 20

what is the motor block for spinal? epidural?

Answer 20

spinal-dense
epidural- minimal

Question 21

hypotension is more likely in which regional anesthetic

Answer 21

spinal

Question 22

what is the difference in duration for spinal and epidural

Answer 22

spinal is limited and fixed
epidural is unlimited

Question 23

dosing of LA in spinal and epidural is based on

Answer 23

spinal- dosage
epidural- volume

Question 24

in what type of regional is LA toxicity more common in

Answer 24

epidural

Question 25

what is the anterior segment of the vertebra known as? posterior?

Answer 25

anterior-body posterior - vertebral arch

Question 26

what 2 structures link the anterior and posterior segments

Answer 26

lamina and pedicle

Question 27

what is used as the landmark to find the middle line of the back

Answer 27

spinous process

Question 28

cervical and thoracic spinous process require needle approach from

Answer 28

cephalic (above)

Question 29

what are the symptoms of a facet joint injury

Answer 29

pain and muscle spasm in the area of skin severed by that nerve (dermatome)

Question 30

inferior angle of scapula is located at

Answer 30

T7

Question 31

superior aspect of iliac crest is located at

Answer 31

L4

Question 32

posterior superior iliac spine is located at

Answer 32

S2

Question 33

what is tuffiers line

Answer 33

intercristal line horizontal line runs across the top edge of the hip bones and matches the L4 vertebra

Question 34

in infants the intercristal line corresponds to

Answer 34

L5-S1

Question 35

what is located at the base of the sacrum and aligns with S5 vertebra

Answer 35

sacral hiatus

Question 36

what does the sacral hiatus act as an access point for

Answer 36

caudal anesthesia

Question 37

what is the sacral cornua

Answer 37

landmark for caudal anesthesia

Question 38

what is the conus medullaris and where does it end

Answer 38

spinal cord tapers off at the end ends between L1 and L2 infants L3

Question 39

what is the cauda equina

Answer 39

bundle of spinal nerves extending from conus medullaris to dural sac

Question 40

where does the subarachnoid space end

Answer 40

dural sac S2 in adults S3 in infants

Question 41

filum terminale is

Answer 41

structure that continues downward from the end of spinal cord continuation of pie mater functions to anchor the spinal cord to the coccyx

Question 42

where is the internal filum terminale

Answer 42

begins at the conus medullaris extending to dural sac L1-S2

Question 43

where is the external filum terminale

Answer 43

starts from the dural sac and extends into the sacrum S2-S5

Question 44

blood supply to the spinal cord includes

Answer 44

one anterior spinal artery originating from vertebral artery two posterior spinal arteries originating from vertebral artery

Question 45

anterior spinal artery syndrome can lead to

Answer 45

motor paralysis loss of pain and temperature sensation below affected area

Question 46

what are the 4 causes of ischemia discussed in lecture

Answer 46

low BP mechanical blockage blood vessel disease bleeding

Question 47

what supplies the lower 2/3 of spinal cord

Answer 47

artery of adamkewicz arises from T7-9 and L2 regions

Question 48

name the ligaments in ordered from posterior to anterior

Answer 48

supraspinous ligament intraspinous ligament ligamentum flavum posterior longitudinal ligament anterior longitudinal ligament

Question 49

what ligaments are not included in a paramedic approach that would be in a midline

Answer 49

suprospinous ligament intraspinous ligament

Question 50

what is the order of layers in a midline approach for a spinal

Answer 50

skin subq fat supraspinous ligament interspinous ligament ligamentum flavum dura mater subdural space arachnoid mater subarachnoid space

Question 51

when is a paramedian approach favorable

Answer 51

interspinous ligament calcified or patient cannot flex their spine