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ANE 8509 principles of anesthesia > spinal and epidurals neuraxial anesthesia physiology (exam one) > Flashcards

spinal and epidurals neuraxial anesthesia physiology (exam one) Flashcards

(63 cards)

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1
Q

Spinal anesthesia location

A

subarachnoid space of the spinal cord

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2
Q

Spinal anesthesia target

A
  • acts on myelinated preganglionic fibers of the spinal nerve roots
  • inhibits neural transmission in the superficial layers of the spinal cord
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3
Q

epidural anesthesia location

A

in the epidural space outside the dura mater

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4
Q

epidural anesthesia diffusion and leakage

A

diffusion: through the dural cuff to reach nerve roots
leakage: can leak through the intervertebral foramen into the paravertebral area

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5
Q

what determines the block height in spinal or epidural space

A

the spread of local anesthetic

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6
Q

controllable factors that affect the spread of local anesthetic- spinal

A

barcity
patient position
dose
site of injection

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7
Q

non-controllable factors that affects the spread of local anesthetics- spinal

A
  • volume of csf
  • increased intra-abdominal pressure(obesity, pregnancy )
  • age (elderly)
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8
Q

what does not affect the spread of local anesthetics- spinal

A
  • barbotage (repeated aspiration and reinjection of CSF)
  • speed of injection
  • orientation of Bevel
  • addition of vasoconstrictor
  • gender
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9
Q

The most reliable factor affecting how far and wide the anesthetic spreads when using a hypo or isobaric solution depends on? (spinal)

A

dose

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10
Q

for hyperbaric solutions what is crucial in determining how it spreads for spinal

A

relative density of the anesthetic to CSF

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11
Q

what correlates to extensive spread of LA in intrathecal space for spinal

A

low csf volume

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12
Q

what happens to LA and CSF volume with advanced age for spinal

A

neural nerves are vulnerable to LA and CSF volume decreases

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13
Q

Pregnancy effect on CSF volume for spinals

A

decrease csf volume due to increased intraabdominal pressure

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14
Q

significant controllable factors for epidural that affects spread

A

local anesthetic volume
level of injection
local anesthetic dose

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15
Q

most important drug related factor that affects spread of LA in epidural

A

local anethetic volume

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16
Q

most important procedure related factor that affect spread of LA in epdiural

A

level of injection

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17
Q

non-controllable factors that affect spread of LA in epidural

A

pregancy
old age

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18
Q

controllable factors that have a small effect on spread in epidural

A

local anesthetic concentration
patient position

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19
Q

non-controllable factors that have a small effect on spread for epidurals

A
  • height (taller or shorter stature may slightly affect spread)
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20
Q

what does not affect the spread of local anesthetics in epidurals

A

additives in the anesthetic
direction of the bevel of the needle
speed of injection

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21
Q

what might the additives in the anesthetic change in epidurals

A

onset of time and duration

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22
Q

injecting the lumbar region in epidurals spreads which way

A

cephalad

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23
Q

injecting the mid thoracic region in epidurals spreads which way

A

balanced between cephalad and caudad

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24
Q

injection in the cervical region in epidurals spreads which way

A

caudad

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25
nerve fibers table, slide 46
26
what refers to how different types of nerve fibers have varying sensitivites to local anesthetics, affecting the level of block achieved
differential blockade
27
sensory blockade occur at what concentration of LA and whats the result
lower concentration of LA that doesnt affect motor neurons results in higher block level compared to motor block
28
what is autonomic blockade
requires even lower concentration of LA than sensory.
29
does autonomic blockade affect sensory or motor
both leading to the highest level ob blockade
30
what are the arrangement of nerves and their function
B= autonomic preganglionic fibers(venodilation, hypotention) C= pain and temperature A-delta= pain and temperature A-gamma= motor tone A-beta = touch and pressure A-alpha= motor and proprioception
31
sensory level is
2 levels above motor level
32
sympathetic level is
2-6 levels higher than sensory level
33
put in order what is blocked first to last between temperature, pain and touch or pressure
1. temperature 2. pain- assessed with pinprick 3. touch or pressure- light touch/pressure sensation
34
what are the levels of the modified bromage scale
0-no motor block 1. slight motor block- patient cant raise an extended leg but can still move the knees and feet 2. moderate motor block- the patient cannot raise an extended leg or move the knee but can move the feet 3. complete motor block. the patient cannot move the legs, knees, or feet.
35
the modified bromage scale evaluates
the function of lumbosacral nerves (lower spine and sacral nerve areas)- does not assess movement above these regions
36
what are the systemic effects of neuraxial anesthesia cv
decreased preload- sympathectomy leads to venodilation decreased afterload- arterial dilation decreased cardiac output -due to decreased venous return and SVR decreased heart rate- blocking of cardiac accelerator fibers
37
heart rate in neuraxial anesthesia decreases due to
blockade of cardiac accelerator fibers activation of reflexes: bezold jarisch reflex, reverse bainbridge reflex
38
Bezold jarisch relfex is mediated by
5HT3 receptors in the vagus nerve and ventricular myocardium
39
Reverse bainbridge reflex is triggered by
reduced stretching of hearts right atrium
40
initial response of neuraxial anesthesia in cardiac output
may initially increase then decrease over time due to changes in blood vessel dilation speeds
41
unopposed parasympathetic tone to the cardioaccelerator fibers can result
bradycardia hypotension sudden cardiac arrest
42
sudden cardiac arrest can be seen in
young adults with high parasympathetic tone
43
sudden cardiac arrest can occur how long after onset of spinal
20-60 mins
44
sudden cardiac arrest is associated with
large blood loss and orthopedic cement
45
prevention of spinal anesthesia induced hypotention
vasopressors 5HT3 antagonists- mitigate reflexes fluid management positioning
46
fluid management for spinal anesthesia induced hypotension
Coloading: administering iv fluids right after spinal block prevents drop in bp Avoid preload: pre block hydration has minimal impact on preventing hypotension Avoid excess fluids: overload the circulatory system
47
what positions can help to prevent hypotension
slight pelvic tilting
48
Treatment of spinal induced hypotension
**vasopressors:** ephedrine and epinephrine **anticholinergic** **fluids**: crystalloids or colloids position: trendelenburg position
49
the systemic effects of neuraxial anesthesia in pulmonary
minimal impact on tidal volume, RR, ABG decreased ERV small decrease in vital capacity blockade of accessory muscles from high thoracic blockade
50
special consideration for pulmonary in neuraxial anesthesia
use caution in copd, pickwickian syndrome feelings of dyspnea from loss of sensory feedback loss of ability to take big breaths and strong cough
51
Apnea occurs from neuraxial anesthesia as a result of
reduced blood flow to the brainstem, affecting the brains breathing pattern High concentrations of LA in the spinal fluid that causes nerve paralysis stopping breathing (rarely occurs)
52
parasympathetic effects that occur from neuraxial anesthesia
**Parasympathetic Afferent**: transmits sensations of saitety, distention and nausea **Parasympathetic Efferent**: tonic contractions, sphincter relaxation, peristalsis and secretion
53
sympathetic effects that occur from neuraxial anesthesia
**sympathetic afferent**: transmits visceral pain **sympathetic efferent**: inhibits peristalsis and GI secretion causing sphinicter contraction and vasoconstriction
54
sympathetic innervation of GI tract stems from
T5-L2
55
impact of neuraxial anesthesia on GI
* reduces sympathetic tone * increases parasympathetic activity * changes in unopposed vagal tone
56
changes in unopposed vagal tone
* relaxes sphincter * increases peristalsis * small contracted gut with active peristalsis * increased GI blood flow * nausea /vomitting (20% of pts) * reduces postoperative incidence of ileus in abd surgery
57
neuraxial anesthesia effects on renal blood flow
* no change in renal blood flow when map is maintained
58
sympathetic blockade above T10 affects
bladder control- relaxed urinary sphincter
59
addition of neuraxial opiods:
* decrease in detruser contraction * increase in bladder capacitance
60
The changes that occur from neuraxial anesthesia effects on GU lead to
* urinary retention/incontinence * need for foley catheter with neuraxial anesthesia
61
# systemic effects of neuraxial anesthesia on metabolic/endocrine Activation of somatic and visceral afferent fibers from pain, tissue trauma and inflammation causes
* elevated cortisol * epinephrine * norepinehrine * vasopressin * activation of raas
62
neuraxial blockade can partially suppress (major invasive surgery) or totally block (lower extremity)
neuroendocrine response
63
maximal benefits of neuraxial anesthesia on metabolic/endocrine occurs
if the neuraxial blockade occurs before the surgical stimulus

ANE 8509 principles of anesthesia (5 decks)

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