Spinals and Epidurals

Question 1

Resuscitation Equipment

Answer 1

Monitors
Equipment (Spinal or Epidural)
Working IV
Medication
O2
Sedation

Question 2

Absolute contraindications

Answer 2

PATIENT REFUSAL

Lack of Cooperation

Uncorrected coagulopathies

Infection at the site of block

Question 3

Uptake and Spread from Subarachnoid space

Answer 3

Concentration of LA in CSF
Surface area of nerve tissue exposed
Lipid content of nerve tissue
Blood flow to nerve tissue

Question 4

Distribution

Answer 4

Baricity
Position
Dose

Question 5

most common physiologic change?
Treatment?

Answer 5

hypotension and bradycardia

–> fluid bolus and pressers

Question 6

GI sympathetic innervation

Answer 6

T6-L2

Question 7

GI changes

Answer 7

Increased secretions
Sphincters relax
Bowel constricts
Nausea and Vomiting about 20%
Atropine to treat after high spinal

Question 8

Onset, Duration and Dose: Lidocaine

Answer 8

3-5 mins
60 mins
25-50 mg (25-100mg)

Question 9

Onset, Duration and Dose: Tetracaine

Answer 9

3-6 mins
70-180 mins
5-20 mg

Question 10

Onset, Duration and Dose: Bupivicaine

Answer 10

5-8 mins
90-150 mins
5-20 mg

Question 11

Iliac crest location

Answer 11

L4-L5

Question 12

Paramedian approach:

1st resistance?

Answer 12

Needle inserted 1cm lateral and 1 cm inferior to space
-angle needle medially and cephalad

Ligamentum Flavum

Question 13

1st sign of cardiovascular collapse?

Answer 13

Bradycardia, treat aggressively

Question 14

Epidural injection location?

Answer 14

L2-L4

Question 15

Epidural below T4: vasomotor tone controlled by:

Answer 15

T5-L1

decreased venous return, and subsequent decreased CO

Question 16

Epidural: Above T4

Answer 16

T1-T4 cardioaccelerators
profound hypotension and bradycardia

Question 17

Key factor of block coverage?

Answer 17

Volume

Question 18

Adults: __-__ mL for each level to be blocked
______ gets more spread cephalad than caudal
______ even spread up and down

Answer 18

1-2 mL
lumbar
thoracic

Question 19

Height
<5’2” use __mL per level
>5’2” increase by __mL for each 2 inches

Answer 19

1 mL
0.1 mL

Question 20

Pregnancy and Obesity
_______ dose
Epidural vein engorgement and increased adipose tissue

Answer 20

decreased

Question 21

Epidural: advance catheter __-__ cm more

Answer 21

5-7

Question 22

Test dose:

Answer 22

3mL of 1.5% Lido with 15mcg of epi

Question 23

Epidural Dosing: Lumbar

Answer 23

1-2mL per segment
give n 5mL increments q3-5 mins

Question 24

Epidural Dosing: Thoracic

Answer 24

0.7 mL per segment
3-6 mL q 30mins

Question 25

Epidural Dosing: Caudal

Answer 25

3mL per segment

Question 26

Epidural continuous infusion dose:

Answer 26

4-15 mL/hr

Question 27

Local for crashing and burning patient?

Answer 27

Lido 1.5% w/ 1:200,000 epi

Question 28

Anticoagulant DC: Ticlodipine

Answer 28

14 days before

Question 29

Anticoagulant DC: Clopidogrel

Answer 29

7 days before

Question 30

Anticoagulant DC: Abciximab

Answer 30

avoid all together

Question 31

Anticoagulant DC: warfarin

Answer 31

4-5 days before

Question 32

Anticoagulant DC: IV heparin

Answer 32

delay until 1 hour after block, remove catheter 2-4 hours after last dose

Question 33

Anticoagulant DC: LMWH

Answer 33

preop: block 10-12 hours after last dose. high dose = delay 24 hours post-op: 2 hour delay after catheter removal

Question 34

Anticoagulant DC: herbal supplements

Answer 34

5-7 days before surgery

Question 35

Patient SOB: bed?

Answer 35

RT