Techniques for Spinal / Epidural Anesthesia - Exam 1

Question 1

We have to be prepared to do GETA with every neuraxial case due to these 6 things:

Answer 1

-Failed block
-High spinal
-LAST
-Anaphylaxis
-CV collapse
-Case exceeds duration of local anesthetic

Question 2

3 common reasons for failure of blocks

Answer 2

-Wrong location
-Wrong dose
-Wrong position

Question 3

Spinal kit contents (pic)

Answer 3

Question 4

Spinal needle (pic)

Answer 4

Question 5

What two spinal needles are cutting needles?

Answer 5

Quincke
Pitkin

Question 6

4 benefits of a pencil point tip needle in a SAB

Answer 6

-They drag fewer contaminants
-Click or pop can be sensed with them
-Carry significantly less risk of PDPH (<1%)
-Failure rate of only about 5%

Question 7

Spinal procedure steps (pic)

Answer 7

Question 8

8 common problems encountered in SAB

Answer 8

-Lack of free flow CSF when spinning 360 degrees
-No swirl
-Resistance with injection
-Paresthesia
-Checking swirl halfway/end?
-Blood instead of CSF
-No block
-Partial block

Question 9

Epidural kit contents (pic)

Answer 9

Question 10

Which epidural needle has the most curvature?

How many degrees?

Answer 10

Tuohy
30 degrees

Question 11

These epidural needles has a 15 degree curve

Answer 11

Hustead and Weiss

Question 12

This epidural needle is preferred when catheter placement is difficult or the angle is steep (thoracic epidural)

How many degrees is its curvature?

Answer 12

Crawford
0 degrees

Question 13

Which epidural needle has the “wings”?

Answer 13

Weiss

Question 14

What characteristic of the Tuohy needle makes it less likely to puncture the subarachnoid space?

Answer 14

blunt tip

Question 15

On the styleted epidural needle, each mark = ___ cm(s)

The window is the ____ cm mark

Answer 15

• 1
• 10

Question 16

The optimal epidural catheter depth is __-__ cm

Answer 16

3-5

Question 17

Why do multi-orifice catheters have a lower incidence of inadequate anesthesia?

Answer 17

Better distribution of LA spread

However, they have a higher incidence of inadvertent intravascular placement

Question 18

These epidural catheters are stronger and less likely to shear when removed/replaced. Their softer tips reduce inadvertent SAB placement

Answer 18

Coil reinforced catheters

Question 19

You are doing an epidural and reach the epidural space with the needle. 4 cm of the needle is visible. What is the depth of the epidural space?

Where should we secure the catheter?

Answer 19

9 - 4 = **5 cm **

8-10 cm at the skin

Question 20

It is best to perform an epidural on a patient with a lumbar tattoo when the tattoo is ___ months or older

Answer 20

5

Question 21

Epidural procedure steps (pic)

Answer 21

Question 22

What two methods can be used to identify the epidural space?

Answer 22

• LOR
• Hanging drop method

Question 23

What is the composition of the test dose?

Answer 23

3 mL of 1.5% lidocaine mixed with epinephrine (1:200,000)

Question 24

You give the test dose and notice a jump in HR by 20%. What do you suspect?

What should you do?

Answer 24

Accidental IV injection
Replace the catheter

Question 25

What are some symptoms you see after administering a test dose that clue you in that you may be in a vein?

Answer 25

-jump in HR -Tinnitus -Metallic taste in mouth -Numbness around the mouth

Question 26

What are some symptoms you see after administering a test dose that clue you in that you may be in the subarachnoid space?

Answer 26

-Dense motor block within 5 min of test dose | Need to replace the catheter...*probably* unless your hospital is chill

Question 27

How to time the test dose in a laboring patient?

Answer 27

Give after the contraction ends for clearer results

Question 28

If you give a test dose to patients who are on heart medications and your needle is in a blood vessel, you may see an increase in ___

Answer 28

BP!!! >20 mmHg

Question 29

What are the two dosing options to maintain an epidural?

Answer 29

Infusion or bolus dose

Question 30

With an epidural, the initial dose is given in increments of __ mL and you give __-__ mL per segment of the spine that needs to be anesthetized

Answer 30

5 1-2 mL

Question 31

You know it is time for a top up dose of your epidural when the block has regressed ____ segments. How much do you give?

Answer 31

* 2 segments * 50-75% of the initial loading dose ## Footnote Aspirate before each top up dose

Question 32

Recommended "top up time" from initial dose for Lidocaine and Mepivacaine?

Answer 32

60 min

Question 33

Recommended "top up time" from initial dose for 2-Chloroprocaine?

Answer 33

45 min

Question 34

Recommended "top up time" from initial dose for Bupivicaine / Ropivacaine?

Answer 34

120 min

Question 35

6 common problems encountered during an epidural

Answer 35

-CSF "wet tap" -Paresthesia -Unable to thread catheter -Aspiration of blood -Positive test dose -"false positive" test dose

Question 36

With CSE, what do you do first? The spinal or epidural?

Answer 36

You do the spinal then the epidural

Question 37

CSE procedure (pic)

Answer 37