TEST - in general from PRODIGY

Question 1

MILLILITER dose range for LA dosing for caudal anesthesia

Answer 1

0.5-1.0mL / kg

Question 2

define ‘field block’

Answer 2

injection of large amount of LA into SQ to block cutaneous nerves

Question 3

popliteal blocks disrupt transmission in the _____ n.

Answer 3

sciatic

Question 4

popliteal block and ______ n. blocks will provide complete anesthesia below knee.

Answer 4

saphenous

Question 5

After spinal, pt. has RR 16bpm, SpO2 100%, c/o dyspnea… where is block level?

Answer 5

T2-T4 blocks indicate sensory loss to chest wall movement = dyspnea despite WNL RR… C2-C3 will result in denervation to phrenic nerve and intercostal muscles = hypoxia, hypercarbia, respiratory arrest

Question 6

spinal epidurals occur in this order: the _______ is inserted first then the ________ is performed 2 interspaces below

Answer 6

epidural, spinal

Question 7

ANTERIOR border of epidural space? POSTERIORLY?

Answer 7

believe it or not, ANT. is posterior longitudinal segment and POS. is vertebral lamina and ligamentum flavum

Question 8

lumbar spinal peaks at which interspace?

Answer 8

L3

Question 9

INJECTION of hyperbaric spinal @ L3 means the drug will spread which direction?

Answer 9

caudal and cephalad since L3 is the peak

Question 10

what nerve fibers/ spinal column level innervate urinary bladder tone

Answer 10

S2-S4

Question 11

caudal anesthesia is good below whiche level?

Answer 11

level of umbilicus

Question 12

spinal-epidural rationale for labor pain… which is first?

Answer 12

spinal for early, epidural for active labor

Question 13

what cardiac condition is C.I. for neuraxial anesthesia

Answer 13

aortic stenosis

Question 14

pregnant patients receive what fraction of spinal anesthetic than non-pregnant patients?

Answer 14

1/3 less

Question 15

epidural blood patch: how much autologous blood and where?

Answer 15

15mL one interspace below level of dural puncture

Question 16

epidural opioids exert effects on receptors at which LAMINA (2) aka the ___________ ___________.

Answer 16

II and III aka substantia gelatinosa

Question 17

epinephrine, clonidine, and phenylephrine dosing to prolong spinal

Answer 17

epi = 0.1-0.2ml 1:1000 
clonidine = 75-100mcg
phenylephrine = 2-5mg (no way but this is from PRODIGY)

Question 18

appropriate opioid dosing for morphine, fentanyl and sufenta in spinal blocks

Answer 18

FENTANYL = 10-25 mcg
SUFENTA = 10mcg
preservative free MORPHINE = 250mcg

Question 19

epidural catheter needle placement (BL and unilateral)

Answer 19

cephalad for BL, 45 towards side you wish to blck

Question 20

epidural DC’d ___ hours prior LMWH dosing

Answer 20

2

Question 21

SAS (subarachnoid space) extends to __-___ in adults and __-___ in kiddos

Answer 21

S2-S3, L1-L3

Question 22

SPINAL-epidural blocks: injection of epidural anesthetic does what to your previously doses spinal anesthetic?

Answer 22

increases block height

Question 23

which areas/level of spinal column are MOST dependent when supine

Answer 23

T4-T8

Question 24

SCIATIC nerves divides into which two n.? Superior or inferior to popliteal fossa?

Answer 24

tibial & common peroneal n. and superior to knee

Question 25

popliteal artery lateral to semiTENDONosis tendon? T or F

Answer 25

True dat

Question 26

PDH relieved in which posish'

Answer 26

supine

Question 27

is patient age a C.I. for spinal anesthesia?

Answer 27

nope

Question 28

primary innervation of PENIS

Answer 28

PUDENDAL

Question 29

SCIATIC nerve roots are

Answer 29

L4-S3

Question 30

spinal anesthesia DURATION determined by

Answer 30

dose and LA chosen (opioids increase duration too)

Question 31

caudal anesthesia: more likely to have intrathecal anesthesia in kiddos or adults? why?

Answer 31

kids, d/t epidural sac extension to S3 in kids

Question 32

caudal anesthesia covers

Answer 32

procedures below diaphragm - rectal, inguinal, lower extremity surgery

Question 33

sacral hiatus is insertion point for CAUDAL anesthesia... it's location is b/t

Answer 33

S4 and S5

Question 34

epidural space is largest at what level of spinal column (general)

Answer 34

LUMBAR

Question 35

PABA is? found in what LA?

Answer 35

PARA-aminobenzoic acid in ESTER local anesthetics

Question 36

femoral n. block which is most lateral? n., artery, vein?

Answer 36

n.

Question 37

first pop in spinal is? second?

Answer 37

ligamentum flavum, dura mater

Question 38

cardiac arrest s/p spinal indicated by what symptoms? caused by a blockade of which fibers at T1-T5

Answer 38

bradycardia & hypotension, cardioacceleratory

Question 39

things that increase likelihood of PDPH... list em'

Answer 39

young females, multiple attempts, large gauge needle use

Question 40

insertion of needle 2cm medial and caudal to anterior iliac spine and injecting 10-15mL LA after entering fascia lata you are blocking which n.?

Answer 40

lat. femoral cutaneous n.

Question 41

hyperbaric spinal is placed @ L3, which direction will it travel if patient remains sitting position? Caudal, cephalad, both?

Answer 41

caudal for a 'saddle block'

Question 42

paramedian approach - which part of vertebrae would you likely encounter first? Pedicle? spinous process, lamina, or transverse process?

Answer 42

lamina

Question 43

most common pediatric neuroaxial anesthetic?

Answer 43

caudal

Question 44

most common SE of epidural anesthetics?

Answer 44

urinary retention

Question 45

most common SE for morphine epidural anesthetic? bupivicaine?

Answer 45

MORPHINE - pruritis | BUPIVICAINE - hand weakness followed by hypotension

Question 46

which n. prevents ADDUCTION of legs?

Answer 46

obturator

Question 47

which position is best for a combined spinal/epidural technique? sitting, standing on head, lateral, prone?

Answer 47

SITTING

Question 48

popliteal n. located __________ (in space) to popliteal artery?

Answer 48

laterally

Question 49

which n. block in combo w/ popliteal fossa n. block would completely (when done right) would completely anesthetize the foot?

Answer 49

SAPHENOUS n. - remember, we are blocking the SCIATIC n. prior to jump off point of TIBIAL and PERONEAL branches... what remain is the terminal branch of the femoral n.

Question 50

which spinal needle is a 'cutting' needle?

Answer 50

Quincke

Question 51

**IMPORTANT PENIS INNERVATION STUFF B/C WE HAVE PENISES** : What n. block the penis?

Answer 51

pudendal, genitofemoral, and ilioinguinal

Question 52

saphenous n. can be blocked posterior to to medial malleolus? TRUE or FALSE

Answer 52

FALSE - anterior

Question 53

epidural segmental spread is directrly related to _______ (DOSE, POSITION, VOLUME, or BARICITY)

Answer 53

VOLUME - REMEMBER, spinals are DOSE dependent

Question 54

how much epinephrine is in an epidural test dose lidocaine?

Answer 54

EPI - 15mcg lido - 45 mcg or 3ml of 1.5% lido (15mgml) and 1:200,000 epi

Question 55

3 part question on spinal blockade sympathectomy. 1. What levels block cardioaccelatory fibers? 2. What does cardioaccelatory blockade cause? 3. A sensory block at T6 means autonomic (sym) block at T_ and motor at T_.

Answer 55

spinal anesthesia cause sympathomemectomy which causes venous pooling via dilation of venous capitance vessels (minimal arterial dilation) AKA: venodilation. Cardioaccelatory blockade occurs b/t T1-T4 - so watch out for BRADYcardia and decreased contractility. T4 and T8 respectively

Question 56

SYMPATHECTOMY is results in

Answer 56

unopposed VAGAL activity (parasympathetic),

Question 57

SLUDGE is the handy acronym for crazy PNS crap what does it mean?

Answer 57

Salivation: stimulation of the salivary glands Lacrimation: stimulation of the lacrimal glands Urination: relaxation of the internal sphincter muscle of urethra, and contraction of the detrusor muscles Defecation: relaxation of the internal anal sphincter Gastrointestinal upset: Smooth muscle tone changes causing gastrointestinal problems, including diarrhea Emesis: Vomiting

Question 58

sympatholysis d/t neuroaxial anesthetics do what to the GI tract?

Answer 58

peristalsis = generalized constriction of bowel, increased bloodflow, increased intralumen pressure

Question 59

Tip of the scapula (shoulder blade duh) corresponds w/ which thoracic vertebrae?

Answer 59

T7

Question 60

most prominent cervical vertebrae is?

Answer 60

C7

Question 61

tip of twelfth rib corresponds w/ which thoracic vertebrae?

Answer 61

L1

Question 62

iliac crest corresponds w/ which thoracic vertebrae?

Answer 62

L4

Question 63

sacral cornua, coccyx, and pos. sup. iliac spines are all good surface anatomy markers for?

Answer 63

caudal anesthesia

Question 64

Caudal anesthesia: are paresthesias, and 'fullness' normal senstations w/ injection?

Answer 64

yep

Question 65

What is the cause of APNEA w/ spinal anesthesia? treatment?

Answer 65

from the lack of perfusion to brainstem... corrected w/ hemodynamic resuscitation