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Spinals / Epidurals
Basics exam 3
| Question | Answer |
|---|---|
| Vertebral column extends from _______ to _________ | Foramen magnum, sacral hiatus |
| How many bones are in each section of the vertebral column? | Cervical = 7. Thoracic = 12. Lumbar = 5. Sacral = 5 fused. Coccygel = 4 fused |
| On the vertebrae the ____ is where the nerve roots will exit & the ____ is where the spinal cord, CSF, & meninges are | intervertebral foramen, vertebral foramen |
| In the vertebral column the spinal nerves come out below the corresponding vertebrae except ____ | C1 - C7 - come out above vertebrae |
| What is the order of vertebral ligaments starting from the skin, moving towards the spine? | supraspinous ligament, interspinous ligament, ligamentum flavum |
| Where the spinal cord ends is called ____ | conus medullaris |
| What is the conus medullaris in adults? In kids? | adults = L1-L2. Kids = L3 |
| Cauda equina is _____ | spinal nerves continue in the dural sac after the conus medullaris |
| Which nerve roots join & exit through intervertebral foramen? | anterior spinal nerve roots, posterior spinal nerve roots |
| Where does the dural sac end in adults? In children? | adults = S2. Children = S3 |
| Dermatome is ______ | each spinal nerve innervates a region of skin |
| C8 dermatome = | 5th digit |
| T1-T2 dermatome = | inner aspect of forearm |
| T4 dermatome = | nipple line |
| T6 dermatome = | xyphoid |
| T10 dermatome = | umbilicus |
| T12 dermatome = | inguinal ligament |
| S1 dermatome = | outer side of foot |
| What is the anatomy of spinal cord? | preganglionic nerves of SNS originate from T1-L2 & travel w/ spinal nerves before forming symp chain which extends the length of spinal column: stellate ganglion, splachnic nerves, & celiac plexus |
| Anterior spinal artery.... | arises from the vertebral artery at the base of the skull & runs along the anterior surface of the spinal cord. Supplies blood to anterior 2/3 of spinal cord |
| Posterior spinal arteries (paired)... | arises from the posterior inferior cerebellar arteries & runs along the dorsal surface of the spinal cord, medial to the posterior nerve roots. Supplies blood to the posterior 1/3 of spinal cord |
| Which 2 arteries also supply the anterior spinal artery? | intercostal & lumbar arteries |
| Artery of Adamkewicz... | arises for the aorta. Major blood supply to the anterior lower 2/3 of the spinal cord |
| A potential space filled w/ adipose tissue, connective tissue, & blood vessels is .... | epidural space |
| Our CSF is located in the _____ aka ____ | intrathecal space AKA subarachnoid space |
| Absolute contraindications are (there are 7): | patient refusal, coagulopathy, infection at injection site, severe hypovolemia, increased ICP, severe aortic stenosis, severe mitral stenosis |
| Relative contraindications are (there are 5): | sepsis, uncooperative pt, demyelinating lesion (ex. ALS), hypovolemia, severe spinal deformity |
| What is spinal anesthesia? | injection of local anesthetic into CSF that bathes the nerve roots in the subarachnoid space causing an interruption of sensory, motor, & sympathetic fiber conduction |
| Spinals are only done in the ____ region | lumbar |
| Spinal anesthetic landmarks are _____ | line between posterior iliac crests, midline is spinous processes, line crosses L4 vertebrae |
| The largest interspace is ____ | L2-L3 |
| In spinal anesthesia, what order are the nerves blocked? | autonomic > sensory > motor |
| In spinal anesthesia, what is the order of blockade from lowest to highest (caudal to cephalad)? | motor blockade, 2 segments up = sensory blockade, 2 segments up = sympathetic blockade |
| The physiologic effects of spinal anesthesia come from _____ | decreased sympathetic tone and/or unopposed parasympathetic tone |
| One of the biggest side effects from high spinal is _____ | slow HR |
| Spinal anesthesia is also called ____ or ____ | subarachnoid block or intrathecal block |
| Position for spinal or epidural is ____ or ____ | sitting w/ back arched or lateral decubitus |
| Monitoring for spinal or epidural is _____ | pulse ox, BP cuff, EKG monitor |
| What size needle is used for epidural? For spinal? | epidural = 17 or 18 gauge. spinal = 22 or 25 gauge |
| Contaminating epidural or spinal needle w/ chloraprep or betadine may cause _____ | aseptic meningitis |
| What "flow" confirms placement of spinal? | free flow of CSF in 4 quadrants |
| What layers will the needle go through in midline approach for spinal anesthesia? | cephalad angle through supraspinous ligament, interspinous ligament, ligamentum flavum "pop", dura |
| What layers will the needle go through in paramedian approach for spinal anesthesia? | 1-2 cm lateral to midline, needle is directed medial & cephalad through paraspinous muscles, ligamentum flavum "pop", dura |
| What 4 factors affect distribution of spinal local anesthetics? | baricity, contour of the spinal canal & pt position, volume & dose of local anesthetic, use of vasoconstrictor |
| 2 Side effects of intrathecal opioids are: | pruritis (95% of the time), & nausea/vomiting (d/t central effects) |
| 2 benefits of intrathecal opioids are: | analgesia w/o loss of motor function, & can be used w/ or w/o local anesthetics |
| Indications for spinal anesthesia are (there are 6): | lower abdominal, inguinal, urogenital, rectal, lower extremity, C-section |
| Complications of spinal anesthesia are (there are 9): | hypotension-vasodilation, bradycardia d/t cardioaccelerator fiber blockade, postdural puncture headache, high spinal, nausea secondary to hypotension or unopposed PsNS activity, urinary retention, backache, transient radicular irritation, cardiac arrest |
| What is a high spinal? | Respiratory compromise & potential inability to control cardiac function |
| Advantages of spinal anesthesia are (there are 6): | complete motor & sensory block, rapid onset, small doses of local anesthetic, ability to use opioid, ability to use a vasoconstrictor, limits risk of PE & DVT |
| Disadvantages of spinal anesthesia are (there are 2): | limited duration of action, total spinal |
| What is a total spinal? | loss of cardiac & respiratory function, resulting in LOC |
| For epidural anesthesia the iliac crests posteriorly intersect which vertebrae? | L4 |
| Epidural anesthesia has a _____ onset & _____ (more/less) dense anesthesia compared to spinal anesthesia | slower onset, less dense anesthesia |
| What is the differential blockade in epidural anesthesia? | motor block is 4 segments lower than sympathetic block, sympathetic block = sensory block |
| What type of surgeries can epidurals be used? | lower abdominal, postpartum tubal ligation, inguinal, C-section, as an adjunct to general anesthesia (ex. large abdominal surgeries) |
| Due to the angle of the vertebrae, for epidural anesthesia the paramedian approach would be best for which region of the vertebrae? | thoracic |
| What is the risk w/ paramedian approach in epidural anesthesia? | may increase risk for vessel cannulation b/c vessels run laterally |
| What is the gold-standard test dose for epidural anesthesia? | 1.5% lidocaine w/ epinephrine 1:200,000 |
| If epidural test dose is placed intravascularly, what will happen? | immediate increase in HR |
| What confirms absence of accidental subarachnoid placement of epidural catheter? | absence of motor or saddle block after 3-5 min |
| What 2 techniques help confirm placement of needle in epidural space? | loss of resistance & hanging drop |
| Distribution of local for epidural placement is due to (2 things): | volume & concentration of local anesthetic, & presence of vasoconstrictor |
| How mL of local anesthetic are needed for each segment to be blocked in epidural anesthesia? | 2 mL |
| What are complications of epidural anesthesia (there are 5)? | hematoma secondary to anticoagulation, infection, catheter shearing, wet tap - dural puncture which results in headache, or total spinal |
| What are 3 advantages of epidural anesthesia? | slower onset, continuous infusion via epidural catheter, postop analgesia |
| What are 5 disadvantages of epidural anesthesia? | more technical skill required, slower onset, less dense motor block, spinal headache, or unilateral block |
| What are the landmarks for caudal anesthesia? | Sacral hiatus (5 cm from tip of coccyx between sacral cornua) |
| What confirms placement of caudal anesthetic? | confirmed by injecting 5 mL air in the skin = crepitus |
| The 1 complication of caudal anesthesia is: | spinal anesthesia |
| What is the 1 advantage of caudal anesthesia? | postop analgesia |
| What are the 2 disadvantages of caudal anesthesia? | difficulty placing - ineffective block, infection |
Created by:
Thommy413
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