Podcast
Questions and Answers
What is a potential cause of inadequate anesthesia during neuraxial blocks?
What is a potential cause of inadequate anesthesia during neuraxial blocks?
What complication can result from an excessive dose of local anesthetic during spinal or epidural anesthesia?
What complication can result from an excessive dose of local anesthetic during spinal or epidural anesthesia?
Which of the following symptoms indicates a high spinal block?
Which of the following symptoms indicates a high spinal block?
What immediate treatment is recommended for patients experiencing hypotension due to high spinal blockade?
What immediate treatment is recommended for patients experiencing hypotension due to high spinal blockade?
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Intravascular injection of local anesthetic can result in which of the following?
Intravascular injection of local anesthetic can result in which of the following?
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What should be done if a patient exhibits signs of hypotension during neuraxial anesthesia?
What should be done if a patient exhibits signs of hypotension during neuraxial anesthesia?
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Which patient population may require reduced doses of local anesthetic due to sensitivity?
Which patient population may require reduced doses of local anesthetic due to sensitivity?
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What is the primary focus of managing a 'total spinal' or high spinal block?
What is the primary focus of managing a 'total spinal' or high spinal block?
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What anatomical landmark is significant for performing neuraxial blockade to avoid spinal cord injury in adults?
What anatomical landmark is significant for performing neuraxial blockade to avoid spinal cord injury in adults?
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What condition may lead to a clinically significant spinal hematoma?
What condition may lead to a clinically significant spinal hematoma?
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What is a primary symptom of meningitis that may arise from contamination during neuraxial block procedures?
What is a primary symptom of meningitis that may arise from contamination during neuraxial block procedures?
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Which of the following is a sign of a spinal epidural abscess?
Which of the following is a sign of a spinal epidural abscess?
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In the case of a healthy female patient who desires spinal anesthesia, which factor is a consideration?
In the case of a healthy female patient who desires spinal anesthesia, which factor is a consideration?
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After the induction of anesthesia, what is an appropriate initial management step if the blood pressure drops to 80/45?
After the induction of anesthesia, what is an appropriate initial management step if the blood pressure drops to 80/45?
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What potential complication can occur due to trauma to the nerve roots during surgery?
What potential complication can occur due to trauma to the nerve roots during surgery?
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What key measure should be employed to minimize the risk of contamination during neuraxial blocks?
What key measure should be employed to minimize the risk of contamination during neuraxial blocks?
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What is a potential effect of extremely high levels of local anesthetics on the cardiovascular system?
What is a potential effect of extremely high levels of local anesthetics on the cardiovascular system?
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What is the most effective initial treatment for post-dural puncture headache (PDPH)?
What is the most effective initial treatment for post-dural puncture headache (PDPH)?
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What complication is most likely to occur in male patients undergoing neuraxial blocks?
What complication is most likely to occur in male patients undergoing neuraxial blocks?
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Which factor is NOT associated with an increased incidence of post-dural puncture headache?
Which factor is NOT associated with an increased incidence of post-dural puncture headache?
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What is the primary goal of treatment for complications arising from extremely high levels of local anesthetics?
What is the primary goal of treatment for complications arising from extremely high levels of local anesthetics?
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What is the common origin of postoperative backache following neuraxial blocks?
What is the common origin of postoperative backache following neuraxial blocks?
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What is a potential complication of neuraxial blocks that involves injury to the spinal cord?
What is a potential complication of neuraxial blocks that involves injury to the spinal cord?
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Which of the following is NOT a conservative treatment option for post-dural puncture headache?
Which of the following is NOT a conservative treatment option for post-dural puncture headache?
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Study Notes
Neuraxial Anesthesia Review
- Neuraxial anesthesia involves procedures like spinal and epidural blocks.
- Preoperative preparation includes determining the type of surgery (elective or mandatory), preparing for general anesthesia (GA), collecting medical history (medications, allergies, etc), and monitoring vital signs.
- Steps include explaining the procedure, sterile positioning, injection, and repositioning.
- Postoperative monitoring of vitals is crucial.
Complications of Neuraxial Blocks
- Inadequate Anesthesia/Analgesia: Failure rates are inversely proportional to clinician experience. Factors include needle movement during injection, incomplete needle placement, and diminished anesthetic potency.
- High Neural Blockade: Excessive dose or individual sensitivity can lead to exaggerated blockade, affecting upper extremities, causing dyspnea, potentially leading to hypotension, bradycardia. "High spinal" (total spinal) involves cranial nerves and results in unconsciousness, apnea, hypotension.
- Intravascular Injection: Accidental injection of local anesthetic into blood vessels results in very high serum levels, affecting the central nervous system (seizure, unconsciousness) and the cardiovascular system (hypotension, arrhythmias).
- Urinary Retention: Local anesthetic blocking S2-S4 nerve roots decreases bladder tone and inhibits voiding reflex. Epidural opioids can also interfere, particularly in males. Urinary catheterization is often required.
- Backache: Needle passage through tissues can cause varying degrees of tissue trauma, leading to bruising, inflammation, and possible reflex muscle spasms, which can cause postoperative back pain. This is often mild and self-limited.
- Post-dural Puncture Headache (PDPH): Characterized by bilateral, frontal/occipital pain, throbbing, photophobia or nausea. Pain is aggravated by standing/sitting, relieved by lying down. Onset usually 12-72 hours post procedure.
- Neurological Injury: Direct nerve root or spinal cord injury is possible, particularly if neuraxial blockade is performed too high. Postoperative peripheral neuropathies can result, with some cases being permanent.
- Spinal/Epidural Hematoma: Trauma can cause minor epidural bleeding, but significant hematoma may occur with coagulation disorders, causing compression of neural tissue, ischemia(lack of blood-flow), and symptoms like back and leg pain, motor weakness, and sphincter dysfunction. Surgical intervention is often required.
- Meningitis and Arachnoiditis: Infection is possible due to contaminated equipment/solutions or skin organisms. Presents with pain and neurologic symptoms. Strict sterile technique is essential.
- Epidural Abscess: Spinal epidural abscess (EA) is a rare devastating complication. Symptoms typically include back pain, nerve root/radicular pain, motor/sensory deficits, sphincter dysfunction, and fever.
Case Studies
- 26-year-old male for knee arthroscopy: Both general and neuraxial anesthesia are options.
- 55-year-old smoker, female with hip replacement: Anesthetic choices include general, spinal, and combined spinal-epidural, considering the patient's hypertension, diabetes, and pre-existing conditions.
- 22-year-old female for Cesarean section (CS): Assessment of coagulopathy, hydration status, and managing hypotension is critical if spinal anesthesia is chosen.
- 60-year-old male with cervical disc herniation: Treatment options involving analgesics, physiotherapy, and cervical epidural injections could alleviate pain/symptoms given corrective surgery is in the future.
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Description
This quiz covers key concepts in neuraxial anesthesia, including spinal and epidural blocks. It explores preoperative preparations, procedural steps, and the importance of postoperative monitoring. Additionally, complications such as inadequate anesthesia and high neural blockade are discussed.
