Podcast
Questions and Answers
What is the purpose of administering a test dose during epidural anesthesia?
What is the purpose of administering a test dose during epidural anesthesia?
- To verify the location of the catheter is not in the spinal or intravascular space (correct)
- To ensure the correct amount of anesthetic is administered
- To assess the patient’s reaction to the anesthetic
- To determine the onset time of the analgesia
What is the effect of adding bicarbonate to an epidural anesthetic solution?
What is the effect of adding bicarbonate to an epidural anesthetic solution?
- It increases the onset speed of the anesthetic by increasing pH of LA (non-ionized, lipophilic) so it cross membranes easier (correct)
- It enhances the potency of lipophilic opioids
- It prolongs the duration of action of the anesthetic
- It reduces the volume needed for effective administration
Which of the following is a disadvantage of hydrophilic opioids in epidural anesthesia? (select all that apply)
Which of the following is a disadvantage of hydrophilic opioids in epidural anesthesia? (select all that apply)
- Rapid onset of analgesia
- Higher CSF solubility
- Unpredictable duration of analgesia with slow onset (correct)
- Delayed respiratory depression (correct)
Which local anesthetic is typically preferred for spinal blocks due to its long duration of action?
Which local anesthetic is typically preferred for spinal blocks due to its long duration of action?
What potential issue arises from the use of a cutting needle in spinal anesthesia?
What potential issue arises from the use of a cutting needle in spinal anesthesia?
What outcome may occur if a local anesthetic with hypobaric characteristics is administered without immediate patient positioning?
What outcome may occur if a local anesthetic with hypobaric characteristics is administered without immediate patient positioning?
What is the primary difference in technique between spinal and epidural anesthesia?
What is the primary difference in technique between spinal and epidural anesthesia?
What is a risk associated with spinal anesthesia that is minimized with epidural anesthesia? Select 2
What is a risk associated with spinal anesthesia that is minimized with epidural anesthesia? Select 2
Which of the following anatomical landmarks correlates with the L4 vertebra?
Which of the following anatomical landmarks correlates with the L4 vertebra?
Which contraindication is considered absolute for spinal anesthesia?
Which contraindication is considered absolute for spinal anesthesia?
How does the epidural space change in different regions of the spinal column?
How does the epidural space change in different regions of the spinal column?
What is a primary characteristic of the level of anesthesia achieved in epidurals? (select 2)
What is a primary characteristic of the level of anesthesia achieved in epidurals? (select 2)
Which condition is classified as a relative contraindication for spinal anesthesia?
Which condition is classified as a relative contraindication for spinal anesthesia?
What anatomical structure does the cauda equina encompass?
What anatomical structure does the cauda equina encompass?
Where in the spinal cord is cerebrospinal fluid (CSF) found?
Where in the spinal cord is cerebrospinal fluid (CSF) found?
What ligaments does an epidural needle pass through from superficial to deep?
What ligaments does an epidural needle pass through from superficial to deep?
Which ligaments does a spinal needle pass through from superficial to deep?
Which ligaments does a spinal needle pass through from superficial to deep?
What is the sacral hiatus?
What is the sacral hiatus?
Patients receiving antithrombotic medications are at increased risk of what complication during neuraxial anesthesia?
Patients receiving antithrombotic medications are at increased risk of what complication during neuraxial anesthesia?
Where does the subarachnoid space end in adults?
Where does the subarachnoid space end in adults?
Where does the spinal cord end in adults and neonates?
Where does the spinal cord end in adults and neonates?
What can be found in the epidural space? (Select all that apply)
What can be found in the epidural space? (Select all that apply)
Match the dermatome with its associated area:
Match the dermatome with its associated area:
What is the preferred position for neuraxial anesthesia in the ill or frail patient?
What is the preferred position for neuraxial anesthesia in the ill or frail patient?
What is the preferred position for neuraxial anesthesia during a knee operation?
What is the preferred position for neuraxial anesthesia during a knee operation?
Why is the sitting position preferred for neuraxial anesthesia?
Why is the sitting position preferred for neuraxial anesthesia?
What is the end of the spinal cord?
What is the end of the spinal cord?
What structures lie below the spinal cord?
What structures lie below the spinal cord?
What are the advantages of the midline approach to neuraxial anesthesia? (Select all that apply)
What are the advantages of the midline approach to neuraxial anesthesia? (Select all that apply)
What are the advantages of the paramedian approach to neuraxial anesthesia?
What are the advantages of the paramedian approach to neuraxial anesthesia?
What are the advantages of epidural anesthesia? (Select all that apply)
What are the advantages of epidural anesthesia? (Select all that apply)
What are the advantages of spinal anesthesia? (Select all that apply)
What are the advantages of spinal anesthesia? (Select all that apply)
How is the placement of intrathecal anesthesia confirmed?
How is the placement of intrathecal anesthesia confirmed?
What determines the level of anesthesia in epidurals?
What determines the level of anesthesia in epidurals?
What is the target in neuraxial anesthesia?
What is the target in neuraxial anesthesia?
When is epidural anesthesia considered suboptimal?
When is epidural anesthesia considered suboptimal?
What is a complication of an epidural dose of local anesthetic in the intrathecal space?
What is a complication of an epidural dose of local anesthetic in the intrathecal space?
What is a complication of an epidural dose placed intravascularly?
What is a complication of an epidural dose placed intravascularly?
Which of the following opioids are considered hydrophilic? (Select all that apply)
Which of the following opioids are considered hydrophilic? (Select all that apply)
Which of these neuraxial opioids are lipophilic? (Select all that apply)
Which of these neuraxial opioids are lipophilic? (Select all that apply)
What are the advantages of lipophilic neuraxial opioids? (Select all that apply)
What are the advantages of lipophilic neuraxial opioids? (Select all that apply)
What are complications of lipophilic neuraxial opioids? (Select all that apply)
What are complications of lipophilic neuraxial opioids? (Select all that apply)
Which type of neuraxial anesthesia is noted for having a more rapid onset of block and requires less local anesthetic?
Which type of neuraxial anesthesia is noted for having a more rapid onset of block and requires less local anesthetic?
What does baricity refer to in terms of neuraxial anesthesia?
What does baricity refer to in terms of neuraxial anesthesia?
What are the determinants of the level and duration of a spinal block? (Select all that apply)
What are the determinants of the level and duration of a spinal block? (Select all that apply)
Which of the following local anesthetics are commonly used in spinal anesthesia?
Which of the following local anesthetics are commonly used in spinal anesthesia?
Which local anesthetic (LA) is least likely to result in cardiotoxicity?
Which local anesthetic (LA) is least likely to result in cardiotoxicity?
What are the characteristics of epidural anesthesia? (Select all that apply)
What are the characteristics of epidural anesthesia? (Select all that apply)
Which of the following are characteristics of spinal anesthesia? (Select all that apply)
Which of the following are characteristics of spinal anesthesia? (Select all that apply)
Which meningeal layer serves as the principal barrier to prevent drugs from crossing into the cerebrospinal fluid (CSF)?
Which meningeal layer serves as the principal barrier to prevent drugs from crossing into the cerebrospinal fluid (CSF)?
What is unique about thoracic spinous processes as compared to lumbar spinous processes?
What is unique about thoracic spinous processes as compared to lumbar spinous processes?
Why are nerve roots in the epidural space harder to anesthetize?
Why are nerve roots in the epidural space harder to anesthetize?
Which type of nerve fibers are most sensitive to local anesthetics (LA)?
Which type of nerve fibers are most sensitive to local anesthetics (LA)?
Which nerve fibers are the most resistant to local anesthetics?
Which nerve fibers are the most resistant to local anesthetics?
What is the correct order of blockade in a differential sensory blockade?
What is the correct order of blockade in a differential sensory blockade?
Blockade of which sympathetic fibers is associated with a reduction in systemic vascular resistance (SVR)?
Blockade of which sympathetic fibers is associated with a reduction in systemic vascular resistance (SVR)?
What is sympathectomy in the context of neuraxial anesthesia?
What is sympathectomy in the context of neuraxial anesthesia?
What causes a decrease in vital capacity during neuraxial anesthesia?
What causes a decrease in vital capacity during neuraxial anesthesia?
When is spinal anesthesia indicated? (select all that apply)
When is spinal anesthesia indicated? (select all that apply)
What type of local anesthetic solution is characterized by a more predictable spread moving to more dependent regions of the spinal cord?
What type of local anesthetic solution is characterized by a more predictable spread moving to more dependent regions of the spinal cord?
How can a saddle block be achieved in spinal anesthesia?
How can a saddle block be achieved in spinal anesthesia?
Which short-acting local anesthetic (LA) is rarely used due to a high failure rate and nausea?
Which short-acting local anesthetic (LA) is rarely used due to a high failure rate and nausea?
What are the advantages of chloroprocaine? (Select all that apply)
What are the advantages of chloroprocaine? (Select all that apply)
What are the characteristics of lidocaine? (Select all that apply)
What are the characteristics of lidocaine? (Select all that apply)
Which of the following statements is true regarding local anesthetics with a higher pKa?
Which of the following statements is true regarding local anesthetics with a higher pKa?
What is pKa?
What is pKa?
If lidocaine has a pKa of 7.7 and bupivacaine has a pKa of 8.1, which will have a faster onset of action?
If lidocaine has a pKa of 7.7 and bupivacaine has a pKa of 8.1, which will have a faster onset of action?
How do vasoconstrictors prolong sensory and motor blockade? Select the correct mechanism.
How do vasoconstrictors prolong sensory and motor blockade? Select the correct mechanism.
What type of sensation is usually lost first in neuraxial anesthesia?
What type of sensation is usually lost first in neuraxial anesthesia?
What are used as indicators of adequate surgical anesthesia in assessing a neuraxial block?
What are used as indicators of adequate surgical anesthesia in assessing a neuraxial block?
What is the general principle for the volume of local anesthetic (LA) used in epidural anesthesia?
What is the general principle for the volume of local anesthetic (LA) used in epidural anesthesia?
Pregnant women require ____ local anesthetic (LA) to produce epidural spread due to engorgement of the epidural veins.
Pregnant women require ____ local anesthetic (LA) to produce epidural spread due to engorgement of the epidural veins.
Why is less local anesthetic (LA) indicated for epidural anesthesia in the elderly?
Why is less local anesthetic (LA) indicated for epidural anesthesia in the elderly?
What is the effect of opioids on epidural anesthesia?
What is the effect of opioids on epidural anesthesia?
What are the advantages of the combined spinal-epidural technique? (Select all that apply)
What are the advantages of the combined spinal-epidural technique? (Select all that apply)
What is caudal anesthesia?
What is caudal anesthesia?
Which of the following are risk factors for a postdural puncture headache? (Select all that apply)
Which of the following are risk factors for a postdural puncture headache? (Select all that apply)
What causes urinary retention after neuraxial anesthesia?
What causes urinary retention after neuraxial anesthesia?
What is the primary site of local anesthetic action in spinal anesthesia?
What is the primary site of local anesthetic action in spinal anesthesia?
What is the secondary site of action in spinal anesthesia?
What is the secondary site of action in spinal anesthesia?
Why is autonomic blockade typically higher than sensory or motor blockade? select 2
Why is autonomic blockade typically higher than sensory or motor blockade? select 2
For a spinal anesthetic, the sensory block will typically be how many dermatome levels higher than the motor block?
For a spinal anesthetic, the sensory block will typically be how many dermatome levels higher than the motor block?
Where does the dural space extend to?
Where does the dural space extend to?
What is the landmark for a thoracic epidural?
What is the landmark for a thoracic epidural?
What is the epidural space bound to anteriorly?
What is the epidural space bound to anteriorly?
How is local anesthetic delivered in a combined spinal-epidural (CSE) technique?
How is local anesthetic delivered in a combined spinal-epidural (CSE) technique?
Why does neuraxial anesthesia produce sympathectomy rather than parasympathectomy?
Why does neuraxial anesthesia produce sympathectomy rather than parasympathectomy?
Which tissues are passed through in a paramedial approach to spinal anesthesia? (Select all that apply)
Which tissues are passed through in a paramedial approach to spinal anesthesia? (Select all that apply)
Which neuraxial technique is associated with greater systemic absorption?
Which neuraxial technique is associated with greater systemic absorption?
Hypotension is a complication of neuraxial anesthesia
Hypotension is a complication of neuraxial anesthesia
Why does an epidural have a lower risk of hypotension compared to a spinal?
Why does an epidural have a lower risk of hypotension compared to a spinal?
In spinal anesthesia, how high is the sensory blockade above the motor blockade?
In spinal anesthesia, how high is the sensory blockade above the motor blockade?
In spinal anesthesia, how many dermatomes higher is the autonomic blockade compared to the sensory block?
In spinal anesthesia, how many dermatomes higher is the autonomic blockade compared to the sensory block?
In epidural anesthesia, how high is the sensory and autonomic block above the motor block?
In epidural anesthesia, how high is the sensory and autonomic block above the motor block?
What is the most important determinant of intrathecal spread when using a hypobaric or isobaric solution?
What is the most important determinant of intrathecal spread when using a hypobaric or isobaric solution?
What is the target for neuraxial opioids?
What is the target for neuraxial opioids?
Flashcards
What is spinal anesthesia?
What is spinal anesthesia?
Involves injecting a local anesthetic into the cerebrospinal fluid (CSF) within the subarachnoid space, producing a more intense sensory and motor block with less discomfort and lower anesthetic volume.
What is epidural anesthesia?
What is epidural anesthesia?
Punctures are done without penetrating the dura, reducing the risk of headaches, and produces a segmental sensory block.
What landmark is associated with L4 vertebra?
What landmark is associated with L4 vertebra?
The line between the iliac crests corresponds with L4 vertebra.
What landmark is associated with C7 vertebra?
What landmark is associated with C7 vertebra?
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What are the anatomical ranges of the subarachnoid and epidural spaces?
What are the anatomical ranges of the subarachnoid and epidural spaces?
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What is the cauda equina?
What is the cauda equina?
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What are the curvatures of the thoracic and lumbar spine?
What are the curvatures of the thoracic and lumbar spine?
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How many vertebrae are there?
How many vertebrae are there?
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What are the effects of a T4 block?
What are the effects of a T4 block?
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What are absolute contraindications for spinal/epidural anesthesia?
What are absolute contraindications for spinal/epidural anesthesia?
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What are relative contraindications for spinal/epidural anesthesia?
What are relative contraindications for spinal/epidural anesthesia?
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What medications are used in epidurals?
What medications are used in epidurals?
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What is the typical dosing for epidural anesthesia?
What is the typical dosing for epidural anesthesia?
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What is a test dose for epidural anesthesia?
What is a test dose for epidural anesthesia?
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What are characteristics of hydrophilic opioids in epidurals?
What are characteristics of hydrophilic opioids in epidurals?
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What are characteristics of lipophilic opioids in epidurals?
What are characteristics of lipophilic opioids in epidurals?
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What are some complications of epidural anesthesia?
What are some complications of epidural anesthesia?
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What is baricity in anesthesia?
What is baricity in anesthesia?
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What is the Gertie Marx needle used for?
What is the Gertie Marx needle used for?
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How can the risk of post-dural puncture headache be reduced?
How can the risk of post-dural puncture headache be reduced?
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What are caudal blocks used for?
What are caudal blocks used for?
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What does the epidural space contain, and where is it largest?
What does the epidural space contain, and where is it largest?
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What structures need to be penetrated for spinal anesthesia?
What structures need to be penetrated for spinal anesthesia?
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How is epidural anesthesia administered?
How is epidural anesthesia administered?
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What is the significance of the sacral hiatus for anesthesia?
What is the significance of the sacral hiatus for anesthesia?
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How is spinal anesthesia placement confirmed?
How is spinal anesthesia placement confirmed?
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Why is epidural anesthesia safer than spinal anesthesia?
Why is epidural anesthesia safer than spinal anesthesia?
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How is the level of anesthesia controlled in epidurals?
How is the level of anesthesia controlled in epidurals?
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Study Notes
Spinal and Epidural Anesthesia
- Spinal anesthesia: Involves injecting local anesthetic into the cerebrospinal fluid (CSF) within the subarachnoid space.
- Requires penetrating the supraspinous ligament, interspinous ligament, ligamentum flavum, and dura mater.
- Results in a more intense sensory and motor block with less discomfort and lower volume of local anesthetic needed.
- Placement is confirmed by the appearance of CSF; characterized by an "all or nothing" block effect.
Epidural Anesthesia
- Epidural anesthesia: Punctures are done without penetrating the dura, reducing the risk of post-dural puncture headaches.
- Produces a segmental sensory block by titrating local anesthetic; motor block achieved by adjusting concentration.
- Allows for postoperative infusion and can be positioned laterally or seated for administration.
- Epidural space contains fat, lymph, and arteries, largest in the lumbar region.
Anatomical Landmarks and Vertebral Information
- The line between the iliac crest correlates with L4 vertebra.
- Bony prominence at the inferior neck corresponds with C7 vertebra.
- Subarachnoid space extends to S2; dura/epidural space spans from foramen magnum to sacral hiatus.
- Cauda equina ranges from L1 to S5; sacral hiatus often absent in 8% of adults.
Block Characteristics
- Thoracic convexity = kyphosis; lumbar concavity = lordosis.
- Spinal vertebrae count: 33 total (7 cervical, 12 thoracic, 5 lumbar, 5 sacral).
- T4 block impacts sympathetic function two levels above T2 and motor function two levels below T6.
Contraindications for Anesthesia Techniques
- Absolute contraindications: Coagulopathy, infection at the injection site, severe aortic or mitral stenosis, increased intracranial pressure.
- Relative contraindications include pre-existing neurological disease, peripheral neuropathies, sepsis, and hypertrophic cardiomyopathies.
Epidural Anesthesia Techniques
- Medications used in epidurals include lidocaine and chloroprocaine; the addition of epinephrine prolongs analgesic duration.
- Dosing typically involves 1-2 mL of solution per segment blocked with goals to cover 12-16 segments.
- Test dose: 3 cc of 1.5% lidocaine with 1:200,000 epinephrine to confirm catheter placement without resistance.
Opioid Use in Epidurals
- Hydrophilic opioids: Long duration and high CSF solubility, but slow onset and potential for delayed respiratory depression.
- Lipophilic opioids: Rapid onset and short duration, suitable for patient-controlled analgesia (PCA) but risk systemic absorption.
Complications of Epidural Anesthesia
- Potential issues: Lack of block effect, nerve injury, infection, epidural hematoma or abscess, dural puncture, hypotension, last (local anesthetic systemic toxicity), respiratory depression, sedation, and bladder distention.
- Baricity influences the spread of local anesthetic; hypobaric solutions risk floating, whereas hyperbaric solutions settle.
Use of Combined Techniques
- A combined spinal-epidural technique utilizes the Gertie Marx needle for spinal anesthesia.
- Smaller gauge needles reduce the risk of post-dural puncture headache; blunted tip needles decrease the risk further.
- Caudal blocks are frequently employed in pediatric anesthetics due to safety and effectiveness.
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Description
This quiz covers the essentials of spinal and epidural anesthesia, including their administration techniques, anatomical landmarks, and differences in effects. Learn about the mechanisms behind these anesthesia types and their implications in clinical practice.
