Recent

  • Show all results for ""
Spinal and Epidural Anesthesia Overview
49 Questions
0 Views

Spinal and Epidural Anesthesia Overview

Created by
@SleekDramaticIrony

Questions and Answers

What is the purpose of administering a test dose during epidural anesthesia?

  • To verify the location of the catheter is not in the spinal 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?

  • It enhances the potency of lipophilic opioids
  • It prolongs the duration of action of the anesthetic
  • It reduces the volume needed for effective administration
  • It increases the onset speed of the anesthetic by increasing pH of LA (uncharged, lipophilic) so it cross membranes easier (correct)

    • 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)

    • What is a common complication associated with epidural anesthesia?

    <p>Postdural puncture headache</p> Signup and view all the answers

    Which local anesthetic is typically preferred for spinal blocks due to its effectiveness?

    <p>Bupivicaine</p> Signup and view all the answers

    What potential issue arises from the use of a cutting needle in spinal anesthesia?

    <p>Higher risk of postdural puncture headache</p> Signup and view all the answers

    What outcome may occur if a local anesthetic with hypobaric characteristics is administered without immediate patient positioning?

    <p>Total spinal anesthesia</p> Signup and view all the answers

    What is the primary difference in technique between spinal and epidural anesthesia?

    <p>Spinal anesthesia punctures the dura mater while epidural does not.</p> Signup and view all the answers

    Which statement accurately describes the range of a T4 block in terms of sympathetic and motor function?

    <p>Sympathetic block occurs two levels above T2 while motor block is two levels below to T6.</p> Signup and view all the answers

    What is a primary risk associated with spinal anesthesia that is minimized with epidural anesthesia?

    <p>Postdural puncture headache.</p> Signup and view all the answers

    Which of the following anatomical landmarks correlates with the L4 vertebra?

    <p>Line between the iliac crest.</p> Signup and view all the answers

    Which contraindication is considered absolute for spinal anesthesia?

    <p>Severe aortic stenosis.</p> Signup and view all the answers

    How does the epidural space change in different regions of the spinal column?

    <p>It is largest in the lumbar region and decreases in the thoracic region.</p> Signup and view all the answers

    What is a primary characteristic of epidural anesthesia concerning volume and drug concentration?

    <p>Volume influences the level of analgesia achieved.</p> Signup and view all the answers

    Which condition is classified as a relative contraindication for spinal anesthesia?

    <p>Pre-existing neurologic disease.</p> Signup and view all the answers

    What anatomical structure does the cauda equina encompass?

    <p>L1 to S5 vertebrae.</p> Signup and view all the answers

    Where in the spinal cord is cerebrospinal fluid (CSF) found?

    <p>Subarachnoid space</p> Signup and view all the answers

    What ligaments does an epidural needle pass through from superficial to deep?

    <p>Supraspinous ligament, Interspinous ligament, Ligamentum flavum to the epidural space</p> Signup and view all the answers

    Which ligaments does a spinal needle pass through from superficial to deep?

    <p>Supraspinous ligament, Interspinous ligament, Ligamentum flavum, Dura mater</p> Signup and view all the answers

    What is the sacral hiatus?

    <p>The opening between the unfused lamina of the fourth and fifth sacral vertebrae that is absent in 8% of adults</p> Signup and view all the answers

    Patients receiving antithrombotic medications are at increased risk of what complication during neuraxial anesthesia?

    <p>Hematoma</p> Signup and view all the answers

    Where does the subarachnoid space end in adults?

    <p>At the level of the S2 vertebra</p> Signup and view all the answers

    Where does the spinal cord end in adults and neonates?

    <p>L1-L2 in adults, L3 in neonates</p> Signup and view all the answers

    What can be found in the epidural space? (Select all that apply)

    <p>Fat</p> Signup and view all the answers

    Match the dermatome with its associated area:

    <p>C4 = Clavicles T4 = Nipple line T6 = Tip of xiphoid process T10 = Umbilicus L3 to L4 = Knee and distal thigh S2 to S4 = Perineum S1 = Lateral foot</p> Signup and view all the answers

    What is the preferred position for neuraxial anesthesia in the ill or frail patient?

    <p>Lateral position</p> Signup and view all the answers

    What is the preferred position for neuraxial anesthesia during a knee operation?

    <p>Lateral position with the operative side down</p> Signup and view all the answers

    Why is the sitting position preferred for neuraxial anesthesia?

    <p>It facilitates easier access to the epidural space.</p> Signup and view all the answers

    What is the end of the spinal cord?

    <p>Conus medullaris (L1-L2)</p> Signup and view all the answers

    What structures lie below the spinal cord?

    <p>Cauda equina</p> Signup and view all the answers

    What are the advantages of the midline approach to neuraxial anesthesia? (Select all that apply)

    <p>Direct insertion of the spinal needle into the midline allows a straightforward pathway to the interspace.</p> Signup and view all the answers

    What are the advantages of the paramedian approach to neuraxial anesthesia?

    <p>Facilitates the procedure in cases of spinal deformity or difficult anatomy</p> Signup and view all the answers

    What are the advantages of epidural anesthesia? (Select all that apply)

    <p>Less risk for hypotension</p> Signup and view all the answers

    What are the advantages of spinal anesthesia? (Select all that apply)

    <p>Requires less local anesthesia</p> Signup and view all the answers

    How is the placement of intrathecal anesthesia confirmed?

    <p>Presence of cerebrospinal fluid (CSF)</p> Signup and view all the answers

    What determines the level of anesthesia in epidurals?

    <p>Volume of drug and level of injection</p> Signup and view all the answers

    What is the target in neuraxial anesthesia?

    <p>Nerve roots of the spinal cord</p> Signup and view all the answers

    When is epidural anesthesia considered suboptimal?

    <p>Procedures involving the lower sacral roots</p> Signup and view all the answers

    What is a complication of an epidural dose of local anesthetic in the intrathecal space?

    <p>Total spinal anesthesia</p> Signup and view all the answers

    What is a complication of an epidural dose placed intravascularly?

    <p>Hypotension and tachycardia</p> Signup and view all the answers

    Which of the following opioids are considered hydrophilic? (Select all that apply)

    <p>Morphine</p> Signup and view all the answers

    Which of these neuraxial opioids are lipophilic? (Select all that apply)

    <p>Fentanyl</p> Signup and view all the answers

    What are the advantages of lipophilic neuraxial opioids? (Select all that apply)

    <p>Rapid onset</p> Signup and view all the answers

    What are complications of lipophilic neuraxial opioids? (Select all that apply)

    <p>Systemic absorption</p> Signup and view all the answers

    Which type of neuraxial anesthesia is noted for having a more rapid onset of block requiring less local anesthetic?

    <p>Spinal anesthesia</p> Signup and view all the answers

    What does baricity refer to in terms of neuraxial anesthesia?

    <p>The density of anesthetic solution compared to cerebrospinal fluid</p> Signup and view all the answers

    What are the determinants of the level and duration of a spinal block? (Select all that apply)

    <p>Baricity</p> Signup and view all the answers

    Which of the following local anesthetics are commonly used in spinal anesthesia?

    <p>Lidocaine</p> Signup and view all the answers

    Which local anesthetic (LA) is least likely to result in local anesthetic systemic toxicity (LAST)?

    <p>Ropivacaine</p> Signup and view all the answers

    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.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    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.

    More Quizzes Like This

    Spinal Anesthesia Overview
    18 questions

    Spinal Anesthesia Overview

    InfallibleUvite avatar
    InfallibleUvite
    Local Anesthetics in Medical Practice
    30 questions

    Local Anesthetics in Medical Practice

    SpectacularEpilogue avatar
    SpectacularEpilogue
    Spinal Anesthesia Complications
    10 questions

    Spinal Anesthesia Complications

    CelebratedGhost avatar
    CelebratedGhost
    Spinal Anesthesia vs. Epidural Anesthesia Quiz
    17 questions

    Spinal Anesthesia vs. Epidural Anesthesia Quiz

    FantasticWombat avatar
    FantasticWombat
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser