40 Questions
What is the name of the landmark for caudal anesthesia?
Sacral hiatus
What is the level of the posterior iliac crest?
S2
What is the shape of the sacrum?
Triangular
What is the function of the sacrococcygeal ligament?
Fuses S5 and the coccyx
What is the name of the line that passes through the summit of the iliac crest?
Intercristal line
What is the characteristic of the lamina of S5?
It is incomplete and bridged by ligaments
What is located at the base of the sacrum?
Sacral hiatus
What is fused with the sacrum?
Coccyx
What is the effect of local anesthetic on neural transmission in the spinal cord?
It inhibits neural transmission in the superficial layers.
What is the clinical relevance of a 70-year-old patient needing a hip replacement in relation to spinal anesthesia?
The dose of local anesthetic needs to be lowered.
What determines the block height in spinal or epidural anesthesia?
The spread of local anesthetic in the spinal or epidural space.
What is a potential complication of spinal anesthesia?
Leakage of local anesthetic into the paravertebral area.
What is the location where local anesthetic can leak through?
The intervertebral foramen.
What is the name of the type of anesthesia being discussed?
Spinal anesthesia.
What is the effect of local anesthetic on the superficial layers of the spinal cord?
It inhibits neural transmission.
What is a factor that affects the distribution of local anesthetic?
The age and medical condition of the patient.
What type of surgical procedures are commonly performed with spinal anesthesia?
Surgical procedures involving the lower abdomen, perineum, and lower extremities
Which of the following is a factor that increases the risk of PONV?
Non-smokers
What is the primary purpose of the Hippocratic Oath?
To guide medical ethics
What is the typical dosage of propofol for induction?
1.5-2.5 mg/kg
What is the benefit of using propofol in combination with central neuralaxial anesthesia?
Greater mental alertness
In which type of surgery is epidural anesthesia commonly used?
Thoracic surgery
What is the primary mechanism by which anesthetic gases and opioids contribute to PONV?
Release of neurotransmitters that stimulate the vomiting center
What is the typical dosage range of propofol for maintenance anesthesia?
100-300 mcg/kg
What is the location of the epidural space?
Between the ligamentum flavum and the dura mater
What is the potential impact of the epidural space on medication spread?
It acts as a barrier to medication spread
What is the significance of the plica mediana dorsalis in epidural catheter insertion?
It is a possible reason for complications in epidural catheter insertion
What is the role of the plica mediana dorsalis in unilateral blocks?
It might play a role in cases where an epidural does not equally affect both sides of the body
What is the correct amount of catheter to leave in the epidural space?
3-5cm
What is the location of the subarachnoid space?
Between the arachnoid mater and the pia mater
What is the significance of the pia mater in the subarachnoid space?
It coats the spinal cord
Which cranial nerve is responsible for transmitting sensory information from the face?
Cranial nerve 5
What is a characteristic of sufentanil?
It travels and crosses the placenta
Which branch of the trigeminal nerve handles sensation from the forehead and scalp?
V1 - Ophthalmic Nerve
What is the primary function of the trigeminal nerve?
Sensory innervation of the face
Which of the following is NOT a branch of the trigeminal nerve?
V4 - Hypoglossal Nerve
Which branch of the trigeminal nerve is responsible for sensory input from the upper teeth?
V2 - Maxillary Nerve
Why does the face not use spinal nerves for sensory innervation?
No reason, the face does use spinal nerves
What is the correct sequence of the trigeminal nerve branches?
V1, V2, V3
Which of the following is a function of the trigeminal nerve?
Sensory innervation of the face
Study Notes
Surgical Procedures
- Orthopaedic surgery involves a lot of spinal procedures
- Vascular surgery focuses on the legs
- Thoracic surgery is an adjunct to GETA, using epidural anesthesia instead of spinal
Hippocratic Oath
- "I will, according to my ability and judgment, prescribe a regimen for the health of the sick; but I will utterly reject harm and mischief"
Post-Operative Nausea and Vomiting (PONV)
- Caused by induction medication, such as anesthetic gases and opioids
- Factors that increase the risk of PONV:
- Females
- Non-smokers
- Age 40 and higher
Propofol
- Drip: 100-300mcg/kg
- Induction: 1.5-2.5 mg/kg
- Provides great mental alertness
- Can be used with central neuralaxial anesthesia
Surface Landmarks
- Superior illiac crest
- Intercristal or Tuffier line
- S2 at the level of Posterior Iliac crest
- Sacrum: a triangular-shaped section of fused vertebra (5)
- S1-S4 are fused, S5 is not fused, and Sacrococcygeal ligament fuses these two
Caudal Anesthesia
- Landmark: Sacral Hiatus, located at the base of the sacrum and aligns with the S5 vertebra
- Covered by the Sacrococcygeal ligament
- Be cautious that the catheter is still in the epidural space
Epidural Space
- 3-5cm of catheter is left in the epidural space
- Potential impact of barrier formation on medication spread and catheter insertion
- Clinical relevance: unilateral blocks and complications in placing an epidural catheter
Subarachnoid Space (Intrathecal)
- Located between the arachnoid matter and the pia matter
- Pia mater coats the spinal cord
Sensory Innervation of the Face
- Cranial nerve 5 = trigeminal nerve
- Supplies sensory innervation to the face
- Branches of the Trigeminal Nerve: V1 (Ophthalmic Nerve), V2 (Maxillary Nerve)
Local Anesthetic Distribution and Block Height
- Factors affecting local anesthetic distribution and block height
- Clinical relevance: Spinal or intrathecal block for a 70-year-old patient needing a hip replacement, requiring a lower dose of local anesthetic
This quiz tests your knowledge of various surgical procedures involving the lower abdomen, perineum, lower extremities, orthopaedic surgery, vascular surgery, and thoracic surgery.
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