Term
What is a nerve plexus?
What are some examples? |
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Definition
A group of nerve fibers that intertwine to supply an area.
Cervical, brachial, lumbar |
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Term
The area of cutaneous sensation supplied by a spinal nerve is known as what?
How is this helpful for practice? |
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Definition
Dermatomes.
If you know the dermatomes you can estimate the level of your block. |
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Term
Are lateral and midline dermatone levels equal?
Identify the following sensory levels:
C4
T2
T4
T6
T10
S3 |
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Definition
No, especially when checked caudad to T10.
C4 = clavicles
T2 = 2nd rib
T4 = nipple line
T6 = xyphoid process
T10 = umbilicus
S3 = saddle block
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Term
When was the earliest SAB done?
Who did this? |
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Definition
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Term
| What is the order a SAB spreads? |
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Definition
1. SAS
2. Nerves of the cauda equina
3. Laterally to the nerve rootlets
4. Laterally to the nerve roots
5. Into the spinal cord |
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Term
| What are some advantages of using a SAB? |
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Definition
Less toxic to major organ systems
Preserves spontaneous respiration
Decreased risk of aspiration
Less N/V
Mental Alertness (TURP)
Wound bleeding reduced
Decreased incidence of DVT |
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Term
| What are some disadvantages of SAB? |
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Definition
More strain on CV system (quicker progression of hypotension)
Awareness
Post dural puncture headaches
Does not decrease incidence of post-op pulm. complications
Does not make a difference re: post-op outcomes! |
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Term
| When are some situations to consider a SAB? |
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Definition
Vascular, lower extrem.
Lower abdominal (below T8)
Extremity procedures
C sections
TURP
Pts with renal, hepatic, or metabolic disease
Higher risk for DVT |
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Term
| Besides procedure type, what should be considered before using a SAB? |
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Definition
Will the pt cooperate?
Can they remain in the same position?
Length of procedure
Outpatient vs inpatient
Surgeon preference |
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Term
| What should be done preoperatively before SAB? |
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Definition
Informed consent: risks, benefits, potential complications, alternatives
Patient prep: assessment, chart review, reassurance, NPO |
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Term
Besides pain pathways, what else does SAB block?
What happens? |
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Definition
Sympathetic autonomic pathways
Vasodilation in the periphery |
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Term
What should be done to reduce the risk of a drop in BP in someone receiving a SAB?
When is this done? |
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Definition
Fluids!
NPO deficit is often replaced in the pre-op area. |
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Term
What patients (according to age) with have the most profound response to autonomic block?
What if the patient can't tolerate a large volume load? |
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Definition
Younger patients
Use of pressors, may want to avoid SAB |
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Term
What must be available before attempting spinal anesthesia?
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Definition
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Term
What are the 2 types of needles used in SAB?
How are they different?
Which type shows a decreased incidence of post dural puncture headaches? |
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Definition
Cutting bevel tips and pencil point. Bevel tips cut through structures, whereas pencil points separate fibers.
Pencil point |
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Term
What is Tuffier's line?
What is the largest laminar space? |
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Definition
AKA intercristal line, plane formed along the iliac crest, contiguous with L4. (although this is not always L4--can range from L3 to L5)
L5 |
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Term
| What position is used for spinals? Why? |
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Definition
| Sitting position, with the shoulders relaxed and the back pushed out. This opens the vertebral spinous processes and helps identify spaces. |
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Term
| In terms of monitors, what is minimum with spinals? |
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Definition
| A baseline BP, often a pulse ox. |
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Term
| What are tricks to help with patient positioning? |
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Definition
Have them hug a pillow
Have the shoulders relaxed and dropped
Place the feet on a chair or stool
Ideally have someone in front of them giving them support. |
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