Term
Physiologic changes accociated with SABs
1) What happens renally? (and bladder)
2) What happens Hepatically? |
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Definition
1) As long as BP is maintained renal blood flow will increase d/t vasodilation. Loss of autonomic control of the bladder can result in urinary retention.
2) Liver is not impacted any differently than during general anesthesia. |
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Term
Physiologic changes accociated with SABs
1) What happens to the G.I. tract?
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Definition
- Sympathetic block yields unopposed parasympathetic activity
- results in small, contracted gut w/active peristalsis
- excellent operative conditions for laproscopic procedures.
- post op epidural anesth. improves G.I. function postop.
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Term
Physiologic changes accociated with SABs
Sympathetic blockade reduces ____________
which are released in response to surgical trauma. |
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Definition
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Term
Physiologic changes accociated with SABs
This is associated with up to 20% of pts receiving neuraxial blocks. This is primarily r/t GI peristalsis but may also be due to opioid use, hypotension, hypoxemia and psycholigical stimuli. |
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Definition
| What is Nausea and Vomiting. |
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Term
What is the most common complication of both SAB and epidural anesthesia?
How does this happen?
What are the symptoms? |
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Definition
1) Post dural puncture headache
2) Leakin' CSF through the hole in the dura by needle. Medulla and brainstem lose hydrolic support-
- drop into foramen magnem
- stetch meninges pulling on tentorium
3) Headache: bilat, frontal, OR retroorbital and occipital extending into neck.
- Hallmark sign: headache worse with upright position- Improves with supine position.
- associated with photophobia and nausea
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Term
When is the usual onset of PDPH?
How long can it last if untreated?
What are contributing factors? |
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Definition
1) 12-72 hours
2) can last up to 10 days to weeks
3) Contributing factors:
-cutting needles (vs pencilpoint)
-size of needle
-multiple punctures
-female
-Pregnancy
-Prior History of PDPH
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Term
| What does conservative management of PDPH include?: |
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Definition
-horizontal position
-Fluid hydration
- Analgesics
-500 mg caffeine benzoate, 300 mg of caffeine or theophylline |
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Term
| Walk me through the steps of a blood patch for treatment of PDPH: |
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Definition
1) Obtain informed consent
2) Access epidural space at or below level of puncture site (blood tends to travel cephalad)
3) Obtain 20 ml of venous blood (usually from antecube) in a sterile fashion
4) Inject blood into epidural space until pt feels pressure in the back, buttocks, or legs. (about 12-15 mls)
5) Keep pt. supine for 30-60 minutes. |
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Term
How quickly is relief achieved using a blood patch?
If it fails, can it be repeated? |
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Definition
Relief in pain is almost immediate for most patients.
Yes- blood patch can be repeated in 24 hours.
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Term
| Backache can be a complication of SAB or epidural anesthesia. Usually this is a benign symptom, however what is an important complication we should always consider when a pt. c/o backache? |
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Definition
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Term
1) When does a total spinal occur?
2) Is the onset slow or fast? Why?
3) How do I prevent the total spinal monster from getting me?
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Definition
1) Can occur when an epidural drug is inadvertantly injected into the SAS.
2) Fast as hell bitch. Becaus epidural dose is 5-10 times more than the SAB.
3)- Prevention is always best
-Aspirate during placement (make sure you are in right place)
-utilizing test dose
-ALWAYS ASPIRATE BEFORE BOLUSING EPIDURAL |
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Term
| What happens to the pt with a total spinal? |
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Definition
-Numbness of tongue and mouth
-Lightheadedness (tinnitus, visual disturbances)
-Muscle twitching (seen with garbled speech and irrational behavior)
-Convulsions, coma
-Apnea, cardiac arrest. |
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Term
| What is the treatment for a total spinal? |
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Definition
1) Try not to crap yourself
2) Ventilate and intubate
3) Postion change (try to get the spinal to go down)
4) Vasopressors
5) Amnesia
6) continue to treat ABCs
7) treat seizures or dysrhythmias
8) Call your lawyer |
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Term
Persistent neurological deficits can occur after nerve roots or the spinal chord have been injured.
What action can we take in adults and children that will help prevent this? |
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Definition
| 1) Start SAB lower than L1 in adults and L3 in children |
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Term
1) What are the risk factors that predispose a pt. to permanent nerve damage/ parasthesia or paralysis during attempted SAB administration?
2) What happens if I inject directly into the spinal chord? |
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Definition
1) Multiple attempts
Presence of a parasthesia
2) Well the pt. gets some paralysis or parasthesia then you get the old "slide 44" treatment from Sam Bernstein. |
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Term
If a pt is having a sustained parasthesia while you are attempting to establish a SAB you should:
a) Not worry about it
b) Drive the needle to the hub
c) Tell your CRNA that's how you do
d) redirect the needle |
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Definition
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