Regional Quiz 2 - Spinal And Epidural Study Test

Epinephrine is frequently added to local anesthetics to prolong their duration of action. Epinephrine is a vasoconstrictor that reduces blood flow to the area where the anesthetic is injected. This helps to slow down the absorption of the anesthetic, allowing it to stay in the area for a longer period of time and prolonging its effects. By constricting blood vessels, epinephrine also reduces bleeding at the site of injection, which can further enhance the duration of the anesthetic's action.

A patient with aortic stenosis is not a good candidate for spinal anesthesia because it can lead to a sudden drop in blood pressure, which can be dangerous for patients with this condition. Spinal anesthesia can cause vasodilation and decrease in systemic vascular resistance, leading to decreased cardiac output. Therefore, it is important to avoid spinal anesthesia in patients with aortic stenosis to prevent any potential complications.

When preparing for a patient undergoing spinal anesthesia, it is important to prepare the room in the same way as for a general anesthesia (GA) case. This includes setting up the standard monitors and ensuring that all necessary equipment and supplies are available. While the other options mention not needing GA drugs or only drawing up medications for a MAC case, these are not appropriate for a patient undergoing spinal anesthesia. Therefore, preparing the room exactly as for a GA case is the correct answer.

The spinal cord is a long, cylindrical structure that extends from the base of the brain to the lower back. In an adult patient, the spinal cord typically ends around the level of the first lumbar vertebra (L1) or the second lumbar vertebra (L2). Therefore, the correct answer is L1-L2.

The proper needle insertion for a caudal block is at the Sacral Hiatus. The Sacral Hiatus is a small opening at the base of the sacrum, which is the triangular bone at the base of the spine. This is the ideal location for needle insertion because it allows for the administration of medication directly into the caudal epidural space, which is the area surrounding the sacral nerves. This technique is commonly used for pain management during childbirth or for lower abdominal and pelvic surgeries.

We have 31 pairs of spinal nerves. The spinal nerves are part of the peripheral nervous system and are formed by the combination of dorsal and ventral roots. There are 31 pairs of spinal nerves in total, with each pair connected to a specific segment of the spinal cord. These nerves are responsible for transmitting sensory information from the body to the brain and carrying motor commands from the brain to the muscles and organs.

Adding glucose to the bupivicaine solution increases its density, resulting in a hyperbaric solution. This can be achieved by dissolving a certain amount of glucose in the solution, which increases its specific gravity. The increased density allows for better distribution and prolonged effect of the medication when used in certain medical procedures, such as spinal anesthesia. Mixing equal parts LA (local anesthetic) and CSF (cerebrospinal fluid) or adding sterile water would not achieve the desired hyperbaric solution. Therefore, the correct method is to add glucose to increase the density.

The correct answer is the interspinous ligament. This ligament is located between the spinous processes of adjacent vertebrae in the spine. It helps to limit excessive flexion and rotation of the spine. The ligamentum flavum is located between the laminae of adjacent vertebrae and helps to maintain the upright posture. The supraspinous ligament is located above the spinous processes and connects them together. The dura mater is the outermost layer of the spinal cord and does not refer to a specific ligament in this context.

Based on the given symptoms of severe back pain, worsening pain upon palpation, fever, and feeling weaker, it suggests a possible epidural abscess. An epidural abscess is a serious infection that can occur after an epidural procedure. To confirm the diagnosis, an MRI is needed. Therefore, the appropriate action would be to send the patient for an MRI to investigate the suspected epidural abscess.

Patients with severe mitral stenosis have an absolute contraindication to spinal anesthesia. Mitral stenosis is a condition characterized by narrowing of the mitral valve in the heart, which can lead to impaired blood flow. Spinal anesthesia involves injecting medication into the spinal canal, which can cause a drop in blood pressure. In patients with severe mitral stenosis, this drop in blood pressure can be dangerous and potentially life-threatening. Therefore, spinal anesthesia should be avoided in these patients to prevent complications.

Acetylcholine is the primary neurotransmitter of the parasympathetic nervous system. It is responsible for transmitting signals between nerve cells and plays a crucial role in regulating various bodily functions, such as digestion, heart rate, and relaxation. Acetylcholine acts as a chemical messenger, binding to receptors on target cells and initiating a response. It is released by parasympathetic neurons and helps in promoting rest and digestion, as opposed to the fight-or-flight response mediated by norepinephrine.

The correct answer is the supraspinous ligament. This ligament can be identified based on its location in the photo and its characteristic appearance. It is a strong fibrous band that connects the spinous processes of adjacent vertebrae in the spine. It runs along the posterior aspect of the vertebral column, from the base of the skull to the sacrum. The supraspinous ligament helps to stabilize the spine and limit excessive flexion (forward bending) of the vertebral column.

The lumbar area of the spine has the greatest width of the epidural space. This is because the lumbar vertebrae are larger and have a wider space between them compared to the cervical and thoracic vertebrae. The wider epidural space in the lumbar area allows for easier access during procedures such as epidural anesthesia or lumbar punctures.

When a solution is isobaric, it means that it has the same pressure as the surrounding fluid, in this case, the cerebrospinal fluid (CSF). Therefore, when the isobaric solution is injected into the CSF, it will not experience any significant change in pressure. As a result, it will stay at roughly the same level as the CSF, without sinking or floating up.

The loss of resistance technique is commonly used to determine if the epidural needle is in the epidural space. This technique involves applying pressure to the plunger of the syringe while advancing the needle. Once the needle enters the epidural space, the resistance to the plunger decreases, indicating that the needle is in the correct position. This technique is preferred over relying solely on the feeling of a "pop" or the presence of cerebrospinal fluid flow, as these factors can be unreliable indicators of proper needle placement.

The patient complaining of ringing in the ears and an increased heart rate after administering the test dose of lidocaine with epinephrine indicates signs of intravascular injection. Intravascular injection can lead to systemic toxicity and should be stopped immediately to prevent any further complications.

The epidural catheter should be inserted 3-5 cm into the patient. This depth allows for optimal placement of the catheter in the epidural space, ensuring effective administration of anesthesia or pain medication. Inserting the catheter too shallowly (1-2 cm) may result in inadequate pain relief, while inserting it too deeply (5-10 cm) may increase the risk of complications such as dural puncture. Therefore, the recommended depth for inserting the epidural catheter is 3-5 cm.

When the CSF is heavier than the LA injected, it causes the LA to float up. This means that the local anesthetic solution is less dense than the cerebrospinal fluid, resulting in it being distributed in a higher position within the spinal canal. This phenomenon is known as hypobaric.

The motor level blockade is usually two dermatomes below the sensory level.

Maintaining the patient in an upright position and on bedrest is not an appropriate treatment for Post dural Puncture headache. This position may actually exacerbate the headache and prolong the recovery process. The other options, such as performing a blood patch at the same interspace prior epidural, encouraging the patient to drink lots of fluids, and administering IV caffeine, are all appropriate treatments for Post dural Puncture headache.

CSF (cerebrospinal fluid) is produced by ependymal cells of the choroid plexus. The choroid plexus is a network of blood vessels located in the ventricles of the brain. Ependymal cells line the ventricles and are responsible for producing CSF. These cells actively transport substances from the blood into the ventricles, creating the composition of CSF. CSF plays a crucial role in protecting and nourishing the brain and spinal cord, as well as maintaining a stable environment for neural function.

The concentration of Bupivacaine is given as 0.25% which means there is 0.25 grams of Bupivacaine in 100 ml of solution. To find how much Bupivacaine is in 30 ml's of solution, we can use the proportion method. So, (0.25 grams / 100 ml) = (x grams / 30 ml). Solving for x, we get x = (0.25 grams / 100 ml) * 30 ml = 0.075 grams = 75 mg. Therefore, there is 75 mg of Bupivacaine in 30 ml's of 0.25% Bupivacaine solution.

To make a hypobaric solution of bupivicaine, one would add 6-8ml of sterile water. This is because a hypobaric solution refers to a solution that has a lower density than the surrounding fluid. By adding sterile water, which has a lower density than bupivicaine, the overall density of the solution will decrease, resulting in a hypobaric solution. Adding glucose to increase the density or mixing equal parts LA (local anesthetic) and CSF (cerebrospinal fluid) would not result in a hypobaric solution. Therefore, the correct answer is by adding 6-8ml of sterile water.

The CSE technique does not provide a decreased risk of infections. While it offers advantages such as allowing titration of anesthetic to increase levels, rapid onset for women in labor, and post-op pain control, it does not specifically address the risk of infections. This means that the CSE technique may not have any specific measures or benefits to reduce the likelihood of infections compared to other techniques or methods.

Local anesthetics produce conduction blockade of neural impulses by preventing passage of sodium ions through selective sodium channels in nerve membranes, not chloride ions through selective chloride channels. Therefore, the statement is false.

The proper technique for injection of anesthetic into the epidural space is to aspirate prior to injection to make sure you do not get cerebrospinal fluid (CSF), and then inject the anesthetic slowly at a rate of 3-5 cc every 3 minutes. This slow injection helps to avoid an increase in CSF pressure, which can lead to a headache.

The angle of the scapula roughly correlates to the T7 vertebrae. This means that the angle of the scapula is located around the level of the seventh thoracic vertebrae in the spine.

Ascites refers to the accumulation of fluid in the abdominal cavity. When there is increased intrabdominal pressure due to ascites, it can cause compression of the spinal nerves and result in a higher level of blockade during spinal anesthesia. This is because the increased pressure can cause the local anesthetic to spread higher in the spinal canal, leading to a higher level of numbness or paralysis.

The correct answer is "All The Above" because the given statements are all correct. The comic strip shows a person asserting their rights, someone expressing enthusiasm for tasers, and a comment about the cop knowing the person's name. Therefore, all of the statements mentioned in the options are true.

Epidural anesthesia has several advantages, including better control of the level of anesthesia, providing postoperative analgesia, and being suitable for obstetric patients. However, a more intense blockade is not considered an advantage of epidural anesthesia. While epidural anesthesia can provide effective pain relief, a more intense blockade may increase the risk of complications and side effects. Therefore, it is not listed as an advantage of epidural anesthesia.

After performing spinal anesthesia, the sensory blockade at the level of T10 indicates that the nerves responsible for sensory perception below this level are temporarily blocked. The sympathetic blockade is expected to occur at a higher level, specifically at T8, which means that sympathetic nerve activity will be reduced or blocked in the areas below T8. On the other hand, the motor blockade is expected to occur at a lower level, specifically at T12, which means that motor function will be temporarily impaired below this level. Therefore, the correct answer is T8, T12.

The epidural space is the area between the outermost layer of the spinal cord and the vertebral column. It contains various structures, including spinal nerve roots, fatty connective tissue, and lymphatics. However, muscle tissue is not typically found in the epidural space.

Severe hypertension is not a complication associated with the CSE technique. The CSE technique, also known as combined spinal-epidural anesthesia, involves the administration of a spinal block followed by an epidural catheter placement. Complications commonly associated with this technique include catheter migration into the spine, a higher incidence of infection, and the possibility that the patient may not be able to safely ambulate. However, severe hypertension is not typically a complication of this technique.

To increase the density of a block without affecting the spread, giving a higher concentration of drug would be the most suitable option. Increasing the concentration means adding more drug molecules to a given volume, which would increase the density of the block. This can be achieved without changing the spread of the drug, as the volume and dose remain the same. Giving a higher volume or a higher dose of the drug would not necessarily increase the density without affecting the spread.

As a person ages, there are certain physiological changes that occur in their body. These changes can affect the way medications, including anesthesia, are distributed and metabolized. In the case of epidural anesthesia, increased age can lead to a decrease in the elasticity and permeability of the spinal tissues. This can cause the anesthesia to spread further along the spinal cord, leading to an increased spread of the block. Therefore, the correct answer is that increased age will result in increased spread of epidural anesthesia.

The spinal needle will need to be directed significantly cephalad in the thoracic area of the spine due to the slant of the spinous processes of the vertebrae. This means that the needle will need to be inserted at a higher angle in order to reach the desired location in the spinal canal.

Combined Spinal/Epidural (CSE) is a technique that combines the benefits of both spinal anesthesia and epidural anesthesia. It involves inserting a small spinal needle into the subarachnoid space to deliver a single dose of medication, and then placing an epidural catheter for continuous medication delivery. CSE can be used for procedures that require either spinal or epidural anesthesia, providing flexibility in anesthesia management. Therefore, the given statement is false, as CSE can be used for procedures that call for epidurals.

The correct answer is 10-20 cc's. The volume of blood to be injected for a blood patch to treat post-dural puncture headache (PDPH) depends on the size of the patient and the severity of the headache. A blood patch involves injecting a small amount of the patient's own blood into the epidural space to seal the puncture site and alleviate the headache. The recommended volume for a blood patch is typically between 10-20 cc's, but it may vary based on individual factors.

The posterior 1/3 of the spinal cord is supplied by the posterior spinal arteries. These arteries run along the back of the spinal cord and provide blood supply to the posterior portion of the cord. The anterior spinal artery supplies the anterior 2/3 of the spinal cord, while the artery of Adamkiewicz is a larger artery that supplies the lower thoracic and lumbar regions of the spinal cord. The posterolateral spinal vein is not involved in the blood supply of the spinal cord.

Increasing the dose of a medication used for spinal blockade will result in an increase in the level of the blockade. This means that the medication will spread to a higher level in the spinal cord, resulting in a larger area of numbness or anesthesia. The intensity or depth of the blockade may also increase, but the main effect of increasing the dose is an increase in the level of the blockade.

The ventral root carries all efferent signals heading out to the periphery. Efferent signals are motor signals that travel from the central nervous system to the peripheral nervous system, allowing for movement and response in the body. The ventral root is responsible for transmitting these signals from the spinal cord to the muscles and glands in the body. The dorsal root, on the other hand, carries afferent signals, which are sensory signals that travel from the periphery to the central nervous system. Unmyelinated fibers of white matter and epineurium are not specifically involved in carrying efferent signals.

The correct answer is 12. Lidocaine is a local anesthetic commonly used in medical procedures. The concentration of lidocaine in the solution is given as 2%. To determine the safe amount to administer, the patient's weight is relevant. In this case, the patient weighs 60 kg. The recommended dosage of lidocaine is typically 1-5 mg/kg. Since the question does not specify a specific dosage, we can assume the lower end of the range. Therefore, 1 mg/kg x 60 kg = 60 mg. To convert this to milliliters, we need to know the concentration of the lidocaine solution. If the concentration is 2%, then 60 mg / 2% = 3000 mg. Since 1 ml is equivalent to 1000 mg, 3000 mg / 1000 mg/ml = 3 ml. Therefore, the safe amount to administer is 3 ml, which matches the correct answer of 12.

Taking a daily baby aspirin is considered safe and should be continued up until surgery and post-op for a patient about to receive neuraxial blockade. This is because baby aspirin is a low-dose form of aspirin that helps prevent blood clots. Neuraxial blockade involves injecting medication into the space around the spinal cord, which can increase the risk of blood clots. By continuing the baby aspirin, the patient's blood will remain thin and reduce the risk of clot formation during and after the procedure.

In this scenario, the patient experiences profound bradycardia due to the spinal anesthesia going higher than expected. Administering atropine as the first step is appropriate because it is a medication commonly used to treat bradycardia. Atropine works by blocking the action of the vagus nerve, which helps to increase heart rate. Administering 100% oxygen may also be beneficial, but it is not the first priority in this situation. Glycopyrrolate is another medication that can be used to treat bradycardia, but atropine is typically the first-line treatment. Epinephrine is not the initial choice for bradycardia and is usually reserved for more severe cases.

When injecting into an epidural catheter, it is necessary to aspirate every 3-5 mls. This is done to ensure proper placement of the catheter and to prevent any accidental injection into a blood vessel or the subarachnoid space. Aspiration helps to confirm that the needle is in the correct position and that the medication will be delivered to the desired location. By aspirating regularly during the injection, any potential complications can be identified and addressed promptly.

A sympathetic blockade at the level of T6 is considered safe for the patient because it does not pose any immediate or significant risks. The sympathetic nerves control various functions in the body, including heart rate, blood pressure, and sweating. However, a blockade at T6 does not affect the vital functions controlled by the sympathetic nervous system. Therefore, the patient is not at risk for dural puncture headache, bradycardia, or inadequate blockade at this level.

In this scenario, the presence of a large abdominal tumor can affect the spread and distribution of the anesthetic. The tumor may compress the nerves in the epidural space, resulting in a decreased volume of the space available for the anesthetic to spread. As a result, a smaller amount of anesthetic may be required to achieve the desired effect. Therefore, the correct answer is "I would expect to use less anesthetic."

During the emergent repair of a dissecting aortic aneurysm, the artery of Adamkiewicz may have been damaged, leading to Mr. Goldman's symptoms of leg weakness and urinary incontinence. The artery of Adamkiewicz, also known as the great anterior radiculomedullary artery, is a critical artery that supplies blood to the lower spinal cord. Damage to this artery can result in ischemia and compromise the blood supply to the spinal cord, leading to neurological deficits such as weakness and loss of bladder control.

Placing the patient in a lateral position during the administration of an epidural will not help decrease the incidence of post-dural puncture headache (PDPH). PDPH is a common complication of epidural procedures, characterized by a severe headache that occurs after the puncture of the dura mater. The use of a rounded point needle, smaller gauge needle, and orienting the needle parallel to the meningeal fibers can all help reduce the risk of PDPH. However, the position of the patient during the administration of the epidural does not have a significant impact on the incidence of PDPH.

If a patient accidentally receives total spinal anesthesia, it means that the anesthetic has spread to the entire spinal cord, resulting in complete loss of sensation and motor function below the level of the injection. This can be a life-threatening situation as it affects the patient's ability to breathe and maintain blood pressure. However, if the patient's vital signs remain stable, it indicates that they are still able to maintain adequate respiratory function and blood pressure, making it safe to proceed with the surgery. Therefore, the statement is true.