Notes in 45 Spinal, Epidural, and Caudal Blocks

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Published	12/13/2023	A lumbar puncture enters the {{c1::subarachnoid}} space
Published	12/13/2023	Performing a lumbar (subarachnoid) spinal puncture below {{c1::L2}} in an adult and {{c1::L3}} in a child usually avoids potential…
Published	12/13/2023	The principal site of action for neuraxial blockade is believed to be the {{c1::nerve root}} during initial onset of block.
Published	12/13/2023	Differential blockade is the phenomenon where {{c1::sympathetic}} blockade is two segments above {{c2::sensory}} blockade.
Published	12/13/2023	Neuraxial blocks typically impact hemodynamics by causing {{c1::hypotension}} and {{c1::bradycardia}}.
Published	12/13/2023	Neuraxial anesthesia should not be administered in patients with elevated {{c1::intracranial}} pressure.
Published	12/13/2023	Epidural anesthesia has a {{c1::slower}} onset than spinals.
Published	12/13/2023	Caudal epidural anesthesia is a common regional technique in {{c1::pediatric patients}}.
Published	12/13/2023	The thoracic vertebrae spinous processes are {{c1::long}} and project {{c1::posteroinferioly (slant down)}}
Published	12/13/2023	What are the three ligaments that a needle will pass through on a midline neuraxial approach?{{c1::supraspinous ligament}} → {{c2::interspinous ligame…
Published	12/13/2023	The meninges are composed of what 3 layers?{{c1::dura mater}}{{c1::arachnoid mater}} {{c1::pia mater}}
Published	12/13/2023	The {{c1::pia mater::meninges layer}} is a delicate, vascular connective tissues that adheres closely to the spinal cord.
Published	12/13/2023	The {{c1::arachnoid}} mater adheres closely to the {{c1::dura}} mater, separated only by a narrow serous cavity known as the {{c2::subdural space}}.&n…
Published	12/13/2023	{{c3::Cerebrospinal fluid (CSF)}} is contained between the {{c1::pia}} mater and the {{c1::arachnoid}} mater in the {{c2::subarachnoid}} space.
Published	12/13/2023	The {{c1::anterior}} spinal artery is formed from the {{c2::vertebral}} artery and {{c2::radicular}} arteries at the base of the skull.
Published	12/13/2023	The principle site of action for spinal and epidural anesthesia is the {{c1::nerve root}}.
Published	12/13/2023	Patients with pre-existing spinal deformities, previous spinal surgeries, and chronic back pain are considered {{c1::relative::absolute/relative}} con…
Published	12/13/2023	NSAIDs and aspirin do not increase the risk of {{c1::spinal hematoma}} from neuraxial anesthesia or epidural catheter removal.
Published	12/13/2023	Neuraxial anesthetics should not be administered for {{c1::14}} days after administration of ticlopidine (Ticlid).
Published	12/13/2023	Neuraxial anesthetics should not be administered for {{c1::7}} days after administration of clopidogrel (Plavix).
Published	12/13/2023	Subcutaneous heparin for DVT prophylaxis should be held for {{c1::0 hours (does not need to be held)}} prior to neuraxial anesthesia or epidural cathe…
Published	12/13/2023	Removal of an epidural catheter should occur {{c1::1 hour}} before or {{c1::4 hours}} after heparin administration.
Published	12/13/2023	The dural sac terminates at the level of {{c1::S2::vertebrae}}.
Published	12/13/2023	The {{c1::sacral hiatus}}, which is located at the {{c2::S5}} vertebrae, serves as an entry point to the epidural space into the sacrum for caudal ane…
Published	12/13/2023	{{c1::Chloroprocaine (2-3%)}} has the fastest onset of epidural anesthetics
Published	12/13/2023	{{c2::Hydro}}philic opioids, such as morphine, have a spinal duration of {{c1::6}}-{{c1::24}} hours
Published	12/13/2023	For a patient on prophylactic enoxaparin, you should hold the drug for {{c1::12 hours}} before performing a neuraxial block.
Published	12/13/2023	For a patient on therapeutic enoxaparin, you should hold the drug for {{c1::24 hours}} before performing a neuraxial block.
Published	12/13/2023	Enoxaparin should be held for {{c1::2 hours}} after the removal of an epidural catheter.
Published	12/13/2023	Enoxaparin should be held for {{c1::12 hours}} before the removal of an epidural catheter.
Published	12/13/2023	IV heparin infusions should be held for {{c1::2 hours}} after placement of an epidural catheter or spinal injection
Published	12/13/2023	IV heparin infusions should be held for {{c1::4 hours}} after removal of an epidural catheter
Published	12/13/2023	Two two spinal needles with a "cutting tip" are the {{c1::Quincke}} and {{c1::Pitkin}}
Published	12/13/2023	What are the three pencil point (blunt) tip spinal needles? {{c1::Sprott}}, {{c1::Whitacre}}, and {{c1::Pencan}}
Published	12/13/2023	{{c1::Smaller::bigger/smaller}} gauge needles have a lower incidence of post-dural puncture headache.
Published	12/13/2023	{{c1::Vasoconstrictors}} may be added to local anesthetic solutions because they delay the absorption and may provide weak spinal analgesia.
Published	12/13/2023	A supine position causes hyperbaric solutions to settle in the most dependent area of the spine, thereby limiting spinal anesthesia to {{c1::T4}} and …
Published	12/13/2023	The Tuohy needle has a {{c1::30}}° curve and has a {{c2::blunt}} tip.
Published	12/13/2023	{{c1::Incremental}} dosing and test doses with periodic {{c2::aspiration}} are used to reduce the risk of local anesthetic systemic toxicity.
Published	12/13/2023	Hypobaric solutions are less dense than CSF, and move {{c1::cephalad (float)}} in an upright patient
Published	12/13/2023	Isobaric solutions have a density similar/equal to CSF, and {{c1::remain at the level of injection::move how?}}
Published	12/13/2023	Hyperbaric solutions are more dense than CSF, and move {{c1::caudally (sink)}} in an upright patient
Published	12/13/2023	Hyperbaric solutions are created by mixing local anesthesia with {{c1::5-10% dextrose}}
Published	12/13/2023	How far should you thread the catheter into the epidural space?{{c1::4 cm}}
Published	12/13/2023	What is the cranial border of the epidural space?{{c1::Foramen magnum}}
Published	12/13/2023	What is the caudal border of the epidural space?{{c1::Sacrococcygeal ligament}}
Published	12/13/2023	What is the lateral borders of the epidural space?{{c1::Vertebral pedicles}}
Published	12/13/2023	What are the posterior borders of the epidural space?{{c1::Ligamentum flavum}} and {{c1::Vertebral lamina}}
Published	12/13/2023	Spinal anesthesia can cause {{c1::hypotension}}, which can be minimized with left uterine displacement, patient positioning, {{c2::fluid boluses}}, an…
Published	12/13/2023	Caudal anesthesia is a form of {{c2::epidural}} anesthesia which the injection is made at the {{c1::sacral hiatus S5}}.
Published	12/13/2023	{{c1::Hypovolemia}} is an absolute contraindication to neuraxial blockade because it will worsen the hypotension from a sympathetctomy.
Published	12/13/2023	What valvular diseases are contraindications to neuraxial anesthesia?Severe {{c2::aortic stenosis}} and {{c1::mitral stenosis}}
Published	12/13/2023	The {{c1::posterior superior iliac spine}} correlates with the {{c2::S2}} vertebra in adults, which is where the {{c3::dural sac}} terminates.
Published	12/13/2023	With epidural anesthesia, the primary determinant of spread is {{c1::volume of injectate}}.
Published	12/13/2023	Opioid additives to local anesthetics for spinal anesthesia primarily affect the {{c1::quality}} of the block.
Published	12/13/2023	{{c1::Epinephrine::additive}} delays vascular absorption and reduces peak systemic blood levels of all epidurally administered local anesthe…
Published	12/13/2023	The {{c1::cauda equina}} is a bundle of spinal nerves extending from the {{c2::conus medullaris}} to the end of the {{c3::dural sac}}
Published	12/13/2023	{{c1::Cauda equina syndrome}} is caused by {{c2::high concentrations of local anesthetics}} that leads to low back pain, numbless and tingling of the …
Published	12/13/2023	Administration of {{c1::5% lidocaine}} increases the risk of cauda equina syndrome.
Published	12/13/2023	Cauda equina syndrome is characterized by {{c1::bowel}} and {{c1::bladder}} dysfunction, {{c2::low back}} pain, and leg {{c3::weakness}}.
Published	12/13/2023	Transient neurological symptoms (TNS) can be caused by the {{c1::lithotomy}} position, or any position that stretches the {{c2::sciatic}} nerve.
Published	12/13/2023	{{c1::Ambulatory}} surgeries increase the risk of transient neurologic symptoms (TNS).
Published	12/13/2023	{{c2::Transient Neurologic Symptoms (TNS)}} is characterized by severe {{c1::back}} and {{c1::butt}} pain that radiates to {{c1::both legs}}…
Published	12/13/2023	If a patient is placed supine after a spinal with a hyperbaric solution, the local anesthetic will slide down the lumbar lordosis and p…
Published	12/13/2023	{{c1::High neural blockade}} is a complication of spinal/epidural anesthesia due to an exagerated dermatomal spread.
Published	12/13/2023	Large doses of spinal anesthetics predisposes patients to {{c1::high neural blockade::complication}}.
Published	12/13/2023	What complication of neuraxial blockade results in bradycardia, respiratory insufficiency, and hypotension?{{c1::High spinals}}
Published	12/13/2023	High Neural Blockade: When a block extends to {{c1::cranial nerves}} it is called a {{c2::"total spinal"}}
Published	12/13/2023	A high neural blockade can cause {{c2::apnea}} due to {{c1::medullary hypoperfusion}}.
Published	12/13/2023	Symptoms of a spinal hematoma or epidural hematoma include: sharp {{c1::back}} and {{c1::leg}} pain with {{c2::motor}} weakness and/or {{c2::sphincter…
Published	12/13/2023	TNS (transient neurological symptoms) is most commonly associated with {{c1::hyperbaric lidocaine::drug}}
Published	12/13/2023	Adding {{c1::sodium bicarbonate}} immediately before injection of a local anesthetic will {{c2::accelerate}} the onset of neuraxial blockade by increa…
Published	12/13/2023	The goal of using a test dose in an epidural is to elucidate mild symptoms and signs of {{c1::intravascular injection}}, but avoid {{c2::seizures…
Published	12/13/2023	The lowest point of the spinal cord in supine position or lateral decubitus is around {{c1::T5}}, where a {{c2::hyperbaric solution::hypo/iso/hyperbar…
Published	12/13/2023	If you suspect a spinal hematoma or abscess, prompt {{c1::decompression::surgical procedure}} within {{c2::8}} hours is imperative.
Published	12/13/2023	The {{c1::Bezold-Jarisch}} reflex causes {{c2::bradycardia}} and {{c2::asystole}} in the absence of a T1-4 neuraxial blockade.
Published	12/13/2023	Hyperbaric solutions: the weight is {{c1::more}} than CSF and the baricity is {{c2:: > 1.0015}}
Published	12/13/2023	Hypobaric solutions: the weight is {{c1::less}} than CSF and the baricity {{c2::< 0.9990}}
Published	12/13/2023	Isobaric solutions: the weight is {{c1::the same as}} CSF and the baricity is {{c2::1.0000}}-{{c2::1.0006}}
Published	12/13/2023	The {{c1::direction}} and {{c2::speed}} of injection will affect the dermatomal spread of local anesthetics in spinal anesthesia.
Published	12/13/2023	How does increased intra-abdominal pressure affect spinal anesthesia spread?{{c1::Increased}}
Published	12/13/2023	A high sympathetic block may block the {{c1::cardioaccelerator fibers}}, leading to bradycardia.
Published	12/13/2023	There are {{c1::7}} cervical vertebrae.
Published	12/13/2023	There are {{c1::12}} thoracic vertebrae.
Published	12/13/2023	There are {{c1::5}} lumbar vertebrae.
Published	12/13/2023	There are {{c1::5}} sacral vertebrae.
Published	12/13/2023	There are {{c1::4}} coccygeal bones/vertebrae.
Published	12/13/2023	The {{c1::filum terminale}} is a fibrous extension of the {{c2::pia mater}} and connects the {{c3::conus medullaris}} to the {{c3::coccyx}}.
Published	12/13/2023	Lumbar vertebrae are primarily characterized by their {{c1::large body}}.
Published	12/13/2023	Spinal nerves exit the spinal column via the {{c1::intervertebral}} foramens.
Published	12/13/2023	What anatomic landmark correlates with the termination of the dural sac?{{c1::posterior superior iliac spines}}
Published	12/13/2023	In neuraxial anesthesia, a needle is advanced through the {{c2::interlaminar}} foramen, which is covered by the {{c1::ligamentum flavum::ligament}}
Published	12/13/2023	The ligamentum flavum ligament tends to feel like {{c1::a sharp increase in resistance}}.
Published	12/13/2023	If a patient becomes hypotensive after spinal anesthesia with a hyperbaric solution, you {{c1::should not::should/should not}} place the patient in a …
Published	12/13/2023	If a patient becomes hypotensive after spinal anesthesia with a hyperbaric solution, placing a patient in Trendelenburg position will shift the h…
Published	12/13/2023	{{c1::Elderly::age}} patients and patients with severe {{c2::kyphosis}} have decreased CSF volume, which causes {{c2::higher}} anesthetic level spread…
Published	12/13/2023	Blocking the T5-L1 nerves causes vaso{{c2::dilation}} of the {{c2::venous capacitance}} vessels, thereby decreasing venous return to the heart.
Published	12/13/2023	The lumbar vertebrae spinous processes are {{c1::short}} and project {{c1::nearly horizontally and slightly down}}
Published	12/13/2023	If a spinal or epidural hematoma is suspected, you should obtain a STAT {{c1::MRI}} or {{c1::CT}}, and get a neurosurgical consultation for {{c2:…
Published	12/13/2023	Transient Neurologic Symptoms (TNS) is usually treated with {{c1::analgesic}} medications and {{c2::trigger point}} inje…
Published	12/13/2023	{{c2::Pencil point}}-tipped needles have a lower incidence of post-dural puncture headache.
Published	12/13/2023	Neuraxial anesthetics should not be administered for {{c1::8}} hours after administration of eptifbatide (integrilin).
Published	12/13/2023	Severe {{c1::left ventricular outflow}} obstruction is a contraindication to neuraxial blockade.
Published	12/13/2023	During neuraxial anesthesia, hypotension should be treated with {{c1::vasopressors}}.
Published	12/13/2023	The anterior spinal artery supplies the {{c1::anterior ⅔}} of the spinal cord.
Published	12/13/2023	The anterior spinal artery courses down the {{c1::anterior}} surface of the spinal cord.
Published	12/13/2023	Fentanyl is a {{c1::lipo}}philic opioid with a spinal onset of 5-10 minutes
Published	12/13/2023	When performing neuraxial anesthesia, you should feel {{c1::two::#}} "pops" as the needle traverses the {{c2::ligamentum flavum and dura}}.
Published	12/13/2023	The paired {{c2::posterior spinal}} arteries and {{c2::posterolateral spinal}} arteries supply the {{c1::posterior ⅓}} of the spinal cord.
Published	12/13/2023	Differential blockade is the phenomenon where {{c1::sensory}} blockade is two segments above the {{c2::motor}} blockade.
Published	12/13/2023	Hypobaric solutions are created by mixing local anesthetics with {{c1::sterile water}}
Published	12/13/2023	Isobaric solutions are created by mixing local anesthesics with {{c1::CSF}} or {{c2::saline}} in a 1:1 ratio.
Published	12/13/2023	A lack of {{c1::consent}} is an absolute contraindication to neuraxial blockade.
Published	12/13/2023	Coagulopathies such as platelets less than {{c1::100,000}} and INR > {{c2::1.5}} are considered absolute contraindications to spinal anesthesia.&nb…
Published	12/13/2023	{{c1::Sepsis}} and skin infections at the site of injection are contraindications to neuraxial blockade because of the increased risk of {{c2::meningi…
Published	12/13/2023	{{c1::Demyelinating}} CNS diseases such as multiple sclerosis are contraindications to {{c2::spinal}} anesthesia.
Published	12/13/2023	{{c1::Uncooperative}} patients are a contraindication to neuraxial blockade, because they need to be able to sit still to achieve the appropriate…
Published	12/13/2023	A {{c2::paramedian}} approach to spinal anesthesia is used in patients with calcified ligaments, such as {{c1::elderly}} and {{c1::arthritic}} patient…
Published	12/13/2023	In a paramedian approach, the needle transverses the {{c1::paraspinous}} muscle instead of the supraspinous and interspinous ligaments.
Published	12/13/2023	Spinal anesthesia may inadvertently cause {{c2::urinary retention}} due to blockade of {{c1::S2}}-{{c1::S4}} root fibers.
Published	12/13/2023	{{c4::Post-dural puncture headaches}} occur due to a loss of {{c2::CSF}} through a hole in the meninges.
Published	12/13/2023	Post-dural puncture headaches present with a severe {{c1::fronto-occipital}} headache radiating to the {{c2::neck}} and {{c2::shoulders}}.
Published	12/13/2023	Post-dural puncture headaches present with headaches, {{c1::photophobia}}, and {{c2::tinnitus}}.
Published	12/13/2023	Post-dural puncture headaches are aggravated when {{c1::upright::position}} and relieved when {{c1::lying down::position}}.
Published	12/13/2023	{{c1::Young females::patient population}} carry the highest risk of post-dural puncture headaches due to the intracranial changes of progesterone and …
Published	12/13/2023	Neuraxial anesthetics should not be administered for {{c1::8}} hours after administration of aggrastat (tirofiban).
Published	12/13/2023	Injection of an epidural dose into the {{c2::subarachnoid}} space or {{c1::subdural}} space can cause a high/total spinal.
Published	12/13/2023	Use of {{c1::small bore}} catheters for spinal anesthesia increases the risk of {{c2::cauda equina}} syndrome.
Published	12/13/2023	Lipophilic opioids have a {{c1::fast}} onset and a {{c2::short}} duration of action when used intrathecally.
Published	12/13/2023	Hydrophilic opioids have a {{c1::slow}} onset and a {{c2::long}} duration of action when used intrathecally.
Published	12/13/2023	{{c1::Hydro}}philic opioids produce delayed respiratory depression that manifests after 6-12 hours.
Published	12/13/2023	In the Bezold-Jarisch reflex, {{c1::vasodilation}} and decreases in preload cause {{c2::serotonin}} release.
Published	12/13/2023	In the Bezold-Jarisch reflex, stimulation of {{c1::5-HT3}} receptors in the ventricles will lead to {{c2::bradycardia}} and {{c2::asystole}}.&nbs…
Published	12/13/2023	What dermatome is found at the xiphoid process? {{c1::T6}}
Published	12/13/2023	What dermatome is found at the pinky? {{c1::C8}}
Published	12/13/2023	What dermatome is found at the pubic symphysis? {{c1::T12}}
Published	12/13/2023	Larger {{c1::doses}} of spinal anesthetics will significantly affect the spread of spinal anesthesia.
Published	12/13/2023	In healthy patients, neuraxial anesthesia produces {{c1::minimal}} effects on the respiratory system.
Published	12/13/2023	Neuraxial anesthesia should be used cautiously in patients with {{c1::severe COPD}} because it reduces {{c2::accessory}} muscle function.
Published	12/13/2023	What GI effects does neuraxial anesthesia produce?{{c1::Increased peristalsis}}
Published	12/13/2023	Neuraxial anesthesia {{c1::inhibits}} the neuroendocrine stress response to surgery.
Published	12/13/2023	{{c1::Epidural::spinal/epidural}} anesthesia is {{c2::safe}} in a patient with multiple sclerosis.
Published	12/13/2023	ID structure 1: {{c1::body}}
Published	12/13/2023	ID structure 2: {{c1::pedicle}}
Published	12/13/2023	ID structure 3: {{c1::transverse process}}
Published	12/13/2023	ID structure 4: {{c1::lamina}}
Published	12/13/2023	ID structure 5: {{c1::spinous process}}
Published	12/13/2023	ID structure 6: {{c1::Facet}}
Published	12/13/2023	ID structure 7: {{c1::vertebral foramen}}
Published	12/13/2023	A T4 level block may cause {{c1::dyspnea}} because the {{c2::T6}} level innervates the {{c3::intercostal}} muscles.
Published	12/13/2023	{{c2::Transient Neurologic Symptoms (TNS)}} is a complication of neuraxial anesthesia that develops within 2-6 hours and persists for up to {{c1:…
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