Spinal Anesthesia

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Author:
meowzart
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39727
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Spinal Anesthesia
Updated:
2010-10-16 14:42:26
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spinal regional
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questions on spinal anesthesia
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  1. List 3 benefits of spinal anesthesia
    • - allows monitoring of mental and cardiac status
    • - avoids airway manipulation
    • - blocks adrenal/stress response to surgery
    • - less incidence of DVTs
  2. List 2 absolute contraindications for spinals
    • - refusal
    • - coagulopathy
    • - infection at injection site
    • - young children with aberrant anatomy
  3. List 2 relative contraindications for spinals
    • hypovolemia
    • sepsis
    • chronic progressive neurologic disorders (eg MS)
    • chronic back pain
    • previous back surgery
    • increased ICP
  4. List 3 factors that affect the level and duration of spinal anesthesia
    • patient position
    • volume of anesthetic
    • rate of injection
    • site of injection
    • baricity of the local
    • use of epinephrine
  5. What additive prolongs the duration of spinal?
    a) epinephrine
    b) ephedrine
    c) atropine
    epinephrine
  6. When is hypobaric local anesthetic indicated in a spinal?
    • - head down procedures (eg rectal surgery)
    • - procedures where patient lies on the opposite side (eg nephrectomy)
  7. When are isobaric solutions indicated in spinal anesthetic
    • - lower extremity and urologic procedures
    • - tends to stay at the site of injection
  8. How long after the injection and positioning of the patient is the spinal level 'fixed'?
    a) 5 minutes
    b) ten to fifteen minutes
    c) 30 minutes
    ten to 15 minutes
  9. Describe the progression of ONSET of nerve blockade in a spinal - sensory;motor and autonomic
    first is autonomic then sensory then motor
  10. Describe the progression of OFFSET of nerve blockade in a spinal - sensory; motor and autonomic
    first motor then sensory then autonomic
  11. What dermatome levels are the autonomic and motor functions compared to sensory?
    • motor is 2 dermatomes lower
    • autonomic is 2 dermatomes higher
  12. Anatomically - where is the dermatome T4?
    nipple
  13. Anatomically - where is the dermatome T6?
    xiphoid
  14. Anatomically - where is the dermatome T10?
    navel
  15. Anatomically - where is the dermatome L1?
    groin
  16. Anatomically - where is the dermatome L4?
    knees
  17. How much does adding epinephrine to the local anesthetic, extend the duration of a spinal?
    a) doubles
    b) triples
    c) quadruples
    doubles
  18. What is the duration of a spinal using lidocaine
    - a) 1-1.5 hours
    - b)1.5 - 3 hours
    - c) 2-3 hours
    - d) 2-4 hours
    1 to 1.5 hours
  19. What is the duration of a spinal using tetracaine
    - a) 1-1.5 hours
    - b)1.5 - 3 hours
    - c) 2-3 hours
    - d) 2-4 hours
    2-3 hours
  20. What is the duration of a spinal using bupivicaine
    - a) 1-1.5 hours
    - b)1.5 - 3 hours
    - c) 2-3 hours
    - d) 2-4 hours
    1.5 - 3 hours
  21. List 5 complications from spinal anesthesia?
    • mild temperature loss
    • N & V
    • urinary retention
    • hypotension
    • high spinal
    • bradycardia
    • temporary mild hearing loss
    • dural puncture headache
    • hematoma formation
    • backache
  22. List cause and treatment for the following complication of spinal anesthesia?
    mild temperature loss
    • Cause: vasodilation (ANS block)
    • Tx warm blankets
  23. List cause and treatment for the following complication of spinal anesthesia?
    N & V
    • Cause: usually hypotension, possibly from unopposed vagal stimulation (ANS block)
    • Tx
    • - monitor for nausea
    • - meds
    • - monitor and maintain BP
  24. List cause and treatment for the following complication of spinal anesthesia?
    Urinary retention
    • Cause:
    • - decreased sensation and muscle tone of bladder (sensory and motor block)
    • Tx
    • - assess for distention
  25. List cause and treatment for the following complication of spinal anesthesia?
    hypotension
    • Cause: autonomic block impairs vasoconstriction
    • Tx
    • - IV crystalloid
    • - possibly ephedrine
  26. List S &S and treatment for the following complication of spinal anesthesia?
    high spinal (above T4)
    • S & S
    • - whispering speech,
    • - weak upper extremities;
    • - loss of sensation along chest
    • - resp failure from hypotension; diaphragm paralysis; IC muscle paralysis
    • Tx intubation may be necessary
  27. What should the nurse suspect if she sees the following?
    - whispering speech,
    - weak upper extremities;
    - loss of sensation along chest
    - resp failure


    What are S & S of a high spinal blockade
    high spinal
  28. List cause and treatment for the following complication of spinal anesthesia?
    bradycardia
    • - develops if cardiac accelerating fibres (T1-4) are blocked
    • Tx - atropine
  29. How does taking beta blockers affect a patient post-spinal?
    not able to produce compensatory tachycardia in the presence of hypovolemia thus more likely to have hypotension
  30. List cause and treatment for the following complication of spinal anesthesia?
    hearing loss
    • possibly from temporary decrease is CSF
    • usually more frequent with larger needles
    • Tx - transient
  31. List S & S, cause and treatment for the following complication of spinal anesthesia?
    Dural puncture headache
    • cause:
    • - persistent leak of CSF
    • S & S:
    • - occiptal h/a that is worse when sitting
    • - usually on day 2
    • Tx
    • - blood patch
  32. What is the cause of the following complication of spinal anesthesia?
    - unusually long duration of spinal;
    - complains of back pain;
    - persistant hypotension
    • hematoma
    • - rare but disastrous
    • - hematoma compresses spinal cord and nerve
    • - Tx - surgical decompression - 50% success
  33. List cause and treatment for the following complication of spinal anesthesia?
    Backache
    • traumatic insertion or stretching of ligaments with muscle relaxation
    • Tx analgesics
  34. Testing of cold perception post-spinal tests what type of nerve fibre?
    autonomic
  35. What level of nerve function does plantar flexion of toes indicate (dermatome)
    S1-2
  36. What level of nerve function does dorsal flexion of toes indicate (dermatome)
    L4-5
  37. What level of nerve function does raising the knees indicate (dermatome)
    L2-3
  38. What is the duration of Morphine in a spinal?
    - a) 1-2 hours
    - b) 2-3 hours
    - c) 4-6 hours
    - d) 8-24 hours
    8-24 hours
  39. What is the duration of Fentanyl in a spinal?
    - a) 1-2 hours
    - b) 2-3 hours
    - c) 4-6 hours
    - d) 8-24 hours
    1-2 hours

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