Charts

Question 1

Spinal dermatomes: C5 _________

Answer 1

Clavicles

Question 2

Spinal dermatomes: C6 ________

Answer 2

Thumb

Question 3

Spinal dermatomes: C6, 7, 8 __________

Answer 3

Hand

Question 4

Spinal dermatomes: C8 ____________

Answer 4

Ring and little fingers

Question 5

Spinal dermatomes: T4 __________

Answer 5

Nipples

Question 6

Spinal dermatomes: T10 __________

Answer 6

Umbilicus

Question 7

Id the size and function for the following fiber:

B

Answer 7

<3 microns

Fx: Preganglionic, sympathetic

Question 8

Id the size and function for the following fiber:

C

Answer 8

.3-1.3 microns

Fx: Temperature, dull pain

Question 9

Id the size and function for the following fiber:

A-delta

Answer 9

1-4 microns

Fx: temperature, sharp pain

Question 10

Id the size and function for the following fiber:

A-gamma

Answer 10

3-6 microns

Fx: muscle spindle, muscle tone

Question 11

Id the size and function for the following fiber:

A-beta

Answer 11

6-22 microns

Fx: Light pressure, touch

Question 12

Id the size and function for the following fiber:

A-alpha

Answer 12

6-22 microns

Fx: somatic motor, proprioception

Question 13

What are the containdications or comments for antiplatelet medications?

• ticlopindine
• clopidergrel
• GP IIB/IIIa inhibitors
• Tricagrelor
• psrasugrel
• what medications must be delayed after epidural removal? (3) Whats the delay time?

Answer 13

• NSAIDS: No contraindication
• Discontinue ticlopindine 14 days, clopidergrel 7 days, GP IIB/IIIa inhibitors 8-48 hr in advance
• Tricagrelor: 5-7 days, psrasugrel 7-10 days
• Epidural removal: 6-24 hours dleay until restarting tricagrelor, prasugrel and clopidogrel

Question 14

What are the containdications or comments for unfractionated heparin subq medications?

Answer 14

• No contraindication with twice daily dosing and total daily dose <10,000
• consider delaying heparin until after block if technical difficulty anticipated
• the safety of neuraxial blockade in patients receiving doses >10,000 units/day of UFH or more than twice daily dosing of UFH has not be established

Question 15

What are the containdications or comments for unfractionated heparin IV medications?

Answer 15

• Heparinize 1 hour after neuraxial technique
• Remove catheter 2–4 hours after last heparin dose
• No mandatory delay if traumatic insertion

Question 16

What are the containdications or comments for LMWH medications?

Answer 16

• Twice-daily dosing: LMWH 24 hours after surgery, regardless of technique
• Remove epidural catheter 2 hours before first dose of LMWH

Question 17

What are the containdications or comments for Warfarin medications?

Answer 17

• Normal INR (before neuraxial technique)

- Remove catheter when INR ≤ 1.5 (initiation of therapy)

Question 18

What are the containdications or comments for fonaparinux medications?

Answer 18

• Single injection, atraumatic needle placement or alternate thromboprophylaxis
• Avoid indwelling catheters

Question 19

What are the containdications or comments for direct thrombin inhibitors medications?

Answer 19

• ASRAPM: Insufficient information; suggest avoiding neuraxial techniques
• Belgian and German Societies: Needle placement 8–10 hours after dose; delay subsequent doses 2–6 hours after needle placement

Question 20

What are the containdications or comments for thrombolytics medications?

Answer 20

Absolute contraindication

Question 21

What are the containdications or comments for herbal therapy?

Answer 21

• No evidence for mandatory discontinuation before placement neuraxial technique
• Be aware of potential drug interactions with the “3 Gs”: ginkgo biloba, garlic, and ginseng

Question 22

What are the containdications or comments for Factor Xa therapy?

Answer 22

• Time between epidural anesthetic technique and next anticoagulant dose: rivaroxaban, 4–6 hours; apixaban, 6 hours
• Time before last anticoagulant dose and epidural catheter removal: rivaroxaban, 22–26 hours; apixaban, 26–30 hours
• Time between removal of epidural catheter and next anticoagulant dose: rivaroxaban and apixaban, 4–6 hours

Question 23

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of 2-Chloroprocaine?

Answer 23

Conc: 2%-3
Onset: 10-15 min
Plain: 45-60 min
1:200,000 epinephrine: 60-90 min

Question 24

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of lidocaine?

Answer 24

Conc: 1.5%-2
Onset: 15 min
Plain: 80-120 min
1:200,000 epinephrine: 120-180 min

Question 25

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of mepivacine?

Answer 25

Conc: 1.5%-2 Onset: 15 min Plain: 90-140 min 1:200,000 epinephrine: 140-200 min

Question 26

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of bupivacine?

Answer 26

Conc: .5-.75% Onset: 20 min Plain: 165-225 min 1:200,000 epinephrine: 180-240 min

Question 27

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of etidocaine?

Answer 27

Conc: 1 Onset: 15 min Plain: 130-200 min 1:200,000 epinephrine: 150-225 min

Question 28

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of ropivacine?

Answer 28

Conc: .5% .75-1 Onset: 15-20 min Plain: 140-180 min 1:200,000 epinephrine: 150-200 min

Question 29

What is the concentration, onset, plain duration and 1:200,000 epinephrine duration of levobupivacine?

Answer 29

Conc: .5% .75-1 Onset: 15-20 min Plain: 150-225 min 1:200,000 epinephrine: 150-240 min

Question 30

What is the redosing concentration, time to two segment regression (min) and recommended time for top up from initial dose of 2-chloroprocaine?

Answer 30

- Concentration: 3% - time to two segment regression (min): 45-75 Min - recommended time for top up from inital dose: 45 min

Question 31

What is the redosing concentration, time to two segment regression (min) and recommended time for top up from initial dose of lidocaine?

Answer 31

- Concentration: 2% - time to two segment regression (min): 60-140 Min - recommended time for top up from inital dose: 60 min

Question 32

What is the redosing concentration, time to two segment regression (min) and recommended time for top up from initial dose of bupivacaine?

Answer 32

- Concentration: .10 - time to two segment regression (min): 180-260 Min - recommended time for top up from inital dose: 120 min

Question 33

What is the redosing concentration, time to two segment regression (min) and recommended time for top up from initial dose of ropivacine?

Answer 33

- Concentration: .1 - time to two segment regression (min): 180-260 Min - recommended time for top up from inital dose: 120 min

Question 34

Epidural: dose.

Answer 34

Dose is high (10-20mL)

Question 35

Epidural: onset.

Answer 35

slow (25-30min)

Question 36

Epidural: what is the neuromuscular blockade?

Answer 36

Dose not cause as significant a neuromuscular blockade

Question 37

Epidural: what is a positive indication of this?

Answer 37

Multiple dosing possible, Can be given along various points along the spinal column

Question 38

Spinal: dose.

Answer 38

Dose is low (1.5-2mL)

Question 39

Spinal: onset.

Answer 39

fast (5min)

Question 40

Spinal: what is the neuromuscular blockade?

Answer 40

Causes a significant neuromuscular blockade

Question 41

Spinal: what is the dose frequency?

Answer 41

Single dose

Question 42

Spinal: what is important about the location of spinal?

Answer 42

Can only be given at specific locations in the spinal column to avoid damaging the spinal cord