1.
Angulation of needle for paramedian approach?: 10-25 angle toward midline
2.
Antiplatelet drug Criteria: -NSAID's do not appear to increase the risk of spinal hematoma.
-Potent agents need to be stopped prior and effects worn off.
-Ticlopidine (Ticlid)- 14 days
-Clopidogrel (plavix) -7 days
-Abciximad (Rheopro) -48 hrs
-Eptifibatide (Integrilin) -8 hrs
3.
Assesment of dermatomal level using pinprick or tempurature sensation: Tempurature- Sympathectomy
Sensory level- Pinprick
4.
Differential Blockade Heights: Sympathetic Block Heights (measured by temp)- 2 segments higher than sensory block.
Sensory Block Height (Measured by pain/light touch, pinprick)- 2 segments higher than motor blockade.
5.
Fibrinolytic/Thrombolytic Therapy Criteria: Best to avoid neuraxial anesthesia
6.
If emergencies do not work for profound hypotention and bradycardia after spinal administration how much epi should you push?: 5-10 ug IV
7.
LMWH Criteria: -If bloody needle or catheter placement occurs LMWH should be delayed for 24hrs post op.
-Trauma may signal increased hematoma risk
-If LMWH is used postop it should be started at least 2 hrs aft catheter removal.
-If catheter is present. It should be taken out 10 hrs after a dose of LMWH and subsequent dosing should not occur for another 2 hrs.
8.
Skin wheal location for paramedian approach: 2 cm lateral to the inferior aspect of the superior spinous process of the desired level
9.
Standard (unfractionated) Heparin Criteria: -Prophylactic minidose subQ is not a contraindication to neuraxial anesthesia
-For intraop heparin use block must be performed >1 prior to administration
-Removal of epidural cath should occur 1 hr prior to or 4 hrs after subsequent heparin dosing
-AVOID neuraxial admin. for pts on THERAPEUTIC DOSING or an ELEVATED PTT
-If pt started heparin after epidural placement. Catheter must be removed after d/c or interruption of infusion.
10.
Warfarin Criteria: Must be stopped. INR & PT must be documented and normal prior to the block
-If it was given prophylactically. If the initial dose was given >24 hrs ago or if more than 1 dose was given the PT & INR need to be checked.
-If only 1 dose was given within 24 hours it should be safe to proceed.
-Removal of epidural catheter from pt receiving low dose 5 mg/d is safe
11.
What are two intervensions that are not IV med pushes that you can do to tx hypotention?: Increase IV fluid, autotransfusion by placing the patient in a head down position
12.
What is the recommended volume replacement for spinal anesthesia?: 10-20 ml/kg in a healthy adult
