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Figure 13.2 Surface anatomy for neuraxial anesthesia. Anesthetic techniques: reGionAl ● 175 lead to anterior spinal artery syndrome, resulting in bilateral lower extremity paralysis with preservation of proprioception and vibration. The spinal nerve roots exit the spinal canal via intervertebral foramen. The nerves arise above their respective vertebrae, but starting at T1, they exit below their vertebrae. As a result, there are eight cervical nerve roots, but only seven cervical vertebrae. Each spinal nerve innervates an area of skin referred to as a dermatome (see Fig. 13.3). Indications and Contraindications As with any anesthetic procedure, the risks and benefits of neuraxial regional anesthesia must be discussed with the patient. Potential risks are shown in Table 13.1. Spinal anesthesia is primarily indicated for lower abdominal surgery, the perineum, and lower extremities. Epidural anesthesia is primarily indicated for lower abdominal surgery, thoracic surgery, surgery on the lower extremities, and labor. Epidurals can have sacral nerve root “sparing” and may not be optimal for surgery involving this area. Contraindications to neuraxial anesthesia are listed in Table 13.2. Mechanism of Action The most common medication given for regional anesthesia is a local anesthetic. Local anesthetic that has been injected directly into the subarachnoid space (spinal) or that has diffused into the subarachnoid space from the epidural space (epidural) bathes the nerve root and inhibits synaptic transmission of action potentials. The effect of local anesthetics on nerve fibers varies
176 ● AnesthesiA student survivAl Guide Figure 13.3 Dermatomes. (Reproduced with permission from Stewart, O. Functional Neuroscience. Springer Press. 2000).
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Page 162 and 163: Anesthesia Equipment and Monitors B
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Page 204 and 205: Table 13.1 Risks of neuraxial anest
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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