Regional Anesthesia for the Neuroaxis, Chest, Abdomen

33 Pages·2010·21 MB·English

by  Raj Gupta

Regional Anesthesia for the
Neuroaxis, Chest, Abdomen
Regional/APS Rotations
(Slides by Randall Malchow, MD)
Regional Anesthesia for
Chest and Abdomen
Thoracic Epidurals
Intercostals
Paravertebral Block
Ilioinguinal, Iliohypogastric
Blocks
TAP/Rectus Sheath Blocks
Caudals
Thoracic Dermatomes

note C4-T2 interface
Thoracic Spine
Sharply angulated sp proc
 
Min flexion of spine (facets)
 
Thin ligamentum flavum
 
Thin epidural space 3-4 mm
 
(5-6 mm in lumbar)
Interspace:
 
–  T4- Upper Rib Fxs
–  T6- Thoracotomies
–  T10- Laparotomies
Midline Thoracic
Epidural
Spinous Process
 
at Trans Process
of level below
Angle 60-75 deg
 
cephalad
Paramedian
Approach
  Esp impt at mid-thor
region (Thoracotomy,
MIDCABG)
  Lg aperture
  1 cm contralat to upper
T6 sp proc
  Touch side of sp proc,
then adv needle
perpendicular to lamina
  Adv 15-30deg med; 45
deg cephalad
TEA: for Cardiac
Surgery
Timing: Day Before vs
 
DOS
Consider periop anticoag
 
(eg Valves)
Preinduction placement/
    Opioid: hydrophilic to
Test Dose maximize other dermatomes
  T3- Sternotomy   UE numbness common
Arrow Flex-tip?   LE deficits concerning
 
Induction: Midaz 0.2mg/   Duration: 72hrs; remove p
 
CT’s out
kg; Panc
Limit advancement, 3cm
 
Secure catheters well
 
Half rate during CPB

USG Lumbar Epidural (parasag)
Note 3 branches of Intercostal Nerves:
-posterior
-lateral
-anterior
Intercostal Nerve Block