Neuraxial Anatomy, Central Neuraxial Blocks, and Spinal Cord Vascularity — WACS Viva & Clinical Scenarios (Anatomy, Applied Anatomy and Regional Anaesthesia)

Exam-style neuraxial anatomy, central neuraxial blocks, and spinal cord vascularity viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 32-year-old Gravida 3 Para 2 at 38 weeks gestation with severe pre-eclampsia and a blood pressure of 170/110 mmHg presents for emergency Caesarean section due to fetal distress. Outline your anatomical approach, landmark identification, needle selection, and complete anaesthetic management for performing a subarachnoid block in this patient.
• SCENARIO 2: A 68-year-old male with severe lumbar spondylosis and degenerative scoliosis is scheduled for elective bilateral transurethral resection of the prostate. Surface anatomical landmarks in the midline are impalpable and distorted. How would you plan, justify, and execute a paramedian spinal anaesthetic technique, detailing the anatomical structures traversed compared to the midline approach?
• SCENARIO 3: A 24-year-old primigravida experiences an accidental dural puncture with an 18G Tuohy needle during an epidural placement for labour analgesia. Forty-eight hours postpartum, she develops an incapacitating frontal-occipital headache worsening on standing and associated with photophobia and neck stiffness. Detail your anatomical reasoning, diagnostic workup, conservative measures, and technique for an epidural blood patch.
• SCENARIO 4: A 55-year-old male undergoes open repair of a thoracoabdominal aortic aneurysm. Postoperatively in the recovery room, he develops bilateral flaccid lower extremity paralysis with loss of pain and temperature sensation, while light touch and proprioception remain intact. What is the anatomical and vascular basis of this condition, and what is your urgent anaesthetic and critical care management to optimize spinal cord perfusion pressure?
• SCENARIO 5: A 72-year-old female on prophylactic low-molecular-weight heparin following a revision total knee arthroplasty had an indwelling lumbar epidural catheter removed 6 hours after the morning dose. Twelve hours later, she complains of severe back pain, progressive motor weakness in both legs, and urinary retention. Describe your immediate diagnostic approach, anatomical localising principles, and emergency intervention pathway.