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Download Spinal Anaesthesia
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Spinal Anaesthesia Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College August Bier 1885 Local Anaesthetic Drugs • Lignocaine 2% • Lignocaine 5% • Bupivacaine 0 .5% Lignocaine • Dose 3mg /kg • 7mg/kg with adrenaline • Prolong action/reduces the toxicity Lignocane Toxicity • • • • Tingling sensation around mouth Drowsiness Hypotension Fits Treatment • Dizepam/Thiopentone • Muscle relaxant Bupivacaine • Longacting 4-6 hours • Deferential blockers -Sensory more than Motor -Dose- 1-1.5 mg/kg -Cardiac Toxic -No Tachyphylaxis- Repeat drug SPINAL CORD Flow of CSF Where Spinal Cord Ends Cauda Equina BLOOD SUPPLY TO SPINAL CORD 100% Sterile Spinal Anaesthesia Holding for Spinal Sitting Position Flexion Structures Pierced Spinal Needle Factors Influence The Level Of Anaesthesia • The level of Injection • The volume of drug • Tilt of Table • Speed of Injection Advantages of spinal anaesthesia Full and complete anaesthesia • Prolonged block: Pain free postoperatively • Alternative to GA for certain poor risk patients esp.: - Difficult airway - Respiratory disease • Contracted bowel • Good muscle relaxation • Suitable for certain surgical procedures: • Caesarian section (awake patient, bonding) -Lower limb surgery -Lower abdominal surgery - Urological & gyneacological procedures. SITTING / LYING Reason For the Patho physiological Changes • Blockade of the Sympathetic Systems Cardivascular Changes • Hypotension • Tachycardia • Bradycardia • Sympathetic Blockade • Marys law/Mayos Reflex • Bainbridge Reflex Drug for Spinal Anaesthesia • Lignocaine • Bupivacaine • 5% with Glucose • 0.5% with Glucose • Hyperbaric Stay in the lowest area as per gravity • Does not mix up with CSF Complications • On Table • Delayed On Table Complication • Hypotension • • • • IV Isotonic Fluids Vasopressors Oxygen by mask AtropineBradycardia Pregnancy & Spinal • Aortocaval Occlusion • Pre loading with IV Fluids • Left lateral Position • Vasopressors • Oxygen therapy Delayed Complication • Head ache • Sixth Cranial nerve palsy • Infection How to prevent Delayed Complication • Use Thin Spinal needles • Sterile Precaution Indication • • • • • Economical Pulmonary Diseases Full Stomach Lower Abdominal Surgery Ischemic Heart Diseases for Lower Abdominal Surgery Relative Contraindication • • • • • • • Hypotensive Patients Cardiac failure Raised ICT Spinal Deformity Refusing Patients Bleeding Diathesis Skin Infection
