spinal anesthesia

Spinal Anaesthesia : 

Spinal Anaesthesia Dr.Muneebuddin M R (DA) PG Student Department of Anaesthesiology Vinayaka Mission Medical College, Karaikal

History : 

History CSF Discovered – Domenico Catugno 1764 CSF Circulation – F Magendie 1825 First spinal analgesia - J Leonard Corning 1885 First planned spinal analgesia – August Bier (16th August 1898)

August Bier 1885 : 

August Bier 1885

Spinal Anatomy : 

Spinal Anatomy

Flow of CSF : 

Flow of CSF

: 

Where Spinal Cord Ends : 

Where Spinal Cord Ends

Cauda Equina : 

Cauda Equina

BLOOD SUPPLY TO SPINAL CORD : 

BLOOD SUPPLY TO SPINAL CORD

Indication : 

Indication Lower abdominal, inguinal, urogenital, rectal and lower extremity surgery. Economical Pulmonary Diseases Full Stomach Lower Abdominal Surgery Ischemic Heart Diseases for Lower Abdominal Surgery

Absolute Contraindication : 

Absolute Contraindication Patient refusal Infection at the site. Coagulopathy or bleeding diathesis Severe hypovolemia Increased ICP Severe mitral or aortic stenosis

Relative Contraindication : 

Relative Contraindication Sepsis Uncooperative patieny Preexisting neurological deficit Demyelinating lesions Stenotic valvular heart disease Hypotensive Patients Cardiac failure Spinal Deformity

Local Anaesthetic Drugs : 

Local Anaesthetic Drugs Lignocaine 2% Lignocaine 5% Bupivacaine 0 .5%

Lignocaine : 

Lignocaine Dose 3mg /kg 7mg/kg with adrenaline Prolong action/reduces the toxicity

Lignocane Toxicity : 

Lignocane Toxicity Tingling sensation around mouth Drowsiness Hypotension Fits Treatment Dizepam/Thiopentone Muscle relaxant

Bupivacaine : 

Bupivacaine Longacting 4-6 hours Deferential blockers -Sensory more than Motor -Dose- 1-1.5 mg/kg -Cardiac Toxic -No Tachyphylaxis- Repeat drug

100% Sterile : 

100% Sterile

Patient Position : 

Patient Position Lateral Decubitus Sitting position Prone position Anorectal position Jack knife position

Spinal Anaesthesia : 

Spinal Anaesthesia

SITTING / LYING : 

SITTING / LYING

Holding for Spinal : 

Holding for Spinal

Sitting Position : 

Sitting Position

Flexion : 

Flexion

Techniques of LP : 

Techniques of LP Middle approach Paramedian approach Taylor’s approach

Structures Pierced : 

Structures Pierced

Spinal Needle : 

Spinal Needle

Spinal needle : 

Spinal needle Hub fused to a Canula fitted with a removable Stylet 3.5 to 4 inches in length Gauge of SN and colour coding 18 G – Pink 24 G - Orange 19 G - Ivory 25 G - Brown 20 G – Yellow 23 G - Blue 22 G - Black

Factors Influence The Level Of Anaesthesia : 

Factors Influence The Level Of Anaesthesia Baricity The level of Injection Patient height Direction of needle Position of patient The volume of drug Amount of drug Speed of Injection

Other factors : 

Other factors Intra abdominal pressure Spinal curvature Prior surgery Age Obesity Pregnancy Spread of the agent Addition of vasoconstrictor Redistribution of the local anesthetic from SA space.

Advantages of spinal anaesthesia : 

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:

Slide 34: 

Caesarian section (awake patient, bonding) Lower limb surgery Lower abdominal surgery - Urological & gyneacological procedures.

Reason For the Patho physiological Changes : 

Reason For the Patho physiological Changes Blockade of the Sympathetic Systems

Cardivascular Changes : 

Cardivascular Changes Hypotension Tachycardia Bradycardia Sympathetic Blockade Marys law/Mayos Reflex Bainbridge Reflex

Drug for Spinal Anaesthesia : 

Drug for Spinal Anaesthesia Lignocaine Bupivacaine Hyperbaric Stay in the lowest area as per gravity 5% with Glucose 0.5% with Glucose Does not mix up with CSF

Sequence of nerve block : 

Sequence of nerve block Vasomotor block – dilatation of skin vessels and increased cutaneous blood flow Block of cold temperature fibres Sensation of warmth Temperature discrimination is next lost Slow pain Fast pain Tactile sense lost Motor paralysis Presurre sense abolished Proprioception and MTI senses

Modified Bromage scale- Onset of Motor block : 

Modified Bromage scale- Onset of Motor block Scale 0 – Free movement of legs and feet with ability to raise extended leg. Degree of block – none(zero) Scale 1 – Inability to raise extended leg and knee, flexion is decreased but full flexion of feet and ankles is present. Degree of block – partial (33%) Scale 2 - Inability to raise le or flex knees, flexion of ankle and feet present. Degree of block – partial (66%) Scale 3 – Inability to raise leg, flex knees or ankle or move toes. Degree of block – complete paralysis. Recovery is reverse of onset, plantar flexion of big toe is a good, early sign of recovery.

Complications : 

Complications On Table Delayed

On Table Complication : 

On Table Complication Hypotension IV Isotonic Fluids Vasopressors Oxygen by mask Atropine-Bradycardia

Pregnancy & Spinal : 

Pregnancy & Spinal Aortocaval Occlusion Pre loading with IV Fluids Left lateral Position Vasopressors Oxygen therapy

Delayed Complication : 

Delayed Complication Head ache postdural puncture headache Sixth Cranial nerve palsy Infection Backache Nausea Hypoventilation Urinary retention Neurological

How to prevent Delayed Complication : 

How to prevent Delayed Complication Use Thin Spinal needles Sterile Precaution