spinal anaesthesia dr.m.kannan md da professor and hod department of anaesthesiology tirunelveli...

Spinal Anaesthesia

Dr.M.Kannan MD DAProfessor And HODDepartment of

AnaesthesiologyTirunelveli 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

• Hyperbaric

Stay in the lowest area as per gravity

• 5% with Glucose• 0.5% with Glucose

• Does not mix up with CSF

Complications

• On Table

• Delayed

On Table Complication

• Hypotension • IV Isotonic Fluids• Vasopressors• Oxygen by mask• Atropine-

Bradycardia

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