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