Spinal Anaesthesia Dr M Kannan MD DA Professor

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 3 mg /kg • 7 mg/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 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