Spinal Anaesthesia

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Spinal Anaesthesia

• Dr.M.Kannan MD DA
• Professor And HOD
• Department of Anaesthesiology
• Tirunelveli Medical College

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August Bier 1885
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Local Anaesthetic Drugs

• Lignocaine 2
• Lignocaine 5
• Bupivacaine 0 .5

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Lignocaine

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

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Lignocane Toxicity

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

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Bupivacaine

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

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SPINAL CORD
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Flow of CSF
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Where Spinal Cord Ends
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Cauda Equina
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BLOOD SUPPLY TO SPINAL CORD
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100 Sterile
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Spinal Anaesthesia
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Holding for Spinal
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Sitting Position
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Flexion
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Structures Pierced
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Spinal Needle
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Factors Influence The Level Of Anaesthesia

• The level of Injection
• The volume of drug
• Tilt of Table
• Speed of Injection

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

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SITTING / LYING
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Reason For the Patho physiological Changes

• Blockade of the Sympathetic Systems

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Cardivascular Changes

• Hypotension
• Tachycardia
• Bradycardia

• Sympathetic Blockade
• Marys law/Mayos Reflex
• Bainbridge Reflex

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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

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Complications

• On Table
• Delayed

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On Table Complication

• Hypotension

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

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Pregnancy Spinal

• Aortocaval Occlusion

• Pre loading with IV Fluids
• Left lateral Position
• Vasopressors
• Oxygen therapy

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Delayed Complication

• Head ache
• Sixth Cranial nerve palsy
• Infection

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How to prevent Delayed Complication

• Use Thin Spinal needles
• Sterile Precaution

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Indication

• Economical
• Pulmonary Diseases
• Full Stomach
• Lower Abdominal Surgery
• Ischemic Heart Diseases for Lower Abdominal
  Surgery

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Relative Contraindication

• Hypotensive Patients
• Cardiac failure
• Raised ICT
• Spinal Deformity
• Refusing Patients
• Bleeding Diathesis
• Skin Infection