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 3mg /kg
• 7mg/kg with adrenaline
• Prolong action/reduces the toxicity
Lignocane Toxicity
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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
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IV Isotonic Fluids
Vasopressors
Oxygen by mask
AtropineBradycardia
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
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Economical
Pulmonary Diseases
Full Stomach
Lower Abdominal Surgery
Ischemic Heart Diseases for Lower
Abdominal Surgery
Relative Contraindication
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Hypotensive Patients
Cardiac failure
Raised ICT
Spinal Deformity
Refusing Patients
Bleeding Diathesis
Skin Infection