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

Bupivacaine Longacting 4-6 hours Deferential blockers -Sensory more than Motor -Dose 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 HypotensionIV 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