1. Spinal Anaesthesia Dr.M.Kannan MD DA Professor And HOD Department of Anaesthesiology Tirunelveli Medical College

2. August Bier 1885

4. Local Anaesthetic Drugs Lignocaine 2% Lignocaine 5% Bupivacaine 0.5%

5. Lignocaine Dose 3mg /kg 7mg/kg with adrenaline Prolong action/reduces the toxicity

6. Lignocane Toxicity Tingling sensation around mouth Drowsiness Hypotension Fits Treatment Dizepam/Thiopentone Muscle relaxant

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

8. SPINAL CORD

9. Flow of CSF

10. Where Spinal Cord Ends

12. Cauda Equina

14. BLOOD SUPPLY TO SPINAL CORD

15. 100% Sterile

16. Spinal Anaesthesia

17. Holding for Spinal

18. Sitting Position

19. Flexion

20. Structures Pierced

21. Spinal Needle

22. Factors Influence The Level Of Anaesthesia The level of Injection The volume of drug Tilt of Table Speed of Injection

23. 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: -

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

25. SITTING / LYING

26. Reason For the Patho physiological Changes Blockade of the Sympathetic Systems

27. Cardivascular Changes Hypotension Tachycardia Bradycardia Sympathetic Blockade Marys law/Mayos Reflex Bainbridge Reflex

28. 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

29. Complications On Table Delayed

30. On Table Complication HypotensionIV Isotonic Fluids Vasopressors Oxygen by mask Atropine- Bradycardia

31. Pregnancy & Spinal Aortocaval Occlusion Pre loading with IV Fluids Left lateral Position Vasopressors Oxygen therapy

32. Delayed Complication Head ache Sixth Cranial nerve palsy Infection

33. How to prevent Delayed Complication Use Thin Spinal needles Sterile Precaution

34. Indication Economical Pulmonary Diseases Full Stomach Lower Abdominal Surgery Ischemic Heart Diseases for Lower Abdominal Surgery

35. Relative Contraindication Hypotensive Patients Cardiac failure Raised ICT Spinal Deformity Refusing Patients Bleeding Diathesis Skin Infection