1. Spinal Anaesthesia

2. August Bier 1885

3. SPINAL ANESTHESIA

4. ANAESTHETICS USED HYPERBARIC (HEAVY)‏ LIGNOCAINE 5% IN 7.5%DEXTROSE
BUPIVACAINE 0.5% IN 5% DEXTROSE

5. HOW A HEAVY ANAESTHETIC SOLUTION FLOWS IN CSF

6. INDICATIONS Economical Pulmonary Diseases Full Stomach
Lower Abdominal Surgery
Ischemic Heart Diseases for Lower Abdominal Surgery
Fit patient requiring lower abdominal, anal of lower extremity surgery
A patient having relative contraindication to general anaesthesia eg respiratory infection, asthma, or a deformed airway
Operations where the patient needs to be placed prone eg excision pilonidal sinus
Operations of one lower extremity ( hemispinal)‏

7. CONTRAINDICATIONS Hypotensive Patients Cardiac failure Raised ICT
Spinal Deformity
Refusing Patients
Bleeding Diathesis
Skin Infection

8. CONTRAINDICATIONS Unco-operative patient
Operations lasting more than 2 hours
Hypovolemic shock
Children
Sepsis anywhere on the back
Operations on the thorax and above

9. TECHNIQUE Preload with 500- 1000ml crystalloid
Premedicate – pentazocine,prometazine, atropine
Moniter BP,pulse and O2 sat, heart rhythm

10. COMPLICATIONS IMMEDIATE
Hypotension- increase IV fluids, use small doses of vasoconstrictors eg mephenteramine ( 3mg iv as needed)‏
Bradycardia- iv atropine
Respiratory distress- supplement with O2, bag and mask or intubate
Inadequate block – supplement with IV ketamine
Total spinal
IV Isotonic Fluids
Vasopressors
Oxygen by mask

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

12. COMPLICATIONS
LATE
Headache
Meningitis
Back pain

13. Local Anaesthetic Drugs
Lignocaine 2%
Lignocaine 5%
Bupivacaine 0 .5%

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

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

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

17. SPINAL CORD

18. Where Spinal Cord Ends

20. 100% Sterile

21. Spinal Anaesthesia

22. Holding for Spinal

23. Sitting Position

24. Structures Pierced

25. Spinal Needle

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

27. 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: -

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

29. SITTING / LYING

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

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

32. 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

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