SPINAL

ANESTHESIA
Jeffri Prasetyo Utomo
Dian Prima
Rinni Sintani
Aditya Guna Wicaksono
Radhillah Azman
Steven Martin Fulliman
Yusuf Agung Nugraha
Anesthesia and Intensive Care Department
Brawijaya University
Saiful Anwar Hospital
 1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
 DEFINITION
Neuraxial anesthesia technique in which local anesthetic is
placed directly in the intrathecal space (subarachnoid space)

INDICATION
1. Spinal anesthesia provides excellent operating conditions for
surgery below the umbilicus.
2. Thus, it has been used in the fields of urological,
gynecological, obstetric, and lower abdominal and perineal
general surgery.
3. More recently, spinal anesthesia has been used in surgery
above the umbilicus
Hadzic A, NYSORA. Textbook of Regional Anesthesia and Acute Pain Management. NYSORA. 2nd Edition
Hadzic A, NYSORA. Textbook of Regional Anesthesia and Acute Pain Management. NYSORA. 2nd Edition
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
Steven L. Orebaugh and Hillenn Cruz Eng. Neuroaxial Anatomy. Newyork
school of Regional Anasthesia, Hadzic’s Textbook of Regional anesthesia
& Acute Pain Management 2nd edition, 2017. McGraw-Hill. P.324
Steven L. Orebaugh and Hillenn Cruz Eng. Neuroaxial Anatomy.
Newyork school of Regional Anasthesia, Hadzic’s Textbook of
Regional anesthesia & Acute Pain Management 2nd edition, 2017.
McGraw-Hill. P. 325
Adrian Chin and André van Zundert. Spinal Anesthesia. Newyork school of Regional
Anasthesia, Hadzic’s Textbook of Regional anesthesia & Acute Pain Management
2nd edition, 2017. McGraw-Hill. P.340
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
 Structures of commonly used local anesthetics

Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management.
2nd edition. Clinical pharmacology of local anesthetics. Mc Graw Hill Education. 2017.p 124-37
 MECHANISMS OF LOCAL ANESTHETIC ACTION

Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s clinical anesthesiology. 6th edition. Local Anesthetics. McGraw-Hill
Education.2018. p.425-36
 MECHANISMS OF LOCAL ANESTHETIC ACTION

Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s clinical anesthesiology. 6th edition. Local Anesthetics. McGraw-Hill Education.2018.
Potency and Speed of
Duration Onset

Local Anesthetics
Pharmacodynamics

Organs effect:
Cardiovacular

Other Respiratory
CNS
Differential
Sensory
Factors Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and
acute pain management. 2nd edition. Clinical pharmacology of local Nerve Block
anesthetics. Mc Graw Hill Education. 2017.p 124-37
 Absorptio
Distributio
n n
Local Anesthetics
Pharmacokinetics

Biotransformati
on & Excretion

Butterworth JF, Mackey DC, Wasnick JD. Morgan and Mikhail’s clinical anesthesiology. 6th edition. Local Anesthetics. McGraw-Hill Education.2018.
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Clinical pharmacology of local anesthetics. Mc Graw Hill Education.
2017.p 124-37
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Spinal ansthesia. Mc Graw Hill Education.
2017.p 341
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Spinal ansthesia. Mc Graw Hill Education.
2017.p 342
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Spinal ansthesia. Mc Graw Hill Education.
2017.p 343
Central Cardiova
Nervous scular
System Toxicity
Direct
Toxic
Side
Effets
Allergic Neurotoxic
Reactions Effets
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and
acute pain management. 2nd edition. Clinical pharmacology of local
anesthetics. Mc Graw Hill Education. 2017.p 124-37
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
 POSITION
1. Sitting
2. Lateral decubitus
3. Prone/jack knife

Hadzic A, NYSORA. Textbook of Regional Anesthesia and

Acute Pain Management. NYSORA. 2nd Edition
 INSERTION TECHNIQUE
1. Median
2. Paramedian
3. Taylor

Hadzic A, NYSORA. Textbook of Regional Anesthesia and Acute

Pain Management. NYSORA. 2nd Edition
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Clinical pharmacology of local anesthetics. Mc Graw Hill
Education. 2017.p 124-37
No Complication Incident Cause Management
1. PONV Nonobstetric 42% Multifactorial Metoclopramide 10 mg (for SC)
Parturient 80% Serotonine 5-HT (for SC + Morphine)

2. Shivering 55% Spinal anesthesia Iv Meperidine 50 mg

decrease body temp after Iv Tramadol 0.25 mg/kg, 0.5 mg/kg, or
30 minutes 1 mg/kg
Iv Clonidine 30,60,90, or 150 mcg
3. Itch 40% Side effect of opioid Naloxone or 5-HT3 (to reduce severity
of itching)

4. Hearing 3-92% Unknown Transient, Full recovery in 15 days

Impairment

5. POUR 5-70% Neural interruption of the Bladder Training

micturition relex, Bladder
overdistention
6. PDPH 1-1.7% Loss of 10% of total CSF Metylxantine

Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Clinical pharmacology of local anesthetics. Mc Graw Hill
Education. 2017.p 124-37
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
 Paresthesia
Contaminated spinal trays Inj local anesthesia
Aseptic techniques
Lumbal puncture
mask

Prolong hypotensi Hyperbaric lid

Vasoconstriction Lithotomy po
hematoma Repeat dosin
Multiple sin

Respiratory depression
Cardiovascular compromise
Loss of Consciousness
1. DEFINITION, INDICATION AND CONTRAINDICATION
2. ANATOMY AND DERMATOMES
3. PHARMACOLOGY AND LOCAL ANESTHESIA DRUG
4. TECHNIQUE AND PROCEDURE
5. MILD COMPLICATION AND ITS TREATMENT
6. SEVERE COMPLICATION AND ITS TREATMENT
7. FAILED MANAGEMENT
Hadzic A, Butterworth J. Hadzic’s textbook of regional anesthesia and acute pain management. 2nd edition. Clinical pharmacology of local anesthetics. Mc Graw Hill
Education. 2017.p 124-37
A PICTURE IS
WORTH A
THOUSAND
WORDS