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- 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

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

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