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What tips are crucial for successful TSSA?
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Detailed pre-procedure planning, gentle needle advancement with frequent CSF checks, using the preferred position (sitting or lateral), and having backup plans for complications.
Name some safe adjuvants used in TSSA.
Fentanyl, dexmedetomidine, clonidine, ketamine, and midazolam.
What are some challenges faced during TSSA and their management?
Challenges include shoulder pain, for which slow insufflation and sedation can be used, and monitoring CO2 levels with nasal prongs or ETCO2 monitoring devices to manage subcutaneous emphysema.
How can shoulder pain during laparoscopic surgery be managed in TSSA?
Shoulder pain can be managed by slow insufflation, low pressure, local anesthetic infiltration, and sedation if necessary.
How should patients on antiplatelet or anticoagulant therapy be managed for TSSA?
The protocols for managing patients on antiplatelet or anticoagulant therapy in TSSA are similar to those in lumbar spinal anesthesia.
Why is frequent checking for CSF necessary in thoracic spinal anesthesia?
Frequent CSF checks ensure proper needle placement and drug administration due to the narrow interlaminar space at the thoracic level.
What advantages does TSSA offer over general anesthesia?
Hemodynamic stability, early recovery and ambulation, and less risk of DVT and postoperative complications.
What is the recommended angulation for the needle during TSSA?
40-45 degree angulation is recommended.
What is the difference in drug spread between thoracic and lumbar spinal anesthesia?
In thoracic spinal anesthesia, 1ml of drug covers approximately 6 segments (3 up, 3 down).
What are some contraindications for TSSA?
Severe hypovolemia, neurological disorders, long-duration surgeries unless combined with catheter techniques, local infection, and increased intracranial pressure.
Why is the cutting needle preferred over the pencil point needle for TSSA?
The cutting needle lowers the risk of neurological injury and causes less membrane damage compared to the pencil point needle.
Which patients are ideal candidates for Thoracic Segmental Spinal Anesthesia (TSSA)?
High-risk cardiac and respiratory patients, and those undergoing short procedures or specific surgeries like breast surgery and laparoscopic cholecystectomy.
What special precautions are required when performing TSSA on pediatric patients or those with a full stomach?
Pediatric practice requires caution, and patients with a full stomach require precautions similar to lumbar spinal anesthesia.
What are the key distances between posterior structures and the spinal cord at different thoracic levels?
T2: 5.19mm, T5: 7.75mm, T10: 5.88mm, T6: 5.95mm (mid-thoracic).
Why is ongoing research important for the practice of TSSA?
Ongoing research is important to support clinical experiences, ensure safety, and facilitate the wider adoption and standardization of TSSA techniques.
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