Spinal Anesthesia

Continuing Education Activity

• Origins: Began with isolation of local anesthetics, first being cocaine.
• First Use: 1898 in Germany by August Bier.
• Neuraxial Anesthesia: Placement of local anesthetic in/around CNS.
• Spinal Anesthesia: Local anesthetic in intrathecal (subarachnoid) space.
• Objectives:
  • Identify spinal anesthesia techniques.
  • Determine indications and complications.
  • Importance of interprofessional care coordination.

Introduction

• CNS Components: Brain and spinal cord.
• Spinal Anesthesia: Neuraxial technique; anesthetic in subarachnoid space.
• CSF: Houses in subarachnoid space, 130-140 mL in adults, 500 mL produced daily.
• Use: Surgical procedures in lower abdomen, pelvis, and extremities.

Anatomy and Physiology

• Spine Composition: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral bones.
• Anesthesia Location: Mid to low lumbar levels (L3/4 or L4/5) to avoid spinal cord damage.
• Dermatomal Anatomy: Important for understanding blockade levels (e.g., T10 for cesarean sections).

Indications

• Common Uses: Lower abdomen, pelvis, perineal, lower extremities surgeries.
• Counseling and Consent: Required due to awake/sedated state of patients.
• Procedure Suitability: Best for short procedures.

Contraindications

• Absolute: Lack of consent, elevated ICP, procedure site infection.
• Relative: Neurological diseases, severe dehydration, coagulopathy, mitral/aortic stenosis.
• Guidelines: ASRA guidelines for patients on anticoagulants etc.

Equipment

• Sterile Environment: Cap, mask, sterile gloves, proper monitoring.
• Anesthesia Kits: Include antiseptic, drape, spinal needle, anesthetic solutions.

Personnel

• Qualified Staff: Performed by certified anesthesiologist or trainee under supervision.
• Assistant Role: Help with equipment and patient safety.

Preparation

• History and Examination: Check prior anesthetic exposure, allergies, spine/sensory exams.
• Drugs Used: Lidocaine, Bupivacaine, Tetracaine, Mepivacaine, Ropivacaine, etc.

Technique or Treatment

• Patient Position: Sitting or lateral decubitus.
• Aseptic Technique: Chlorhexidine antiseptics, mask, cap.
• Needle Insertion: Midline or paramedian approach.

Complications

• Common Issues: Backache, postdural puncture headache, nausea, hypotension.
• Severe Complications: Total spinal anesthesia, neurological injury, spinal hematoma.

Clinical Significance

• Benefits: Allows major procedures on awake patients, beneficial for cesarean sections.
• Postoperative Pain Control: Better with neuraxial anesthesia.

Enhancing Healthcare Team Outcomes

• Patient Selection: Critical with thorough history and examination.
• Monitoring: Post-op hemodynamics monitoring essential.
• Discharge: Patient advised on possible complications, follow-up appointments necessary.