SPINAL ANAESTHESIA

Useful for lower abdominal, perineum, lower extremity surgery Avoid in: - Patients in shock, not yet fully resuscitated - Infection at site of spinal needle placement - Frank coagulopathy - Patient refusal - Convulsion or raised intracranial pressure due to brain tumour Preload patient with 500-1000 ml of normal saline Position patient in sitting (A) or lateral position Prepare lower spinal area carefully Have patient maximally flex lower spine to open intraspinous space (B) Point of needle entry should be between L4-L5 or between L5-S1

• Perform lumbar puncture with fine spinal needle (25 or 27 gauge), ensuring good flow of cerebrospinal fluid
• Inject 1.5-2.0 ml "heavy" lidocaine or bupivacaine
• Quickly turn patient to supine position
• Be extra vigilant, actively treat any fall in blood pressure

• Check all equipment, drugs as for general anaesthesia
• In pregnant women at term, block easily goes high
• Always give oxygen to mother during Caesarean section
• Act immediately to treat unresponsive patient, whether the cause is hypotension or high spinal
• A death or complication after spinal is usually due to neglect of vital signs