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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
Module4_01 Module4_02
  • 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
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