What are the contraindications of spinal anesthesia?

There are major known contraindications to neuraxial anesthesia (spinal and epidural). The absolute contraindications are lack of consent from the patient, elevated intracranial pressure (ICP), primarily due to intracranial mass and infection at the site of the procedure (risk of meningitis).

Which is the most common complication of spinal anesthesia?

The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade. The diagnoses and management of these sequelae are discussed.

What are the indications of spinal Anaesthesia?

Indications

  • Orthopaedic surgery on the pelvis, hip, femur, knee, tibia, and ankle, including arthroplasty and joint replacement.
  • Vascular surgery on the legs.
  • Endovascular aortic aneurysm repair.
  • Hernia (inguinal or epigastric)
  • Haemorrhoidectomy.
  • Nephrectomy and cystectomy in combination with general anaesthesia.

Is spinal stenosis a contraindication to spinal anesthesia?

Pre-existing stenosis may contribute to spinal cord injury because the narrower canal cross-sectional area in such patients renders them more at risk of nerve compression or local anaesthetic neurotoxicity 1-3.

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Which complication is associated with spinal anesthesia?

Spinal anaesthesia is a common regional anaesthesia technique performed by anaesthesiologists since 1898 (1). It has some complications such as hypotension, bradycardia, cardiac arrest, nausea–vomiting, transient neurologic problems, headache, pruritus and urinary retention (2) . …

Is spinal anesthesia better than general?

Unlike general anesthesia, spinal anesthesia does not require patients to use breathing tubes. Patients who take medications to control blood pressure, have COPD, or are long-term smokers have a hard time with breathing tubes, which makes spinal anesthesia a far better option for them.

Does spinal anesthesia cause back pain?

The incidence of back pain is higher after epidural anesthesia compared with spinal anesthesia (level 2). Back pain after spinal or epidural anesthesia is mild in intensity and decreases with time (level 1). Preexisting low back pain is a risk factor for persistent back pain after neuraxial anesthesia.

What are the advantages and disadvantages of spinal anesthesia?

Spinal vs. Epidural

Spinal Epidural
Procedure Time brief longer
Quality of Block high not as good as spinal
Disadvantages increased risk of hypotension, dural puncture headache
Advantages ability to produce segmental block, greater control over analgesia, possibility of long term analgesia

What are the steps of spinal anesthesia?

The technique of administering spinal anesthesia can be described as the “4 P’s”: preparation, position, projection, and puncture. Preparation of equipment/medications is the first step. It is important to think ahead. Discuss with the patient options for anesthesia.

How long do you have to lay flat after spinal anesthesia?

4 Most anesthesiologists recommend that patients should lie flat in bed for several hours after the procedure is performed. This is believed to decrease CSF hydrostatic pressure that may affect the rate of CSF leak from the dural puncture.

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Can spinal anesthesia cause paralysis?

Despite the low incidence, some patients reject spinal anaesthesia, because they fear this complication. The risks of paralysis are extremely low. The actual incidence of neurological dysfunction resulting from bleeding complications is estimated to be 1 in 150,000 for epidurals and 1 in 220,000 for spinal anaesthesia.

Why does spinal anesthesia fail?

Inability to either puncture the dura (dry tap) or obtain free flow of cerebro-spinal fluid (CSF) after alleged dural puncture is one of the obvious causes of failure of spinal anaesthesia. The main reasons are blocked needle, poor patient positioning, and faulty needle placement technique.

How long is the effect of spinal anesthesia?

The length of time that the spinal anaesthetic takes to wear off will depend on the medications that the anaesthetist uses for the spinal anaesthetic. Usually the block will have worn off in four hours and you will be able to get out of bed six hours after the spinal anaesthetic.

How can you prevent spinal anesthesia complications?

7 to 1. 8 in 100, 000 patients [1]. On the other hand, proper patient selection, meticulous attention to detail, well-known patient related changes and in the case of difficult circumstances, using image techniques [x rays, fluoroscopy and ultrasound] as a guide may help to prevent or decrease complications.

Why is head low after spinal anesthesia?

Studies have shown that a 10 degree head down tilt can result in cephalad spread of analgesia when compared to the horizontal group. So, in cases where the spinal block level was not high enough to perform a given surgery, the Trendelenburg position has been used to extend the level of the block.

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