Spinal Anaesthesia Flashcards
(10 cards)
1
Q
3 ligaments posterior to anterior you encounter when injecting into
A
Injecting into subarachnoid space
- supraspinatus
- interspinous
- ligamentum flavum
Go look at diagram to label !! Past paper
2
Q
Spinal vs Epidural
A
Spinal only done from L1 L2 in adults L3 L4 in kids (Lumbar area)
Epidural anywhere
3
Q
What is WEDGE
A
- After local anaesthesia injected, lay patient flat and:
o Avoid aorto-caval compression (WEDGE)
Wedge patient to allow preload because aorta is compressed by the large uterus (aorta-caval syndrome).
4
Q
Contraindications for the use of spinal anaesthesia:
A
- Patient refusal
- Cardiovascular pathology hypovolemia / shock / fixed cardiac output states (valve stenosis NB, constrictive pericarditis)
- Clotting disorders low platelets (HELLP syndrome) / use of anti-coagulants (heparin / warfarin / clexane)
- Inadequate equipment including resuscitation equipment
- General infections (bacterial) or infection at the site of needle entry
- Active neurological pathology such as raised intracranial pressure
5
Q
Complications of spinal anaesthesia: ACUTE
A
- Hypotension & bradycardia = cardiac arrest
o Sympathetic blockade decr SVR and incr HR / nausea & vomiting
o High spinal T1 – T4 (supply to heart) will give you decr HR & decr SVR
6
Q
Post dural puncture headache (PDPH)
A
o 2 – 7 days after
o Patients need to lie flat
o Blood patch gold standard treatment
▪ Start with NSAID (paracetamol / caffeine)
7
Q
Post op complications of spinal
A
- urinary retention
- meningitis
- spinal cord trauma
- PDPH
- Extensive spread of spinal anaesthesia
- Backache
- Neurological sequelae
- Nausea & vomiting
8
Q
Advantages of epidural:
A
- Lower incidence of hypotension
- Unlimited duration
- Able to use for postoperative analgesia
- Possibility of less motor blockade
- Less risk of headache
9
Q
Advantages of spinal:
A
- Quick onset
- Technically easier to perform
- Excellent sacral anaesthesia
10
Q
A
