Spinal and Epidural Anaesthesia Flashcards
(32 cards)
What are the 22 vertebrae?
– 7 cervical
– 12 thoracic
– 5 lumbar
– 5 sacral
– 4 coccygeal segments
How many curves in the vertebral column?
Three
Which parts of the vertebral column are convex anteriorly?
Cervical and lumbar
Which parts of the vertebral column are convex posteriorly?
Thoracic
The role of spinal anaesthesia is to administer local into which space?
Subarachnoid space
In a spinal, local anaesthetic is injected into what fluid?
Cerebral spinal fluid
What effect does the local anaesthetic have in a spinal?
Interrupts nerve transmission of spinal nerves, causes temporary loss of motor, sensory and autonomic function
Spinal anaesthesia is suitable for any surgical procedure performed at what level?
The lower extremity or trunk below the level of T10
What are contraindications for spinal anaesthesia?
- Patient refusal
- Infection at injection site
- Hypovolaemia
- Allergy to any drugs required
- Increased intracranial pressure
- Blood thinning medications
Why are very narrow needles commonly used in a spinal?
To prevent dural puncture headache
What are the different designs of spinal needle?
- Quinke (cutting, traumatic bevel)
- Whitacre and sprotte (non-cutting, atraumatic pencil point with side hole)
What is the most commonly used local anaesthetic for skin for a spinal and epidural?
Lidocaine
What agents can be used intrathecally in a spinal?
- Preservative-free morphine with local anaesthetic
- Preservative-free morphine with saline
- Diamorphine in saline
- Any other local anaesthetic
How long is spinal onset?
7-10 minutes
How long can a spinal last?
1-2 hours, dependent on drug(s) administered
What are the advantages of spinal anaesthesia?
- Reduced mortality
- Fewer drugs used
- Excellent postoperative pain control
- No ‘hangover’ effects like those produced with general anaesthesia
What are the disadvantages of spinal anaesthesia?
- The technique can be difficult
- Potential headache after
- Not suitable for all procedures
- Not suitable for those on blood thinners
- Can be painful for the patient
What are some minor spinal risks?
- Nausea and vomiting
- Shivering
- Itching
- Transient mild hearing impairment
- Urinary retention
What are some moderate spinal risks?
- Failed spinal (conversion to GA)
- Post-dural puncture headache
What are some major spinal risks?
- Needle trauma
- Infection
- Vertebral canal haematoma
- Spinal cord ischaemia
- Cauda equine syndrome
- Arachnoiditis
- Nerve injury
- Total spinal block
- Cardiovascular collapse
- Death
What is a total spinal block?
A serious condition when the loss of the motor, sensory and autonomic function spreads beyond T4.
What are signs of total spinal block?
- Vomiting
- Hypotension
- Respiratory depression
- Apnoea
- Hypoxia
- Bradycardia
- Cardiac arrest
- Anxiety in awake patients
- Arm/hand paralysis
- Unconsciousness
What is management of a total spinal block?
- Vagolytics eg. Atropine
- Sympathomimetics eg. Ephedrine, Adrenaline
- Vasopressors eg. Metaraminol, Phenylephrine
- Fluid boluses
- Leg elevation
- Oxygenation
- Secure airway: Intubation and ventilation
The role of an epidural is to administer local anaesthetic into what space?
The epidural space
