Assessment for Spinal Anaesthesia

Question 1

1. Preoperative Assessment:

Answer 1

1. Physical Examination: ASA status
2. Airway exam
3. CIs to spinal

Question 2

2. Preoperative Equipment Check:

Answer 2

1. Anaesthesia Machine Check
2. Tilting table with lateral arm supports
3. Anaesthetic wedge
4. Suction apparatus, tubing and Yankuaer nozzles

Question 3

3. Resuscitation Equipment Check:

Answer 3

1. Ambubag

2. Defibrillator & how to use it

Question 4

4. Intubation Equipment Check

Answer 4

1. Check airway trolley

Question 5

5. Preparation Patient:

Answer 5

1. Premedication + fasting orders
2. Preload - good IV access with 500ml clear fluid
3. Urinary catheter
4. Consent

Question 6

6. Draw up-essential drugs:

Answer 6

1. Phenylephrine
2. Ephedrine / Atropine
3. Check if Sux is in ice bucket

Question 7

7. Spinal Technique:

Answer 7

1. Measure NIBP before starting, set NIBP to read at 1 min intervals
2. AND feel for volume of patient’s pulse
3. AND apply pulse oximeter
4. AND apply ECG
5. Administer 500ml of Ringer’s lactate while performing spinal

Question 8

8. Lumbar Puncture technique:

Answer 8

1. Appropriate needle insertion technique and direction
2. Understanding of spinal anatomy
3. Use of Pencil Point Needle and method

Question 9

9. Actions after Spinal administered:

Answer 9

1. Head and Shoulders raised
2. Monitored NIBP at 1 min intervals
3. Communicate with patient
4. Continue careful fluid administration
5. Rapid administration of vasopressor and/or prophylactic infusion if any signs of hypotension
6. Assessment of level of block:
   T4 - nipple
   T6 - xiphoid
   T10 - umbilicus

Question 10

10. Recovery Mx:

Answer 10

1. Understands need for recovery
2. Documents level of spinal and completes postoperative charts
3. D/C criteria after neuraxial anaesthesia:
   Reduced by at least 2 segments

Question 11

11. Knowledge of action if cardiac arrest:

Answer 11

1. Informs team and call for help
2. Immediate chest compressions
3. BMV airway Mx
4. Intubation
5. ADR bolus 1 mg each 3 minutes

Question 12

12. Knowledge of action if failed spinal:

Answer 12

1. Wait at least 20 min
2. Immediate conversion to GA - very early in procedure, won’t tolerate ketamine boluses
3. Supplementation and top up with local and N2O and ketamine - later on in procedure, surgery nearly complete
4. Wait and repeat spinal - NOT advised - risk of high/total spinal with too much volume given
5. Abandon Local attempt and refer - multiple attempts spinal in high BMI

Question 13

Order

Answer 13

1. Pre-op assessment
2. Pre-op equipment check
3. Resus equipment check
4. Intubation equipment check
5. Preparation of patient
6. Draw-up essential drugs
7. Spinal technique
8. LP technique
9. Actions after spinal - position + monitoring
10. Recovery Mx - Monitoring + D/C
11. Knowledge if cardiac arrest
12. Knowledge if failed spinal