Spinal and Epidural Anaesthesia

Question 1

What is spinal anesthesia?

Answer 1

Spinal anesthesia is the injection of small amounts of local anesthetics into the cerebrospinal fluid (CSF) below L1, where the spinal cord ends, to achieve anesthesia of the lower body below the umbilicus.

Question 2

What are the advantages of spinal anesthesia (SAB)?

Answer 2

Advantages of SAB include cost-effectiveness, high patient satisfaction, minimal respiratory effects, patent airway, and reduced risk of hypoglycemia, muscle relaxation, and less blood loss during surgery.

Question 3

Why is spinal anesthesia preferred for patients with respiratory diseases?

Answer 3

Spinal anesthesia produces few adverse effects on the respiratory system, provided high blocks are avoided, making it suitable for patients with respiratory diseases.

Question 4

How does spinal anesthesia affect the airway?

Answer 4

Spinal anesthesia maintains control of the airway, reducing the risk of obstruction or aspiration of gastric contents.

Question 5

Why is spinal anesthesia beneficial for diabetic patients?

Answer 5

Spinal anesthesia allows diabetic patients to remain awake, reducing the risk of unrecognized hypoglycemia.

Question 6

What type of muscle relaxation does spinal anesthesia provide?

Answer 6

Spinal anesthesia provides excellent muscle relaxation for lower abdominal and lower limb surgeries.

Question 7

How does spinal anesthesia impact bleeding during surgery?

Answer 7

Blood loss during surgery is less under spinal anesthesia compared to general anesthesia.

Question 8

How does spinal anesthesia affect splanchnic blood flow?

Answer 8

Spinal anesthesia increases blood flow to the gut, reducing the incidence of anastomotic dehiscence.

Question 9

What is the effect of spinal anesthesia on visceral tone and gut function?

Answer 9

Spinal anesthesia contracts the bowel and relaxes sphincters while allowing peristalsis to continue, aiding rapid return of gut function post-surgery.

Question 10

How does spinal anesthesia impact post-operative coagulation?

Answer 10

Spinal anesthesia reduces the incidence of post-operative deep vein thrombosis and pulmonary emboli.

Question 11

What are the primary indications for spinal anesthesia?

Answer 11

Primary indications for spinal anesthesia include operations below the umbilicus, perineal, genital, and most leg surgeries.

Question 12

Why might spinal anesthesia be preferred for elderly patients or those with chronic systemic diseases?

Answer 12

Spinal anesthesia is suitable for elderly patients and those with chronic systemic diseases like diabetes, hepatic, renal, and mild cardiac diseases.

Question 13

What are the contraindications of spinal anesthesia?

Answer 13

Contraindications include patient refusal, uncooperative patients, clotting disorders, hypovolaemia, septicemia, and certain neurological conditions.

Question 14

Why is spinal anesthesia contraindicated in patients with clotting disorders?

Answer 14

Spinal anesthesia is contraindicated in patients with clotting disorders due to the high risk of hematoma formation from ruptured peridural veins.

Question 15

Why is spinal anesthesia contraindicated in patients with hypovolaemia?

Answer 15

Hypovolaemic patients must be adequately rehydrated and resuscitated before spinal anesthesia due to its marked hypotensive effects.

Question 16

What are the effects of septicemia on spinal anesthesia?

Answer 16

Spinal anesthesia in patients with septicemia increases the risk of CSF infection and meningitis.

Question 17

What local anesthetic agents are used for spinal anesthesia?

Answer 17

Local anesthetics used for spinal anesthesia include hyperbaric, hypobaric, and isobaric agents, with hyperbaric being preferred.

Question 18

Which local anesthetic agent is preferred for spinal anesthesia and why?

Answer 18

Bupivacaine (Marcaine) 0.5% hyperbaric is preferred for spinal anesthesia due to its predictable spread below the injection level.

Question 19

What factors affect the spread of local anesthetic solutions in the CSF?

Answer 19

Factors affecting the spread include the baricity of the anesthetic, patient positioning, injection level, speed of injection, obesity, and pregnancy.

Question 20

What is the procedure for performing a spinal injection?

Answer 20

Spinal injection involves a sterile technique, antiseptic application, intradermal anesthetic injection, and needle insertion until CSF appears.

Question 21

What are some complications of spinal anesthesia?

Answer 21

Complications of spinal anesthesia include hypotension, headache (PDPH), urinary retention, neurological issues, and rare cases of permanent paralysis.

Question 22

How can hypotension caused by spinal anesthesia be managed?

Answer 22

Hypotension management includes fluids, oxygen, leg elevation, increased IV infusion rate, and vasoconstrictors like phenylephrine or ephedrine.

Question 23

What are the symptoms and management of post-dural puncture headache (PDPH)?

Answer 23

Post-dural puncture headache is postural, often occipital, and associated with nausea, vomiting, and photophobia; managed with bed rest and analgesics.

Question 24

What is epidural anesthesia and how does it work?

Answer 24

Epidural anesthesia involves injecting local anesthetics into the peridural space to block conduction at intradural spinal nerve roots, used for analgesia.

Question 25

What are the differences between spinal and epidural anesthesia?

Answer 25

Spinal anesthesia involves injecting into the subarachnoid space, while epidural anesthesia injects into the epidural space, with differences in onset, density, and level of administration.