Spinal/caudal Flashcards
What are the indications for doing a spinal anaesthetic?
- C-sections
- Surgeries that are less than 2 hours
- Surgeries that involve anything below T10
What are the 3 layers of the posterior back?
- supraspinal ligament
- interspinous ligament
- ligamentum flavum
What is the difference between a spinal and epidural?
An epidural can occur anywhere along the spinal cord and goes into the epidural space which is a potential space. Epidural takes longer to work(30 minutes)
A spinal goes into the sub-arachnoid space and has CSF. It also works faster(usually between 2-3 minutes)
Which level do we do the spinal?
L3/L4
What are the factors that affect the spread of the drug?
- Baricity
What is baricity?
It is the density of a substance when compared to human CSF fluid example. dextrose
What are the movements/positions we can lay the patient in in order to facilitate movement of the spinal?
- Thoracic block- we must immediately lay the patient down
2. Sacral plexus block-let the patient sit up for 5 minutes
Name 6 absolute contraindications for doing a spinal on a patient:
1, When a patient refuses
- When you have inadequate equipment/ not able to change to GA
- clotting disorders which can cause a epidural or spinal haematoma which can cause paralysis in 6 hours if not detected
- make sure INR>1,5
- Platelets<75
- Urea>25 - local or systemic sepsis
- Active neurological pathology-increased ICP
- Cardiac abnormalities: pericarditis, asystoles
What are post-operative complications of a spinal?
- Urinary retention
- Meningitis/neural damage
- Post Dural puncture headache(2-7 days after) when you have too much CSF leak
- Spinal/epidural abscess/ haematoma
What is the conservative Rx for post dural puncture headache?
- Bedrest
- IV fluids
- Analgesia
- Caffeine
What is the definitive treatment for post dural puncture headache?
- Blood patch
How do we reduce the incidence of post dural puncture headache?
- Using the thinnest needle(25/26G) pencil point instead of cutting needle
Why is urea important?
A deranged urea causes platelet dysfunction
What are the acute/intra-op complications:
- failed spinal from obese patient
- high spinal(T1-T4))
- Total spinal
- Hypotension
- bradycardia
What is the management of infection as a complication?
- antibiotics and surgical decompression
What is the management of a spinal haematoma as a complication?
- Decompression within 6/8 hours
What is the management of a high spinal?
Do ABC’s
What is NB about caudals and lignocaine?
It is neurotoxic
What are the relative contra-indications?
- disease of the spinal column that makes inserting the needle difficult
- severe headaches
What does the level and extent of the spinal depend upon?
- The concentration of the solution injected
- The volume of the solution
- Position of the patient
- Speed and force that we inject the solution with
What can we do to decrease the effects of the spinal?
- Preload the patient with fluids(crystalloids or colloids)
- Elevate the legs to improve venous drainage
- Use phenylephrine -an intravenous alpha adrenergic agonist
- Atropine and glycopyrrolate to cancel the parasympathetic effects and stabilize the heart
What size needles do we usually use for spinal?
25-30 gauge needles
With PDPH, what makes the headache better?
-lying down as standing can worsen it
What are signs of urinary retention associated with spinal blocks?
- increased heart rate
- increased blood pressure
- pressure or pain below the waist
What should you do if a total spinal block occurs?
- start cpr
- give phenylephrine or adrenaline
- give intravascular fluids
- endotracheal intubation and mechanical ventilation
What takes longer to work between an epidural anaesthesia and spinal?
Epidural
Which space is an epidural injected?
-extradural space
Which procedures do we do caudal blocks in usually?
-circumcision, cystoscopy, removal of haemmorhoids
Where is the epidural anaesthesia usually injected?
-ligamentum flavum and the dura mater
Where is the epidural anaesthesia usually injected?
-ligamentum flavum and the dura mater
