Total Spinal Flashcards
What are the signs and symptoms of total spinal anaesthesia?
CVS - Hypotension (N&V), bradycardia, cardiac arrest
Resp - Dyspnoea, breathing difficulty, hypoventilation, hypoxaemia, respiratory arrest
CNS - tingling in hands, difficulty speaking, seizures, loss of consciousness
May be abrupt, or gradual in context of ascending block
What are the differential diagnoses?
- Vasovagal
- Haemorrhage
- LA toxicity
- IVC compression
- Embolus
Outline a management plan for a total spinal
- Call for help!
- Start CPR if loss of cardiac output
- Place in (L) lateral tilt
- Secure airway, ventilate with 100% O2 if dec LOC or respiratory distress
- Vasopressors and fluids to maintain adequate blood pressure (Ephedrine, Phenylephrine etc)
- Elevate legs to improve venous return
- Adrenaline boluses if limited response to above
- Atropine for bradycardia
- Urgent O&G assessment to determine fetal distress necessitating urgent delivery
What doses would you give of the following drugs - atropine, ephedrine, phenylephrine, adrenaline
Atropine 0.6-1.2mg
Ephedrine 12-15mg
Phenylephrine 100mcg
Adrenaline 25-50mcg
What considerations need to be taken into account when performing CPR?
The gravid uterus needs to be displaced off the IVC - (L) lateral tilt
There is a very high risk of aspiration - consider early intubation
Diminished maternal cardiac output will be exacerbated by a foetus - baby delivery
Outline subsequent management if there is no foetal distress
Transfer to ICU for ongoing ventilatory, cardiovascular, and monitoring support
BIS monitoring may be useful to titrate sedation
Document
Exclude other causes of collapse - hypoglycaemia, anaphylaxis, LA toxicity
