Spinal anesthesia in clinical routine
Abstract
Spinal anesthesia (SPA) is a commonly technique used to block afferent (sensory) transmission. As a form of neuraxial blockade local anesthetics are injected in the subarachnoid space of the lumbar spine. SPA can be used in surgery of lower limb, anorectal surgery and provide an excellent and favorable alternative to general anesthesia in cesarean section. Onset and duration of action as well as adverse effects such as cardiotoxicity are directly related to pharmacological and –kinetic characteristics of local anesthetics. Hyperbaric solutions show faster time to achieve sensory blockade compared to isobaric. Opioids or other drugs like clonidine can be successfully used to prolong duration of blockade. Old drugs such as prilocaine open up new ways in ambulatory surgery.
When performing SPA, it is important to be aware of complication, their prevention and treatment. Systemic toxicity due to high intravascular concentration of LA is a rare, but life-threatening complication requiring immediate treatment. In contrast, hypotension due to sympathetic blockade and consecutive vasodilation is common and related to severe effects (e.g. reduction of uteroplacental perfusion leading to fetal acidosis and hypoxia). Fluid management and vasopressor therapy are controversially discussed in current literature.
Neurological complication such as spinal epidural hematoma or abscess often require neurosurgical therapy, while other such as transient neurological symptoms or post-dural puncture headache can be treated conservatively.
It seems favorably to implement a hospital wide acknowledge standard how to perform SPA in different patient collectives. Continuous training and education for medical staff performing SPA on a regular basis in order to be able to deal confidently with adverse effects (e.g.) is highly recommended.
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DOI: http://dx.doi.org/10.18103/imr.v3i1.310
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