Central Neural BlockadeSpinal and Epidural including cadual blocks
results in sympathetic blocks, SENSORY ANALGESIA AND MOTOR BLOCK(DEPENDING ON DOSE,CONCENTRATION, AND /OR VOLUME OF LOCAL ANAESTHESTIC) AFTER INSERTION OF A
NEEDLE IN THE PLANE OF THE CENTRONEURAXIS.
Following points have to be taken into consideration for SA.
Description of typical vertebra Ligaments of vertebral column Meninges of Spinal cord Anatomic curves of spine Developmental anatomy of spine Arterial supply of spinal cord 7.Veins of spinal cord
SPINAL ANAESTHSIA Technique is described under the following four ‘ P ‘ Parameters
a) Preparation b) Position c) Projection d) Puncture and an added ‘P’ of e) Pharmacology – Drugs A) PREPARATION The first ‘P’ relates to equipments mainly spinal needles and the disposable or sterilized spinal tray. Spinal needle have thin contributions for designs from Pierri Lund,Sornings,Beer and lastly Schiwidetsky who gave the present day small gauge, rust proof resilient needles design.
Spinal needles are divided into two main categories.
A) Dura Cutting Type i) Ownke-Babcock needle ii) Pit-kin needle B) Dura Spreading/Splitting type i) Whitacre needle (pencil point type) ii) Sprotte needle iii) C. Greene needle iv)
Touhy needle v)
Hustead Needle- Test of Quality of needle- Needle to be tested for
A) Flexibility and resilience B) Smigly fitting stylet and canula. B)POSITION:- This part of spinal anaesthesia is most poorly achieved. There are three positions.
a) Lateral Decubitus
Position b) Setting position
c) Prone Position
A) Lateral Decubitus;- B) Sitting Position:- C) Prone Position:- Technique of Spinal Puncture a) Midline Approach b) Paramedian c) Taylors Approach General recommendation to be followed for all three techniques for safe practice. i) Aseptic surgical Technique for hands scrubing ii) Sterile Gloves iii) Use Aseptic technique to open tray iv) Cleaning and draping of skin prior to puncture v) Touch only sterile articles once gloved vi) Use a introducer before spinal needle insertion vii) Avoids doing spinal Puncture in following cases a. Bleeding Time b. Generalised bacteraemia c. Local Injection viii) Use of approved conc of local anaesthetic agent 1) Midline Approach 2) Paramedian ( Lateral Approach) 3) Taylor Approach:- Lumbosacral Approach Main Aim of Anesthesiologists is to secure anaesthesia of
a) Sufficient duration b) Sufficient Height Factors Affecting Spinal Anaesthetic Block Height A) Patient Factors B) Technique of Injection C) Spinal Fluid Criteria D) Local Anaesthetic Solution Criteria Major factors among the following are
A) Anatomic curves of spinal column B) Density/ baricity/ positon C) Mass of drug (Dosage)
All other are minor contributors A) Factors regarding the patient characteristics affecting height are: Age : It is statistically shows no major difference between 3rd to 7th decade of life.
a) For people of old age following are difference affect block duration and height
i) Decrease Absorption of drug in SA space due to sclerotic vessels and diminished blood flow so longer stay of drug
ii) Specific gravity of CSF is increased so hyprbaric solution act as isobaric (decrease baricity) so decrease spread.
iii) Decrease in CSF volume with increasing specific gravity from cranial region to sacral region so in tredelenberg position hyperbaric solution will have more baricity and hence more spread.
iv) Lumbar Lardosis or thoracic hyphosis may be present causing upward spread of drug into thoracic concavity.
B) Infants & Children Infants also premature shows shortest d
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