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Topic: Spinal anaesthesia

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	Combined Spinal-Epidural Anesthesia?
		Spinal block is a simple technique which requires a small dose of local anesthetic to provide surgical anesthesia (1,2) with rapid, intense and reliable block without missed segments (1,3), greater muscle relaxation (1) and minimal risk of drug toxicity to the mother as well as to the fetus (3).
		The incidence of spinal anesthesia in an orthopedic institute in Firenze increased from 22% in 1989 to 42% in 1993 (6).
		Spinal anesthesia patients were quicker to drink fluids (3.4±0.3 vs. 5.1 ±0.7 hr), required less narcotic analgesia (0.6 ±1 vs. 1.2±0.2 intramuscular injections) and had a lower incidence of vomiting (0.2±0.09 vs. 1.07±0.34).
	www.csen.com /anesthesia/book (15184 words)

	Spinal Anaesthesia and Specific CV Conditions
		Spinal anaesthesia is not contraindicated in patients with coronary artery disease.
		Spinal anaesthesia presents difficulties in women with mitral stenosis and the onset of a tachycardia may result in cardiac decompensation and pulmonary oedema.
		Although the benefits of spinal anaesthesia over general anaesthesia with respect to cardiac morbidity reduction remain unproven, there is no reason to believe that morbidity is increased provided that there is a clear understanding of the haemodynamic effects and of the requirement for appropriate and timely intervention.
	www.manbit.com /oa/c83.htm (1191 words)

	Spinal Anaesthesia - a Practical Guide (page 1)
		Spinal anaesthesia produces few adverse effects on the respiratory system as long as unduly high blocks are avoided.
		Spinal anaesthesia is particularly suitable for older patients and those with systemic disease such as chronic respiratory disease, hepatic, renal and endocrine disorders such as diabetes.
		Patients may be understandably apprehensive and initially state a preference for general anaesthesia, but if the advantages of spinal anaesthesia are explained they may then agree to the procedure and be pleasantly surprised at the outcome.
	www.nda.ox.ac.uk /wfsa/html/u12/u1208_01.htm (1509 words)

	welcome to the iafroum.org's july2ooo page
		General anaesthesia may be required for caesarian delivery in an obtunded patient, when time is not available for the safe administration of epidural block or when coagulopathy contraindicates the use of regional anaesthesia or when regional anaesthesia has failed.
		A common justification for preferring epidural to spinal anaesthesia is the belief that incrementally dosing the epidural catheter increases the epidural sensory blockade in stages and minimises the risk of hypotension.
		For that reason the use of spinal anaesthesia in emergency situation, in which it would be of greatest benefit to pre-eclamptic women in avoiding the need of general anaesthesia, may be limited by the time available to pre hydrate the patient.
	www.theiaforum.org /jjuly2000.htm (1241 words)

	SPINAL ANAESTHESIA AND LEFT VENTRICULAR EJECTION FRACTION
		The decrease of the mean arterial blood pressure in spinal anaesthesia is correlated to the decrease of the CBF.
		Spinal anaesthesia can be used also in patients with coronary artery disease (stable angina pectoris).
		Spinal anaesthesia induces very little changes in the LV ejection fraction, arterial blood pressure and heart rate in patients that do not suffer from angina pectoris.
	www.csen.com /anesthesia/ejection-fraction.htm (1043 words)

	Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in ...
		Six infants in the spinal anaesthesia group became restless despite successful spinal blockade and supplementary anaesthesia was administered to restore adequate operating conditions: four patients received inhaled halothane and two received intravenous propofol.
		In the spinal anaesthesia group, during the early part of the study, nine infants received IM ketamine for sedation prior to performance of lumbar puncture.
		Williams 2001, fewer infants in the spinal anaesthesia group had post-operative apnoea in the absence of pre-operative apnoea but this was not statistically significant.
	www.nichd.nih.gov /cochraneneonatal/Craven/CRAVEN.HTM (5358 words)

	welcome to the iaforum.org's january2001 page
		The unequal spread of the local anaesthetic in the cerebro spinal fluid, along with prolonged high concentration of the drug around the nerve endings was theorized to be the cause of this dreaded complication.
		Such spinal catheters have a single hole and its size varies between 30 – 32 G. The other – macro catheters are of 22G or 24G size and are mounted on a Quincke beveled 27G or 29G spinal needle provided with a pull wire.
		The advantages claimed for CSA are- prolonged spinal anaesthesia like a continuos epidural, decreased dose of local anesthetic required as compared to an epidural, less hemodynamic variations following the spinal block as compared to single bolus technique and ability to use intrathecal narcotics spinally for cancer pain relief.
	www.theiaforum.org /jan2001.htm (1379 words)

	Anaesthetic methods for ambulatory knee surgery
		Anaesthesia should be specifically tailored for ambulatory surgery, and the anaesthetic drugs must have consistent onset and offset times, permitting rapid changes in the levels of drug effect (Philip 1997).
		Although spinal anaesthesia is considered a simple procedure with a high margin of safety, it is not entirely free from risks.
		The severe neurological complications associated with spinal anaesthesia and other central blocks may be due to the neurotoxic effects of local anaesthetics, direct neural tissue injury caused by a needle or catheter and spinal cord compression by an epidural haematoma or abscess (Alahuhta 2001).
	herkules.oulu.fi /isbn9514267729/html/x318.html (4154 words)

	JustEves.com - Anaesthesia and You
		GENERAL ANAESTHESIA: In this type of anaesthesia you are put to sleep initially by an intravenous medication or by administration of an inhalation anaesthetic via a mask held over the nose and mouth, or a combination of both.
		REGIONAL ANAESTHESIA: This type of anaesthesia only numbs a part of the body by giving a local anaesthetic near a group of nerves and is generally used for less complex procedures.
		SPINAL ANAESTHESIA: The anaesthetic is injected into the fluid surrounding the spinal cord in the lower back.
	www.justeves.com /surgeries/types_of_anaesthesia.shtml (349 words)

	Regional techniques compared
		Spinal anaesthesia (Chapter 63) compared to other techniques of anaesthesia (including epidural analgesia (Chapter 1), caudal analgesia (Chapter 22) and combined subarachnoid-epidural analgesia (Chapter 62)) for labour and delivery.
		Epidural anaesthesia is also suitable for both labour and delivery but, sometimes, sacral segments may be difficult to block (with a lumbar epidural) and the blocks may occasionally be patchy or asymmetrical (1).
		Continuous spinal anaesthesia is obtained with negligible risk of local anaesthetic toxicity to the mother and fetus.
	www.manbit.com /OA/c70.htm (754 words)

	Spinal Anaesthesia - A Practical Guide (page 1)
		If a spinal anaesthetic and the ensuing surgery are performed skillfully, the majority of patients are very happy with the technique and appreciate the rapid recovery and absence of side-effects.
		Spinal anaesthesia is especially indicated for older patients and those with systemic disease such as chronic respiratory disease, hepatic, renal and endocrine disorders such as diabetes.
		However, special considerations apply to managing spinal anaesthesia in pregnant patients (see later) and it is best to become experienced in its use in the non-pregnant patient before using it for obstetrics.
	www.nda.ox.ac.uk /wfsa/html/u03/u03_003.htm (759 words)

	Naropin® now approved for intrathecal administration in the European Union
		Naropin® is currently approved for epidural anaesthesia during surgery and post-operative pain relief, pain relief in childbirth, Caesarean section, local infiltration anaesthesia, for surgery using peripheral nerve block techniques and for continuous peripheral nerve block for post operative pain relief.
		Spinal (= intrathecal or subarachnoid) block technique involves the injection of local anaesthetic into the cerebrospinal fluid at the lower part of the backbone, thereby temporarily stopping the nerve impulse transmission and the sensation of pain from a part of the body.
		When general anaesthesia is used, muscle relaxation is instead achieved by addition of a neuromuscular blocking agent to the general anaesthetic agent.
	www.medicalnewstoday.com /index.php?newsid=6319 (568 words)

	Surgical Care at the District Hospital
		May cause hypotension related either to extensive sympathetic blockade, (for example, after “high” spinal anaesthesia) or to direct depression of cardiac function from high blood levels of the drug.
		Spinal anaesthesia is a technique commonly used for caesarean section (CS).
		The onset of the spinal block at the correct height should make the mother comfortable because the pains of labour are abolished.
	www.steinergraphics.com /surgical/005_14.4.html (1207 words)

	Spinal versus epidural anaesthesia for caesarean section (Cochrane Review) (Site not responding. Last check: 2007-10-21)
		Background: Regional anaesthesia (spinal or epidural anaesthesia) for caesarean section is the preferred option when balancing risks and benefits to the mother and her fetus.
		Spinal anaesthesia for caesarean section is thought to be advantageous due to simplicity of technique, rapid administration and onset of anaesthesia, reduced risk of systemic toxicity and increased density of spinal anaesthetic block.
		Spinal anaesthesia has a shorter onset time, but treatment for hypotension is more likely if spinal anaesthesia is used.
	www.cochrane.org /Cochrane/revabstr/ab003765.htm (479 words)

	A Guide to Spinal Anaesthesia for Caesarean Section for Anaesthetists and Anesthesiologists
		Spinals have become the anaesthetic of choice for Caesarean section in the major Canadian teaching centres.
		A spinal produces a more rapid onset of block, including a more rapid sympathetic block, which causes peripheral vasodilatation and hypotension which is frequently more severe than that associated with epidural anaesthesia.
		Spinal anaesthesia is an excellent technique for Caesarean section.
	www.oyston.com /anaes/local/spinalcs.html (2108 words)

	Low molecular weight heparins in medicine and anaesthesia
		When neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture is employed, patients anticoagulated or scheduled to be anticoagulated with low molecular weight heparins or heparinoids for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma which can result in long-term or permanent paralysis.
		There is an increased risk of spinal haematoma in patients with indwelling epidural catheters: it may be of advantage to withold LMWH until epidural anesthesia has stopped.
		LMWH are associated with an increasing incidence of spinal haematoma in patients undergoing neuraxial anaesthesia, particularly epidurals.
	www.4um.com /tutorial/currents/lmwh.htm (2719 words)

	[No title]
		The incidence of post-dural puncture headache (PDPH) after the use of a standard spinal needle (Quincke) is dependent on the size of the needle.
		Newer spinal needles with special tip design (modifications of the original pencil point Whitacre needle) have lowered the incidence of PDPH to an acceptable level.
		introduced the 'atraumatic' spinal needle (a modified pencil point needle) and reported that the incidence of PDPH could be reduced to less than 1%.
	www.frca.co.uk /article.aspx?articleid=100127 (376 words)

	British Medical Journal: Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: ...
		Objectives To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality.
		Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not deafly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone.
		We used the key words "regional anaesthesia," "regional anesthesia," "spinal," or "epidural" and the Cochrane Collaboration search terms for randomised trials.[3] Once papers were identified, authors' names and study titles were used as search terms.
	www.findarticles.com /p/articles/mi_m0999/is_7275_321/ai_68996878 (1017 words)

	Article (Site not responding. Last check: 2007-10-21)
		In order to evaluate the technical difficulties in using the needles, the attempts of insertion of the spinal needle and the renunciation to use it, and the partial or total failures, were recorded.
		The incorrect positioning of the introductor is one of the factors that contributed to an increase in the average attempts of spinal needle insertion in group A patients (1.55 versus 1.33) to reach the subarachnoid space.
		This can suggest that the most important characteristic of a spinal needle to determine the loss of CSF across the dural hole is its diameter, more than the atraumatic conformation and less than the tip, at least in the smaller diameters.
	www.mednet.odessa.ua /med/anes/1/21.htm (2431 words)

	VAT - Local and Regional Anaesthesia
		Local Anaesthesia for Inguinal and Femoral Hernia Repair is a good article from Update in Anaesthesia.
		Low Spinal Anaesthesia for Caesarean Section describes 100 cases using this technique.
		Anaesthesia for Opthalmic Surgery Part 1: Regional Techniques in Update in Anaesthesia is an excellent introduction, with clear illustrations.
	www.virtual-anaesthesia-textbook.com /vat/ra.html (436 words)

	Characteristics of anaesthesia
		The incidence of leg pain and back pain was far higher in the 5% lidocaine spinal anaesthesia group than in the groups with the general anaesthetics used (III), or in the 2% lidocaine spinal anaesthesia group (IV).
		No connection between TNS and 2% lidocaine spinal anaesthesia could be shown, although some of the 2% lidocaine spinal patients had symptoms that resembled TNS (IV).
		This may be due the impracticability of local anaesthesia when tourniquets are used and the fear of inadequate anaesthesia and patient discomfort (Forssblad & Weidenhielm 1999).
	herkules.oulu.fi /isbn9514267729/html/x2025.html (1297 words)

	Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery -- Ranasinghe et ...
		Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery -- Ranasinghe et al.
		Spinal anaesthesia is simple to institute, rapid in
		0.75% in dextrose 8.5% was used for the spinal injection.
	bja.oxfordjournals.org /cgi/content/full/91/2/299-a (964 words)

	Epidural or spinal anaesthesia reduces major postoperative complications
		Giving patients epidural or spinal anaesthesia (known as neuraxial blockade) during major surgery reduces mortality by about a third and also reduces the risk of serious postoperative complications in a wide range of patient groups, finds a study in this week's BMJ.
		Furthermore, the benefits did not differ by the type of surgical group, the type of neuraxial blockade (epidural or spinal), or in trials where neuraxial blockade was combined with general anaesthesia, add the authors.
		The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia, say the authors.
	www.eurekalert.org /pub_releases/2000-12/BMJ-Eosa-1412100.php (274 words)

	Guide to Spinal Anaesthesia for Caesarean Section - References
		Authors Brownridge P Title Spinal Anaesthesia Revisited: An Evaluation of Subarachnoid Block in Obstetrics Source Anaesth Intens Care (1984) 12:334-342.
		Conclusion: "Spinal anaesthesia does not deserve to remain in the doldrums in obstetrical practice".
		The reference "Spinal anaesthesia in Obstetrics" above (Morgan) is a very good comprehensive review of the literature on spinal anaesthesia in obstetrics.
	www.oyston.com /anaes/local/sp-cs-rf.html (353 words)

	Factors affecting spread of spinal anaesthesia
		There is evidence to support the opinion that the taller the patient, the lower the dermatome level of analgesia for a given dose of local anaesthetic (1, 2, 3, 4, 5, 40).
		There appears to be a correlation between age and the height of spinal anaesthesia (3, 10, 11, 43).
		In patients with a decreased volume of CSF (such as parturients, women in the 2nd or 3rd trimester of pregnancy (44), patients with ascites or patients with large intra-abdominal tumours), the spread of spinal anaesthetic solution is greater than normal (4).
	www.manbit.com /oa/C98.htm (451 words)

	Epidural: spinal anaesthesia (Site not responding. Last check: 2007-10-21)
		The epidural space lies between the outermost covering of the spinal cord and the vertebral canal formed by the spine bones.
		The epidural is a popular form of spinal anaesthesia because it has fewer side effects.
		It is used increasingly to provide pain relief, or to reduce the need for deep general anaesthesia – to relax muscles – during childbirth.
	www.ivillage.co.uk /print/0,,163001,00.html (575 words)

	CSE Combined Spinal Epidural Anesthesia
		This much discussed technique combines the low failure-rate and reduced latency period of spinal anaesthesia with the option of prolonging anaesthesia through the peridural catheter as required.
		By eliminating friction during the spinal needle's passage through the Tuohy, the important tactile sensation of dura puncture is unobscured.
		A Sprotte spinal needle is inserted coaxially into an Epidural Special Sprotte or Tuohy and emerges through the lateral opening of the Epidural needle.
	www.dynamedical.com /pg2i.html (236 words)

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