University:
Michigan State University
Course:
ANES 621 | Concepts in Clinical Anesthesiology I (Interim New)
Academic year:

2024
Views:

56

Pages:

17
Author:

hacedoras1kxy

SPINALS, EPIDURALS AND CAUDALS Introduction ● ● ● ● ● ● ● Two main types of anaesthesia – general and regional. REGIONAL anaesthesia – Drugs administered directly to the spinal cord or nerves to locally block afferent and efferent nerve input. Indications Contraindications Equipment Technique Complications Definitions ● ● ● ● Regional anaesthesia – The use of local anaesthetic either alone or to supplement general anaesthesia aiming to prevent or reduce nerve conduction of painful impulses to higher centres. Spinal anaesthesia – Injection of a local anaesthetic directly into the CSF within the sub-arachnoid space. Epidural anaesthesia – Injection of a local anaesthetic into the potential space outside the dura. Caudal anaesthesia – Injection of local anaesthetic into the caudal canal producing block of the sacral and lumbar nerve roots. Advantages of regional anaesthesia ● ● ● ● ● ● ● ● ● Analgesia / anaesthesia provided predominantly in area required, thereby avoiding the systemic administration of drugs. Spontaneous ventilation can be preserved – benefit in those with respiratory disease. Generally less disturbance of co-existing systemic disease requiring medical therapy. Airway reflexes preserved. May improve access and facilitate surgery. Reduced blood loss with controlled hypotension. Less equipment required and reduced cost. Less volatile agent required if used in conjunction with GA. Some techniques can be continued postoperatively. Indications – Spinal anaesthesia ● ● ● Surgical procedures to the lower body below dermatome T10. Analgesia for upper abdominal surgery in combination with general anaesthesia. “circumstances where a skilled anaesthetist is not readily available to administer a general anaesthetic” Oxford Medical dictionary 1996 ● Indications – Epidural anaesthesia Surgery – can be done using epidural as sole anaesthetic but normally combined with light GA. - Pulmonary Vascular Labour ● - Abdominal - Urological Acute pain relief Trauma ● Chronic pain states - Thoracic - Cardiac - Gynaecological / - Orthopaedic - Post op - Miscellaneous (eg pancreatitis) - Indications – Caudal Anaesthesia ● ● ● Provides a way of administering a sacral epidural. Popular in paediatrics. Adults - Surgery (anorectal, gynaecological, orthopaedics) - Obstetric (episiotomy, removal of placenta) Chronic pain Paediatric - Major abdominal and orthopaedic surgery - Inguinal hernia repair - Surgery to genitalia Contraindications to regional techniques ABSOLUTE - - Patient refusal Anticoagulation / coagulopathy Local anaesthetic allergy Localised infection Untreated hypovolaemia RELATIVE - - Systemic sepsis Raised ICP Skeletal anomalies Neurological disease Previous local surgery Fixed cardiac output state eg aortic stenosis Unco-operative patient Equipment - spinals ● Needle choice – Quinke / Whitacre / Sprott ● - Gauge eg 25G Introducer ● Syringes ● Sterile drapes, swabs, betadine etc ● Local anaesthetics bupivicaine 2.5ml – 3.25ml - 0.5% hyperbaric Technique - spinals ● Consent and explanation ● Prepare equipment, IV access, monitoring, scrub ● Positioning – Sitting v Lateral ● Approach – midline / paramedian ● Clean skin, drape, identify position ● Skin anaesthesia, introducer, spinal needle, inject local Equipment - Epidurals ● ● Sterile drapes, swabs, betadine etc Tuohy needle (16-18G) - markings ● Plastic catheter ● Syringes ● Local anaesthetics - curved tip ● Technique - epidurals Consent and explanation ● Prepare equipment, IV access, monitoring, scrub ● Positioning – Sitting v Lateral ● Clean skin, drape, identify position ● ● Skin anaesthesia, Tuohy needle, loss of resistance technique, air v water. Catheter insertion, test dose then main dose Technique - Caudals ● ● ● ● ● Consent and explanation Prepare equipment, IV access, monitoring, scrub, GA Clean skin, drape, identify position Identify sacral hiatus, advance needle through sacrococcygeal membrane and inject local. Catheter may be inserted.

Spinals, Epidurals and Caudals

Related Documents

Recommended Documents

Description

Related Documents

Free up your schedule!

Take 5 seconds to unlock