Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Sep 2003
ReviewPhysiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia.
There are numerous physiological effects of spinal anaesthesia. This chapter focuses on the physiological effects that are of clinical relevance to the anaesthesiologist, and provides suggestions for successful management of this simple and popular technique. The mechanisms and clinical significance of spinal-anaesthesia-induced hypotension, bradycardia and cardiac arrest are reviewed. ⋯ The importance of thermoregulation during spinal anaesthesia, and the clinical consequences of spinal-anaesthesia-induced hypothermia are reviewed. Effects of spinal anaesthesia on ventilatory mechanics are also highlighted. Lastly, the sedative and minimum-alveolar-concentration-sparing effects of spinal anaesthesia are discussed to reinforce the need for the judicious use of sedation in the perioperative setting.
-
Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudySpinal anaesthesia for outpatient surgery.
Spinal anaesthesia in the outpatient is characterized by rapid onset and offset, easy administration, minimal expense, and minimal side effects or complications. Spinal anaesthesia offers advantages for outpatient lower extremity, perineal, and many abdominal and gynaecological procedures. Development of small-gauge, pencil-point needles are responsible for the success of outpatient spinal anaesthesia with acceptable rates (0-2%) of postdural puncture headache (PDPH). ⋯ Lidocaine remains the most useful agent for outpatient spinal anaesthesia. For longer procedures, mepivacaine is an excellent spinal anaesthetic agent. Attention to technique, reduction of dose and addition of fentanyl to lidocaine result in effective spinal anaesthesia with rapid recovery and a low incidence of significant side effects or complications.
-
Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudyLocal anaesthetics and additives for spinal anaesthesia--characteristics and factors influencing the spread and duration of the block.
Different characteristics of patients and local anaesthetic formulations will influence the spread of spinal anaesthesia. The predictability of the spread of spinal anaesthesia can be improved by altering both baricity of the solution, and the position of the patient during the intrathecal local anaesthetic injection. The role of adrenaline and clonidine in prolonging the block and associated side effects is discussed. The role of opioids added to local anaesthetic solutions is discussed from a cost/benefit point of view.
-
Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudyThe combined spinal--epidural technique.
In recent years, the use of regional anaesthesia techniques for surgery, obstetrics and post operative pain management have increased in popularity. The combined spinal-epidural (CSE) technique has attained widespread popularity for patients undergoing major surgery below the umbilicus who may require prolonged and effective postoperative analgesia. The CSE technique is now well established in several institutions. This chapter includes the clinical experience, advantages and potential problems, and discusses future perspectives of the CSE technique.
-
Best Pract Res Clin Anaesthesiol · Sep 2003
Review Comparative StudySpinal anaesthesia and the use of anticoagulants.
This chapter addresses the increasing incidence of spinal haematoma after central neuraxis anaesthesia in patients receiving drugs that affect coagulation. Administration of low-molecular-weight heparins in the perioperative period is highlighted because these drugs remain the 'gold standard' for prophylaxis against deep-vein thrombosis. ⋯ In addition, issues such as those concerning the administration of unfractionated heparin, anti-vitamin K drugs or new antiplatelet and antithrombotic medications are addressed. Finally, specific recommendations regarding each class of drug are defined in order to avoid the occurrence of a rare but catastrophic event such as spinal haematoma.