COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIA
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Transcript of COMPLICATIONS OF SPINAL & EPIDURAL ANAESTHESIA
COMPLICATIONS OFSPINAL & EPIDURAL
ANAESTHESIANUR HANISAH ZAINOREN
COMPLICATIONS O
HypotensionMost common complication
Due to sympathetic blockade
Treatment:Prophylactic: preloading with 1-1.5L of
crystalloid
Curative: head low position (15degree)A. FluidsB. Ephedrine (vasopressor)C. Oxygen inhalation
BradycardiaIncidence: 10%Treatment: iv Atropine
Usually because of severe hypotension leading to
medullary ischemiaOR
Due to high or total spinal
Immediate management: Intermittent Positive
Pressure Ventilation (IPPV)
RespiratoryParalysis(Apnea)
Nausea & vomitingDue to hypotension causing central hypoxia
Treatment:• treat hypotension• oxygenation• antiemetics
Cardiac arrestCauses:• Severe hypotension• Total spinal/very high spinal• Local LA toxicity/anaphylaxis
Immediate start CPR
High spinal Or
Total spinalHigh spinal: spinal above the desired level causing problems to the patient
Too high spinal (above cervical) is called as very high or total spinal
Management: Depend on the level of block
Attempt the removal at once
If not possible, get a portable xray and call for neurosurgeon
Bloody tapUsually occurs due to
puncture of the epidural vein
Withdrawn and reinserted
Urinary retentionMost common postoperative complication
Due to blockade of S2,3,4
Catheterization may be required
Postdural Spinal
HeadacheLow pressure headache due to seepage of CSF FROM HOLE CREATED BY SPINAL NEEDLEChange hemodynamic of CSF
Incidence decrease due to use of smaller gauge needle
Clinical features:• Usually presents after 12-24hrs• Usually occipital but can be
frontal• May be associated withpain
neck stiffness• Pain increase on sitting,
relieves on lying down
MeningitisAseptic: chemical
meningitis because of antiseptic solution like
betadine, glove's starch, blood drops transported
with needle
Usually no treatment required
Infective: usually due to staph. epidermidis carried
from skin along with needle
Treament: iv antibiotics
Due to direct injury to nerve fibers by trauma or by LA
Usually seen with continuous spinal with small bore catheters
Clinical features:• retention of urine• Incontinence of feces• Loss of sexual function• Loss of sesation in periaal
region
Cauda Equina Syndrome
Chronic Adhesive
Arachnoiditis
Epidural Hematoma
(Traumatic Spinal)Can results in• Spinal cord ischemia• Paraplegia• Anterior spinal artery
syndrome
Epidural Abscess
Treatment: neurosurgical intervention
COMPLICATIONS OF
EPIDURAL ANAESTHESIA
Inadequate (patchy)
BlockNumerous fibrous bands in epidural space, so drug may not be equally distributed
L5 & S1 segments are the most difficult to be blocked because of their large size
HypotensionLess seen as compared to spinal because action of drug is slow in epidural.
So, body gets time to compensate
Total Spinal
Dura is accidentally punctured by needle or catheter during injection
Large volume (usually 10-20ml of drug is used) of hypobaric solution (plain bupivacaine and lignocaine are slightly hypobaric) is injected in subarachnoid space
Manifestations:• marked hypotension• bradycardia• apnea• dilated pupils • unconsciousness
Prevention:• Always confirm the position of
needle/catheter by giving a test dose with lignocaine + adenaline
• Never inject a bolus, always give drug in increments of 3-5ml
Treatment:• Intubate and IPPV with 100% oxygen• Vasopressor• Atropine
Dural Puncture
Incidence is 1%
If dura is punctured with epidural needle, there are 2 options:
1. Give hyperbaric LA through this needle (convert it to spinal)
2. Remove the needle and give epidural in higher space
Reference:• Short Textbook of Anaesthesia, 5th edition,
Ajay Vadav
Thank you :)