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Spinal anesthesia is also known as a sub-arachnoid block, or SAB. It is different from epidural anesthesia because it is administered with a needle. Due to heightened risk of injuring the spinal cord, the exact placement of a spinal anesthesia injection is important. Spinal anesthesia can be used as a regional anesthesia for patients with greater hypertension risks, irritated airways, anatomical abnormalities, and geriatric patients. For this reason, spinal anesthesia is common in assisted living facilities.

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Increased Risk with Spinal Anesthesia

The use of spinal anesthesia may need to be decided on an emergency basis. It is important for geriatric patients, expecting mothers, and other patients with possible need for spinal anesthesia to understand the medical process. Dangers and benefits have both been associated with using spinal anesthesia instead of other anesthetic options. Preexisting conditions may increase the chances of negative outcomes, making informed patient consent a critical step to the procedure.

Preexisting factors that can heighten risk include:

  • Sepsis

  • Other infections, near site of lumbar puncture

  • Lesions of the brain

  • Spinal disorders

  • Maternal hypotension

  • Bleeding disorders

Administering Spinal Anesthesia

After obtaining patient consent, the doctor will sterilize the site of lumbar puncture for the spinal anesthesia. There are a large number of options for the anesthetic drug, including lignocaine, ropivacaine, tetracaine, and cinchocaine. Bupivacaine, or Marcaine, is the most common. The medical practitioner may also use a vasoconstrictor or an opioid to prolong the pain relieving effects of the spinal anesthesia. The physician will then select the density of the anesthetic drug to better control the way it spreads through the body. Hyperbaric solutions are the most frequently used and easily controlled substances for spinal anesthesia.

The doctor will then insert a 9 centimeter-long needle into the patient’s back. It must be placed just below L2 on the lumbar vertebral column. This ensures the safety of the spine since a properly positioned needle will not puncture the spinal cord at this site. The tip of the needle has a pencil point, or small bevel, to inject the anesthetic solution. For large patients, a needle of 12.7 centimeters in length may be used. Additional spinal anesthesia may be injected if necessary.

Spinal Anesthesia Complications

There are serious health implications if spinal anesthesia is not correctly used. Problems may arise due to human error, typically as a result of inaccurate dosage. Further complications can occur if the needle is not inserted properly or placed in an incorrect location. Anesthesiologists should maintain a close watch over their patients to monitor for any adverse side effects.

Adverse side effects of spinal anesthesia include:

  • Injury to the dura

  • Dropped foot

  • Leaking spinal cord fluid

  • Nerve damage

  • Paraplegia

  • Cardiac arrest

Spinal anesthesia is most effective for patients needing surgical procedures in the abdomen or below. Due to the nature of these medical procedures, the most common problems affect the lower portions of the body. The anesthesiologist should discuss all options, health concerns, and possible outcomes with the patient prior to obtaining consent. If the anesthesiologist fails to explain a portion of the procedure, or administers the anesthesia incorrectly, medical malpractice can occur.

 

Sources:

BerrinGunaydin, AycaTas, and Krzysztof M. Kuczkowski. “Do We Worry About Latex Allergy During Cesarean Delivery Under Spinal Anesthesia?.” Journal of Anesthesia 25 (2011): 792-793.Web. 19 June 2012.
Nelson, Sara, AlaSzczepura, and Deidre Wild.”Medication administration errors for older people in long-term residential care.”BMC Geriatrics 11 (2011): 82. Academic OneFile.Web. 19 June 2012.
TadahikoIshiyama, Kazuhiro Shibuya, Yoshihide Terada, Hironobu Iwashita, and TaishiMasamune, et al.“Cardia Arrest After Spinal Anesthesia In A Patient With Neurally Mediated Syncope.” Journal of Anesthesia 26 (2012): 103-106. Web. 19 June 2012.