Digital Library - Spinal Anesthesia

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Indication for Spinal Anesthesia and Epidural Anesthesia

  1. Surgery:
    Majority of surgical operation for lower abdominal procedures.
    1. GYN surgery for TAH, vaginal hysterectomy, etc.
    2. General surgery for appendectomy, inguinal herniorrhaphy, rectal surgery, etc.
    3. Urology for cystoscopy, bladder tumor, TURP
    4. Orthopedic surgery for total hip replacement, hip pinning, knee surgery, etc.

  2. Obstetrics: a). Labor - patient in active labor with severe pain. Epidural anesthesia can be given safely in most patients with pre-eclampsia, diabetes, or history of previous cesarean section b). Delivery - epidural analgesia can be rapidly extended through an epidural catheter to ameliorate the pain of delivery c). Cesarean Section - spinal and epidural anesthesia are first choice for Cesarean section

  3. Postoperative Pain Relief - Narcotics are the drugs of choice for this indication. Fentanyl, morphine or meperidine, with or without local anesthetic, can be used. Late respiratory depression is the most feared side effect; nausea, vomiting, pruritus can also occur.

  4. Chronic Pain - Epidural steroids are used to treat patients with back pain. In addition, local anesthetic epidural can be used diagnostically during the work-up of back pain syndromes.
Contraindication for Spinal and Epidural Anesthesia
  1. Absolute
    1. localized infection of puncture site
    2. coagulopathy - platelet count < 100,000, elevated PT or PTT
    3. patient with sepsis and bacteremia
    4. patient refusal
    5. hypovolemia - blood loss, dehydration
    6. presence of VP shunt

    2). Relative

    1. patient unable to tolerate a sympathectomy
      1. unstable angina
      2. uncontrolled hypertension
      3. mitral or aortic stenosis
    2. progressive central neurologic disease
    3. patient with prior difficulty with spinal anesthesia
    4. scoliosis, spinal fusion, chronic back pain
    5. medicolegal consideration
    6. surgeon refusal

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