March 4, 2014

Regional Anesthesia Dr. Rey F. Atal

Definitions
Spinal anesthesia
o Intrathecal - administration of medication
into subarachnoid space
o CSF leaks
o Faster onset of action
o Use smaller volume of anesthetic
o Block sensory and motor
Epidural Anesthesia
o Epidural administration of medication into
epidural space
o Technique go inward, push syringe
forward there is pressure; when it gives
youre in the epidural space loss of
resistance technique
o Slower takes time to diffuse to spinal
nerves
o Need larger volume for anesthetic to
diffuse
o Larger bore, bigger needle Toughy, can
cause post-puncture headache
o Only block sensory patient can still walk
Regional Anesthesia
Spinal lower extremities, lower abdomen, pelvis
o Abdominal surgery from T4 down,
cholecystectomy
Epidural cervical, thoracic, lumbar, caudal
o Indications post-operative pain, relieve
pain
o Major surgery, trauma (# ribs), palliative
care (intractable pain), labor and delivery,
abdominal surgery, pelvic surgery, lower
limb surgery
3 Types of Solutions
Hypobaric
Isobaric
Hyperbaric specific gravity of patient greater
than CSF Trendelenberg position
Contraindications
Absolute contraindication
o Patient refusal
o Known allergy to opioid or local anesthetic
o Infection/abscess near the proposed
injection site
o Hematological disorder
o Increase ICP
Relative contraindication
o Sepsis
o Anticoagulant drugs
o Hypotension
o Hypovolemia most common complication
of spinal anesthesia
o Spinal deformity
o Neurological disorder

Positions
Sitting height of sensory block (lumbar T4,
thoracic T2)
o Enlarged abdomen
Lateral decubitus patient assumes a sitting or
side-lying position with the back arched toward the
physician. Helps to spread the vertebrae apart
Advantages and Disadvantages
Advantage - patient remains conscious
Disadvantaage - patient may prefer to be asleep,
practice and skill is required for the best results
Drugs
Opioids
o Adverse Effects
Sedation and respiratory depression
IV narcan
N/V opioids stimulate the
chemoreceptor trigger zone
primperan
Pruritus diphenhydramine or
narcan
Urinary retention
GI slowing
Amides
o Primarily hepatic
o Plasma concentration may accumulate with
repeated doses
Esters
o More toxic esters (PABA by-product)

March 4, 2014
Perioperative Anesthesia Dr. Rey F. Atal
Fluid Compartments
Average adult male is approximately 60% water by
weight
Average adult female is 50%
Exam Example
Computations on exam
Ex: 75 kg male patient, elective cholecystectomy,
NPO = 6 hours
o Compute for maintenance fluid
requirement
1st 10 kg = 4 x 10 kg = 40 ml/kg/hr
Next 10 kg = 2 x 10 kg = 20
ml/kg/hr
Above 20 kg = 1 x 55 kg = 55
ml/kg/hr
115 ml/kg/hr
o Fluid deficits
115 ml/kg/hr x 4 = 690 ml
o Additional degree of tissue trauma
75 kg x 4 = 300 ml
o TFR 1st hour
300 + 115 + 690 = 1.106 L

Surgical Anesthesia: Regional and Perioperative Anesthesia Dr. Atal OLFU International Class - CML

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