Spinal Anesthesia
Rasha S Bondok M.D.
Assisstant Professor
Ain-Shams University
van Zundert AJ, Stultiens G, Jakimowicz J et al. Segmental spinal anaesthesia for cholecystectomy in a
patient with severe lung disease. Br J Anaesth, 2006;96:464-466.
Major Concern
Robertson HJ, Smith RD. Cervical myelography: survey of modesof practice and major complications.
Radiology. 1990;174:79Y83
Yousem D.M. , Gujar S.K. Are C12 Punctures for Routine Cervical Myelography below the Standard of
Care? A JNR 2009;30:1360-1363
7.6mm
T2
5.2 mm
T5
7.75 mm
T10
5.88 mm
3.3mm
5.9mm
Imbelloni L E et al. Magnetic resonance imaging of the spinal column Br. J. Anaesth.
2008;101:433-434
Imbelloni L E , Gouveia Low Incidence of Neurologic Complications during Thoracic
2.7 (0.85)mm
T6
3.75 (1.5)mm
T9
2.45 (0.6)mm
Lee R.A., et al The anatomy of the thoracic spinal canal in different positions: a magnetic
resonance imaging investigation. Reg Anesth Pain Med.2010;35(4):364-369
How To Perform A
Thoracic
Spinal Technique
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic
spinal anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008;
14(1): 63-69
Technique
Technique
A
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic
spinal anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1):
63-69
Technique
The distance from skin to epidural space being
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic spinal
anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1): 63-69
Technique
The dura is then pierced
The two needles secured together by a
locking device ..ensures that the spinal
needle does not move any further forward
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic spinal
anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1): 63-69
Technique
Once flow of clear CSF has confirmed correct
placement
Inject 1 ml isobaric bupivacaine 5 mg/ml
+
0.5 ml of sufentanil/fentanyl
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic spinal
anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1): 63-69
Technique
Only when the block is considered adequate
An effective block extent includes the T4 to L2
Sensory block:
a) Upper sensory level:
T2
T4
T3
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic
spinal anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1):
63-69
Sensory block:
Lower sensory level:
L4
L2
L1
L3
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental thoracic spinal
anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008; 14(1): 63-69
Motor block:
2; 25%
1; 25%
0
50%
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental
thoracic spinal anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA
2008; 14(1): 63-69
Film: The spread of local anaesthetic solutions in the glass spine By Dr Len Carrie
Haemodynamic stability :
van Zundert AA, Stultiens G, Jakimowicz JJ et al. Laparoscopic cholecystectomy under segmental
thoracic spinal anaesthesia: a feasibility study. Br J Anaesth 2007.
Lee RA,Van Zundert AAJ,Visser WA et al.Thoracic combined spinal epidural anesthesia. SAJAA 2008;
14(1): 63-69
Although..
Accidental dural puncture during needle
Cons!!!!!
Spinal cord damage is a potentially disastrous
Recommendations
Patient
THANK YOU