Question

A 25-year-old lady is posted for hernia surgery under spinal anaesthesia. You are called to monitor this lady.
How will you prepare a patient for spinal anaesthesia?

Hint:

Proper patient positioning and sterile technique are critical to performing a successful spinal anaesthesia. Always check for any contraindications before proceeding.

Answer 1

Step 1: Preoperative Assessment.
- History Taking: Assess the patient's medical history, including any contraindications for spinal anaesthesia (e.g., allergies, infections, neurological disorders, or prior spinal surgeries).
- Physical Examination: Check for any signs of infection at the site of the spinal injection, and assess the patient's general condition (vital signs, cardiovascular and respiratory status).
- Laboratory Investigations: Perform routine investigations such as blood tests (hemoglobin, platelets, coagulation profile) to ensure the patient is fit for anaesthesia.
- Consent: Obtain informed consent, explaining the procedure, potential risks, and benefits to the patient.

Step 2: Preoperative Preparation.
- Fasting: Ensure that the patient has fasted for at least 6 hours for solids and 2 hours for clear fluids before the procedure.
- Intravenous Access: Establish an IV line for fluid administration and emergency medication if required.
- Monitoring Setup: Prepare the necessary monitoring equipment such as ECG, pulse oximeter, non-invasive blood pressure cuff, and capnography.
- Preoperative Medications: Administer any prescribed premedications (e.g., anxiolytics) if necessary to help the patient relax.

Step 3: Positioning and Local Anesthesia.
- Position the patient in the sitting or lateral position with adequate support to facilitate the lumbar puncture.

Step 4: Conclusion.
The patient should be well-prepared physically and psychologically before undergoing spinal anaesthesia, ensuring safety and reducing anxiety.