Question

A 25-year-old lady is posted for hernia surgery under spinal anaesthesia. You are called to monitor this lady.
What are the complications anticipated in spinal anaesthesia? How will you manage them?

Hint:

Monitoring for hypotension and using appropriate fluid management techniques are key in preventing and managing complications in spinal anaesthesia. Always be alert for neurological symptoms during the procedure.

Answer 1

Step 1: Hypotension.
- Cause: Spinal anaesthesia can lead to vasodilation and decreased venous return, causing hypotension.
- Management: Preload the patient with IV fluids before the procedure. If hypotension occurs, administer IV fluids and vasopressors (e.g., ephedrine, phenylephrine). Adjust the position to improve venous return (e.g., Trendelenburg position).
- Prevention: Administer fluid boluses before anaesthesia and consider using low-dose local anaesthetics to minimize the effects on the cardiovascular system.

Step 2: Post-Dural Puncture Headache (PDPH).
- Cause: Leakage of cerebrospinal fluid through the puncture site can result in a headache.
- Management: Encourage the patient to lie flat and hydrate well. If the headache persists, consider an epidural blood patch or other interventions.
- Prevention: Use a fine-gauge spinal needle and avoid multiple attempts at lumbar puncture.

Step 3: Infection.
- Cause: Infection at the puncture site or meningitis can occur if proper sterile techniques are not followed.
- Management: If infection is suspected, administer broad-spectrum antibiotics and manage accordingly. Strict aseptic technique during the procedure is essential to prevent infection.

Step 4: Neurological Injury.
- Cause: Accidental puncture of the nerve root or spinal cord during the procedure can lead to neurological deficits.
- Management: If neurological symptoms such as numbness, weakness, or tingling occur, discontinue the procedure and consult a neurologist. Immediate MRI or CT of the spine may be required to assess injury.
- Prevention: Correct needle placement and careful anatomical knowledge are essential to avoid nerve injury.

Step 5: Conclusion.
Spinal anaesthesia is generally safe, but complications such as hypotension, PDPH, infections, and neurological injuries can occur. Proper preparation, technique, and timely management of these complications ensure patient safety.