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Author Topic: spinal anaesthesia and sepsis  (Read 1016 times)

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risottolover

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spinal anaesthesia and sepsis
« on: August 08, 2010, 05:29:34 AM »
would you do a spinal anaesthesia for a 70 year old man with congestive cardiac failure for drainage of infected leg stump post amputation. It is infected with MRSA, he is on vancomycin , apyrexial , WCC 6. He has decompensated heart failure and is on diuretics and intermittent cpap for his pulmonary oedema.
I am concerned about the risk of spinal cord infection with mrsa, but feel it is still safer to spinal him, than give a GA to his decompensated heart.
« Last Edit: August 08, 2010, 05:34:14 PM by risottolover »
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George K

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Re: spinal anaesthesia and sepsis
« Reply #1 on: August 09, 2010, 10:50:02 AM »
No way.

No how.

I always prefer GA for uncompensated cardiac patients (but that's a different discussion) because I can control the hemodynamics better than with a spinal. I can be gentle, use etomidate and slowly get the vapor where I need it for the procedure. Of course, there's always a little muscle relaxant, if you need it.  :D

As far as sepsis goes, as far as I know, there's no evidence that you can cause CNS sepsis in this scenario (I'd love to be proved wrong, by the way), but if, just if, it does happen, you're without a leg (pun intended) to stand on.

The older I get (and I'm in practice for 30 years now), the more dangers I see with regional (particularly spinal) anesthesia.
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sandiphari

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Re: spinal anaesthesia and sepsis
« Reply #2 on: August 22, 2010, 02:04:49 PM »
POPLT.N.BLOCK EVEN SA WITH VASOPRESSURES CAN BE GIVEN SAFELY.
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kalpesh shah

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Re: spinal anaesthesia and sepsis
« Reply #3 on: August 28, 2010, 12:29:32 PM »
sciati n.block is better option if area around the needle entry looks non infacted.....touching the central neuraxial system is more dengerous than peripheral nerve..... and as others said GA is also a reasonable choice.....but we prefere nerve block .....
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anaesami

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Re: spinal anaesthesia and sepsis
« Reply #4 on: September 13, 2010, 03:12:01 AM »
make it a hemi-spinal and all your problems are solved. thecal tap with affected side down, volume of injectate less than 2ml [of 0.5% bupivacaine hyperbaric], keep in position for 10 minutes and then supine or surgical position.
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