failed spinal

[kalpesh shah]

what should be the ideal prtocol for totally failed spinal and partially acted spinal anaesthesia..???????


failed spinal is no action clinically with apparantly perfact spinal anaesthesia....


reply with ur experiences........

thank you... ???

[NOMOREGAS]

No problem:you can perform a new spinalö approch one space above.
If the local anesthetic has`nt drenche nervous roots I don`t see the matter of question.
Tell me your point.

[jafo1964]

Convert to GA if block is acting but is patchy or of inadequate spread
IF totally failed, double confirm and then proceed to repeat spinal with all precautions in place
Would like to report this case history to drive home the point of safety first while repeating spinals

22 year old ASA 1 man with trauma lands for wound debriment and external fixator for tibia. Was sat up and spinal given by junior resident. Spinal taken up but extremely patchy and around L2 level. Patient uncomfrotable . So repeat spinal given patient went in for severe hypotension and bradycardia. Finally asystole. Revived with diffculty and put on ventilator. Lost on day3 to MOFS.

Cause probabaly very high level of block due to repeat spinal in a inadequately volume resuscitated patient.

So please be careful about repeating spinals. Choose patient carefully. Never repeat spinals in trauma and obstetrics. In such patients safer to give an uncomplicated GA if no absolute contraindications

regs

[NOMOREGAS]

In my opinion and practice the question of repeated spinal anesthesia in case of previous failure depends only from three factors.
The first is at which "level" u have done the former puncture.
The second is the "dose" of local anestethic u have just administered i.e if hyperbaric or plain!
The third the "position" of the patient will take on the bed during surgery and the related spread of the drug.
Of course nobody can ever think to practice a second spinal anestesia in case of labour, in case of shocked or trauma patient,and in every situation in which u might face up a difficult intubation !!!
NOMOREGAS

[kalpesh shah]

thanks for the reply,,,,,,, ???,,
    suppose pt is relatively containdicated for G.A.(like bronchial asthema,COPD)...and spinal is partialy acted.......???? many a time in private practice infrastucture for G.A. is basic only....so giving G.A. is comaratively more difficult...  what is the role of epidural in this case ???? is there any guidelines for such failed or partialy acted spinal ???


thanks,,,,,, ???

[NOMOREGAS]

Hallo,
Epidural is absolutly controindicated in case of previous spinal puncture.
Can u consider loco regional blocks instead of?
NOMOREGAS

[jafo1964]

I do not think that epidural is absolutely contraindicated.
You probably feel that the after spinal, if you give epidural the drug placed in the epidural space will force itelf into the spinal space
yes it can,  but it does not cause any huge problems if you titrate slowly and carefully
that is the basis of COMBINED SPINAL EPIDURAL  which is indeed a safe technique
Yes there may be a role for blocks
If elective, postponing case is an option
regs

[Dr. Mian]

Strongly agree with last post to the point that I strictly use CSEA as opposed to spinal anesthesia even when I am not considering epidural analgesia postop.

[yogenbhatt1]

HI, there is a fear that your repeat spinal can go much higher and give a total block.
But now there is an option available.
Consider repeating the spinal with a drug that is isobaric. We use a lot of Ropivacain in NS which is isobaric and giving any position will not push drug higher due to gravity.
We do a lot of cases where muscle relaxation is  not much needed. And for that, does the drug have shorter or lesser muscle relaxation? I do not think so, though the manufacturers claim so.
Keep the molecule in mind if stuck in a case next time.