Spinal anesthesia in surgery: Indications and contraindications

The article is professionally consulted by Specialist Doctor I Tran Thi Anh Hien - Department of Surgical Anesthesia - Vinmec Central Park International Hospital and Specialist I Nguyen Duc Thong - Anesthesiologist Resuscitation - Department of General Surgery - Vinmec Danang International General Hospital.

If used correctly and in the right dose, spinal anesthesia is a method that offers many benefits to support during surgery. With a reasonable price and a number of other advantages, spinal anesthesia is increasingly being chosen by more and more patients. However, not everyone can get this procedure.

Spinal anesthesia, also known as arachnoid anesthesia, is performed by injecting local anesthetic into the subarachnoid space in the lower back. Cerebrospinal fluid mixes with cytotoxic drugs, causing nerve root conduction, causing motor paralysis and loss of sensation to be reversible. To perform spinal anesthesia, it is necessary to have experienced people and master the principles and techniques, besides, this method requires cooperation between the patient and the anesthesiologist. During this procedure, the patient will remain awake, so the patient needs to cooperate well with the anesthesiologist to perform the technique.

Intraoperative spinal anesthesia is indicated in the following cases:
Perform obstetric and gynecological surgery: Caesarean section, treatment of uterine prolapse, hysterectomy, ovary removal, and a some other gynecological surgery.... Perform urological surgery: Surgery of prostate, bladder, ureter, kidney and genitals Perform orthopedic surgery 2 legs Perform regional surgery lower abdomen: appendix, pelvic surgery, inguinal hernia, rectal polyps, anal fistula, hemorrhoids.. Perform lumbar spine surgery Perform surgery on patients with impaired liver function, liver failure. reduced kidney function, diabetes, respiratory disease, asthma, tuberculosis... In a few cases, spinal anesthesia can be administered during upper abdominal surgery such as cholecystectomy, although However, it must be combined with general anesthesia. Spinal anesthesia is usually indicated in cases of surgery for all organs from the navel area down.

Spinal anesthesia is contraindicated in patients with the following manifestations:
Increased intracranial pressure Patient refuses to undergo spinal anesthesia procedure Infected skin of puncture site Patient has coagulopathy blood Use of anticoagulants such as aspirin, heparin... Abnormal spine deformities, such as: scoliosis, kyphosis... Allergic to anesthetics Patients with severe heart disease, such as severe heart failure, mitral stenosis, severe aortic valve regurgitation. Epilepsy Patients Psychiatric patients Decreased circulatory volume has not yet been compensated for circulating volume The doctor performing spinal anesthesia is inexperienced, lacks technical facilities

In addition to the above contraindications, some of the following cases need to be carefully considered before performing spinal anesthesia, including:
Patients with malnutrition Patients with osteomyelitis joints Patient has headaches Patient has spinal pain, herniated discs in the lumbar spine. Patients with cerebrovascular fibrosis Patient's blood pressure is unstable Patients with anemia Patients with blood clots Patients with cardiovascular disorders

To avoid the risk of complications caused by spinal anesthesia, patients need to keep a few things in mind:
To improve the functioning of the lungs and heart, patients need to quit smoking about 6 weeks before surgery List all medications you are taking to your doctor and need to be checked by an anesthesiologist, especially anticoagulants and cardiovascular drugs. If you have an allergic reaction to the medicine or any other side effect, you should tell your anesthesiologist right away. The effect of the anesthetic will be reduced if you drink alcohol. Within 24 hours before surgery, you absolutely must not drink alcohol Fasting 6-8 hours before surgery to avoid vomiting during spinal anesthesia. If the patient has only eaten within 6 hours before surgery, this surgery can be delayed or suspended to avoid the patient aspiration during anesthesia, airway obstruction due to food from the stomach. reflux into the trachea.

Spinal anesthesia should be performed in a medical facility with adequate monitoring and resuscitation equipment and absolute sterility.
Spinal anesthesia is the most commonly used method today, but not everyone can be performed this procedure. You need to consult your doctor and need to be carefully examined before choosing spinal anesthesia for surgery
Graduating from the Resident Doctor training program, Dr. Tran Thi Anh Hien has experienced many different environments. working in different schools such as Binh Dan Hospital, Ho Chi Minh City University of Medicine and Pharmacy Hospital and Phap Viet Hospital before returning to work at the Anesthesia and Anesthesia Unit - Department of Surgical Anesthesia - General Hospital Vinmec Central Park International.
Doctor Duc Thong has 14 years of experience in the field of Anesthesia. Especially, with 12 years working at the Department of Anesthesiology and Resuscitation at C Da Nang Hospital, Dr. Thong has extensive experience in the field of Anesthesia and resuscitation for elderly patients with many comorbidities and serious illnesses. surgery; helping many heavy and complicated surgeries to be successful. Currently, he is an anesthesiologist at the Department of General Surgery - Vinmec Da Nang International General Hospital.
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