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Spinal anaesthesia should only be undertaken by or under the supervision of clinicians with the necessary knowledge and experience. Spinal anaesthesia should only be given in a fully equipped operating suite where all the necessary resuscitative equipment and drugs are immediately available. The anaesthetist must remain in constant attendance until the operation is finished and must supervise the recovery until the anaesthesia has worn off.
Intravenous access, e.g. and IV infusion, should be in place before starting the spinal anaesthesia.
Regardless of the local anaesthetic used hypotension and bradycardia may occur. This should be prevented either by pre-loading the circulation with the crystalloidal or colloidal solutions, or by injecting a vasopressor, such as Ephedrine 20-40 mg IM, or treated promptly with, for example Ephedrine 5-10 mg intravenously and repeated as necessary.
Hypotension is common in patients with hypovolemia due to haemorrhage or dehydration and in those with aortocaval occlusion due to abdominal tumours or the pregnant uterus in late pregnancy. Hypotension is poorly tolerated by patients with coronary or cerebrovascular disease.
Spinal anaesthesia can be unpredictable and very high blockades are sometimes encountered with paralysis of the intercostals muscles and even the diaphragm, especially in pregnancy. On rare occasions it will be necessary to assist or control ventilation.
Chronic neurological disorders, such as multiple sclerosis, old hemiplegia due to stroke etc., are not thought to be adversely affected by spinal anaesthesia, but call for caution.
NB. Because spinal anaesthesia may be preferable to general anaesthesia in some high-risk patients, attempts should be made to optimize their general condition pro-operatively when time allows.
Effects on ability to drive cars and use machines: Spinal anaesthesia per se has little effect on mental function and coordination but will temporarily impair locomotion and alertness.
