Marcain 0.5% Spinal Heavy Special Precautions

One should be aware that spinal anaesthesia can sometimes lead to major blocks, with paralysis of intercostal muscles and the diaphragm, especially in pregnant women.
Caution should be exercised in patients with degree II or III AV block since local anaesthetics can lower the conduction capacity of the myocardium.
Elderly patients and patients with severe hepatic disease, severely impaired renal function or in poor general condition also require special attention.
Patients treated with class III anti-arrhythmic drugs (e.g. amiodarone) should be closely observed and ECG monitoring should be considered, since the cardiac effects of bupivacaine and class III anti-arrhythmic drugs can be additive.
Intrathecal anaesthesia can lead to hypotension and bradycardia. The risk of such effects can be reduced by e.g. injection of a vasopressor. Hypotension should be treated immediately with administration of an intravenous sympathomimetic, and repeated if required.
Like all local anaesthetic drugs, bupivacaine can cause acute central nervous and cardiovascular toxic effects in cases of use leading to high concentrations in the blood. This applies particularly after inadvertent intravascular administration.
Ventricular arrhythmia, ventricular fibrillation, sudden cardiovascular collapse and death have been reported in association with high systemic concentrations of bupivacaine. However, with the doses normally used for spinal anaesthesia high systemic concentrations are uncommon.
An uncommon, but dangerous, side effect in spinal anaesthesia is extensive or total spinal blockade, which results in cardiovascular depression and respiratory depression. The cardiovascular depression is caused by extensive sympathetic blockade, which can result in hypotension and bradycardia, or even cardiac arrest. Respiratory depression can be caused by blockade of the innervation of the respiratory muscles, including the diaphragm.
There is an increased risk of extensive or total spinal blockade in elderly patients and patients in late stages of pregnancy. The dose should therefore be reduced for these patients.
In rare cases spinal anaesthesia can cause neurological damage, resulting in paraesthesia, anaesthesia, motor weakness and paralysis. Neurological disorders, such as multiple sclerosis, hemiplegia, paraplegia and neuromuscular disturbances are not thought to be adversely affected by spinal anaesthesia, but caution should be exercised.
Effects on Ability to Drive and Use Machines: Depending on the dose and method of administration, bupivacaine can have a transient effect on movement and coordination.