Spinal Anaesthesia for Emergency Surgery

Abstract

Spinal anaesthesia has experienced more waves of popularity and unpopularity perhaps than any other anaesthetic method. During the past two decades there has been a decrease in the use of spinal anaesthesia for surgical operations. There are several reasons for this trend, including improvement in general anaesthetic techniques and agents, increasing knowledge about the action of drugs upon body functions, the widespread use of muscle relaxants and other agents, all of which made general anaesthesia safer. But, we can admit that we find more accidents with the use of other methods which continue to enjoy popularity. Technical incompetence of the anaesthesiologist and unwillingness to overcome deficiences are the actual basis for reluctance to use spinal anaesthesia. Its limitations are clearly defined. The indications for its use are generally accepted as are the physiologic principles underlying its application. We believe that despite its decline in popularity it remains an extremely useful procedure and is the technique of choice for patients who are well selected and evaluated. The question arises. Why then is this method not being used as frequently as it should in our practice? The reasons usually given are:

• 1. Patients do not like spinal anaesthesia. This dislike is based upon hearsay, and not previous experience. We believe that fear existing about spinal anaesthesia can be eliminated with proper psychological preparation. The most effective selling point is a good result.

• 2. It is mistakenly believed that spinal anaesthesia consumes too much time. However, with experience and skill, this procedure requires only five to ten minutes, and the time necessary to prepare the operative field is ample for the onset of analgesia. With the judicious use of some barbiturate or nitrous oxide it provides us with truly balanced anaesthesia.

• 3. Too many failures and serious complications occur following spinal anaesthesia. As far as failures are concerned, we believe that proper teaching of this technique will greatly reduce the incidence of failure. In recent years teaching centers have emphasized the superiority of general anaesthesia and have neglected the use of regional anaesthetic techniques. This is very unfortunate because an anaesthesiologist should be able to administer spinal anaesthesia as well as general anaesthesia. Failures will occur even in the most skilled hands; however, failures will also occur with general anaesthesia. The difference is that failures with spinal anaesthesia are more obvious to everyone while those that follow general anaesthesia may go totally unrecognized. The bare fact that the surgeon was able to complete his operation and the patient survived is not a criterion that general anaesthesia was properly administered. Thorough knowledge of the physiological changes occurring during spinal anaesthesia can greatly minimize the ill effects of this technique. Serious complications from spinal anaesthesia, such as cardiovascular collapse from extensive vasomotor block and neurologic sequelae, are usually due to lack of skill and knowledge about the method.