Spinal Anesthesia: Safe Practice and Management of Adverse Events


Key Points

  • Spinal anesthesia has been used effectively and safely for over 100 years, but its use should still be considered only after careful evaluation of each eligible patient.

  • It is relatively simple to perform but requires an understanding of relevant anatomy and physiology in order to achieve safe and efficient anesthesia for the surgery.

  • Spinal failures do occur and may be related to patient, equipment, or other specific factors.

  • The degree and duration of spinal anesthesia can be modulated by the dose and baricity of the local anesthetic.

  • Catheter techniques may be useful in certain circumstances

  • Hemodynamic complications, including hypotension and bradycardia, may occur after spinal blockade; treatment with sympathomimetics, preloading with fluids, or even adjustment of patient positioning usually address these problems.

  • Urinary retention is a common complication following spinal anesthesia; careful supervision of bladder function is important to prevent long-term bladder dysfunction.

  • Thorough documentation of the spinal procedure can help determine the source of radiculopathy following spinal blockade. Early detection of nerve damage can help prevent long-term sequelae.

  • Etiology of transient neurologic symptoms (TNS) is poorly understood and results from a variety of factors.

  • Postdural puncture headache occurs as a result of CSF leakage through the dura at the site of puncture; symptoms are relieved by lying horizontally, and an epidural blood patch may speed recovery.


Spinal Subarachnoid Complications Regional block Spinal anesthesia 


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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Anesthesia and Intensive Care MedicineTöölö Hospital/Helsinki University HospitalHelsinkiFinland

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