Neuraxial Anesthesia — Spinal, Epidural, and Caudal ….docVIP

Neuraxial Anesthesia — Spinal, Epidural, and Caudal Anesthesia Neuraxial anesthesia can be used alone, in combination with general anesthesia, or for post-op pain control. It is also useful in the management of chronic pain. Advantages of these techniques — a potential reduction in post-operative morbidity, (and maybe mortality) Decreased incidence of venous thrombosis or pulmonary embolism Fewer cardiac complications in high risk patients by alleviating the stress response Less bleeding and fewer transfusion requirements Decreased incidence of vascular graft occlusion Decreased incidence of pneumonia and respiratory depression after upper abdominal and thoracic surgery in patients with COPD Possibly earlier return of GI function In OB, neuraxial anesthesia allows the mother to stay awake for labor, vaginal delivery, or cesarean section, and is associated with less morbidity and mortality in cesarean sections than general anesthesia. Proposed mechanisms to achieve these benefits: Amelioration of the hyper-coagulable state associated with surgery Sympathectomy-induced increases in tissue blood flow Improved oxygenation from decreased splinting Enhanced peristalsis Suppression of the neuro-endocrine stress response to surgery Anatomy Spinal canal contains the spinal cord enclosed in the dura mater and bathed in CSF The epidural space: Is bounded anteriorly by the posterior longitudinal ligament, laterally by the vertebral pedicles, and posteriorly by the ligamentum flavum. Communicates with the paravertebral space by way of the intervertebral foramina. The spinal cord extends from the foramen magnum to L1 in adults, L3 in children. Anterior (motor) and posterior (sensory) nerve roots from the spinal cord join and exit the spinal canal through the intervertebral foramena to form spinal nerves. The lower nerve roots form the cauda equina The dural sac extends to S1. Blood supply to the spinal cord: anterior two-thirds by the unpaired anterior spinal artery from the