At present, the relevance of the so-called “one-day surgery” and outpatient surgery is increasing. As a result, the anesthesiologist is faced with the task of choosing the method of anesthesia that best meets the requirements of outpatient surgery. According to experts, the optimal method of anesthesia in the outpatient practice of a proctologist is spinal anesthesia – traditional and selective.
Spinal anesthesia is performed by injecting small doses of a local anesthetic into the cerebrospinal fluid. The introduction is made in the lumbar region below the level of the end of the spinal cord (L-2). Spinal anesthesia is easy to perform, provides the necessary conditions for performing surgery and a comfortable state for the patient.
BENEFITS OF SPINAL ANESTHESIA:
- Safety for the patient: minimizing the negative effects of anesthesia on organs and systems
- Respiratory system. Spinal anesthesia has minimal impact on the respiratory system. Less risk of airway obstruction and aspiration
- Endocrine system. The risk of undetected hypoglycemia in an awake patient is extremely low. Patients return to normal diet and insulin therapy immediately after surgery
- Hemostasis system. Possibility of early activation of the patient; reducing the risk of thromboembolic complications
- Gastrointestinal tract. Unlike general anesthesia, spinal anesthesia is characterized not only by the preservation, but also by the enhancement of gastrointestinal motility due to the activation of the parasympathetic nervous system. It is generally accepted that spinal anesthesia helps to reduce the incidence of postoperative intestinal paresis, and also reduces the need for narcotic analgesics
- The immune system. It is well known that general anesthesia serves as a powerful immunosuppressant due to the direct inhibition of lymphocyte function by general anesthetics, as well as due to the stress response. Unlike general anesthesia, regional anesthesia contributes to the preservation of cellular and humoral immunity; in addition, the presence of low concentrations of amide group anesthetics in the blood gives some anti-inflammatory effect. There is every reason to believe that regional methods of anesthesia help to reduce the incidence of purulent-septic complications in the postoperative period
- Improves organ blood flow, which promotes faster healing
- Satisfaction for the patient. Provides full pain relief during surgery and in the immediate postoperative period; the patient (optional) can be conscious; can drink and eat immediately after the operation as part of the diet associated with the operation itself
Indications:
- Operations below the navel
- Gynecological and urological operations
- Caesarean section
- Surgeries on the lower limbs
- Perineal surgery
Contraindications:
А) ABSOLUTE
- Patient refusal
- Coagulopathy, thrombocytopenia
- Clinically significant hypovolemia
- Pronounced signs of vagotonia
- AV block, sick sinus syndrome
- Puncture site skin infections, sepsis, meningitis
- Exacerbation of herpes infection
- Intracranial hypertension
- Allergic reactions to local anesthetics of the amide group
B) RELATIVE
- The urgency of the situation and the lack of time for patient preparation and manipulation
- Psycho-emotional lability of the patient or low level of intelligence in the latter
- Aortic stenosis, severe chronic heart failure
- A real opportunity to expand the volume and increase the intervention time
- Peripheral neuropathy
- CNS demyelinating diseases
- Mental illness
- Treatment with aspirin or other antiplatelet agents
- Significant spinal deformity
- Previous spinal injuries
SELECTIVE SPINAL ANESTHESIA
Selective spinal anesthesia is the most rational and safe method of anesthesia that meets all the requirements of modern outpatient proctology. The essence of selective spinal anesthesia is that selective blocking of the necessary spinal segments is carried out using small volumes of a hyperbaric solution of a local anesthetic. The introduction of an anesthetic in the sitting position provides anesthesia of the perineum without the development of hypotension and practically without disturbance of the movement of the lower extremities.
METHOD.
After standard local anesthesia, a spinal puncture is performed at the L3-L4 level with thin spinal needles (diameter G25, G26). A hyperbaric solution of local anesthetic is used at a dose of 6 mg, regardless of the patient’s body weight. The introduction is carried out in a sitting position, followed by the patient in a sitting position for 10 minutes. Adequate anesthesia is achieved, fully satisfying both the surgeon and the patient. Sedation is usually not carried out. Motor block – 0 points for P. Bromage. The duration of anesthesia until complete recovery is on average 90 – 120 minutes.
This type of anesthesia is the most effective and safest method of anesthesia for proctological operations in the conditions of “one-day surgery”.
LITERATURE:
- Shvets A. Spinal anesthesia Russian Society of Regional Anesthesia
- U.F. Casey (Gloucestershire, UK) Spinal Anesthesia – A Practical Guide
- A.I. Kozhan, Z.V. Zarudneva, L.A. Ivanchenko, V.V. Panasyuk. Selective spinal anesthesia during perineal surgery Proceedings of the 2nd congress of coloproctologists of Ukraine
