What are the contraindications to spinal anesthesia?
Patients with increased intracranial pressure
run a risk of brainstem herniation after dural puncture, as CSF pres-sure
within the vertebral column is released. Passage of the spinal needle through
areas of infected tissue may seed the subarachnoid space with microorganisms.
Septicemia has been questioned as a potential source of contamination of the
subarachnoid space. In 1992, Carp and Bailey noted that dural puncture in
bacteremic rats was associated with the development of meningitis. Antibiotic
treatment before dural puncture appeared to eliminate the risk of post-dural
puncture meningitis.
Inability to obtain consent for spinal
anesthesia from the patient is an absolute contraindication to the technique.
Patients with documented allergies to local anesthetics should not receive a
drug from the class of anesthetics to which they have reacted. Hypovolemia
increases the risk of hypotension following sympathectomy and should be
corrected before the initiation of spinal anesthesia. Clotting abnormalities
increase the risk of epidural or even subarachnoid hematoma formation, with
subsequent compression of neural structures. Pre-existing neurologic disease
had been considered a relatively strong contraindi-cation to spinal anesthesia
at one time. Experience with subarachnoid blocks in such patients has not
demonstrated exacerbation of peripheral neuropathies or low back pain.
Progressive neurologic abnormalities, such as multiple sclerosis and
amyotrophic lateral sclerosis, may present with increased symptomatology
following spinal anesthe-sia, but this probably represents the natural course
of the disease and not an adverse effect of the spinal anesthetic.
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