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Chapter: Clinical Cases in Anesthesia : Spinal Anesthesia

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.

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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Clinical Cases in Anesthesia : Spinal Anesthesia : What are the contraindications to spinal anesthesia? |


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