ILA Dan Saddle Block
-
Upload
armandorahadian -
Category
Documents
-
view
239 -
download
1
description
Transcript of ILA Dan Saddle Block
![Page 1: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/1.jpg)
Anestesi Spinal :ILA and Saddle Block
LUSI JELITA SARI
FK TRISAKTI
03011171
![Page 2: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/2.jpg)
ANATOMY OF SPINAL CORD
33 Vertebrae◦7 Cervical◦12 Thoracic◦5 Lumbar◦5 Sacral◦4 Coccygeal
![Page 3: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/3.jpg)
ANATOMY OF SPINAL CORD• Spinal Cord
– Adult• Begins: Foramen Magnum• Ends: L1
– Newborn• Begins: Foramen Magnum• Ends: L3
– Terminal End: Conus Medullaris– Filum Terminale: Anchors in sacral region– Cauda Equina: Nerve group of lower dural sac
![Page 4: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/4.jpg)
Saggital Sections
![Page 5: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/5.jpg)
Spinal MeningesDura Mater
◦Outer most layer◦ Fibrous
Arachnoid◦Middle layer◦Non-vascular
Pia◦ Inner most layer◦Highly vascular
Sub Arachnoid Space◦ Lies between the arachnoid
and pia
![Page 6: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/6.jpg)
Physiology Of Childbirth
Stage I
Stage II
Stage III
Stage IV
![Page 7: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/7.jpg)
Sources of Pain During Labour
![Page 8: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/8.jpg)
DEFINITION
![Page 9: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/9.jpg)
Indication of Spinal Anesthesia
• Lower extremity surgery
• Pelvic surgery
• Obstretrical surgery
• Rectum and perineum
• Urology surgery
• Lower abdominal surgery
![Page 10: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/10.jpg)
Contraindications of Spinal Anasthesia
Absolute• Patient refused • Infection at the injection site• Coagulopathy• Severe hypovolemia• Increased intracranial pressure• Inexperience / unaccompained
consultanst• Severe hypotention
relative
• Sepsis• Uncooperative pasient• Neurological disorder• Severe spinal deformity
![Page 11: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/11.jpg)
Complications
• Hypotention
• Bradycardia
• Vomiting, nausea
• High spinal
![Page 12: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/12.jpg)
– Spinal head ache• More common in women ages 13-40• Larger needle size increase severity• Onset typically occurs first or second day post-op• Treatment:
– Bed rest– Fluids– Caffeine– Blood patch
![Page 13: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/13.jpg)
Spinal Technique
• Preload with 500- 1000ml crystalloid• Premedicate Preparation & Monitoring
◦EKG◦NBP◦Pulse Oximeter
Patient Positioning◦ Lateral decubitous◦Sitting◦Prone (hypobaric technique)
• Mark the location of injection• sterilize
![Page 14: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/14.jpg)
![Page 15: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/15.jpg)
Drugs in Spinal Anesthesia
• hyperbaric
-Lidokaine 5% in dextrose 7.5%,
dose :20-50mg(1-2ml).
-Bupivakaine 0.5% in dextrose 8.25% ,
dose : 5-15mg(1-3ml).• Isobaric
-Bupivakaine 0.5% in water, dose : 5-20mg.
![Page 16: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/16.jpg)
![Page 17: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/17.jpg)
ILA (Intrathecal Labour Analgesia)
• Requirement
- Patient demand
- Informed consent
![Page 18: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/18.jpg)
Drugs In ILA
• Fentanil
• Klonidin
• Buvipacain o,5% heavy
![Page 19: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/19.jpg)
Indication of ILA
mother
• Labor pain• Long first stage of labor• Anxietas• Patient demand• Pregnancy with
abnormalities of the cardiovascular system
baby
• premature
![Page 20: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/20.jpg)
Contraindications of ILA
• Patient refused
• Local infection
• Bleeding disorder
• Allergy
• Post SC
![Page 21: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/21.jpg)
Saddle Block
• Indication of saddle block
- Perineum
- Buttocks
- Inner thighs
![Page 22: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/22.jpg)
Saddle Block Technique
![Page 23: ILA Dan Saddle Block](https://reader035.fdocuments.net/reader035/viewer/2022081419/5695d0511a28ab9b0291f816/html5/thumbnails/23.jpg)
THANK YOU