spinal for abdominal surgery

[deleted59964]

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i don’t do many abdominal surgeries under spinal ... just obstetrics really. does anyone do this much? how high an incision will you do a spinal for?

 

[Planktonmd]

I have done abdominal surgery under epidural anesthesia a few times in certain patients where GA was problematic and that allows the flexibility to increase your level as needed.

 

[deleted59964]

I have done abdominal surgery under epidural anesthesia a few times in certain patients where GA was problematic and that allows the flexibility to increase your level as needed.

thanks ...

did you see much hemodynamic change from the level of the block?

what about respiratory compromise (the point i guess if trying to avoid a GA) once you lose the abdominal and some intercostal muscles is the respiratory compromise an issue in those with little reserve?

i was thinking maybe use heavy bupivicaine in a spinal and position carefully to get the desired level ...

i guess i would normally do a careful GA and accept that the patient may need a slow wean from ventilation... is a spinal a viable alternative?

 

[Planktonmd]

Hypotension should be expected and treated when you are trying to do a high neuraxial anesthetic. There is nothing wrong with running a little phenylephrine infusion during the surgery.
Respiratory compromise could be an issue but less likely with an epidural dosed gradually to desired level.
If I am going to do a spinal for abdominal surgery I would do a CSE, use maybe 15 mg heavy Bupi and then augment the level and density of the block as needed using epidural Lidocaine 2%.

 

[deleted59964]

Hypotension should be expected and treated when you are trying to do a high neuraxial anesthetic. There is nothing wrong with running a little phenylephrine infusion during the surgery.
Respiratory compromise could be an issue but less likely with an epidural dosed gradually to desired level.
If I am going to do a spinal for abdominal surgery I would do a CSE, use maybe 15 mg heavy Bupi and then augment the level and density of the block as needed using epidural Lidocaine 2%.

thanks