Spinal Anesthesia

Spinal anesthesia is administered through injection to anaesthetize or numb the lower part of the body before performing surgery on the patient. Spinal anesthesia is a type of regional anesthesia and will block the pain below the site of the injection. This kind of anesthesia is injected into the spine of the lower back through a long needle. The medicine is directly administered into the fluids surrounding the spine. This is normally given between L3 - L4. Unlike general anesthesia, here the patient is awake and conscious during the procedure.

Surgeries performed under spinal anesthesia

Spinal anesthesia suits simple surgical procedures involving short duration. It is a single shot and hence medicine is given only once and no catheter is placed for further medication. Once the medicine is administered, spinal anesthesia starts working instantly. As soon as the shot is given, patient will begin to experience a hot feeling in the lower part of the body and subsequently the area becomes numb. Spinal anesthesia is appropriate for the surgeries performed below the umbilicus like:

• Vaginal repair or vaginal hysterectomies
  
• Hernia operation
  
• Piles
  
• Varicose veins
  
• Orthopaedic surgeries on the legs, pelvis
  
• Prostate removal
  
• Operation on genitals
  
• Surgery for trauma on lower limbs
  

Spinal anesthesia procedure

Firstly, patient will be positioned appropriately. The patient will be made to sit on the edge of the operating table keeping the stool under the legs for support or the patient will be made to lie down on one side, knees tucked up to the chest. Once positioned, the lower back will be cleaned with antiseptic lotion. Small dose of local anesthesia will be given at the site where the spinal will be administered so that patient does not feel the piercing pain. The anesthetist administers the spinal injection and will remain in the operation theatre throughout to check the progress and the effect of anesthesia.

Spinal anesthesia complications

Spinal anesthesia is less risky when compared to general anesthesia. Patient can return to normalcy in no time and also there are less chances of developing chest and lung infections and other respiratory disorders. However, spinal anesthesia may give rise to few side effects like:

• Headache
  
• Itching on the body
  
• Low blood pressure
  

These conditions are quite manageable and treatable and will wane off within few hours after the procedure. Neurological injury is an extremely rare complication that may be caused by spinal anaesthesia.

Ureteroscopy

Ureteroscopy is a common urological procedure administered in patients having urinary tract and bladder related disorders. Ureteroscopy is recommended for patients having kidney stones. The movement of the renal stones is monitored by urologists. Ureteroscopy is a minimal invasive endoscopic procedure predominantly involving the urethra, upper urinary tract and the urinary bladder.

Ureteroscopy Procedure

A flexible or rigid form of telescope is passed through the urethra in order to view the affected region. The procedure is performed under general or spinal anesthesia. The telescopic examination of the ureter and associated organs reveals the exact location of the stone and also other disorders of the system. Other diagnostic tests such as X-rays, CT scan, EKG along with laboratory parameters like urinalysis and complete blood count also help in the effective determination of the underlying condition. This technique is usually followed by the other associated procedures such as lithotripsy in which laser beams are administered to the affected region to dissolve the calculi(stone) or to clear urinary tract strictures. The entire procedure may last from 30 minutes to three hours and patients are advised to stay in the hospital for a day.

The urologist uses the uterescope to remove small kidney stones while larger stones need to be broken up before removal. A kidney stone that has escaped from the kidney and got stuck in the ureter can be pushed back into the kidney. Here it has to be broken into smaller pieces to aid removal. A stent is usually left in place to allow the kidneys to pass the urine to the bladder. This is kept for a few days in case there is swelling and subsequent difficulty in draining the kidney of the urine.

Complications and risk factors

Hematuria happens because of the insertion of the ureteroscope. It usually subsides within 3 days. Antimicrobial therapy is given if hematuria is followed by an infection. Other possible complications are:

Stent associated pain
Perforations caused because of stents
Abdominal pain
Lower back pain
Urethral stricture or perforation

Anesthesia

Anesthesia is a procedure that is administered to control pain, heart rate, blood pressure and other vital parameters during a surgical procedure. It is temporary state which allows the patient to recover and gain control of his coordination a few hours after a surgical procedure.

Anesthesia is an exact procedure which requires theoretical and practical expertise. Any kind of dosage variation can be fatal to the patient. During general anesthesia, patients are advised to abstain from eating and drinking 12 hours before the procedure as it may lead to aspiration associated complications during the procedure. Thorough examination of the patient history is done to evaluate for drug sensitivity and allergic patterns with respect to the type of anesthesia administered. Anesthetics such as inhalants or IV forms are given depending upon the type of surgical procedure.

General anesthesia

General anesthesia is administered during complicated procedures such as cardio thoracic surgery, oncogenic or organ specific surgery. In this procedure, the patient goes into a stage of total unconsciousness with administration of anesthetic gases and intravenous anesthetics such as halothane, Sevoflurane, Enflurane, Desflurane, Isoflurane, Propofol, etomidate and thiopental. Some anesthetics such as Propofol are hypnotic in nature. It has been widely used because of its nature to bring back the patient to conscious state a few hours after the surgical procedure. In addition to the inhalant and intravenous forms of anesthesia which are administered, neuromuscular blockage is also required as it helps in respiratory ventilation along with intubation. Most of these neuromuscular blockade agents are derived from curare compounds which is a skeletal muscle relaxant.

Local anesthesia

Local anesthetics are either administered as a combination with general anesthetics are as a post-operative anesthetic agent. Most of the local anesthetics are amides and esters. Some of the local anesthetic amides include lidocaine, prilocaine, ropivacaine and etidocaine. The ester forms of these anesthetics include tetracaine, procaine, cocaine and benzocaine. Local anesthetic drugs are given directly in the region where the surgical procedure has to take place. Most dental procedures involve the administration of local anesthetics. The patient is conscious and experiences numbness only in the region where the procedure is being done.

Regional anesthesia

This form of anesthesia is given to block pain in a larger area of the body where the procedure is done. Patient is sedated in most cases. Regional anesthetic drugs usually work on the principle of nerve block caused in the peripheral region. This includes a procedure called spinal anesthesia where the drug is administered in a specific area of the spine to numb the corresponding region of the body. Regional anesthesia is administered at a specific location to numb the region for surgical intervention. Local anesthetics are administered either in the topical or injectable form to desensitize the area of surgical intervention.

Risk factors of anesthesia

Malignant hyperthermia is one of the rare yet life threatening complications of anesthesia. This adverse reaction is caused when succinyl choline (muscle relaxant) is administered. In this reaction, the muscle fibers of the body tend to dissociate from each other. Spinal and epidural anesthetic procedures have headaches as side effects due to the leakage of cerebrospinal fluid from region of injection. Nausea, vomiting and nerve damages are some of the predominant side effects of anesthetic procedures. These are controlled by administration of IV medications. In some patients, the insertion of endotracheal tube during procedures such as bronchoscopy may lead to sore throat for a few days. Apart from all the presumptive risk factors and side effects of anesthetic drugs, some have toxic effects on liver and kidneys. In such conditions, patients are examined for tolerance and toxicity before administering anesthetic gases such as halothane.