Continuous spinal anesthesia: what's new?

-Continuous spinal anaesthesia combines the advantages of single-dose spinal anaesthesia, rapid onset and a high degree of success, with those of a continuous technique.

-The introduction of micro-catheters invigorated interest in the technique and allowed its expansion to additional populations and surgical procedures. However, multiple cases of cauda equina syndrome associated with micro-catheters and (primarily) hyperbaric lidocaine solution led to withdrawal of micro-catheters from the US market.

-In 1992, FDA banned the use of spinal catheters thinner than 24G after 12 cases of cauda equina.

20G cathters are recommended in geriatric patients.

-Continuous spinal anesthesia provides adequate level and duration of anesthesia in elderly and high risk patients undergoing lower abdominal and lower limb surgery

-Indications: postoperative analgesia, chronic pain relief, previous spinal surgery, procedures of unpredictable length, significant cardiac disease, morbid obesity, difficult epidural catheter placement, difficult airway.

-Plain bupivacaine 0.5% is a safe local anesthetic during continuous spinal anesthesia.

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In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

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