Continuous Spinal Anesthesia in the Poor Risk and Aged Surgical Patient

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ANESTHESIA in the poor risk and the aged surgical patient has always been of prime interest to both the surgeon and the anesthesiologist. An anesthetic method must be selected which not only gives adequate relaxation and analgesia, but which is compatible with the patient's debilitated condition.

Anesthesia in the poor risk patient requires (1) the least possible dosage of a relatively nontoxic anesthetic agent; (2) minimal disturbance of an already unstable physiology,. and (3) adequate relaxation. Continuous spinal anesthesia utilizing the ureteral catheter technic1,2 satisfies these requirements. The indwelling spinal catheter permits small and repeated injections of the anesthetic agent; thereby the dosage can be adjusted individually to each of these extremely ill patients. To avoid the fall in blood pressure which follows widespread motor and vasomotor paralysis, the segmental type of continuous spinal anesthesia is used.3 During continuous spinal anesthesia, the patient is awake and cooperative except when supplementary agents are employed. The protective reflexes therefore are not attenuated. The relaxation is maximal, an item of particular interest to the surgeon.

Saklad.3 The patient is placed in the lateral recumbent position; the skin of the back is prepared with a satisfactory antiseptic solution. A syringe containing 2 cc. of a solution of procaine (1 per cent) and ephedrine (50 mg.) is used to raise a cutaneous wheal at the intended site of puncture (L-3 or 4). The remainder of this solution is injected laterally into the muscles of the back. A 3½ inch 16 gauge Tuohy needle is inserted. . .



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