We asked the NYSORA YouTube Community for their professional opinion regarding two situations relating to spinal anesthesia patient groups, namely (i) the patient with scoliosis and (ii) the patient with aortic stenosis. The results are in.
SITUATION (i) Spinal Anesthesia in Patients with Scoliosis
Scoliosis is often seen in elderly patients presenting for total knee or total hip replacement under spinal anesthesia, and this can make it challenging to estimate the midline and interspaces. Although ultrasound can be used to determine the midline, and the best insertion site for the needle, ultrasound-assisted spinal anesthesia requires a substantial degree of skill.
In a recent poll, we asked our YouTube community members to select the paramedial technique of choice in patients with scoliosis. Respondents were asked to choose from four options, of which 2 were above and below the L-4,L-5 level approaching the spinal anesthesia insertion from the concave side of scoliosis,
and the other 2 options were above or below L4-L5%, with insertion of the spinal needle in a paramedial technique from the convex side of scoliosis.
Here are the responses of our community members:
Which do you think is the best option?
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SITUATION (ii) Spinal Anesthesia and Aortic Stenosis
Although traditional teaching maintains that spinal anesthesia in patients with aortic stenosis is contraindicated, that is because patients with long-standing aortic stenosis have a hypertrophic left ventricle that is highly dependent on diastolic pressure in order to feed the hypertrophic myocardium through the coronary arteries.
Spinal anesthesia can also result in a sympathetic nervous system block that could, potentially, cause precipitous hypotension and myocardial ischemia in patients with aortic stenosis. However, general anesthetics also cause hypotension; as is the case with most induction agents and inhalational anesthetics.,
So which of the two anesthetic techniques is safer for patients with aortic stenosis?
We pitched the question in a poll to our Youtube Community, and here are the results.
70% of the Community on NYSORA’s channel felt that spinal anesthesia in patients with moderate to severe aortic stenosis is contraindicated, whereas 21% felt that it was not contraindicated, and 9% of the respondents to the poll reported that they were not sure.
The comments posted by our NYSORA Youtube channel community reveal that, rather than an actual contraindication, as it is often described in traditional anesthesiology textbooks, aortic stenosis is, perhaps, a relative contraindication, with a number of colleagues reporting a preference for spinal anesthesia in patients with aortic stenosis.
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