Thoracic Spinal Anesthesia

Abstract

In 1909 Thomas Jonnesco published his interesting paper under the title General spinal anesthesia through an approach of the subarachnoid space at a thoracic level, providing condition for surgery on the skull, head, neck and thorax. Etherington-Wilson proposed explaining the various possibilities for the spinal anesthesia. Leonardo da Vinci was considered the discoverer of Human and animal Anatomy. Image techniques have opened a gret new field for the study of anatomy in the living man. The modern means of image, associated to computed means have facilitated the evaluation of the CSF volume, through antero-posterior and height measures of the subarachnoid space based on bi-dimentional studies of MRI. The studies of the thoracic column with MRI show that exist a space between the dura-mater and the spinal cord (medula). Thoracic ouncture performed with needles proved safe and without neurological injury. Thoracic spinal anesthesia is a viable procedure, with a low incidence of hypotension and did not present any neurologic problem.

Effectiveness of Segmental Thoracic Spinal Anaesthesia in Breast Surgery: An Observational Study

“…They found a greater space at the mid-thoracic level than the lumbar region, sufficient enough for intrathecal drugs 13 . Imbelloni et al investigated on magnetic resonance imaging of the thoracic spine and concluded that the maximum distance between the dura mater and the spinal cord is usually at the level of T5-T6 intervertebral space 12 . In this study, T5-T6 space was chosen because it has a maximum distance of 7.75 mm in comparison to other spaces.…”

“…However, there is significant debate regarding this practice around the world. The main concerns are fear of iatrogenic injury to the spinal cord, cephalad spread of local anaesthetic causing a complete block, and haemodynamic instability owing to blockade of cardio accelerator sympathetic fibres 12 .…”

“…Furthermore, the anesthetic dose requirement during the procedure is lower, which minimally affects cardiovascular stability 14 . This technique can be valuable for providing greater hemodynamic stability, better analgesia, with higher patient satisfaction, lesser incidence of nausea, vomiting and reduced postanaesthesia care stay [3][4][5]12 . This study was planned to evaluate the effectiveness of segmental thoracic spinal anaesthesia in different breast surgeries.…”