الفهرس 
Historical perispectivesOnly 14 pages are availabe for public view
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Abstract
Neuraxial anesthesia have been shown to blunt the “stress response” to surgery, decrease intraoperative blood loss, lower the incidence of postoperative thromboembolic events, possibly decrease morbidity in high-risk surgical patients, and serve as a useful method to extend analgesia into the postoperative period.
Proficiency in neuraxial anesthesia requires
a through understanding of anatomy of the spine and cord especially: vertebrae, ligaments, meninges, epidural space and the spinal cord.
The principal site of action for neuraxial blockade is the nerve root. Local anesthetic is injected into CSF (spinal anesthesia) or the epidural space (epidural and caudal) and bathes the nerve root in the subarachnoid space or epidural space producing both somatic and autonomic blockade.
The physiologic effects of neuraxial blocks are often misinterpreted as complications, these physiologic effects include: cardiovascular, respiratory, gastrointestinal, renal, metabolic and endocrinal effects.
The pharmacology of local anesthesia is an integration of the physiology of excitable cells and the mechanism by which local anesthetics are capable of interrupting conduction of neural messages. The common characteristics of molecules with local anesthetic action have been identified and can explain the properties of agents. Local anesthetics can be classified into two main groups: Amide group and ester group.
Spinal, epidural and caudal anesthesia techniques should be performed only after appropriate monitors are applied in setting where equipment for air way management and resuscitation is immediately available. It is often helpful for the technique to be broken down into
a series steps: preparation, projection and puncture.
The complication of neuraxial anesthesia range from bothersome to crippling and life-threatening complication.
Broadly, the complication can be classified into:
• General complications:
1. Hypotension.
2. Urinary retention.
3. Intravascular injection.
4. Allergic reaction to local anesthetic.
5. Total spinal or massive epidural.
• Neurologic complications:
1. Nerve injury.
2. Headache.
3. Vascular injury.
4. Infection.
5. Local anesthesia toxicity.
6. Ischemic injury.