COMPLICATIONS OF SPINAL ANESTHESIA FOR SCHEDULED SURGERY EXPERIENCE OF THE MILITARY HOSPITAL MOULAY ISMAIL MEKNES

Spinal anesthesia is a widely practiced technique in anesthesia, it has advantages compared to general anesthesia. It requires little equipment and anesthetic drugs and is therefore inexpensive. Spinal anesthesia, like any medical act, is associated with certain accidents, and its complications, although rare, are becoming more and more a concern for anesthesia specialists. Our work focuses on the practice of spinal anesthesia in the operating room of the Moulay Ismail Military Hospital of Meknes (HMMIM) and especially on the morbidity and mortality due to this type of anesthesia. In addition, the objectives of our work are: - To report the incidence of this anesthetic practice. - To study the incidents and or intraoperative complications of spinal anesthesia (Morbi-mortality). - To compare our results with the data in the literature. The 5010 patients who underwent scheduled surgery under spinal anesthesia with an age ranging from 14 to 70 with a predominance of male 3557 cases or 71% against 1451 female cases or 29% (sex ratio 2.45). In our study series 38.90% had arterial hypertension in their history, 32.4% were diabetic, 13.20% had liver disease, 7.3% had renal failure, 5.5% had thromboembolic disease, 1.75% had psychiatric disorders, 1.40% were followed in oncology. 3206 cases were classified ASA I or 64%, 1102 cases ASA II or 22% and 701 cases ASA III or 14%. The puncture was performed in the sitting position in 3714 cases (74.14%) and in the lateral decubitus position in 1296 cases (25.85%). In our series 468 patients presented intraoperative complications including arterial hypotension, bradycardia, nausea and vomiting, failure and conversion to general anesthesia, impossible approach and cardio respiratory arrest. While the complications and risks are extremely rare, given their seriousness, prevention requires mastery of the technique, respect for simple safety measures, knowledge of the pharmacology of the products used, detection of prodromal signs announcing serious complications and rapid management of these manifestations. Rigor in the choice of the technique according to the clinic but also to the terrain must be the rule.