Spinal anaesthesia

Backflow of cerebrospinal fluid through a 25 gauge spinal needle after puncture of the arachnoid mater during initiation of spinal anaesthesia
Schematic drawing showing the principles of spinal anaesthesia.

Form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm long.

- Spinal anaesthesia

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Caesarean section

Surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mother at risk.

A team of 4 performing a caesarean section
A 7-week-old caesarean section scar and linea nigra visible on a 31-year-old mother: Longitudinal incisions are still sometimes used.
Transvaginal ultrasonography of a uterus years after a caesarean section, showing the characteristic scar formation in its anterior part
Suturing of the uterus after extraction
Closed incision for low transverse abdominal incision after stapling has been completed
Removal of the baby
Illustration depicting caesarean section
A baby being removed from its dying mother's womb
A caesarean section performed by indigenous healers in Kahura, Uganda. As observed by medical missionary Robert William Felkin in 1879.
Saint Caesarius of Terracina, invoked for the success of caesarean delivery
Fictional 15th-century depiction of the birth of Julius Caesar

It may be done with a spinal block, where the woman is awake, or under general anesthesia.

Intrathecal administration

Diagrammatic representation of a section across the top of the skull, showing the membranes of the brain, etc. ("Subarachnoid cavity" visible at left.)

Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anesthesia, chemotherapy, or pain management applications.

Hypotension

Low blood pressure.

Many anesthetic agents and techniques, including spinal anesthesia and most inhalational agents, produce significant vasodilation.

Fentanyl

Powerful opioid used as a pain medication and, together with other medications, for anesthesia.

A fentanyl nasal spray with a strength of 100 μg per use
A fentanyl transdermal patch with a release rate of 12 micrograms per hour, on a person's arm
US yearly overdose deaths, and some of the drugs involved. Among the more than 70,200 deaths estimated in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (other ) with over 28,400 overdose deaths.
US yearly deaths involving other, predominantly fentanyl.
A package of 30 tablets, 600 mcg of fentanyl, each
Fentanyl powder (23% fentanyl) seized by a sheriff

Fentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural anaesthesia and analgesia.

Surgery

Medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas.

Surgery underway at the Red Cross Hospital in Tampere, Finland during the 1918 Finnish Civil War.
Plates vi & vii of the Edwin Smith Papyrus, an Egyptian surgical treatise
Sushruta, the author of Sushruta Samhita, one of the oldest texts on surgery
Hippocrates stated in the oath (c. 400 BC) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists
Ambroise Paré (c. 1510–1590), father of modern military surgery.
12th century medieval eye surgery in Italy
Joseph Lister, pioneer of antiseptic surgery
Hieronymus Fabricius, Operationes chirurgicae, 1685
John Syng Dorsey wrote the first American textbook on surgery
An operation in 1753, painted by Gaspare Traversi.

Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable.

Cocaine

Tropane alkaloid and stimulant drug obtained primarily from the leaves of two coca species native to South America, Erythroxylum coca and Erythroxylum novogranatense.

Cocaine hydrochloride
Lines of cocaine prepared for snorting
A 2010 study ranking various illegal and legal drugs based on statements by drug-harm experts. Crack cocaine and cocaine was found to be the third and fifth overall most dangerous drugs respectively.
Side effects of chronic cocaine use
A pile of cocaine hydrochloride
A piece of compressed cocaine powder
A woman smoking crack cocaine
"Rocks" of crack cocaine
Biological source of cocaine molecule in the context of the tropane class of molecules. The biological source of each tropane alkaloid is indicated by species, and below that a phylogenetic map is provided.
Biosynthesis of N-methyl-pyrrolinium cation
Biosynthesis of cocaine
Robinson biosynthesis of tropane
Reduction of tropinone
Coca leaf in Bolivia
"Cocaine toothache drops", 1885 advertisement of cocaine for dental pain in children
Advertisement in the January 1896 issue of McClure's Magazine for Burnett's Cocaine "for the hair".
Pope Leo XIII purportedly carried a hip flask of the coca-treated Vin Mariani with him, and awarded a Vatican gold medal to Angelo Mariani.
In this 1904 advice column from the Tacoma Times, "Madame Falloppe" recommended that cold sores be treated with a solution of borax, cocaine, and morphine.
Women purchase cocaine capsules in Berlin, 1929
D.C. Mayor Marion Barry captured on a surveillance camera smoking crack cocaine during a sting operation by the FBI and D.C. Police.
Drug overdoses killed more than 70,200 Americans in 2017, with cocaine overdoses making up 13,942 of those deaths.
United States CBP police inspect a seized shipment of cocaine
The U.S. Coast Guard in Miami offloading confiscated cocaine
Cocaine smuggled in a charango, 2008
Cocaine adulterated with fruit flavoring
Opioid involvement in cocaine overdose deaths. The green line is cocaine and any opioid (top line in 2017). The gray line is cocaine without any opioids (bottom line in 2017). The yellow line is cocaine and other (middle line in 2017).<ref name=NIDA-deaths>{{cite web | url = https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates | title = Overdose Death Rates | archive-url = https://web.archive.org/web/20151128091723/https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates| archive-date=28 November 2015 | work =  By National Institute on Drug Abuse (NIDA) }}</ref>
Delphic analysis regarding 20 popular recreational drugs based on expert opinion. Cocaine was ranked the 2nd in dependence and physical harm and 3rd in social harm.<ref name="Lancet">{{cite journal|vauthors = Nutt D, King LA, Saulsbury W, Blakemore C|title = Development of a rational scale to assess the harm of drugs of potential misuse|journal = Lancet|volume = 369|issue = 9566|pages = 1047–53|date = March 2007|pmid = 17382831|doi = 10.1016/S0140-6736(07)60464-4|s2cid = 5903121|author-link4 = Colin Blakemore|author-link1 = David Nutt }}</ref>

1898 saw Heinrich Quincke use cocaine for spinal anesthesia.

Post-dural-puncture headache

Complication of puncture of the dura mater (one of the membranes around the brain and spinal cord).

Meninges of the CNS

PDPH is a common side effect of lumbar puncture and spinal anesthesia.

August Bier

German surgeon.

August Bier
Cerebrospinal fluid flowing through a 25 gauge spinal needle during spinal anesthesia
Intravenous regional anesthesia

He was the first to perform spinal anesthesia and intravenous regional anesthesia.

James Leonard Corning

American neurologist, mainly known for his early experiments on neuraxial blockade in New York City.

James Leonard Corning, American neurologist

On August 16, 1898, German surgeon August Bier (1861–1949) performed surgery under spinal anesthesia in Kiel.

Local anesthetic

Medication that causes absence of pain sensation.

Many local anesthetics fall into two general chemical classes, amino esters (top) and amino amides (bottom)
This LA system is designed to prevent needlestick injury. A cartridge of LA fits into the disposable needle, which can be locked when not in use and can be separated from the handle.
Procaine
Lidocaine
Tetrodotoxin

Spinal anesthesia (subarachnoid block)