A review of the complications of spinal anaesthesia with experiences in Canadian teaching hospitals from 1959 to 1969

As WE ENTER A NEW DECADE it is interesting to think retrospectively and consider the changes we have witnessed. Anaesthesia is becoming a clinical science. We attempt to train our younger men to be selective in the methods best adapted to meet a wide variety of clinical situations. The modern practitioner is less prone to be influenced by habit, personal preferences and expediency. Progress of this type demands a continuing reappraisal of both methods and agents. Spinal anaesthesia is one of the older techniques in our armamentarium. Since first introduced some sixty years ago, the record has been turbulent at times. A massive bibliography is now available and it can be condensed into an interesting history. Many have contributed to improvements in safety and in decreasing the factors responsible for morbidity. Others have introduced alternative conduction methods in an attempt to avoid some of the complications of spinal anaesthesia. It is important to establish an objective appraisal as a result of current knowledge. Composite experience should enable us to decide whether or not spinal anaesthesia deserves a continuing and recognized place in the armamentarium of younger men being prepared for careers as anaesthetists. Historically, spinal anaesthesia was introduced by Bier in 1898. It was ten years later that Mr. Barker, ~ a British surgeon, presented a paper to the Section of Pharmacology and Therapeutics of the British Medical Association. This was the formn for all topics on anaesthesia at that time. He described the findings following performance of lumbar puncture on nine patients two days after the administration of intraspinal Stovaine. He reported the spinal fluid to be turbid due to pleoeytosis. These findings substantiated the clinical manifestations of meningeal irritation which were encountered. This was one of the first reports of what was probably a chemical irritation produced by a local anaesthetic agent injected intraspinally. The method continued to be used for another ten years before another and more dramatic hazard began to appear. Respiratory arrest resulting from total spinal anaesthesia began to be reported as the responsible factor in many anaesthetic deaths in the early 1920s. This is now a completely preventable complication, and if it does occur we can prevent serious sequelae by artificially supporting respiratory function. However, in those days the situation was different and in 1929 an article appeared by Sise, 2 who wrote as follows: "During the past year when spinal anaesthesia has enjoyed a great wave of popularity, there have