Lesson 1Nerve injury prevention, recognition, and immediate/long-term management including neurological assessment and referral pathwayReviews mechanisms of neuraxial nerve injury, prevention through technique and positioning, structured neurological assessment, documentation, and pathways for urgent imaging, specialist referral, and long-term follow-up planning.
Mechanical and ischemic injury mechanismsPositioning and needle technique safeguardsImmediate neurological examination stepsDocumentation and patient communicationReferral pathways and long-term follow-upLesson 2Peri-procedural monitoring timeline: continuous monitoring during block placement and first 30–60 minutes post-injectionDefines a structured monitoring timeline before, during, and after spinal injection, specifying vital sign frequency, sedation and motor checks, documentation standards, and criteria for extended or higher-level monitoring.
Pre-block baseline assessment and consentMonitoring during needle placementFirst 30 minutes post-injection checksExtended monitoring for high-risk patientsDocumentation of trends and interventionsLesson 3Recognition and management of bradycardia and high spinal: early signs, atropine, vasopressors, airway management, and escalation triggersExplores early recognition of bradycardia and high spinal, including prodromal symptoms, monitoring strategies, drug choices, airway manoeuvres, and clear escalation thresholds to prevent progression to cardiovascular collapse or respiratory arrest.
Prodromal symptoms and early warning signsMonitoring parameters and alarm thresholdsAtropine dosing and indicationsVasopressor selection and titrationAirway support and escalation triggersLesson 4Infection control and management of suspected neuraxial infection: signs, cultures, imaging, and antibiotic strategiesFocuses on aseptic technique, risk factors, and early signs of neuraxial infection, outlining diagnostic workup with cultures and imaging, antibiotic selection, and indications for neurosurgical consultation or drainage.
Aseptic technique and environmental controlsEarly clinical signs of neuraxial infectionLaboratory tests and culture strategiesRole of MRI and other imaging modalitiesEmpiric and targeted antibiotic regimensLesson 5Management of high or total spinal: stepwise resuscitation, respiratory support, transfer criteria, and documentationCovers structured resuscitation for high or total spinal, focusing on airway control, ventilation, haemodynamic support, team roles, transfer to higher care, and meticulous documentation for clinical, legal, and quality purposes.
Recognition of total spinal anesthesiaAirway control and ventilation strategyHemodynamic resuscitation sequenceTeam communication and role allocationTransfer criteria and documentation pointsLesson 6Prevention and immediate treatment of hypotension: fluid management, phenylephrine vs ephedrine dosing and indicationsDetails mechanisms and risk factors for hypotension after spinal anaesthesia, emphasising fluid strategies, vasopressor selection, phenylephrine versus ephedrine dosing, and tailored treatment algorithms for different patient populations.
Risk factors and pathophysiology of hypotensionPreload optimization and fluid choicesPhenylephrine dosing and titrationEphedrine dosing and clinical indicationsAlgorithmic treatment in special populationsLesson 7Approach to failed, partial, or patchy block: differential diagnosis, rescue options (supplemental sedation, top-up spinal, conversion to GA, peripheral block), and timingAddresses evaluation of failed, partial, or patchy block, including differential diagnosis, troubleshooting, safe timing for repeat spinal, options for conversion to general anaesthesia or peripheral blocks, and documentation of decisions.
Systematic assessment of block adequacyTechnical versus pharmacologic failureCriteria for repeat or top-up spinalConversion to general anesthesia optionsUse of peripheral nerve blocks as rescueLesson 8Post-dural puncture headache: prevention with needle choice/technique, conservative measures, and indications for epidural blood patchCovers risk factors and mechanisms of post-dural puncture headache, preventive needle and technique choices, conservative management, criteria and timing for epidural blood patch, and counselling on prognosis and follow-up.
Risk factors and pathophysiology of PDPHNeedle type and insertion technique choicesConservative treatment and patient adviceIndications and timing for blood patchFollow-up, red flags, and re-evaluationLesson 9Medication safety and adverse events reporting: local anaesthetic systemic toxicity recognition and lipid emulsion protocolExplains medication safety principles in spinal anaesthesia, recognition of local anaesthetic systemic toxicity, immediate management steps, lipid emulsion dosing protocol, and institutional reporting of adverse drug events.
Drug selection, labeling, and double-checksEarly neurologic and cardiac signs of LASTImmediate non-lipid supportive measuresLipid emulsion dosing and infusion stepsAdverse event reporting and debriefing
