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An analysis of complications registered after 15382 epidural anesthesias and 20035 combined general anesthesias with artificial ventilations of lungs under conditions of a city multitype hospital was made. General amount of complications during epidural anesthesia was 4.43%, during endotracheal narcosis--5.01%.
Spinal anesthesia recently has gained popularity for elective cesarean section. Our anesthesia service changed from epidural to spinal anesthesia for elective cesarean section in 1991. To evaluate the significance of this change in terms of time management, costs, charges, and complication rates, we retrospectively reviewed the charts of patients who had received epidural (n = 47) or spinal (n = 47) anesthesia for nonemergent cesarean section. Patients who received epidural anesthesia had significantly longer total operating room (OR) times than those who received spinal anesthesia (101 +/- 20 vs 83 +/- 16 min, [mean +/- SD] P < 0.001); this was caused by longer times spent in the OR until surgical incision (46 +/- 11 vs 29 +/- 6 min, P < 0.001). Length of time spent in the postanesthesia recovery unit was similar in both groups. Supplemental intraoperative intravenous (i.v.) analgesics and anxiolytics were required more often in the epidural group (38%) than in the spinal group (17%) (P < 0.05). Complications were noted in six patients with epidural anesthesia and none with spinal anesthesia (P < 0.05). Average per-patient charges were more for the epidural group than for the spinal group. Although direct cost differences between the groups were negligible, there were more substantial indirect costs differences. We conclude that spinal block may provide better and more cost effective anesthesia for uncomplicated, elective cesarean sections.
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Interscalene brachial plexus anesthesia is often used for surgeries involving the shoulder and upper arm. This method of regional anesthesia decreases pain, nausea, and vomiting associated with general anesthesia. One infrequent complication of interscalene brachial plexus block is tension pneumothorax. Recognition of early signs and symptoms of tension pneumothorax and expeditious treatment for rapid decompression before physiologic decompensation is mandatory. This article discusses the interscalene brachial plexus block procedure leading to the pathogenesis, clinical presentation, diagnosis, and treatment of tension pneumothorax.
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BACKGROUND: Obstetrical anesthesia services may be provided by Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, or a combination of the two providers. Research is needed to assist hospitals and anesthesia groups in making cost-effective staffing choices. OBJECTIVES: To identify differences in the rates of anesthetic complications in hospitals whose obstetrical anesthesia is provided solely by CRNAs compared to hospitals with only anesthesiologists. METHODS: Washington State hospital discharge data were obtained from 1993 to 2004 for all cesarean sections, and were merged with a survey of hospital obstetrical anesthesia staffing. Anesthetic complications were identified via International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Resulting rates were risk-adjusted using regression analysis. RESULTS: Hospitals with CRNA-only staffing had a lower rate of anesthetic complications than those with anesthesiologist staffing (0.58% vs. 0.76%, p=.0006). However, after regression analysis, this difference was not significant (odds ratio for CRNA vs. anesthesiologist complications: 1.046 to 1, 95% confidence interval 0.649-1.658, p=.85). DISCUSSION: There is no difference in rates of complications between the two types of staffing models. As a result, hospitals and anesthesiology groups may safely examine other variables, such as provider availability and costs, when staffing for obstetrical anesthesia. Further study is needed to validate the use of ICD-9-CM codes for anesthesia complications as an indicator of quality.
Postoperative complications due to anesthetic technique were assessed in 1220 patients undergoing abdominal, neurosurgical, breast, head and neck operations or other surgical procedures. All patients were interviewed directly for vomiting, sore throat, headache, suxamethonium myalgias, ocular, vascular, nerve complications and awareness, 24 and 48 hours postoperatively. The incidence of vomiting was significantly higher in abdominal (27.2%) versus the extra-abdominal operations (16.2%), (p less than 0.005), overall incidence 17.6%. Spontaneous breathing was associated with lower incidence of vomiting (p less than 0.001), but a higher incidence of sore throat (p less than 0.001), headache (p less than 0.05) and suxamethonium muscle pains (p less than 0.001), versus controlled ventilation. The incidence of ocular complications was 4.7%, of local vascular complications 15.2%, of peripheral nerve problems 0.33% and of awareness 0.16%.
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Spinal anesthesia is a frequently used technique for surgery of the lower extremities. A complication of this form of regional anesthesia is post-lumbar puncture headache. Rapid diagnosis and treatment are essential in preventing prolonged disability and neurologic sequelae. Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.
Bacterial meningitis following spinal anaesthesia is a rare but serious complication. We describe a case in which an old woman received spinal anaesthesia for hip replacement. Diagnosing the aetiologic agent is a major medical challenge. The possible aetiological causes of this complication are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted.
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Analysis of the reasons responsible for complications of anesthesia in abdominal delivery has shown that such complications are most frequent before fetus extraction. They are: poorly corrected hypo- or hypertension and tachycardia; damages of major vessels, pleura and lungs upon central vein puncture; severe hypoxia in difficult or abortive intubations with mouth, larynx, pharynx, trachea and esophagus injuries; regurgitation and development of aspiration pneumonia (Mendelson syndrome); toxic and allergic reactions to psychopharmacological, narcotic and local anesthetic agents; signs of laryngobronchiolospasm; complications during suture of the uterus and abdominal cavity when main anesthesia is performed (hypotonic bleeding with the onset of ARDS, hemodynamic disturbances due to microembolism of the pulmonary artery branches upon active contractions of the uterus caused by uterotonics, side effects of myorelaxants); complications in the early postoperative period (prolonged apnea, the onset of acute cardiopulmonary and hepatic failure).
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Ocular regional anesthesia can be accomplished with either a peribulbar or retrobulbar approach. Each has advantages and disadvantages. Complications can be vision-threatening or life-threatening. Positioning the eye in neutral gaze when retrobulbar block is executed and using a needle no longer than 31 mm are effective strategies to reduce the incidence of serious complications.