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[Complications of regional anesthesia (author's transl)].

In spite of the great advances in anesthesia, regional anesthesia has not lost its importance. The development of new, longer-acting local anesthetics has extended its indication still more. The causes of accidents lie mostly in ignorance ofthe pharmacology of local anesthetics and their adjuvants, in faulty technical performance of the nerve blockade and last but not least in inadequate knowledge of the therapy, of the side effects and complications. The various complications of regional anesthesia are reported on and the necessary therapy dealt with.

Adjuvants, Anesthesia↗

Complications of general anesthesia for Nd:YAG laser resection of endobronchial tumors.

We studied the incidence and mechanisms of cardiovascular complications and postoperative respiratory insufficiency associated with GA and Nd:YAG laser endobronchial tumor resection. The records of 73 patients undergoing 87 procedures were reviewed. Preoperative status, anesthetic methods and perioperative complications were analyzed by multiple regression to determine predictors of outcome. Twenty-three percent of patients had greater than 90 percent mainstem bronchus obstruction. Longer serum elimination half-life of relaxant drug was significantly correlated with longer duration of mechanical ventilation after neuromuscular blockade reversal. Cardiovascular complications were noted in 24 procedures and often required therapeutic intervention. Variables predicting cardiovascular complications included longer duration of GA and increasing age. Perioperative respiratory and cardiovascular complications are common after GA for Nd: YAG laser resection. Short-acting neuromuscular relaxants, careful assessment prior to postoperative extubation, limiting duration of GA and cardiovascular monitoring are recommended when implementing GA for Nd: YAG laser resection of endobronchial tumors.

Adenocarcinoma↗

[A complication of epidural anesthesia: cerebral pneumatocele. A case report].

Having had a case themselves the authors report a rare complication of epidural anaesthetic, namely pneumocephaly. When it occurs it is usually after a difficult puncture; and usually thought of if headaches are unusually severe of there is a picture of intracranial rise in pressure. Then a tomodensitometry will lead to the diagnosis. Literature shows that it can be a serious condition, sometimes fatal, which means that the case has to be followed up very carefully and tomodensitometry has to be repeated until complete cure has been obtained.

Adult↗

Neurologic complications after neuraxial anesthesia or analgesia in patients with preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy.

BACKGROUND: The risk of severe neurologic injury after neuraxial blockade is extremely rare among the general population. However, patients with preexisting neural compromise may be at increased risk of further neurologic sequelae after neuraxial anesthesia or analgesia. METHODS: We retrospectively investigated 567 patients with a preexisting peripheral sensorimotor neuropathy or diabetic polyneuropathy who subsequently underwent neuraxial anesthesia or analgesia. Patient demographics, neurologic history, the indication and type of neuraxial blockade, complications, and block outcome were collected for each patient. RESULTS: The majority of patients had chronically stable neurologic signs or symptoms at the time of block placement, with very few reporting progression of their symptoms within the last 6 mo. The type of neuraxial technique included spinal anesthesia in 325 (57%) patients, epidural anesthesia or analgesia in 214 (38%) patients, continuous spinal anesthesia in 24 (4%) patients, and a combined spinal-epidural technique in four (1%) patients. Overall, two (0.4%; 95% CI 0.1%-1.3%) patients experienced new or progressive postoperative neurologic deficits, in the setting of an uneventful neuraxial technique. In these patients, the neuraxial block may have contributed to the injury secondary to direct trauma or local anesthetic neurotoxicity around an already vulnerable nerve. Sixty-five (11.5%) technical complications occurred in 63 patients. The most common complication was unintentional elicitation of a paresthesia (7.6%), followed by traumatic (evidence of blood) needle placement (1.6%) and unplanned dural puncture (0.9%). There were no infectious or hematologic complications. CONCLUSIONS: The risk of severe postoperative neurologic dysfunction in patients with peripheral sensorimotor neuropathy or diabetic polyneuropathy undergoing neuraxial anesthesia or analgesia was found to be 0.4% (95% CI 0.1%-1.3%). Clinicians should be aware of this potentially high-risk subgroup of patients when developing and implementing a regional anesthetic care plan.

Aged↗

Localized complications from local anesthesia.

The inherent safety of local anesthetics allows practitioners to use them frequently with the confidence that adverse events are rare. Nevertheless, complications can occur. The aim of this article is to briefly review the localized adverse events that may result from local anesthetic administration. Descriptions of each complication will be followed by suggestions for prevention and management. In spite of a dentist's conscientious practice, many of these complications cannot always be prevented.

Anesthesia, Dental↗

Respiratory complications associated with anesthesia.

Adverse pulmonary outcomes that follow anesthesia and surgery are often attributed to anesthesia care. PPCs are a significant concern for anesthesia caregivers because they use drugs and techniques that temporarily decrease lung volume, impair airway reflexes, limit immune function, and depress secretion mobilization. A significant component of perioperative risk derives from the surgical site, postoperative pain, and effects of pharmacologic pain management. Rapidly evolving surgical and anesthesia techniques and the introduction of newer pharmaceutical agents make it difficult to identify best practice from retrospective experience reported in the perioperative literature. Prospective studies that deal with specific patient populations, incomparable patient groups or techniques, and unique practice bias have limited validity of claims regarding several promising approaches to perioperative risk reduction. In the absence of clear scientific principles, a perioperative pulmonary risk management strategy for the early part of this century is based on the consensus practice of informed clinicians (Box 4).

Anesthesia↗

[Intracranial diffusion. A complication of retrobulbar anesthesia].

Retrobulbar anesthesia is considered a safe, effective local-regional technique for ocular surgery. However, local complications that can arise from needle trauma during injection, include retrobulbar hemorrhage, perforation of the ocular globe and occlusion of the artery and/or the central vein of the retina. Systemic complications, such as respiratory arrest, convulsions and cardiovascular collapse, have also been reported, and although they only occur in less than 1% of cases, they are potentially life threatening. We report two cases of intracranial diffusion after retrobulbar anesthesia and describe possible mechanisms that may contribute to its development.

Aged↗