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PubMed2000

Complications of spinal and epidural anesthesia.

In conclusion, major complications after neuraxial techniques are rare but can be devastating to the patient and the anesthesiologist. Prevention and management begin during the preoperative visit with a careful evaluation of the patient's medical history and appropriate preoperative discussion of the risks and benefits of the available anesthetic techniques. Alternative anesthetic techniques, such as peripheral regional techniques or general anesthesia, should be considered for patients at increased risk for neurologic complications following neuraxial block. The decision to perform a regional anesthetic technique on an anesthetized patient must be made with care, as these patients are unable to report pain on needle placement or injection of local anesthetic. Efforts should also be made to decrease neural injury in the operating room through careful patient positioning. Postoperatively, patients must be followed closely to detect potentially treatable sources of neurologic injury, including expanding spinal hematoma or epidural abscess, constrictive dressings, improperly applied casts, and increased pressure on neurologically vulnerable sites. New neurologic deficits should be evaluated promptly by a neurologist, or neurosurgeon, to document formally the patient's evolving neurologic status, arrange further testing or intervention, and provide long-term follow-up.

Anesthesia, Epidural↗
PubMed2002

Complications of inhaled anesthesia delivery systems.

Inhaled anesthesia delivery systems (ADS) have evolved in the past 20 years from simple pneumatic machines to complex computer-controlled devices. For the purposes of this discussion, we will outline some of the potential complications that may result from the use of these systems. Because of the complexity of modern ADS, it is incumbent on the anesthesiologist to be cognizant of potential problems that may arise with their use. Even though it is now more difficult than ever for the practitioner to develop a comprehensive understanding of these machines, it remains essential for the safe practice of anesthesia. When the anesthesiologist understands the basic design differences between products from different manufacturers, it is more likely that the appropriate preoperative checks will be performed and that delivery of a safe anesthetic can be ensured. Although malpractice claims associated with anesthesia delivery systems are rare, when they do occur they may be severe, and they continue to occur. These complications may range in severity from mild hypercapnia to awareness and even death.

Air Pressure↗
PubMed1955

Spinal anesthesia; a survey of neurologic complications.

The incidence of severe neurologic complications from spinal anesthesia in San Diego County in a series of 32,882 cases in a five-year period was 0.012 per cent. Morbidity of 1 in 10,000 cases compares favorably with morbidity associated with general anesthesia. Meticulous technique and abandonment of continuous spinal anesthesia can further reduce the incidence of complications. More emphasis should be placed on the elimination of preexisting neurologic disease as a contraindication to spinal anesthesia.

Anesthesia, General↗
PubMed1993

[Complications of spinal anesthesia compared to general anesthesia. A prospective study of 408 consecutive orthopedic patients].

UNLABELLED: In this prospective study the preoperative risk classification and pulmonary status was compared to postoperative mortality and morbidity, following either spinal or general anaesthesia. We studied 408 consecutive orthopaedic patients. Comparing the anaesthetic methods we found no differences in mortality or in frequency of cardiac complications, while the non-cardiac complications were seen more frequently in patients who had undergone spinal anaesthesia (p < 0.05). Patients from the lower risk groups with a preoperative abnormal pulmonary status had a higher frequency of postoperative pulmonary complications following spinal anaesthesia than following general anaesthesia (p = 0.015). IN CONCLUSION: 1) We find no difference in postoperative mortality depending on the anaesthetic method chosen, 2) the predictive value of the Boston Cardiac Risk index is identical for the two anaesthetic methods, and 3) the anaesthetic method of choice for the pulmonary disabled patient has not yet been established.

Adult↗
PubMed2002

Risks and complications of neuraxial anesthesia and the use of anticoagulation in the surgical patient.

Recognition of the risk of thromboembolic phenomena to patients in the postsurgical period has resulted in the practice of administering prophylactic anticoagulant agents to those patients who are at high risk for this complication. Institution of a perioperative anticoagulant or antithrombotic protocol needs to be considered when a regional anesthetic is proposed as part of, or as the total, anesthetic management of the patient. This article reviews current data on the risks involved in the use of neuraxial regional anesthesia in the care of surgical patients in whom prophylactic thromboembolic anticoagulant therapy is planned. Guidelines are established to help the physician minimize the risks of a neuraxial hematoma forming, monitor the patient for this complication, and optimally treat him or her if a hematoma were to occur.

Journal Article↗
PubMed2000

[Premedication and sedation complications during ophthalmic anesthesia].

Sedation allows patients to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command. For ophthalmic surgery patient's anxiety and discomfort can be relieved during placement of a peribulbar block and during surgery by intravenous sedation. Intravenous sedation should only be administered by an anesthetist. Three different classes of drugs are used for intravenous sedation: analgesics (fentanyl and alfentanil), benzodiazepines (midazolam) and profofol, an intravenous anesthetic. Sedation may result in ventilatory, cardiovascular and neurologic complications. Excessive sedation can induce hypoventilation from central ventilatory depression or airway obstruction. Uncontrolled and unexpected movements of the head could result in major surgical complications. For the prevention of the complications related to sedation the same monitoring as for general anesthesia is essential.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[A rare complication of regional anesthesia].

A prolonged blockade of the brachial plexus by a subclavicular approach was performed in a 22-year-old patient with combined trauma and severe pain in the left arm. The administration of 20 ml of a 0.3% dicaine solution through a catheter led to spinal anesthesia accompanied by the development of transient hemodynamic and respiration disturbances, which were arrested without medication or controlled lung ventilation. A possible reason for this complication is traumatic plexitis. When performing a blockade of the brachial plexus one should administer a test dose of an anesthetic prior to the entire drug dosage.

Adult↗
PubMed1989

[Subdural location of a catheter. A complication of peridural anesthesia].

A case of an involuntarily placed subdural catheter (between arachnoid and dura) is described. The catheter was thought to be in the epidural space. It was placed at T9/10 in order to achieve postoperative epidural analgesia in a patient with colonic surgery. Administration of 4 ml bupivacaine 0.5% was followed by segmental analgesia (left: C7 to T9, right: T2 to T8) 10 min later. The systolic blood pressure fell from 85 to 50 mmHg. No motor block was detectable. After 150 min remission of analgesia was complete. All effects were reproducible. Using 1.3 ml of a radiopaque fluid, a spinal X-ray film showed a typical subdural picture with radiopacity detectable on the left from C8 to T8 and on the right from T1 to T7. An additional 2.7 ml did not visualize the lumbar subdural space as well. No radiopaque fluid entered the epidural or intrathecal space. It may be that accidental subdural catheter placement in regional anesthesia is not as rare as it was thought to be a few years ago. There is at present no available epidural technique that guarantees the avoidance of this complication. In addition, the symptoms of 'subdural analgesia' vary to a great extent. Therefore, the diagnosis can only be verified by X-ray examination. If patients with epidural analgesia are supervised with care and uncommon dose responses are recognized, subdural catheter placement will not lead to a severe and dangerous situation for the patient.

Adult↗
PubMed2002

Complications of regional anesthesia: an overview.

Perhaps the clearest picture of the numbers and types of injuries from regional anesthesia is provided by the ASA Closed Claims Project database. In reviewing these data, it is valuable to keep in mind, of course, that the lack of a denominator makes the calculation of incidence impossible. For the decade of the 1990s, 308 claims were associated with regional anesthesia (versus 642 claims associated with general anesthesia). The percentage of these claims for patient death (10%) continued its steady decline from more than 20% in the 1970s and 13% in the 1980s. The primary reason for death remains cardiac arrest associated with neuraxial blockade, though this now represents only 30% of the deaths as opposed to 61% in the 1970s and 40% in the 1980s. There were 71 permanent disabling injuries among the 308 claims. The most common of these (23%) was associated with nerve blocks of the eye (13 retrobulbar, 3 peribulbar), and typically the injury entailed loss of vision. Second in frequency (21%) were pain-management related claims involving, for example, neuraxial opiates or neurolytic blocks. Third in frequency (20%) were nerve injuries associated with neuraxial and peripheral blocks followed by epidural hematomas (13%).

Anesthesia, Conduction↗
PubMed1990

[Neurologic complication following spinal anesthesia for manual detachment of the placenta].

Long-term paralysis of the lower extremities was observed in a 31-year-old fourth-gravida patient, undergoing a curettage under spinal anaesthesia because of placenta accreta. The patient recovered within three days from her neurological signs and symptoms, consisting of complete paresis of the hip and knee flectors and severe headache. Clinical investigations including a neurological examination, spinal puncture, x-ray pictures of the lumbosacral area and haemograms revealed no evidence for an infection, abscess or haematoma. With regard to the fact, that neurological deficiency disappeared completely within three days, it seems probable, that the symptoms were caused by the longer lasting gynaecological position (Steinschnitt-position) during the period of delivery and curettage thereafter.

Adult↗