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PubMed1990

Laryngospasm-induced pulmonary edema: case report.

Laryngospasm during the emergent phase of anesthesia is a respected complication well known to any PACU nurse. One complication of laryngospasm is noncardiac pulmonary edema (NCPE). NCPE can be a catastrophic complication of anesthesia. A case report is presented to illustrate the signs and symptoms of laryngospasm and NCPE. The physiology of hemoptysis and hypoxemia is reviewed. The mechanism of laryngospasm-induced pulmonary edema is described. The need for PACU nurses to comprehend the pathophysiology and implications of laryngospasm and hypoxemia is paramount when determining proper treatment. PACU nurses should be particularly alert to and aware of this complication.

Adult↗
PubMed2003

[Spinal anesthesia in a parturient complicated with idiopathic thrombocytopenic purpura].

A 27-yr-old parturient with idiopathic thrombocytopenic purpura was scheduled to undergo resection of a left ovarian cyst at 15 weeks gestation. Platelet counts were between 46,000 and 64,000.microliter-1, bleeding time was 2 min, and she denied having unusual bleeding diathesis. As the patient was reluctant to receive general anesthesia for fear of latent adverse effects of the drugs on the fetus, we selected spinal anesthesia and the perioperative course was uneventful. However, it is questionable to perform regional anesthesia in patients with coagulation disorders, for spinal hematomas leading to paraplegia can be a rare but devastating complication of regional anesthesia. According to our extensive literature review, it was revealed that platelet insufficiency, both in terms of function and count, did not represent a major risk factor for spinal hematomas associated with regional anesthesia, especially for spinal anesthesia. We suggest that spinal anesthesia may be safely performed in patients if their platelet counts exceed around 50,000.microliter-1.

Adult↗
PubMedDate not supplied

Peripheral foot blockade versus popliteal fossa nerve block: a prospective randomized trial in 51 patients.

The majority of foot and ankle operations are performed on an outpatient basis and often under some form of regional anesthesia. In this prospective, randomized study of 51 patients undergoing elective unilateral forefoot procedures, we compared 2 different anesthetic techniques: the peripheral foot blockade and the popliteal sciatic nerve block. Variables assessed included the quality of surgical anesthesia, postoperative analgesia, and the incidence of postoperative complications. The anesthesia was classified as effective if it was the sole anesthetic technique for the forefoot surgery. We found successful results in both groups: 92% in the foot block group and 96% in the popliteal block group. Analysis of time required to perform the anesthetic procedure showed a significant difference between the 2 groups, with foot block being considerably faster (14.3 minutes vs 19.2 minutes for popliteal block) (P = .0078). Foot block patients demonstrated 10.96 hours of analgesia, whereas popliteal block patients exhibited 14.32 hours (P = .132). With a mean follow-up of 5.7 months, we did not find anesthesia-related complications in any of the patients. Both techniques showed a high level of safety and efficacy, with no significant difference detected between them. Our patients showed a high rate of satisfaction with both procedures (96% for foot block patients and 96.1% for popliteal block patients) and reported a good discharge disposition. These data show that both procedures are safe and effective anesthetic techniques and well suited to forefoot ambulatory surgery.

Anesthetics, Local↗
PubMed1987

Endoscopic surgery under local anesthesia.

Transurethral resection for papillary tumors and benign prostatic hypertrophy was performed in 26 patients under local anesthesia, sometimes in association with neuroleptanalgesia. 14 superficial bladder tumors were so treated: 9 adenomas and 3 bladder neck obstructions were resected in elderly debilitated patients. No patient required general anesthesia. No complications due to local anesthesia were noted.

Anesthesia, Local↗
PubMed2003

Forearm compartment syndrome from intravenous mannitol extravasation during general anesthesia.

IMPLICATIONS: Complications of IV mannitol administration resulting in compartment syndrome may warrant surgical intervention. Compartment syndrome is difficult to diagnose in the anesthetized patient. Infusing mannitol in an observed IV site permits discontinuation of mannitol before complications ensue. Early recognition and surgical intervention averted potential impairment in our patient.

Anesthesia, General↗
PubMed1991

[Cardiac risk patients in anesthesia].

Cardiac complications are the major cause of morbidity and mortality in patients undergoing noncardiac operations. The perioperative risk of adverse cardiac events is particularly high in patients with significant coronary artery disease, heart failure or critical aortic stenosis. Prolonged intraperitoneal and intrathoracic operations, major vascular surgery, emergency procedures, and intraoperative hypotension and tachycardia promote and increase incidence and severity of cardiac complications. Recent experience has shown, however, that elective noncardiac operations can be performed with justifiable risk even in patients with endstage cardiac disease awaiting heart transplantation. Surgery, if indicated, can thus nowadays hardly be denied even in the presence of high cardiac risk. Successful anesthetic management requires detailed information about the cause and severity of the underlying disease, thorough understanding of its specific hemodynamic particularities, indepth knowledge about hemodynamic effects and interactions of anesthetic drugs, and experience with extended hemodynamic monitoring. Anesthetic choice by itself appears to be of minor significance. Cardiac surgery prior to major elective noncardiac procedures is advocated in patients with significant coronary artery disease or severe valve lesions. The incidence of life-threatening cardiac complications is particularly high in the postoperative period; prolonged hemodynamic monitoring in an intensive care unit is therefore mandatory.

Anesthesia↗
PubMed1977

[Changes in the retinal vessels in mandibular nerve anesthesia. A potential for complications].

Examinations of the eyegrounds were made on thirty subjects after conduction anesthesia with xylocitin of the inferior alveolar nerve as well as on nine subjects after sodium chloride injections in order to determine the effect of mandibular conduction anesthesia on retinal vessels. Retinal vascular widths were measured and arteriovenous indices determined. The subjects were divided into groups according to preexisting general diseases, age, sex, and smoking habits. Retinal vascular changes were determined in dependence on age and smoking habits after injections made into the mandibular foramen, and the manner of origin and the results are discussed with particular reference to data reported in the literature.

Anesthesia, Conduction↗
PubMed1992

Complications of continuous spinal anesthesia.

The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. General complications include infection, backache, hematoma, and neurological sequelae. Specific complications are all related to catheter use. The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.

Anesthesia, Spinal↗
PubMed1994

[Systemic complications and side effects of retrobulbar anesthesia in risk patients].

BACKGROUND: Serious systemic complications with possibly lethal exit after retrobulbar anesthesia have been reported. The present study was performed to evaluate the incidence of complications after anesthesia in risk patients with pre-existing diseases. 2.8% of 3000 cataract operations in our department during October 1991 to April 1993 were performed under general anesthesia, 97.2% under local anesthesia. PATIENTS AND METHODS: 1000 anesthesia protocols of these cataract operations under retrobulbar anesthesia and facial block with anesthesia stand-by were analyzed retrospectively. After retrobulbar injection in Atkinson technique we performed a modified O'Brien facial block. The patients were assigned to five different risk groups on the basis of a special point system. RESULTS: The mean age of the patients increased with the risk group from 60.4 years in group 1 to 77.1 years in group 5. Cardiovascular, pulmonary and general risk factors appeared more frequently in the groups of higher risk. The frequency of cardiovascular complications was dependent on affiliation to risk group. The percentual frequency of cardiovascular complications increased from 1.7% in risk group 1 to 7.7% in risk group 5. Decrease of heart rate or blood pressure of more than 30%, or in combination, with the necessity of medical treatment occurred absolutely and relatively most frequently. The frequency of cardiovascular complications amounted 2.2% in the mean. Life-threatening complications with the need of endotracheal intubation or other occurred in 0.1%. CONCLUSION: The relatively high total frequency of systemic complications of 2.4% is related with age and preexisting diseases. The results underline the necessity of anesthesia stand-by in risk patients with the essential requirements for treatment of typical complications.

Aged↗
PubMed1995

[Efficacy and complications of topical cocaine anesthesia in functional endoscopic sinus surgery].

A 4% cocaine (total dose; 200 mg) solution with 1 mg epinephrine was used as a topical anesthetic for 178 cases undergoing functional endoscopic sinus surgery. Complications were investigated before and during surgery. Bleeding amount and operative duration were compared between patients with and without topical cocaine application. Tachycardia (26 cases) was the only complication encountered in this study. Tachycardia occurred at a high incidence in cases which used atropine as a premedication. Total bleeding amount did no differ significantly between those with and without topical cocaine. However, minimum bleeding cases (less than 20 ml) were found in the cocaine group more frequently than in the non-cocaine group. Operative durations of cases with cocaine anesthesia were significantly shorter than cases without cocaine anesthesia. Those findings suggest that cocaine is effective for prevention of bleeding from micro-vessels and/or mucosal oozing, whereas bleeding from macro-vessels was not controlled by topical cocaine application. Topical cocaine anesthesia produced no major complications, even at 200 mg, in the presence of 1 mg epinephrine and when atropine use was avoided.

Adolescent↗
PubMed1997

The incidence of complications associated with local anesthesia in dentistry.

Local anesthetics are frequently administered in dentistry and thus can be expected to be a major source of drug-related complications in the dental office. Additionally, the dentist will more often be confronted with the treatment of risk patients; thus, the incidence of side effects can be expected to rise. In this study, 2731 patients receiving dental anesthesia were evaluated by questionnaire for risk factors, type and dosage of local anesthetic applied, type and duration of treatment, and complications associated with the administration of the local anesthetic. Of all patients, 45.9% had at least one risk factor in their medical histories, with cardiovascular diseases and allergies being the most frequent. The overall incidence of complications was 4.5%. It was significantly higher in risk patients (5.7%) than in nonrisk patients (3.5%). The most frequently observed complications (dizziness, tachycardia, agitation, nausea, tremor) were transient in nature and did not require treatment. Severe complications (seizure, bronchospasm) occurred in only two cases (0.07%). Articaine was found to be administered in over 90% of all dental anesthesias in Germany despite the great variety of local anesthetics available. Articaine 1:100,000 caused more sympathomimetic side effects than did articaine 1:200,000. Additionally, doses of local anesthetics proved not to be strictly determined according to body weight, especially for patients weighing less than 50 kg. In summary, it can be stated that dental local anesthesia can be considered safe. Nevertheless, the incidence of complications due to dental anesthesia can be expected to be further reduced if (a) patients are routinely evaluated for risk factors with an adequate medical history prior to dental treatment, (b) doses of local anesthetics are strictly determined according to body weight, (c) anesthetics with low concentrations of epinephrine are used, and (d) the concept of a differentiated dental anesthesia is applied.

Adult↗
PubMedDate not supplied

Postoperative transient bradycardia and asystole after bilateral bunionectomies performed using spinal anesthesia.

Medical complications after elective bunionectomy procedures are rarely encountered. This paper presents a case report of a healthy 51-year-old male patient who experienced transient bradycardia and asystole postoperatively after bilateral bunionectomies. The foot surgeon must be prepared for, be able to recognize, and then treat these untoward medical events.

Anesthesia, Spinal↗
PubMed1990

Does preoperative antiplatelet therapy increase the risk of hemorrhagic complications associated with regional anesthesia?

Hospital records of 805 patients given 1013 spinal or epidural anesthetics were retrospectively studied to determine whether preoperative antiplatelet medications were significantly related to the development of hemorrhagic complications. Preoperative antiplatelet medications were taken by 391 (39%) patients, including 113 patients receiving multiple drugs. No patient developed signs of spinal hematoma or postoperative neurologic deficits. However, patients receiving antiplatelet medications had an increased incidence of "minor" hemorrhagic complications such as blood-tinged cerebrospinal fluid or blood aspirated through the spinal or epidural needle or catheter (P less than 0.05). When considered independently as risk factors, age and epidural anesthesia were not statistically significant determinants of the incidence of minor hemorrhagic complications. The combination of increased age and epidural (but not spinal) anesthesia was associated with a 4.5% incidence of minor hemorrhagic complications (P less than 0.05). Aspiration of blood through the spinal or epidural needle may not imply an increased risk for serious hemorrhagic complications. Clinical and laboratory screening of patients for preexisting coagulopathies and atraumatic needle placement may reduce the risk of minor hemorrhagic complications involved in patients given antiplatelet medications before the induction of regional anesthesia.

Adolescent↗
PubMedDate not supplied

The safety and efficacy of combined spinal and epidural analgesia/anesthesia (6,002 blocks) in a community hospital.

BACKGROUND AND OBJECTIVES: This study examined the safety and efficacy of combined spinal and epidural (CSE) analgesia/anesthesia performed in a community hospital. METHODS: Labor and Surgical Anesthesia Quality Assessment Worksheets were completed by the responsible anesthesiologist for 7,893 general anesthetics and 7,931 regional anesthetics from January 1, 1994 to December 31, 1997. A retrospective computerized analysis of these data tabulated the number of regional anesthesia techniques and identified anesthesia effectiveness and complications associated with these procedures. The safety and efficacy of CSE analgesia/anesthesia (6,002 blocks) was assessed by comparing these results with reported complications and failure rates for spinal and epidural anesthesia. RESULTS: The CSE technique did not increase the risk of anesthesia complications, as compared with the reported prevalence associated with major regional anesthesia. It provided decreased failure rates for labor analgesia and comparable or decreased failure rates for surgical anesthesia, when compared with reported failure rates for epidural anesthesia. Apnea did not occur in parturients who received 4,164 CSE blocks with intrathecal sufentanil (ITS; 10, 15, or 20 microg) for labor pain relief. However, the prevalence of laboring patients requiring intravenous medication for side effects was related to the dose of ITS: 10 microg (1.1%), 15 microg (4.6%), and 20 microg (5.5%) (P < .001). Patients who received prior systemic narcotics less than 6 hours before ITS were twice as likely to require intravenous treatment for low oxygen saturation/drowsiness (21%) than were those who experienced dysphagia or pruritus (10%) (P < .001). CONCLUSIONS: This review of 6,002 CSE blocks performed in a community hospital has demonstrated that CSE labor analgesia, surgical anesthesia are safe and efficacious. We believe that patient observation and continuous pulse oximetry for 1-2 hours after administration of ITS and prompt treatment with intravenous naloxone for severe drowsiness, low oxygen saturation (PaO2 < 90% unresponsive to mask oxygen), or dysphagia should be used to minimize the risk of apnea.

Analgesia, Epidural↗