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PubMed1999

Complications of local dental anesthesia and anatomical causes.

Anatomical descriptions usually include only the average topographical relationships, but the anatomical structures particularly in the head region display great variability. This is one of the essential causes underlying side effects and complications of local dental anesthesia. In examinations of intravascular needle placement in over 6000 local anesthetic injections in the jaws, positive blood aspiration occurred most frequently (5.8%) at the mandibular foramen. The close proximity to the cerebral vessels explains the frequency of severe side effects. Anatomical studies on the course of the maxillary artery and its branches as well as the course of the nerve demonstrate that unexpected anatomical constellations can lead to both anesthetic failure and dramatic side effects.

Anesthesia, Dental↗
PubMed1990

Immediate contralateral amaurosis after retrobulbar anesthesia.

Many potential complications associated with retrobulbar anesthesia have been reported. Of these, sudden loss of vision in the contralateral eye is the least expected. We report a case of immediate loss of vision in the fellow eye after retrobulbar anesthesia for cataract extraction. Possible etiology such as emboli thrown during ventricular fibrillation, direct optic nerve anesthetic injection with reflux to the chiasm, cortical stroke, amaurosis fugax, arterial injection of anesthetic material, and hysteric reaction are discussed.

Aged↗
PubMed1997

Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990.

BACKGROUND: Anesthesia-related complications are the sixth leading cause of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979-1990. METHODS: Each state reports deaths that occur within 1 yr of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. Maternal death certificates (with identifiers removed) matched with live birth or fetal death certificates when available from 1979-1990 were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated. Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries. RESULTS: The anesthesia-related maternal mortality rate decreased from 4.3 per million live births in the first triennium (1979-1981) to 1.7 per million in the last (1988-1990). The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia-related deaths have decreased since 1984. The case-fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9-2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9-21.8) times that after 1985. CONCLUSIONS: Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks. The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths. Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia.

Adult↗
PubMed1998

Complications of abortion performed under local anesthesia.

OBJECTIVE: To assess the incidence of complications of abortion performed under local anesthesia. DESIGN: Prospective study. SETTING: A family planning center in the Paris area. POPULATION: Eight hundred and fifty-eight women admitted for abortion under local anesthesia. MAIN OUTCOME MEASURES: Incidence of immediate (the day of vacuum aspiration) and delayed complications (at the follow-up visit 2 weeks after the procedure). RESULTS: Among the 858 women who underwent vacuum aspiration, 683 (80%) attended the follow-up visit 2 weeks after the procedure. Fifty-nine percent of the 858 women had not had a previous abortion, 25% had had one, and 16% had had two or more. The average duration of amenorrhea was 8.6 weeks (19% at 6 or 7 weeks, 67% between 8 and 10 weeks, and 14% after 10 weeks). The overall complication rate was 3.4% (23/683) (95% CI=2.0-4.8%). The incidence of immediate complications was 1.7% (15/858) (0.8-2.6%) and that of delayed complications 1.2% (8/683) (0.4-2.0%). CONCLUSION: This study confirms the safety and efficacy of abortion by vacuum aspiration under local anesthesia.

Abortion, Incomplete↗
PubMed2003

[Prevention of cardiovascular accidents during locoregional anesthesia].

Cardiovascular complications can be divided into 2 big categories involving the cardiovascular system in locoregional anaesthesia: those of local anaesthetics with direct effect on sympathetic fibres, which regulate the cardiovascular activity and those who derives from alteration of the normal cardiac function due to the toxic effect of the drugs. While the first are referred to the extension of a central block, the second considers the overdose caused by accidental intravenous injection. This is more frequent in peripheral blocks then in central blocks. The use of catheters in both central and peripheral blocks introduces another factor of risk due to a prolonged administration of local anaesthetics. The prevention of those complications should foresee through an accurate anamnesis the subjective conditions of risk: so we have to choose the best individual technique and dose of anaesthetics; the use of qualitative correct material, the ENS as a support to identify nerve structures and the application of more recent and safe drugs represented by the compound of S(-) enantiomers, Ropivacaine and Levobupivacaine. Which are described to be less cardiotoxic but with the same characteristics as Bupivacaine. Finally don't forget respect the classical rules of security during locoregional anaesthesia.

Anesthesia, Conduction↗
PubMed1994

[Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications].

BACKGROUND: Retrobulbar anesthesia (RETRO), combined with a facial block, is the most frequently employed method of anesthesia in cataract surgery. There is, however, an increasing tendency to use peribulbar anesthesia (PERI), which is claimed to provide the same degree of anesthesia and akinesia as RETRO while reducing many of the complications. OBJECTIVES OF THE STUDY: Survey of the principal techniques of RETRO, facial block and PERI as well as of the most important local anesthetics and additives; quantitative investigation of resulting akinesia and sensory blockade; comparison of systemic and local complications (literature review). TECHNIQUES OF LOCAL ANESTHESIA: A) RETRO: 1) Atkinson technique: injection within the orbital muscle cone, superonasal eye position during injection; 2) Unsöld technique: primary eye position during injection (advantage: lower risk of optic nerve lesion). - B) Facial block: 1) O'Brien technique: injection anterior to the tragus of the ear, just above the condyloid process of the mandible (disadvantage: frequently blockade of the upper portion only of the peripheral facial nerve); 2) Nadbath/Rehman technique (modified O'Brien block): injection just inferior to the earlobe (advantage: better orbicularis akinesia due to blockade of upper and lower portions of peripheral facial nerve); 3) van Lint technique: infiltration anesthesia at the temporal orbital margin, aiming at the short zygomatic branches of the facial nerve (disadvantage: bad orbicularis akinesia). - C) PERI: 1) Technique with two injections outside the muscle cone (inferotemporally and superonasally), just past the equator; 2) one-injection technique, mostly inferotemporally (disadvantage: worse akinesia). LOCAL ANESTHETICS: A) Short and weak action: lidocaine and prilocaine; advantages: good tissue penetration, low toxicity. - B) Intermediate duration and potency of action: mepivacaine; advantage: pronounced vasoconstrictor activity, alternative to adrenaline. - C) Long and strong action: 1) etidocaine; advantage: pronounced motor blockade, particularly suitable for facial block; 2) bupivacaine; advantage: pronounced sensory blockade, excellent postoperative analgesia; disadvantage: relatively toxic (cave: cardiac and respiratory arrest). - D) Mixtures of local anesthetics: mostly lidocaine-bupivacaine mixture; combines the advantages short-onset action (lidocaine) and long-duration action (bupivacaine). ADDITIVES TO LOCAL ANESTHETICS: Adrenaline: prolongs the action of local anesthetics with short and intermediate duration of action, reduces the incidence of hemorrhages and of intraoperative vitreous bulging. - Hyaluronidase: highly effective for prevention of vitreous bulging. AKINESIA AND SENSORY BLOCKADE: In randomized order, 160 cataract patients received PERI (technique with 2 injections) with 6, 8 or 10 ml of a bupivacaine-lidocaine-hyaluronidase mixture (without facial block) or RETRO (Unsöld technique) with 5 ml of the above mixture, combined with a Nadbath/Rehman facial nerve block (5 ml etidocaine-lidocaine mixture). Measured 20 min after injection (intervening period of oculopression), the smallest ocular motility (Kestenbaum limbus test) was left after RETRO. After administration of PERI - even with a volume of 10 ml - the range of residual ocular motility was always higher, i.e., there was a less reliable globe akinesia than after RETRO. The lid closure force (Straub technique) averaged zero after all methods of anesthesia; however, the smallest spread (highest reliability) was observed after PERI. Complete corneal anesthesia (Draeger esthesiometer) was found in nearly all cases, i.e., RETRO and PERI are comparably effective concerning sensory blockade...

Adult↗
PubMed1998

[Mandibular osteomyelitis after mandibular conduction anesthesia].

Several complications following a mandibular nerve block were reported in the literature. In some cases pterygomandibular abscess formation may be caused by mandibular needle injections. There is no report of odontogenic osteomyelitis of the ascending mandibular ramus in the literature. Here two patients with osteomyelitis of the ascending ramus following a mandibular nerve block injection are presented.

Adult↗
PubMed1988

Anesthesia for cesarean section: minimizing risk and complications.

Managing cesarean section anesthesia is challenging and fraught with hazards. Each anesthetic option has different maternal and fetal risks. Emphasis on regional anesthesia when possible and utilization of state-of-the-art monitoring such as pulse oximetry and end-tidal capnography will improve the anesthetic outcome.

Anesthesia, Epidural↗
PubMed1983

[Use of stereotaxic neurosurgery in the treatment of pain in cervicofacial cancers].

Mesencephalic tractotomy employing the stereotaxic method was conducted 12 times in 11 patients with pain due to cervicofacial cancer only partially relieved by high doses of opiates. Immediate results were spectacular in 10 cases and partial on the other 2 occasions. However, relief was not permanent even in patients in whom the greatest improvement was obtained, and the usual analgesics had to be prescribed after 3 months. The operation, which requires only a short period of anesthesia, was always well supported, complications being anesthesia of one side of the body in 2 patients and convergence paralysis in two cases, one of which was transient. Mesencephalic tractotomy constitutes a new weapon for the treatment of diffuse cervicofacial cancer pain not responding to major medical treatment. Elective thermocoagulation of the Vth and IXth nerves was also successfully employed for systematized pains.

Adult↗
PubMed2003

Outcome of surgery on infants younger than 1 month with congenital glaucoma.

PURPOSE: To determine the visual outcomes and surgical and anesthetic complication rates of patients with newborn glaucoma operated within 1 month of age. DESIGN: Retrospective, consecutive, noncomparative case series. PARTICIPANTS: All children with newborn glaucoma who underwent surgery between January 1990 and December 2000 were included. METHODS: The medical records of 25 consecutive patients (47 eyes) who underwent primary combined trabeculotomy and trabeculectomy either bilaterally in a single session or unilaterally were reviewed retrospectively. Outcomes were evaluated using Kaplan-Meier survival analysis. MAIN OUTCOME MEASURES: Clinical outcome assessment included corneal clarity, intraocular pressure (IOP), bleb characteristics, visual acuity, refractive errors, and identification of surgical and anesthetic complications. RESULTS: The mean follow-up was 3.1+/-1.8 years (range, 9.5 months-7.4 years). The mean preoperative IOP was 26.9+/-5.2 mmHg (range, 14-42 mmHg). At the final follow-up visit, the mean IOP was 14.5+/-3.8 mmHg (range, 8-28 mmHg). The percentage reduction in IOP was 43.3+/-21.5 (P<0.0001). Twelve-, 24-, and 36-month survival rates for complete success for IOP control were 89.4%, 83.6%, and 71.7%, respectively, which were maintained for 7 years of follow-up. After surgery, complete clearance of corneal edema was achieved in 66% of the eyes. Data on visual acuity was available for 19 patients. Final best spectacle-corrected visual acuity was 20/40 or better in the better eye in 5 patients (26.3%), 7 patients (36.8%) obtained 20/60 or better in the better eye, 8 patients (42.1%) achieved final visual acuity of less than 20/60 to 20/200 in the better eye (low vision), and four patients obtained less than 20/400 visual acuity in the better eye (blind) according to World Health Organization criteria. However, there was no eye with absent perception of light in the better eye. Myopia (mean spherical equivalent, 4.6+/-3.2 diopters) was the most common refractive error, present in approximately half of the eyes (n = 23; 53.8%). There were no significant intraoperative or postoperative complications in any patient. Anesthesia-related complications developed in 2 patients; however, they were resuscitated successfully. CONCLUSIONS: Primary combined trabeculotomy-trabeculectomy offers a viable surgical option in infants that have cloudy corneas at birth as a result of congenital glaucoma. It is associated with a favorable visual outcome and a low rate of anesthetic complications in an Indian population.

Cornea↗
PubMed1999

[Anesthetic management for implantation of implantable cardioverter-defibrillators].

Implantable cardioverter-defibrillators (ICDs) were implanted in 44 patients at the authors' institution. The anesthetic management was reviewed retrospectively. Ten of the 44 patients received the third generation ICD devices, while the rest received the fourth generation devices. For thirteen patients receiving the fourth generation devices, implantation was performed under local anesthesia with monitored care of anesthesiologists. Propofol was infused to achieve deep sedation during induced ventricular fibrillation and later cardioversion for testing the devices. Implantation was performed under general anesthesia with combination of fentanyl and volatile anesthetics for the remaining 31 patients. Patients who received ICDs under local anesthesia had significantly greater values of ejection fraction in preoperative examination than values in patients who received ICDs under general anesthesia. Operation time of the implantation under local anesthesia was significantly shorter than that under general anesthesia. Though infusion of propofol produced a moderate decrease of blood pressure in patients who received ICDs under local anesthesia, no patient showed major complication. Local anesthesia with sedation with propofol can be an option in anesthetic management for implantation of an ICD if an anesthesiologist cares the patient whose cardiac function is not compromised.

Adult↗
PubMed1980

Anesthetic considerations for the oral surgery patient with hemophilia.

Hemophiliac patients undergoing oral surgical procedures can be a challenge for both dental and medical personnel involved in their care and treatment. Anesthetic management of hemophiliac patients may be safely attained by various pain control techniques including local anesthesia. Possible complications resulting from administration of anesthesia must be kept in mind at all times. Preparation, caution, and gentleness are necessities for administration of safe and effective anesthesia to the hemophiliac patient.

Analgesics↗
PubMed2004

Anesthetic management of labor pain: what does an obstetrician need to know?

BACKGROUND: Obstetrical anesthesia is considered by many to be a high-risk subspecialty of anesthesia practice that is laden with clinical challenges and medico-legal liability. Anesthesia-related complications are the sixth leading cause of pregnancy-related maternal mortality in the United States. COMPLICATIONS: Difficult or failed intubation following induction of general anesthesia for cesarean delivery remains the major contributory factor to anesthesia-related maternal complications. REQUIREMENTS: Communication skills and exchange of information (between anesthesiologists, obstetricians, and nurses) in an ever changing environment of labor and delivery are essential for a perfect outcome, which is always expected when providing safe passage for both the mother and her fetus from antepartum to postpartum period. The safe provision of labor anesthesia and/or analgesia requires appropriate staff, facilities, and equipment for proper patient safety. DISCUSSION: This article is intended for obstetricians and reviews the current guidelines for the administration of obstetrical anesthesia and analgesia.

Anesthesia, Obstetrical↗