jueves, 26 de abril de 2012

anestesia raquídea


La anestesia raquídea fue descrita por Bier en 1898 y después de más de 100 años sigue siendo una de las técnicas más seguras y económicas disponibles. Como todo en medicina, la raquianestesia tiene sus fallas y complicaciones. Hace algunos días un colega hizo una pregunta sobre raquia fallida y se decidió enviar algunos artículos al respecto de esta excelente técnica de bloqueo.
Se le invita a disfundir este proyecto entre sus colegas locales o a distancia, ya que deseamos poder llegar a mas sitios con información de utilidad práctica y actualizaciones relacionadas con nuestra especialidad.
Anestesia espinal fallida: mecanismos, tratamiento y prevención
Failed spinal anaesthesia: mechanisms, management, and prevention
P. D. W. Fettes1, J.-R. Jansson, J. A. W. Wildsmith
British Journal of Anaesthesia 102 (6): 739-48 (2009) 
Although spinal (subarachnoid or intrathecal) anaesthesia is generally regarded as one of the most reliable types of regional block methods, the possibility of failure has long been recognized. Dealing with a spinal anaesthetic which is in some way inadequate can be very difficult; so, the technique must be performed in a way which minimizes the risk of regional block. Thus, practitioners must be aware of all the possible mechanisms of failure so that, where possible, these mechanisms can be avoided. This review has considered the mechanisms in a sequential way: problems with lumbar puncture; errors in the preparation and injection of solutions; inadequate spreading of drugs through cerebrospinal fluid; failure of drug action on nervous tissue; and difficulties more related to patient management than the actual block. Techniques for minimizing the possibility of failure are discussed, all of them requiring, in essence, close attention to detail. Options for managing an inadequate block include repeating the injection, manipulation of the patient's posture to encourage wider spread of the injected solution, supplementation with local anaesthetic infiltration by the surgeon, use of systemic sedation or analgesic drugs, and recourse to general anaesthesia. Follow-up procedures must include full documentation of what happened, the provision of an explanation to the patient and, if indicated by events, detailed investigation.
http://bja.oxfordjournals.org/content/102/6/739.full.pdf 
 
Las causas anatómicas de la raquianestesia fallida pudieran ser más comunes de lo que se piensa 
Anatomical causes of failed spinal anaesthesia may be commoner than thought.
Popham PA.
Br J Anaesth. 2009 Sep;103(3):459; author reply 459. 
Editor- I read with interest the review of potential causes of failed spinal anaesthesia by Fettes and colleagues. Iam concerned that they appear to dismiss epidural cysts too readily. A variety of types have been described. The most common are thought to be Tarlov cysts which, with the increasing use of magnetic resonance imaging, are now estimated to be present in 4.5-9% of the adult population.
http://bja.oxfordjournals.org/content/103/3/459.1.full.pdf 

 

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Anestesiología y Medicina del Dolor
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