Complicaciones de anestesia regional

Complicaciones neurológicas de la anestesia regional Neurologic complications of regional anesthesia Barrington, Michael J.; Snyder, Gabriel L. Current Opinion in Anaesthesiology 2011;24:554-560.  doi: 10.1097/ACO.0b013e32834ae1f7 Purpose of review: Regional anesthesia is evolving rapidly and increasing in popularity as evidenced by the large number of publications on the topic. In this healthcare environment, continual assessment of the safety and efficacy of clinical practice is critical. Neurologic complications of regional anesthesia can result in disability and are feared by patients and clinicians. Ultrasound guidance is unique as a nerve localizing technique in terms of being able to image needle-nerve proximity and potentially prevent direct trauma to nerves. This article reviews the recent literature relevant to neurologic complications of regional anesthesia. Recent findings: The incidence of intraneural injection during regional anesthesia is higher than previously appreciated. Defining intraneural injection and its significance are the subject of current debate. Clinical studies with small sample sizes suggest that intraneural injection may not necessarily be responsible for nerve injury. Inflammatory mechanisms may contribute to perioperative nerve injury. Ultrasound guidance has not been proven to reduce the incidence of nerve injury due to peripheral nerve blockade (PNB). Increased utilization of PNB is not associated with an increase in perioperative nerve injury. Summary: The pathogenesis of perioperative nerve injury is complex with multiple potential etiologies and mechanisms. The role of intraneural injections as a modifiable risk factor for neurologic complications due to regional anesthesia remains topical. Relevant publications include studies on the morphology of peripheral nerves and risk of perioperative nerve injury in the context of both neuraxial anesthesia and PNB. http://journals.lww.com/co-anesthesiology/Fulltext/2011/10000/Neurologic_complications_of_regional_anesthesia.15.aspx?WT.mc_id=EMxj01x20111114xL12  Complicaciones neurológicas inducidas por la anestesia espinal Spinal anesthesia-induced neurological complications Ganem EM, Castiglia YM, Vianna PT. CET, FMB, UNESP. Rev Bras Anestesiol. 2002 Jul;52(4):471-80. Abstract BACKGROUND AND OBJECTIVES: Although rare, spinal anesthesia-induced neurological complications may determine serious sequelae. This study aimed at presenting these complications in order to elucidate triggering factors and help in the diagnosis of such injuries. CONTENTS: The following complications are presented: needle and catheter-induced nerve injury, post dural puncture headache, anterior spinal artery syndrome, spinal hematoma, septic meningitis, aseptic meningitis, adhesive arachnoiditis, cauda equina syndrome, and transient neurological symptoms. CONCLUSIONS: The understanding of triggering factors of spinal anesthesia-induced neurological complications may prevent injuries and help early diagnosis and treatment, therefore changing patients prognosis. JUSTIFICATIVA Y OBJETIVOS: Complicaciones neurológicas de la anestesia subaracnoidea, a pesar de raras, pueden determinar secuelas importantes. El objetivo de este estudio es presentar estas complicaciones con la finalidad de esclarecer los factores desencadenantes, lo que facilita el diagnóstico de las lesiones. CONTENIDO: Son presentadas las siguientes complicaciones: lesión del nervio desencadenada por la aguja y catéter, cefalea postpunción, síndrome de la arteria espinal anterior, hematoma espinal, meningitis bacteriana, meningitis aséptica, aracnoiditis adhesiva, síndrome de la cola de caballo y síntomas neurológicos transitorios. CONCLUSIONES: El conocimiento de los factores desencadenantes de complicaciones neurológicas determinadas por la anestesia subaracnoidea puede prevenir las lesiones, diagnosticar y tratar más precozmente y, de ese modo, cambiar el pronóstico de las mismas http://www.scielo.br/pdf/rba/v52n4/v52n4a12.pdf    Aracnoiditis adhesiva progresiva despues de anestesia espinal Progressive adhesive arachnoiditis following spinal anesthesia. WOODS WW, FRANKLIN RG. Calif Med. 1951 Sep;75(3):196-8. Abstract Neurological complications-some of them serious-sometimes occur following spinal anesthesia. In the majority of the relatively few cases in which they occur, they are caused by factors which can be obviated. Rigid adherence to defined safeguards will reduce the incidence of complications and overcome most of the objections to the procedure http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1521038/pdf/califmed00231-0013.pdf    Complicaciones Neurológicas de la Anestesia Neuroaxial Dr. Víctor M. Whizar-Lugo, Dr. Juan C. Flores-Carrillo Servicios Profesionales de Anestesiología y Medicina del Dolor, Centro Médico del Noroeste. Adscrito. Unidad de Cuidados Intensivos, Hospital General de Tijuana. ISESALUD. Tijuana B.C., México. www.anestesia-dolor.org   vwhizar@anestesia-dolor.org Anestesia en México 2006;18:133-144. Resumen En las últimas tres décadas se han incrementado en uso de los bloques neuroaxiales debido a que producen anestesia excelente y segura, analgesia postoperatoria y tienen una baja incidencia de complicaciones severas. La mayoría de los anestesiólogos vemos a la anestesia regional como una alternativa segura de la anestesia general; menos eventos de tromboembolia, de infarto del miocardio, menor posibilidad de delirio postanestésico, menor tiempo de recuperación comparado con la anestesia general, además de tener costos reducidos. Debido a estos y otros factores es que se han incrementado los pacientes manejados con anestesia regional en todas las edades y tipos de enfermos; pediátricos, en obstetricia, ambulatorios y ancianos por mencionar algunos. Sin embargo, los riesgos y beneficios de los bloqueos neuroaxiales son diferentes en cada paciente. Las complicaciones graves son raras: desde inyecciones i.v. accidentales de anestésicos locales hasta daño cerebral irreversible. Hay una gran variedad de eventos deletéreos como la punción dural con o sin cefalea, parestesias, dolor lumbar, hematoma epidural, meningitis aséptica, irritación neurológica transitoria, cauda equina, y muchos más. Esta revisión se orienta en los riesgos neurológicos de los bloqueos neuroaxiales. Palabras clave. Complicaciones neurológicas, anestesia neuroaxial. http://www.fmca.org.mx/revista/RAM8/2006-18-3/006.pdf

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