Bloqueos neuroaxiales difíciles

La espalda difícil se vuelve espalda menos difícil con la ultrasonografía  "Difficult back", turns into "less difficult back" by ultrasonography. Kim YH. Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Korean J Anesthesiol. 2011 Nov;61(5):355-7. Epub 2011 Nov 23.  Despite the accumulation of medical experience, better training, advanced equipment and safer local anesthetics, the incidence of neurological complications after central neuraxial blockade has not decreased [1]. Several explanations have been suggested, including the increased popularity of regional anesthesia as well as the increasing prevalence of risk factors (e.g., obesity [2], diabetes [3], and potent anticoagulant [4]). http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-61-355.pdf   Prediciendo la dificultad de hacer bloqueos neuroaxiales  Predicting the difficulty in performing a neuraxial blockade. Kim JH, Song SY, Kim BJ. Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea. Korean J Anesthesiol. 2011 Nov;61(5):377-81. Epub 2011 Nov 23. Abstract BACKGROUND: Traumatic placement of a needle during a neuraxial blockade has been related to many complications such as postdural puncture headache, trauma to neural structures and even spinal hematoma, causing permanent neurologic deficits. Although efforts to minimize the complications caused by traumatic neuraxial blockade have been made, nothing was found to be clear. The authors investigated the predictors of difficult neuraxial blockade using the first puncture success and number of attempts as measures to assess the difficulty. METHODS: In this prospective observational study, 253 patients scheduled for elective surgery underwent spinal or epidural anesthesia. Patient data (age, sex, height, weight, body mass index, and quality of anatomical landmarks), the provider's level of experience, type of blockade (spinal or epidural), needle type/gauge and the distance from skin to subarachnoid or epidural space were recorded. Significant variables were first determined by Student's t-test and Pearson's chi square test and then logistic and Poisson regression tested the association of the first puncture success and number of attempts with the significant variables. RESULTS: The provider's level of experience and the distance from skin to subarachnoid or epidural space were significant in logistic and Poisson regression. Body mass index was significant only in Poisson regression and the quality of anatomical landmarks was significant only in logistic regression. CONCLUSIONS: Provider's level of experience and the distance from skin to subarachnoid or epidural space influenced the difficulty in performing a neuraxial blockade. http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-61-377.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229015/pdf/kjae-61-377.pdf

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