La falla de anestesia raquídea raquia puede llegar al 3-4%, siendo la inyección subdural una de las explicaciones. Se manifiesta por una extensión inadecuada del bloqueo sensitivo, con duración breve. En ocasiones se han reportado bloqueos altos y de corta duración o falla total de la anestesia espinal o peridural. Hay tres explicaciones para la aspiración de LCR y falla de la anestesia raquídea: Alteraciones anatómicas de la aracnoides que permiten LCR en el espacio subdural. Otra posibilidad es que el bisel de la aguja de raquia, en especial las de tipo punta de lápiz, se coloque en el espacio subdural y en el subaracnoideo, lo cual hace posible la salida de LCR a través de la aguja espinal. El anestésico local inyectado se difunde en ambos espacios resultando en una raquia fallida e insuficiente. Por último, la punción accidental de la duramadre durante intento de bloqueo peridural puede facilitar la salida de LCR al espacio subdural y la colocación inadecuada del catéter peridural en este espacio.
Failure of spinal anesthesia can reach 3 to 4%, subdural injection being one explanation. It is manifested by inadequate extension of sensory block, with short duration. Sometimes high blockages have been reported, with short duration or total failure of spinal or epidural anesthesia. There are three explanations for CSF aspiration and failure of spinal anesthesia: Arachnoid anatomical malformations that allow the presence of CSF in the subdural space. Another possibility is that the bevel of the spinal needle, especially the pencil tip type, is placed in the subdural space and into the subarachnoid simultaneously, which makes possible the CSF outflow through the spinal needle. The injected local anesthetic diffuses into both spaces resulting in a failed spinal anesthesia. Finally, the accidental dural puncture during attempted epidural block may facilitate the exit of CSF subdural space and improper placement of the epidural catheter in this space
.
|
| Bloqueo subdural y el anestesiólogo |
SUBDURAL BLOCK AND THE ANAESTHETIST
D Agarwal, M Mohta, A Tyagi, AK Sethi
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg. Bahadur Hospital, Delhi, India
Anaesthesia and Intensive Care, 2010,Vol 38, No. 1
SUMMARY
There are a number of case reports describing accidental subdural block during the performance of subarachnoid or epidural anaesthesia. However, it appears that subdural drug deposition remains a poorly understood complication of neuraxial anaesthesia. The clinical presentation may often be attributed to other causes. Subdural injection of local anaesthetic can present as high sensory block, sometimes even involving the cranial nerves due to extension of the subdural space into the cranium. The block is disproportionate to the amount of drug injected, often with sparing of sympathetic and motor fibres. On the other hand, the subdural deposition can also lead to failure of the intended block. The variable presentation can be explained by the anatomy of this space. High suspicion in the presence of predisposing factors and early detection could prevent further complications. This review aims at increasing awareness amongst anaesthetists about inadvertent subdural block. It reviews the relevant anatomy, incidence, predisposing factors, presentation, diagnosis and management of unintentional subdural block during the performance of neuraxial anaesthesia.
|
| Inyección subdural. ¿Cual es el estándar de oro? |
Subdural injection: what's the gold standard?
Hogan QH, Mark L.
Reg Anesth Pain Med. 2009 Jan-Feb;34(1):10-1
. doi: 10.1097/AAP.0b013e31819268a0.
Epidural anesthesia is an act of faith. We insert the epidural needle, typically without radiological guidance, to a depth that is determined by inferred rather than directly witnessed endpoints. A catheter is passed that cannot be steered but can only be controlled by the single parameter of how far it is advanced. The distribution of the injected solution is likewise not under direct control except by the single parameter of how much is injected. In addition to these considerations, the contents of the epidural space are highly heterogenous,1,2 so it is understandable that the anesthetic effect is variable. Possibilities include excessive or inadequate anesthetic spread, brief anesthetic duration, excessive hemodynamic changes, and variable motor block. When the actual events in a particular case fall outside the range of expected possibilities, a good clinician will ponder the pathophysiological options.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872160/pdf/nihms107315.pdf
|
| Inyección intradural accidental durante el intento de bloqueo peridural. Informe de un caso |
Accidental intradural injection during attempted epidural block -A case report-.
Yun JS, Kang SY, Cho JS, Choi JB, Lee YW.
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):205-8. doi: 10.4097/kjae.2011.60.3.205. Epub 2011 Mar 30.
Abstract
Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071485/pdf/kjae-60-205.pdf
|
| ¿Bloqueo subdural complicando anestesia espinal? |
Subdural Block Complicating Spinal Anesthesia?
Baljit Singh, MD and Puneet Sharma, MD
Anesth Analg 2002;94:1007-9.
IMPLICATIONS:Features suggestive of subdural block appeared after an apparently normal subarachnoid block. The long bevel of the reusable Quincke-type spinal needle may have contributed to the development of this complication. We propose that spinal needles should have a smaller bevel to minimize the possibility of such a complication.
Spread of local anesthetic in the subdural space, as a complication of epidural anesthesia, is well known. It can be clinically diagnosed or at least strongly suspected on the basis of characteristic features of extensive spread, slow onset of neural block, relative lack of sympathetic block, progressive respiratory depression, and incoordination, rather than apnea (1). We report a case of probable subdural block as a complication of subarachnoid anesthesia. Leak of local anesthetic into the subdural space during subarachnoid injection of local anesthetic has not been reported.
http://www.anesthesia-analgesia.org/content/94/4/1007.full.pdf
|
|
No hay comentarios:
Publicar un comentario