| Inicio súbito de bloqueo subaracnoideo después de cateterización subdural. ¿Un caso de ruptura de aracnoides? |
Sudden onset of subarachnoid block after subdural catheterization: a case of arachnoid rupture?
D W Elliott, F Voyvodic and P Brownridge
Br. J. Anaesth. (1996) 76 (2): 322-324. doi: 10.1093/bja/76.2.322
We describe a patient who received an apparently uneventful extradural block in labour but developed rapid extension of neural block within minutes of receiving her first incremental dose 2 h later. Computed contrast tomography revealed radio-opaque dye within both the subdural and subarachnoid spaces, but none within the extradural space. This case report demonstrates that subdural spread of low-dose local anaesthetics is not always clinically distinguishable from extradural analgesia and that the arachnoid membrane may subsequently perforate with potentially serious consequences.
http://bja.oxfordjournals.org/content/76/2/322.full.pdf
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| Afasia transitoria despues de anestesia raquídea en un paciente ortopédico |
Transient aphasia following spinal anaesthesia in an orthopaedic patient
Bindra Tripat, Gupta Ruchi, Thukral Sonika
South Afr J Anaesth Anlg 2012; 18(6): 346-347
Abstract
A 50-year-old male [American Society of Anesthesiologists (ASA) grade II] was scheduled for lower limb orthopaedic surgery. The subarachnoid space was localised with difficulty at L3/4 interspace and 3 ml of hyperbaric bupivacaine was given. Within a few minutes, the patient developed aphasia with a very high sensory block extending to C2 dermatome, followed by apnoea. The patient remained haemodynamically stable throughout surgery and respiration resumed within five minutes. Inadvertent subdural deposition of local anaesthetic was speculated to be the cause of this unusual presentation.
http://www.sajaa.co.za/index.php/sajaa/article/view/984/1177
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| Presentación rara de bloqueo subdural accidental en anestesia epidural para parto |
Case Report: Rare Presentations of Accidental Subdural Block in Labor Epidural Anesthesia
Song, Shah & Ramachandran
Open Journal of Anesthesiology, 2012, 2, 142-145
Abstract
The incidence of accidental injection or catheterization of the subdural space during performance of a neuroaxial block has recently increased. It can occur even when an experienced practitioner performs the neuraxial procedure. The presentation of numerous unexplainable clinical signs in the process of continuous epidural anesthesia, which do not fit the clinical picture of subarachnoid or intravascular injection, should envoke a high suspicion for unintentional subdural block. We report two cases of patients who achieved prolonged labor analgesia via epidural technique with only half the initial loading dose of local anesthetic. Both patients also had short episodes of hypotension. Additionally, one patient presented with severe hypoxemia and mild motor block of both upper and lower extremities. The other patient presented with transit unresponsiveness without motor block. Both patients rapidly responded to vasopressors. Desaturation in one patient, however, was persistent lasting for more than four hours. Her bedside chest X-ray was inconclusive "possible pulmonary edema" and the follow up Chest CT Scan on the second day revealed aspiration pneumonia. Based on the clinical findings, these two cases were suggestive of subdural block with cranial nerve involvement.
http://www.scirp.org/journal/PaperInformation.aspx?paperID=22246
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| Bloqueo subdural-otros puntos |
Subdural block-further points
Anaesthesia, 1994, Volume 49, pages 794-795
Summary
An obstetric epidural performed for analgesia showed a changing pattern of neurological block. The original features suggestive of a subdural block were complicated when aspiration of cerebrospinal fluid from the catheter became possible. Subsequent management as a continuous subarachnoid catheter allowed delivery.
Keywords: Anaesthetic techniques, regional;epidural. Complications;subdural; hypotension
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1994.tb04455.x/pdf
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