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INFLUENCIA DE LAS CARACTERÍSTICAS DE LAS AGUJAS Y DE LOS CATÉTERES EN LA MORBILIDAD PRODUCIDA Y EN LOS FALLOS ANESTÉSICOS
Miguel Ángel Reina, Andrés López, José De Andrés
Servicio de Anestesiología Reanimación y Tratamiento del dolor
Hospital de Móstoles. Hospital Madrid Montepríncipe y Torrelodones, Madrid
Consorcio Hospital General Universitario. VALENCIA
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| Raquia fallida: mecanismos, tratamiento y prevención |
Failed spinal anaesthesia: mechanisms, management, and prevention.
Fettes PD, Jansson JR, Wildsmith JA.
University Department of Anaesthesia, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK. paulfettes@nhs.net
Br J Anaesth. 2009 Jun;102(6):739-48. doi: 10.1093/bja/aep096. Epub 2009 May 6.
Abstract
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 mechanismsof 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.
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