sábado, 26 de octubre de 2013

Resistencia a los anestésicos locales/Local anaesthetics resistance

Resistencia a los anestésicos locales en una embarazada con plexopatía lumbosacra

Local anesthetic resistance in a pregnant patient with lumbosacral plexopathy.
Kavlock R, Ting PH.
Department of Anesthesiology, University of Virginia Health Center, Charlottesville, Virginia, USA. pht5d@virginia.edu
BMC Anesthesiol. 2004 Jan 16;4(1):1.
BACKGROUND: We report a case of a patient with apparent resistance to local anesthetics. While similar cases of failure of regional anesthetics are often attributed to technical failure, the overall clinical presentation and history of this patient suggests a true resistance to local anesthetics. CASE PRESENTATION: This patient presented for elective cesarean section and the decision for regional anesthesia was made. While attempting to place an epidural, the patient failed to achieve adequate skin analgesia despite multiple attempts at local infiltration. When a spinal was ultimately placed, sensory or motor blockade was not obtained despite no evidence of technical problems with technique. Further questioning revealed multiple prior episodes of local anesthetic failure in this patient. CONCLUSIONS:While the failure rate of spinal anesthesia has been shown range from 4-13% and is often attributed to technical failure, elements of this particular case suggest a true resistance to local anesthetics.

Efecto de la mordedura (s) previa de alacrán sobre la acción de bupivacaína intratecal. Estudio de caso

Effect of previous scorpion bite(s) on the action of intrathecal bupivacaine: A case control study.
Panditrao MM, Panditrao MM, Sunilkumar V, Panditrao AM.
Department of Anaesthesiology and Intensive Care, Padmashree Dr. Vithalrao Vikhe Patil Foundation's Medical College and Hospital, Vilad Ghat, Ahmednagar, Maharashtra, India.
Indian J Anaesth. 2013 May;57(3):236-40. doi: 10.4103/0019-5049.115593.
BACKGROUND: During the routine practice in the institution, it was observed that there were persistent incidents of inadequate/failed spinal anaesthesia in patients with a history of single or multiple scorpion bite/s. To test any possible correlation between scorpion bite and the altered response to spinal anaesthesia, a case control study was conducted involving patients with a history of scorpion bite/s and without such a history. METHODS: Randomly selected 70 (n=70) patients of either sex and age range of 18-80 years, were divided into two equal groups, giving past history of one or multiple scorpion bites and giving no such a history. The anaesthetic management was identical inclusive of subarachnoid block with 3.5 ml. 0.5% bupivacaine heavy. The onsets of sensory, motor and peaks of sensory and motor blocks were observed with the pin-prick method and Bromage scale. After waiting for 20 min, if the block was inadequate, then balanced general anaesthesia was administered. The analysis of the data and application of various statistical tests was carried out using Chi-square test, percentages, independent sample t-test and paired t-test. RESULTS: Demographically both groups were comparable. In scorpion bite group, the time of onsets of both sensory and motor blocks and time for the peak of sensory and motor blocks were significantly prolonged, 4 patients had failed/inadequate sensory block and 5 patients hadfailed/inadequate motor block while all the patients in non-bite group had adequate intra-operative block. CONCLUSION: We conclude that there appears to be a direct correlation between the histories of old, single or multiple scorpion bites and development of resistance to effect of local anaesthetics administered intrathecally.
KEYWORDS: Failure of local anaesthetics, history of scorpion bite, randomized case control study, route of administration, subarachnoid block


¿Las mordeduras de alacrán llevan al desarrollo de resistencia al efecto de los anestésicos locales?
Does scorpion bite lead to development of resistance to the effect of local anaesthetics?
Panditrao MM, Panditrao MM, Khan MI, Yadav N.
Department of Anaesthesiology and Intensive Care, Padmashree Dr. Vithalrao Vikhe Patil Foundation's Medical College and Hospital, Vilad Ghat, Ahmednagar, Maharashtra, India.
Indian J Anaesth. 2012 Nov;56(6):575-8. doi: 10.4103/0019-5049.104582.
A patient posted for vaginal hysterectomy was administered subarachnoid block, which failed, so was repeated in one space above. The block failed again, after waiting for 30 min. Patient gave a history of scorpion bite twice, once at the age of 17 years on her right foot and again about 8 months back. Thereafter, balanced general anaesthesia was given. On eighth post-operative day, after explaining about her possible special condition (?Resistance to local anaesthetic agents), the patient was given left median, ulnar and radial nerve blocks at the wrist and local infiltration near the anatomical snuff box. There was neither sensory nor motor block. The scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of 'resistance' to the action of local anaesthetic agents.
KEYWORDS: Resistance to local anaesthetics, scorpion bite, various routes


Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
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