sábado, 5 de abril de 2014

Paro cardiaco y raquia/Cardiac arrest and spinal anesthesia

Paro cardiaco no anticipado en anestesia raquídea: Un misterio no evitable con revisión de la literautra

Unanticipated cardiac arrest under spinal anesthesia: An unavoidable mystery with review of current literature.
Kumari A, Gupta R, Bajwa SS, Singh A.
Anesth Essays Res [serial online] 2014 [cited 2014 Mar 15];8:99-102.
Cardiac arrest during anesthesia and perioperative period is a matter of grave concern for any anesthesiologist. But such mishaps have been reported for one reason or the other in the literary sciences. We are reporting the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in two young and healthy patients. Fortunately, these patients were successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. Occurrence of such cases needs timely reporting and exploring all the possible causes of these unusual and possibly avoidable events. The present case reports are an important addition to a series of recently published mishaps that occurred during spinal anesthesia in young and healthy patients.
Keywords: Asystole, bradycardia, cardiac arrest, spinal anesthesia


Reanimación totalmente exitosa a pesar de un paro cardíaco prolongado

Fully successful resuscitation despite prolonged cardiac arrest.
Asadi HK, Pollard J.
Saudi J Anaesth. 2011 Jul;5(3):314-6. doi: 10.4103/1658-354X.84109.
Sudden cardiac arrest following spinal anesthesia is a relatively common and often fatal complication. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring and prompt intervention at the first sign of cardiovascular instability should improve outcomes.
KEYWORDS: Anesthesia-spinal, heart arrest, resuscitation


Paro cardiaco después de raquianestesia en Tahilandia. 
Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40,271 anesthetics.
Charuluxananan S, Thienthong S, Rungreungvanich M, Chanchayanon T, Chinachoti T, Kyokong O, Punjasawadwong Y.
Anesth Analg. 2008 Nov;107(5):1735-41. doi: 10.1213/ane.0b013e31817bd143.
BACKGROUND AND OBJECTIVES: As part of the Thai Anesthesia Incidents Study of anesthetic adverse outcomes, we evaluated the incidence and factors related to cardiac arrest during spinal anesthesia. METHODS: During a 12-mo period (March 1, 2003, to February 28, 2004), a prospective, multicenter registry of patients receiving anesthesia was initiated in 20 hospitals (7 university, 5 tertiary, 4 general, and 4 district hospitals) across Thailand. Anesthesia personnel reported patient-, surgery-, and anesthetic-related variables and adverse outcomes, including cardiac arrest during spinal anesthesia (defined as the time period from induction of spinal anesthesia until the end of operation). Adverse event specific forms were recorded within 24 h of an anesthetic procedure whenever a specific adverse event occurred. Univariate and multivariate analysis were used to identify factors related to cardiac arrest during spinal anesthesia. A P value <0.05 was considered significant. RESULTS: In the registry of 40,271 cases of spinal anesthesia, there were 11 cardiac arrests, corresponding to an incidence of 2.73 (95% CI: 1.12-4.34) per 10,000 anesthetics. The mortality rate was 90.9% among patients who arrested. Among 11 patients who arrested, there were 5 cases of cesarean delivery and 6 cases of extremity surgery, including hip surgery. In 4 patients (36.3%), the anesthetic contributed directly to the arrest (high sympathetectomy, local anesthetic overdose, or lack of electrocardiography monitoring), whereas some arrests were associated with specific events (cementing of prosthesis, massive bleeding, suspected pulmonary embolism, and suspected myocardial infarction). From multivariate analysis, the risks of cardiac arrest during anesthesia were shorter stature (odds ratio 0.944 [95% CI: 0.938-0.951], P < 0.001), longer duration of surgery (odds ratio 1.003 [95% CI: 1.001-1.005], P = 0.002), and spinal anesthesia administered by the surgeon (odd ratio 23.508 [95% CI: 6.112-90.415], P < 0.001), respectively. CONCLUSION:The incidence of cardiac arrest during spinal anesthesia was infrequent, but was associated with a high mortality rate. If the surgeon performed the spinal anesthetic, this was a significant factor associated with cardiac arrest. Increasing the number of anesthesiologists, improving monitoring guidelines for spinal anesthesia and improving the nurse-anesthetist training program may decrease the frequency of arrest and/or improve patient outcome.


Anestesiología y Medicina del Dolor

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