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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. General complications include infection, backache, hematoma, and neurological sequelae. Specific complications are all related to catheter use. The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.
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PMID:Complications of continuous spinal anesthesia. 145 49

The production of microcatheters small enough to be threaded through 22- to 26-gauge spinal needles has focused renewed attention on the technique of continuous spinal anesthesia. This technique has a specific combination of advantages which cannot be duplicated by any other method of regional blockade. The most important of these advantages is that sensory blockade can be produced quickly and precisely with small doses of local anesthetic, that the duration of anesthesia can be extended indefinitely, and that recovery is rapid when short-acting local anesthetics are used. Inadequate anesthesia, failure to thread the catheter, catheter breakage, prolonged neurologic deficits (e.g., cauda equina syndrome), and postdural puncture headache are uncommon complications. This installment of the AANA Journal Course will explore the latest developments regarding this emerging regional technique.
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PMID:AANA Journal course. 15: new technologies in anesthesia: update for nurse anesthetists--continuous spinal anesthesia. 189 71

The neurological features of acromegaly are reviewed and two cases are reported. The most common neurological complications of active hypersomatotropism are headache, acroparesthesia and visual disturbance. Primary peripheral neuropathy, myopathy, entrapment myelopathy and/or cauda equina syndrome are uncommon, especially in young acromegalics. It is postulated that peripheral neuropathy in acromegaly is due to the entrapment of a nerve secondary to a soft tissue edematous mechanism by traumatic compression, angulation and/or stretching of the nerve in acquired extraspinal intermuscular, fibrous or osseofibrous tunnel stenosis; and/or in acquired spinal lateral recess stenosis, rather than true primary neuropathic or secondary endocrinological complications of hypersomatotropism. Proximal weakness is more likely arthropathic rather than myopathic, neuropathic or endocrinologic. Differential diagnosis of backache is briefly discussed. Further investigations of the mechanisms and the conservative treatment for neurological involvements in acromegaly are needed.
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PMID:Neurological features of acromegaly: a review and report of two cases. 284 43

Continuous spinal anaesthesia using the incremental technique was used in nineteen high risk patients with multiple medical problems, seventeen of whom were elderly, for lower limb orthopaedic and pelvic surgery. An intrathecal catheter (18G/28G) was inserted under local anaesthesia via the lumbar interspinous space. Spinal anaesthesia was induced with small incremental doses of 0.5% bupivacaine hydrochloride through the intrathecal catheter to achieve the level of analgesia required for surgery. The duration of surgery ranged from 45 to 300 minutes (mean + S.D 100 + 37 min). The initial volume of 0.5% bupivacaine required for surgery ranged from 0.8 ml-2.0 ml (1.2 + 0.7 ml) and the total volume ranged from 0.9 ml to 3.1 ml (mean + S.D 1.4 + 0.7 ml). Haemodynamic stability was well maintained perioperatively. Only two patients required 6 mg of ephedrine and 1 mg of aramine respectively for a greater than 25% reduction in systolic blood pressure with induction of spinal anaesthesia. Intrathecal morphine 0.1-0.3 mg was administered to 15 patients at the end of surgery for postoperative pain relief with good effect. One patient developed late respiratory depression from an inadvertent overdose of intrathecal morphine. No neurological sequelae were noted and no patient developed a postdural puncture headache. The use of the microcatheter was discontinued in the U.S.A and Australia following four case reports of cauda equina syndrome with this technique. Current opinion, however, is that the reported cauda equina syndrome was due to the neurotoxic effects of lignocaine 5% that was used and not due to the microcatheter per se. Continuous spinal anaesthesia is now used widely in Europe when cardiovascular stability is desired in poor risk patients undergoing lower limb and lower abdominal surgery.
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PMID:Continuous spinal anaesthesia--early experience in University Hospital, Kuala Lumpur. 866 64

Recent case reports of cauda equina syndrome after continuous spinal anesthesia have led to a reevaluation of the indications and applications of this regional anesthetic technique. However, few large studies have formally investigated the frequency of neurologic complications using macro- and microcatheter (smaller than 24 gauge) techniques. This retrospective review examines 603 continuous spinal anesthetics, including 127 administered through a 28-gauge microcatheter, performed between June 1987 and May 1992. The surgical procedure was orthopedic in 397 of 476 (83.4%) macrocatheter patients. All microcatheter patients were parturients. Three patients reported pain (persistent paresthesia) postoperatively. In two patients, the symptoms resolved in 4 days; the other patient was discharged 8 days postoperatively with residual foot pain. There was also one patient with aseptic meningitis and one patient with a sensory cauda equina syndrome (still present after 15 mo). There were 58 (9.6%) patients with a postdural puncture headache (PDPH), including 42 of 127 (33.1%) patients in the microcatheter group. An epidural blood patch was performed in 41 (6.8%) patients. The frequency of neurologic complications, excluding PDPH, is similar to those in published reviews. However, PDPH in microcatheter patients is more frequent than previously reported.
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PMID:Neurologic complications of 603 consecutive continuous spinal anesthetics using macrocatheter and microcatheter techniques. Perioperative Outcomes Group. 942 86

Paget's disease of bone is associated with involvement of the central and peripheral nervous system. The brain, spinal cord, cauda equina, spinal roots, and cranial nerves can be affected in Paget's disease due to their anatomic relationship to bone. Neurologic syndromes are uncommon but include headache, dementia, brain stem and cerebellar dysfunction, cranial neuropathies, myelopathy, cauda equina syndrome, and radiculopathies. The central complications result from pagetic involvement of the skull. Expansion of diseased bone can result in compression of cranial nerves as they exit their bony foramina. Softening of the skull leads to basilar invagination with compression of the brain stem, cerebellum, and lower cranial nerves. Brain stem compression can cause hydrocephalus. Rarely, there is direct compression of the brain from acute epidural hematoma or hypertrophy of the calvarium. Myelopathy, cauda equina syndrome, and radiculopathies most commonly result from hypertrophy of the spine with direct compression. Spinal stenosis can also result from ossification of extradural structures or pathologic fractures. Ischemia from vascular compression or a steal syndrome has also been described. Neurologic complications rarely occur due to sarcomatous transformation of pagetic bone. Magnetic resonance imaging (MRI), computerized tomography (CT)-myelography, and bone X-rays are helpful to localize the lesion and direct therapy. Treatment options include surgical decompression, ventricular shunt placement, and medical management with calcitonin and/or the bisphosphonates. The selection of treatment will vary depending upon the rate of progression and the severity of the neurologic deficit.
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PMID:The neurologic complications of Paget's disease. 1051 Feb 21

The complications of failure, neural injury and local anaesthetic toxicity are common to all regional anaesthesia techniques, and individual techniques are associated with specific complications. All potential candidates for regional anaesthesia should be thoroughly evaluated and informed of potential complications. If there is significant risk of injury, then these techniques should be avoided. Central neural blockade (CNB) still accounts for more than 70% of regional anaesthesia procedures. Permanent neurological injury is rare (0.02 to 0.07%); however, transient injuries do occur and are more common (0.01 to 0.8%). Pain on injection and paraesthesiae while performing regional anaesthesia are danger signals of potential injury and must not be ignored. The incidence of systemic toxicity to local anaesthetics has significantly reduced in the past 30 years, from 0.2 to 0.01%. Peripheral nerve blocks are associated with the highest incidence of systemic toxicity (7.5 per 10000) and the lowest incidence of serious neural injury (1.9 per 10000). Intravenous regional anaesthesia is one of the safest and most reliable forms of regional anaesthesia for short procedures on the upper extremity. Brachial plexus anaesthesia is one of the most challenging procedures. Axillary blocks are performed most frequently and are safer than supraclavicular approaches. Ophthalmic surgery is particularly suited to regional anaesthesia. Serious risks include retrobulbar haemorrhage, brain stem anaesthesia and globe perforation, but are uncommon with skilled practitioners. Postdural puncture headache remains a common complication of epidural and spinal anaesthesia; however, the incidence has decreased significantly in the past 2 to 3 decades from 37 to approximately 1%, largely because of advances in needle design. Backache is frequently linked with CNB; however, other causes should also be considered. Duration of surgery, irrespective of the anaesthetic technique, seems to be the most important factor. The syndrome of transient neurological symptoms is a form of backache that is associated with patient position and use of lidocaine (lignocaine). Disturbances of micturition are a common accompaniment of CNB, especially in elderly males. Hypotension is the most common cardiovascular disturbance associated with CNB. Severe bradycardia and even cardiac arrest have been reported in healthy patients following neuraxial anaesthesia, with a reported incidence of cardiac arrest of 6.4 per 10 000 associated with spinal anaesthesia. Prompt diagnosis, immediate cardiopulmonary resuscitation and aggressive vasopressor therapy with epinephrine (adrenaline) are required. New complications of regional anaesthesia emerge occasionally, e.g. cauda equina syndrome with chloroprocaine, microspinal catheters and 5% hyperbaric lidocaine, and epidural haematoma formation in association with low molecular weight heparin. Even so, after 100 years of experience, most discerning physicians appreciate the benefits of regional anaesthesia.
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PMID:Complications of regional anaesthesia Incidence and prevention. 1136 50

The objective of this prospective 18-month study was to evaluate the clinical and laboratory effects of repeated intrathecal injections of chemotherapy in children with acute leukemia. All procedures were performed under general anesthesia, and complications were prospectively recorded. Laboratory measurements included lumbar puncture opening pressure, cerebrospinal fluid (CSF) chemistry, and cell count and morphology. Central venous pressure and ophthalmologic examinations were also performed. Forty-seven children underwent 247 intrathecal injections of chemotherapy. Adverse effects (13.7% of the procedures) included nausea and vomiting, back pain, and headache. One child each had transient cauda equina syndrome, transient communicating hydrocephalus, and persistent sacral plexus injury. The mean lumbar puncture opening pressure was significantly higher after intrathecal therapy than before (22 +/- 8 vs. 15 +/- 9 cm H2O, P = 0.02) and higher than reported in age-matched children without leukemia. All CSF chemistries, cell count, and morphology were normal. The overall incidence of complications was 13.7%. Most were mild and resolved quickly, but significant neurologic complications did occur. Lumbar puncture opening pressure was significantly higher in children with acute leukemia after intrathecal chemotherapy.
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PMID:Prospective evaluation of clinical and laboratory effects of intrathecal chemotherapy on children with acute leukemia. 1595 82

Liposomal cytarabine has been proven to be useful for the prevention and intrathecal treatment of neoplastic meningitis. It has no demonstrable myelosuppressive effects and may therefore be an attractive alternative for prophylaxis and treatment of the central nervous system (CNS) relapse after allogeneic haematopoietic stem cell transplantation (HSCT). The use of liposomal cytarabine had not been reported in HSCT recipients. We retrospectively reviewed the feasibility of liposomal cytarabine in the prophylaxis (n=2) and treatment (n=4) of neoplastic meningitis in a cohort of patients after allogeneic HSCT. This report focusses on neurological complications after intrathecal application of liposomal cytarabine. Mild headache was the most commonly reported adverse event. Two patients experienced sacral radiculopathy with irreversible cauda equina syndrome in one patient. Another patient progressed with pre-existing leukencephalopathy. Intrathecal liposomal cytarabine should be used very cautiously in allogeneic HSCT recipients with a history of CNS complications potentially involving cerebral-spinal fluid circulation, since significant neurotoxicity was observed in patients with extensive CNS-directed pre-treatment. The feasibility and safety of liposomal cytarabine in HSCT recipients has to be evaluated in a prospective study.
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PMID:Neurological complications after intrathecal liposomal cytarabine application in patients after allogeneic haematopoietic stem cell transplantation. 1870 21

Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia was reviewed. Common crisis which is encountered during regional anesthesia includes toxic reaction to local anesthetic drugs, allergic reaction induced by local anesthetic drugs, reaction induced by epinephrine, nerve injury, hematoma etc. Concerning peripheral nerve block, crisis encountered during brachial plexus block, interscalene block and supraclavicular block used for surgical operation of upper extremity was discussed. On the other hands, there are various common crises encountered during epidural anesthesia and spinal anesthesia. These crises include hypotension, bradycardia, total spinal anesthesia, postspinal headache and infection, and hematoma in the spinal canal. Especially, epidural hematoma and epidural abcess have possibility to cause nerve defect symptoms such as motor paralysis and sensory disturbance if appropriate treatment was not started in early stage. Moreover crisis such as cauda equina syndrome and anterior spinal cord syndrome have possibility to remain permanent and hard to cure. We anesthesiologists should make efforts to prevent crisis, to detect crisis in early stage, and to treat it in early stage.
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PMID:[Crisis management during regional anesthesia including peripheral nerve block, epidural anesthesia and spinal anesthesia]. 1946 97


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