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Facial paresis and low frequency hearing loss was observed 16 days after spinal anaesthesia in a 22 years old male patient. Both disturbances disappeared within a short time of bed rest as the only therapy. The hearing loss showed the typical picture which we have observed in the last few years as a complication of spinal anaesthesia. The facial paresis which appeared at the same time could well be caused by low of cerebrospinal fluid pressure due to leakage via the puncture hole.
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PMID:[Transient low frequency hearing loss and facial paralysis following spinal anesthesia. A case report]. 405 Nov 68

1. Perfusion of 1% procaine into the cerebral ventricles of conscious dogs produced mild paresis, defaecation, vomiting, jerky movements of eyelids, brisk nystagmus, increase in amplitude of respiration and sometimes loss of consciousness. Procaine 2% produced paralysis, loss of consciousness and sometimes respiratory depression.2. Procaine 2% perfused into the cerebral ventricles of dogs under chloralose anaesthesia produced an initial increase in amplitude of respiration, which preceded its final depression, which is due primarily to procaine and only partly to a change in pH.3. The site of action for the initial increase in amplitude of respiration was in the fourth ventricle, for it did not occur on perfusion of procaine into the cranial subarachnoid space.4. Perfusion of spinal subarachnoid space with procaine is enough to cause respiratory failure even when the procaine does not reach the medulla.
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PMID:Procaine perfused into cerebral ventricles and subarachnoid space in conscious and anaesthetized dogs. 568 94

Experimental downer cows were produced by maintaining healthy cows in sternal recumbency for 6, 9, or 12 hours with the right pelvic limb positioned under the body. Halothane anesthesia was used to create this artificial parturient paresis-like position. In 8 of 16 experiments, cows were able to stand within 3 hours after anesthesia, but the others remained recumbent until death or euthanasia. There was no correlation between duration of the treatment and ability to stand after enforced recumbency. The appearance of the right pelvic limb of downer cows resembled the injured limbs of human patients with compartmental/crush syndrome, as well as the limbs of clinical downer cows. The affected limbs were swollen and held in rigid extension. Some animals which were able to stand also had swollen right pelvic limbs. Systemic signs of crush syndrome included dark yellow or brown urine suggestive of myoglobinuria, and marked elevation of serum creatine kinase enzyme levels. Highest creatine kinase levels were observed at 24 hours in the ambulatory group and at 48 hours in the downer group. Necropsy of downer animals revealed ischemic necrosis of the caudal thigh muscles and inflammation of the sciatic nerve caudal to the proximal end of the femur. Evidence of peroneal nerve damage was observed in at least 9 animals.
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PMID:The role of pressure damage in pathogenesis of the downer cow syndrome. 692 Feb 48

The anaesthesiological problems related to prolonged reconstructive plastic surgery in 22 patients were investigated in retrospect. Surgery consisted mainly of reconstructions, including microvascularization (7 emergency reimplantations, 15 plastic reconstructions), and the duration of the balanced anaesthesias varied between 5 h 10 min and 15 h 35 min. As the patients were relatively young and healthy, no serious cardiovascular complications occurred. Blood loss was intentionally replaced with dextran, in most instances, and in a group of 15 elective patients, mean haematocrit level decreased from 0.41 to 0.31 during surgery. In about half of the material, the central temperature was monitored; it remained within 35.8-38 degrees C. In the longest anaesthesia (15 h 35 min) the temperature stayed within 0.4 degrees C, the patient placed on a heating mattress. In 2 patients, transient paresis of the muscles of the hand, which was exposed and abducted for i.v. infusion and blood pressure recording, was observed. A questionnaire was sent to the patients and 19 of 20 responded. The predominant subjective complaint was nausea, while sensations following catheterization of the bladder were also a common untoward recollection. One patient developed laryngeal oedema after extubation and about a third experienced breathing difficulties on awakening from the anaesthesia. Postoperative pain appeared not to be a significant problem.
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PMID:Anaesthesia for patients undergoing prolonged reconstructive and microvascular plastic surgery. 715 5

A 50-year-old man had an inguinal hernia repair under spinal anaesthesia with bupivacaine. On the 2nd postoperative day, he complained of backache and paresis at the posterior part of the lower extremities, well relieved by non-steroidal anti-inflammatory drugs. On the 6th postoperative day, he came back to hospital, because of low back pain associated with a heavy feet sensation. The hypothesis of a neurological complication of the spinal anaesthesia was considered. The interview of the patient revealed a history of lumbar disk disease, not reported during the preoperative visit. After an in depth clinical examination, two causes seemed possible: subarachnoid haematoma and lumbar disk protusion. Against the first diagnosis were the initial clinical signs. However, in many cases, objective neurological deficit arise too late to allow efficient neurosurgical treatment. Thus, a MRI examination was performed which is non invasive in comparison with a computed tomography myelogram. In our patient, it did not detect a true lumbar disk protusion, but a simple degenerative disease of the L5-S1 disk. In suppressing the lumbar lordosis, spinal anaesthesia probably allowed a distension of spinal capsules and tendons, responsible for the troubles.
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PMID:[Delayed low back pain after spinal anesthesia]. 748 83

Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the pathoanatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accommodative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.
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PMID:Volkmann's ischemic contracture of the foot and ankle: evaluation and treatment of established deformity. 755 Sep 46

Axillary block is a common anesthetic technique for operations on the hand and forearm. In our hospital, with many trainees in anaesthesia, only 250-300 axillary blocks per year are performed by about 30 colleagues. This implies a small number of blocks for each anaesthetist. The present study was designed to assess whether it is possible to teach this technique and use it with an adequate degree of success under these conditions. We used a nerve stimulator and studied whether the success of the block under these conditions is independent of anaesthetist's experience in this technique. Furthermore, we examined other factors involved in the success of the block. METHODS. The study included 112 patients subjected to elective surgery of the upper extremity; all received an axillary block. We used a nerve stimulator and injected mepivacaine 1% without adrenaline. The following parameters were recorded: the number of blocks to date performed by the anaesthetist; the minimal current required for nerve stimulation; the dose of local anaesthetic; the time between the end of injection and the beginning of surgery; the quality of sensory and motor blockade after 10, 20, and 30 min. Sensory blockade was assessed by the pinprick method (no blockade, analgesia, anaesthesia); motor blockade was judged by comparing the muscle strength of both arms (no blockade, paresis, paralysis). Data were analyzed using the Mann-Whitney test, with P < 0.05 considered statistically significant. RESULTS. Of the 112 blocks, 95 (85%) were successful; 17 (15%) failed and the patients required general anaesthesia. Eight of the successful blocks showed a decrease in analgesic quality after > or = 70 min and required additional analgesics or general anaesthesia. We found no correlation between the experience of the anaesthetist and the success of the block. The minimal required current for nerve stimulation in the success group was 0.4 mA and differed significantly from the value of 0.6 mA in the failure group (Table 3). The dose of mepivacaine was higher in the success group (5.9 vs. 5.3 mg/kg). Complete sensory blockade was more frequently achieved for the median, ulnar, and radial nerves than for the musculocutaneus and cutaneous brachii medialis (Fig. 3). The frequency of complete sensory blockade (anaesthesia) had increased by 21.9% between the 20th and 30th min. Complete motor blockade was less often achieved than sensory blockade (Fig. 4). CONCLUSIONS. Using the method of electrostimulation, the axillary block is an appropriate anaesthetic technique that can be applied in a hospital where each anaesthetist only occasionally performs it. Prior to injection of the local anaesthetic, the current for nerve stimulation should be reduced to < 0.5 mA. The time between the end of injection and the beginning of surgery should be no less than 30 min because complete sensory blockade can more often be achieved. The dose of mepivacaine should be no less than 6 mg/kg body weight.
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PMID:[Axillary blockade of the brachial plexus. A prospective study of blockade success using electric nerve stimulation]. 771 18

Damage to a plexus or peripheral nerve is a rare and avoidable complication of surgical anesthesia. We reviewed 2,750 case histories of patients who underwent surgery between 1985 and 1992, finding 6 cases of nerve lesions presenting postoperatively. Sequelae involved 1 abdomino-genital neuralgia, 1 case of post-epidural radicular pain, 2 cases of peroneal nerve palsies and 2 of cubital paresis. Three of these cases were related to position during surgery, 1 to position during a prolonged period in bed in the intensive care unit, 1 to the anesthetic technique and 1 to surgical manipulation. Our data are important given the difficulty of studying the incidence of such cases due to patient dispersion and the loss of records of possible occurrences. The mechanisms by which lesions are produced are sometimes difficult to pinpoint but all are generally preventable.
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PMID:[Postoperative lesions of the peripheral nerves. 8 years' analysis]. 777 80

We report the case of a 3 year old boy who developed cardiac arrest during general anesthesia, immediately after the subcutaneous administration of hydrogen peroxide solution. Massive pulmonary embolization was hypothesized as the postoperative ECG showed an acute heart strain. However the occurrence of transient anisocoria, associated with a paresis affecting the left arm, remained unexplained. Since brain MR did not reveal any pathological data, a direct toxicity of hydrogen peroxide on a limited area of the CNS could be assumed.
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PMID:[Severe pulmonary gas embolism caused by intraoperative administration of hydrogen peroxide]. 780 Jan 88

A study was performed to compare the follow-up results of superficial temporal artery-middle cerebral artery anastomosis between a group of nine elderly patients (aged 70 years or over) and another group of 24 non-elderly patients (aged less than 70 years) with cerebral ischemia. The 33 patients, comprising 26 males and seven females, were evaluated pre- and postoperatively by four-vessel angiography, CT scan, MRI and cerebral blood flow (CBF) examination using either xenon inhalation or 123I-IMP SPECT. In some patients, additional evaluations were done. For those with dementia, the minimental scale (MMS), P300 event-related potential, the Hachinski ischemia score, and the vowel word counting test (Kaneko's KANAHIROI) were used, and for the hemiplegic, the Barthel index indicating ability of daily life (ADL) was employed. The results of follow-up for periods ranging from 12 to 55 months were "excellent" (returned to previous job) or "good" (able to perform self-care) in 27 of the 33 patients (81.8%) including six (66.6%) of the elderly group and 21 (87.5%) of the non-elderly group. There was no significant difference between the two groups by statistical evaluation. Among the nine patients with dementia (five under 70, four 70 years of age or over), eight (four under 70, four 70 or over) showed "rapid recovery" with improved postoperative MMS, P300, vowel word counting score and CBF. One patient under 70 (Case 5; a 47-year-old male) with a delayed 2-day recovery from general anesthesia, took as long as 6 months to obtain the self-care ability in daily life. Excluding this patient, all of the remaining eight patients responded quickly to surgery and were able to go home with their families after 2 to 4 weeks, there being no significant difference between the two age groups. In the 14 patients with hemiplegia/paresis (nine under 70, five 70 or over), a definitely better result was obtained for the non-elderly group. Eight of the nine non-elderly patients (89%) showed full ADL (Barthel index 100), whereas only one of three elderly patients (33.3%) showed almost full ADL (Barthel index 97). In five progressive stroke patients, (three under 70, two 70 or over) ultra-early bypass was performed within 8 hours postictus. Definitely better results were obtained in the patients aged less than 70, who showed rapid recovery and were able to return to their previous jobs 1 to 3 months after surgery. In contrast, the two patients aged 70 or over showed no improvement. In this report, we discuss the clinical and physiological variables that may be important for selection of elderly patients for cerebrovascular bypass surgery.
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PMID:[Results of superficial temporal artery-middle cerebral artery anastomosis for elderly and non-elderly patients with cerebral ischemia]. 782 13


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