Introduction: Most anesthesiologists use the thoracic epidural, with a 0.75% incidence of accidental perforation. However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury. The main objective of this retrospective study was to evaluate the incidence of paresthesia and neurological complications, as well as cardiocirculatory changes after thoracic spinal anesthesia. Methods:We conducted a retrospective audit, between January 2007 and December 2019. We reviewed the record sheets of patients who experienced paresthesia for thoracic spinal anesthesia with two types of needles of the same gauge, isobaric and hyperbaric 0.5% bupivacaine and puncture in the sitting or left lateral position, and median and paramedian insertion.Results: Paresthesias occurred in 5.9% of patients. 41 patients experienced a paresthesia with cut needle compared with 43 patients with pencil point, without statistical difference. All paresthesias were transient, and lasted a maximum of three days. No sequelae neurologic were observed in all patients during this study. Bradycardia occurred in 3.1% of the patients and hypotension in 13.2% of the patients, easily corrected by the use of atropine and vasopressor. Conclusion:All 84 paresthesias observed in this study were associated with free flow of CSF when the stylet was removed from the needles. An association was not found between the type of the spinal needle and the incidence of paresthesias. This study with 1,406 patients showed that thoracic spinal anesthesia is safe and without neurological sequelae, with a puncture between T8 and T11.

There is significant and renewed attentiveness in the use of regional anesthesia techniques for many common surgeries. The vast majority of anesthesiologists world wide use the routinely the hyperbaric solution of bupivacaine for almost all types of surgery. However, they ignore that spinal anesthesia has more to offer. A different kind of technique for a different kind of patients. The understanding of spinal anesthesia in relation to sensory and motor blocks with hyperbaric and isobaric solutions is shown in this article. The possibilities of performing unilateral spinal anesthesia are described. The use of posterior spinal anesthesia shows that it is possible to perform only sensitive spinal anesthesia without motor block.The possibility of using isobaric and hypobaric solutions for different types of surgery has increased considerably. Thoracic spinal anesthesia has been shown feasible and safe for different types of surgeries, and more recently, thoracic continuous spinal anesthesia is being used. This article shows the possibility of performing spinal anesthesia for laparoscopic surgery, thoracic spinal anesthesia, segmental spinal anesthesia and continuous techniques.

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Background: The existence of fine gauge needles with a traumatic bevel, pencil tip type; it is possible to increase the indication of spinal anesthesia in young people and to reduce the incidence of post-puncture headache. We present a case of a post-dural puncture headache occurring after perforation dura mater using a 20-gauge needle introducer for spinal anesthesia with Whitacre needle. Case report: A 34-year-old man (body weight 67 kg, height 176 cm, ASA I) with right femoral diaphysis fracture. After analgesia with inguinal lumbar plexus block, spinal anesthesia using a 20G needle introducer before inserting the 27G Whitacre needle. At first attempt, removal of the Whitacre stylet demonstrated CSF completely filling the needle hub. The introducer needle was withdrawn immediately. New punction was performed at L4-L5 level and single lumbar puncture via median with 27G Whitacre needle through the 20G introducer guide. After dripping of CSF, 15 mg of 0.5% isobaric bupivacaine was administered. After 48 hours the patient reported PHDP. Within three days the postural headache settled with conservative treatment consisting of oral analgesia while maintaining adequate hydration. Conclusions: The introducer needle does carry the risk of accidental dural puncture, and this fact happened in our patient using the 20G introducer of 35 mm in length resulting in severe headache and lasting for three days.

Introduction:In 1860, Albert Niemann isolated cocaine from leaves and reported that by placing the crystals on his tongue, and his tongue became benumb. In the Brazil is a country with greatest annual consumption rates becoming one of the biggest consumer markets of cocaine worldwide. The objective of this study, carried out through a questionnaire survey, was to find out the degree of knowledge of anesthesiologists from a tertiary hospital in their conduct towards a cocaine user. Methods:The study is a research of descriptive exploratory, prospective, transversally cut, quantitative, through the application of a questionnaire in Department of Anesthesia with patients using cocaine. Anesthesiology residents of the hospital were excluded. The questionnaire (Appendix A) was applied from July to December 2020 with four identification questions and five open questions relevant to the objective of the study. To analyze the data, we use Descriptive Statistics graphs to profile the individual surveyed and build their respective distribution. Results:The percentage of response was obtained in 66.6% of the teams, 28 men and 12 women. The duration of anesthesia practice ranged from 1 to 36 years. Of the 40 anesthetists, 75% suspend the surgery and 25% refer them to the operating room. All anesthesiologists find these patients during their month of work. Of the total 95% of anesthesiologists use clinical criteria. Of the 40 anesthetists, 36 believe that the guidelines for anesthesia in cocaine users should be reviewed. Conclusion:Anesthesiologists, as perioperative physicians, have a vital role to play in the comprehensive care in patients with addiction to licit or to illicit drugs. The study showed that anesthesiologists need to be proactive and that there is a need to revise the guidelines for these patients.