Incidence and Etiology of Failed Spinal Anesthetics in a University Hospital

Munhall, Robert J.; Sukhani, Radha; Winnie, Alon P.

doi:10.1213/00000539-198809000-00008

Cited by 81 publications

(50 citation statements)

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“…Notably, all the spinal inductions at L2-L3 were successful, while a failure rate of 14.2% and 10.5% was observed with use of L3-L4 and L4-L5, respectively. This is consistent with the study by Munhall et al, 21 where 0.0% failure rate was noted when L2-L3 was used compared with a failure rate of 7.3% at L4-L5. Patients who achieved a block height of T8-T10 had 100% failure rate, while 33.3% and 1.3% failure rates were seen at block heights T6-T7 and T4-T5 respectively.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa

Alabi

Adeniyi

Adeleke

et al. 2017

South African Family Practice

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Section: Discussionsupporting

confidence: 92%

“…There are mixed reports in the literature concerning the association of free flow of CSF and FSA. Munhall et al 21 reported a lack of correlation between the free flow of CSF and FSA while Levy et al 22 reported a significantly higher failure rate among patients who had a dry tap of CSF.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa

Alabi

Adeniyi

Adeleke

et al. 2017

South African Family Practice

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“…1,2 This may be due in part to the fact that the vast majority of anesthesiologists master the conventional surface landmark-based techniques for spinal anesthesia with success rates approaching 96%. 3 In addition, there is less familiarity and greater perceived difficulty of spinal sonoanatomy compared with sonoanatomy for other blocks. 4,5 Recently, a novel SonixGPS TM electromagnetic needle tracking system (Ultrasonix, Richmond, BC, Canada) that provides a real-time display of current and projected needle tip positions has been approved by Health Canada for US-guided needle interventions.…”

Section: Résumé Objectif Le Sonixgpsmentioning

confidence: 99%

Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series

Brinkmann

Tang

Sawka

et al. 2013

Can J Anesth/J Can Anesth

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Purpose The SonixGPS TM is a novel needle tracking system that has recently been approved in Canada for ultrasound-guided needle interventions. It allows optimization of needle-beam alignment by providing a real-time display of current and predicted needle tip position. Currently, there is limited evidence on the effectiveness of this technique for performance of realtime spinal anesthesia. This case series reports performance of the SonixGPS system for real-time ultrasound-guided spinal anesthesia in elective patients scheduled for joint arthroplasty. Methods In this single-centre case series, 20 American Society of Anesthesiologists' class I-II patients scheduled for lower limb joint arthroplasty were recruited to undergo real-time ultrasound-guided spinal anesthesia with the SonixGPS after written informed consent. The primary outcome for this clinical cases series was the success rate of spinal anesthesia, and the main secondary outcome was time required to perform spinal anesthesia. Results Successful spinal anesthesia for joint arthroplasty was achieved in 18/20 patients, and 17 of these required only a single skin puncture. In 7/20 (35%) patients, dural puncture was achieved on the first needle pass, and in 11/20 (55%) patients, dural puncture was achieved with two or three needle redirections. Median (range) time taken to perform the block was 8 (5-14) min. The study procedure was aborted in two cases because our clinical protocol dictated using a standard approach if spinal anesthesia was unsuccessful after three ultrasound-guided insertion attempts. These two cases were classified as failures. No complications, including paresthesia, were observed during the procedure. All patients with successful spinal anesthesia found the technique acceptable and were willing to undergo a repeat procedure if deemed necessary. Conclusions This case series shows that real-time ultrasound-guided spinal anesthesia with the SonixGPS system is possible within an acceptable time frame. It proved effective with a low rate of failure and a low rate of complications. Our clinical experience suggests that a randomized trial is warranted to compare the SonixGPS with a standard block technique. Résumé Objectif Le SonixGPSTM est un système innovant de suivi de l'aiguille récemment approuvé au Canada pour les interventions échoguidées réalisées avec une aiguille. Cet appareil optimise l'alignement entre l'aiguille et le faisceau grâce à un affichage en temps réel du positionnement actuel et prévu de la pointe de l'aiguille. À l'heure actuelle, les données probantes concernant l'efficacité de cette technique pour réaliser une rachianesthésie en temps réel sont limitées. Cette série de cas porte sur la performance du système SonixGPS pour réaliser une rachianesthésie échoguidée en temps réel chez des patients devant subir une chirurgie non urgente d'arthroplastie.

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“…Most anesthesiologists believe that the incidence of spinal anesthesia failure is extremely low, but this varies widely among studies and has been reported to be as high as 17% [5]. However, with careful attention, anesthesiologists can avoid expectable failure and drop, lowering the incidence of spinal anesthe- sia failure to about 4% [6]. There are several causes of the failure: unsuccessful lumbar punctures, solution injection errors, inadequate intrathecal spreads, ineffective drug actions, and inadequate management [7].…”

Section: Discussionmentioning

confidence: 99%

Spinal anesthesia in a patient with postoperative iatrogenic pseudomeningocele - A case report -

Lee

Choi

et al. 2018

Anesth Pain Med

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Spinal anesthesia was introduced more than 100 years ago and is one of the most reliable regional anesthetic methods. CASE REPORTA 67-year-old, 148 cm, 75 kg female was admitted for right total knee arthroplasty. She was diagnosed with diabetes mellitus 10 years ago, and hypertension five years ago. The Although spinal anesthesia is one of the most reliable anesthetic techniques in clinical practice, failures may occur in daily practice at rare occasions. Their causes are diverse and they include anatomical structural variations. In particular, postoperative anatomical changes often occur in patients who have undergone spine surgery and may cause failures of spinal anesthesia. Postoperative pseudomeningocele constitutes extradural cerebrospinal fluid collected from a dural tear and it is considered a very rare complication of spine surgery. We describe the case where a patient with unexpected postoperative iatrogenic pseudomeningocele received lower extremity surgery under spinal anesthesia.

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Incidence and Etiology of Failed Spinal Anesthetics in a University Hospital

Cited by 81 publications

References 0 publications

Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa

Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa

Single-operator real-time ultrasound-guided spinal injection using SonixGPS™: a case series

Spinal anesthesia in a patient with postoperative iatrogenic pseudomeningocele - A case report -

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