Neurological complications of central nerve blocks

Renck, H.

doi:10.1111/j.1399-6576.1995.tb04188.x

Cited by 132 publications

(56 citation statements)

References 60 publications

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“…Spinal and extraspinal operations, which may create a contiguous port of entry for micro-organisms into the epidural space or lead to hematogenous seeding, and especially anesthesiological procedures may favor the development of SEA. Although spinal anesthesia [76,174] and lumbar puncture in children with bacteremia [369] can lead to the development of bacterial meningitis, most authors agree that the risk of infection following nerve block anesthesia near the spinal cord should not be overestimated [78,119,157,257,290,302,337,360,376,377]. Spinal epidural abscess is generally thought to be a "very rare, severe complication" [302] of central nerve blocks.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

“…Case reports and case series from 1954 to 1997 were statistically evaluated with respect to epidemiology, comorbidity factors, symptomatology, causative infectious agents, diagnostic and therapeutic procedures, and outcome of treatment. Several excellent review articles on the neurologic complications following central nerve block including epidural anesthesia have been published [25,274,290,302,376,377]. In addition, the literature review of Michel et al [241] from 1997 offers an up-to-date synopsis of the relationship between epidural anesthesia and SEA.…”

Section: Introductionmentioning

confidence: 99%

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Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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Spinal epidural abscess (SEA) was first described in the medical literature in 1761 and represents a severe, generally pyogenic infection of the epidural space requiring emergent neurosurgical intervention to avoid permanent neurologic deficits. Spinal epidural abscess comprises 0.2 to 2 cases per 10,000 hospital admissions. This review intends to offer detailed evaluation and a comprehensive meta-analysis of the international literature on SEA between 1954 and 1997, especially of patients who developed it following anesthetic procedures in the spinal canal. In this period, 915 cases of SEA were published. This review is the most comprehensive literature analysis on SEA to date. Most cases of SEA occur in patients aged 30 to 60 years, but the youngest patient was only 10 days old and the oldest was 87. The ratio of men to women was 1:0.56. The most common risk factor was diabetes mellitus, followed by trauma, intravenous drug abuse, and alcoholism. Epidural anesthesia or analgesia had been performed in 5.5% of the patients with SEA. Skin abscesses and furuncles were the most common source of infection. Of the patients, 71% had back pain as the initial symptom and 66% had fever. The second stage of radicular irritation is followed by the third stage, with beginning neurological deficit including muscle weakness and sphincter incontinence as well as sensory deficits. Paralysis (the fourth stage) affected only 34% of the patients. The average leukocyte count was 15,700/microl (range 1,500-42,000/microl), and the average erythrocyte sedimentation rate was 77 mm in the first hour (range 2-50 mm). Spinal epidural abscess is primarily a bacterial infection, and the gram-positive Staphylococcus aureus is its most common causative agent. This is true also for patients who develop SEA following spinal anesthetics. Magnetic resonance imaging (MRI) displays the greatest diagnostic accuracy and is the method of first choice in the diagnostic process. Myelography, commonly used previously to diagnose SEA, is no longer recommended. Lumbar puncture to determine cerebrospinal fluid protein concentrations is not needed for diagnosis and entails the risk of spreading bacteria into the subarachnoid space with consequent meningitis; therefore, it should not be performed. The therapeutic method of choice is laminectomy combined with antibiotics. Conservative treatment alone is justifiable only for specific indications. Laminotomy is a therapeutic alternative for children. The mortality of SEA dropped from 34% in the period of 1954-1960 to 15% in 1991-1997. At the beginning of the twentieth century, almost all patients with SEA died. Parallel to improvements in the mortality rate, today more patients experience complete recovery from SEA. The prognosis of patients who develop SEA following epidural anesthesia or analgesia is not better than that of patients with noniatrogenic SEA, and the mortality rate is also comparable. The essential problem of SEA lies in the necessity of early diagnosis, because only timely treatment is able to av...

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Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spinal epidural abscess: a meta-analysis of 915 patients

Waldbaur²,

2000

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“…Although the incidence of such complications is not reflected in this study, neurological injury is extremely rare. [16][17] According to several large studies published at least 20 yr ago, the reported frequency of persistent sensory and motor deficits following spinal anesthesia in approximately 50,000 patients ranged from 0.005% to 0.7%. [18][19][20] Over the years, this safety record of spinal anesthesia has not changed, with reported incidences of 0.08% to 0.12% according to three recent large studies involving more than 50,000 patients.…”

Section: Neuraxial Blocksmentioning

confidence: 99%

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Peng

Smedstad

2000

Can J Anesth/J Can Anesth

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Purpose: To review the pattern of malpractice litigation related to regional anesthesia in Canada. Source: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997.Principal Findings: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. Conclusion:Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.Objectif : Revoir les accusations pour faute professionnelle concernant l'anesthésie régionale au Canada. Source : L'Association canadienne de protection médicale (ACPM) a fourni les renseignements au sujet de toutes les réclamations réglées de 1990 à 1997 qui concernaient l'anesthésie.Constatations principales : De 1990 à 1997 il y a eu 7 909 poursuites judiciaires réglées qui impliquaient des membres de l'ACPM (56 000). De ce nombre, 61 cas étaient liés à l'anesthésie régionale, donc environ 20 % des 310 cas touchant des anesthésiologistes. Dans 42 cas, il s'agissait de blocs neuraxiaux et l'issue de la poursuite a été favorable (action rejetée ou jugement en faveur du médecin accusé) dans 37 cas. Dans 19 cas, c'était des blocs nerveux périphériques. Toutes ces poursuites ont été favorables aux médecins. Globalement, 10 % des réclamations liées à l'anesthésie régionale ont été défavorables contre 28 % de toutes les réclamations anesthésiques et 30 % de celles des membres de l'ACPM. Le degré d'invalidité concernant l'anesthésie régionale ont été : aucun, 10 %; mineur, 49 %; majeur, 36 %; catastrophique, 5 %. Aucun décès n'est lié aux poursuites pour faute professionnelle dans des cas d'anesthésie régionale, à comparer à 17 % dans tous les groupes d'anesthésie et 11 % des réclamations parmi tous les membres. Conclusion :De toutes les réclamations concernant l'anesthésie au Canada, 20 % sont reliées à l'anesthésie régionale. L'issue de ces poursuites est favorable aux médecins dans 90 % des cas. Des résultats cliniques défa-vorables sont liés à des lésions catastrophiques ou majeures. Auc...

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“…27 Continuous infusions of opiates must be especially discouraged as these are associated with parmobilisation. Neurological complications are fortunately rare, 76 as are infections in the epidural space, ticularly long periods of apnoea and very severe arterial desaturations. 50 even though all the natural barriers are breached.…”

Section: -74mentioning

confidence: 99%

Prevention of respiratory complications after abdominal surgery

Richardson¹,

Sabanathan²

1997

Thorax

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Objective. To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus (BMJ 1996;312:148-53) Postoperative respiratory morbidity continues to be a tention), a stiffened abdominal wall and, possibly, diaphragmatic dysfunction. 1 These pathophysiological major factor in the utilisation of resources and maintenance of hospitalisation after major surgery. The inchanges underpin the events in the immediate postoperative period and morbidity and mortality depend troductory article draws attention to this but, as the aetiology, prevention and management are multiupon their severity. The main factor behind all these events, and the one which is most amenable to modfactorial, the approach of this review to this subject has been broadened. ulation, is severe postoperative pain. This discussion paper will review the effects of an The incidence of pulmonary complications is higher after upper abdominal or chest surgery than operations abdominal incision, its analgesic management, and postoperative physiotherapy on the generation of poston other parts of the body. These wounds produce a severe and prolonged alteration in pulmonary mechoperative respiratory complications. anics.1 Impaired ventilation and ineffective expectoration result in a postoperative failure of expansion or progression of collapse of lung segments, thereby encouraging infection. The ensuing shunt with venous Effects of anaesthesia and an abdominal incision on pulmonary physiology admixture results in hypoxaemia. Postoperative oxygen supply may therefore falter while oxygen demands are Some great minds have pondered the problem of postoperative complications. Pasteur, Haldane and Beecher increased due to metabolic hypermetabolism and hypercatabolism of the neuroendocrine stress response to were all convinced of the importance of active collapse of the lung after abdominal operations with shallow trauma.2 At the same time the work of breathing is increased due to the need for increased alveolar ventbreathing as the major cause of postoperative hypoxia and pulmonary complications.3-5

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Neurological complications of central nerve blocks

Cited by 132 publications

References 60 publications

Spinal epidural abscess: a meta-analysis of 915 patients

Spinal epidural abscess: a meta-analysis of 915 patients

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims

Prevention of respiratory complications after abdominal surgery

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