Spinal (subarachnoid) block. A review of 11,574 cases

Moore, Daniel C.

doi:10.1001/jama.195.11.907

Cited by 62 publications

(20 citation statements)

References 12 publications

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“…[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. 8,10,11 Similarly, neurological complications following epidural anesthesia, as reviewed by Dawkins three decades ago, are uncommon.…”

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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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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“…The correlation between age and hypotension during SA has been previously reported and is re-emphasized by our fi nding 16 . It ranges from 25 to 82% in the elderly 17,18 . With the combination of fl uids and vasopressors given early at a lower threshold criteria, hypotension was easily controlled and none of our patients suffered myocardial or renal consequences.…”

Section: Discussionmentioning

confidence: 99%

Spinal anaesthesia in elderly for laparoscopic cholecystectomy

Gautam

2018

J. Kathmandu Med. Coll.

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Background: Prevalence of aging patients appearing for laparoscopic cholecystectomy to treat cholelithiasis is ever on the rise. Associated co-morbidities make the elderly prone to peri-operative complications during laparoscopic cholecystectomy performed under general anaesthesia. Objectives: This study aims to assess the safety and applicability of spinal anaesthesia for the elderly undergoing laparoscopic cholecystectomy. Methodology: In this cross-sectional study, fi fty-four patients of age 65 years or more undergoing laparoscopic cholecystectomy were studied. Hyperbaric Bupivacaine 15 milligrams was used in spinal anaesthesia to obtain sensory block to fi fth thoracic dermatome. Local anaesthetics were instilled intra-peritoneally before surgical dissection. Surgery was performed through three ports with carbon dioxide pneumoperitoneum at eight mmHg intra-abdominal pressure. Data included demography, co-morbidities, need for analgesics or general anaesthesia, operative and post-operative complications and hospital stay. Univariate analysis for peri-operative events and bivariate analysis for outcome and explanatory variables were done. Results: The mean age was 71.4 years with co-morbidity in 40 patients. Conversion to open cholecystectomy occurred in three patients necessitating general anaesthesia. Surgery was completed laparoscopically under spinal anaesthesia in remaining 51 patients. Increment in intra-abdominal pressure was required in fi ve patients. Six patients needed analgesics for shoulder pain. Intra-operative hypotension and shivering occurred in 15 and four patients respectively. Post-operatively, urinary retention and nausea occurred in four and three patients respectively. Mean hospital stay was 3.2 days. Conclusion: There is no undue risk in spinal anaesthesia for conducting laparoscopic cholecystectomy in the elderly and it is effi cient for uncomplicated cholelithiasis with minimal modifi cations in surgical technique.

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“…been performed in the past. [2][3][4][5][6][7][8][9] Although a number of beneficial outcomes related to regional anesthesia remain open to debate, it is generally accepted that the analgesia provided is without equal, and benefits to patients with poor respiratory reserve are apparent postoperatively whether or not the technique is combined with general anesthesia. Yet, despite the amount of evidence demonstrating the safety of regional anesthesia as a technique, and indeed attesting to the improved outcome associated with it, 10 many patients continue to regard the technique with some apprehension.…”

Section: Discussionmentioning

confidence: 99%