The Neurotoxicity of Drugs Given Intrathecally (Spinal)

Hodgson, Peter S.; Neal, Joseph M.; Pollock, Julia E.; Liu, S. S.

doi:10.1097/00132582-199909000-00006

Cited by 17 publications

(22 citation statements)

References 70 publications

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“…Discomfort from TNS is self-limited and can be treated with potent non-steroidal anti-inflammatory drugs (NSAIDs) and trigger point injections. 21 Neurotoxic etiology for TNS remains speculative. Patients reporting TNS do not develop sensory or motor deficits in contrast to cauda equina syndrome.…”

Section: Tnsmentioning

confidence: 99%

“…Sensitive measures of neural electrophysiology (SSEP, EMG, nerve conduction velocity, H reflex, F waves) do not change during TNS as compared to before spinal anesthesia. 22 Laboratory work in both intrathecal and desheathed peripheral nerve models indicate that concentration of lidocaine is a critical factor in the neurotoxicity 21 of desheathed peripheral nerves. Yet, clinical trials report high incidences of TNS (17%) with spinal injection of very dilute lidocaine concentrations (0.5%, 1%) 13 that touch upon the minimal effective concentration for spinal lidocaine (0.0-07%).…”

Section: Tnsmentioning

confidence: 99%

See 1 more Smart Citation

Current issues in spinal anesthesia

Liu

2002

Can J Anesth/J Can Anesth

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PINAL anesthesia is a venerable and simple technique. Technical competence is achieved early during training (> 90% technical success rate) after only 40-70 supervised attempts. 1 Although the ease and long history of spinal anesthesia may give the impression that it is an unsophisticated technique, much has been recently learned regarding the anatomy, physiology, pharmacology, and applications of spinal anesthesia.A An na at to om my y The arachnoid membrane is an important structure, as spinal agents must be delivered within its confines. The arachnoid membrane is composed of overlapping layers of epithelial cells connected by tight junctions. This anatomic arrangement allows the arachnoid membrane, not the dura, to function as the principal meningeal barrier (90% of resistance) to materials crossing in and out of the cerebrospinal fluid (CSF). The arachnoid membrane serves not only as a passive container of CSF but also actively processes and transports agents attempting to cross the meninges. Recent studies demonstrate that metabolic enzymes are expressed in the arachnoid membrane that can affect agents (e.g., epinephrine) and neurotransmitters important for spinal anesthesia (e.g., acetylcholine). 2 Active transport of compounds across the arachnoid membrane occurs in the area of the neural root cuffs where unidirectional transport of materials from the CSF into the epidural space occurs and may contribute to clearance of spinal anesthesia agents. After injection of spinal anesthetics, dilution with the CSF occurs prior to arrival at effector sites in the CNS. Thus, individual variation in lumbosacral volumes of CSF and distribution within this volume will affect spinal anesthesia. Recent imaging with magnetic resonance demonstrates great variability between individuals in volume of lumbosacral CSF with a range of 28-81 mL. Interestingly, obese individuals have substantially less CSF (~10 mL less) that is partly due to compression of the neural foramina. Clinical correlation between volume of lumbosacral CSF and spinal anesthesia with hyperbaric lidocaine and isobaric bupivacaine is excellent with CSF accounting for 80% of the variability for peak block height and regression of sensory and motor block. 3 Unfortunately, volume of lumbosacral CSF does not correlate with external physical measurements other than weight. Thus, CSF volume cannot be easily estimated from physical examination and is not easily applied to the clinical setting. 3 P Ph hy ys si io ol lo og gy y Cardiovascular The most common serious side effects from spinal anesthesia are hypotension and bradycardia, and closed claims surveys of 40,000-550,000 spinal anesthetics indicate an incidence of cardiac arrest from 0.04-10/10,000. 4,5 Large surveillance studies typically observed incidences of hypotension around 33% and bradycardia around 13% in non-obstetrical populations. 4 Risk factors for hypotension in non-obstetrical populations include block height $ T5, age $ 40 yr, baseline systolic blood pressure (SBP) < 120 mmHg, and spinal punctur...

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Section: Tnsmentioning

confidence: 99%

Section: Tnsmentioning

confidence: 99%

Current issues in spinal anesthesia

Liu

2002

Can J Anesth/J Can Anesth

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“…However, the results achieved in studies using ketamine HCl (0.3-0.6 mg/kg/IT) in rats, rabbits, and primates (8,16) have shown that neurotoxicity was at a negligible level. A different study reported that spinal myelopathy developed depending on dosage, but no information has been found regarding nerve damage caused by IT ketamine (17).…”

Section: Discussionmentioning

confidence: 98%

Effects of Intrathecal Administration of Ketamine HCl in Young Calves: A Clinical Trial

Kiliç

Yayla

Kamiloğlu

et al. 2015

Bulletin of the Veterinary Institute in Pulawy

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The purpose of the study was to investigate the clinical, biochemical, and cardiovascular effects of intrathecal (IT) administration of ketamine HCl in calves. The study was performed on seven Simmental and three Montofon calves, 1.70 ± 1.16 weeks old, weighing approximately 37 kg, undergoing surgical procedures including femur fracture repair (one case), atresia anus (five cases), prolapsed rectum (one case), suturing on rear limbs (two cases), and urethrostomy (one case). After administering IT ketamine HCl at a dose of 3 mg/kg to all calves, the level and depth of the anaesthesia was checked with a pinprick test. Each animal was monitored by recording heart rate, arterial blood pressure, respiratory rates, and rectal temperature. Furthermore, certain biochemical parameters, blood gases, oxygen-total haemoglobin, and electrolyte levels were measured. All data were statistically evaluated using Minitab 16 software. Anaesthesia occurred in all calves at an average of 5.00 ± 1.41 min (range: 3-7) and continued for an average of 61.4 ± 40 min (range: 55-70). Sufficient anaesthesia was achieved in all animals for the required operations, and no complications occurred with regard to clinical and haemodynamic measurements. We concluded that in calves, which are not deemed suitable for administration of local anaesthetic via IT due to certain side effects, sufficient anaesthesia can be provided with ketamine by the same method for operations performed in the perineal area and hind extremities, and that this could be a good alternative for anaesthesia under field conditions.

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“…However, since it has undesirable effects such as hypotension, bradycardia, prolonged duration of motor paralysis, cardiotoxicity and central nervous system toxicity, there led to the identification of long acting pure S-enantiomer of ropivacaine. [8][9][10][11][12] Ropivacaine, as compared to bupivacaine, has lower potential for cardiac and central nervous systemic toxic effects and shows greater differentiation between sensory and motor blockade with hemodynamic stability. 13 Ropivacaine is nearly identical to bupivacaine in onset, quality and duration of sensory block, but it produces lesser duration of motor blockade, has a better safety profile.…”

Section: Discussionmentioning

confidence: 99%