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Potential Neurotoxicity of Lidocaine and Dextrose Solutions Used for Spinal Anesthesia
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
Inadvertent carotid artery puncture is a well-known complication of internal jugular vein cannulation. A case of cerebral infarct subsequent to carotid artery puncture during internal jugular vein cannulation is reported.
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
We report a 27-year-old patient who developed transient bilateral lingual nerve palsy following the use of a laryngeal mask to maintain the airway during a general anaesthetic for arthroscopy of the wrist.
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
We report a case series of five anaemic patients (haemoglobin: 8.7 +/- 0.8 g.dl-1) with chronic obstructive lung disease in whom trials of weaning from the ventilator were unsuccessful. After transfer to our regional weaning centre, blood was transfused to increase the haemoglobin value to 12 g.dl-1 or higher. Subsequently, all patients were weaned successfully. We conclude from our experience that in anaemic patients with chronic obstructive lung disease there should not be a fixed transfusion threshold. In anaemic patients in whom difficulty in weaning from the ventilator is experienced, blood transfusion should be tailored to the individual patient's needs. Transfusion in those with chronic obstructive airways disease may lead to successful weaning.
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
Friedreich's ataxia is an inherited disorder of the nervous system, requiring special care during anaesthesia, because of increased sensitivity to muscle relaxants. We report a case of Friedreich's ataxia in a 31-year-old woman, anaesthetised on two occasions, for tendinoplasty and pes cavus repair. Atracurium was used for neuromuscular blockade and monitored by a train-of-four twitch technique. The patient's response was normal. She returned to adequate spontaneous breathing within 20 min of the last dose of the muscle relaxant without need for anticholinesterase administration. When neuromuscular function is monitored, normal doses of muscle relaxant can safely be used in these patients.
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
We describe a patient admitted to the intensive care unit following a penetrating head injury. This patient developed agranulocytosis and subsequently pancytopenia secondary to an idiosyncratic drug reaction. The possible causative drugs are phenytoin, cloxacillin, ceftriaxone and ceftazidime. The patient was treated with recombinant human granulocyte colony-stimulating factor.
... Some European countries took the advice of the FDA safety alert but other countries, including the United Kingdom, did not. Neurological problems following the use of microcatheters is multifactorial and is thought more likely to be due to potential neurotoxicity from anaesthetic solutions than the catheters themselves [29]. It has also been stated that, although statistics may suggest an association, a causal relationship has not been proven [30]. ...
We present a woman in her first pregnancy, with known aortic stenosis prior to conception, who successfully underwent regional anaesthesia for an elective Caesarean section using a subarachnoid microcatheter. The anaesthetic management of patients with aortic stenosis requiring noncardiac surgery is a complex and contentious matter, particularly when the situation is compounded by the physiological changes accompanying pregnancy and delivery. This is the first reported use of a subarachnoid microcatheter in such a patient. The choice of technique is discussed and compared with other options for providing anaesthesia.
... Betroffen sind überwiegend ältere Patienten. Läsionen unterhalb von L1 können ein Cauda-equina-Syndrom hervorrufen, sie wurden insbesondere im Rahmen der kontinuierlichen SPA mit Mikrokathetern beobachtet ( Rigler et al., 1991;Lambert et al., 1992;Möllmann et al., 1992). ...
Für die unilaterale SPA, insbesondere für die Einflussfaktoren „LA-Dosis“ und „Seitenlagerungsdauer“, existiert bis heute keine einheitliche Vorgehensweise. Insgesamt wurden 128 Patienten erfasst und einer von vier Behandlungsgruppen zugeordnet. Die Gruppen unterschieden sich hinsichtlich der applizierten Bupivacain-Dosis (7,5 versus 10 mg) und der Dauer der Seitenlagerung (10 versus 20 min). Die Ausdehnung der sensorischen Blockade wurde anhand der Qualitäten „Algesie“ und „taktile Ästhesie“ erfasst. Die motorische Blockade wurde mit der modifizierten Bromage-Skala beurteilt. Die Patienten der Gruppen I und II zeigten mit 80% bzw. 74% signifikant häufiger eine streng unilaterale SPA als Patienten der Gruppen III und IV. Ein positiver Einfluss der prolongierten Seitenlagerung ließ sich nicht nachweisen. Es erscheint sinnvoll, die Injektionsdosis der zu erwartenden Operationszeit anzugleichen und bei Operationen von 60 bis 90 Min Dauer die Bupivacain-Dosis von 7,5 mg zu bevorzugen.
This chapter discusses the emergencies that may arise during or consequent upon the administration of regional anaesthesia, including its use in acute pain management. Emergencies in regional anaesthesia may be caused by the drugs used, including additives and preservatives, or the particular regional blocks. Most of the crises that follow regional anaesthesia have the potential for permanent damage to the CNS. The emphasis must be on prevention rather than treatment.
A patient is presented who developed severe pain in both legs, that began 5 h after a spinal anaesthetic with lignocaine 5% in dextrose 7.5%, but lasted for less than 24 h.
The safety of lidocaine spinal anesthesia has recently been called into question by reports of both permanent and transient neurologic toxicity. This study explored the possibility of adapting the longer acting spinal bupivacaine to ambulatory surgery. Sixty patients presenting for ambulatory arthroscopy were randomized to four groups receiving the following spinal anesthetics: Group I (15 mg bupivacaine), 3 mL of 0.5% spinal bupivacaine in 8% dextrose; Group II (10 mg bupivacaine), 2 mL of the 0.5% spinal bupivacaine+1 mL saline; Group III (7.5 mg bupivacaine), 1.5 mL of the 0.5% spinal bupivacaine%1.5 mL saline; Group IV (5 mg bupivacaine), 1 mL of the 0.5% spinal bupivacaine+2 mL saline. Maximum block height was T-5 in Group I versus T-8 in the other groups. Onset times to peak block were similar in all groups and averaged 14 min. Time to two-segment regression, complete regression, micturition, and discharge were significantly reduced from Group I to Group II and from Group II to Group III. Reductions in times between Groups III and IV did not achieve statistical significance. Times from placement of the spinal block until discharge were 471 +/- 35, 260 +/- 15,202 +/- 14, and 181 +/- 8 min, respectively, for the four groups. The intensity of motor block decreased significantly from group to group, such that 13 of the 15 patients in Group IV failed to achieve Bromage level 2 or 3. The intensity of sensory block also decreased from group to group with four patients in Group IV having pain intraoperatively that required further treatment. Therefore, Group III provided the optimum combination of adequate depth of anesthesia and rapid recovery. The results of this study indicate that spinal anesthesia with 7.5 mg of 0.5% bupivacaine in 8% dextrose diluted with an equal volume of saline provides an acceptable spinal anesthetic for ambulatory arthroscopy with a recovery profile appropriate to the ambulatory setting.
Aortic stenosis in pregnancy carries a high fetal and maternal morbidity and mortality. Spinal analgesia/anesthesia is considered by many to be contraindicated in these patients. The rapid onset of sympathetic block induces hypotension, which can result in myocardial hypoperfusion and myocardial ischemia. We describe a case of moderate to severe aortic stenosis, diagnosed during pregnancy, in which pain relief during labor and delivery was managed using a continuous spinal catheter. Pure intrathecal opioid analgesia was used initially to maintain hemodynamic stability. However after two bolus administrations of sufentanil, analgesia was further maintained using ropivacaine and sufentanil. A spinal catheter was chosen to provide reliable anesthesia, which could be extended rapidly for cesarean section.
In the United Kingdom, cardiac disease is the second most common cause of all maternal deaths. The best anaesthetic technique for caesarean section in these patients has yet to be established. We describe a low-dose combined spinal-epidural technique in four high-risk obstetric patients who presented to this unit. Invasive monitoring was used in each case, and drugs with significant cardiovascular effects were avoided or used with extreme caution. Multidisciplinary team involvement, including serial echocardiography in the antenatal period, is strongly recommended.
Bupivacaine is a long-acting amide local anesthetic that was introduced to clinical practice in the early 1980s. Since then it has been extensively used for both peripheral blocks as well as neuraxial blockade in concentrations varying from 0.125% to 0.75%. Despite the relatively narrow safety margin, bupivacaine has become the most frequently used local anesthetic in obstetric anesthesia. It is 95% metabolized in the liver and 5% excreted unchanged in urine. Bupivacaine cardiotoxicity is related to the total dose rather than to the concentration of bupivacaine administered. It produces a dose-dependent delay in the transmission of impulses through the cardiac conduction system by blocking sodium channels. Transient neurologic symptoms (TNS) defined as bilateral symmetrical pain in the lower back and buttocks with radiation to both lower extremities after 5% lidocaine spinal anesthetic was first described by Schneider in 1993. Several studies have failed to show TNS after spinal anesthesia using bupivacaine 0.5% or 0.75%. In the literature there is only 1 case report of TNS after spinal anesthesia using bupivacaine and morphine. The following report describes a case of TNS following spinal anesthesia with bupivacaine 0.75%.
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