1/11. 'Shared spinal cord' scenario: paraplegia following abdominal aortic surgery under combined general and epidural anaesthesia.Serious neurological complications of abdominal aortic vascular surgery are rare but devastating for all involved. When epidural blockade is part of the anaesthetic technique such complications may be attributed to needles, catheters or drugs. We present a patient who developed paraplegia following an elective abdominal aortic aneurysm repair. Continuous epidural blockade was part of the anaesthetic technique and postoperative analgesia. In this case the spinal cord damage was explained by ischaemia caused by the aortic surgery. This event has made us aware of a rare complication associated with abdominal aortic surgery and highlighted safety aspects of epidural anaesthesia in such patients.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/11. Local anaesthesia for laminectomy surgery.Neurosurgical patients presenting for laminectomy surgery may have premorbid pathology that either contraindicates general anaesthesia or at least represents a significant risk to the patient. We present a sample case from a series of ten patients in whom laminectomy surgery was performed under local anaesthesia. The mean duration of surgery was 98 minutes and the average dose of lignocaine used was 1.91 mg/kg and, therefore, within safe limits. One patient was converted to a general anaesthetic. We believe that local anaesthesia can offer a safe and satisfactory alternative, in patients who may otherwise be denied surgery. The additional advantage of awake neuro-monitoring, may also reduce the risk of inadvertant spinal cord injury.- - - - - - - - - - ranking = 1.4keywords = anaesthesia (Clic here for more details about this article) |
3/11. Damage to the conus medullaris following spinal anaesthesia.Seven cases are described in which neurological damage followed spinal or combined spinal-epidural anaesthesia using an atraumatic spinal needle. All patients were women, six obstetric and one surgical. All experienced pain during insertion of the needle, which was usually believed to be introduced at the L2-3 interspace. In all cases, there was free flow of cerebrospinal fluid before spinal injection. There was one patchy block but, in the rest, anaesthesia was successful. Unilateral sensory loss at the levels of L4-S1 (and sometimes pain) persisted in all patients; there was foot drop in six and urinary symptoms in three. magnetic resonance imaging showed a spinal cord of normal length with a syrinx in the conus (n = 6) on the same side as both the persisting clinical deficit and the symptoms that had occurred at insertion of the needle. The tip of the conus usually lies at L1-2, although it may extend further. Tuffier's line is an unreliable method of identifying the lumbar interspaces, and anaesthetists commonly select a space that is one or more segments higher than they assume. Because of these sources of error, anaesthetists need to relearn the rule that a spinal needle should not be inserted above L3.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
4/11. syringomyelia and pregnancy-case report.The course of a pregnancy in a woman with syringomyelia is presented. She was first admitted at 28 weeks' gestation suffering neurologic symptoms associated with a spinal cord injury, which had happened in the past. The disease was diagnosed with a magnetic resonance imaging (MRI). Delivery was accomplished by elective caesarean section under general anaesthesia at 37 weeks, in order to avoid straining during the second stage of an imminent labour.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/11. Post-operative paraplegia following spinal cord infarction.Thoracic epidural analgesia is a frequently utilised technique. Neurological complications are uncommon, but of grave consequence with significant morbidity. Spinal cord infarction following epidural anaesthesia is rare. We present a case where a hypertensive patient underwent an elective sigmoid colectomy under combined general/epidural anaesthesia for a suspected malignant abdominal mass. An epidural infusion was used for intra-operative and post-operative analgesia. During surgery, the blood pressure was labile and she was hypotensive. Postoperatively, the patient became confused, pyrexial and tachycardic and developed systemic inflammatory response syndrome requiring intensive care management. She developed a flaccid paralysis at L3 level with areflexia, analgesia and impaired sensation. A spinal cord infarct in the region of the conus extending into the thoracic cord was diagnosed. Complications of epidural anaesthesia are easily recognised when they develop immediately; their relationship to the anaesthesia and the post-operative period may be misjudged or underestimated when they appear after a delay, if neurological signs are masked by lack of patient cooperation and drowsiness or if the epidural anaesthesia is prolonged by long-acting drugs. New neurological deficits should be evaluated promptly to document the evolving neurological status and further testing or intervention should be arranged if appropriate. The association with epidural anaesthesia as a cause of paraplegia is reviewed. The aetiological factors that may have contributed to this tragic neurological complication are discussed.- - - - - - - - - - ranking = 1.2keywords = anaesthesia (Clic here for more details about this article) |
6/11. Obstetrical anaesthesia and analgesia in chronic spinal cord-injured women.Improved acute and rehabilitative care and emphasis on integrating patients into society after spinal cord injury is likely to result in increasing numbers of cord-injured women presenting for obstetrical care. Anaesthetists providing care to these women should be familiar with the complications resulting from chronic cord injury and aware that many may be aggravated by the physiological changes of normal pregnancy. These complications include reduced respiratory volumes and reserve, decreased blood pressure and an increased incidence of thromboembolic phenomena, anaemia and recurrent urinary tract infections. patients with cord lesions above the T5 spinal level are at risk for the life-threatening complication of autonomic hyperreflexia (AH) which results from the loss of central regulation of the sympathetic nervous system below the level of the lesion. Sympathetic hyperactivity and hypertension result in response to noxious stimuli entering the cord below the level of the lesion. Labour appears to be a particularly noxious stimulus and patients with injuries above T5 are at risk for AH during labour even if they have not had previous AH episodes. morbidity is related to the degree of hypertension and intracranial haemorrhage has been reported during labour and attributed to AH. We report our experience in providing care to three parturients with spinal cord injuries. Two patients had high cervical lesions, one of whom experienced AH during labour and was treated with an epidural block. The second was at risk for AH having had episodes in the past and received an epidural block to provide prophylaxis for AH. In both cases epidural blockade provided effective treatment and prophylaxis for AH.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
7/11. Perioperative autonomic hyperreflexia in high spinal cord lesions: a case report.We report the case of a 20-year-old man with serious perioperative attacks of autonomic hyperreflexia starting during urological surgery 14 months after a complete C6-C7 spinal cord injury. The intraoperative attacks were controlled by deepening the level of anaesthesia, while the postoperative attacks were treated with emepronium bromide. A brief discussion of the pathophysiology and treatment is given.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/11. accidents following extradural analgesia in children. The results of a retrospective study.A retrospective multicentre study of the complications observed after regional anaesthesia in children was undertaken in 1991 at the request of the association of Anesthesistes-Reanimateurs Pediatriques d'Expression Francaise (ADARPEF). The incidence of accidents seen in the study was comparable to that found in the literature. Five cases which were exceptional due to the severity of the sequelae have been analysed separately. Different pathophysiological mechanisms are proposed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
9/11. Autonomic hyperreflexia during labour.We present two cases of automatic hyperreflexia (AH) during labour in women with spinal cord damage, in whom AH developed before and after delivery. The AH was successfully controlled using epidural anaesthesia in Case #1, but failed in Case #2. The blood pressure was controlled with nicardipine. However, overdose of nicardipine produces vasodilation and its side effects include headache, flushing and palpitation similar to AH. Considering these effects, we recommend epidural anaesthesia to control AH, because epidural anaesthesia does not only reduce BP, but also blocks the noxious stimuli and relieves the symptoms of AH. Our experience suggests that the epidural catheter can be placed two to three weeks before the date of predicted childbirth, because the onset of labour in a patient with spinal cord damage is difficult to predict and can proceed very rapidly. Also, the epidural catheter is available after the delivery. We recommended the epidural catheter is maintained for 24-48 hr postpartum.- - - - - - - - - - ranking = 0.6keywords = anaesthesia (Clic here for more details about this article) |
10/11. Intravenous salbutamol treatment for penile erection arising during cystoscopy of cervical spinal cord injury patients.Two patients with long-standing tetraplegia after spinal cord injury developed reflex penile erection in the operation theatre. One had not received any anaesthesia, and penile erection occurred after introduction of the cystoscope into the urethra, and also autonomic dysreflexia. Intravenous salbutamol, in a dose of 10 micrograms, produced immediate and persistent penile detumescence and salbutamol-induced fall in blood pressure was of therapeutic value. In the second patient, penile erection occurred during general anaesthesia prior to cystoscopy. Immediate and persistent penile detumescence was achieved with intravenous salbutamol 20 micrograms. There was transient fall of blood pressure which responded to intravenous infusion of 0.9% sodium chloride. Salbutamol-induced fall in blood pressure is of therapeutic value in those spinal cord injury patients who develop, in addition to penile erection, autonomic dysreflexia precipitated by urethral instrumentation, or bladder distension with the irrigating fluid. Intravenous salbutamol is preferable to intra-cavernosal phenylephrine, noradrenaline, metaraminol, and epinephrine, or intravenous ephedrine which are contraindicated in patients with hypertension.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
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