Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000600003
Brazilian Journal of Anesthesiology
Scientific Article

Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos?

Neurological complications and damage of regional block in children under general anesthesia: a real problem or sporadic cases?

Verônica Vieira da Costa; Mônica Rossi Rodrigues; Maria do Carmo Barretto de Carvalho Fernandes; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942006000600003 Braz J Anesthesiol, vol.56, n6, p.583-590, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: Tem sido discutido se a técnica de anestesia regional em crianças, que na maioria das vezes é realizada após a anestesia geral, é realmente segura. Há o risco potencial de uma lesão neurológica permanente ou temporária quando o paciente não pode informar eventual parestesia ou dor, durante a realização da anestesia regional, o que gera insegurança por parte dos anestesiologistas. O objetivo deste estudo foi avaliar a prevalência de complicações e seqüelas neurológicas da anestesia regional em crianças sob anestesia geral. MÉTODO: Numa análise prospectiva foram estudadas crianças submetidas a intervenções cirúrgicas ortopédica e plástica reparadora sob anestesia regional associada à anestesia geral. A indução e a manutenção da anestesia foram por vias venosa ou inalatória. Após anestesia geral era realizada anestesia regional e avaliada a existência de complicações imediatas, o número de punções realizadas, complicações de médio prazo e presença de seqüelas neurológicas. RESULTADOS: Num período de 13 meses foram estudadas 499 crianças de ambos os sexos, com idade média de 6,7 anos. A maioria dos pacientes foi submetida à anestesia geral associada à peridural lombar ou caudal. A prevalência de complicação imediata foi 3,6%, sendo a mais freqüente o sangramento no momento da punção. A prevalência de complicações em médio prazo foi 1,1%, sendo a mais freqüente a hipoestesia e não houve seqüela neurológica de longo prazo. CONCLUSÕES: Os resultados do presente estudo são concordantes com os de outros autores com relação à baixa prevalência de complicações da anestesia regional em crianças sob anestesia geral, sem deixar seqüelas neurológicas. Isso pode ser atribuído ao uso de material adequado e a experiência da equipe de anestesia.

Palavras-chave

ANESTESIA, Pediátrica, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND METHODS: It has been questioned whether regional block in children, which most of the time is done under general anesthesia, is really safe. There is the potential risk of permanent or temporary neurological damage when the patient cannot complain of eventual paresthesia or pain while the block is being performed, making anesthesiologists very insecure. The aim of this study was to evaluate the prevalence of neurological complications and damage of regional block in children under general anesthesia. METHODS: A prospective analysis of children who underwent orthopedic and reconstructive plastic surgeries under regional block associated with general anesthesia was undertaken. Anesthesia was induced and maintained by the intravenous or inhalational route. Regional block was done after general anesthesia and immediate complications, number of punctures, mean term complications, and the presence of neurological damage were evaluated. RESULTS: Four hundred and forty-nine children, boys and girls, with a mean age of 6,7 years, were evaluated over a 13-month period. The majority of the patients underwent general anesthesia associated with epidural lumbar or caudal block. The prevalence of immediate complications was 3.6% and bleeding at the time of the puncture was the most frequent complication. The prevalence of average term complications was 1.1%, and hyposthesia was the most frequent complication. There was no long-term neurological damage. CONCLUSIONS: The results of this study are similar to those found by other authors regarding the low prevalence of complications of regional block in children under general anesthesia, without the occurrence of permanent neurological damage. This can be attributed to the use of adequate material and the experience of the anesthesia team

Keywords

ANESTHESIA, Pediatric, ANESTHETIC TECHNIQUES, Regional, ANESTHETIC TECHNIQUES, Regional, ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS

References

Bosenberg A. Pediatric regional anesthesia update. Paediatr Anaesth. 2004;14:398-402.

Bosenberg AT, Ivani G. Regional anaesthesia: children are different. Paediatr Anaesth. 1998;8:447-450.

Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia. Reg Anesth Pain Med. 1998;23:104-107.

Krane EJ, Dalens BJ, Murat I. The safety of epidurals placed during general anesthesia. Reg Anesth Pain Med. 1998;23:433-438.

Anand KJ, Carr DB. The neuroanatomy neurophysiology, and neurochemistry of pain, stress and analgesia in newborns and children. Pediatr Clin North Am. 1989;36:795-822.

McNeely JK, Faber NE, Rusy LM. Epidural analgesia improves outcome following pediatric fundoplication: A retrospective analysis. Reg Anesth. 1997;22:16-23.

Ivani G, Tonetti F, Mossetti V. Update on postoperative analgesia in children. Minerva Anestesiol. 2005;71:501-505.

Wood CE, Goresky GV, Klassen KA. Complications of continuous epidural infusions for postoperative analgesia in children. Can J Anaesth. 1994;41:613-620.

Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83:904-912.

Bromage PR. Masked mischief. Reg Anesth. 1996;21:62-63.

Fischer HB. Regional anaesthesia: before or after general anaesthesia?. Anaesthesia. 1998;53:727-729.

Katz N, Hurley R. Epidural anesthesia complicated by fluid collection within the spinal cord. Anesth Analg. 1993;77:1064-1065.

Absalom AR, Martinelli G, Scott NB. Spinal cord injury caused by direct damage by local anaesthetic infiltration needle. Br J Anaesth. 2001;87:512-515.

Kasai T, Yaegashi K, Hirose M. Spinal cord injury in a child caused by an accidental dural puncture with a single-shot thoracic epidural needle. Anesth Analg. 2003;96.

Aldrete JA, Ferrari H. Myelopathy with syringomyelia following thoracic epidural anaesthesia. Anesth Intensive Care. 2004;32:100-103.

Horlocker TT, Abel MD, Messick JM. Small risk of serious neurologic complications related to lumbar epidural catheter placement in anaesthetized patients. Anaesth Analg. 2002;96:1547-1552.

Tsui BC, Armstrong K. Can direct spinal cord injury occur without paresthesia?: A report of delayed spinal cord injury after epidural placement in an awake patient. Anesth Analg. 2005;101:1212-1214.

Martinez-Garcia E, Pelaez E, Roman JC. Transverse myelitis following general and epidural anaesthesia in a paediatric patient. Anaesthesia. 2005;60:921-923.

Drasner K. Thoracic epidural anesthesia: asleep at the wheal?. Anesth Analg. 2004:99.

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