Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000100011
Brazilian Journal of Anesthesiology
Review Article

Falhas na anestesia subaracnóidea

Failure of subarachnoid blocks

Hugo Praxedes; Antonio Leite Oliva Filho

http://dx.doi.org/10.1590/S0034-70942010000100011 Braz J Anesthesiol, vol.60, n1, p.90-97, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Desde Bier, é descrita falha de anestesia subaracnóidea que causa desconforto ao paciente e que ocorre, eventualmente, mesmo diante de profissionais hábeis que a tenham conduzido de forma tecnicamente correta. Há variação, no entanto, de conceito de falha e, principalmente, de identificação precisa de causas. O objetivo do trabalho é identificar melhor as causas deste desconforto por meio de revisão sistemática de publicações com casuística significativa. CONTEÚDO: Dividiu-se a análise em três tópicos: anatomia e suas variações; o agente anestésico, que trata da seleção do agente, suas soluções e adições, de forma a atingir o resultado mais apropriado à intervenção cirúrgica proposta; e a dose, discutindo-se concentração, volume ou dose gravimétrica, no sentido de obter resultado mais adequado tanto no que diz respeito à intensidade do bloqueio quanto à sua duração. CONCLUSÕES: As falhas são mais afeitas a fatores técnicos: avaliação anatômica adequada, escolha criteriosa da agulha e do local da punção, cuidados no armazenamento dos agentes, adequação de dose, baricidade, além de posicionamento correto do paciente durante e após punção, tudo adequado ao objetivo cirúrgico.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Due to the discomfort caused to patients, failure of subarachnoid blocks that happen occasionally even when properly conducted be the most capable professionals have been described since Bier. However, the concept of failure and especially identification of the causes vary. The objective of this report was to identify the causes of this discomfort through a systematic review of publications with a significant number of patients. CONTENTS: The analysis was divided in three topics: anatomy and its variations; anesthetic agent, focusing on drug selection, its solutions, and additions to achieve the most appropriate result of the proposed surgery; and the dose, discussing concentration, volume, or gravimetric dose, to obtain the most adequate result regarding the intensity of the blockade and its duration. CONCLUSIONS: Failures are more commonly secondary to technical factors: adequate anatomic assessment, judicious choice of the needle and puncture site, care when storing the drugs, dose adequacy, and baricity, besides proper patient positioning during and after the puncture, and they all should be adequate for the surgical objective.

Keywords

ANESTHETIC TECHNIQUE, Regional, COMPLICATIONS, COMPLICATIONS

References

Bier A. Versuche über kokainiserung des ruchenmarkes. Dtsche Z Chir. 1899;51:361-9.

Di Cianni S, Rossi M, Casati A. Spinal anesthesia: an evergreen technique. Acta Biomed Ateneo Parmense. 2008;79:9-17.

Munhall RJ, Sukhani R, Winnie AP. Incidence and etiology of failed spinal anesthetics in a university hospital: a prospective study. Anesth Analg. 1988;67:843-848.

Moore DC, Bridenbaugh LD, Bagdi PA. The present status of spinal (subarachnoid) and epidural (peridural) block: a comparison of the two technics. Anesth Analg. 1968;47:40-49.

Moore DC. Spinal anesthesia: bupivacaine compared with tetracaine. Anesth Analg. 1980;59:743-750.

Levy JH, Islas JA, Ghia JN. A retrospective study of the incidence and causes of failed spinal anesthetics in a university hospital. Anesth Analg. 1985;64:705-710.

Manchikanti L, Hadley C, Markwell SJ. A retrospective analysis of failed spinal anesthetic attempts in a community hospital. Anesth Analg. 1987;66:363-366.

Tarkkila PJ. Incidence and causes of failed spinal anesthetics in a university hospital: a prospective study. Reg Anesth. 1991;16:48-51.

Imbelloni LE, Sobral MGC, Carneiro ANG. Incidência e causas de falhas em anestesia subaracnóidea em hospital particular: estudo prospectivo. Rev Bras Anestesiol. 1995;45:159-164.

Hoppe J, Popham P. Complete failure of spinal anaesthesia in obstetrics. Int J Obstet Anesth. 2007;16:250-255.

Lorenzo AV. Falhas da raquianestesia. Rev Bras Anestesiol. 1978;28:347-358.

Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94:888-906.

Carpenter RL, Hogan QH, Liu SS. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology. 1998;89:24-29.

Hirabayashi Y, Fukuda H, Saitoh K. Failed spinal anaesthesia: cause identified by MRI. Can J Anaesth. 1996;43:1072-1075.

Harris A, Goldberg LG. Spinal anaesthesia with nupercaine and procaine: a comparative study. Ann Surg. 1931;94:934-938.

Ruben JE, Kistler EM. An evaluation of hypobaric pontocaine for spinal anesthesia with a report of 200 cases. Anesthesiology. 1949;10:621-64.

Adams BW. Lignocaine spinal analgesia in transurethral prostatectomy. Anaesthesia. 1956;11:297-302.

Bouchacourt V. Causas de fallas del bloqueo subaracnóideo; formas de evitarlas. Anest Analg Reanim. 2005;20:31-37.

Stienstra R, Veering BT. Intrathecal drug spread: is it controllable?. Reg Anesth Pain Med. 1998;23:347-351.

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