Parada cardiorrespiratória em raquianestesia

Juliana Arruda Godoy Limongi; Rossana Sant

doi:10.1590/S0034-70942011000100012

Review Article

Parada cardiorrespiratória em raquianestesia

Cardiopulmonary arrest in spinal anesthesia

Juliana Arruda Godoy Limongi; Rossana Sant'Anna de Melo Lins

http://dx.doi.org/10.1590/S0034-70942011000100012 Braz J Anesthesiol, vol.61, n1, p.115-120, 2011

PDF

Downloads: 7

Resumo

JUSTIFICATIVA E OBJETIVOS: A raquianestesia faz parte do dia a dia de inúmeros anestesiologistas. É considerada bastante segura, embora existam algumas complicações relacionadas a essa técnica, dentre as quais a mais temida é a ocorrência de parada cardiorrespiratória (PCR). A incidência real de PCR relacionada à raquianestesia, bem como sua etiologia, ainda não estão completamente elucidadas, o que motivou a realização deste artigo. CONTEÚDO: Foram revisados artigos publicados, nos últimos vinte anos, em revistas indexadas ao Medline e em um livro-texto. O propósito desta revisão foi identificar a incidência de PCR relacionada à anestesia subaracnoidea e a etiologia desses casos. Procurou-se também identificar eventuais fatores de risco. Por fim, as estratégias de tratamento descritas na literatura foram revisadas a fim de se determinar a melhor conduta diante de um caso de PCR no curso de bloqueio espinhal. CONCLUSÕES: A incidência de PCR relacionada à raquianestesia é bastante variável, e parece ser menor quando comparada à anestesia geral. No passado, acreditava-se que a PCR era decorrente de hipoxemia, relacionada, principalmente, à sedação excessiva. Entretanto, hoje se sabe que a PCR no curso de um bloqueio subaracnoideo tem etiologia cardiocirculatória, relacionada principalmente à redução da pré-carga resultante do bloqueio simpático. Existem também outros fatores que aumentam o risco para o desenvolvimento de PCR, dentre os quais merecem relevância: alterações no posicionamento do paciente e hipovolemia. Em relação ao tratamento, está bem sedimentado que o mais importante é que seja instituído precocemente. Além de um agente vagolítico, deve-se lançar mão precocemente de um simpaticomimético, em especial adrenalina, a fim de minimizar os danos para o paciente.

Palavras-chave

COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Spinal anesthesia is an integral part of the daily routine of countless anesthesiologists. It is considered to be a safe procedure, although some complications related to this technique, among them the most feared is cardiopulmonary arrest (cardiac arrest, CA), do exist. The real incidence of CA related to spinal anesthesia, as well as its etiology, is not known and has motivated this review article. CONTENTS: Articles published in the last twenty years in Medline indexed journals and in a textbook were reviewed. The objective of the present review was to identify the incidence of spinal block anesthesia-related CA and the etiology of those cases. We also tried to identify possible risk factors. Finally, treatment strategies described in the literature were reviewed in order to determine the best conduct when facing a case of CA during spinal anesthesia. CONCLUSIONS: The incidence of spinal anesthesia-related CA varies, and it seems to be lower when compared to that of general anesthesia. In the past, it was believed that CA was due to hypoxemia related especially to excessive sedation. However, nowadays, it is known that the etiology of CA during spinal block anesthesia is related to cardiocirculatory factors, mainly a reduction of preload resulting from sympathetic blockade. Other factors that increase the risk of developing CA also exist. Among those factors, the following should be mentioned: changes in patient positioning and hypovolemia. It is very important to institute treatment as soon as possible. Besides a vagolytic agent, early use of a sympathomimetic drug, especially adrenaline, is also recommended to minimize damage to the patient.

Keywords

Anesthesia, Spinal, Bradycardia, Heart arrest, Intraoperative Complications

References

Carpenter RL, Caplan RA, Brown DL. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-916.

Mordecai MM, Brull SJ. Spinal anesthesia. Curr Opin Anaesthesiol. 2005;18:527-533.

Lovstad RZ, Granhus G, Hetland S. Bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases. Acta Anaesthesiol Scand. 2000;44:48-52.

Pollard JB. Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesth Analg. 2001;92:252-256.

Koop SL, Horlocker TT, Warner ME. Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival. Anesth Analg. 2005;100:855-865.

Newland MC, Ellis SJ, Lydiatt CA. Anesthetic-related cardiac arrest and its mortality: a report covering 72,959 anesthetics over 10 years from a US Teaching Hospital. Anesthesiology. 2002;97:108-115.

Lee LA, Posner KL, Domino KB. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claim analysis. Anesthesiology. 2004;101:143-152.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-486.

Auroy Y, Benhamou D, Bargues L. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274-1280.

Charuluxananan S, Thiethong S, Rungreungvanich T. Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40,271 anesthetics. Anesth Analg. 2008;107:1735-1741.

Garat J, Barreiro G. Parada cardíaca inesperada em anestesia. Rev Bras Anestesiol. 1993;43:119-127.

Sprung J, Warner ME, Contreras MG. Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518,294 patients at a tertiary referral center. Anesthesiology. 2003;99:259-69.

Zuercher M, Ummenhofer W. Cardiac arrest during anesthesia. Curr Opin Crit Care. 2008;14:269-274.

Biboulet P, Aubas P, Dubourdieu J. Fatal and non fatal cardiac arrests related to anesthesia. Can J Anaesth. 2001;48:326-332.

Chan RPC, Auler Jr JOC. Estudo retrospectivo da incidência de óbitos anestésico-cirúrgicos nas primeiras 24 horas: Revisão de 82.641 anestesias. Rev Bras Anestesiol. 2002;52:719-727.

Braz JRC, Silva ACM, Carlos E. Parada cardíaca durante anestesia em hospital universitário de atendimento terciário (1988 a 1996). Rev Bras Anestesiol. 1999;49:257-262.

Caplan RA, Ward RJ, Posner K. Unexpected cardiac arrest during spinal anesthesia: a closed claim analysis of predisposing factors. Anesthesiology. 1988;68:5-11.

Butterworth J. Physiology of spinal anesthesia: what are the implications for management?. Reg Anesth Pain Med. 1998;23:370-373.

Liguori GA, Sharrock NE. Asystole and severe bradycardia during epidural anesthesia in orthopedic patients. Anesthesiology. 1997;86:250-257.

Geffin B, Shapiro L. Sinus bradicardia and asystole during spinal and epidural anesthesia: a report of 13 cases. J Clin Anesth. 1998;10:278-285.

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

Mackey DC, Carpenter RL, Thompson GE. Bradycardia and asystole during spinal anesthesia: a report of three cases without morbidity. Anesthesiology. 1989;70:866-868.

Jordi EM, Marsch SCU, Strebel S. Third degree heart block and asystole associated with spinal anesthesia. Anesthesiology. 1998;89:257-260.

Jones JR. Cardiac arrest during spinal anesthesia. IV. Anesthesiology. 1988;68.

Bernards CM. Epidural and Spinal Anesthesia. Clinical Anesthesia. 2006:691-717.

Pollard JB. Common mechanisms and strategies for prevention and treatment of cardiac arrest during epidural anesthesia. J Clin Anesth. 2002;14:52-56.

Cooper JM. Cardiac arrest during spinal anesthesia. Anesth Analg. 2001;93.

Gratadour P, Viale JP, Parlow J. Sympathovagal effects of spinal anesthesia assessed by the spontaneous cardiac baroreflex. Anesthesiology. 1997;87:1359-1367.

Thrust DN, Downs JB. Vagotonia and cardiac arrest during spinal anesthesia. Anesthesiology. 1999;91:1171-1173.

McConaghie I. Vasovagal asystole during spinal anesthesia. Anaesthesia. 1991;46:281-282.

Pollard JB. Can we explain the high incidence of cardiac arrest during spinal anesthesia for hip surgery?. Anesthesiology. 2003;99:754-755.

Auroy Y, Benhamou D. Can we explain the high incidence of cardiac arrest during spinal anesthesia for hip surgery?: In reply. Anesthesiology. 2003;99.

Brown DL, Carpenter RL, Moore DC. Cardiac arrest during spinal anesthesia. III. Anesthesiology. 1988;68:971-972.

Pollard J. Cardiac arrest during spinal anesthesia. Anesth Analg. 2001;93.

Frerichs RL, Campbell J, Bassell GM. Psychogenic cardiac arrest during extensive sympathetic blockade. Anesthesiology. 1988;68:943-944.

Rosenberg JM, Wahr JA, Sung HC. Coronary perfusion pressure during cardiopulmonary resuscitation after spinal anesthesia in dogs. Anesth Analg. 1996;82:84-87.

Rosenberg JM, Wortsman J, Wahr JA. Impaired neuroendocrine response mediates refractoriness to cardiopulmonary resuscitation in spinal anesthesia. Crit Care Med. 1998;26:533-537.

Pollard JB. High incidence of cardiac arrest following spinal anesthesia. Anesthesiology. 2002;96:515-516.

Parada cardiorrespiratória em raquianestesia

Cardiopulmonary arrest in spinal anesthesia

Juliana Arruda Godoy Limongi; Rossana Sant'Anna de Melo Lins

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol