Falha no bloqueio após anestesia subaracnoidea: frequência e fatores contribuintes
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Data
2014-03-13
Autores
Oliveira, Ronaldo Rodrigo de Sá [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Justificativa e Objetivo - A anestesia subaracnoidea é uma das técnicas de anestesia regional mais seguras e utilizadas. Contudo, a possibilidade de falhas há muito reconhecida é, ainda nos dias atuais, problema intrigante. A palavra falha sugere que não houve bloqueio após a introdução do anestésico local no espaço subaracnoideo ou, se o bloqueio ocorreu, ele não foi suficiente para possibilitar a realização da cirurgia. O objetivo deste estudo foi avaliar a incidência de falhas de bloqueio em pacientes submetidos à anestesia subaracnoidea correlacionando-a com os fatores que a desencadearam. Método - Participaram deste estudo prospectivo pacientes com idades superiores a 18 anos submetidos a anestesia subaracnoidea com bupivacaína a 0,5% entre dezembro de 2008 e janeiro de 2011. Foram avaliados o gênero, o índice de massa corporal, o estado físico, a especialidade cirúrgica, o biotipo, as características corporais, a anatomia espinal, a identificação das marcas anatômicas, a capacidade de flexionar a coluna, a posição do paciente no momento da realização do bloqueio, se a posição era adequada, o espaço intervertebral puncionado, a via de abordagem, o número de tentativas para o sucesso da punção, o número de espaços puncionados, o calibre e o tipo da agulha, a presença do liquor no início e no final da injeção do anestésico local, se o mesmo fluiu fácil, a característica do liquor e do anestésico local e a presença de adjuvantes, a experiência do anestesiologista e o trimestre do ano. Foram consideradas falhas as anestesias cujo bloqueio sensitivo e ou motor não se estabeleceu ou se instalou parcialmente após 15 minutos da administração do anestésico local. Quando presentes, as falhas foram caracterizadas como total ou parcial. Sempre que ocorreu falha total foi obrigatória a pesquisa das sensibilidades térmica e dolorosa em área de períneo. Para análise estatística o teste de ...
Background and Objective - Subarachnoid anesthesia is one of the safest and most used regional anesthesia techniques; however, the possibility of failures has long been recognized, and continues to be an intriguing problem to this day. The word failure suggests that no blockade occurred following the introduction of local anesthetics into the subarachnoid space, or when the blockade did occur, it was insufficient to enable surgery. The purpose of this study was to evaluate the incidence of block failure in patients submitted to subarachnoid anesthesia and correlate failure with the factors that triggered it. Method - The study participants were patients aged 18 years-old or over submitted to subarachnoid anesthesia with 0.5% bupivacaine between December 2008 and January 2011. The following factors were evaluated: patient sex, body mass index, physical status, surgical specialty, biotype, body characteristics, spinal anatomy, identification of anatomical markings, the patient’s spinal flexibility, the patient's position at the time of blockade, whether the position was adequate, the intervertebral space punctured, the puncture approach, the number of attempts needed to achieve successful puncture, the number of spaces punctured, the size and type of needle, the presence of cerebrospinal fluid (CSF) at the onset and completion of local anesthetic injection, whether the CSF flowed easily, the characteristics of the CSF and the local anesthetic and the presence of adjuvants, the clinical experience of the anesthesiologist and the time of year. Failure was considered to have occurred when sensory or motor blockade was not established or was partially established 15 min after local anesthetics administration. When present, the failures were characterized as complete or partial. Evaluation of pain and thermal sensitivity in the perineal region was required to define total failures. For statistical analysis, the ...
Background and Objective - Subarachnoid anesthesia is one of the safest and most used regional anesthesia techniques; however, the possibility of failures has long been recognized, and continues to be an intriguing problem to this day. The word failure suggests that no blockade occurred following the introduction of local anesthetics into the subarachnoid space, or when the blockade did occur, it was insufficient to enable surgery. The purpose of this study was to evaluate the incidence of block failure in patients submitted to subarachnoid anesthesia and correlate failure with the factors that triggered it. Method - The study participants were patients aged 18 years-old or over submitted to subarachnoid anesthesia with 0.5% bupivacaine between December 2008 and January 2011. The following factors were evaluated: patient sex, body mass index, physical status, surgical specialty, biotype, body characteristics, spinal anatomy, identification of anatomical markings, the patient’s spinal flexibility, the patient's position at the time of blockade, whether the position was adequate, the intervertebral space punctured, the puncture approach, the number of attempts needed to achieve successful puncture, the number of spaces punctured, the size and type of needle, the presence of cerebrospinal fluid (CSF) at the onset and completion of local anesthetic injection, whether the CSF flowed easily, the characteristics of the CSF and the local anesthetic and the presence of adjuvants, the clinical experience of the anesthesiologist and the time of year. Failure was considered to have occurred when sensory or motor blockade was not established or was partially established 15 min after local anesthetics administration. When present, the failures were characterized as complete or partial. Evaluation of pain and thermal sensitivity in the perineal region was required to define total failures. For statistical analysis, the ...
Descrição
Palavras-chave
Anestesia por condução, Anestesicos, Toxicidade - Testes, Anestesiologia, Conduction anesthesia
Como citar
OLIVEIRA, Ronaldo Rodrigo de Sá. Falha no bloqueio após anestesia subaracnoidea: frequência e fatores contribuintes. 2014. 64 f. Tese (doutorado) - Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2014.