Masui. The Japanese journal of anesthesiology
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Spinal epidural hematoma following neuraxial anesthesia is a rare condition that usually presents with acute and, if any, progressive neurological symptoms including pain, sensory/motor impairment, and bladder/ rectal disturbance. Although possible pathogenesis is mainly considered to be a direct injury of Batson's venous plexus, preoperative coagulation status and anticoagulant therapy also play some role in its development. Therefore, to prevent such a disastrous complication, one must choose an appropriate anesthetic technique and monitor neurological function of the patient at a regular time interval. In addition, it is highly recommended to carefully follow the recently revised regional anesthesia guideline for the patient receiving antithrombotic or thrombolytic therapy, although we still need further understanding and investigation of the complexity around this issue.
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More than one hundred years have passed since Bier first succeeded in spinal anesthesia. Spinal anesthesia now spreads all over the world because it has many advantages. Spinal anesthesia requires both a simple technique and a small volume of drug, produces profound analgesia, and is devoid of systemic pharmacologic side effects. ⋯ Those include cardiac arrest, meningitis, intracranial subdural hematoma, spinal epidural hematoma and cauda equina syndrome. Patients should be informed in detail of the incidence, severity, and outcome of these complications, especially when alternative analgesic methods can be chosen. The prediction, early detection and prompt start of the treatment of the complications after spinal anesthesia are important to minimize the risk of adverse outcome.
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The innovation of ultrasound-guided regional anesthesia technique has enabled the anesthesiologist to secure an accurate needle position and to monitor the distribution of the local anesthetic in real time. However, the evidence is necessary concerning increased benefits and reduced complications compared to conventional guidance techniques. ⋯ Common complications of nerve blocks can be avoided with major principles of ultrasound-guided technique, which involves similar risk of complications and requires similar amount of knowledge for management. It is necessary to establish the recommendations for the scope of practice, teaching curriculum and the opinion for implementing the medical practice of ultrasound-guided regional anesthesia.
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Review Case Reports
[Risk management in regional anesthesia: current trends in medical professional liability insurance].
This article aims to highlight current trends in medical professional liability insurance. We present two cases of the lawsuit associated with regional anesthesia. ⋯ To avoid malpractice risks, it is important to fully understand the risks of this clinical role and how to protect yourself from potential lawsuits. Every anesthesiologist should feel obliged to pay attention to legal questions concerning medical subjects, though judgments on the contents and the extent of the informationthat must be given to patients are complex and difficult to understand for anybody not experienced in law.
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Peripheral nerve block has many advantages in surgical anesthesia with or without general anesthesia; postoperative analgesia, faster postoperative rehabilitation, and chronic pain management. However, serious adverse complications after peripheral nerve block can happen. Therefore, anesthetists should obtain full informed consent for possible complications, and require scrupulous attention to this procedure. This review focuses on complications of brachial plexus block because it is the most popular peripheral nerve block.