Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Dec 2004
[Accidental intravascular injection of 0.5% ropivacaine during thoracic epidural anesthesia: case reports.].
Ropivacaine was introduced in the clinical practice a little more than 10 years ago, and has been associated to low risk for central nervous system and cardiovascular complications. These reports aimed at presenting a case of cardiac arrest and another one of neurological toxicity after accidental intravascular ropivacaine injection during epidural anesthesia. ⋯ The prompt Identification and treatment of the accidental intravascular injection, as well as ropivacaine pharmacological profile, were decisive in both cases for the satisfactory recovery of our patients.
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Rev Bras Anestesiol · Dec 2004
[Pulmonary edema after topic phenylephrine absorption during pediatric eye surgery: case report.].
Topic phenylephrine solutions are commonly used in eye procedures to promote capillary decongestion or pupil dilation. This article describes a case of severe hypertension followed by pulmonary edema during strabismus correction procedure. Possible cause of this complication might have been systemic absorption of phenylephrine eyedrops. Our objective is to discuss preventive means for such complication as well as the most adequate treatment. ⋯ Topic phenylephrine should be cautiously administered before surgery and the anesthesiologist should be informed so that measures may be taken to prevent systemic absorption of large amounts. If there is absorption, preconized management should be followed, that is, decrease blood pressure without inducing myocardial depression, as it is the case with beta-blockers or calcium channel blockers. Direct action vasodilators, or alpha-blockers, are the options for severe hypertension induced by systemic phenylephrine absorption.
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Rev Bras Anestesiol · Dec 2004
[Preload during spinal anesthesia for cesarean section: comparison between crystalloid and colloid solutions.].
Maternal hypotension is the most common complication following spinal anesthesia for cesarean section. This study aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to cesarean section under spinal anesthesia following preload with either crystalloid or colloid (modified fluid gelatin). ⋯ In the conditions of this study, colloid (modified fluid gelatin) was equivalent to crystalloid (lactate Ringer) in preventing or decreasing the incidence of hypotension in patients submitted to cesarean section under spinal anesthesia.
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There are no statistical data on the use of neuromuscular blockers in Brazil. This study aimed at statistically analyzing this topic. ⋯ Atracurium is the most popular neuromuscular blocker in Brazil; there is a high percentage of succinylcholine usage in non-emergency situations; neuromuscular transmission monitors are seldom used and, as a corollary, there is a significant percentage of clinical criteria to consider patients recovered. We have observed that approximately 30% of anesthesiologists had some type of NMB-related complication.
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Rev Bras Anestesiol · Dec 2004
[Pain during spinal canal puncture and its relationship with ligamentum flavum, dura-mater and posterior longitudinal ligament innervation.].
Pain during spinal puncture is a warning that needle tip has touched a nervous structure. If patients refer pain during puncture, it is mandatory to interrupt the technique. Anesthetic solution should not be injected to prevent potential nervous root or spinal cord injury. Needle should be drawn back and have its direction changed before a new advance is attempted. Pain complain is totally impossible if patients are asleep under the influence of general anesthesia and that is why blockade with conscious patients is advisable. Pain is only referred when needle or catheter tip bypass the medium sagital plane to reach the antero-lateral epidural compartment, thus being able to touch nervous rootlets close to intervertebral foramina. Except for studies on skin, subcutaneous tissue and interspinous ligament innervation, this study aimed at reviewing the innervation of some spinal canal structures, namely, ligamentum flavum, posterior longitudinal ligament, dura-mater and intervertebral disk. ⋯ Ligamentum flavum is not innervated, thus explaining lack of pain during puncture. Other pains during puncture may be attributed to Luschka's nerve, which innervates posterior longitudinal ligament and dural ventral portion.