University:
Michigan State University
Course:
ANES 621 | Concepts in Clinical Anesthesiology I (Interim New)
Academic year:

2019
Views:

496

Pages:

6
Author:

lankstoetp12

Complications of regional anaesthesia Complications Estimated frequency Comments Direct nerve damage 1:10,000 – 1:30,000 No effective treatment Spinal Haematoma 1:150,000 – 1:220,000 Requires urgent evacuation Spinal infection 1:100,000 – 1:150,000 Aggressive Abs +/evacuation Drug error Unknown Avoidable, may be fatal Systemic toxicity Unknown May be fatal without treatment Respiratory depression Unknown Especially using opiods Hypotension Common Early treatment needed Confusional states Common in elderly Especially using opiods Pruritis / nausea / urinary retention Up to 16% incidence Treat effectively Technical failure 5-25% Accept failure Consider alternative Complications – Spinal anaesthesia ● Physiological consequences – Hypotension, urinary retention, bradycardia. ● Headache – dural puncture. ● Neurological sequelae - usually temporary, secondary to pressure or stretching, permanent damage rare. - anterior spinal artery syndrome. - infection. Complications – Epidural anaesthesia ● ● ● Similar to spinal (physiological, headache, neurological) Shearing or migration of catheter Total spinal - inadvertent injection of large volume of LA into CSF. - profound motor block, may reach cervical cord affecting arms. - may produce respiratory failure as phrenic nerves blocked. - if reaches cerebral CSF unconsciousness, hypotension, arrest. - Management - CALL FOR HELP including vasopressors, atropine, - ABC, supportive fluids, head down tilt. Complications – Caudal anaesthesia ● ● ● ● Incorrect needle placement - Too superficial leads to failed block. - Too deep can pass into pelvic cavity, may puncture viscera or enter birth canal. Intravascular injection into rich plexus of sacral veins. Infection Dural puncture Conclusions ● ● ● ● ● Safe, effective anaesthesia and analgesia. Not just for those not fit enough for GA! Thorough knowledge of indications, contraindications and techniques required. Serious complications rare – must be recognised and managed early. Less serious complications more common and usually treatable.

Complications of Regional Anaesthesia

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