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ISSN 1726-6718 (Electronic)
Revista Cubana de Anestesiología y Reanimación

2018, Number 3

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Revista Cubana de Anestesiología y Reanimación 2018; 17 (3)

Failure or resistance in spinal anesthesia for cesarean section

Miranda RA

Language: Spanish
References: 11
Page: 1-7
PDF size: 71.66 Kb.


ABSTRACT

Introduction: Regional anesthesia is the most used in obstetric caesarean section. In particular, the use of intrathecal anesthesia has its advantages. Although the failure rate is low, the onset of this event generates difficulties that deserve attention.
Objective: To describe the anesthetic management in an obstetric patient with failure of regional intrathecal anesthesia.
Clinical case: Female patient, aged 20 years, who was administered intrathecal anesthesia by the specialist. There were no errors in the lumbar puncture, this was done with a trocar 25 of Whitacre tip. No sensory, motor or sympathetic block was observed, so general endotracheal anesthesia was performed, which went on smoothly. In the immediate postoperative period, joint hypermobility was observed, leading to suspicion of the diagnosis. This was positive in conjunction with the Neurology service, Ehlers-Danlos syndrome type 3 was determined.
Conclusions: The failure rate is very low for subarachnoid anesthesia. However, for a patient of this type, it should be completely ruled out. There are few documented cases of resistance to local anesthesia. If it were the case, it should be studied exhaustively to look for strategies that allow an optimal anesthetic management.


REFERENCES

  1. Yera Nadal JL, Garrido Suárez BB. Temas de Medicina del dolor. La Habana: ECIMED; 2017. Capítulo 16. p. 214-30.

  2. Eger E, Saidman LJ, Westhorpe R. The Wondrous Story of Anesthesia. Ed Springer: New York; 2014. p. 37-49.

  3. Jones GW, Samuel RA, Biccard BM. Management of failed spinal anaesthesia for caesarean section. S Afr Med J. 2017;107(7):611-14.

  4. Bouchacourt Víctor. Causas de fallas del bloqueo subaracnoideo; formas de evitarlas. Anest Analg Reanim. 2005 [citado 10 may 2018];20(1):31-37. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688- 12732005000100005&lng=es

  5. Bollini Carlos A. Por qué puede fallar un bloqueo subaracnoideo. Rev Arg Anest. 2017;65(6):459-62.

  6. Chávez-Ruiz FJ. Fallas y complicaciones en la Anestesia Regional Obstétrica. Rev Mexicana Anest. 2017;40(1):150-54.

  7. Fettes DW, Jansson JR, Wildsmith AW. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anaesth. 2009;102(6):739-48.

  8. Arendt-Nielsen L, Kaalund P, Bierring P, Hogsaa B. Insufficient effect of local analgesics in Ehlers-Danlos type III patients (connective tissue disorder). Acta Anaesthesiol Scand. 1990;34:358-61.

  9. Hakim AJ, Grahame R, Norris P, Hopper C. Local anaesthetic failure in joint hypermobility syndrome. J Soc Med. 2005;98:84-85.

  10. Baraniuk C. The people who can´t go numb at the dentist´s. BBC. 2017 [citado 20 ene 2018];20(1):31-37. Disponible en: http://www.bbc.com/future/story/20170106-the-people-who-cant-go-numb-at-thedentists

  11. Batas D, Nejad MR, Prabhu MR. Resistance to local anesthetics: a case report. Br J Anaesth. 2017 [citado 3 oct 2017]. Disponible en: https://doi.org/10.1093/bja/el 1576.




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