Abstract:
BACKGROUND:Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serious complications. METHODS:Requests were sent to 4,927 French anesthesiologists in advance of a subsequent 5-month study period. Participating anesthesiologists were asked for detailed reports of serious complications occurring during or after regional anesthetics performed by them during the study interval. Details regarding each complication then were obtained via a second questionnaire. RESULTS:The number of responding anesthesiolgists was 736. The number of regional anesthetics performed was 103,730, corresponding to 40,640 spinal anesthetics, 30,413 epidural anesthetics, 21,278 peripheral nerve blocks, and 11,229 intravenous regional anesthetics. Reports of 98 severe complications were received, with follow-up information being obtained for 97. In 89 cases, complications were attributed fully or partially to regional anesthesia. Thirty-two cardiac arrests, seven of which were fatal, occurred during the study. Of these, 26 occurred during spinal anesthesia, with 6 being fatal, 3 occurred during epidural anesthesia, and 3 more occurred during peripheral blocks. The higher incidence of cardiac arrest during spinal anesthesia (6.4 +/- 1.2 per 10,000 patients) compared with all other regional anesthesia (1.0 +/- 0.4 per 10,000 patients) was statistically significant (P < 0.05). Of 34 neurologic complications (radiculopathy, cauda equina syndrome, paraplegia), 21 were associated either with paresthesia during puncture (n = 19) or with pain during injection (n = 2), suggesting nerve trauma or intraneural injection. Twelve patients who had neurologic complications after spinal anesthetics had no paresthesia during needle placement and no pain on injection. Of these 12 patients (7 with radiculopathy and 5 with cauda equina syndrome), 9 received intrathecal hyperbaric lidocaine, 5%. The incidence of neurologic injury was significantly greater after spinal anesthesia (6 +/- 1 per 10,000 cases; P < 0.05) than after each of the other types of regional procedures (1.6 +/- 0.5 per 10,000 cases for the weighted average). Seizures attributed to elevated serum levels of local anesthetics occurred in 23 patients, but none suffered a cardiac arrest. CONCLUSIONS:(1) The incidence of cardiac arrest and neurologic injury related to regional anesthesia were very low, but both were more than three SDs greater after spinal anesthesia than after other regional procedures. (2) Two thirds of the patients with neurologic deficits had either a paresthesia during needle placement or pain on injection. (3) Seventy-five percent of the neurologic deficits after nontraumatic spinal anesthesia occurred in patients who had received hyperbaric lidocaine, 5%.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Auroy Y,Narchi P,Messiah A,Litt L,Rouvier B,Samii Kdoi
10.1097/00000542-199709000-00005subject
Has Abstractpub_date
1997-09-01 00:00:00pages
479-86issue
3eissn
0003-3022issn
1528-1175journal_volume
87pub_type
杂志文章相关文献
ANESTHESIOLOGY文献大全abstract:BACKGROUND:Propofol is an alternative to thiopental as an intravenous induction agent for cesarean section. Because it has relaxant effects on vascular and other smooth muscles, the authors set out to determine whether propofol has any effect on pregnant human uterine smooth muscle in an isolated preparation. METHODS:...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199807000-00017
更新日期:1998-07-01 00:00:00
abstract::The effects of vasopressor therapy on intracranial pressure (ICP) during hypotension were evaluated in 45 adult cats anesthetized with pentobarbital and hyperventilated via an endotracheal tube with nitrous oxide, 70 per cent, and oxygen, 30 per cent, to maintain Paco2 25 plus or minus 5 torr. Hypotension was induced ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197504000-00011
更新日期:1975-04-01 00:00:00
abstract::Four volunteers judged eight levels of thermal stimuli induced by a Hardy dolorimeter, varying in intensity from extremely painful to a low level seldom even perceived. Half of the 406 stimuli were applied during acupuncture and half either before insertion or after removal of the needles. The experimental design mini...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197511000-00005
更新日期:1975-11-01 00:00:00
abstract:BACKGROUND:Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interv...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-200506000-00007
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Previous studies have shown that desflurane and isoflurane produce similar hemodynamic actions. This investigation examined the cardiovascular effects of desflurane and isoflurane in the presence or absence of dexmedetomidine, a highly selective alpha 2-adrenergic agonist that may be clinically useful as a p...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199311000-00021
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:Up to 84% of women who undergo operative vaginal delivery receive neuraxial analgesia. However, little is known about the association between neuraxial analgesia and neonatal morbidity in women who undergo operative vaginal delivery. The authors hypothesized that neuraxial analgesia is associated with a redu...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000003589
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the mos...
journal_title:Anesthesiology
pub_type: 杂志文章,多中心研究
doi:10.1097/ALN.0000000000002508
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:The severity of spontaneous myocardial hypercarbic acidosis during cardiac arrest previously has been predictive of the likelihood of restoring spontaneous circulation. The present study investigated whether hypercarbia itself impairs cardiac resuscitation. Since coronary perfusion pressure is the overriding...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199302000-00019
更新日期:1993-02-01 00:00:00
abstract::Depressive effect of halothane on carotid sinus baroreceptor function may be due to direct local action, in the CNS, or both. Paris of dogs were anesthetized with pentobarbital and ventilated with oxygen. The carotid sinus of the recipient dog was isolated and perfused with blood from the common carotid artery of the ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198408000-00009
更新日期:1984-08-01 00:00:00
abstract::Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly combined with intravenous morphine patient-controlled analgesia to relieve postoperative pain. NSAIDs have a documented 30-50% sparing effect on morphine consumption. However, most of the studies have not demonstrated a decrease in morphine adverse effects. A m...
journal_title:Anesthesiology
pub_type: 杂志文章,meta分析
doi:10.1097/00000542-200506000-00027
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:The Bispectral Index (BIS) and the Patient State Index (PSI) quantify depth of anesthesia by analyzing the electroencephalogram. The authors examined the response of BIS and PSI to sevoflurane anesthesia. METHODS:In 22 patients, sevoflurane anesthesia was induced by inhalation with a tight-fitting facemask ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181895fd0
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200203000-00031
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:The authors explored the database of the first International Study of Postoperative Cognitive Dysfunction study to specify the domains of cognitive function that were most vulnerable and to determine the pattern of deterioration in patients with preoperative cognitive impairment. METHODS:One thousand two hu...
journal_title:Anesthesiology
pub_type: 杂志文章,多中心研究
doi:10.1097/00000542-200703000-00006
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:High-frequency oscillatory ventilation (HFOV) at higher frequencies minimizes the tidal volume. However, whether increased frequencies during HFOV can reduce ventilator-induced lung injury remains unknown. METHODS:After the induction of acute respiratory distress syndrome in the model by repeated lavages, 2...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31829419a6
更新日期:2013-08-01 00:00:00
abstract::Despite evidence from animal experiments to the contrary, nitrous oxide (N2O) reportedly does not induce myocardial ischemia when used as an adjunct to fentanyl anesthesia in patients with coronary artery disease who have well-preserved left ventricular (LV) function. However, the incidence of ischemia with N2O admini...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198910000-00008
更新日期:1989-10-01 00:00:00
abstract::Patients with mitral valve disease can develop pulmonary artery hypertension that persists after mitral valve replacement. In 1987, nitric oxide (NO) was reported to be an important factor accounting for the biologic activity of endothelium-derived relaxing factor. Inhaled NO was subsequently reported to be a selectiv...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199211000-00007
更新日期:1992-11-01 00:00:00
abstract::The authors determined the thiopental dose needed for satisfactory induction in ten neonates, 0-14 days of age, and 20 infants, 1-6 months of age. A single iv bolus of thiopental was given. Thirty seconds after injection the anesthesia mask was applied and the response was observed during the following 30 s while the ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198909000-00004
更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:Ulnar neuropathy is well-recognized as a potential complication of procedures performed on anesthetized patients. However, reported outcomes and risk factors for this problem are based on small series and anecdotes. METHODS:We retrospectively reviewed the perioperative courses of 1,129,692 consecutive patie...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:: Recent population studies have suggested that children with multiple exposures to anesthesia and surgery at an early age are at an increased risk of cognitive impairment. The authors therefore have established an animal model with single versus multiple exposures of anesthetic(s) in young versus adult mice...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3182834d77
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Cerebral injury is among the most common and disabling complications of open heart surgery. Attempts to provide neuroprotection have yielded conflicting results. We assessed the potential of propofol-induced burst suppression during open heart surgery to provide cerebral protection as determined by postopera...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000542-199905000-00006
更新日期:1999-05-01 00:00:00
abstract::Malpractice claims filed against anesthesiologists for care involving obstetric (OB) anesthesia (n = 190) were taken from the American Society of Anesthesiologists' Closed Claims Database and compared to claims not involving OB cases (n = 1351). The most common complications in the OB claims were (percentage of all OB...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199102000-00009
更新日期:1991-02-01 00:00:00
abstract:BACKGROUND:Resiniferatoxin is a potent capsaicin analog. Intrathecal administration leads to selective, prolonged opening of the transient receptor potential V1 ion channel, which is localized mainly to C-fiber primary afferent nociceptive sensory neurons. Following work in laboratory animals, the authors explored the ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200511000-00020
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:The authors reviewed efficacy and safety data for ondansetron for preventing postoperative nausea and vomiting (PONV). METHODS:Systematically searched, randomized, controlled trials (obtained through MEDLINE, EMBASE, Biological Abstracts, manufacturer's database, manual searching of journals, and article ref...
journal_title:Anesthesiology
pub_type: 杂志文章,meta分析
doi:10.1097/00000542-199712000-00004
更新日期:1997-12-01 00:00:00
abstract::The authors present a simple and clinically applicable method for the serial monitoring of pulmonary microvascular enzyme function in vivo. This method requires the intravenous injection of trace amounts of a radiolabelled substrate and the collection of a single arterial blood sample. Simultaneous measurement of pulm...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198801000-00008
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND:Transient receptor potential vanilloid 1 channels integrate nociceptive stimuli and are predominantly expressed by unmyelinated C-fiber nociceptors, but not low-threshold mechanoreceptive sensory or motor fibers. A recent report showed that the transient receptor potential vanilloid 1 channel agonist capsaic...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e31818958f7
更新日期:2008-11-01 00:00:00
abstract::The formation of acute edema in the tracheobronchial mucosa following local instillation of hydrochloric acid or gastric juice was studied in rats. Protein extravasation using the Evans blue technique was measured and used to indicate edema formation. A pH dependent Evans blue extravasation was observed whereby pH 2 p...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198803000-00005
更新日期:1988-03-01 00:00:00
abstract::The relationship between neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH) was investigated using the in vitro skeletal muscle contracture test to screen for MH-susceptibility in NMS patients. The maximum contracture tension which developed following exposure to halothane (1-3%), and incremental dos...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198707000-00004
更新日期:1987-07-01 00:00:00
abstract:BACKGROUND:Anesthetics inhibit airway smooth muscle contraction in part by a direct effect on the smooth muscle cell. This study tested the hypothesis that the anesthetics halothane and hexanol, which both relax airway smooth muscle in vitro, inhibit acetylcholine-promoted nucleotide exchange at the alpha subunit of th...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200407000-00019
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Neurocognitive dysfunction is a common complication of cardiac surgery using cardiopulmonary bypass (CPB). Elucidating injury mechanisms and developing neuroprotective strategies have been hampered by the lack of a suitable long-term recovery model of CPB. The purpose of this study was to investigate neurolo...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200112000-00031
更新日期:2001-12-01 00:00:00
abstract::The authors investigated the value of high-dose thiopental (TH) therapy after 16-min complete global brain ischemia (GBI) in three groups of pigtailed monkeys, using a neck cuff model of GBI with 96 h intensive care postischemia (PI). Control group (n18): Normotension was restored within 2 min PI; paralysis/controlled...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198402000-00002
更新日期:1984-02-01 00:00:00