ABSTRACT
Background and Objectives - Post dural puncture headache (PDPH) is the most frequent neurological complication of spinal anesthesia, being considerably incapacitating in some cases. The purpose of this study was to show the possibility of early hospital discharge following the performance of an epidural blood patch for PDPH. Methods - Sixty patients aged 18 to 42 years, physical status ASA1, presenting PDPH were studied. The epidural blood patch was performed with 10 ml of autologus blood, in the interspace immediately cranial to that of accidental puncture. Following injection of blood, patients were instructed to remain in bed without a pillow for a period of 4 hours. The assessment for headache was done at 4, 6, 12 and 18 hours following the blood patch, with the standing. In case of complete regression, patients were discharged from the hospital and requested to contact the anesthesiologist immediately in case of new symptons. All patients were controlled one week after the blood patch. The complications due to the technique were registered. Results - Fifty-nine out of the 60 patients (98,3 per cent) showed complete relief of symptons at the first assessment (4h). One patient had no relief of symptons after 18 hours and a new blood patch was sucessfully performed 24h later. In 7, patient moderate lumbar pain was observed and 1 patient developed hyperthermia. Conclusions - The sucess of the epidural blood patch technique and early hospital discharge was evident. The relief of symptoms within the first 4 hous allowed most patients to be discharged from the hospital before 24 hours of the procedure.
Subject(s)
Female , Adolescent , Adult , Anesthesia, Spinal/adverse effects , Headache , Pain, Postoperative , Patient Discharge , Dura Mater , Spinal PunctureABSTRACT
Em 30 cirurgias experimentais realizadas no Biotério da ECM Al em 1984, a mortalidade geral registrada alcançou a cifra de 23%. Esse trabalho avaliou as condutas anestésicas empregadas, concluindo que o principal fator determinante dos óbitos teria sido a intoxicaçäo brasileira. As anestesias foram divididas em dois grupos, no segundo (Grupo 2), os resultados se mostraram mais satisfatórios, onde a mortalidade foi mínima e os animais já saíam quase conscientes da sala de cirurgia. Neste, foram empregados na anestesia, morfinomiméticos-anestésicos inalatórios, enquanto que, no primeiro Grupo 1, utilizaram-se barbitúricos-morfinomiméticos, grupo que a mortalidade foi significativa. Apesar de um stress anestésico-cirúrgico de várias horas, a sobrevida foi na totalidade de 77%, o que permitiu a avaliaçäo de toda metodologia empregada. De um modo geral, as anestesias foram mais seguras quando o anestésico principal foi o fentanil, droga responsável pela excelente estabilidade cardio-vascular e nenhum efeito depressor sobre o sistema nervoso central