ABSTRACT
Ocular motor palsy is a rare but alarming complication of subarachnoid puncture. In order to better understand this condition, a literature search was performed in English of PubMed articles for cranial nerves III, IV, and VI palsies after spinal puncture. Sixty-five articles (dated 1930-2015) were identified, and 114 cases were obtained for analysis. Subarachnoid anesthesia was the most frequent cause (45.6%), with a higher incidence for females than males. The age of patients was 40.24 ± 13.35 years (age range, 6-71 years). The sixth cranial nerve was the most commonly involved (92.1%), with higher frequency in the right eye. Palsy onset started 7.30 ± 4.09 days after puncture. Duration in reversible cases was 80.10 ± 80.67 days. Paresia was permanent in 13 patients, but only 2 patients required extraocular muscle surgery. Treatments included the horizontal position along with analgesics, fluid therapy, and corticosteroids. The usefulness of blood patch remains controversial. It is important for anesthesiologists and other physicians to recognize the cardinal features of this process to ensure early diagnosis, avoid unnecessary tests, and guide appropriate treatment.
Subject(s)
Anesthesia, Epidural/adverse effects , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/etiology , Spinal Puncture/adverse effects , Blood Patch, Epidural/methods , Humans , Informed Consent/standards , Oculomotor Nerve Diseases/therapyABSTRACT
INTRODUCTION: The aim of the study was to compare the sensory, motor, and neuroophthalmological effects of isobaric levobupivacaine and bupivacaine when intrathecally administered. MATERIALS AND METHODS: A prospective, double-blind, randomized study with 60 ASA grade I-II patients aged 18-65 years awaiting knee arthroscopy under spinal anesthesia. Patients received 12.5 mg of isobaric bupivacaine or levobupivacaine. Several features were recorded. RESULTS: No significant intergroup differences were observed for ASA classification, time to micturate, demographic data, surgery duration, and patient/surgeon satisfaction. Similar hemodynamic parameters and sensory/motor blockade duration were found for both groups. There were no neuroophthalmological effects in either group. Sensory (P = 0.018) and motor blockade onset (P = 0.003) was faster in the bupivacaine group. T6 (T2-T12) and T3 (T2-T12) were the highest sensory block levels for the levobupivacaine and bupivacaine groups, respectively (P = 0.008). It took less time to regain maximum motor blockade in the bupivacaine group (P = 0.014), and the levobupivacaine group required use of analgesia earlier (P = 0.025). CONCLUSIONS: Isobaric bupivacaine and levobupivacaine are analogous and well-tolerated anesthetics for knee arthroscopy. However, for bupivacaine, sensory and motor blockade onset was faster, and greater sensory blockade with a longer postoperative painless period was achieved.
Subject(s)
Anesthesia, Spinal/methods , Bupivacaine/analogs & derivatives , Bupivacaine/administration & dosage , Knee/surgery , Adolescent , Adult , Aged , Arthroscopy/methods , Humans , Knee/pathology , Levobupivacaine , Middle AgedABSTRACT
La asociación de hipertensión arterial pulmonar (HAP) y embarazo sigue presentando unos índices de mortalidad materna muy elevados. Las nuevas terapias y el abordaje multidisciplinario han conseguido mejorar el curso del embarazo y el pronóstico fetal, pero no el materno. La observación de que la evacuación del feto e involución uterina coincide con un empeoramiento marcado de la función cardíaca materna sugiere como causa desencadenante el paso súbito de la sangre contenida en el músculo uterino a la circulación general, que al comportarse como una autotransfusión eleva a límites insostenibles las presiones en el corazón derecho. Para evitarlo se ha diseñado una nueva técnica quirúrgica, la cesárea en isquemia-histerectomía, que cierra la circulación uterina antes de la extracción fetal. Se describe la técnica quirúrgica y se aportan 4 casos clínicos ilustrativos (AU)
The association of pulmonary hypertension (PH) and pregnancy still leads to high maternal mortality. New treatments and a multidisciplinary approach have improved the course of pregnancies and fetal outcomes but not maternal prognosis. We observed that fetal evacuation and uterine involution coincides with marked worsening of maternal cardiac function, suggesting that the trigger is blood flow from the uterine muscle to the general circulation. This process acts as an autotransfusion and increases the pressure in the right heart to unsustainable limits. A new surgical technique, cesarean section in ischemia-hysterectomy, has been designed to prevent this event. This technique blocks uterine circulation before fetal extraction. We describe this technique and four cases (AU)
