PMID: 9637641Jun 24, 1998Paper

Causes and prediction of maldistribution during continuous spinal anesthesia with isobaric or hyperbaric bupivacaine

Anesthesiology
P BibouletF d'Athis

Abstract

Many cases of cauda equina syndrome after maldistribution of local anesthetics during continuous spinal anesthesia have been reported. In experiments, a caudad route of catheter travel and the use of hyperbaric agents have been shown to induce these limited blocks. The aim of this clinical study was to verify this hypothesis and seek a predictive factor for the maldistribution of bupivacaine. Continuous spinal anesthesia via a 19-gauge end port spinal catheter was performed in 80 elderly patients randomly assigned to receive either isobaric or hyperbaric solutions. Successive injections of 2.5 mg bupivacaine were performed at 5-min intervals until a sensory level at or cranial to T8 was obtained. Maldistribution was defined by a sensory level caudal to T12 despite a total dose of 17.5 mg of either isobaric or hyperbaric bupivacaine. After surgery, all catheters were injected with contrast media and examined radiographically. The frequency of maldistribution was not significantly different in the isobaric and hyperbaric groups. A caudally oriented catheter tip was found to be a major cause of maldistribution (P < 10(-5)). A thoracic sensory level could be reached in all patients presenting a limited block by simply changing the ...Continue Reading

References

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Citations

May 8, 2001·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·P BibouletF d'Athis
Aug 24, 2004·International Journal of Obstetric Anesthesia·P S SmithG R Lyons
Oct 8, 2003·Best Practice & Research. Clinical Anaesthesiology·Brian K Bevacqua
Jan 27, 2004·Anesthesia and Analgesia·Ban C H TsuiKeith Aronyk
May 24, 2006·Anesthesia and Analgesia·Moussa TraoreJeannette Traore Thomas
Nov 24, 2004·Drugs & Aging·Ban C H TsuiBrendan Finucane
Dec 19, 2013·Saudi Journal of Anaesthesia·Leyla T KilincHale Dobrucali
Sep 10, 2013·Irish Journal of Medical Science·V D Ward, C R Mc Crory
Mar 18, 2011·Women's Health·Christian Loubert, Roshan Fernando
Sep 20, 2000·Mayo Clinic Proceedings·M E Johnson
Mar 14, 2000·European Journal of Anaesthesiology·D MichaloudisA Katsamouris
Apr 18, 2003·Anesthesiology Clinics of North America·Uma Munnur, Maya S Suresh
Jun 5, 2001·Anesthesiology·S S Liu, S B McDonald
Jan 27, 2019·Drugs & Aging·Carole LinBan C H Tsui

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