Déficits neurológicos y aracnoiditis secundarios a anestesia neuroaxial: rol de parestesias, punciones durales, anestésicos locales y género: Protocolo para su tratamiento

• Autores: A. Ramírez Bermejo, J.A. Aldrete, N.C. Godínez Cubillo, S. G. Bautista Sánchez, R. Ghaly, A. Kassian Rank
• Localización: Revista de la Sociedad Española del Dolor (SED), ISSN 1134-8046, Vol. 16, Nº. 6, 2009, págs. 330-343
• Idioma: español
• DOI: 10.1016/s1134-8046(09)72541-8
• Títulos paralelos:
  • Neurological deficit and arachnoiditis secondary to neuroaxial anesthesia: role of paresthesia, dural puncture, local anesthetics and gender: Treatment protocol
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    Introducción: De las complicaciones de la anestesia neuroaxial, la aracnoiditis y el déficit neurológico representan uno de los problemas más serios a los que pueda enfrentarse el anestesiólogo, aun cuando la frecuencia real es desconocida las consecuencias funcionales para los pacientes y legales para el médico son devastadoras, debido principalmente al hecho que la mayor parte de los pacientes no son tratados con oportunidad y las probabilidades de un desenlace catastrófico aumentan. Material y método: Revisión de casos. Resultados: Se presenta una serie de casos en los que se analizan los factores que posiblemente influyeron en la presencia de las complicaciones, los tratamientos empleados y su eficacia para disminuir la incapacidad remanente y lograr su recuperación, así como el resultado de aplicarlo oportunamente. Discusión: Es necesario reconocer que una vez que estas complicaciones se presentan, el objetivo principal es iniciar un plan terapéutico que evite o disminuya las secuelas permanentes, para lo cual se requiere iniciar inmediatamente un tratamiento específico que permita la pronta recuperación de la función; sin embargo, en la actualidad, aún no hay un protocolo de tratamiento que haya demostrado ser eficaz en la disminución de las secuelas.

  • English

    Introduction: Among the complications of neuroaxial anesthesia, arachnoiditis and neurological deficit represent one of the most serious problems that anesthesiologists can face. Although the real frequency of this complication is unknown, the functional consequences for the patient and legal repercussions for the physician are devastating, mainly because most patients are not treated in a timely fashion, increasing the probability of a catastrophic outcome. Methods: Case review. Results: We reviewed a series of cases and analyzed the factors that possibly influenced the presence of complications, the treatments used and their effectiveness in reducing permanent disability and in achieving recovery, as well as the results of their timely application. Discussion: Once these complications appear, the primary objective is to initiate a therapeutic plan that avoids or reduces permanent sequels. To do this, specific treatment that allows functional recovery must be started immediately. However, currently there is no treatment protocol with demonstrated effectiveness in reducing sequels.

• Referencias bibliográficas
  • Horlocker, TT, Abel, MD, Messick, JM Jr, Schroeder, DR. (2003). Small risk of serious neurologic complications related to lumbar epidural...
  • Horlocker, TT, McGregor, DG, Matsushige, JM, Schroeder, DR, Besse, JA. (1997). A retrospective review of 4767 consecutive spinal anesthetics:...
  • Moen, V, Dahlgren, N, Iristedt, L. (2004). Neuroilogical complications after central neuraxial blockades in Sweden: 1990-1999. Anesthesiology....
  • Auroy, Y, Benhamou, D, Brages, L. (2002). Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hot Line service....
  • Aroma, U, Lahdensuu, M, Cozanitis, DA. (1997). Severe complications associated with epidural and spinal anaesthesia in Finland. 1987-1993:...
  • Chenney, FW, Domino, KB, Caplan, RB, Posner, KL. (1999). Nerve injury associated with anesthesia: a closed claim analysis. Anesthesiology....
  • Lofsky, AS. (2005). Complications of cervical epidural blocks attract Insurance company attention. APSF News Letter.. 20. 45-60
  • Aldrete, JA, Ghaly, RF. (2008). Timing of early treatment of neurological deficits postintervention and operative spinal procedures. Anesthesiology.....
  • Tezlaff, JE, Detzler, JA, Wu, C, Smith, MP, Bell, G. (1998). Influence of lumbar spine pathology on the incidence of paresthesia during spinal...
  • Rowlingson, JC. (1993). Toxicity of local anesthetic additives. Reg Anesthe.. 18. 456
  • Otero, P, Aldrete, JA, Terragona, L, Guizar, G. (2005). Síndrome de cauda equina y arachnoiditis consecuencia de una puncion dural incidental...
  • Parry, H. (2001). Spinal cord damage. Anaesthesia.. 56. 290
  • Selander, D. (1993). Neurotoxicity of local anesthetics: animal data. Reg Anesth.. 18. 461
  • Lambert, LA, Lambert, DH, Strichartz, GR. (1994). Irreversible conduction block in isolated nerve by high concentrations of local anesthetics....
  • Moore, DC, Spierdijk, J, Van Kleef, MD, Coleman, RL, Love, GF. (1982). Chloroprocaine neurotoxicity: four additional cases. Anesth Analg.....
  • Rackle, JP, Jourden, L, Benknadra, A. (1988). Effect of adding Na bicarbonate to bupivacaine for spinal anesthesia in elderly patients. Anesth...
  • Pizzolato, P, Renegra, OJ. (1959). Histopathologic effects of long exposure of local anesthetics on peripheral nerves. Anesth Analg.. 38....
  • Gentili, F, Hudson, AR, Hunter, D, Kline, DG. (1980). Nerve injection injury with local anesthetic agents: a light and electron microscopic,...
  • Kitagawa, N, Oda, M, Totoki, T. (2004). Possible mechanisms of irreversible nerve injury caused by local anesthetics: detergent properties...
  • Johnson, ME, Uhl, CB, Spittier, K, Wang, H, Gores, GJ. (2004). Mitochodrial injury and caspase activation by the local anesthetic lidocaine....
  • Hall, ED. (1993). Neuroprotective action of glucocorticoid and non-glucocorticoid steroids in acute neuronal injury. Cell Molec Neurobiol.....
  • Haller, I, Hausott, B, Tomaselli, RA, Keller, C, Klimaschewski, L. (2006). Neurotoxicity of lidocaine involves specific alteration of the...
  • Casatti, A, Fanelli, G, Aldegheri, G, Leoni, A, Casaletti, E. (1998). A transient urologic deficit following intrathecal injection of 1% bupivacaine...
  • Covino, BG, Marx, GT, Finster, M, Zsigmond, EK. (1980). Prolonged sensory/motor deficits following inadvertent spinal anesthesia. Anesth Analg.....
  • López-Soriano, F, Lajarín, B, Verdún, JM, Rivas, F, López, RJ. (2002). Cauda equina hemysindrome after intradural anesthesia with bupiva-caine...
  • Rudolph, H, De Jong, HR. (1994). Last round for a "heavyweight". Anesth Analg.. 78. 2-4
  • Vandam, DL. (2004). Concerning neurologic sequelae of spinal anesthesia. Anesthesiology.. 100. 176
  • Aldrete, JA. (2003). Neurologic deficits and arachnoiditis from neuraxial anaesthesia. Acta Anaesthesiol Scand.. 47. 3-12
  • Reynolds, F. (2001). Damage to the conus medularis following spinal anaesthesia. Anaesthesia.. 56. 238
  • Tsui, BHC, Asmstron, K. (2005). Can direct spinal cord injury occur without paresthesia? A report of spinal cord injury after epidural placement...
  • Aldrete, JA. Neurological deficit and arachnoiditis from chloro-procaine intended epidural entering the subdural space.
  • Sghirlazoni, A, Marazzi, R, Pareyson, D. (1989). Epidural anesthesia and spinal arachnoiditis. Anaesthesia. 44. 317
  • Aldrete, JA, Ferrari, H. (2004). Myelopathy with syringomyelia following thoracic epidural anaesthesia. Anaesth Intensive Care.. 32. 100
  • Nesaturay, S. (1998). Steroids and spinal cord injury: revisiting the NASCIS-2 and the NASCIS-3 trials. J. Trauma.. 45. 1088
  • Rhen, T, Cidlowoski, JA. (2005). Anti-inflammatory action of glucocorticoids-new mechanism for old drugs. N Eng J Med.. 353. 1711
  • Radwas, IA, Saito, S, Goto, F. (2003). Neurotrophic factors can partially reverse morphological changes induced by mepivacaine and bupivacaine...
  • Means, ED, Anderson, DK, Waters, TR, Anderson, DK. (1981). Effects of MTP in compression trauma to the feline spinal cord. J Neurosurg.. 55....
  • Chicawa, T, Ikata, T, Katoh, S. (2001). Preventive effect of lecithinized superoxidase dismutase and MTP on spinal cord injury in rats: transcriptional...
  • Braughler, JM, Hall, ED, Means, ED. (1987). Evaluation of intensive MTP Na succinate dosing regimen in experimental spinal cord injury. J...
  • Ghaly, RF. (2001). Recovery after high dose methylprednisolone and delayed evacuation. J Neurosurg Anesth.. 13. 323
  • Hall, ED. (1993). Neuroprotrctive actions of glucocoticoid and non-glucocorticoid steroidal in neuronal injury. Cell Molec Neurobiol,. 338....
  • Hashimoto, K, Hampl, K, Nakamura, Y, Bollen, AW, Feiner, J, Drasner, K. (2001). Epinephrine increases the neurotoxic potential of intrathecally...
  • Takeda, K, Sawamura, S, Sekiyama, H, Tamai, H, Hanaoka, K. (2004). Effect of methylprednisolone on neuropathic pain and spinal glial activation...
  • Fu, ES, Saporta, S. (2005). Methylprednisolone inhibits production of Interleukin-1beta and Interleukin-6 in the spinal cord following compression...
  • Hayashi, M, Ueyama, T, Senba, E. (1997). Expression of neurotropin and IL-1beta, RNAs following spinal cord injury and the effects of MTP....
  • Weller, RO, Engelhardt, B, Phillips, MJ. (1996). Lymphocyte targeting of the central nervous system: a review of afferent and efferent CNS-immune...
  • Bracken, MB, Collins, WF, Freeman, DF, Shepard, MJ, Wagner, FW, Silten, RM. (1984). Efficacy of MTP in acute spinal cord injury. JAMA.. 254....
  • Bracken, MB, Theodore, R, Holford, TR. (1990). A randomized control trial of MTP or naloxone in the treatment of spinal cord injury: results...
  • Bracken, MB, Shepard, MJ, Collins, WF, Holford, TR, Young, W, Baskin, DS. (1992). Methylprednisolone or naloxone treatment after acute spinal...
  • Bracken, MB, Shepard, MJ, Collins, WF, Holford, TR, Baskin, DS, Eisenberg, HM. (1993). Effects of timing of MTP or naloxone administration...
  • Bracken, MB, Shepard, MJ, Holford, TR, Summers, LL, Aldrich, EF, Fazl, M. (1997). Administration of MTP for 24 or 48 hrs or tirilazad mesylate...
  • Fehlings, MG, Sekhorn, LHS, Tator, C. (2001). The role and timing of decompression in acute spinal cord injury. Spine.. 26. 101
  • Rabchevsky, AG, Fuggacia, I, Sullivan, PG. (2002). Efficacy of MTP therapy for the injured rat spinal cord. J Neurosic Res.. 68. 7-18
  • (2002). Guidelines of the American Association of Neurological Surgeons: Pharmacological therapy after acute spinal cord injury. Neurosurgery.....
  • Bracken, MB. (2001). Methylprednisolone and acute spinal cord injury: an update and randomized evidence. Spine. 26. 547
  • Takea, K, Sawuamura, S, Skiyama, H, Tamai, H, Hanaoka, K. (2004). Effects of MTP on neuropathic pain and spinal glial activation in rats....
  • Aldrete, JA, Ghaly, RF. the evidence revealed. 2. Alfil. México DF.
  • Usubiaga, JE. (1977). Complicaciones neurológicas en la anestesia epidural. Salvat. Barcelona.