Predominant use of 0.9% saline solution in major surgery has little impact on outcome as assessed by duration of mechanical ventilation, intensive care unit stay, hospital stay, and postoperative complications, but it does appear to be associated with increased perioperative blood loss.

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Purpose: Spinal anaesthesia is selected for many lower extremity surgical procedures each year in the United States with a high degree of safety and efficacy. Even when adverse neurological outcomes have occurred, anatomical abnormality or coagulopathy have been implicated in the majority of cases. Epinephrine is used in high concentrations in many of these anaesthetics to increase the duration and intensity of the block. Although epinephrine is known to decrease spinal cord blood flow, its use in normal patients has not caused complications. We report a case where spinal anaesthesia with bupivacaine and epinephrine resulted in anterior spinal artery compromise and the development of a cauda equina syndrome postoperatively. Clinical Features: A 57-yr-old man with severe coronary artery and peripheral vascular disease was scheduled for incision and drain of an abscess of the left thigh. He received an atraumatic dural puncture and injection of 12.5 mg bupivacaine with 0.2 ml I:1000 epinephrine. During onset, he experienced a severe, painful sensation of the thighs which resolved with development of the block. Postoperatively, he was noted to have exacerbation of proximal muscle weakness and decreased perineal sensation and rectal tone. Subsequent EMG studies demonstrated proximal neuron loss consistent with cauda equina syndrome, presumed to be related to insufficiency of the anterior spinal artery. Conclusion: Routine use of epinephrine in spinal anaesthesia for patients with multi-organ vascular disease should be considered carefully because of the possibility of vascular insufficiency of the spinal cord which would be exaggerated by the vasoconstrictive effect of epinephrine.Object.if : Aux E~tats-Unis, la rachianesth&ie est choisie pour de nombreuses interventions chirurgicales des membres inf&ieurs et comporte un haut niveau d'innocuJt~ et d'efficacit& M~me quand des incidents neurologiques se sont produits, I'anomalie anatomique ou la coagulopathie a Et~ incriminEe dans la majoritE des cas. L~EpinEphrine est utilisEe en concentrations ElevEes dans beaucoup d'anesth&iques rachidiens afin d'accro~re la dur& et I'intensit~ du bloc. Bien que I'~pin6phrine soit connue pour diminuer le debit sanguin de la moelle Epini&e, son usage chez les patients normaux n'a pas cause de complications. Nous signalons ici un cas oE la rachianesthEsie avec bupivaca't'ne et EpinEphrine a cause une atteinte de I'artEre spinale ant&ieure et le dEveloppement postopEratoire du syndrome de la queue de cheval. Aspects cliniques : Un homme de 57 ans, pr&entant une sEvEre coronopathie et une maladie vasculaire p&iph&ique, devait subir I'incision et le drainage d'un abcEs sur la cuisse gauche. II a re~;u une ponction durale atraumatique et une injection de 12,5 mg de bupivaca'[ne avec 0,2 ml I : I 000 d'EpinEphrine. Pendant rinduction, il a EprouvE une douleur pEnible ~ la cuisse, douleur qui est disparue ~ mesure que s'installait I'anesth&ie. AprEs la chirurgie, on a remarqu~ une accentuation de la faiblesse des muscles proximaux, une dim...