Complete failure of spinal anaesthesia in obstetrics

Hoppe, Juliana Bender; Popham, P.

doi:10.1016/j.ijoa.2006.12.005

Cited by 36 publications

(30 citation statements)

References 42 publications

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“…However, they all lack a precise cause-effect relationship. This analysis brings a feeling similar to that mentioned by Hoppe and Popham: "After reviewing a number of cases over several years in which uneventful spinal blocks failed completely for no apparent reason, a literature search was conducted in an effort to explain the apparently inexplicable 9 . "Success of the spinal block requires the deposit of the correct dose of the proper drug in the CSF contiguous to the medullary cone and cauda equina, without physical, physiological, or biochemical barriers that would prevent the know effects of said drug on the nerve structure or, in other words, the right dose of the right agent in the right place."…”

Section: Introductionmentioning

confidence: 62%

“…The length of the bevel of the needle can also contribute with the failures. If a long bevel is partially introduced into the subarachnoid space, free flow of CSF is observed, but, during the injection, part of the anesthetic solution can remain outside the space, leading to a result different than that expected 9 . The same can be seen with pencil-tip needles with larger lateral holes, such as proposed by Sprotte.…”

Section: The Right Placementioning

confidence: 89%

“…During its trajectory, it can encounter obstacles like bone, ligament, or postural deformities that can stop the needle or deviate it from the original route. During this trajectory, perforation of the anesthetic "pouch" created by excessive infiltration of the tissues before the puncture is possible 9 . This will cause a backflow of clear fluid, leading to positioning error.…”

Section: The Right Placementioning

confidence: 99%

“…Although the dura mater-arachnoid membrane adhesion is firm, it is fragile, and detachment during insertion of the needle can occur. This can lead to the subdural administration of the anesthetic, reflecting on complete failure 9 . Although a simple pre-anesthetic method to evaluate the volume of CSF of a patient does not exist, one of the reported causes of failure is the possibility that the volume of CSF is higher than average.…”

Section: The Right Placementioning

confidence: 99%

“…"Success of the spinal block requires the deposit of the correct dose of the proper drug in the CSF contiguous to the medullary cone and cauda equina, without physical, physiological, or biochemical barriers that would prevent the know effects of said drug on the nerve structure or, in other words, the right dose of the right agent in the right place." Hoppe and Popham 9 were also extremely precise when they proposed this definition of successful spinal block. Similarly, Lorenzo 10 stated a long time ago that failures were a result of: (1) lack of contact between the anesthetic and nerve structures; (2) administration of low volume or concentration of the anesthetic; (3) using attenuated anesthetic secondary to aging of the solution (repeated autoclaving); or (4) inadequate patient positioning after the spinal injection.…”

Section: Introductionmentioning

confidence: 99%

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Falhas na anestesia subaracnóidea

Praxedes

Filho

2010

Rev. Bras. Anestesiol.

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Section: Introductionmentioning

confidence: 62%

Section: The Right Placementioning

confidence: 89%

Section: The Right Placementioning

confidence: 99%

Section: The Right Placementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Falhas na anestesia subaracnóidea

Praxedes

Filho

2010

Rev. Bras. Anestesiol.

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Designing for self-organisation in sociotechnical systems: resilience engineering, cognitive work analysis, and the diagram of work organisation possibilities

Naikar

Elix

2019

Cogn Tech Work

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In designing sociotechnical systems, accounting for the phenomenon of self-organisation is critical. Empirical studies show that workers in these systems adapt not just their individual behaviours, but also their collective structures to deal with complex work environments. The concept of self-organisation can explain how such adaptations can be achieved spontaneously, continuously, and relatively seamlessly, and why this phenomenon is important for dealing with instability, uncertainty, and unpredictability in the task demands. However, existing design approaches such as resilience engineering and cognitive work analysis are limited in their capacity to design for self-organisation. This paper demonstrates that the diagram of work organisation possibilities, a recent addition to cognitive work analysis, provides a sound theoretical basis for designing for self-organisation. That is, it shows how essential components of the diagram are aligned with the concept of self-organisation and are well-grounded in empirical observations of adaptation in a variety of sociotechnical systems, specifically emergency management, military, and healthcare systems. Consequently, designs based on this diagram should have the potential to facilitate the emergence of new spatial, temporal, and functional organisational structures from the flexible actions of individual, interacting actors, thereby enhancing a system's capacity for dealing with a dynamic, ambiguous work environment. Future research should focus on validating these ideas and demonstrating their value in industrial settings.

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