Serious Non-Fatal Complications Associated With Extradural Block in Obstetric Practice

Abstract

A retrospective study of serious non-fatal complications of extradural block in obstetric practice was carried out using a postal questionnaire. Two hundred and three obstetric units in the United Kingdom (responsible for 2,580,000 deliveries from 1982 to 1986 inclusive) responded. A total of 505,000 extradural blocks were performed, 84% for relief of pain in labour and 16% for Caesarean section. Of 108 events reported, five were associated with permanent disability. Neuropathy involving a single spinal nerve, acute toxicity from the local anaesthetic, and problems associated with accidental dural puncture were the commonest complications. This investigation indicates the need for a prospective study. Although rare, serious complications could be reduced further by meticulous technique, while early diagnosis and treatment of untoward events would reduce the incidence of permanent disability.

Pericardial placement of a pulmonary artery catheter

“…The pericardium consists of an outer fibrous sac and an inner serous sac [1]. The heart and roots of the great vessels lie inside the fibrous sac and invaginate the serous sac from behind.…”

Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review

“…Two of the larger population studies to date also argue against an association [20,28]. These countrywide, 5-year retrospective population surveys of obstetric anaesthesia performed in Finland [20] and the UK [28] reported no definite cases from a total of almost 750 000 central neuraxial anaesthetics, of which a majority were epidurals. In 2009, a UK-wide audit of over 700 000 central neuraxial anaesthetics did identify a single case of severe adhesive arachnoiditis resulting in paraplegia following a spinal anaesthetic, but could not attribute causality [21].…”

“…These can result from direct trauma to neural elements or, more rarely, through introduction of infection, hypoxic cord injury, expanding epidural haematomas or injection of anaesthetic into or adjacent to a canal already critically stenosed by osteophytes, disc protusion or less common abnormalities, such as arteriovenous fistulae [22]. Adhesive arachnoiditis is a rare, but recognised cause of neurological deficit following central neuraxial anaesthesia [5,12,17,[22][23][24][25][26][27][28][29].…”

Anforderungen an die Hygiene bei Punktionen und Injektionen

“…Im Einzelnen sind dies die Empfehlungen: -Händehygiene [4], -Prävention Gefäßkatheter-assoziierter Infektionen [5], -Anforderungen an die Hygiene bei der Reinigung und Desinfektion von Flä-chen [6], -Prävention postoperativer Infektionen im Operationsgebiet [7], -Anforderungen der Hygiene bei Operationen und anderen invasiven Eingriffen [8], -Anforderungen der Krankenhaushygiene und des Arbeitsschutzes an die Hy gienebekleidung und persönliche Schutzausrüstung [9], -Personelle und organisatorische Voraussetzungen zur Prävention nosokomialer Infektionen [10], -Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten [11]. [44,45,46,47,50]. In Einzelfäl-len konnte der Nasen-Rachen-Raum des durchführenden Arztes aufgrund molekularer Typisierung der Erreger als Infektionsquelle identifiziert werden [47].…”