Reversibles, toxisches Kaudasyndrom nach einer unkomplizierten Spinalanästhesie mit hyperbarem Bupivacain 0,5 %

Zusammenfassung

Die spinale und epidurale Anästhesie wird sehr häufig eingesetzt. Insbesondere die steigende Anzahl ambulanter operativer Eingriffe wird diese Anästhesieform weiter zunehmen lassen. Die spinale und epidurale Anästhesie ist als sicheres Verfahren zu beurteilen, jedoch entstehen in seltenen Fällen Komplikationen, die in Einzelfällen sehr schwerwiegend sein können. Zu unterscheiden sind systemische, traumatische, entzündliche, vaskuläre und toxische Komplikationen. Die Komplikationen können passagerer Natur sein oder bleibende Schäden hinterlassen. Im Einzelnen werden in unterschiedlicher Häufigkeit folgende Komplikationen beobachtet: Herz-Kreislauf-Stillstand, epileptische Anfälle, Kopfschmerzen, subdurale Hämatome, epidurale Blutungen, radikuläre Schmerzen oder Ausfälle, Meningitiden, Diszitiden, spinale Infarkte, Luftembolien und toxische Komplikationen. Die Kenntnis der Komplikationen der Spinal- und Epiduralanästhesie ist in der postoperativen (Notfall-)Situation, bei der prognostischen Einschätzung und bei Begutachtungen von Bedeutung.

Abstract

Spinal and epidural anaesthesia is frequently administered. Particularly increasing ambulatory treatment leads to the increase of these interventions. Normally it is a reliable and frequent intervention. Complications are rare but sometimes severe. Complications may be transient or lasting. It is useful to distinguish between systemic events such as cardiac arrest or epileptic seizures and more localized events like headache, subdural or epidural haemorrhage, radiculopathies, meningitis, discitis, air embolism and toxic complications regarding the spinal cord and the cauda equina. The knowledge of these complications is fundamental. Especially in a postoperative case of emergency to predict the outcome and to estimate the damage possibly caused by this medical intervention.

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