Bloqueo neuroaxial alto tras epidural fallida en cesárea urgente. A propósito de un caso.

 

Autores/as

DOI:

https://doi.org/10.30445/rear.v13i6.921

Palabras clave:

bloqueo espinal alto, cesárea, anestesia obstétrica

Resumen

Se describe el caso de una gestante en la que se realiza anestesia intradural para cesárea por analgesia epidural inadecuada. La paciente llevaba un catéter epidural para analgesia del parto que fue inicialmente efectivo, requiriendo varios bolos para control del dolor en la última etapa. Pese a no haber administrado anestésico local por catéter epidural en los últimos 30 minutos previos a la realización de la cesárea, no tener bloqueo motor ni sensitivo adecuado previamente y haber reducido la dosis habitual intratecal, se produjo bloqueo espinal alto con desaturación y necesidad de intubación orotraqueal. 

Dada la complejidad del manejo de este tipo de situaciones y la importancia de la identificación y tratamiento precoz de un bloqueo espinal alto se describe el caso y se analizan las situaciones concomitantes de este escenario clínico.

 

 

Citas

- Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia. 2008;63(8):822–32.

- Portnoy D, Vadhera RB. Mechanisms and management of an incomplete epidural block for cesarean section. Anesthesiology Clinics of North America. 2003;21(1):39–57.

- Gaiser R. Anesthetic Considerations in the Obese Parturient. Clinical Obstetrics and Gynecology. 2016;59(1):193–203.

- Bauer M, Kountanis J, Tsen L, Greenfield M, Mhyre J. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. International Journal of Obstetric Anesthesia. 2012;21(4):294–309.

- Vaida S, Cattano D, Hurwitz D, Mets B. Algorithm for the anesthetic management of cesarean delivery in patients with unsatisfactory labor epidural analgesia. F1000Research. 2015;4:98.

- Furst SR, Reisner LS. Risk of high spinal anesthesia following failed epidural block for cesarean delivery. Journal of Clinical Anesthesia. 1995;7(1):71–4.

- Stone PA, Thorburn J, Lamb KS. Complications of Spinal Anaesthesia Following Extradural Block for Caesarean Section. Obstetric Anesthesia Digest. 1989;9(3):178.

- Beck GN, Griffiths AG. Failed extradural anaesthesia for Caesarean section. Complication of subsequent spinal block. Anaesthesia. 1992;47(8):690–2.

- Carvalho B. Failed epidural top-up for cesarean delivery for failure to progress in labor: the case against single-shot spinal anesthesia. International Journal of Obstetric Anesthesia. 2012;21(4):357–9.

- Butwick A, Carvalho B, Danial C, Riley E. Retrospective analysis of anesthetic interventions for obese patients undergoing elective cesarean delivery. Journal of Clinical Anesthesia. 2010;22(7):519–26.

- Blumgart C, Ryall D, Dennison B, Thompson-Hill L. Mechanism Of Extension Of Spinal Anaesthesia By Extradural Injection Of Local Anaesthetic. British Journal of Anaesthesia. 1992;69(5):457–60.

- Einhorn LM, Habib AS. Evaluation of failed and high blocks associated with spinal anesthesia for Cesarean delivery following inadequate labour epidural: a retrospective cohort study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2016;63(10):1170–8.

- Lamon AM, Einhorn LM, Cooter M, Habib AS. The impact of body mass index on the risk of high spinal block in parturients undergoing cesarean delivery: a retrospective cohort study. Journal of Anesthesia. 2017;31(4):552–8.

- Dadarkar P, Philip J, Weidner C, Perez B, Slaymaker E, Tabaczewska L, et al. Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit. International Journal of Obstetric Anesthesia. 2004;13(4):239–43.

- Campbell DC, Tran T. Conversion of epidural labour analgesia to epidural anesthesia for intrapartum Cesarean delivery. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2008;56(1):19–26.

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Publicado

2021-07-05

Cómo citar

Crespo Gómez, C. (2021). Bloqueo neuroaxial alto tras epidural fallida en cesárea urgente. A propósito de un caso.:  . Revista Electrónica AnestesiaR, 13(6). https://doi.org/10.30445/rear.v13i6.921