Author/Editor		Potočnik, Iztok; Oberauner, Lucija
Title		Subduralni blok - zaplet epiduralne anestezije
Translated title		Subdural block - a complication of epidural anaesthesia
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 6
Publication year		2003
Volume		str. 377-9
Language		slo
Abstract		Background. Epidural anaesthesia (EA) is a regional anaesthesia method that interrupts afferent nerve conduction. Epidural space (ES) is a space between internal leaf of a dura mater and spinal periosteum. The complications of regional anaesthesia are rare and are less common than those ofgeneral anaesthesia. The incidence of permanent neurological deficit is 0.03-0.1%. Subdural injection is a complication of epidural anaesthesia with an incidence of 0.82%. Subdural space is difficult to enter deliberately as arachnoidea is closely adherent to the overlying dura in most patients. Injection of the local anaesthetic solution into this space produces a high level of sensory and motor anaesthesia. Patients and methods. A case of 47 year-old female operated for cancer of the rectosigma is described. According to the kind of operation, a combined general and epidural anaesthesia was used. Despite proper insertion of a epidural catheter and recommended tests of its incorrect placement, the total spinal block developed. It is believed that a rare complication in the form of so-called subdural block occurred. Conclusions. Combined general and epidural anaesthesia is becoming widespread for major surgery and it is commonly used in developed countries. The purpose of this study was to warn on relatively rare complication of epidural anaesthesia. Only careful attention and a high index of suspicion for the development of the signs of subdural block will prevent complications.
Summary		Izhodišča. Epiduralrta anestezija (EA) je metoda področne anestezije, pri kateri prekinemo prevajanje živčnega draž jaja po aferentni poti. Epiduralni prostor (EP) se razteza med notranjim listom trde možganske ovojnice (dura mater) in pokostnico hrbtenjačnega kanala. Zapleti pri izvajanju področne anestezije so redki in niso pogostejši od splošne anestezije. Pojavnost trajnih nevroloških okvar znaša 0, 03-0,1 %. Subduralni blok (SB) je redek zaplet pri izvajanju epiduralne anestezije (0,82%). Subduralni prostor je težko dostopen, saj je pri večini ljudi pajčevnica neposredno zrasla z notranjo stranjo trde možganske ovojnice. Vbrizganje lokalnih anestetikov v ta ozki prostor povzroči visok nivo senzorične in tudi motorične blokade. Bolniki in metode. Opisan je primer 47-letne bolnice, ki so ji zaradi raka odstranili rektosigmo. Glede na vrsto posega smo se odločili za kombinirano splošno in epiduralno anestezijo. Kljub pravilno izvedenemu uvajanju epiduralnega katetra in izvedbi priporočenih testov za oceno ustrezne namestitve se je pri bolnici razvila slika popolne spinalne blokade. Najverjetneje je šlo pri bolnici za subduralni blok. Zaključki. Kombinirana anestezija se je v zadnjih letih zelo razmahnila. Pogosto se uporablja po vsem razvitem svetu. Z opisanim primerom bi radi opozorili na relativno redek zaplet pri izvajanju epiduralne anestezije. Le skrajna pozornost in dobro poznavanje kliničue slike subduralnega bloka bosta omogočila pravočasno spoznavo znakov, ustrezno ukrepanje in preprečitev zapletov.
Descriptors		ANESTHESIA, EPIDURAL SUBDURAL SPACE NERVE BLOCK MIDDLE AGE SPINAL NERVES