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In this case report, we describe the use of cerebrospinal fluid lavage as a successful treatment of an inadvertent intrathecally placed epidural catheter in a 14-yr-old girl who underwent a combination of epidural anesthesia and general anesthesia for orthopedic surgery. In this case, a large amount of local anesthetic was injected (the total possible intrathecal injection was 200 mg of lidocaine and 61 mg of bupivacaine), resulting in apnea and fixed dilated pupils in the patient at the end of surgery. Twenty milliliters of cerebrospinal fluid was replaced with 10 mL of normal saline and 10 mL of lactated Ringer's solution from the "epidural" catheter. Spontaneous respiration returned 5 min later, and the patient was tracheally extubated after 30 min. No signs of neurological deficit or postdural puncture headache were noted after surgery.Cerebrospinal lavage may be a helpful adjunct to the conventional supportive management of patients in the event of an inadvertent total spinal.

Among the many challenges attending childbirth in economically disadvantaged countries such as Malawi is the need to provide timely anesthesia for operative deliveries. A timesheet questionnaire was used to determine the interval from when an anesthetist was informed about a case to the start of delivery. Subjects were 78 consecutive women having cesarean section. The prevailing recommendation is that this interval should not exceed 30 minutes. At the time the decision to operate was made, the lives of 15 women or their fetuses were immediately threatened (grade 1). In 37 other cases, there was fetal or maternal compromise but no immediate threat to life (grade 2). In 21 grade 3 cases, delivery was necessary but there was no maternal or fetal compromise. Finally, 5 women were operated on at a time suitable to both the mother and the obstetric team (grade 4). Spinal anesthesia was used primarily in 83% of cases and after a spinal had failed in 5%. In 12% of cases, general anesthesia was used at the outset. In 1 grade 1 case (8%) and 7 grade 2 cases (19%), the anesthetist was unavailable for longer than 15 minutes, most often because of the need to attend to another patient. The time to starting anesthesia exceeded 10 minutes in 3 grade 1 cases (23%) and 18 grade 2 cases (49%). In approximately half of these cases, the patient was unavailable. In 73% of all cases, the anesthetist was at hand before the patient entered the operating room. The time from starting anesthesia to readiness for surgery exceeded 15 minutes in 3 grade I cases (21%) and 14 grade 2 cases (38%). There was an identifiable anesthetic problem in approximately half of these cases. This experience suggests that a brief delay while performing a difficult spinal anesthetic is not important when compared with the frequently lengthy delays in presentation and preoperative care. When a cause for delay is not apparent, it could be that the anesthetist has not perceived one.

IMPLICATIONS We report a case of successful administration of a spinal anesthetic to a patient with progressive chronic inflammatory demyelinating polyneuropathy (CIDP). There have been no reports of regional anesthetic management of patients with CIDP.

DEMOGRAPHICS Case Title: Dante Jackson’s Anterior Cruciate Ligament (ACL) Repair (Cardiovascular collapse from a “high spinal”). Patient Name: Dante Jackson. Case Description and Diagnosis: A spinal anesthetic that results in cardiovascular collapse in a 24-year-old healthy male presenting for repair of the left ACL injury. Simulation Developers: Yetunde Olutunmbi, MD; William McIvor, MD; and Jessica Borrell. Dates of Development: June–December 2008. Target Audience: Medical students (4th year), Anesthesiology residents (post-graduate year 2–5), Anesthesiology faculty for continuing medical education (CME), student registered nurse anesthetist (SRNA), or certified registered nurse anesthetist (CRNA).

Summary Spinal anesthesia has been practiced in pediatric patients for roughly the same period of time that it has been used in adults. Many different drugs and dosages have been successfully employed, and it appears that spinal anesthesia without sedation may offer real advantages in the premature infant at high risk for postanesthetic apnea. However, avoidance of general anesthesia will not guarantee that a neonate with multiple medical problems will not evidence apnea or other difficulties in the postoperative period, and it is still recommended that postoperative respiratory monitoring be employed in an inpatient setting. The popularity of spinal anesthesia for the “little folk” varies as the wheel of anesthetic practice revolves and the clinical challenges facing the practitioner alter. However, as Corning noted in his early report of a therapeutic cocaine spinal anesthetic, “Whether the method will ever find an application as a substitute for etherization in genitourinary or other branches of surgery, further experience alone can show. Be the destiny of the observation what it may, it has seemed to be, on the whole, worth recording.”12

Pain is the predominant symptom of degenerative knee arthritis and the main reason patients undergo total knee arthroplasty (TKA). Variation in patient response to pain has proved difficult to quantify. The effect of removing pain by testing TKA patients' range of motion (ROM) before and after the administration of anesthesia has not previously been analyzed. This study objectively quantifies the effect of eliminating pain on knee joint ROM for a typical group of TKA patients with osteoarthritis. We prospectively recruited 141 patients with osteoarthritis admitted for TKA to assess the inhibitory effect of pain on ROM. Passive maximum flexion, extension, and ROM were measured preoperatively before and after administration of anesthesia (spinal anesthetic followed by femoral and sciatic regional nerve blocks). Following pain abolition, passive maximum flexion increased by an average of 13.4 degrees (SD=11.9 degrees), passive maximum extension improved by an average of 3.0 degrees (SD=4.2 degrees), and passive ROM increased by an average of 16.4 degrees (SD=13.1 degrees). The change in each parameter was statistically significant (P

Three cases of colorectal foreign bodies are presented and the literature is reviewed. Case 1: A 47-year-old man, who had inserted a seasoning bottle in his rectum on January 3, was admitted to National Yokosuka Hospital on January 5, 1990. A pelvic x-ray film showed the object in the sigmoid colon, and an emergency operation was performed. The bottle (11cm in length) was removed from the sigmoid colon. The patient was discharged 16 days after the operation without complications. Case 2: A 40-year-old man presented with a self-inserted seasoning bottle in his rectum that he was unable to remove and was admitted to the hospital on July 24, 1990. Edema of the rectum precluded manual removal of the object. At laparotomy, the bottle (7.5cm in length) was removed from the rectum. The patient's postoperative course was good and he was discharged on August 26. Case 3: A 62-year-old man was admitted on December 12, 1990 for evaluation of a one-day history of a foreign body in the anorectum following autoerotic transanal manipulation with a vibrator. The 6×3×3cm object was removed manually after a spinal anesthetic. The patient was discharged on the third postoperative day.

This chapter discusses major injuries such as paraplegia caused by epidural, caudal, and spinal anesthetic techniques.

The distribution of spinal anesthesia is affected by the density and viscosity of the local anesthetic solution that, in turn, may be influenced by the temperature of the injectate. Our hypothesis in the present study was that the temperature of the injectate influences its distribution into the subarachnoid space. We measured the density and viscosity of hyperbaric 0.5% bupivacaine at 25 degrees C and 37 degrees C and tested the onset and extent of spinal anesthesia achieved by these solutions in 36 patients. The densities of the two solutions were similar (mean [sd]): 25 degrees C, 1.028 [0.000], versus 37 degrees C, 1.028 [0.000] (g/mL), but the viscosity was more at 25 degrees C than at 37 degrees C (0.01116 [0.00003] versus 0.00843 [0.00002] g x cm(-1) x s(-1); P0.001). The maximum cephalad extent of loss of pinprick sensation was significantly higher with 37 degrees C (T2 with 37 degrees C versus T5 with 25 degrees C; P0.001), but the time to achieve peak block height was similar. In conclusion, we showed a consistent, but modest, increase in the cephalad level of spinal anesthesia by warming hyperbaric bupivacaine 0.5% from 25 degrees C to 37 degrees C. Viscosity was reduced in the warmed solution, but it is unclear if this or other factors led to the difference in spinal anesthetic level.

We describe two cases where we attempted to reduce the adverse effects of inadvertent spinal anaesthesia by aspirating local anaesthetic-contaminated cerebrospinal fluid (CSF). Analysis of this CSF for its local anaesthetic concentration revealed that we were able to recover 51% and 39% of the administered lignocaine. It is suggested that such aspiration may be a helpful additional measure to the supportive management of this complication.

Purpose. An epidural injection of saline was reported to extend spinal anesthesia because of a volume effect. The aim of this study was to evaluate the influence of the baricity of spinal local anesthetics upon the extension of spinal anesthesia by epidural injection of saline. Methods. Forty patients undergoing elective lower-limb surgery were randomly allocated to four groups of 10 patients each. Group A received no epidural injection after the spinal administration of hyperbaric tetracaine (dissolved in 10% glucose). Group B received an epidural injection of 8 ml of physiological saline 20 min after spinal hyperbaric tetracaine. Group C received no epidural injection after spinal isobaric tetracaine (dissolved in physiological saline). Group D received an epidural injection of 8 ml of saline 20 min after spinal isobaric tetracaine. The level of analgesia was examined by the pinprick method at 5-min intervals. Results. The levels of analgesia 20 min after spinal anesthesia were significantly higher in hyperbaric groups than in isobaric groups [T5 (T2–L2) vs. T7 (T3–12)]. After epidural injection of saline, the levels of analgesia in groups B and D were significantly higher than in groups A and C. The segmental increases after epidural saline injection were 2 (0–3) in group B and 2 (1–7) in group D. Sensation in the sacral area remained 20 min after spinal block in one patient in group D; however, it disappeared after epidural saline injection. Conclusion. In this study, 8 ml of epidural saline extended spinal analgesia. However, there was no difference between the augmenting effect in isobaric and hyperbaric spinal anesthesia. We conclude that the reinforcement of spinal anesthesia by epidural injection of saline is not affected by the baricity of the spinal anesthetic solution used.

Dexmedetomidine is used as spinal anesthetic adjuvant for potentiating the actions of local anaesthetics. We devised this study to compare the effects of 3, 5 and 10 μg dexmedetomidine on 3 ml of 0.75% isobaric ropivacaine in patients undergoing inguinal hernia repair. 64 patients were divided into 4 groups. Group 1 was given spinal ropivacaine, while groups 2, 3 and 4 received additional 3, 5, 10 μg dexmedetomidine respectively. Duration of two segment sensory regression (72.25±9.46, 97.63±8.17, 125.63±9.96, 125.63±9.96 minutes in groups 1, 2, 3 and 4 respectively), duration of analgesia (156.00±8.40, 278.38±13.69, 356.00±11.84, 441.56±16.62 minutes in groups 1, 2, 3 and 4 respectively), motor block (133.31±10.90, 258.25±23.29, 330.50±22.66, 408.63±19.14 minutes in groups 1, 2, 3 and 4 respectively) and sensory block (188.00±13.26, 188.00±13.26, 384.50±30.85, 487.50±40.60 minutes in groups 1, 2, 3 and 4 respectively) were significantly prolonged in patients receiving dexmedetomidine in a dose dependent manner. Peak sensory block and side effects were unaffected by dexmedetomidine. We conclude that dexmedetomidine prolongs the duration of sensorimotor block and analgesia in a dose dependent manner.

In 2006, when the birth of her second child was only weeks away, 24-year-old Robin Rodgers began losing weight and vomiting. Her doctor ordered her to be hospitalized and fed through a tube until she delivered. But the nutrition source container that was feeding her via a feeding tube in her stomach was mistakenly connected to an existing intravenous line. Tragically, both Rodgers and her unborn child died. That same year, a Wisconsin nurse mistakenly injected a spinal anesthetic into an IV tube, killing 16-year-old Jasmine Gant, who was giving birth. In another incident, premature infant Chloe Back was mistakenly connected to a bag of breast milk through her IV tube. In this case, the baby did not die, but formed blood clots throughout her body, bled profusely, and suffered seizures for months afterward. In response to these and the many other reports of tubing misconnections that have plagued healthcare workers and human factors engineers for decades, a Sentinel Alert was issued by the Joint Commission in 2006 to draw attention to the gravity of the matter. This year, articles in a number of publications, most prominently the New York Times and Las Vegas Review Journal, have again brought the issue to the forefront. These articles led to a Congressional committee inquiry and a call for new regulations by the Nevada Medical Association. They also prompted the medical device industry and the U.S. Food and Drug Administration (FDA) to publicize the work that has been underway for some time in the development of a new international standard that many hope will virtually eliminate future tubing misconnections. The first of a series of new standards is currently at final voting (FDIS) stage internationally, and will be issued after approval under the designation and title ISO 80369-1, Small-bore connectors for liquids and gases in healthcare applications. Other parts of the series will address connectors for specific applications. In the meantime, 80369-1 is expected to provide unprecedented methods to identify specific connector solutions for a variety of medical applications. Brad Noe, technical resources manager at Becton Dickinson and Company, is co-chair of the AAMI small bore connectors working group, which serves as the U.S. technical advisory sub-group (sub-TAG) for the ISO/IEC connector standards, and is also project leader for two of the ISO/TC 210 project groups developing the series. Noe says that human error due to device issues, environment of care, and other factors certainly plays a part in such misconnections, although “how much a part,” he says, “is difficult to quantify. The misconnection of tubing sets due to working in dimly lit conditions, inability to trace the line from connection point to connection point, or incorrect or missing labels all contribute,” he explains. AAMI is the secretariat for the international committees that are jointly developing 80369 (ISO/TC 210 and Human Factors Initiatives Aim to Make Tubing Misconnections Old News

Adjuvants such as opioids or epinephrine are commonly added in small volumes to multicomponent spinal anesthetic solutions.In this study, we tested the hypothesis that final adjuvant concentrations vary depending on the devices and techniques used to prepare the anesthetic solution. We compared two aspiration devices, the filter needle and the filter straw, in a laboratory study. Two techniques for drawing up and estimating adjuvant volumes were assessed, as was variation in the composition of a model spinal anesthetic solution resulting from intra- and interindividual variability. A model hyperbaric anesthetic solution consisting of tetracaine, dextrose, and methylene blue (MB) as a small-volume tracer solution was studied. The components were drawn up into a syringe through one of two commercially supplied aspiration devices, a filter straw or a filter needle. The effect of the order of aspiration of the components into the syringe was measured by determining the MB concentration in the final solution by optical absorbance. Ten experienced anesthesiologists then prepared samples of the test solution using one of two different techniques to estimate tracer volume in the aspiration syringe. In comparison studies, the MB tracer was added to the hyperbaric solution with a tuberculin syringe. The order of aspiration of the solution components had a large effect on the final concentration of the MB tracer in the ultimate mixture. Variation in the MB concentration was on the order of four- to fivefold. Effects were larger for the filter straw compared with the filter needle. A comparison of 10 anesthesiologists revealed large intra-and interindividual variations in the final composition of the model anesthetic solution. The concentration of tracer added to the mixture with a tuberculin syringe approximated the planned yield. We conclude that the devices and techniques used to prepare mixtures of drugs for delivery to the cerebrospinal fluid may influence the concentrations of drugs in the anesthetic and, thus, the dose supplied to the patient receiving spinal anesthesia. Variation in clinical effects of spinal anesthetics may be attributable, in part, to variation in the composition of the anesthetic. Implications: This laboratory study demonstrates the potential for large variation in the composition of spinal anesthetic mixtures. (Anesth Analg 1998;87:1326-30)

Posterior reversible encephalopathy syndrome (PRES) is a clinico-neuroradiological syndrome characterized by various symptoms of neurological disease. It has commonly been reported in association with acute hypertension, pre-eclampsia, eclampsia, sepsis, and exposure to immunosuppressants. Here, we report on a normotensive woman who developed a severe frontal headache, visual disturbances, and hypertension 3 days after undergoing an emergency laparotomy for ischemic colitis during which she suffered an inadvertent dural puncture. Neuro-imaging revealed features consistent with PRES. The patient went on to make a good recovery, being discharged 21 days postoperatively, with only minor visual disturbances and memory problems. This case highlights the importance of awareness of PRES to all specialties. On reviewing the literature, we feel that PRES may be a potential differential diagnosis to post-procedural neurological symptoms in those patients undergoing routine procedures such as spinal anesthetics or lumbar punctures.

HA had a significant past history of being injured in a car accident in 1967 that resulted in severe injuries to both legs. In 1972, due to this injury, HA permanently retired from the military. HA became a barber but it became apparent that his past leg injury prevented him from standing long hours. As a result of HA’s leg problems, he entered the V.A. Hospital. On 7/12/76, HA underwent an initial operation to drain an infection from one of his ankles. He was given a spinal anesthetic for that operation and recovered from the anesthesia without complications. However, the operation was not completely successful, and HA was scheduled for an additional operation on 7/14/76. Dr. CH, an anesthesia resident in his fourth month at the V.A. Hospital program, was assigned to administer the anesthetic to HA on 7/14/76. Dr. CH’s supervising physician was Dr. CK, a board-certified anesthesiologist, who was provided to the V.A. Hospital under a contract between the V.A. Hospital and its affiliated medical school. When HA was taken to surgery, Dr. CH attempted to administer the spinal anesthetic, but his attempt to introduce the needle was unsuccessful. Dr. CK then obtained a successful spinal tap and administered 12 mg of tetracaine

More premature infants are now surviving because of advances in perinatal care. Premature infants often have congenital anomalies requiring operative correction and are at increased risk for developing postoperative apnea. The purpose of this study was to review our results with spinal anesthesia in infants. Twenty-two infants (average age at operation, 11 weeks) had spinal anesthesia for surgery to the spine or lower extremities. One patient with bilateral developmental dysplasia of the hip had staged operations 1 month apart. Twelve infants (55%) were considered to be at increased risk for general anesthesia. The spinal anesthetic was 1% tetracaine made hyperbaric with 10% dextrose (tetracaine dose, 0.5 mg/kg). Spinal anesthesia was successful in all 23 cases. The average follow-up was 4 years, 1 month, and no complications were attributed to the spinal. Spinal anesthesia is a safe and effective substitute for general anesthesia in infants having spinal and lower extremity operations and is particularly beneficial for high-risk infants.

Background: Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Methods: Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. Results: LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Conclusions: Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

Hypotension is one of the well-known complications following spinal anesthesia, and Trendelenburg position seems to have been used as one of the management of it. But, Trendelenburg position generally raises spinal anesthetic level with the use of hyperbaric tetracaine, and blood pressure may even further decrease. If simple elevation of lower extemities can prevent hypotension successfully without raising spinal anesthetic level following hyperbaric spinal anesthesia, there will be a possibility for us to replace Trendelenburg position with the elevation of lower extremities. We examined 50 cases of hyperbaric spinal anesthesia followed by elevation of lower extremities with the angles of l5 and 30 degrees. At each case, hydration with 10 ml per Kg was performed during the fixation time (about 30 minutes) and then, blood pressure(systolic and diastolic), heart rate were checked with the time-interval of 1 and 2 minutes for each angle. The paired T-test showed that systolic and diastolic blood pressure after spinal anesthesia was increased in all cases with mean values of 2.74~5.68 mmHg for systolic blood pressure(p

Lidocaine, tetracaine, and bupivacaine are the local anesthetic agents most commonly employed for spinal anesthesia in the U.S. Lidocaine provides a short duration of anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than one hour. Tetracaine and bupivacaine are used for procedures lasting 2 to 5 hours. Tetracaine appears to provide a somewhat longer duration of anesthesia and a more profound degree of motor block than does bupivacaine. On the other hand, compared with tetracaine, bupivacaine has been demonstrated to be associated with a decreased incidence of hypotension. In addition, bupivacaine may be better than tetracaine for use in orthopedic surgical procedures since it appears to be associated with a lower incidence of tourniquet pain. Vasoconstrictors can prolong the duration of spinal anesthesia of all three agents. However, the greatest duration is seen when vasoconstrictors are added to tetracaine solutions. Lidocaine and bupivacaine do not appear to benefit as much from the addition of vasoconstrictors. In general, the local anesthetic agents that are currently available for spinal anesthesia provide significant versatility. By carefully considering the planned surgical procedure, the surgeon's requirements, and the patient's characteristics (e.g., age, height, gravidity), and by understanding the factors that influence spinal anesthesia, the anesthesiologist can select a local anesthetic agent that will assure adequate and satisfying spinal anesthesia.

Summary Bupivacaine HCl, 0.25, 0.5 and 1.0%, was administered epidurally to cats and the duration of block recorded. Subsequent gross and microscopic examination of the spinal cords revealed morphological changes due to the presence of the polyethylene catheter in the epidural space. There was no evidence of drug-induced morphological changes. Spinal anesthesia with 0.25, 0.5 and 1.0% bupivacaine HCl was performed in sheep, and durations of sensory analgesia and motor block were recorded. Despite certain limitations, inherent in all animal models, the sheep is an excellent model for the study of spinal anesthetic agents.

Experiments leading to the development of a model to study meconium aspiration of the newborn are described. The final model consisted of the undelivered progeny of a hysterotomized pregnant dog under spinal anesthetic. The puppies were subjected to tracheal intubation and meconium injection before clamping of their umbilical cords. This model may be used to provide objective evidence of the value of parenteral steroid administration in instances of meconium aspiration in the newborn.

It is well known that the pregnant patient requires less anesthetic agent for induction of spinal anesthesia than does the nonpregnant patient. The purpose of this study was to demonstrate that compression of the inferior vena cava by the pregnant uterus or by an abdominal binder causes engorgement of the vertebral venous system, which in turn decreases the capacity of the spinal subarachnoid space for spinal fluid. Therefore, a smaller quantity of anesthetic agent would be required to induce spinal anesthesia. A spinal anesthetic was administered under standard conditions to 20 nonpregnant patients, 15 pregnant patients at term, and 15 nonpregnant patients in whom the inferior vena cava pressure was artificially increased to approximately 250 mm. of water. The results indicated that an increase in inferior vena cava pressure causes a decreased requirement for anesthetic agent for the induction of spinal anesthesia.

The report is based on a study of 565 consecutive and unselected cases of cesarean section in 345 of which spinal anesthesia was used. There was no mortality attributable to the spinal anesthetic. Although 220 of the entire series were performed under other types of anesthesia, the preference has been for spinal. The drugs used, their dosage, and the technique of injection are detailed. The incidence and treatment of unfavorable reactions, and precautionary measures for their prevention are given. The reasons for the preference of spinal anesthesia and its objections and contraindications are presented.

1. A double blind study has evaluated the comparative merits of mepivacaine and tetracaine as spinal anesthetic agents in vaginal delivery. 2. Mepivacaine was found to be characterized by a more rapid onset of and more profound anesthesia, although with a shorter duration of action.

As a part of the careful study of patients submitted to the operation of total thyroidectomy for heart disease, we have conducted skin temperature observations before and after the operative procedure. We have utilized the method of Gibbon and Landis.1 This method has been shown to produce adequate vasomotor dilatation and is far simpler than the other methods of injection of foreign proteins, the induction of a general or spinal anesthetic, or the blocking of sympathetic ganglia or peripheral nerves with novocaine or alcohol.The operative procedure on all patients was done under local anesthesia, thereby eliminating the variability of blood flow studies as seen after a general anesthesia (Herrick et al.2). The skin temperature determinations were all done in a small room, free from air currents, and having a constant temperature of 68–72°F. and humidity between 40 and 50%. This gives constant findings as shown by Talbot.3 The patients in all cases were in bed in a semi-Fowler position and the points of e...

Cerebral blood flow and arterial–sagittal differences for oxygen have been measured in unpremedicated dogs maintained at, 37.0 C. All were paralyzed, had received a spinal anesthetic, and were artificially ventilated. In each of a first group, measurements with and without halothane were carried out with 70 per cent N2O in O2 and with 70 per cent N2 in O2. In a second group, either N2O or N2 was used throughout and measurements were made in the absence of halothane and at 0.1, 0.4, and 0.7 per cent halothane (alveolar). In the absence of halothane and at 0.1 per cent halothane, the average rate of consumption of O2 by the brain (CMRo2) was 11 per cent greater with N2O than with N2. At 0.4 and 0.7 per cent halothane, CMRo2 was greater with N2O but the differences were not significant. It is concluded that N2O per se is not a cerebral metabolic depressant and that the anesthetic action of N2O is not based on generalized cerebral metabolic depression.

São relatados 11 casos de seqüelas de raqueanestesia observados no Serviço de Neurologia de um hospital geral. Em 8 casos o exame radiológico mostrou a existência de espinha bifida oculta; em um caso a anamnese assinalou a ocorrência de enurese até os 18 anos de idade. Os autores chamam a atenção para êste fato e correlacionam a preexistência de malformação do sistema nervoso central à alta incidência das seqüelas. Por êsse motivo aconselham a pesquisa dessas alterações, clínica e radiològicamente, antes de ser indicada a raqueanestesia. Report of 11 cases with neurological sequelae after rachianesthesia. The neurological symptoms were: root pains, sexual impotence, weakness of the lower limbs and sphincter disturbances. None of these patients had any neurological symptom before the administration of spinal anesthetic. Eight patients presented spina bifida occulta without neurological signs. Of the 3 cases with normal roentgenogram one had enuresis until 18 years old. The authors suggest that clinical and roentgenogram studies should be done before each rachianesthesia procedure.

Summary 1. One group of 185 patients received dibucaine spinal anesthesia for delivery and is compared with a like number receiving lidocaine as to rapidity of action and degree of anesthesia obtained. 2. Dibucaine was noted to produce hypesthesia in an average of 230.9 seconds, and lidocaine in 162.9 seconds, regardless of the level obtained. 3. Lidocaine repeatedly produced a sensation of warmth and/or tingling in the toes within one minute of administration. This psychic lift that “the drug is working” cannot be underestimated. 4. Dibucaine produced totally adequate results in 61.7 per cent, whereas lidocaine produced the same results in 96.8 per cent. 5. Hypotensive reactions and other complications were infrequent in each group. 6. Lidocaine, by virtue of its rapid action and high degree of reliability, has replaced dibucaine as the spinal anesthetic agent of choice in our delivery rooms.