| Budget Amount *help |
¥2,500,000 (Direct Cost: ¥2,500,000)
Fiscal Year 1989: ¥800,000 (Direct Cost: ¥800,000)
Fiscal Year 1988: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 1987: ¥700,000 (Direct Cost: ¥700,000)
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| Research Abstract |
In order to clarify the cause of cardiac arrest under spinal anesthesia, we studied cardiac arrest associated with spinal anesthesia. We collected cases from literatures, judicial reports and malpractice cases reported to local medical association.
Thirty three cases were collected. The mean age of patients was thirteen years old. As local anesthetic for spinal anesthesia, dibucaineor or its complex was mainly used. There was variation of initial signs of the major complication, which was consisted of cyanosis, hypotension, dyspnea, respiratory arrest. These signs were noted within 30 minutes after spinal anesthesia. These cases had been uneventful throughout the procedure until sudden changes occured.
Immediate treatment for these crises also varies with the individual cases. Artificial ventilation, cardiac massage, establishment of airway, oxygen inhalation and administration of vasopressor were done.
Nevertheless, these treatments hardly effected for some cases. About the half of the p
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atients died in 6 hours and many survived patients became vegetable state. The etiology of death or shock was classified as anaphylactic shock, idio-syncracy, respiratory insufficiency and so on.
According to a cumulative study of anesthetic mortality, the incidence of anesthetic death associated with spinal anesthesia was extremely high in puberty ages. This is not only because an acute appendicitis is frequently seen in this age group, but also there must be a certain specific risk in anesthesia itself. Spinal anesthesia was performed by a surgeon himself and patients were seen by a circulating nurse instead of anesthetists.
Concerning about this major complications, the following risk factors can be picked up ; allergic response, idiosyncrasy, high level anesthesia, abnormal sympathetic response, poorly monitoring and inappropriate management. Combining these factors might cause cardiac arrest under spinal anesthesia. Therefore these factors should be removed as much as possible whenever spinal anesthesia are given. Less
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