[Complications of local and regional anesthesia. An analysis of closed files of insurance companies].
We report a review of closed insurance claims for local and regional anaesthesia mishaps in the main private professional insurance companies. Twenty eight cases with extensive written documentation were discovered, spanning a 6 years interval between 1983 and 1989, involving 21 epidural, 6 spinal and 1 caudal anaesthesias, half with surgical and half obstetrical indication, and excluding all other blocks. Twenty four out of the 28 patients were relatively healthy. ASA I or II, only 4 ASA III. They fitted 4 items of our taxonomy of known complications: 15 cardiac arrests, 10 neurological damages, 1 systemic toxic reaction to local anaesthetic drug and 1 allergic reaction to dextran. The cardiac arrests resulted primarily from the 3 following or contributing factors: hypovolemia (in 3 cases), added sedation (7) and high or total spinal block following reinforcing doses (8). Twenty two had a poor outcome: 8 deaths, 7 severe neurological injuries, a baby was dead and another child had severe neurobehavioral sequellae. The author points out the limitation of this study--a biased sample of all adverse events and inability to derive an incidence. However some of these events reveal patterns of anaesthetic management which lead to poor outcomes.
Département d'Anesthésie-Réanimation, GH Cochin Port Royal, Paris.
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Morisot
D000328:Adult; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000772:Anesthesia, Local / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007345:Insurance Claim Review; D007351:Insurance, Liability; D008297:Male; D011247:Pregnancy; D020196:Trauma, Nervous System
Complications des anesthésies loco-régionales. Analyse des dossiers classés des compagnies d'assurance.