RESUMEN
We described a case of discitis and meningitis following spinal anaesthesia for transurethral resection of the prostate. The patient received antibiotics for a month before surgery, because of Klebsiella prostatitis. Spinal anaesthesia was performed in L3-L4 interspace by using 22G Quincke needle. Bacteriaemia occurred during the first postoperative hours. Ten days after spinal anaesthesia, patient suffered from lumbar pain, exacerbated by vertebral percussion, and motor weakness within lower limb, which was marked on right side. MRI examination showed L3-L4 discitis with psoas abcess in regard, and epiduritis marked around L3 right spinal root. CSF examination confirmed meningitis but no bacteria was found. Antibiotics were administered over a 6 weeks period, and then patient discharged from hospital without neurological sequellae. Infectious discitis related to disk puncture during spinal anaesthesia and postoperative bacteriaemia was likely in our patient.
Asunto(s)
Anestesia Raquidea/efectos adversos , Discitis/etiología , Complicaciones Posoperatorias/terapia , Resección Transuretral de la Próstata/efectos adversos , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Discitis/microbiología , Discitis/terapia , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Imagen por Resonancia Magnética , Masculino , Meningitis/etiología , Meningitis/microbiología , Complicaciones Posoperatorias/microbiologíaRESUMEN
We compared intrathecal ropivacaine to bupivacaine in patients scheduled for transurethral resection of bladder or prostate. Doses of ropivacaine and bupivacaine were chosen according to a 3:2 ratio found to be equipotent in orthopedic surgery. One hundred patients were randomly assigned to blindly receive either 10 mg of isobaric bupivacaine (0.2%, n = 50) or 15 mg of isobaric ropivacaine (0.3%, n = 50) over 30 s through a 27-gauge Quincke needle at the L2-3 level in the sitting position. Onset and offset times for sensory and motor blockades and mean arterial blood pressure were recorded. Pain at surgical site requiring supplemental analgesics was recorded. Cephalad spread of sensory blocks was higher with bupivacaine (median level, cold T(4) and pinprick T(7)) than with ropivacaine (cold T(6) and pinprick T(9)) (P<0.001). Eight patients in Group Ropivacaine received IV alfentanil (P<0.01). Onset time (mean +/- SD) to T(10) anesthesia and offset time at L2 were not different (bupivacaine = 13 +/-8 min, 127+/-41 min; ropivacaine = 11+/-7 min, 105+/-29 min). Complete motor blockade occurred in 43 patients with bupivacaine and in 41 patients with ropivacaine (not significant). Total duration of motor blockade was not different. No difference in hemodynamic effects was detected between groups. No patient reported back pain. We conclude that 15 mg of intrathecal ropivacaine provided similar motor and hemodynamic effects but less potent anesthesia than 10 mg of bupivacaine for endoscopic urological surgery.
Asunto(s)
Amidas , Anestesia Raquidea , Anestésicos Locales , Bupivacaína , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Monitoreo Intraoperatorio , Dimensión del Dolor , Ropivacaína , Resección Transuretral de la Próstata , Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos UrológicosRESUMEN
A 43-year-old man who presented a perplexing diagnostic challenge, had diffuse linitis plastica involving the entire gastrointestinal tract (autopsy). Although the usual primary site is the stomach in case of linitis plastica, invasion of the large and small bowel is rarely seen, but must be searched with proctoscopic exam and barium enema. We review the literature and discuss the pathogeny of this disorder.