23 de agosto de 2013

Artigo recomendado: Phrenic Nerve Function after Interscalene Block Revisited

Now, the Long View
Quinn H. Hogan
Anesthesiology 2013; 119:250-2, Quinn H. Hogan

Anesthesiologists are very good at immediate observation and intervention. For instance, hemodynamic disorders or inadequate ventilation are apparent to us in real time with customary vigilance and modern monitoring. Less evident are the delayed consequences of our actions. Only relatively recently we have become suspicious that volatile anesthetics might alter immunological function or neurological development months after administration. Similarly, in the realm of plexus and peripheral nerve blocks, we have long understood the immediate risks of injecting local anesthetic into the systemic circulation, which included vessel damage leading to bleeding, neural trauma, and anesthetization of unintended targets. Our focus of care is to avoid these immediate dangers. In contrast, delayed harm after blocks is less subject to our scrutiny. A case series reported in the current issue of Anesthesiology suggests that our attention should also extend into the long-term time frame regarding phrenic nerve function after interscalene blockade (ISB).

Acute loss of diaphragmatic activity after block of the phrenic nerve during ISB has been recognized as a predictable hazard since the landmark study by Urmey et al. in 1991. Now, Kaufman et al. report a series of 14 patients referred to them for treatment of chronic diaphragmatic paralysis that was clearly due to phrenic nerve damage after ISB. Few conclusions can be made from a case series with certainty, but their observations support several preliminary hypotheses.

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