Anestesia regional: tipos y técnicas

ANESTESIA REGIONAL ANESTESIA REGIONAL Dra. Ma. Eugenia Mellafe Profesora Asistente Departamento Anestesiología Hospital Clínico U. de Chile

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANATOMIA DE LA COLUMNA VERTEBRAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL ANATOMIA

ANESTESIA REGIONAL fibras nerviosas: Fibras Nerviosas Periféricas Fibra Sensación Terminación de raíz dorsal Tracto Ascendente Velocidad de conducción (M/sec) Diámetro Promedio (µmol/L) Mielina A-a Tacto suave Profundo Columna dorsal ipsilateral 100 15 Abundante A-ß 50 8 A-d Agudo Superficial Tracto Espinotalámico Contralateral 6-30 3 Delgada C Sensación de quemazón duradera Superficial Tracto Espinotalámico Contralateral 0.5-2 1 Ninguno Adaptado y Traducido de: Paris PM, Uram M, Ginsburg MJ: Physiological mechanisms of pain. In Paris PM, Stewart RD, editors: Pain management in emergency medicine, Norwalk, Conn, 1988, Appleton & Lange.

Secuencia clínica de la anestesia ,[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA REGIONAL BALANCEADA ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

Anestesia Neuroaxial Balanceada ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESICOS LOCALES ,[object Object],ANESTESIA REGIONAL

ELECCIÓN DEL ANESTÉSICO LOCAL ,[object Object],ANESTESIA REGIONAL

ANESTESICOS LOCALES ,[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

TOXICIDAD DECRECIENTE DE LOS ANESTESICOS LOCALES ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESICOS LOCALES ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESICOS LOCALES ANESTESIA REGIONAL Notas .- (1) E= Ester; A= Amida. (2) Concentración habitualmente utilizada. (3) Expresada en miligramos (mg), S/V= Sin vasoconstrictor; C/V= Con vasoconstrictor. Anestésico Tipo 1 Lipofilia relativa pK a Latencia (min.) Duración (h) T 1/2 (h) Conc 2 Dosis máxima 3 S/V C/V Bupivacaína A 30 8,1 5' 6-8 2,7 0,25-0,5 300 200 Clorprocaína E 0,6 9,1 9' 0,5-1 0,1 1-3 800 600 Etidocaína A 140 7,7 4' 4-9 2,5 0,5-1,5 300 300 Lidocaína A 3,5 7,8 3' 1-2 1,5 0,5-2 500 300 Mepivacaína A 2 7,7 4' 2-3 2 0,5-2 500 300 Prilocaína A 2 7,8 2' 1-3 1,5 0,5-3 600 400 Procaína E 0,6 8,8 10' 0,7-1 0,1 1-2 750 500 Tetracaína E 80 8,4 15' 3-5 - 0,25-1 300 200

ANESTESICOS LOCALES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

MARCAS Y REPAROS ANESTESIA REGIONAL

POSICION DEL PACIENTE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],ANESTESIA REGIONAL

PLANOS ,[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

TECNICA A. R. ESPINAL ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],[object Object],ANESTESIA REGIONAL

VIAS DE ABORDAJE ANESTESIA REGIONAL VENTAJAS DESVENTAJAS VIA MEDIA La más frec. L2-3, L3-4 - % sup de fracasos -obliga a flexionar mucho la espalda -favorece trauma de lig interespinoso (dorsalgias) -No evita quistes degenerativos en lig interespinoso VIA LATERAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANESTESIA RAQUIDEA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA RAQUIDEA ,[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA RAQUIDEA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA ESPINAL INDICACIONES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

[object Object],ANESTESIA REGIONAL Cx anal S2-S5 Cx del pie L2-L3 Cx pierna / Cx muslo L1 Cx cadera Endoscopia ureterovesical Obstetricia T10 Cx cólica Cx urológica Cx ginecológica T6-T8 Cx submesocólica T4-T5

ANESTESIA PERIDURAL ,[object Object],[object Object],ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA PERIDURAL ANESTESIA REGIONAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

TECNICA A.R. PERIDURAL ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA PERIDURAL ,[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA EPIDURAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA EPIDURAL ,[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA PERIDURAL INDICACIONES ,[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA REGIONAL A. RAQUIDEA A. EPIDURAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],ANESTESIA REGIONAL

LA ANESTESIA COMBINADA ,[object Object],ANESTESIA REGIONAL

CONTRAINDICACIONES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

COMPLICACIONES NEUROLOGICAS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

COMPLICACIONES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

COMPLICACIONES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

CEFALEA POSTPUNCION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

CEFALEA POST PUNCIÓN DURAL 0.02 AL 3 % ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA REGIONAL ANESTESIA REGIONAL PERIFERICA DRA. MA EUGENIA MELLAFE M

FIBRAS NERVIOSAS ANESTESIA REGIONAL

BUPIVACAINA UNA MEZCLA RACEMICA ANESTESIA REGIONAL

ANESTESIA REGIONAL INTRAVENOSA ,[object Object],ANESTESIA REGIONAL

TÉCNICA ANESTESIA REGIONAL MARCAS : ....scritorioKU englishMV englischnini3e.mov ENPD ....scritorioKU englishMV englisch1f8sse.mov

ANESTESIA REGIONAL bloqueo mapeo

CLASIFICACION SEGÚN SU COMPLEJIDAD ANESTESIA REGIONAL Técnicas ARP Extremidad superior Extremidad inferior B ásicas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medias ,[object Object],[object Object],[object Object],[object Object],Avanzadas ,[object Object],[object Object],[object Object],[object Object]

AXILA ANESTESIA REGIONAL ,[object Object],[object Object],[object Object],[object Object]

MUÑECA ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

MUÑECA ANESTESIA REGIONAL MEDIANO CUBITAL FRC Mediano Cubital Radial

BLOQUEOS DIGITALES ANESTESIA REGIONAL

Bloqueo del Nervio Femoral ,[object Object],[object Object],[object Object],ANESTESIA REGIONAL

Bloqueo del Nervio Ciático ANESTESIA REGIONAL

Bloqueo del Nervio Ciático en el Hueco Poplíteo ANESTESIA REGIONAL

CONTRAINDICACIONES DE LOS BNP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

COMPLICACIONES DE LOS BLOQUEOS REGIONALES PERIFÉRICOS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ANESTESIA REGIONAL

ANESTESIA REGIONAL HOSPITAL CLÍNICO U. DE CHILE DEPARTAMENTO DE ANESTESIOLOGÍA ANESTESIA REGIONAL PERIFÉRICA CONTACTO : arg@redclinicauchile.cl

Anestesia regional: tipos y técnicas

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Anestesia regional: tipos y técnicas