6. Which of the following actions is not recommended following an unexpectedly prolonged sensory or motor blockade after neuraxial anesthesia or analgesia?
A. Reduction or discontinuation of local anesthetic infusion and reexamination
B. Neuroimaging for compressive lesion or spinal cord ischemia
C. Corticosteroids if ischemic spinal cord injury
D. Maintain normal blood pressure or consider inducing high-normal-range blood pressure
Answer: C
Should an unexpected prolonged sensory or motor blockade occur following a neuraxial anesthesia or analgesia, the anesthesiologist must rule out reversible causes in an expedient manner. At the physician’s judgement, this may entail reducing or discontinuing local anesthestic infusion and reexamination of the patient within an hour. Immediate neuroimaging to exclude a compressive (hematoma or abscess) processs should be pursued. If imaging is ordered, MRI is preferable to CT, but the diagnosis should not be delayed if only CT is available. However, if CT rule out a compressive lesion, subsequent MRI will be necessary if spinal cord ischemia is suspected.
If imaging rules out an operable mass lesion and spinal cord ischemia is suspected, practitioners should ensure at least normal blood…show more content… There are concerns that antiseptic solutions, particularly chlorhexidine/alcohol mixtures cause arachnoiditis. A retrospective cohort study reported no increased risk in neuraxial complications when chlorhexidine is used as the skin disinfectant. An in vitro study found the commonly used concentrations of chlorhexidine is not more cytotoxic than povidone-iodine, and if allowed to dry, any residual carried by the needle from skin to subarachnoid space would be diluted a 145,000 times over. Chlorhexidine has been proven to be the superior antiseptic agent, and hence is recommended by the ASRA advisory panel as the skin disinfectant of choice for neuraxial
