Anestesia espinal parte III. Mecanismos de acción
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
La anestesia espinal es una técnica ampliamente utilizada en la práctica clínica. Por lo general, el bloqueo nervioso está determinado por tres factores principales. El primero es la distribución del anestésico local en el líquido cefalorraquídeo (LCR), que a su vez se ve afectado por una gran variedad de factores, destacando entre estos el volumen de LCR. El segundo es la absorción, la cual es mayor en los sitios en donde la concentración del fármaco también lo es: para esto afecta la accesibilidad, el contenido lipídico y la irrigación vascular de cada zona. El último factor es la eliminación, mediada principalmente por la irrigación de los distintos compartimentos, y cuyo orden es distinto a la imagen especular del inicio de acción. Los factores mencionados son los principales determinantes de los tiempos de demora de los bloqueos, el orden en el que se logra su acción en las distintas fibras y el bloqueo diferencial. Este texto pretende describir los principales mecanismos de acción mediante los cuales actúa la anestesia espinal y los factores que pueden determinar diferencias en los resultados de esta.
Spinal anesthesia is a widely used technique in medical practice nowadays. Generally, nervous blockage is determined by three main factors. The first of them is the distribution of the local anesthetic in the cerebrospinal fluid (CSF), which can be affected by numerous factors, the most important of them being CSF volume. The second is absorption, which is greatest at the sites with higher drug concentration: this is the result of the accessibility, lipidic content and vascular irrigation of each area. The last of these factors is elimination, mediated mainly by the irrigation of the different compartments, and whose order differs from the mirror image of the onset's action order. The previously mentioned elements are the main sources of variation for the time needed to achieve desired effects, order in which fibers are affected and differential blockage. This text describes the principal mechanisms through which spinal anesthesia works, and the factors which can result in variations of its results.
Spinal anesthesia is a widely used technique in medical practice nowadays. Generally, nervous blockage is determined by three main factors. The first of them is the distribution of the local anesthetic in the cerebrospinal fluid (CSF), which can be affected by numerous factors, the most important of them being CSF volume. The second is absorption, which is greatest at the sites with higher drug concentration: this is the result of the accessibility, lipidic content and vascular irrigation of each area. The last of these factors is elimination, mediated mainly by the irrigation of the different compartments, and whose order differs from the mirror image of the onset's action order. The previously mentioned elements are the main sources of variation for the time needed to achieve desired effects, order in which fibers are affected and differential blockage. This text describes the principal mechanisms through which spinal anesthesia works, and the factors which can result in variations of its results.
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Keywords
Anestesia, Anestesia regional, Anestesia espinal, Farmacocinética, Anesthesia, Regional anesthesia, Spinal anesthesia, Pharmacokinetics