[Complications during and after surgery and childbirth where spinal or epidural analgesia is used. Guidelines for safe practice].

When complications and neurological sequelae occur during a spinal or epidural anaesthetic the causes are clearly related to the procedures in the following cases: severe haemodynamic or respiratory derangement, documented needle trauma of nerve fibres, intraspinal haematoma in anticoagulated or heparinized patients, and epidural infection where an infected epidural catheter entry site is documented. A number of well documented cases have been published in which surgery or patient-related pathology were primary causes of "typical" spinal or epidural neurological complications. These emphasize the importance of searching for other risk factors of neurological sequelae after surgery or child birth in cases where there is no obvious deviation from the normal epidural or spinal procedures. Increased focus on the infrequent, but serious complications of these essentially very safe techniques for surgical anaesthesia and pain relief should serve to increase our vigilance, but should not reduce the application of spinal and epidural analgesia. Guidelines are offered for the effective and safe practice of spinal and epidural anaesthesia and pain relief: adequate supervision of trainee anaesthetists, vigilant monitoring for early detection and handling of complications, and trained nurses on surgical wards to monitor and handle patients during epidural analgesia are important. Sufficient readiness for urgent handling of the very rare, but devastating complications of intraspinal bleeding or infection is an absolute necessity.