Cremasteric Reflex for Identification of Successful Spinal Anesthesia
1997; Lippincott Williams & Wilkins; Volume: 85; Issue: 6 Linguagem: Inglês
10.1097/00000539-199712000-00043
ISSN1526-7598
AutoresYasuhisa Okuda, Toshimitsu Kitajima, Takashi Asai,
Tópico(s)Nausea and vomiting management
ResumoTo the Editor: The level of spinal anesthesia is usually assessed using pinching, pinpricking, or cold stimuli. However, these methods may not be useful in children, patients with Alzheimer's disease, or severely demented patients, who may not be able to give reliable answers to anesthesiologists. For these patients, the level may be assessed by somewhat more objective signs: the absence of reflexes [1] (the tendon, ankle, knee jerks, anal), the absence of response to neuromusclar stimuli [2], and inability to cough [3] or to move legs. We found that assessment of the cremasteric reflex is also useful in male patients. The cremasteric reflex is examined by stroking the upper inner part of thigh in a downward direction. Normally, the cremasteric muscle pulls up the testicle on the side examined, and first and second lumbar segment are involved in this reflex [4]. Therefore, the absence of this reflex after spinal anesthesia indicates the blockade of this region. The presence of the reflex should be confirmed before spinal anesthesia, because the reflex may be absent in elderly men, or in patients with hydroceles [4]. We believe that this simple assessment of the cremasteric reflexes is a useful supplementary technique to confirm successful spinal anesthesia, particularly in male patients who cannot reliably communicate with anesthesiologists. Yasuhisa Okuda, MD Toshimitsu Kitajima, MD First Department of Anesthesiology; Dokkyo University School of Medicine; Mibu, Tochigi, 321-02, Japan Takashi Asai, MD Department of Anesthesiology; Kansai Medical University; Moriguchi, Osaka, 570, Japan
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