Journal articles: 'Aortocaval compression and spinal anaesthesia'

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Mitra, J. K. "Prevention of Hypotension following Spinal Anaesthesia in Caesarean Section - then and now." Kathmandu University Medical Journal 8, no. 4 (June 5, 2012): 415–19. http://dx.doi.org/10.3126/kumj.v8i4.6242.

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Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Aortocaval compression counteraction does not help to prevent hypotension. Intravenous crystalloid prehydration has poor efficacy; thus, the focus has changed toward co-hydration and use of colloids. Phenylephrine is established as a first- line vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.http://dx.doi.org/10.3126/kumj.v8i4.6242 Kathmandu Univ Med J 2010;8(4):415-19

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Zhou, Z. Q., Q. Shao, Q. Zeng, J. Song, and J. J. Yang. "Lumbar Wedge versus Pelvic Wedge in Preventing Hypotension following Combined Spinal Epidural Anaesthesia for Caesarean Delivery." Anaesthesia and Intensive Care 36, no. 6 (November 2008): 835–39. http://dx.doi.org/10.1177/0310057x0803600613.

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Aortocaval compression is a major cause of maternal hypotension. A randomised controlled clinical trial was designed to compare two wedged supine positions for prevention of hypotension following combined spinal epidural anaesthesia for caesarean delivery. Sixty parturients undergoing elective caesarean delivery were randomly assigned to two different wedged supine positions. After the completion of subarachnoid injection, parturients were placed with either a wedge under the right pelvis (group P, pelvic wedge) or under the right lumbar region (group L, lumbar wedge). Systolic blood pressure and heart rate were recorded every minute for 20 minutes from the subarachnoid injection. Hypotension, defined as systolic blood pressure <100 mmHg or 80% of the baseline, was treated with intravenous ephedrine 5 mg. The incidence of hypotension, ephedrine use and neonatal Apgar scores and umbilical arterial pH were recorded. The incidence of hypotension was significantly higher in group P than that in group L (23/30 [77%] vs. 14/30 [47%], P=0.016). Systolic blood pressure decreased significantly in both groups at seven, eight and nine minutes (P <0.001); moreover it was lower at seven, eight and nine minutes in group P than in group L (P <0.01). Heart rate did not change significantly in either group. There were no significant differences between the two groups for Apgar score and umbilical arterial pH. A lumbar wedge is more effective than a pelvic wedge in preventing hypotension following combined spinal epidural anaesthesia for caesarean delivery, although it does not eliminate hypotension.

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Iwama, Hiroshi. "Graduated compression stocking prevents hypotension during spinal anaesthesia." Canadian Journal of Anaesthesia 43, no. 9 (September 1996): 984–85. http://dx.doi.org/10.1007/bf03011819.

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Kurian, J. "Spinal anaesthesia for caesarean section in a patient with cervical cord compression." International Journal of Obstetric Anesthesia 11, no. 1 (January 2002): 61–64. http://dx.doi.org/10.1054/ijoa.2001.0913.

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Zhang, Ke, and Mingshuai Yu. "A case study of spinal nerve compression caused by a small amount of epidural pneumatosis." European Journal of Inflammation 16 (January 1, 2018): 205873921879127. http://dx.doi.org/10.1177/2058739218791270.

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This case describes a patient with painless childbirth in anaesthesia recovery, who suffered from spinal nerve dysfunction because of the presence of a small amount of epidural gas. Although the patient eventually recovered, this reminds us that timely observation and treatment is important in clinical epidural anaesthesia.

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Goudie, T. A., A. W. Winter, and D. J. M. Ferguson. "Lower limb compression using inflatable splints to prevent hypotension during spinal anaesthesia for caeserean section." Acta Anaesthesiologica Scandinavica 32, no. 7 (October 1988): 541–44. http://dx.doi.org/10.1111/j.1399-6576.1988.tb02782.x.

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Šulla, I., V. Balik, D. Maženský, and V. Danielisová. "A Histopathological Study of Ischemic and Compressive Paraplegia in Dogs." Folia Veterinaria 61, no. 2 (June 27, 2017): 27–34. http://dx.doi.org/10.1515/fv-2017-0015.

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AbstractIt is well known that neuronal death, clinically manifested as paresis or plegia, is the end result of many pathological events affecting the central nervous system. However, several aspects of pathophysiological mechanisms involved in the development of tetra- or paraplegia caused by spinal cord traumatic or ischemic damage are only insufficiently understood and their histopathological manifestations remain poorly documented. That is why the authors decided to report on light-microscopic changes observed in 30 μm thick spinal cord sections cut from L3-S1 segments processed by the Nauta staining method in a group of 6 dogs with ischemic paraplegia induced by 30 min of a high thoracic aorta occlusion, and in a different group of 6 dogs with traumatic paraplegia induced by 5 min spinal cord compression with 200 g metallic rod. Both experimental groups (ischemic and compression) of spinal cord injuries (SCI) comprised the same number of mongrel dogs of both sexes, weighing 18-25 kg. In addition, each of the experimental groups had 3 normal dogs that served as controls. All experimental procedures were accomplished under general anaesthesia induced by pentobarbital and maintained by a mixture of halothane and oxygen. Following the 72 hour survival period, all 18 animals were euthanized by transcardial perfusion with 3,000 ml of saline and fixed by 3,000 ml of 10 % neutral formaldehyde during deep pentobarbital anaesthesia. The histopathological manifestation of neural tissue damage caused by ischemia or compression was similar. The light-microscopic images in both groups were characterised by argyrophilia and the swelling of grey matter neurons. However, in the dogs with traumatic SCIs, the changes only reached about 750 μm cranially and caudally from the necrotic epicentre. These findings indicated that the events taking part in secondary spinal cord injury mechanisms are similar in both, ischemic as well as in traumatic SCI.

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Šulla, I., V. Balik, J. Petrovičová, V. Almášiová, K. Holovská, and Z. Oroszová. "Rat Spinal Cord Injury Experimental Model." Folia Veterinaria 60, no. 2 (June 1, 2016): 41–46. http://dx.doi.org/10.1515/fv-2016-0017.

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Abstract Spinal cord injuries (SCI) with their tragic consequences belong to the most serious pathological conditions. That is why they have stimulated basic research workers, as well as health care practitioners, to search for an effective treatment for decades. Animal experimental models have been essential in these efforts. We have jointly decided to test and standardize one of the spinal cord injury compression models in rats. Twentythree adult female Wistar rats weighing 250-320 g were utilized. Employing general anaesthesia along with a mixture of sevoflurane with O2, 2 rats (sham controls) had their vertebral arch of either Th8 or Th9 vertebra removed (laminectomy). The other 21 experimental rats with similar laminectomies were divided into 3 subgroups (n = 7) which received compression impact forces of 30, 40 or 50 g (subgroups-1, -2, and -3, respectively) applied on their exposed spinal medulla for 15 minutes. All rats were observed for 28 days after the experimental procedure and their motor functions were assessed by the Basso, Beattie, Bresnahan (BBB) test 6 hours, 7, 21 and 28 days after the simulated SCI. All 23 rats survived the surgical procedures. The control rats were without any neurological deficits. There were, in every experimental subgroup, 1 or 2 rats with extreme BBB scores. So the rats with the maximum and minimum BBB values were excluded. Then, the results acquired in the residual 5 rats in each group were averaged and statistically analysed by the Tukey multiple comparisons test. Statistically significant intersubgroup differences were found at all survival times equal to or longer than 7 post SCI days. The goal of the SCI experiment was to generate a reproducible and reliable, submaximal spinal cord trauma model. The statistical analyses demonstrated that this objective was best achieved in the subgroup-2 with the 40 g compression.

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&NA;, &NA;. "Sequential Compression Device with Thigh-High Sleeves Supports Mean Arterial Pressure during Caesarean Section under Spinal Anaesthesia." Obstetric Anesthesia Digest 24, no. 1 (March 2004): 40–41. http://dx.doi.org/10.1097/00132582-200403000-00016.

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Adsumelli, R. S. N., E. S. Steinberg, J. E. Schabel, T. A. Saunders, and P. J. Poppers. "Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia." British Journal of Anaesthesia 91, no. 5 (November 2003): 695–98. http://dx.doi.org/10.1093/bja/aeg248.

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Lee, Allison J., Ruth Landau, James L. Mattingly, Margaret M. Meenan, Beatriz Corradini, Shuang Wang, Stephanie R. Goodman, and Richard M. Smiley. "Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status." Anesthesiology 127, no. 2 (August 1, 2017): 241–49. http://dx.doi.org/10.1097/aln.0000000000001737.

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Abstract Background Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining baseline systolic blood pressure, there would be no effect of maternal position on neonatal acid base status in women undergoing elective cesarean delivery with spinal anesthesia. Methods Healthy women undergoing elective cesarean delivery were randomized (nonblinded) to supine horizontal (supine, n = 50) or 15° left tilt of the surgical table (tilt, n = 50) after spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 15 μg, preservative-free morphine 150 μg). Lactated Ringer’s 10 ml/kg and a phenylephrine infusion titrated to 100% baseline systolic blood pressure were initiated with intrathecal injection. The primary outcome was umbilical artery base excess. Results There were no differences in umbilical artery base excess or pH between groups. The mean umbilical artery base excess (± SD) was −0.5 mM (± 1.6) in the supine group (n = 50) versus −0.6 mM (± 1.5) in the tilt group (n = 47) (P = 0.64). During 15 min after spinal anesthesia, mean phenylephrine requirement was greater (P = 0.002), and mean cardiac output was lower (P = 0.014) in the supine group. Conclusions Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid–base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status.

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YUMRU, C. "The effects of graduated compression stockings (GCS) on haemodynamic parameters and postdural puncture headache (PDPH) in spinal anaesthesia." Regional Anesthesia and Pain Medicine 28 (September 2003): 25. http://dx.doi.org/10.1016/s1098-7339(03)00415-2.

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Hennen, G., W. Neukäter, C. A. Haensch, and J. Jörg. "Focal conduction block of the proximal sciatic nerve in compression-neuropathy after spinal anaesthesia, proved by magnetic stimulation." Electroencephalography and Clinical Neurophysiology 102, no. 4 (April 1997): P47. http://dx.doi.org/10.1016/s0013-4694(97)85278-9.

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Yumru, C., N. Ocal, G. Kesriklioglu, and U. Uslu. "The effects of graduated compression stockings (GCS) on haemodynamic parameters and postdural puncture headache (PDPH) in spinal anaesthesia." Regional Anesthesia and Pain Medicine 28, Sup 1 (September 2003): 25. http://dx.doi.org/10.1097/00115550-200309001-00043.

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Samama, C. M., F. Clergue, J. Barre, A. Montefiore, P. Ill, and K. Samii. "Low molecular weight heparin associated with spinal anaesthesia and gradual compression stockings in total hip replacement surgery. Arar Study Group." British Journal of Anaesthesia 78, no. 6 (June 1997): 660–65. http://dx.doi.org/10.1093/bja/78.6.660.

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Thiele, Clare E. "Ruptured Spinal Arteriovenous Malformation: A Rare Cause of Paraplegia in Pregnancy." Case Reports in Obstetrics and Gynecology 2018 (August 9, 2018): 1–4. http://dx.doi.org/10.1155/2018/6096483.

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Background. Ruptured spinal arteriovenous malformation (AVM) is a rare cause of paraplegia in pregnancy, with only a few case reports describing complications from spinal AVMs during pregnancy in the literature. Case. A 32-year-old woman presented at 37 weeks gestation with back pain and rapidly progressive lower limb neurological symptoms. MRI showed a previously undiagnosed spinal AVM at T8. A healthy girl was delivered by caesarean under general anaesthesia to facilitate further investigation. After spinal angiography, it was concluded the most likely aetiology was acute rupture of an intra- and perimedullary AVM with associated haemorrhage at T8 secondary to venous compression from the enlarged uterus at L5 causing high pressure within the AVM and subsequent rupture. The neurosurgical and interventional radiology teams felt the lesion was not amenable to surgical or endovascular intervention. The patient remained paraplegic with no sign of neurological recovery six months after delivery. Conclusion. While new onset paraplegia during pregnancy secondary to ruptured spinal AVM is very rare, it is important to discuss these cases to inform future practice. In contrast to previous case reports, our patient did not spontaneously recover after delivery and was not amenable to surgical or endovascular treatment.

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Šulla, Igor, Ladislav Bačiak, Ivo Juránek, Tatiana Cicholesová, Martin Boldižár, Vladimír Balik, and Nadežda Lukáčová. "Assessment of motor recovery and MRI correlates in a porcine spinal cord injury model." Acta Veterinaria Brno 83, no. 4 (2014): 393–97. http://dx.doi.org/10.2754/avb201483040393.

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The study concentrated on behavioral and magnetic resonance imaging (MRI) characteristics in a porcine spinal cord injury model. Six adult minipigs weighing 32–35 kg were narcotized by thiopental, intubated, and placed on a volume-cycled ventilator. Anaesthesia was maintained by 1.5% sevoflurane with oxygen. Following location of the 1st lumbar vertebra animals were fastened in an immobilization frame. The spinal cord, exposed through a laminectomy, was compressed by a 5 mm thick circular rod with a peak force of 0.8 kg at a velocity of 3 cm·s-1. The next day the minipigs were paraplegic but improved rapidly to paraparesis. On the 12th postoperative day they were euthanasied. Neural tissue changes were evaluated by post mortem MRI, which showed damage to the spinal cord white and/or gray matter in the epicentre of compression with longitudinal spreading over one segment cranially and caudally. Statistical analyses performed by Spearman’s rho test revealed positive correlations between damaged areas and the whole area of the spinal cord white/gray matter (P = 0.047; rs = 0.742) and (P = 0.002; rs = 0.943), respectively. The study confirmed the reliability and reproducibility of the utilised model of spinal cord trauma. The structural changes in the epicentre of injury did not impede the rapid but incomplete recovery of motor functions.

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Colli, Benedicto Oscar, João Alberto Assirati Jr, Hélio Rubens Machado, José Fernando de Castro Figueiredo, Leila Chimelli, Carmine Porcelli Salvarani, and Fábio dos Santos. "Intramedullary spinal cord paracoccidioidomycosis: report of two cases." Arquivos de Neuro-Psiquiatria 54, no. 3 (September 1996): 466–73. http://dx.doi.org/10.1590/s0004-282x1996000300017.

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Two cases of intramedullary paracoccidioidomycosis are reported. Paracoccidioidomycosis is a systemic disease that involves the buccopharyngeal mucosa, lungs, lymph nodes and viscera and infrequently the central nervous system. Localization in the spinal cord is rare. Case 1: a 55-year old male admitted with crural pararesis, tactile/painful hypesthesia and sphincter disturbances of 15 days duration. Cutaneous-pulmonary blastomycosis was diagnosed 17 years ago. Myelotomography showed a blockade of T3-T4 (intramedullary lesion). The lesion surgically removed was a Paracoccidioides brasiliensis granuloma. Treatment with sulfadiazine was started after the surgery. Follow-up of 15 month showed an improvement of the clinical signs. Case 2: a 57-year old male was admitted elsewhere 6 months ago and, with a radiologic diagnosis of pulmonary paracoccidioidomycosis, was treated with amphotericin B. He progressively developed paresthesia and tactile/ pain anaesthesia on the left side, sphincter disturbances and tetraparesis with bilateral extensor plantar response and clonus of the feet. Myelotomography showed a blockade of C4-C6 (intramedullary lesion). The lesion was not found during surgical exploration and the patient deteriorated and died. Post-mortem examination revealed an intramedullary tumor above the site of the mielotomy (Paracoccidioides brasiliensis granuloma). The preoperative diagnosis of intramedullary paracoccidioidomycotic granulomas is difficult because the clinical and radiologic manifestations are uncharacteristic. Clinical suspicion was possible in our cases based on the history of previous systemic disease. Contrary to intracranial localizations, paracoccidioidomycotic granulomas causing progressive spinal cord compression may require early surgery because response to clinical treatment is slow and the reversibility of neurological deficits depends on the promptness of the decompression.

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Kumari, Pradeep, Sifna Tahir, Haveena Kumari, and Altaf Ahmad Mir. "Comparison of commonly used vasopressors for treating hypotension after spinal anaesthesia in elective lower abdominal surgery: a randomized, observational, case-control study." International Journal of Research in Medical Sciences 7, no. 5 (April 26, 2019): 1479. http://dx.doi.org/10.18203/2320-6012.ijrms20191546.

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Background: During caesarean section hypotension due to spinal block is secondary to the sympathetic blockade and aorto-caval compression by the uterus. It can have important consequences for the mother and may affect neonatal outcome. The present study was aimed to compare intravenous bolus doses of phenylephrine and ephedrine to treat maternal hypotension during spinal block for elective caesarean section.Methods: After fulfilling the inclusion criteria, 100 parturient were randomly allocated into two groups of fifty each. For spinal anesthesia lumber puncture was done and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally. In this observational study, patients who developed hypotension under spinal anesthesia were selected for the study. According to their group, patients received either ephedrine 6mg (Group E) or phenylephrine 75µg (Group P) as vasopressor. During the study, number of vasopressor boluses, hemodynamic response and time taken to recover from hypotension was noted.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. In 88% parturient single bolus dose of ephedrine was effective in treating hypotension while phenylephrine was effective in 78% parturient. There was no significant difference observed in total number of boluses used. No significant difference was seen in mean systolic blood pressure, mean diastolic blood pressure and mean arterial pressure over a given period of time in Group E and Group P. Mean systolic BP was less than 20% when compared to baseline in both the groups at different time intervals. In Group P the mean heart rate was significantly lower as compared to the Group E (p<0.05).Conclusions: Intravenous phenylephrine and ephedrine are both similar in performance in treating hypotension after spinal anesthesia for elective caesarean section and the hypotensive control offered is comparable.

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Puyo, M., M. Garcia-Orellana, M. González-Núñez, S. Manrique, M. C. Suescun, and L. Trillo. "Prevention of maternal hypotension during elective caesarean section under spinal anaesthesia with an intermittent pneumatic compression system in lower extremities: preliminary study." European Journal of Anaesthesiology 31 (June 2014): 191. http://dx.doi.org/10.1097/00003643-201406001-00542.

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Piontkovskyi, V. K., and I. V. Fishchenko. "Endoscopic transforaminal lumbar microdiscectomy. A retrospective analysis of 180 clinical cases." Pain medicine 3, no. 3 (November 23, 2018): 51–56. http://dx.doi.org/10.31636/pmjua.v3i3.6.

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The authors performed retrospective analysis of 180 clinical cases of surgical treatment of lumbar herniated discs in patients who underwent endoscopic transforaminal microdiscectomy. This technique allows minimally invasive insertion of the endoscope into the spinal canal under local anaesthesia to decompress the nerve root by removing hernial protrusion under visual control. However, this technique is not universal and cannot be applied to all patients. Considerable practical experience has shown that the surgeon may encounter certain technical difficulties in cases of cranial or caudal sequester migration and in some cases when the access at L5–S1 level is complicated due to the high standing of the iliac crest. However, if there are correct indications, this technique allows to solve the problem of radicular compression syndrome in a short time.

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Spadola, F., G. Barillaro, M. Morici, A. Nocera, and Z. Knotek. "The practical use of computed tomography in evaluation of shell lesions in six loggerhead turtles (Caretta caretta)." Veterinární Medicína 61, No. 7 (July 18, 2016): 394–98. http://dx.doi.org/10.17221/68/2015-vetmed.

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Six adult loggerhead turtles were found stranded and were rescued near Sicily within a period of 12 months. Macroscopically apparent lesions of the shell were present. After thorough physical examination, ketamine-dexmedetomidine-atipamezole induction and tracheal tube insertion all six patients underwent computed tomographic examination under inhalant anaesthesia with isoflurane. A vertebral lesion at the level of the 3rd thoracic-lumbar vertebra with vertebral lamina and the vertebral body being involved without compression of the spinal cord, a vertebral lesion at the level of the 7th thoracic-lumbar vertebra and a vertebral lesion at the level of the 8th thoracic-lumbar vertebra were recorded in the first female. Loss of the shell near the left carapace-plastron bridge, with massive haemorrhage and compression of organs were present in the second female. The remaining four turtles had only superficial lesions with no involvement of bones and organs of the coelom. Computed tomography was proved to be a valuable non-invasive method for clinical examination of stranded sea turtles.

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Sreeram, Sai Charitha, Talari Sampurna, and P. Lakshmi. "A rare case report on cauda equina syndrome." International Journal of Basic & Clinical Pharmacology 6, no. 7 (June 23, 2017): 1820. http://dx.doi.org/10.18203/2319-2003.ijbcp20172755.

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Cauda Equina Syndrome (CES) is a rare but serious neurologic condition in which neurological dysfunction affects the lumbar and sacral nerve roots within the vertebral canal. CES is a clinical entity consisting of low back ache, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anaesthesia and faecal incontinence. It is a rare condition with a prevalence in the general population estimated between 1:100000 and 1:33000. The presentation of CES may vary, especially in the early stages of compression. Magnetic Resonance Imaging (MRI) is the accepted gold standard modality of choice for diagnosing CES which identifies potential mimics such as aortic dissection or spinal infarction. Here we discuss a rare and unique case of CES with atypical presentation, knowledge of which is essential for early diagnosis, treatment and prevention of permanent neurological dysfunction.

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Grubor, Predrag, Milan Grubor, and Rade Tanjga. "Dilemmas in the treatment of tibial diaphyseal fractures." Acta chirurgica Iugoslavica 60, no. 2 (2013): 33–39. http://dx.doi.org/10.2298/aci1302033g.

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Introduction: Tibial fractures accompanied by radius fractures at typical sites are the most common type of fractures. Objective: The study is aimed at using the examined sample to make an efficient and economically acceptable choice in the treatment of tibial diaphyseal fractures. Material and methods: The series comprises a retrospective and prospective study of the treatment of 131 fresh tibial fractures: 31 in women (23.66%) and 100 in men (76.34%) of the average age of 37.89. Nineteen patients (14.50%) were treated conservatively and 112 (85.50%) surgically: 22 (16.79%) with anti-rotation intramedullary nails, 74 (56.49%) with Mitkovic external fixator type M20, and 16 (12.21%) with locking compression plate. General anaesthesia was used in 46 patients (35.11%), while spinal anaesthesia was used in 85 of them (64.89%). Results: According to the Karlstrom-Olerud scoring system, the treatment results were as follows: for the 22 tibiae treated with anti-rotation intramedullary nails: in 15(68.18%) the results were excellent, in 3 (13.64%) they were good and in 4(18.18%) they were poor. As for the results for the 74 tibiae treated with Mitkovic external fixator type M20, they were as follows: in 62(83.78%) excellent, in 9(12.16%) good, and in 3(4.05%) they were poor. The results for the 16 patients treated with locking compression plate were excellent in 10(62.50%), good in 2(12.50%) and poor in 4 patients (25.00%). The treatment results for the 19 tibiae treated with plaster cast were excellent in 12 patients (63.16%), good in 2(10.53%) and poor in 5 (26.32%). The definite results for the 131 fractured tibiae treated with the aforementioned techniques were as follows: excellent in 99(75.57%), good in 17 (12.98%) and poor in 15 patients (11.45%). Discussion: There is a variety of controversial positions concerning the treatment of the tibial diaphysis. Conclusion: On the basis of the results of surgical treatment for the given series, the number of surgical interventions, the price of osteosynthetic material, my preferences in treating tibial diaphyseal fractures would be as follows: Mitkovic external fixator type M20, anti-rotation intramedullary nails and locking compression plate. Conservative treatment is indicated when the X-ray examination confirms that the fragments have a position acceptable for conservative treatment with plaster cast.

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Kyriakou, Charalampia, Anthony Athanasiov, Preetha Prasad, Nicki Panoskaltsis, and Sean Molloy. "Balloon Kyphoplasty in the Management of Myeloma Spinal Disease." Blood 120, no. 21 (November 16, 2012): 4080. http://dx.doi.org/10.1182/blood.v120.21.4080.4080.

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Abstract Abstract 4080 The introduction of new targeted therapeutics agents together with stem cell transplantation have led to a remarkable evolution in the management of Multiple Myeloma (MM) over the last 15 years. Osteolytic disease is the major complication of MM that may lead to devastating skeletal-related events. Up to 90% of the MM patients develop osteolytic lesions during the course of their disease and 70% of patients are affected at some stage with painful progressive vertebral compression fractures (VCFs). Patients with myeloma are living a lot longer and it is thus especially important to maximally treat osteolytic bone disease and in particular, painful VCFs of the spine that cause substantial morbidity, compromised quality of life and increased healthcare costs. Balloon Kyphoplasty is a minimally invasive procedure which has purported benefits of relieving pain and restoring function in patients who are poor candidates or should not undergo invasive procedures. Despite increasing evidence on the use of this procedure, the indications, timing, efficacy, safety and their role in the treatment algorithm of myeloma spinal disease are yet to be defined. We report a retrospective analysis on the outcome of the use of Balloon Kyphoplasty in 103 MM patients with VCFs confirmed by MRI who were treated at the Royal National Orthopaedic Hospital between January 2007 and July 2012. Pending on the level of the fracture, patients were fitted with brace, were receiving monthly bisphosphonates and the majority required high dose opioid pain relief and had restricted mobility. Main indications for the interventional management of the VCFs were severe persistent pain, spinal instability, neurological symptoms, level of fracture and associated high risk for severe kyphosis. All patients had peri-procedure prophylactic antibiotic cover according to the local protocol and their chemotherapy withheld for 10 days. Quantitative outcome measures including the Roland –Morris Disability and Visual Analog Scales (graded 0–10) for pain at rest and pain with activity were assessed prior to the procedure 6 hours post and during the monthly follow up at the MM clinic. In addition, qualitative measures of clinical outcome, pain and mobility improvement, opioid pain relief use were monitored. The median follow up was 3.2 years ranging from 6 weeks to 6.8 years. Fifty-two were male patients, the median age at the time of the procedure was 67 years (41–89) and ECOG performance status was ≥3 in 41% of the patients. Fifty-four patients underwent the procedure at diagnosis within a median time from diagnosis to kyphoplasty of 10 weeks (1 week – 8 months). The time of the procedure was depended on patient's presentation symptoms and signs, chemotherapy, MRI findings and co morbidities. Thirty-four patients were treated with kyphoplasty at the time of disease relapse or progression and 15 patients had the procedure early at diagnosis and later at relapse. Five frail elderly patients unsuitable for general anaesthesia had the procedure performed under local anaesthetic and sedation. A total of 197 painful VCFs were treated. A single vertebral level was treated in 48 patients, with two levels treated simultaneously in 32 patients and three or more levels in 23 patients. All patients tolerated the procedure well. Accidental finding of asymptomatic cement PE was found in one patient. Eight-two percent of the patients had rapid pain relief, became independent of pain relief and their mobility and functionality were markedly improved within a median time of 5 weeks (4 days to 3.5 months). For 32% of the patients mobility improved gradually in view of additional problems with steroid induced myopathy. In conclusion these data suggest that kyphoplasty is a safe procedure for the management of VCFs in MM and results to early and sustained pain relief and functional improvement. Prospective studies are warranted to further define indications and timing of cement augmentation, the number of levels and the role on preventing spinal deformity in MM spinal disease. Disclosures: Molloy: Medtronic Spine & Biologics: Honoraria, Speakers Bureau.

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Kandel, Prakriti Raj, Laxmi Pathak, Gyaneshwar Prasad Singh, and Rajiv Baral. "Minimal Invasive Dynamic Hip Screw Fixation for Intertrochanteric Fractures of Femur." Journal of Universal College of Medical Sciences 4, no. 1 (January 24, 2018): 26–31. http://dx.doi.org/10.3126/jucms.v4i1.19076.

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INTRODUCTION: Good results have been achieved consistently with compression hip screw fixation for stable intertrochanteric femur fractures by conventional method. Thus, this present study was conducted to find out the outcomes for such hip fracture fixation with minimal invasive technique. MATERIALS AND METHOD: This retrospective study was carried out by collecting the records of 66 adult patients with stable intertrochanteric femur fracture managed by Dynamic Hip Screw (DHS) fixation with minimal invasive technique under Spinal Anaesthesia and Epidural Analgesia in Universal College of Medical Sciences and Teaching Hospital (UCMSTH) over a period of 3 years. The patients were in follow up visits for 1 year postoperatively. Operating time, blood loss, decrease in haemoglobin level, analgesic demand, length of hospital stay, fracture union time, early and delayed complications and functional outcome were recorded. RESULTS: This study showed less operative time, less blood loss and less reduction in mean haemoglobin value postoperatively when compared with baseline values. Though complications like pain, stitch infection at surgical site and UTI was seen in few patients, all patients were mobilized within 2nd postoperative day with less rescue analgesic demand and shorter duration of hospital stay of only 8.23 days. However, plate breakage, nonunion, implant cut out, joint infection, delayed union and varus deformity was not observed in any of these patients. Moreover, Harris Hip Score showed good functional outcome.CONCLUSION: Fixation of DHS with minimal invasive technique for stable hip fracture has good functional outcome in cost effective way with fewer incidences of complications.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 26-31

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"Successful Outcome of Cardiac Arrest Management in a Morbidly Obese Parturient Woman During Caesarean Section Delivery: A Case Report." EMJ Reproductive Health, June 12, 2020. http://dx.doi.org/10.33590/emjreprohealth/19-00040.

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During a caesarean section (CS), severe hypotension following spinal anaesthesia, aortocaval compression, and morbid obesity may cause a decrease in cardiac output resulting in cardiac arrest. Cardiopulmonary resuscitation during CS is stressful for all the attending team, which mandates the importance of a high level of skill and readiness to perform perimortem CS. Reported here is a case of 36-year-old, full-term, morbidly obese parturient female who developed cardiac arrest during an emergency CS under spinal anaesthesia before delivery of the baby. Cardiopulmonary resuscitation was performed and enhanced with resuming of left lateral tilt and completion of perimortem CS. A healthy baby was delivered, and the operation was completed with good homeostasis.

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Muthiah, Jeya Pratheef, and Senthil Kumar. N. "A COMPARISON OF LEFT UTERINE DISPLACEMENT USING CLINOMETER GUIDED TABLE TILT VS CONVENTIONAL CRAWFORD WEDGE DURING SPINAL ANAESTHESIA IN CESAREAN SECTION- A PROSPECTIVE RANDOMIZED STUDY." GLOBAL JOURNAL FOR RESEARCH ANALYSIS, June 15, 2021, 7–9. http://dx.doi.org/10.36106/gjra/4803269.

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INTRODUCTION: Enlarged gravid uterus causing aortocaval compression may decrease the venous return and cause maternal hypotension. Maternal position after neuraxial blockade may exacerbate the impact of aortocaval compression and consequences on cardiovascular instability. Left uterine displacement (LUD) after spinal anaesthesia in lower segment cesarean section is essential in preventing supine hypotension syndrome. Decreased cardiac output secondary to vena cava obstruction by the gravid uterus can be prevented by lateral tilt position. AIM OF THE STUDY: This study is therefore designed to evaluate the role of leftward uterine displacement by table tilt using clinometer software or by using crawford wedge tilt and compare the effects on hemodynamics in parturient undergoing lower segment cesarean section (LSCS) under subarachnoid block MATERIALS AND METHODS: The study was carried out in the Department of Anaesthesiology involving Department of Obstetrics and gynecology in Kanyakumari Government Medical College from January 2018 to June 2019. Patients were allocated into two groups by randomization. After spinal anaesthesia parturient in Group T: Lateral Table Tilt by using clinometer -15 degree- (40 parturient). Parturient in Group W: Crawford wedge Tilt- (40 parturient). Patients, age, body weight, BMI and baseline vital parameters were recorded. Incidence of hypotension after spinal anaesthesia in a cesarean section, Total dose Vasopressor required, Level of blockade, APGAR Score, Surgeon satisfaction grading. RESULTS: The demographic parameters like age, height, weight, BMI and the indication for surgery were similar in both groups. There were no difference in mean height level of block between both groups. In comparison of hypotensive incidence in both groups, the high incidence noted in the GROUP W (wedge group) (35%) is higher than the incidence in GROUP T (table tilt) nd th th (7.5%). The incidence of hypotension is signicantly noted at 2 , 4 , 5 minute after the subarachnoid block in wedge group compared to the table tilt group. The dose of vasopressor requirements and average ephedrine dose used is less in GROUP T (table tilt) (0.6±2.3mg) compared to GROUP W (wedge) (3.9±5.7 mg). In comparison of surgeon satisfaction between both groups, surgeons are much satised with the wedge group patient and found difcult, disturbing and sometimes unbearable st th while perform the surgery for the patient in table tilt. The APGAR Scores in GROUP W at 1 minute and 5 minute is (7.3±0.5 and st th 8.7 ±0.5) respectively which are relatively satisfactory compared to the GROUP T (6.8±0.6 and 8.3±0.6) at 1 and 5 minute. CONCLUSION: Table tilt provide a good relief from inferior vena cava and aortocaval compression when compared to the wedge placed under the right hip during cesarean section done under subarachnoid block. Using the wedge is easier and 0 surgeons at our institute found it more comfortable than the table tilt to 15 but anesthetists feel better with table tilt because there is little incidence of hemodynamic variation. We conclude that all the parturient posted for caesarean section should be 0 given a table tilt of 15 placed with angle measured exactly by clinometer to decrease incidence of hypotension occurring due to aortocaval compression

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Mishra, Manoj Kumar, and Sunny Eapen. "COMPARISON OF TWO LOW DOSE REGIMENS OF SUBARACHNOID BLOCK ANESTHESIA FOR LOWER SEGMENT CAESARIAN SECTION." PARIPEX INDIAN JOURNAL OF RESEARCH, December 15, 2020, 1–4. http://dx.doi.org/10.36106/paripex/8301849.

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Hypotension and bradycardia due to sympathetic blockade are two commonest complications of spinal anesthesia leading to maternal and neonatal morbidity and mortality. Aorto caval compression due to gravid uterus also contributes to the development of hypotension. Wedge under right buttock to provide 250 sideways tilt is used to prevent aortocaval compression by gravid uterus.Low dose bupivacaine heavy with intrathecal fentanyl is recommended as strategy to prevent spinal anesthesia induced hypotension and related complications. The present study was done in our tertiary care centre to compare the effects of fixed dose of Fentanyl 20μg (0.4ml) administered along with two low doses 1.6 ml(8mg) and 1.8 ml(9mg) of 0.5% hyperbaric bupivacaine (heavy) and assess the adequacy of surgical anaesthesia for caesarean section and hemodynamic changes intra operatively. There was faster onset of sensory blockade, better haemodynamic stability and prolonged postoperative analgesia in patients administered with1.6ml of 0.5% Bupivacaine heavy (8mg) & 20μg Fentanyl (Gp I) compared with patients administered with 1.8ml of 0.5% Bupivacaine heavy (9 mg) & 20μg Fentanyl (Gp II) . Perioperative analgesia was excellent in both the groups. No patient who developed bradycardia or hypotension in Gp I and only 2 patients in Gp II developed hypotension.Post-operative analgesia was for a longer period in Group II as compared to Gp I.

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Erbas, Yahya Cem, Serhat Pusat, Erdal Yilmaz, Zuleyha Kazak Bengisun, and Ersin Erdogan. "Posterior lumbar stabilization surgery under spinal anaesthesia for patients with degenerative spondylolisthesis, spinal stenosis and lumbar compression fracture." Turkish Neurosurgery, 2015. http://dx.doi.org/10.5137/1019-5149.jtn.14772-15.1.

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Journal articles on the topic 'Aortocaval compression and spinal anaesthesia'

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