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Journal articles on the topic 'Spinale anesthesie'
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1
PENES, Ovidiu, and Emilia VALEANU. "Fine tuning in neuraxial subarachnoid anesthesia." Romanian Journal of Medical Practice 11, no. 2 (June 30, 2016): 172–76. http://dx.doi.org/10.37897/rjmp.2016.2.12.
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The spinal anesthesia, a category of neuraxial anesthesia, is commenced in the lumbar spine, where the local anesthetic (LA) is injected into cerebrospinal fluid (CSF) to anesthetize the spinal nerves. This technique is most frequently used for analgesia and/or anesthesia for different forms of lower extremity, lower abdominal, pelvic, and perineal procedures. Preoperative evaluation that includes a medical history and anesthesia-directed physical examination should be performed for every patient who undergo any type of anesthesia. Focus should be made on the preoperative evaluation, when spinal anesthesia is considered, to prevent medical conditions that may alter the physiologic response to spinal anesthesia or increase the risk of complications and the baricity influences of the anesthetic distribution within the subarachnoid space.
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Park, Ji In, Sang Hi Park, Min Seok Kang, Gil Won Kang, and Sang Tae Kim. "Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service." Anesthesia and Pain Medicine 15, no. 3 (July 31, 2020): 305–13. http://dx.doi.org/10.17085/apm.20021.
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Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.
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Frawley, Geoff, Graham Bell, Nicola Disma, Davinia E. Withington, Jurgen C. de Graaff, Neil S. Morton, Mary Ellen McCann, et al. "Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair." Anesthesiology 123, no. 1 (July 1, 2015): 55–65. http://dx.doi.org/10.1097/aln.0000000000000708.
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Abstract Background: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure. Methods: This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic. Results: RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46). Conclusions: The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.
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Kim, Ha-Jung, Hee-Sun Park, Yon-Ji Go, Won Uk Koh, Hyungtae Kim, Jun-Gol Song, and Young-Jin Ro. "Effect of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Total Knee Arthroplasty." Journal of Clinical Medicine 8, no. 6 (May 31, 2019): 778. http://dx.doi.org/10.3390/jcm8060778.
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Recent studies have reported the advantages of spinal anesthesia over general anesthesia in orthopedic patients. However, little is known about the relationship between acute kidney injury (AKI) after total knee arthroplasty (TKA) and anesthetic technique. This study aimed to identify the influence of anesthetic technique on AKI in TKA patients. We also evaluated whether the choice of anesthetic technique affected other clinical outcomes. We retrospectively reviewed medical records of patients who underwent TKA between January 2008 and August 2016. Perioperative data were obtained and analyzed. To reduce the influence of potential confounding factors, propensity score (PS) analysis was performed. A total of 2809 patients and 2987 cases of TKA were included in this study. A crude analysis of the total set demonstrated a significantly lower risk of AKI in the spinal anesthesia group. After PS matching, the spinal anesthesia group showed a tendency for reduced AKI, without statistical significance. Furthermore, the spinal anesthesia group showed a lower risk of pulmonary and vascular complications, and shortened hospital stay after PS matching. In TKA patients, spinal anesthesia had a tendency to reduce AKI. Moreover, spinal anesthesia not only reduced vascular and pulmonary complications, but also shortened hospital stay.
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Mahan, KT, and J. Wang. "Spinal morphine anesthesia and urinary retention." Journal of the American Podiatric Medical Association 83, no. 11 (November 1, 1993): 607–14. http://dx.doi.org/10.7547/87507315-83-11-607.
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Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.
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McLain, Robert F., Iain Kalfas, Gordon R. Bell, John E. Tetzlaff, Helen J. Yoon, and Maunak Rana. "Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients." Journal of Neurosurgery: Spine 2, no. 1 (January 2005): 17–22. http://dx.doi.org/10.3171/spi.2005.2.1.0017.
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Object. Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages. Methods. In this case-controlled study the authors analyzed outcomes obtained in 400 patients in whom either spinal anesthesia or general anesthesia was induced to perform a lumbar decompression. Patients were matched for anesthesia-related class, preoperative diagnosis, surgical procedure, and perioperative protocols. All aspects of surgery, recovery, postanesthesia care, and pain management were uniform irrespective of the anesthetic type. Case complexity was equivalent. An independent observer performed analysis of the data. Data from the intraoperative period through hospital discharge were collected and compared. Two hundred consecutive patients meeting inclusion criteria were included in each group. Patients were treated for either lumbar stenosis or herniated nucleus pulposus. Demographically, both groups were well matched. Anesthetic and operative times were longer for patients receiving a general anesthetic (p < 0.05), in whom more nausea and greater requirements for antiemetics and pain medication were also present during recovery (p < 0.05). Overall complication rates and, specifically, the incidences of urinary retention were significantly lower in spinal anesthesia—induced patients (p < 0.05). There were no neural injuries in either group, and the incidence of spinal headache was lower in patients receiving a spinal anesthetic (1.5% compared with 3%). Conclusions. Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.
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Palaria, Urmila, Kamal Nayan Joshi, and Yeeti Upreti. "Achondroplasia and emergency caesarean section: A case report." Indian Journal of Clinical Anaesthesia 8, no. 1 (March 15, 2021): 129–32. http://dx.doi.org/10.18231/j.ijca.2021.025.
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Achondroplasia is the commonest variety of rhizomelic dwarfism, which results from abnormal cartilage formation at epiphyseal growth plates. The peculiar facial features, bony deformities and systemic abnormalities often pose a difficulty in administration of anesthesia, particularly in the parturients. There are very few reported cases of spinal anesthesia in achondroplastic parturients, because of its feared high risks. We reported, two cases of achondroplastic parturients with short stature, planned for emergency lower segment caesarean section (LSCS), in view of cephalo-pelvic disproportion under spinal anesthesia. We discussed the anesthetic issues to achondroplastic parturients and finally did under spinal anesthesia. Besides, a myriad of problems encountered in these patients warrant a careful pre-anesthetic evaluation to warrant patients' safety and affirmative procedure outcomes.
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Singh, Biant, Manpreet Kour, Shwetabh Pradhan, and Surinder Singh. "EMERGENCY LAPAROTOMIES: VALIDATING THE ROLE OF SPINAL ANESTHESIA IN HIGH RISK CASES. A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY IN SRINAGAR, GARHWAL, UTTARAKHAND." International Journal of Advanced Research 8, no. 9 (September 30, 2020): 802–5. http://dx.doi.org/10.21474/ijar01/11724.
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Introduction: Perforation peritonitis is very rampant in hilly areas of Garhwal due to excessive consumption of alcohol, smoking and stresses of life due to difficult terrain and working conditions. Most of the patients with co-morbities like COPD have higher pulmonary related complications following surgery under G.A. It is a challenge and concern for surgeons and anesthetists to manage and provide optimal care to these patients. The study validates the role of spinal anesthesia in such cases. Materials And Method: We reviewed all cases of emergency laparotomies done between Jan 2019 and June 2020. Ninety cases were given spinal anesthesia as sole anesthetic agent out of which sixty cases were ASA IV and thirty cases were ASA III. Outcome in all cases was analyzed and recorded. Results: All cases were adequately operated and outcome was successful in all accept three cases which required G.A due to prolonged surgeries. None needed mechanical ventilatory support post operatively. Mean hospital stay was seven days and there was no report of major renal or respiratory complications. Conclusion: Spinal anesthesis is a safe option and alternate to G.A in high risk emergency laparotomies minimizing the requirement of ventilatory support in rural tertiary care hospitals were critical care facilities are compromised.
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Filimonov, R. V., S. A. Potalov, S. D. Shapoval, Yu Yu Malyuk, D. G. Burtsev, Ye V. Petrashenok, Yu Yu Kobelyatskiy, and I. V. Filimonova. "UNILATERAL SPINAL BLOCK FORMATION BY TACHYPHYLAXIS METHOD." Modern medical technologies 46, no. 3 (June 1, 2020): 28. http://dx.doi.org/10.34287/mmt.3(46).2020.5.
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Abstract The article presents the theoretical justification and comparative experience in the formation of a unilateral spinal block by tachyphylaxis in urgent surgery during operations on the lower extremities. The possibility of influencing the duration and severity of motor blockade on the operated side was established using the tachyphylaxis method for administering the anesthetic without decreasing the quality of anesthesia as a whole and without increasing the amount of anesthetic administered. The possibility of reducing the development time of full anesthesia to a minimum fixation time of anesthetic on nerve tissue (10 minutes) due to preliminary «sensitization» to nerve fiber anesthetics was established. The possibility of reducing the need for postoperative analgesia by increasing the duration of the postoperative painless period has been established. Keywords: unilateral spinal anesthesia, frequency-dependent blockade, motor block.
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Shah, Saurin J., Kristen Vanderhoef, and Michael Ibrahim. "Broken Spinal Needle in a Morbidly Obese Parturient Presenting for Urgent Cesarean Section." Case Reports in Anesthesiology 2020 (September 30, 2020): 1–3. http://dx.doi.org/10.1155/2020/8880464.
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Neuraxial anesthesia has become the preferred method of anesthesia for nonemergent cesarean delivery and cases where regional anesthesia is not contraindicated. Multiple cases of broken spinal and epidural needles have been reported in the literature over the last several years; however, the specific incidence of needle breakage is still unknown. Less reliance on general anesthesia and increasing parturient body mass index (BMI) has likely contributed to more reports of broken needles during regional anesthesia for obstetric surgery. We describe a case of a broken spinal needle after attempted spinal anesthetic placement for cesarean delivery in a morbidly obese parturient, subsequent postoperative management, and current treatment recommendations.
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Pascucci, R. C., M. B. Hershenson, N. F. Sethna, S. H. Loring, and A. R. Stark. "Chest wall motion of infants during spinal anesthesia." Journal of Applied Physiology 68, no. 5 (May 1, 1990): 2087–91. http://dx.doi.org/10.1152/jappl.1990.68.5.2087.
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To test the extent to which diaphragmatic contraction moves the rib cage in awake supine infants during quiet breathing, we studied chest wall motion in seven prematurely born infants before and during spinal anesthesia for inguinal hernia repair. Infants were studied at or around term (postconceptional age 43 +/- 8 wk). Spinal anesthesia produced a sensory block at the T2-T4 level, with concomitant motor block at a slightly lower level. This resulted in the loss of most intercostal muscle activity, whereas diaphragmatic function was preserved. Rib cage and abdominal displacements were measured with respiratory inductance plethysmography before and during spinal anesthesia. During the anesthetic, outward inspiratory rib cage motion decreased in six infants (P less than 0.02, paired t test); four of these developed paradoxical inward movement of the rib cage during inspiration. One infant, the most immature in the group, had inward movement of the rib cage both before and during the anesthetic. Abdominal displacements increased during spinal anesthesia in six of seven infants (P less than 0.05), suggesting an increase in diaphragmatic motion. We conclude that, in the group of infants studied, outward rib cage movement during awake tidal breathing requires active, coordinated intercostal muscle activity that is suppressed by spinal anesthesia.
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Sigdel, Rohini, Maya Lama, Sanish Gurung, and Sushil Timilsina. "Anesthesia practice in cesarean delivery in tertiary care hospital: a retrospective observational study." Medical Journal of Pokhara Academy of Health Sciences 1, no. 1 (June 4, 2018): 13–15. http://dx.doi.org/10.3126/mjpahs.v1i1.22452.
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Background: Regional anesthesia is being utilized as the preferred anesthetic technique for cesarean delivery worldwide. This study was performed to review cesarean delivery anesthetic practice in our institute which represents a tertiary care regional hospital.
Methods: Data was collected regarding the number of cesarean delivery performed during the period of six months from January 2017 to June 2017 at Western Regional Hospital. Number of elective versus emergency cesarean delivery, mode of anesthesia and the reason for general anesthesia and complications was recorded.
Results: The number of cesarean delivery was found to be 1174(26.41%) of total deliveries during the study period. Out of which, 64.82% were for emergency indication and 35.18% were elective cesarean delivery. Spinal anesthesia was utilized in 99.03% of elective cesarean section and 97.63% of emergency cesarean section. The percentage of cases performed under general anesthesia was 1.87%. Reasons for general anesthesia included inadequate subarachnoid block, fetal malpresentation, eclampsia and maternal comorbidities. Complications related to general anesthesia like failed intubation, airway difficulty related to general anesthesia and anesthesia related mortality was not encountered.
Conclusion: Spinal anesthesia is utilized widely and safely in obstetric practice at our hospital. Use of labour epidural analgesia should be introduced and encouraged in our setting to minimize the side effects of single shot spinal anesthesia and to avoid general anesthesia when indicated.
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Perlas, Anahi, Vincent W. S. Chan, and Scott Beattie. "Anesthesia Technique and Mortality after Total Hip or Knee Arthroplasty." Anesthesiology 125, no. 4 (October 1, 2016): 724–31. http://dx.doi.org/10.1097/aln.0000000000001248.
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Abstract Background This propensity score–matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty. Methods All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time. A propensity score–matched-pair analysis was performed using a nonparsimonious logistic regression model of regional anesthetic use. Results We identified 10,868 patients, of whom 8,553 had spinal anesthesia and 2,315 had general anesthesia. Ninety-two percent (n = 2,135) of the patients who had general anesthesia were matched to similar patients who did not have general anesthesia. In the matched cohort, the 30-day mortality rate was 0.19% (n = 4) in the spinal anesthesia group and 0.8% (n = 17) in the general anesthesia group (risk ratio, 0.42; 95% CI, 0.21 to 0.83; P = 0.0045). Spinal anesthesia was also associated with a shorter hospital length of stay (5.7 vs. 6.6 days; P < 0.001). Conclusions The results of this observational, propensity score–matched cohort study suggest a strong association between spinal anesthesia and lower 30-day mortality, as well as a shorter hospital length of stay, after elective joint replacement surgery.
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LUTTSEV, Aleksandr B., Oleg N. YAMSHCHIKOV, Aleksandr P. MARCHENKO, Marina A. IGNATOVA, and Natalya M. GRACHEVA. "Experience in the use of combined spinal and epidural anesthesia in hip surgery." Medicine and Physical Education: Science and Practice, no. 2 (2019): 37–43. http://dx.doi.org/10.20310/2658-7688-2019-1-2-37-43.
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In this study we analyze the experience of use combined single-level spinal epidural anesthesia among patients with high anesthetic risk in operations carried out at hip fractures in 2018. Patients of 1st group (26) operated for closed pertrochanteric hip fracture with high anesthetic risk of 3 st. according to American Society of Anesthesiologists, with age from 55 to 90 years (mean age 78.3 years). This group was operated with the use of combined single-level spinal epidural anesthesia. Patients of the 2nd group (25) were operated for femoral neck closed fracture in age from 80 to 96 years (mean age of 86.9 years). The operation for this group was performed using spinal anesthesia. In general 92 patients with this diagnosis were operated in 2018, but we selected for analysis 25 patients over the age of 80 years with an anesthetic risk of 3 st. according to American Society of Anesthesiologists. Patients of the 3rd group (6), were operated for fractures of the upper third, lower third and femoral neck, one patient had a combined fracture of the right femoral neck and the surgical neck of the right humerus. Age of patients varied from 81 to 91 years (mean age 86.8 years), and the risk according to American Society of Anesthesiologists - 3 st. These patients were operated with the use of epidural anesthesia. The aim of the analysis is to evaluate the advantages of combined single-level spinal epidural anesthesia in performing operations for femoral fractures.
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Sharma, Vidushi. "ANALYSIS OF PERI-OPERATIVE BLOOD SUGAR LEVELS IN VARIOUS ANESTHETIC APPROACHES IN NON-DIABETIC AND DIABETIC PATIENTS: COMPARATIVE STUDY FROM CENTRAL INDIA." Journal of Medical pharmaceutical and allied sciences 10, no. 3 (July 15, 2021): 3085–88. http://dx.doi.org/10.22270/jmpas.v10i3.1373.
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Surgical procedures cause a stress response, which results in biochemical and hormonal changes. Elevated blood sugar is the most well-known metabolic disorder. Inadequate glycemic regulation affects perioperative morbidity and mortality. The hyperglycemic reaction varies depending on the anesthetic agent and technique used. The study's aim is to compare non-diabetics and diabetics in terms of the degree to which blood sugar levels rise as a measure of stress during anesthesia and surgery under different anesthetic techniques (controlled). Ninety adult patients (30 to 55 years old) underwent various elective surgeries lasting 60 to 90 minutes under three anesthetic techniques (general (GA), epidural (EA), and spinal (SA)) at a tertiary healthcare center in Central India. 45 of the patients were not diabetic and 45 were diabetics under care. Blood sugar levels were compared between three techniques in each group and between similar techniques in both groups. Blood sugar fluctuation is less with regional techniques and much less with spinal analgesia in diabetics and non-diabetics. Wherever possible, regional techniques can reduce a diabetic's response to surgical stress. The need for an intraoperative insulin regimen may not be required in all procedures, but it is more dependent on the length and severity of the procedure. Glycemic regulation is easier in spinal anesthesia than in general anesthesia since the stress response to surgery is comparatively lower. Where necessary, we prefer spinal anesthesia to epidural and general anesthesia for minimizing surgical stress response.
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Idris, Idris Mohammed, Ghidey Gebreyohanns Weldegiorgis, and Eyasu Habte Tesfamariam. "Maternal Satisfaction and Its Associated Factors towards Spinal Anesthesia for Caesarean Section: A Cross-Sectional Study in Two Eritrean Hospitals." Anesthesiology Research and Practice 2020 (March 21, 2020): 1–8. http://dx.doi.org/10.1155/2020/5025309.
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Objective. Satisfaction of mothers during caesarean section is an important indicator for measuring quality of obstetric anesthesia. This study aimed to determine mothers’ level of satisfaction and the predicting factors of dissatisfaction towards spinal anesthesia during caesarean section. Methods. Cross-sectional study design was utilized in Orotta Maternity Hospital (OMH) and Sembel Hospital from December 2017 to February 2018, in Asmara, Eritrea. Satisfaction of the mothers was measured using a pretested questionnaire. Bivariate and multivariate logistic regression were utilized to identify predictors of dissatisfaction using SPSS (Version 22.0). Results. Involvement of mothers in the choice of anesthesia (3.3%) and explanation about the stay at operating theater (10%) were the two least reported items. As per the subscale analysis, the lowest satisfaction was observed for the preoperative assessment (16.7%). Overall, 87.9% of the mothers were satisfied with the spinal anesthetic service. Hospital at which anesthesia was administered (p<0.001), marital status (p<0.001), and intraoperative pain (p<0.001) were significant predictors of dissatisfaction towards spinal anesthesia. Moreover, the rate of refusal to have spinal anesthesia in the future was 12.5%. Conclusion. Though overall satisfaction can be considered as fair, preoperative assessment is considerably low. Hence, explaining the benefits and risks of the anesthetic techniques as well as considering patient’s opinion is very important while deciding the type of anesthesia.
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Harned, Michael E. "Novel Use of Intraoperative Dexmedetomidine Infusion for Sedation During Spinal Cord Stimulator Lead Placement via Surgical Laminectomy." Pain Physician 1;13, no. 1;1 (January 14, 2010): 19–22. http://dx.doi.org/10.36076/ppj.2010/13/19.
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Background: Spinal cord stimulators are most often placed through a percutaneous approach using minimal sedation and local anesthesia to facilitate intraoperative testing. However, when leads need to be placed using a laminectomy incision additional anesthesia is required which can complicate intraoperative testing. There is no consensus as to the best anesthetic choice when laminectomy-placed leads are required. Objective: We present 2 cases where spinal cord stimulator leads were implanted through a surgical laminectomy under sedation using dexmedetomidine infusion and local anesthesia to provide a cooperative patient for intraoperative testing. Case Report: Patient #1: A 40-year-old female with Complex Regional Pain Syndrome secondary to an automobile accident who had good pain control with a spinal cord stimulator until a lead fracture resulted in loss of stimulation. She required a laminectomy-placed lead which was implanted under dexmedetomidine infusion and local anesthesia. Patient #2: A 54-year-old female with Failed Back Syndrome who had good pain control until a lead fracture resulted in loss of stimulation. She underwent a laminectomy-placed lead, new battery pocket, and removal of the old system under a dexmedetomidine infusion and local anesthesia. Limitations: Report of only 2 cases. Conclusions: The anesthetic management from a laminectomy-placed spinal cord stimulator can present a difficult choice. A general anesthetic or even deep sedation can provide good operative conditions but limits intraoperative testing or in the case of deep sedation risks losing the airway in the prone position. On the other hand, minimal sedation, which facilitates intraoperative testing, can make the surgical procedure extremely uncomfortable or even unbearable. Dexmedetomidine infusion and local anesthesia provide sedation for the operative portions while rendering the patient alert and cooperative during intraoperative testing. Key words: Spinal Cord Stimulator, dexmedetomidine, percutaneous, laminectomy, intraoperative, sedation
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Güneş, Dilara, Hüseyin Konur, Buket OZYAPRAK, and Gönül Erkan. "Comparing Different Positions of the Spinal Needle Tip, During Spinal Anesthesia of the Pilonidal Sinus Surgery." International Journal of Medical Science and Clinical invention 7, no. 01 (January 30, 2020): 4714–19. http://dx.doi.org/10.18535/ijmsci/v7i01.08.
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Aim: Spinal anesthesia is usually the anesthetic method of choice in pilonidal sinus surgery, which is mostly performed as an outpatient operation. Spinal anesthesia is administered via injection of local anesthetic agents into subarachnoid space. Throughout history, spinal needles have undergone changes and have greatly reduced in thickness. In this study, we aimed to compare the effects of caudal or cranially oriented spinal needle tips on anesthesia in patients undergoing pilonidal sinus surgery.
Materials and Methods: This study was performed prospectively with 60 patients who underwent pilonidal sinus surgery with spinal anesthesia at Medeniyet University Göztepe Training and Research Hospital between 01.03.2013 - 30.11.2013. Patients were randomly divided into two groups based on the direction of the spinal needle tip. 25 G Quincke tipped spinal needles were oriented caudally in Group A (n=30) and cranially in Group B (n=30). Two groups were compared in terms of anesthesia duration, hemodynamic parameters, and postoperative data.
Results: No difference was found in comparison of the demographic data of the two groups. Intraoperative mean arterial pressure and heart rate were significantly lower in both groups compared to baseline values. The incidences of postoperative headache, time until mobilization (min) were significantly high and time until first micturition (min) was significantly low in Group B.
Discussion: The data obtained from our study showed that cranial or caudal orientation of the spinal needle tips may have varying intraoperative and postoperative effects. We believe that further randomized controlled studies with larger sample sizes should be conducted to clarify the subject.
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Shrestha, AB, S. Shrestha, KR Sharma, and T. Gurung. "Anesthetic Management of a Parturient with Poliomyelitis Associated with Kyphoscoliosis." Nepal Journal of Obstetrics and Gynaecology 9, no. 1 (September 28, 2014): 67–70. http://dx.doi.org/10.3126/njog.v9i1.11193.
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A 27-year-old primigravida with poliomyelitis associated with kyphoscoliosis underwent cesarean section under spinal anesthesia. Anesthesia poses a significant risk to a parturient with kyphoscoliosis and there is no single regimen that can be recommended for anesthetic management. Regional anesthesia is also challenging for anesthesiologist because the distortion of the spinous process and rotation of the vertebral column. The perioperative period was uneventful. Spinal anesthesia can be safely administered with less adverse effects in poliomyelitis patients with kyphoscoliosis. DOI: http://dx.doi.org/10.3126/njog.v9i1.11193 NJOG 2014 Jan-Jun; 2(1):67-70
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Delgado, Carlos, Wil Van Cleve, Christopher Kent, Emily Dinges, and Laurent A. Bollag. "Neuraxial anesthesia for postpartum tubal ligation at an academic medical center." F1000Research 7 (September 26, 2018): 1557. http://dx.doi.org/10.12688/f1000research.16025.1.
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Background: Use of an in situ epidural catheter has been suggested to be efficient to provide anesthesia for postpartum tubal ligation (PPTL). Reported epidural reactivation success rates vary from 74% to 92%. Predictors for reactivation failure include poor patient satisfaction with labor analgesia, increased delivery-to-reactivation time and the need for top-ups during labor. Some have suggested that this high failure rate precludes leaving the catheter in situ after delivery for subsequent reactivation attempts. In this study, we sought to evaluate the success rate of neuraxial techniques for PPTL and to determine if predictors of failure can be identified. Methods: After obtaining IRB approval, a retrospective chart review of patients undergoing PPTL after vaginal delivery from July 2010 to July 2016 was conducted using CPT codes, yielding 93 records for analysis. Demographic, obstetric and anesthetic data (labor analgesia administration, length of epidural catheter in epidural space, top-up requirements, time of catheter reactivation, final anesthetic technique and corresponding doses for spinal and epidural anesthesia) were obtained. Results: A total of 70 patients received labor neuraxial analgesia. Reactivation was attempted in 33 with a success rate of 66.7%. Patient height, epidural volume of local anesthetic and administered fentanyl dose were lower in the group that failed reactivation. Overall, spinal anesthesia was performed in 60 patients, with a success rate of 80%. Conclusions: Our observed rate of successful postpartum epidural reactivation for tubal ligation was lower than the range reported in the literature. Our success rates for both spinal anesthesia and epidural reactivation for PPTL were lower than the generally accepted rates of successful epidural and spinal anesthesia for cesarean delivery. This gap may reflect a lower level of motivation on behalf of both the patients and anesthesia providers to tolerate “imperfect” neuraxial anesthesia once fetal considerations are removed.
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Maheshwer, Bhargavi, Derrick M. Knapik, Evan M. Polce, Nikhil N. Verma, Robert F. LaPrade, and Jorge Chahla. "Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials." American Journal of Sports Medicine 49, no. 11 (January 7, 2021): 3132–44. http://dx.doi.org/10.1177/0363546520980429.
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Background: Anterior cruciate ligament reconstruction (ACLR) is associated with moderate to severe pain in the immediate postoperative period. The optimal individual preemptive or intraoperative anesthetic modality on postoperative pain control is not well-known. Purpose: To systematically review and perform a meta-analysis comparing postoperative pain scores (visual analog scale [VAS]), opioid consumption, and incidence of complications during the first 24 hours after primary ACLR in patients receiving spinal anesthetic, adjunct regional nerve blocks, or local analgesics. Study Design: Systematic review and meta-analysis. Methods: PubMed, Embase, MEDLINE, Biosis Previews, SPORTDiscus, Ovid, PEDRO, and the Cochrane Library databases were systematically searched from inception to March 2020 for human studies, using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Inclusion criteria consisted of (1) level 1 studies reporting on the use of spinal anesthesia, adjunct regional anesthesia (femoral nerve block [FNB] or adductor canal block [ACB]), or local analgesia in patients undergoing primary ACLR and (2) studies reporting on patient-reported VAS, opioid consumption, and incidence of complications related to anesthesia within the first 24 hours after surgery. Non–level 1 studies, studies utilizing a combination of anesthetic modalities, and those not reporting outcomes during the first 24 hours were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine postoperative pain, opioid use, and complications based on anesthetic modality at multiple time points (0-4, 4-8, 8-12, 12-24 hours). Results: A total of 263 studies were screened, of which 27 level 1 studies (n = 16 regional blocks; n = 12 local; n = 4 spinal) met the inclusion criteria and were included in the meta-analysis. VAS scores were significantly lower in patients receiving a regional block as compared with spinal anesthesia 8 to 12 hours after surgery ( P < .01), patients receiving an FNB versus ACB at 12 to 24 hours ( P < .01), and those treated with a continuous FNB rather than single-shot regional blocks (FNB, ACB) at 12 to 24 hours ( P < .01). No significant difference in VAS was appreciated when spinal, regional, and local anesthesia groups were compared. Conclusion: Based on evidence from level 1 studies, pain control after primary ACLR based on VAS was significantly improved at 8 to 12 hours in patients receiving regional anesthesia as compared with spinal anesthesia. Pain scores were significantly lower at 12 to 24 hours in patients receiving FNB versus ACB and those treated with continuous FNB rather than single-shot regional anesthetic.
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Johnson, M. E., and P. Dadarkar. "Morphologic Assessment of Plasma Membrane Blebbing Provides a Sensitive, Early Indicator of Low Dose Lidocaine Neurotoxicity." Microscopy and Microanalysis 7, S2 (August 2001): 652–53. http://dx.doi.org/10.1017/s1431927600029330.
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Background: Lidocaine is a local anesthetic that is frequently used for spinal anesthesia. in clinical and animal studies, lidocaine is associated with an increased risk of spinal neurotoxicity following spinal anesthesia. The mechanism of lidocaine neurotoxicity has not been fully elucidated, but it does not involve blockade of sodium channels, the mechanism by which lidocaine causes local anesthesia. Previous in vitro studies assessing cytoplasmic calcium, nerve conduction and action potential generation, and cell death, have demonstrated overt neurotoxicity at higher concentrations of lidocaine (≥ 2% [74 mM] of the hydrochloride formulation), but equivocal results at lower concentrations. Clinically available preparations of lidocaine for spinal anesthesia contain 5% or 2.5% lidocaine hydrochloride. in most cases, lidocaine mixes rapidly with cerebrospinal fluid after injection for spinal anesthesia, so that lower concentrations are more clinically relevant. We have therefore evaluated morphologic assessment of plasma membrane blebbing as a more sensitive assay of neuronal injury by lidocaine.
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Shrestha, S., YK Chan, and FN Razali. "Anesthetic Management for a Parturient with Facioscapulohumeral Muscular Dystrophy Undergoing Caesarean Section." Nepal Journal of Obstetrics and Gynaecology 10, no. 2 (January 15, 2016): 54–56. http://dx.doi.org/10.3126/njog.v10i2.14339.
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Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant muscle disorder characterized by progressive weakness and wasting of facial, shoulder girdle and upper arm muscles. Anesthetic management for the parturient with muscular dystrophy is very challenging for anesthesiologists because general as well as regional anesthesia may cause deleterious effect to the patient. We report a case of 28 years parturient with Facioscapulohumeral muscular dystrophy that underwent elective caesarean section under combined spinal epidural anesthesia. Intraoperative and postoperative period were uneventful however the motor block was prolonged. Regional anesthesia especially combined spinal epidural anesthesia can be safely used to provide anesthesia for caesarean section in patients with muscular dystrophy.
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Soomro, Ahmeduddin, Maqsood Ahmed Siddiqui, Ashok Perchani, Hamid Raza, Kamlesh ., and Sorath Luhana. "Efficacy of general anesthesia as compared to spinal anesthesia for patients undergoing ventral abdominal hernia repair, a randomized controlled trial." Professional Medical Journal 28, no. 06 (June 10, 2021): 876–80. http://dx.doi.org/10.29309/tpmj/2021.28.06.4792.
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Objective: To compare the use of general anesthesia with spinal anesthesia in patients undergoing ventral hernia repair. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia CMC Hospital @ SMBBMU Larkana. Period: January 2018 to December 2019. Material & Methods: We included patients above the age of 18 years, who presented with initial complaint of a ventral hernia, requiring surgical intervention. The exclusion criterion was all the patients with co-morbidities like malignancy, having a BMI score of greater than 35, having known allergies to anesthetic agents, and neurologic or neuromuscular diseases. A total of n=120 patients were included in the study and randomly divided into two groups. All the data including clinical parameters, drugs administered, and relevant side effects and complications were recorded in a pre-designed proforma. Results: The study population was n= 120 patients, the mean age was 45.5 +/- 15.5 years, there were n= 42 (35%) males and n= 78 (65%) females. There were no statistically significant differences among the two groups in terms of patient’s age, gender, blood pressures and heart rate. N= 54 (90%) of the patients belonging to the spinal anesthesia group had adequate anesthesia, the rest required administration of supplemental analgesic. None of the cases in the cohort had failure of the anesthetic technique. The postoperative visual analog scale scores at various time intervals (0, 2, 4 and 8 hours post procedure) were higher in the general anesthesia group versus spinal anesthesia group (p value of <0.05). Conclusion: Patients receiving spinal anesthesia had less incidence of post-operative nausea and required less analgesics, while patients receiving general anesthesia had more stable blood pressure profiles.
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Borkar Patil, Vijaya P., and Jayshree J. Upadhye. "Anesthetic complications in cesarean section." International Journal of Research in Medical Sciences 6, no. 10 (September 25, 2018): 3215. http://dx.doi.org/10.18203/2320-6012.ijrms20183849.
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Background: Obstetric anesthetists need to face with the unique situation of providing anesthesia for caesarean sections, where they have to provide care for both the mother and the unborn baby. This study was performed in 100 women who underwent cesarean section, either elective or emergency to evaluate type of anesthesia, anesthetic complications and neonatal outcome.Methods: A retrospective study was conducted in 100 women with singleton pregnancy undergoing cesarean section in the department of Anesthesiology in collaboration with department of Obstetrics and gynecology at Dr PDMMC and Hospital, Amravati from January 2017 to March 2018. Detailed information regarding medical and obstetric history, intrapartum course, postpartum complications diagnosed before hospital discharge, and infant outcome were collected directly from maternal and infant charts. Other details like age of the patient, parity, type of cesarean section and type of anesthesia was noted. American Society of Anesthesiologists (ASA) scores and type of anesthesia was noted.Results: In our study, spinal anesthesia was given in 62 (62%) patients, epidural anesthesia was given in 20 (20%) patients, combined spinal-epidural anesthesia was given in 10 (10%) patients while general anesthesia was given in 8 (8%) patients. Anesthetic complications were less. About 10 (10%) patients had spinal headache, 4 (4%) patients had failed regional anesthesia, 2 (2%) patients had failed intubation while 2 (2%) patients had high spinal anesthesia. Babies of 96 (96%) patients had Apgar score at 5 minutes of more than 7 and babies of 4 (4%) patients had Apgar score at 5 minutes of less than 7. Only babies of 2 (2%) patients required intubation for resuscitation.Conclusions: This study provides strong evidence that the guidelines recommending regional block over GA for most cesarean section. It is beneficial for neonates as well as for mothers.
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Stevens, Rom A., David Beardsley, J. Lee White, Tzu-Cheg Kao, Rod Gantt, and Stephen Holman. "Does Spinal Anesthesia Result in a More Complete Sympathetic Block Than That from Epidural Anesthesia?" Anesthesiology 82, no. 4 (April 1, 1995): 877–83. http://dx.doi.org/10.1097/00000542-199504000-00009.
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Background Spinal and epidural injection of local anesthetics are used to produce sympathetic block to diagnose and treat certain chronic pain syndromes. It is not clear whether either form of regional anesthesia produces a complete sympathetic block. Spinal anesthesia using tetracaine has been reported to produce a decrease in plasma catecholamine concentrations. This has not been demonstrated for epidural anesthesia in humans with level of anesthesia below C8. One possible explanation is that spinal anesthesia results in a more complete sympathetic block than epidural anesthesia. To examine this question, a cross-over study was performed in young, healthy volunteers. Methods Ten subjects underwent both spinal and epidural anesthesia with lidocaine (plain) on the same day with complete recovery between blocks. By random assignment, spinal anesthesia and epidural anesthesia were induced via lumbar injection. Before and 30 min after local anesthetic injection, a cold pressor test (CPT) was performed. Blood was obtained to determine epinephrine and norepinephrine plasma concentrations at four stages: (1) 20 min after placing peripheral catheters, (2) at the end of a 2-min CPT (before conduction block), (3) 30 min after injection of epidural or spinal lidocaine, and (4) at the end of a second CPT (during anesthesia). Mean arterial pressure, heart rate, noninvasive cardiac index, and analgesia to pin-prick were monitored. Results Neither spinal nor epidural anesthesia changed baseline resting values of catecholamines or any hemodynamic variable, except heart rate, which was slightly decreased during spinal anesthesia. Median level of analgesia was T4 during spinal and T3 during epidural anesthesia. CPT before conduction block reliably increased heart rate, mean arterial pressure, cardiac index, epinephrine, and norepinephrine. Conduction block attenuated the increase in response to CPT only in mean arterial pressure (spinal and epidural) and cardiac index (spinal only). Neither technique blocked the increase in heart rate, norepinephrine, or epinephrine to CPT. Conclusions Spinal anesthesia did not result in a more complete attenuation of the sympathetic response to a CPT than did epidural anesthesia. In response to the CPT, spinal anesthesia blocked the increase in cardiac index, and epidural anesthesia resulted in a decrease in total peripheral resistance compared to the pre-anesthesia state. The differences between the techniques are not significant and are of uncertain clinical implications.
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Klöss, Thomas, Gunther Lenz, Heidi Schwandt-Boden, Johannes Bauer, and Raimund Stehle. "The Role of Regional Anesthesia under Field Conditions." Prehospital and Disaster Medicine 5, no. 4 (December 1990): 349–52. http://dx.doi.org/10.1017/s1049023x00027096.
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AbstractThe authors, who served as anesthesiologists for 15 months at an International Committee of the Red Cross (ICRC) surgical field hospital in a Cambodian refugee camp, report their anesthesiologic experience with 2,906 patients. In spite of preferential use of regional anesthetic techniques, general anesthesia was required in 68% of the cases. Local infiltration anesthesia was applied in 21% of the cases, conduction anesthesia in 3%, and spinal anesthesia in 8%.
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Gyawali, Nirmal Kumar. "Spinal Anesthesia for Removal of Thoraco-Lumbar Pedicle Screw." Europasian Journal of Medical Sciences 1, no. 1 (December 11, 2019): 35–39. http://dx.doi.org/10.46405/ejms.v1i1.2.
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Background: Spinal anesthesia compared to the general anesthesia has advantages of decreased blood loss, better cardiovascular stability, and postoperative pain control. This study was designed to evaluate pedicle screw removal at the lateral position under spinal anesthesia. Methods: It is a prospective study done in patients with ASA (American Society of Anaesthesiologist) I and II with ages between 17 to 75 years of both sex admitted for pedicle screw removal surgery during the period March 2018 to April 2019 AD in Western Hospital and research center Nepalgunj. All patients were informed about the risk of conversion to general anesthesia in detail. Spinal anesthesia was given to all 83 patients who came for pedicle screw removal. Result: Out of all patients 54% were from Hills and the remaining 46% were from Terai. The commonest cause of injury was fall from a tree which was in 48 (57.8%) out of 83 cases. The commonest level of injury was L1 followed by L2. The operation was completed under spinal anesthesia. None of the patients required conversion to general anesthesia. And 69 (83.1%) patients did not require any additional medications whereas the remaining 14 (16.86%) needed additional medications. Conclusion: Spinal anesthesia is the safe and effective anesthetic technique for short duration spinal surgery eg pedicle screw removal in terms of perioperative events and in prolonged postoperative analgesia, as well as in terms of patient and surgeon’s satisfaction. Keywords: Spinal Anesthesia, Thoracolumbar, Pedicle Screw
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Lind, Göran, Björn A. Meyerson, Jaleh Winter, and Bengt Linderoth. "Implantation of Laminotomy Electrodes for Spinal Cord Stimulation in Spinal Anesthesia with Intraoperative Dorsal Column Activation." Neurosurgery 53, no. 5 (November 1, 2003): 1150–54. http://dx.doi.org/10.1227/01.neu.0000089107.67673.71.
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Abstract OBJECTIVE To optimize the technique of implanting laminotomy plate electrodes for spinal cord stimulation and to minimize the discomfort of the patients during surgery. This operation is often performed while the patient is under local anesthesia, which is very stressful for the patient, or under general anesthesia, which precludes the use of test stimulation. An alternative approach is to perform the implantation with a spinal anesthetic and to examine whether stimulation-induced paresthesiae can still be evoked to guide the positioning of the electrode. METHODS Spinal anesthesia was induced by bupivacaine (12.5–20 mg), which produced complete motor block and anesthesia up to a midthoracic level. After a single-level laminotomy (thoracic vertebrae 9–11) a four-pole plate electrode was inserted into the epidural space. Stimulation was applied with commonly used parameters, and the electrode was positioned so that the paresthesiae covered the painful region. RESULTS In 19 patients (20 procedures) with different forms of neuropathic pain, implantation of laminotomy plate electrodes could be performed under spinal anesthesia without problems. In all patients, it was possible to evoke paresthesiae, the distribution of which could be reproduced postoperatively. The paresthesia thresholds during surgery were only moderately higher than those recorded after implantation (mean, 3.1 versus 2.1 V, respectively). During an interview after the intervention, no patient reported that he or she had experienced surgery as painful or uncomfortable. CONCLUSION Implantation of laminotomy electrodes can be performed conveniently with spinal anesthesia because it minimizes discomfort for the patient and enables the use of intraoperative test stimulation to guide the positioning of the electrode. In spite of the total motor block and anesthesia, paresthesiae representing the activation of the dorsal columns can be evoked and are well perceived, and the thresholds are not abnormally high. This observation supports the notion that the subarachnoidal anesthetic agent acts predominantly on the spinal rootlets rather than on the spinal afferent pathways.
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Sakura, Shinicki, Mariko Sumi, Yasuko Sakaguchi, Yoji Saito, Yoshihiro Kosaka, and Kenneth Drasner. "The Addition of Phenylephrine Contributes to the Development of Transient Neurologic Symptoms after Spinal Anesthesia with 0.5% Tetracaine." Anesthesiology 87, no. 4 (October 1, 1997): 771–78. http://dx.doi.org/10.1097/00000542-199710000-00009.
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Background Recent reports indicate that transient neurologic symptoms commonly occur after single-injection spinal anesthesia with lidocaine. Information regarding tetracaine has been limited to a single case report. In addition, little is known about the cause of these symptoms or the cofactors that affect their occurrence. The present study sought to determine whether the presence of phenylephrine or the concentration of glucose in the anesthetic solution affects the incidence of transient neurologic symptoms after spinal anesthesia with 0.5% tetracaine. Methods One-hundred sixty patients classified as American Society of Anesthesiologists physical status I or II who were scheduled for elective surgery on a lower limb or perineum were sequentially assigned to one of four equal groups to receive intrathecal 0.5% tetracaine in 7.5% or 0.75% glucose, with or without 0.125% phenylephrine. Patients were evaluated on postoperative day one for the presence of pain, dysesthesia, or both in the legs or buttocks by an investigator unaware of the drug given. Results Symptoms were present in 10 patients (12.5%) receiving a spinal anesthetic containing phenylephrine, but in only one patient (1.3%) receiving spinal anesthesia without phenylephrine. There was no significant difference in the incidence of symptoms between groups receiving 7.5% glucose and those receiving 0.75% glucose (8.8% and 5% of patients, respectively). Conclusions These results suggest that adding phenylephrine to tetracaine for spinal anesthesia increases the potential for transient neurologic symptoms, but that the concentration of glucose does not affect their occurrence.
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Singh, Ram P., and Richa Agrawal. "Anesthesia for a Patient on Monoamine Oxidase Inhibitors." International Journal of Advanced and Integrated Medical Sciences 1, no. 2 (2016): 81–83. http://dx.doi.org/10.5005/jp-journals-10050-10027.
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ABSTRACT Monoamine oxidase (MAO) inhibitors are frequently used for multidrug-resistant major depression, which is emerging as an epidemic in the modern era. Anesthesia during chronic use of MAO inhibitors is a matter of debate because of increased risk of drug interactions with various anesthetic drugs. Cardiac disorders contribute to perioperative and postoperative complications. Recent studies illustrate the safety of anesthesia without discontinuation of MAO inhibitors if sympathetic homeostasis is maintained and known drug interactions are avoided. In this case study, a 72-year-old male psychiatric patient on permanent treatment with tranylcypromine (30 mg/day) was admitted for bipolar hemiarthroplasty. After complete aseptic precautions, spinal anesthesia was achieved by 12.5 mg 0.5% heavy bupivacaine and 30 μg clonidine intrathecally. The anesthetic effect was adequate, but surgery was not completed timely and the effect of spinal anesthesia was weaned off, so general anesthesia was given and surgery was completed. There was no perioperative or postoperative complication. In conclusion, general or regional anesthesia for noncardiac surgery without discontinuation of MAO inhibitors may be safe after careful preoperative evaluation of the patient. How to cite this article Krishan G, Singh RP, Agrawal M, Agrawal R. Anesthesia for a Patient on Monoamine Oxidase Inhibitors. Int J Adv Integ Med Sci 2016;1(2):81-83.
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Carpenter, Randall L., Quinn H. Hogan, Spencer S. Liu, Bert Crane, and James Moore. "Lumbosacral Cerebrospinal Fluid Volume Is the Primary Determinant of Sensory Block Extent and Duration during Spinal Anesthesia." Anesthesiology 89, no. 1 (July 1, 1998): 24–29. http://dx.doi.org/10.1097/00000542-199807000-00007.
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Unlabelled BACKGROUND. Injection of local anesthetic into cerebrospinal fluid (CSF) produces anesthesia of unpredictable extent and duration. Although many factors have been identified that affect the extent of spinal anesthesia, correlations are relatively poor and the extent of spread remains unpredictable. This study was designed to determine whether variability in the volume of lumbosacral CSF among individuals is a contributing factor in the variability of spinal anesthesia. Methods Spinal anesthesia was administered to 10 healthy volunteers with 50 mg lidocaine in 7.5% dextrose. The technique was standardized to minimize variability in factors known to affect the distribution of spinal anesthesia. The extent of sensory anesthesia was assessed by pin-prick and by transcutaneous electrical stimulation. Motor blockade was assessed in the quadriceps and gastrocnemius muscles by force dynamometry. Duration of anesthesia was assessed by pinprick, transcutaneous electrical stimulation, and duration of motor blockade. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Volumes of CSF were correlated with measures of extent and duration of spinal anesthesia using the Kendall rank correlation test. Results Lumbosacral CSF volumes ranged from 42.7 to 81.1 ml. Volumes of CSF correlated with pin-prick assessments of peak sensory block height (P = 0.02) and duration of surgical anesthesia (as assessed by the duration of tolerance to transcutaneous electrical stimulation at the ankle (P < 0.05). Conclusions Variability in lumbosacral CSF volume is the most important factor identified to date that contributes to the variability in the spread of spinal sensory anesthesia.
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Mitsunaga, Jorge Kiyoshi, Vinicius Fernando Calsavara, Elton Shinji Onari, Vinicius Monteiro Arantes, Carolina Paiva Akamine, Adriana Mayumi Handa, Michael Madeira de la Cruz Quezada, et al. "Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial." PLOS ONE 16, no. 5 (May 17, 2021): e0249808. http://dx.doi.org/10.1371/journal.pone.0249808.
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Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.
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Aiono-Le Tagaloa, Leinani, Alexander J. Butwick, and Brendan Carvalho. "A Survey of Perioperative and Postoperative Anesthetic Practices for Cesarean Delivery." Anesthesiology Research and Practice 2009 (2009): 1–7. http://dx.doi.org/10.1155/2009/510642.
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The aim of this survey was to review cesarean delivery anesthetic practices. An online survey was sent to members of the Society of Obstetric Anesthesia and Perinatology (SOAP). The mode of anesthesia, preferred neuraxial local anesthetic and opioid agents, postoperative analgesic regimens, and monitoring modalities were assessed. 384 responses from 1,081 online survey requests were received (response rate = 36%). Spinal anesthesia is most commonly used for elective cesarean delivery (85% respondents), with 90% of these respondents preferring hyperbaric bupivacaine 0.75%. 79% used intrathecal fentanyl and 77% used morphine (median [range] dose 200 mcg [50–400]). 91% use respiratory rate, 61% use sedation scores, and 30% use pulse oximetry to monitor for postoperative respiratory depression after administration of neuraxial opioids. Postoperative analgesic regimens include: nonsteroidal anti-inflammatory agents, acetaminophen, oxycodone, and hydrocodone by 81%, 45%, 25%, and 27% respondents respectively. The majority of respondents use spinal anesthesia and neuraxial opioids for cesarean delivery anesthesia. There is marked variability in practices for monitoring respiratory depression postdelivery and for providing postoperative analgesia. These results may not be indicative of overall practice in the United States due to the select group of anesthesiologists surveyed and the low response rate.
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Safin, R. R., O. G. Anisimov, and A. A. Nazipov. "New method of epidural anesthesia in closed blunt chest injury." Kazan medical journal 82, no. 1 (August 13, 2021): 18–21. http://dx.doi.org/10.17816/kazmj70887.
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The thoracic epidural anesthesia is the most suitable method for the treatment of the closed blunt chest injury but there is probability of the spinal cord injuiry. The original method combining the efficiency of classic thoracic epidural anesthesia with safety and simplicity of lumbar epidural anesthesia is suggested. This method is based on the postulates of the molecular hydrokinetic theory. Two catheters ends are disposed in lumbar epidural space in distance about two inches between them. Through one catheters end the anesthetic solution and through others end the 0,9% saline are injected synchronously in equal volumes. Hydroplunger phenomenon provides the upward anesthetic solution spreading
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Ahmad, Munir, Nadeem Ahmad Khan, Aamir Furqan, and Salman Waris. "WARM AND COLD BUPIVACAINE;." Professional Medical Journal 24, no. 03 (March 7, 2017): 381–85. http://dx.doi.org/10.29309/tpmj/2017.24.03.1553.
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Objectives: To compare the effect of warm and cold bupivacain on shiveringduring infraumblical surgeries in children under spinal anesthesia. Study Design: Randomizedcontrol trial. Setting: Department of anesthesiology, Nishtar Medical College and Hospital,Multan. Period: April 2015 to April 2016. Materials and Methods: A total of 62 patients wereselected for this study. SPSS version 16 was used for data analysis. Frequency and percentageswere calculated for qualitative data and mean ± standard deviation was calculated forquantitative data. Results: There was a remarkable difference shivering score in both groups.Mean shivering score for warm group was 1.1 ± 1.9 and for cold group it was 2.4 ± 1.2.Effectiveness was (74%) in warm group and (19.3%) in cold group. Conclusion: There arethermo sensory fibers in spinal cord that can induce or intensify the onset of shivering, intensityof shivering can be reduced by using warm local anesthetic solution, so anesthetic solutionmust be warm before using in spinal anesthesia.
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Schutte, Soleil S., and Tammy Euliano. "Local anesthetic resistance in a Crohn’s patient undergoing cesarean delivery." Regional Anesthesia & Pain Medicine 45, no. 8 (May 23, 2020): 669–70. http://dx.doi.org/10.1136/rapm-2020-101516.
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IntroductionPatient resistance to local anesthetics is rarely considered as the cause of regional anesthesia failure.Case reportWe report a case of resistance to local anesthetics in a patient with Crohn’s disease who underwent cesarean section under continuous spinal anesthesia.DiscussionResistance to local anesthetics may be more common than we think, especially among patients with chronic pain. Providers should consider local anesthetic resistance when regional anesthesia is unsuccessful. Further research is needed to determine if skin wheal tests and/or a different local anesthetic could improve results.
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Ünsal, Ünlü Ülkün, and Salim Şentürk. "Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey." Ideggyógyászati szemle 74, no. 5-6 (2021): 197–205. http://dx.doi.org/10.18071/isz.74.0197.
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Microdiscectomy (MD) is a standard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD) is another surgical option that has become popular owing to reports of shorter hospitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory workup, nursing care, and two main groups (PELD-MD) medication differed significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.
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Szmuk, Peter, Tiberiu Ezri, Daniel I. Sessler, Arnold Stein, and Daniel Geva. "Spinal Anesthesia Speeds Active Postoperative Rewarming." Anesthesiology 87, no. 5 (November 1, 1997): 1050–54. http://dx.doi.org/10.1097/00000542-199711000-00007.
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Background Redistribution of body heat decreases core temperature more during general than regional anesthesia. However, the combination of anesthetic- and sedative-induced inhibition may prevent effective upper-body thermoregulatory responses even during regional anesthesia. The extent to which each type of anesthesia promotes hypothermia thus remains controversial. Accordingly, the authors evaluated intraoperative core hypothermia in patients assigned to receive spinal or general anesthesia. They also tested the hypothesis that the efficacy of active postoperative warming is augmented when spinal anesthesia maintains vasodilation. Methods Patients undergoing lower abdominal and leg surgery were randomly assigned to receive general anesthesia (isoflurane and nitrous oxide; n = 20) or spinal anesthesia (bupivacaine; n = 20). Fluids were warmed to 37 degrees C and patients were covered with surgical drapes. However, no other active warming was applied during operation. Ambient temperatures were maintained near 20 degrees C. After operation, patients were warmed with a full-length, forced-air cover set to 43 degrees C. Shivering, when observed, was treated with intravenous meperidine. Results The mean spinal analgesia level, which was at the sixth thoracic level during surgery, remained at the T12 dermatome after 90 min after operation. Core temperatures did not differ significantly during surgery and decreased to 34.4 +/- 0.5 degrees C and 34.1 +/- 0.4 degrees C, respectively, in patients given spinal and general anesthesia. After operation, however, core temperatures increased significantly faster (1.2 +/- 0.1 degrees C/h vs. 0.7 +/- 0.2 degrees C/h, mean +/- SD; P < 0.001) in patients given spinal anesthesia. Consequently, patients given spinal anesthesia required less time to rewarm to 36.5 degrees C (122 +/- 28 min vs. 199 +/- 28 min; P < 0.001). Conclusions Comparable intraoperative hypothermia during general and regional anesthesia presumably resulted because the combination of spinal anesthesia and meperidine administration obliterated effective peripheral and central thermoregulatory control. Vasodilation increased the rate of core rewarming in patients after operation with residual lower-body sympathetic blocks, suggesting that vasoconstriction decreased peripheral-to-core heat transfer after general anesthesia.
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Murad khudadad, Amir, and Bwar Ali Hussein. "COMPARISON BETWEEN UNILATERAL SPINAL ANESTHESIA AND CONVENTIONAL SPINAL ANESTHESIA IN ORTHOPEDIC LOWER LIMB OPERATION FOR HEMODYNAMIC STABILITY." Journal of Sulaimani Medical College 10, no. 1 (March 21, 2020): 81–87. http://dx.doi.org/10.17656/jsmc.10243.
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Krusic, Slavica, Branka Nikolic, and Rastko Maglic. "Combined spinal-epidural anesthesia in a patient with spinal muscular atrophy type II undergoing cesarean section: A case report." Vojnosanitetski pregled 77, no. 4 (2020): 431–34. http://dx.doi.org/10.2298/vsp180224074k.
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Introduction. Anesthetic management of a patient with spinal muscular atrophy type II, who underwent elective cesarean section with neuraxial anesthesia is presented in this case report. Case report. A 33-year old woman with first pregnancy and no previous birth, at 39 weeks gestational age was scheduled for a cesarean section due to placenta previa. She had a history of spinal muscular atrophy type II, that confined her to a wheelchair, and a surgical history that included corrective surgery for kyphoscoliosis. The patient had predictors for a difficult intubation (limited mouth opening and reduced neck extension) so the decision was made to attempt the needle-through-needle combined spinal-epidural technique for surgical anesthesia. Harrington rods and scar tissue complicated placement of the combined spinal-epidural anesthesia, however successful placement was achieved. Conclusion. Spinal muscular atrophy in pregnancy is rare and represents big challenge for an anesthesiologist due to respiratory dysfunction, anticipated difficult intubation, severe kyphoscoliosis and limitations of the use neuromuscular blocking agents. The potential risks need to be considered when administering anesthesia in patients with spinal muscular atrophy undergoing a cesarean section.
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Frölich, Michael A. "Role of the Atrial Natriuretic Factor in Obstetric Spinal Hypotension." Anesthesiology 95, no. 2 (August 1, 2001): 371–76. http://dx.doi.org/10.1097/00000542-200108000-00018.
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Background In recent years, the concept of prophylactic volume expansion to prevent hypotension caused by spinal anesthesia has been challenged. Investigators have reevaluated the concept of prehydration in the obstetric patient and the physiologic mechanisms involved. This article addresses whether the hypotensive effects attributed to the atrial natriuretic factor are the reason for the apparent failure of prehydration. Methods Atrial natriuretic factor was measured before (baseline) and 10 min after spinal anesthetic drug injection (control) in 48 healthy pregnant patients scheduled for elective cesarean section. Sixteen patients received hydration with 15 ml/kg crystalloid immediately before spinal anesthesia, 16 patients received the same volume starting with the spinal anesthetic injection, and the remaining 16 patients received no prehydration (control). Blood pressure, heart rate, ephedrine requirements, infused fluids, and urine output were measured. Results Atrial natriuretic factor concentrations increased significantly in prehydrated patients but not in the control group. There was a significant correlation in the change in atrial natriuretic factor concentrations and urine output but no correlation in the control atrial natriuretic factor concentrations and blood pressure or ephedrine requirements. Ephedrine requirements and blood pressure did not differ significantly among study groups. Conclusions Atrial natriuretic factor is a potent endogenous diuretic in the pregnant patient but does not appear to be involved in short-term cardiovascular homeostasis after spinal anesthesia. Prehydration appears to be an ineffective measure to prevent post spinal hypotension in the obstetric patient [corrected].
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Ovechkin, Alexei M., M. E. Politov, N. V. Panov, and S. V. Sokologorsky. "Anaesthetic care of patients undergoing primary hip and knee arthroplasty: evolution of views." Regional Anesthesia and Acute Pain Management 14, no. 2 (December 22, 2020): 53–62. http://dx.doi.org/10.17816/1993-6508-2020-14-2-53-62.
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Operations of total hip arthroplasty (THA) and knee joints (TKA) are among the most frequently performed surgical interventions. At the same time, there is still no consensus regarding the choice of the optimal method of anesthesia for these operations. The review analyzes the approaches to the anesthetic provision of THA and TKA in different countries and different clinics of the same country. The tendencies of a gradual increase in the share of neuraxial anesthesia techniques in the structure of anesthesia for THA and TKA are presented. Based on a number of large population studies, an analysis of the effect of the anesthesia method on the early postoperative period and the results of surgical treatment in general is given. The positive role of epidural and spinal anesthesia, in comparison with general anesthesia, in the complex of anesthetic management of operations on the joints of the lower extremities has been shown.
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Greimel, Felix, Günther Maderbach, Clemens Baier, Armin Keshmiri, Timo Schwarz, Florian Zeman, Winfried Meissner, Joachim Grifka, and Achim Benditz. "General, regional and combination anesthesia in knee arthroplasty: A multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management." Orthopaedic Journal of Sports Medicine 7, no. 6_suppl4 (June 1, 2019): 2325967119S0024. http://dx.doi.org/10.1177/2325967119s00242.
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Aims and Objectives: In recent years, a steadily increasing number of total knee arthroplasty implants have been reported. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. Various anesthesia procedures for the surgical procedure itself as well as pain management programs have been developed. One of the main goals is to reduce postoperative pain and enable better and faster mobilization in the postoperative period. The present study aims to compare the use of general and regional anesthesia and their combination in terms of perioperative pain management and patient satisfaction. Materials and Methods: In the present cohort study, 15.326 patients were examined in 46 orthopedic departments after knee replacement surgery from 2009-2015. The parameters were analyzed on the first postoperative day as part of the project “QUIPS - Quality Improvement in Postoperative Pain Management”, an initiative to compare the outcome parameters in participating hospitals. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction) on a NRS scale. Pain medication necessity was analyzed using the WHO pain ladder classification. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia. Results: Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p0.001). Conclusion: The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.
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Ukolov, K. Yu, V. L. Ayzenberg, M. V. Kapirina, and M. E. Mikitina. "Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 27, no. 1 (April 1, 2020): 31–35. http://dx.doi.org/10.17816/vto202027131-35.
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Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic.
Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement.
Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups.
Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups.
Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.
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Subedi, Asish, and Balkrishna Bhattarai. "Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?" Case Reports in Anesthesiology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/761527.
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As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.25% bupivacaine (30 mL) was administered 30 min prior to spinal block. Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively.
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Martinez-Bourio, Rafael, Mikel Arzuaga, Jose M. Quintana, Luciano Aguilera, Javier Aguirre, Jose L. Saez-Eguilaz, and Anton Arizaga. "Incidence of Transient Neurologic Symptoms after Hyperbaric Subarachnoid Anesthesia with 5% Lidocaine and 5% Prilocaine." Anesthesiology 88, no. 3 (March 1, 1998): 624–28. http://dx.doi.org/10.1097/00000542-199803000-00011.
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Background Hyperbaric 5% lidocaine has been associated with transient neurologic symptoms (TNSs) after spinal anesthesia. A prospective, masked, randomized study was conducted to compare the incidence of TNSs after spinal anesthesia with hyperbaric 5% lidocaine or 5% prilocaine to assess the utility of prilocaine as an alternative to lidocaine in patients having short surgical procedures. Methods The number of patients to be enrolled (100 per group) was determined by power analysis (80%, P = 0.05) considering an incidence of TNSs after spinal anesthesia with lidocaine of at least 11% according to data reported in other studies. Two hundred patients scheduled for elective surgery expected to last <60 min were allocated at random to receive spinal anesthesia with hyperbaric 5% lidocaine or hyperbaric 5% prilocaine. Three to 5 days after spinal anesthesia, all patients were interviewed by an anesthesiologist who was blinded to the group assignment and details of the anesthetic and surgical technique using a standardized symptom checklist. Patients with symptoms underwent neurologic examination. Results Both groups were comparable with regard to demographic data and details of the surgical and anesthetic procedures. The incidence of TNSs in both groups was low and differences were not found (4% in the lidocaine group and 1% in the prilocaine group). The mean age of patients with TNSs (58 yr) was higher than that of patients without TNSs (48 yr; P < 0.05). No relation with any of the other variables was found. Conclusions The low incidence of TNSs among lidocaine-anesthetized patients (4%) may account for the lack of significant differences between hyperbaric 5% lidocaine and 5% prilocaine and to the insufficient power of the study to exclude the possibility of a type II error.
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Filimonov, Roman V., Inna V. Filimonova, Serghey D. Shapoval, and Yury Yu Kobeliatskyi. "COMPARATIVE ANALYSIS OF THE METHODS OF ANESTHETIC MAINTENANCE IN PATIENTS WITH DIABETES WITH THE SYNDROME OF DIABETIC FOOT REQUIRING OPERATIVE INTERVENTION." Wiadomości Lekarskie 72, no. 4 (2019): 558–61. http://dx.doi.org/10.36740/wlek201904110.
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Introduction: In the present article we draw a comparison between such types of regional anesthesia (RA) as unilateral spinal anesthesia (USA), traditional spinal anesthesia (SA) and block anesthesia of peripheral nerve trunk (block anesthesia of sciatic nerve (BASN) on the side of operative intervention) during surgical treatment of patients with the syndrome of diabetic foot. The aim of the article is to compare effectiveness, reliability and safety of such methods of RA as unilateral and traditional spinal anesthesia, as well as block anesthesia of sciatic nerve on the side of operative intervention. Materials and methods: 96 patients with the syndrome of diabetic foot, who received treatment in the department of purulent surgery, were examined. All patients underwent operative interventions of varying degrees of complexity depending on the nature and seriousness of damage degree of extremities, in terms of RA types under investigation. Effectiveness of regional block anesthesia, the time when anesthesia takes effect, duration and deepness were evaluated. Results: It should be noted that USA, as a variant of pain management during operations of foot, provides the most adequate level of surgical pain management in comparison with the other types of anesthesia. During block anesthesia of sciatic nerve more than half of patients are not provided with 100% surgical analgesia, which can lead to additional medicamentous analgosedation. According to the results obtained, pain sensitivity in patients after BASN is reliably higher than in patients after USA and SA in all stages of the study. Conclusions: RA is the main method of choice during operations on foot in comparison with the methods of general anesthesia. Unilateral spinal anesthesia is carried out with the use of smaller amount of anesthetic than traditional spinal anesthesia and block anesthesia of peripheral nerve trunk, which significantly reduces sympathectomy area and leads to the stable hemodynamic during the peri-operative period.
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Kehlet, Henrik, and Eske Kvanner Aasvang. "Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?" F1000Research 4 (December 15, 2015): 1449. http://dx.doi.org/10.12688/f1000research.7100.1.
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Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled trials comparing modern general anesthesia and spinal anesthesia for knee and hip arthroplasty prevents final recommendations and calls for prospective detailed studies in this clinically important field.
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Ariyo, Promise, Miguel Trelles, Rahmatullah Helmand, Yama Amir, Ghulam Haidar Hassani, Julien Mftavyanka, Zenon Nzeyimana, et al. "Providing Anesthesia Care in Resource-limited Settings." Anesthesiology 124, no. 3 (March 1, 2016): 561–69. http://dx.doi.org/10.1097/aln.0000000000000985.
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Abstract Background Anesthesia is integral to improving surgical care in low-resource settings. Anesthesia providers who work in these areas should be familiar with the particularities associated with providing care in these settings, including the types and outcomes of commonly performed anesthetic procedures. Methods The authors conducted a retrospective analysis of anesthetic procedures performed at Médecins Sans Frontières facilities from July 2008 to June 2014. The authors collected data on patient demographics, procedural characteristics, and patient outcome. The factors associated with perioperative mortality were analyzed. Results Over the 6-yr period, 75,536 anesthetics were provided to adult patients. The most common anesthesia techniques were spinal anesthesia (45.56%) and general anesthesia without intubation (33.85%). Overall perioperative mortality was 0.25%. Emergent procedures (0.41%; adjusted odds ratio [AOR], 15.86; 95% CI, 2.14 to 115.58), specialized surgeries (2.74%; AOR, 3.82; 95% CI, 1.27 to 11.47), and surgical duration more than 6 h (9.76%; AOR, 4.02; 95% CI, 1.09 to 14.88) were associated with higher odds of mortality than elective surgeries, minor surgeries, and surgical duration less than 1 h, respectively. Compared with general anesthesia with intubation, spinal anesthesia, regional anesthesia, and general anesthesia without intubation were associated with lower perioperative mortality rates of 0.04% (AOR, 0.10; 95% CI, 0.05 to 0.18), 0.06% (AOR, 0.26; 95% CI, 0.08 to 0.92), and 0.14% (AOR, 0.29; 95% CI, 0.18 to 0.45), respectively. Conclusions A wide range of anesthetics can be carried out safely in resource-limited settings. Providers need to be aware of the potential risks and the outcomes associated with anesthesia administration in these settings.