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Sample records for anesthesia epidural

  1. Spinal and epidural anesthesia

    Science.gov (United States)

    ... you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the ... Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  2. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  3. [Horner syndrome following combined spinal-epidural anesthesia].

    Science.gov (United States)

    Karaca, Ömer; Kumaş Solak, Sezen; Demirgan, Serdar; Bademci, Mehmet

    2016-07-01

    Horner syndrome is rarely observed in connection with epidural anesthesia. It is characterized by ptosis, enophthalmos, miosis, anisocoria, and conjunctival hyperemia in the affected eye, as well as anhydrosis and flushing on the affected side of the face. It is usually a complication spontaneously resolved without permanent neurological deficits. Intraoral anesthesia; stellate ganglion, cervical or brachial plexus blocks; thoracic, lumbar or caudal epidural anesthesia, and intrapleural analgesia are the main causes for Horner syndrome related to anesthesia. Among other causes of Horner syndrome are head and neck surgery, trauma, and puncture of internal jugular vein. The present case of unilateral Horner syndrome appeared in the aortobifemoral bypass after lumbar spinal- epidural anesthesia.

  4. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer;

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase wh...

  5. Central temperature changes are poorly perceived during epidural anesthesia.

    Science.gov (United States)

    Glosten, B; Sessler, D I; Faure, E A; Karl, L; Thisted, R A

    1992-07-01

    Hypothermia and shivering are common during epidural anesthesia for cesarean delivery but are not always accompanied by a sensation of coldness. To test the hypothesis that central temperature changes are not perceived during epidural anesthesia, we measured central and skin temperatures and thermal perception in 30 patients undergoing cesarean delivery with epidural anesthesia. Central temperature decreased 1.0 +/- 0.6 degrees C from control values during anesthesia and surgery, but thermal perception scores did not reflect central temperatures (P = 0.56) or changes in central temperature (P = 0.63). A feeling of warmth was significantly correlated with increased mean skin temperature (P = 0.02) and increased upper body skin temperature (P = 0.03). We conclude that central temperature is poorly perceived and is less important than skin temperature in determining thermal perception during high levels of epidural anesthesia.

  6. CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA

    Institute of Scientific and Technical Information of China (English)

    Jian-qing Xu; Bo Zhu; Tie-hu Ye

    2005-01-01

    @@ SINCE the report that ropivacaine hydrochloride, a new amide local anesthetic, is of lower cardiac toxicity both in animals and humans,1 several studies have shown it to be a clinically effective local anesthetic widely used for both epidural anesthesia2-4 and analgesia5-7. Ropivacaine mesylate made in China is structurally from ropivacaine hydrochloride by substituting a mesylate group for hydrochloride group.8 This study was designed to clinically provide a double-blind comparison of ropivacaine mesylate with ropivacaine hydrochloride in epidural anesthesia and analgesia.

  7. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  8. Laparoscopic hernioplasty with epidural anesthesia; a report of 20 patients

    Directory of Open Access Journals (Sweden)

    Talebpour M

    2007-06-01

    Full Text Available Background: The incidence of inguinal hernia is 15 cases per 1,000 populations. The most common surgical methods of hernia repair are conventional open hernioplasty and laparoscopic hernioplasty. The advantages of laparoscopic hernioplasty are that the regional anatomy is observable, and bilateral herniorrhaphy can be performed at the same time. Since laparoscopic hernia is usually performed under general anesthesia, to shorten the length of hospital stay and to prevent complications, in this study, we evaluated the use of epidural anesthesia during hernioplasty. Methods: This study included 20 male patients treated by a single surgeon. We recorded the PCO2 levels before, during and after surgery, as well as the pain and intra-abdominal pressure. Results: Only one patient required conversion to general anesthesia. Three patients had hernia on the left side only, 14 patients on the right only and three patients had bilateral hernia. The PCO2 levels did not change (P=0.789. Fifty percent of patients had no postoperative pain. The median time to return to work or normal physical activity was 7 days. Conclusion: Laparoscopic inguinal herniorrhaphy is a feasible alternative to open surgical hernia repair. Employing epidural anesthesia prevents the complications of general anesthesia. This method achieves a shorter hospital stay and time to return to normal activity, as well as reduction in pain. Controlled trials comparing laparoscopic and tension-free open herniorrhaphy are needed to further assess the relative benefits of this procedure.

  9. Combined spinal–epidural anesthesia for an elderly patient with proportionate dwarfism for laparotomy

    Directory of Open Access Journals (Sweden)

    Teena Bansal

    2016-01-01

    Full Text Available Anesthesia in a dwarf patient may be challenging as various anatomical anomalies make both general and regional anesthesia difficult. These patients may have atlantoaxial instability, potential for airway obstruction, and associated respiratory problems that may pose problems for general anesthesia. Spinal stenosis, osteophytes, short pedicles, or a small epidural space could complicate regional anesthesia in dwarfs which could lead to difficulties in locating the epidural space and increase the risk of dural puncture. Spinal stenosis may impair cerebrospinal fluid flow such that identification of dural puncture is difficult. This elderly dwarf patient had history of bronchial asthma with restriction of neck extension, managed successfully using combined spinal–epidural anesthesia.

  10. [Epidural anesthesia and analgesia in the perioperative treatment of a patient with Kartagener syndrome].

    Science.gov (United States)

    Errando, C L; Sifre, C; López-Alarcón, D

    1998-12-01

    Kartagener's syndrome is an inherited disease characterized by a triad of symptoms--bronchiectasis, situs inversus and sinusitis--and is classified as an immotile cilia syndrome. Patients may experience specific airway problems when undergoing anesthesia for surgical procedures. We report the case of a woman with Kartagener's syndrome who underwent surgery under epidural anesthesia with postoperative epidural analgesia, both techniques proving successful.

  11. Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Venetiana Panaretou

    2012-01-01

    Full Text Available Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16 and the control group (Group B, n=14. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO 2 levels and the calculation of regional-arterial CO 2 difference (ΔPCO 2 . Additional measurements included mean arterial pressure (MAP, cardiac output (CO, systemic vascular resistance (SVR, and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO 2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

  12. Combined general–epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Science.gov (United States)

    Panaretou, Venetiana; Siafaka, Ioanna; Theodorou, Dimitrios; Manouras, Andreas; Seretis, Charalampos; Gourgiotis, Stavros; Katsaragakis, Stylianos; Sigala, Fragiska; Zografos, George; Filis, Konstantinos

    2012-01-01

    Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results. PMID:23493852

  13. Epidural anesthesia in repeated cesarean section. Anestesia epidural en la cesárea iterativa.

    Directory of Open Access Journals (Sweden)

    Norma Mur Villar

    2003-05-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

    Fundamento: La anestesiología ha experimentado durante los últimos años un desarrollo espectacular en las diferentes áreas de su competencia, entre las que se encuentra sin lugar a dudas, la que centra su actividad asistencial en la paciente obstétrica y todo lo relacionado con su práctica adecuada en estas. Objetivo: Evaluar la eficacia de la anestesia epidural en la cesárea iterativa. Métodos: Estudio descriptivo retrospectivo de una serie de casos (112 en que fue

  14. Effects of thoracic epidural anesthesia on pulmonary venous admixture and oxygenation with isoflurane or propofol anesthesia during one lung ventilation

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    Reda S. Abdelrahman

    2012-10-01

    Conclusions: The administration of thoracic epidural anesthesia, either combined with propofol or isoflurane, was not associated with a relevant impairment of oxygenation during OLV. Therefore Pre-emptive analgesia via an epidural thoracic catheter can be used safely as a standard in lung surgery, decreasing the anesthesia requirements when combined with GA, maximizing the benefits of each form of anesthesia and improving the outcome in patients with cardiopulmonary diseases, hence it was found that it has no effect on oxygenation during OLV, and it is associated with stable hemodynamics.

  15. EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS

    Institute of Scientific and Technical Information of China (English)

    Li Changgen; Peng Xiaoyun; Xu Mingyu; Wang Zhongcheng

    2001-01-01

    Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods:33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n = 11), acupoint-skin electrical stimulation combined with epidural anesthesia (B) group (n= 11 ) and simple epidural anesthesia (C) group (n= 11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2~3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before,NE of group A and B lowered in comparison with pre-operation, particularly group A (P <0.01), while in group C,plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre-operation (P levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint-skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effec t has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. C_onclusion:Acupuncture or acupoint-surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.

  16. Evaluation of caudal epidural anesthesia efficacy by measurement of feet skin temperature in children

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    M. Yu. Kurochkin

    2015-04-01

    Full Text Available Caudal epidural anesthesia in children is not performed in pure form, but only in combination with superficial general anesthesia. Therefore, a search for reliable evaluation criteria of the caudal epidural block onset in children remains actual. Aim. To evaluate effectiveness of caudal epidural anesthesia efficacy by measurement of feet skin temperature in children. Methods and results. We investigated feet skin temperature before the caudal blockade by bupivacaine and after 15–20 minutes in 30 children. The control group included 20 children who underwent total intravenous anesthesia. The study showed that feet skin temperature after caudal blockade significantly increased from 30,1±0,15°C to 33,0±0,1°C (10% and in the control group it did not change significantly. Conclusion. Thus, feet skin thermometry may be considered to be a reliable non-invasive method for assessing the onset of the caudal block.

  17. SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY

    Institute of Scientific and Technical Information of China (English)

    秦必光; 刘颖涛; 李长根; 任亚川; 张兰英; 艾中立; 彭小云; 白占勇

    2001-01-01

    Objective: To study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of smadose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n=66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4~11. Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C ( P < 0. 001 ). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3.75 % higher than group A and B respectively ( P < 0. 001 ), suggesting that acupuncture or acu-point-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.

  18. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    OpenAIRE

    Ditza de Vilhena; Luís Pereira; Delfim Duarte; Nuno Oliveira

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing lo...

  19. Hematoma epidural secundario a anestesia espinal: Tratamiento conservador Epidural hematoma secondary to spinal anesthesia: Conservative treatment

    Directory of Open Access Journals (Sweden)

    M. Bermejo

    2004-11-01

    , cirugía vertebral previa, hepatopatías, fármacos, etc. El tratamiento quirúrgico en forma de laminectomía descompresiva realizada de forma precoz suele ser necesario y es el tratamiento de elección en muchas ocasiones, pero en determinadas condiciones como la que nos ocupa, sin síntomas compresivos, sin un carácter progresivo o bien que estos disminuyan rápidamente, puede optarse por un tratamiento conservador en forma de analgesia y corticoterapia, siempre bajo un estricto control que permita actuar de forma rápida ante cualquier eventualidad negativa en su evolución.Introduction: Epidural hematoma secondary to neuroaxial anesthesia is a rare complication, but highly relevant due to its clinical and medico-legal implications. According to some authors, its incidence can reach 1/190,000-1/200,000 for peridural punctures and 1/320,000 for spinal punctures. Early diagnosis and treatment within the first 6-12 hours is the main aspect related to its therapeutic management. However, in some cases such as the one reported here, surgery is not required and the patient can be managed with a conservative treatment. Clinical case: A 73-year-old patient, ASA IV, with a history of cirrhosis associated to portal hypertension, hypersplenism, COPD, obesity, hypertensive cardiopathy and tricuspid failure. He was scheduled for prostate alcoholization after ruling out surgery. Preoperative blood analyses showed a prothrombin activity of 80% and 90,000 platelets. Several failed attempts of spinal puncture were done, but general anesthesia was finally required with spontaneous ventilation through laryngeal mudpack, propofol, fentanyl and sevoflurane. Clinical manifestations appeared after 36 hours, with non-irradiated severe lumbar pain and plantar cutaneous areflexia. The presence of epidural hematoma at the L1-L4 level was confirmed through NMR. Given the absence of flaccid paraparesis, sphincter involvement or other sensitive-motor signs and after consultation with the Rachis

  20. Paraplegia after thoracotomy under combined general and epidural anesthesia in a child.

    NARCIS (Netherlands)

    Allison, C.E.; Aronson, D.C.; Geukers, V.G.; Berg, R. van den; Schlack, W.S.; Hollmann, M.W.

    2008-01-01

    A 9-year-old boy underwent a thoracotomy for excision of his right third rib under combined general and epidural anesthesia for a Ewings sarcoma. Postoperatively, he was found to have a complete T2-3 paraplegia. Permanent paraplegia was described as a rare complication of thoracotomy in adults, and

  1. Transient Coma Due To Epidural Anesthesia: The Role of Loss of Sensory Input.

    LENUS (Irish Health Repository)

    Dardis, Christopher

    2015-12-21

    Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1-0.3%.

  2. [Combined epidural and spinal anesthesia for cesarean section].

    Science.gov (United States)

    Hody, J L

    1994-01-01

    Combined spinal epidural block has proven its efficacy in skilled hands. This technique allies advantages of spinal anaesthesia, regarding its speed of action and intensity of motor blockade and advantages of postoperative epidural analgesia. This block must be performed with great care and method to reach a success rate of almost 100%. Local anaesthetics and additives are reviewed and commented. The two main complications, hypotension and post dural puncture headache can be contained in very low limits.

  3. Thoracic epidural anesthesia attenuates hemorrhagic-induced splanchnic hypo-perfusion in post-resuscitation experimental hemorrhagic shock

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    Amir S Madjid

    2008-06-01

    Full Text Available The purpose of present study was to assess the effects of thoracic epidural anesthesia on splanchnic perfusion, bacterial translocation and histopathologic changes in experimental hemorrhagic shock in short-tailed macaques (Macaca nemestrina. Sixteen Macaca nemestrinas were randomly assigned to one of two groups i.e. the lidocaine group (n = 8, receiving general anesthesia plus lidocaine thoracic epidural anesthesia; and the saline group (n = 8, receiving general anesthesia alone as control. Hemorrhagic shock was induced by withdrawing blood gradually to a mean arterial pressure (MAP of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated with their own blood and ringer lactate solution (RL. After resuscitation, epidural lidocaine 2% was given in the lidocaine group and saline in the control group. Resuscitation that was performed after one hour hemorrhagic shock, with hemodynamic variables and urine output returned to normal, revealed there was no improvement of splanchnic perfusion. PgCO2, P(g-aCO2, and pHi remained in critical value and tended to deteriorate in the saline group. Contrast to saline group, splanchnic perfusion in lidocaine group tended to improve. This condition was supported by the finding of less bacterial translocation and better histopathologic changes in lidocaine thoracic epidural anesthesia group than in saline group. This study concludes that lidocaine thoracic epidural anesthesia attenuates splachnic hypoperfusion in post-resuscitation hemorrhagic shock in Macaca nemestrina. (Med J Indones 2008; 17: 73-81Keywords: thoracic epidural anesthesia, lidocaine, hemorrhagic shock, splanchnic hypoperfusion, bacterial translocation

  4. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  5. Awake transapical aortic valve implantation using thoracic epidural anesthesia.

    Science.gov (United States)

    Mukherjee, Chirojit; Walther, Thomas; Borger, Michael Andrew; Kempfert, Joerg; Schuler, Gerhard; Mohr, Friedrich Wilhelm; Ender, Joerg

    2009-09-01

    Transapical aortic valve implantation is a minimally invasive, beating-heart procedure that normally requires a general anesthetic. We herein report an 85-year-old patient with impaired pulmonary function who underwent successful transapical aortic valve implantation while awake, using a thoracic epidural anesthetic.

  6. One-week postoperative patency of lower extremity in situ bypass graft comparing epidural and general anesthesia

    DEFF Research Database (Denmark)

    Wiis, Julie Therese; Jensen-Gadegaard, Peter; Altintas, Ümit

    2014-01-01

    BACKGROUND: The purpose of this study was to determine whether anesthesia affects graft patency after lower extremity arterial in situ bypass surgery. METHODS: This investigation was a retrospective study using a national database on vascular surgical patients at a single medical institution. We...... under epidural (n = 386) or general (n = 499) anesthesia. Thirty-day mortality (3.4% for epidural anesthesia versus 4.4% general anesthesia; P = 0.414) and comorbidity were comparable in the 2 groups. Graft occlusion within 7 days after surgery was reported in 93 patients, with a similar incidence...... in the epidural (10.1%) and general (10.8%) anesthesia groups (P = 0.730). When examining a subgroup of patients (n = 242) exposed to surgery on smaller vessels (femorodistal in situ bypass procedures, n = 253), the incidence of graft occlusion was also similar in the 2 groups at 14.0% and 9.4%, respectively (P...

  7. Epidural Anesthesia: New Computer Technology Used to Enhance the Teaching of a Common Anesthetic Procedure

    Science.gov (United States)

    1997-10-01

    Netter ( Netter , 1989) are still in use today. Other methods of teaching include the use of models. Though some are made from real bone, most are plastic...contains information about the history of regional anesthesia that is brief and 26 accurate, sections on physiology and pharmacology, epidural and spinal...CA. National Library of Medicine (1990). Visible human project. Bethesda, Maryland. Netter , F. H. (1989). Atlas of Human Anatomy. Ciba-Geigy Corp

  8. [Temperature changes and thermoregulatory responses during epidural anesthesia in women undergoing cesarean delivery].

    Science.gov (United States)

    Negishi, C; Ozaki, M; Suzuki, H; Ohno, T

    1996-05-01

    Eleven healthy pregnant women were studied to determine temperature changes after induction of epidural anesthesia during cesarean delivery. Epidural anesthesia was induced by 2% lidocaine 15-20 ml (T 5 level) at 25 degrees C ambient temperature. Tympanic membrane and skin surface temperature, skin-temperature gradients (forearm-fingerchip, calf-toe), thermal perception (1-10 scale VAS) and the presence or absence of shivering were measured. Sixty minutes after induction, tympanic temperature decreased for 0.52 +/- 0.26 degrees C and average skin temperature increased for 0.56 +/- 0.17 degrees C. Central hypothermia and shivering did not produce a cold sensation. Temperature gradients of upper limb increased to 2.0 +/- 3.7 degrees C (50 minutes after induction) and the lower limbs decreased to -1.4 +/- 0.55 degrees C (30 minutes after induction). Shivering occurred in 3 patients. We conclude that epidural anesthesia impaired thermoregulatory control and induced redistribution hypothermia as in nonpregnant individuals.

  9. Evaluation of prostaglandin D2 as a CSF leak marker: implications in safe epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Kondabolu S

    2011-07-01

    Full Text Available Sirish Kondabolu, Rishimani Adsumelli, Joy Schabel, Peter Glass, Srinivas PentyalaDepartment of Anesthesiology, School of Medicine, Stony Brook Medical Center, Stony Brook, New York, USABackground: It is accepted that there is a severe risk of dural puncture in epidural anesthesia. Of major concern to anesthesiologists is unintentional spinal block. Reliable identification of cerebrospinal fluid (CSF from the aspirate is crucial for safe epidural anesthesia. The aim of this study was to determine whether prostaglandin D2 could be clinically used as a marker for the detection of CSF traces.Methods: After obtaining Institutional Review Board approval and patient consent, CSF was obtained from patients undergoing spinal anesthesia, and blood, urine, and saliva were obtained from normal subjects and analyzed for prostaglandin D2 (PGD. CSF (n=5 samples were diluted with local anesthetic (bupivacaine, normal saline and blood in the ratios of 1:5 and 1:10. PGD levels in the CSF samples were analyzed with a PGD-Methoxime (MOX EIA Kit (Cayman Chemicals, MI. This assay is based on the conversion of PGD to a stable derivative, which is analyzed with antiserum specific for PGD-MOX. Results: Different concentrations of pure PGD-MOX conjugate were analyzed by EIA and a standard curve was derived. PGD levels in CSF and CSF with diluents were determined and the values were extrapolated onto the standard curve. Our results show a well-defined correlation for the presence of PGD both in straight CSF samples and in diluted CSF (dilution factor of 1:5 and 1:10. Conclusion: Prostaglandin D2 was reliably identified in CSF by enzyme-linked immunosorbent assay when diluted with local anesthetic, saline, and serum, and can be used as a marker to identify the presence of CSF in epidural aspirates.Keywords: epidural, cerebrospinal fluid, leak, marker, prostaglandin D2

  10. Effect of epidural anesthesia using ropivacaine combined with remifentanil on delivery

    Institute of Scientific and Technical Information of China (English)

    Wen Cheng

    2016-01-01

    Objective:Tostudy the ropivacaine combined with remifentanil on analgesic effect and safety of painless labor requirements of maternal epidural anesthesia.Methods:Hospital obstetrics and gynecology scheduled for painless delivery of maternal were selected. 80 cases (analgesic group, the use of ropivacaine epidural analgesia with remifentanil), did not use any analgesia 80 cases of childbirth women as controls group, two groups of mothers underwent index difference childbirth pain were observed during childbirth, birth outcomes and other health care workers with the help of the same group under midwifery.Results:VAS score between T0 time analgesia group and the control group was not statistically significant; in the analgesic, T4, T5, T6 moments analgesia group VAS scores were significantly lower than T1, T2, T3 in the control group. Significantly lower than the control group the first stage of labor analgesia group, significantly longer than the second stage of labor analgesia group control group, two groups of maternal third stage of labor was no significant difference. Mode of delivery between the two groups, birth weight, the first and second 1 min, 5 min Apgar scores were not significantly different.Conclusion: Ropivacaine remifentanil requirements for painless childbirth maternal epidural anesthesia can significantly reduce maternal childbirth pain without causing adverse effects on childbirth and newborns.

  11. Combined spinal epidural anesthesia for cesarean section in a patient with left lung agenesis.

    Science.gov (United States)

    Babita, G; Rashmi, M; Deb, K

    2001-04-01

    Agenesis of the lung is a rare developmental defect characterized by complete absence of one lung, or hypoplasia of one or both lungs. The majority of reported cases have been associated with other congenital anomalies. It is usually detected in childhood as a result of either pulmonary symptoms or associated anomalies. Although pulmonary agenesis has been reported in adults, there is no report of the management of a pregnant patient for cesarean section in the anesthetic literature. We report the management of a 23-year-old pregnant female at 36 weeks' gestation with oligohydramnios and left lung agenesis for elective cesarean section. She presented with a history of repeated chest infection and was found to have restrictive lung function. She had no other congenital anomalies. Combined spinal epidural anesthesia was administered for cesarean section. The intraoperative course was uneventful except for bradyarrhythmias followed by tachyarrhythmias on manipulation of the uterus. She was given low dose epidural morphine with local anesthetic and intramuscular diclofenac for postoperative analgesia. We believe that normal pregnancy can safely be undertaken in the presence of left lung agenesis. In view of associated congenital anomalies in more than 50% of the cases, anesthetic management should include a particularly careful survey of other systems. The patient should otherwise be managed like any patient with limited pulmonary reserve. Combined spinal epidural anesthesia is safe and appropriate for such patients.

  12. 硬膜外麻醉和腰硬联合麻醉用于剖官产手术效果的比较%Comparison of Effect Between Spinal-epidural Anesthesia and Epidural Anesthesia in Caesarean Section

    Institute of Scientific and Technical Information of China (English)

    韩雪初

    2015-01-01

    Objective To compare the effects between spinal-epidural anesthesia and epidural anesthesia in caesarean section so as to provide reference for clinical procedures. Methods 160 pregnant woman who underwent caesarean section in our hospital during July 2012 and November 2014 were divided into group A (n=80) in which epidural anesthesia was performed, and group B (n=80) in which spinal-epidural anesthesia was conducted. The anesthetic effects of were compared between the two groups. Re-sults The excellent and good rate was higher, 100%vs 85.0%, in the group A than in the group B with statistically significant dif-ference, P0.05. Onset time of anesthesia was shorter in the group B than in the group A,P0.05,乙组患者麻醉起效时间明显短于甲组,P<0.05。结论在剖宫产手术中采用腰硬联合麻醉操作方便,成功率高,具有使用价值。

  13. Sevoflurane and thoracic epidural anesthesia for trans-sternal thymectomy in a child with juvenile myasthenia gravis

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    Valluvan Rangasamy

    2014-01-01

    Full Text Available Literature on anesthetic management of juvenile myasthenia gravis (JMG for thymectomy is limited. Recently, use of inhalational agents and total intravenous anesthesia with propofol and remifentanyl has been reported. All these techniques individually or in combination have been tried to avoid the use of muscle relaxant. We report successful use of sevoflurane as sole anesthetic agent for intubation and in combination with thoracic epidural anesthesia for intraoperative anesthetic management in a 5-year-old child with JMG.

  14. Combined spinal epidural anesthesia for laparoscopic appendectomy in adults: A case series

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    Rajesh S Mane

    2012-01-01

    Full Text Available Background: Laparoscopy is one of the most common surgical procedures and is the procedure of choice for most of the elective abdominal surgeries performed preferably under endotracheal general anesthesia. Technical advances in the field of laparoscopy have helped to reduce surgical trauma and discomfort, reduce anesthetic requirement resulting in shortened hospital stay. Recently, regional anaesthetic techniques have been found beneficial, especially in patients at a high risk to receive general anesthesia. Herewith we present a case series of laparoscopic appendectomy in eight American Society of Anaesthesiologists (ASA I and II patients performed under spinal-epidural anaesthesia. Methods: Eight ASA Grade I and II adult patients undergoing elective Laparoscopic appendectomy received Combined Spinal Epidural Anaesthesia. Spinal Anaesthesia was performed at L 2 -L 3 interspace using 2 ml of 0.5% (10 mg hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms of Fentanyl. Epidural catheter was inserted at T 10 -T 11 interspace for inadequate spinal anaesthesia and postoperative pain relief. Perioperative events and operative difficulty were studied. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension. Results: Spinal anaesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and received Fentanyl, one patient was given Midazolam for anxiety and two were given Ephedrine for hypotension. The postoperative period was uneventful. Conclusion: Spinal anaesthesia with Hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients but careful evaluation of the method is needed particularly in compromised cardio respiratory conditions.

  15. EPIDURAL ANESTHESIA BUPIVACAINE 0.5%+ KCL 5 MEQ/L VS BUPIVACAINE 0.5%

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    F ALAVI

    2000-03-01

    Full Text Available Background. Although epidural anesthesia is a Successful method for most surgical procedures on lower extremities and lower abdomen. It is not so favorable because of it's slow onset and differential sensory and motor block. In order to solve this problem effects of additive KCl (5 meq/L into Bupivacaine 0.5 percent according to onset, intensity, duration of block and homodynamic changes during epidural anesthesia will be investigated through the present study. Methods. All the ASA I or II patients at medical centers of Isfahan university of medical sciences throughout 1378, candidate for elective Surgical procedures on lower extremities and lower abdomen with no contraindication for epidural anesthesia were Subdivided into Case (35 patients and Control (35 patients groups in a random manner to perform a double blind clinical trial. Epidural anesthesia applied to cases (by Bupivacaine 0.5 percent+ KCl 5meq/L and controls (by Bupivacaine 0.5 percent. Under identical conditions, data indicating basic MAP, basic heart rate and their changes as well as the onset, duration and intensity of motor and sensory block, were obtained and recorded by the anesthesiologist. Quantitative & qualitative variables were examined by T.test and X2 test respectively. Findings. Sensory onset for cases (8.22±1.43Min was faster than controls (11.56±1.45Min (P<0.005. Motor onset for cases (12.77 ± 1.83Min was faster than controls (20.24±1.71Min (P < 0.005. Sensory duration for cases (l86.34±8.37 Min was longer than controls (162.17±7.47Min (P<0.005. Motor duration for cases (106.25±13.50 Min was longer than controls (77.60 ± 9.94Min (P < 0.005.Intensity of sensory block for cases was greater than controls (P < 0.01. Intensity of motor block for cases was greater than controls (P < 0.001. Mean heart rate changes for cases (7.28±9.37 percent and controls (7 ± 8 percent were not different (P < 0.8. Mean decrease in MAP for cases (20.17 ± 2.10n percent was

  16. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases

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    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.

  17. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

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    Luiz Eduardo Imbelloni

    Full Text Available CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA and combined spinal epidural anesthesia (CSE are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE. There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

  18. High Thoracic Epidural Analgesia as an Adjunct to General Anesthesia is Associated with Better Outcome in Low-to-Moderate Risk Cardiac Surgery Patients

    DEFF Research Database (Denmark)

    Stenger, Michael; Fabrin, Anja; Schmidt, Henrik;

    2013-01-01

    The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome.......The purpose of this study was to evaluate the addition of high thoracic epidural analgesia (HTEA) to general anesthesia in cardiac surgery patients to enhance the fast-track and improvement in outcome....

  19. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics].

    Science.gov (United States)

    Wiedemann, B; Leibe, S; Kätzel, R; Grube, U; Landgraf, R; Bierwolf, B

    1991-11-01

    Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

  20. Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

    Institute of Scientific and Technical Information of China (English)

    XIANG Yan; LI Yu-hong

    2007-01-01

    Objective:To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements,the time to loss of consciousness (LOC),effect-site propofol concentrations,and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied.Methods:Forty-five patients were divided into three groups to receive epidurally administered saline (Group S),1.5% (w/w) lidocaine (Group L),or 0.5% (w/w) ropivacaine (Group R).Propofol infusion was started to produce blood concentration of 4 μg/ml.Once the BIS value reached 40~50,endotracheal intubation was facilitated by 0.1 mg/kg vecuronium.Measurements included the time to LOC,effect-site propofol concentrations,total propofol dose,mean arterial blood pressure (MABP),and heart rate (HR) at different study time points.Results:During induction of anesthesia,both Groups L and R were similar for the time to LOC,effect-site propofol concentrations,total propofol dose,MABP,HR,and BIS.The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S.MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups,or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups.Conclusion:Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC,effect-site propofol concentrations,total propofol dose,and the hemodynamic variables during induction of general anesthesia.

  1. Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

    Science.gov (United States)

    Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

    2017-01-01

    Purpose Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Methods Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Results Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. Conclusion CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

  2. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    Science.gov (United States)

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved.

  3. Propofol-controlled infusion technique in assessing the safe dosage for sedation during epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    Yingmin Cai; Pengbin Liu; Jinxin Song; Rongliang Xue

    2006-01-01

    BACKGROUND:Epidural anesthesia requires a convenient and accurate method to determine the plasma concentration of the given subsidiary drug.The target-controlled infusion(TCI)technique,controlling infusion pump by computer,has been used.Intravenous jnjection of propofol was given for the purpose of measunng plasma concentrations and to observe the effects of different target concentrations on the memory,consciousness,hemodynamics and blood gases of patients,in order to find a safe dosage for sedation in epidural anesthesia.OBJECTIVE:To observe the influence of different target concentrations on the memory,consciousness,hemodynamics and blood gases of patients accepted epiduml anesthesia.DESIGN:A randomized and controlled study.SETTING:Department of Anesthesiology,the Second Affiliated Hospital,Medical College of Xi'an Jiao Tong University.PARTICIPANTS:The expenment was conducted in the Department of Anesthesiology,the Second Affiliated Hospital,Medical College of Xi'an Jiao Tong University from June 2005 to June 2006.Fifty patients underwent surgery for lower abdomen and lower limbs were selected,including 30 males and 20 females,30-60 years old with an average of(46±6)years,weighling(65.8±8.5)kg,and American Society of Anesthesiology(ASA)gradling of Ⅰ-Ⅱ.All the patients were informed and agreed with the items for detection.METHODS:All the patients were given diazepam(10 mg)and atropine(0.5 mg)intramusculady 30 minutes before surgery.They were placed supinely and given oxygen inhalation,their blood pressure,heart rate and blood oxygen saturation were determined,then an epidural puncture was made in the left lateral decubitus position with hands crossed over knees.The patients were in a horizontal position and a radial artery puncture was done,after the epidural cathetar was positioned into epidural space.Blood of radial artery was drawn to get a blood gas,a linked HP multi-functional monitor was used to monitor blood pressure(radial artery

  4. Delayed Diagnosis of Cauda Eqina Syndrome with Perineural Cyst after Combined Spinal-Epidural Anesthesia in Hemodialysis Patient

    Science.gov (United States)

    Akeda, Koji; Tsujii, Masaya; Sudo, Akihiro

    2013-01-01

    Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared. PMID:24066221

  5. [A Case of Postoperative Paraplegia Caused by Idiopathic Spinal Cord Infarction following Hepatectomy under Both General and Epidural Anesthesia].

    Science.gov (United States)

    Koga, Yukari; Hiraki, Teruyuki; Ushijima, Kazuo

    2015-04-01

    A 73-year-old woman (height : 155 cm, weight : 55 kg) was scheduled to undergo a laparotomic hepatectomy and radiofrequency ablation for hepatocellular carcinoma. Her medical history did not include any relevant conditions such as cardiovascular or neurological disorders. A thoracic epidural catheter was introduced at T8-9 before the induction of anesthesia with intravenous propofol. General anesthesia was maintained with the inhalation of oxygen, air, and desflurane, and the continuous infusion of remifentanil. Several intraoperative episodes of mild hypotension occurred, each of which was successfully treated with intravenous ephedrine, but otherwise her anesthetic course was uneventful, and she recovered from the anesthesia smoothly. Her postoperative pain was well controlled with continuous epidural infusion of levobupivacaine and fentanyl, and she could walk by herself on postoperative day (POD) 1. However, she suffered weakness in her lower extremities on POD2 and subsequently fell into complete paraplegia with sensory loss below the T4 level on POD3. A magnetic resonance imaging scan taken on POD4 showed an idiopathic spinal cord infarction (SCI) involving levels T1 through T4, although no epidural abnormalities, e.g., hematomas, were detected. Immediate treatment with methylprednisolone, ozagrel, and edaravone failed to resolve her symptoms. We suggest that it is of great importance to consider SCI as a differential diagnosis as soon as possible in cases of unanticipated postoperative paraplegia.

  6. Morphometric study of sacral hiatus in adult human Egyptian sacra: Their significance in caudal epidural anesthesia

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    Mohamed S Mustafa

    2012-01-01

    Full Text Available Background: The reliability and success of caudal epidural anesthesia depends on anatomic variations of sacral hiatus (SH as observed by various authors. SH is an important landmark during caudal epidural block (CEB.The purpose of the present study was to clarify the morphometric characteristics of the SH in human Egyptian dry sacra and pelvic radiographs and identification of nearest ony landmarks to permit correct and uncomplicated caudal epidural accesses. Methods: The present study was done on 46 human adult Egyptian dry sacra. The maximum height, midventral curved length, and maximum breadth of each sacrum were measured and sacral and curvature indices were calculated. According to sacral indices, sacra were divided into 2 groups (22 male and 24 female sacra. SH was evaluated in each sacrum according to its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior (AP diameter at its apex, and transverse width at its base. Linear distances were measured between the apex of SH and second sacral foramina, right and left superolateral sacral crests. The distance between the 2 superolateral sacral crests also was measured. Results: The most common types of SH were the inverted U and inverted V (in male and inverted V and dumbbell shaped (in female. Absent SH was observed in male group only. The most common location of SH apex was at the level of S4 in all groups of dry sacra and S3 in all groups of lumbosacral spine radiographs, whereas S5 was the common level of its base. The mean SH length, transverse width of its base, and AP diameter of its apex were 2.1±0.80, 1.7±0.26, and 0.48±0.19 cm. Female sacra showed narrower SH apex than male. The distance between the S2 foramen and the apex of the SH was 4.1±1.14, 3.67±1.21, and 4.48±1.01 cm in total, female and male sacra, respectively. Conclusion: Sacrum and SH showed morphometric variations in adult Egyptians. The equilateral triangle is an

  7. Audiovisual distraction as a useful adjunct to epidural anesthesia and sedation for prolonged lower limb microvascular orthoplastic surgery.

    Science.gov (United States)

    Athanassoglou, Vassilis; Wallis, Anna; Galitzine, Svetlana

    2015-11-01

    Lower limb orthopedic operations are frequently performed under regional anesthesia, which allows avoidance of potential side effects and complications of general anesthesia and sedation. Often though, patients feel anxious about being awake during operations. To decrease intraoperative anxiety, we use multimedia equipment consisting of a tablet device, noise-canceling headphones, and a makeshift frame, where patients can listen to music, watch movies, or occupy themselves in numerous ways. These techniques have been extensively studies in minimally invasive, short, or minor procedures but not in prolonged orthoplastic operations. We report 2 cases where audiovisual distraction was successfully applied to 9.5-hour procedures, proved to be a very useful adjunct to epidural anesthesia + sedation, and made an important contribution to positive patients' outcomes and overall patients' experience with regional anesthesia for complex limb reconstructive surgery. In the era when not only patients' safety and clinical outcomes but also patients' positive experiences are of paramount importance, audiovisual distraction may provide a simple tool to help improve experience of appropriately informed patients undergoing suitable procedures under regional anesthesia. The anesthetic technique received a very positive appraisal by both patients and encouraged us to study further the impact of modern audiovisual technology on anxiolysis for major surgery under regional anesthesia. The duration of surgery per se is not a contraindication to the use of audiovisual distraction. The absolute proviso of successful application of this technique to major surgery is effective regional anesthesia and good teamwork between the clinicians and the patients.

  8. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

  9. ANALYSIS OF MATERNAL AND FETAL OUTCOME IN SPINAL VERSUS EPIDURAL ANESTHESIA FOR CESAREAN DELIVERY IN SEVERE PRE-ECLAMPSIA

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    Jyothi

    2015-12-01

    Full Text Available AIM Our primary aim is to analyze of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia. MATERIALS AND METHODS Sixty parturients (60 with severe pre-eclampsia posted for cesarean section were randomized into two groups of thirty (30 each for either spinal anesthesia that is group S or epidural anesthesia that is group E. Spinal group (group S, n=30 received 10mg (2ml of 0.5% of hyperbaric bupivacaine solution intrathecally in left lateral decubitus or sitting position at L3-4 lumbar space with 25G quincke-babcock spinal needle. Patients received 6l/min of oxygen through Hudson’s face mask throughout the surgery. In Epidural group (group E, n=30, after thorough aseptic precautions, an 18G Tuohy’s epidural needle inserted at the L3-4 lumbar space with the patient in lateral decubitus or sitting position. Three ml of 1.5% lidocaine with was given as a test dose. After ruling out any intrathecal injection of the drug, initially 8ml of 0.5% isobaric bupivacaine given and the vitals monitored. Then 3ml top-ups of the same bupivacaine solution is given in a graded manner slowly, simultaneously checking the height of block. A blockade upto T4 to T6 is required. Vitals are carefully monitored and oxygen is provided 6l/min throughout the procedure and surgery. Blood pressure (systolic, mean, diastolic, pulse rate, oxygen saturation are recorded immediately after giving anesthesia, every minute for first 10mins, then every 3mins for the rest of the surgery. Then vitals are also noted post-operatively for the first 24hrs. Apgar score after 1 and 5 minutes, of the newborn baby is also recorded. Other parameters noted were incidence and duration of hypotension or hypertension both intra-operatively and post-operatively, any usage of vasopressors (ephedrine and its dose, convulsions, renal failure, pulmonary edema, requirement for ICU stay and the number of days in the mother, and the incidence of

  10. [CHARACTERISTICS OF COMBINED ANESTHESIA WITH EPIDURAL COMPONENTE DEPENDING ON VEGETATIVE NERVOUS SYSTEM TYPE].

    Science.gov (United States)

    Hasanov, F J; Aslanov, A A; Muradov, N F; Namazova, K N

    2016-01-01

    The research objective was to study the characteristics of combined anesthesia with epidural componente (CAEC) depending on vegetative nervous system type (VNS) in patients who underwent large scale traumatic surgical operations on abdominal cavity organs. The scientific research was conducted in Anaesthesiology--Reanimation Department of the Scientific Surgical Centre named after acad. MA. Topchubashev, the Ministry of Health of the Azerbaijan Republic. The research objects were 69 patients who underwent operations in conditions of CAEC due to different serious surgical pathologies of abdominal cavity organs. VNS type was identified based on electroencephalogram, Cerdo Vegetative Index (CVI), Hildebrandt coefficient (HC) and single neurophysiological tests. The patients were divided into three groups depending on VNS type: I--normotonics--17 patients (24.7%), II--sympathatonics--25 patients (36.2%), and III--vagotonics--27 patients (39.1%). Blood adrenocorticotropic hormone (ACTH) and cortisol concentration were studied in 3 stages: I -preoperative, II--operation traumatic stage, III--the 1st postoperative days. The other indicators (heart rate, systolic blood pressure--SBP, dyastolic blood pressure--DBR average blood pressure--BP ave., pulse oximetry SpO₂, ECG, gases in blood and acid-base balance, electrolytes, blood glucose level, myocardium oxygen demand--MOD) were registered after 20 minutes and the 2nd day after operation besides the above stages. The research results indicated that it is possible to define the vegetative nervous system type superiority based on complex of single tests data, EEG, ECG, Cerdo Vegetative Index, Hildebrandt coefficient. CAEC can be considered optimun alternative of general anesthesia ensuring neurohumoral and hemodynamic stability in large scale, traumatic operations on abdominal cavity organs. Clinical course of CAEC is characterized by firmer hemodynamic and humoral stability in patients with functional balance of

  11. [Optimal dose of midazolam as premedicant for combined spinal and epidural anesthesia with midazolam sedation].

    Science.gov (United States)

    Tabuchi, Y

    1992-04-01

    Sixty patients who underwent simple total hysterectomy under combined spinal and epidural anesthesia with midazolam sedation, were the subjects of a randomized double-blind comparison of intramuscular midazolam 4, 4.5 and 5 mg, and a dose determined by body weight as premedicants. Similar changes in arterial pressure and heart rate were observed. Furthermore sedation and the value of pulse oximetry on arrival were the same. Besides half the patients were amnesic during the procedure of regional approach. However the dose of premedicant was inversely correlated with the maintenance dose. The reduction of pulse oximetry reading on the induction was smaller, while the requirement of vasopressor occurred earlier following the larger dose of premedicant. In spite of the slower induction, the fall of pulse oximetry reading did not decrease. One hour after incision, the reduction of PaO2 was not dose related. In addition count of leucocyte and the level of blood glucose were unchanged. Premedicant determined by body weight was not correlated with the induction dose and amnesic effect. Our findings suggest midazolam 5 mg intramuscularly is the more preferable dose, but careful attention on arterial pressure is required.

  12. Effects of epidural anesthesia on I and II delivery stage and on a newborn

    Directory of Open Access Journals (Sweden)

    Čutura Neđo

    2009-01-01

    Full Text Available Background/Aim. Epidural anesthesia (EA is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process, frequency of vacuum extractor and forceps appliance, and the effect of EA on the newborn. Methods. A total of 360 patients with EA were analyzed at delivery and 1 130 controls without EA. Both groups had vaginal delivery. In both groups deliveries were stimulated by 10 IU of oxytocin in 500 mL of crystalloid solvent, with 15-20 drops per minute. As anaesthetic, Bupivacain (0,25% or 0, 125% was used by the 18 G catheters Braun and Wigon. Level of application was L2-L3 part of spine. Results. The results of this study indicate that deliveries with EA were shorter in duration, but also had much more vacuum extractor and forceps appliance (over 2.5 times than those without EA. Apgar score was significantly higher in the experimental group with multiple deliveries. However, there was no significant deference between average Apgar score of newborns of patients with EA and that of newborns of patients without EA. Conclusion. Application of EA decreases duration of delivery, and has no any adverse effects on newborns.

  13. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

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    Binkert, Christoph A., E-mail: christoph.binkert@ksw.ch [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hirzel, Florian C. [Kantonsspital Winterthur, Department of Gynecology (Switzerland); Gutzeit, Andreas; Zollikofer, Christoph L. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine (Switzerland); Hess, Thomas [Kantonsspital Winterthur, Department of Gynecology (Switzerland)

    2015-10-15

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

  14. Late Onset Spinal Epidural Abscess After Spinal Anesthesia in a Patient With Anklosing Spondylitis: A Case Report

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    Cagatay Ozdol

    2016-07-01

    Full Text Available In this study we present a 61-year-old female patient who was admitted to the hospital with dorsal and lower back pain and recent paraparesis. There was no history of trauma. She was admitted to the hospital due to suffering from ankylosing spondylitis for the past 35 years. Moreover, she had undergone a total hip replacement 2 months prior under spinal anesthesia. Magnetic resonance imaging revealed spinal cord compression due to a mass lesion involving the spinal epidural region at the T11 to T12 level. There were also some imaging findings attributable to discitis. The patient%u2019s neurological condition required an urgent surgical decompression. Spinal epidural abscess is an uncommon complication of spinal anesthesia and invovement of the thoracic region is even rarer. Surgical decompression and antibiotherapy are the treatments of choice for patients with spinal epidural abscesses. Neurological prognosis is generally not promising, particularly when treatment is not begun within the first 72 hours.

  15. Comparison of dexmedetomidine and clonidine as an adjuvant to ropivacaine for epidural anesthesia in lower abdominal and lower limb surgeries

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    Sruthi Arunkumar

    2015-01-01

    Full Text Available Background: The quality and duration of analgesia is improved when a local anesthetic is combined with alpha 2 adrenergic agonist. Though, the effects of clonidine on local anesthetics have been extensively studied, there are limited studies demonstrating the effects of epidural dexmedetomidine on local anesthetics. The aim of our study is to compare the effect of clonidine and dexmedetomidine when used as an adjuvant to epidural ropivacaine in lower abdominal and lower limb surgeries. Materials and Methods: Patients were randomized into two groups-group ropivacaine with clonidine (RC received 15 ml of 0.75% ropivacaine with 1 μg/kg clonidine and group ropivacaine with dexmedetomidine (RD received 15 ml of 0.75% ropivacaine with 1 μg/kg dexmedetomidine epidurally. Onset of sensory analgesia using cold swab, onset of motor blockade using Bromage scale, time to 2 dermatome regression of sensory level, time to first demand for analgesia, sedation using Ramsay sedation scale, intra operative hemodynamic parameters and complications were assessed. Results: The onset (RD-8.53 ± 1.81, RC-11.93 ± 1.96 and duration of sensory blockade (RD-316 ± 31.5, RC-281 ± 37, sedation were found to be significantly better in the dexmedetomidine group. No significant difference was found in terms of onset of motor blockade and hemodynamic changes. Conclusion: Dexmedetomidine at doses of 1 μg/kg is an effective adjuvant to ropivacaine for epidural anesthesia, which is comparable to clonidine.

  16. [Combined spinal and epidural anesthesia for cesarean delivery in a patient with a cervical fracture at C2].

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    Mochidome, Mariko; Sakamoto, Akiyuki; Tanaka, Hidenori; Sugiyama, Daisuke; Kawamata, Mikito

    2013-04-01

    There are only a few reports on cesarean section in a patient with cervical fracture without spinal cord injury (SCI). Such patients have high risks for deterioration of SCI following general or regional anesthesia. Here, we present a patient with a fracture of C2 vertebra who underwent cesarean section safely under combined spinal and epidural anesthesia(CSEA). A 30-year-old woman had a fracture of the C2 cervical vertebra (Hangman's fracture) due to a traffic accident at 34 weeks of gestation. Conservative immobilization of the head and neck was done with a neck collar (Philadelphia brace) in order to prevent subsequent SCI after the spine injury. Pre-viability amniorrhexis was seen at 37 weeks' gestation, and an emergency cesarean section was scheduled under combined epidural and spinal anesthesia (CSEA). Her neck and head were carefully fixed before, during and after surgery in order to prevent subsequent SCI. As a result, cesarean section under CSEA was successfully performed in the patient without any deterioration of the spine and/or SCI.

  17. Exploration of Lumbar Hemp-epidural Block Anesthesia and Epidural Anesthesia in the Clinical Anesthesia Effect%探讨腰麻-硬膜外联合阻滞麻醉与单纯硬膜外麻醉的临床麻醉效果

    Institute of Scientific and Technical Information of China (English)

    王天银

    2015-01-01

    Objective To analyze lumbar hemp-epidural anesthesia and epidural block anesthesia’clinical anesthesia efect. Methods In our hospital 100 patients for surgical treatment were divided into the joint group and regular group, and 50 cases in each group. Regular group of patients used conventional epidural anesthesia, the joint group of patients with lumbar hemp-epidural block anesthesia.Results The joint group of patients with clinical anesthesia efect was obvious higher than that of conventional group of patients with clinical anesthesia efect, al of the diferences in the process(P< 0.05)was statisticaly significant. Conclusions In the process of implementation of anesthesia, the implementation for the patient of hemp-epidural block anesthesia is obvious higher than that of pure epidural anesthesia.%目的:分析单纯硬膜外麻醉以及腰麻-硬膜外联合阻滞麻醉的临床麻醉效果。方法将我院收治的需要手术治疗的100例患者分为联合组以及常规组,每组患者50例。常规组患者使用常规硬膜外麻醉实施麻醉,联合组患者使用腰麻-硬膜外联合阻滞麻醉。结果联合组患者的临床麻醉效果高于常规组患者的临床麻醉效果,在此过程中,P<0.05,差异有统计学意义。结论在实施麻醉的过程中,对于患者实施腰麻-硬膜外联合阻滞麻醉的方法,临床麻醉效果明显高于单纯的硬膜外麻醉。

  18. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency.

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    Mehta, Nandita; Gupta, Sunana; Sharma, Atul; Dar, Mohd Reidwan

    2015-01-01

    Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.

  19. [State of the sympathoadrenal system and hemodynamics in children during congenital heart defect surgery with high thoracic epidural anesthesia using lidocaine-clofelin].

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    Slin'ko, S K

    2000-01-01

    Effects of high thoracic epidural anesthesia (HTEA) on the hemodynamics and sympathoadrenal system were studied in patients during cardiopulmonary bypass surgery. In 55 patients aged 1-14 years, HTEA was used in combination with oxygen-air-halothane anesthesia. In one group lidocaine and fentanyl were used for HTEA and in another clonidine and lidocaine. In the control, standard intravenous fentanyl-diazepam anesthesia was combined with oxygen-air-halothane anesthesia. In the clonidine-lidocaine group the endocrine stress response was decreased in comparison with other groups even without narcotics; hemodynamics was stable even in patients with NYHA class III-IV.

  20. 老年单肺通气患者中全麻联合硬膜外麻醉临床应用研究%Elderly Patients With Single-lung Ventilation Anesthesia Combined With Epidural Anesthesia Clinical Research

    Institute of Scientific and Technical Information of China (English)

    王东

    2015-01-01

    目的:探讨老年单肺通气患者中全麻联合硬膜外麻醉的临床应用效果。方法37例患者均进行全麻联合硬膜外麻醉。结果单肺通气5分钟PO2减少,并低于其余时间点;PCO2增加,并高于其余时间点。结论单肺通气患者采用全麻联合硬膜外麻醉,对于患者的动脉氧合与内分流影响度低,是安全可行的麻醉方式。%Objective To investigate the clinical effect of single-lung ventilation in elderly patients anesthesia combined with epidural anesthesia. Methods37 patients underwent general anesthesia combined with epidural anesthesia.Results After OLV Paw OLV 5 minutes PO2 decrease and below the rest of the time; PCO2 increases, and higher than the rest of the time points.Conclusion One lung ventilation in patients with general anesthesia combined with epidural anesthesia for patients, arterial oxygen and shunt effect degree low, is safe and feasible anesthesia.

  1. The Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty

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    Danninger, Thomas; Stundner, Ottokar; Ma, Yan; Bae, James J; Memtsoudis, Stavros G

    2014-01-01

    Little data exists to detail the effect of hypotensive epidural anesthesia on differential tissue oxygenation changes above and below the level of neuraxial blockade. This study was designed to investigate tissue oxygenation in a clinical setting, using non-invasive near-infrared spectroscopy. Methods Patients aged 18 to 85 years scheduled to undergo primary total hip arthroplasty were enrolled. Muscle oxygenation saturation was measured above and below the level of neuraxial blockade (deltoid and vastus lateralis muscles). Other continuously recorded parameters included cardiac output, stroke volume, heart rate, invasive mean arterial blood pressure and arterial oxygen saturation. Recordings of muscle oxygenation were compared over time separately for upper and lower extremity. Results 10 patients were enrolled. We found an intermittent and significant unadjusted decline of mean muscle oxygenation saturation in the vastus lateralis muscle during first part of the surgery (nadir 2nd quintile: 71.0% vs. 63.3%, p<0.0001). This decline was followed by a return to baseline towards the end of the surgery (71.0% vs. 69.1%, p=0.3429). Mean muscle oxygenation saturation did not change for the same period of time in the deltoid muscle. When adjusting for covariates, the changes in muscle tissue oxygenation remained significant. Conclusion These results indicate that muscle oxygenation saturation, a surrogate parameter for tissue perfusion, is decreased by hypotensive epidural anesthesia, but only within the functional limits of the neuraxial blockade. The etiology of these findings remains to be elucidated. PMID:24563810

  2. Human Lumbar Ligamentum Flavum Anatomy for Epidural Anesthesia: Reviewing a 3D MR-Based Interactive Model and Postmortem Samples.

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    Reina, Miguel A; Lirk, Philipp; Puigdellívol-Sánchez, Anna; Mavar, Marija; Prats-Galino, Alberto

    2016-03-01

    The ligamentum flavum (LF) forms the anatomic basis for the loss-of-resistance technique essential to the performance of epidural anesthesia. However, the LF presents considerable interindividual variability, including the possibility of midline gaps, which may influence the performance of epidural anesthesia. We devise a method to reconstruct the anatomy of the digitally LF based on magnetic resonance images to clarify the exact limits and edges of LF and its different thickness, depending on the area examined, while avoiding destructive methods, as well as the dissection processes. Anatomic cadaveric cross sections enabled us to visually check the definition of the edges along the entire LF and compare them using 3D image reconstruction methods. Reconstruction was performed in images obtained from 7 patients. Images from 1 patient were used as a basis for the 3D spinal anatomy tool. In parallel, axial cuts, 2 to 3 cm thick, were performed in lumbar spines of 4 frozen cadavers. This technique allowed us to identify the entire ligament and its exact limits, while avoiding alterations resulting from cutting processes or from preparation methods. The LF extended between the laminas of adjacent vertebrae at all vertebral levels of the patients examined, but midline gaps are regularly encountered. These anatomical variants were reproduced in a 3D portable document format. The major anatomical features of the LF were reproduced in the 3D model. Details of its structure and variations of thickness in successive sagittal and axial slides could be visualized. Gaps within LF previously studied in cadavers have been identified in our interactive 3D model, which may help to understand their nature, as well as possible implications for epidural techniques.

  3. Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents

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    Ali Alagoz

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. METHODS: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I and fourth year (Group II according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. RESULTS: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05. Change of needle insertion level was statistically higher in Group II (p = 0.008, whereas paresthesia was significantly higher in Group I (p = 0.007. Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p < 0.001, 0.005. CONCLUSION: Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.

  4. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures

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    Jin JW

    2015-08-01

    Full Text Available Jianwen Jin,1 Gang Wang,2 Maowei Gong,3 Hong Zhang,3 Junle Liu21Department of Clinical Medicine, Fujian Health College, Fuzhou, 2Department of Anesthesiology, Chinese People’s Liberation Army 105 Hospital, Hefei, 3Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of ChinaBackground: Geriatric patients with femoral neck fracture (FNF have unacceptably high rates of postoperative complications and mortality. The purpose of this study was to compare the effects of epidural anesthesia versus peripheral nerve block (PNB on postoperative outcomes in elderly Chinese patients with FNF.Methods: This retrospective study explored mortality and postoperative complications in geriatric patients with FNF who underwent epidural anesthesia or PNB at the Chinese People’s Liberation Army General Hospital from January 2008 to December 2012. The electronic database at the Chinese People’s Liberation Army General Hospital includes discharge records for all patients treated in the hospital. Information on patient demographics, preoperative comorbidity, postoperative complications, type of anesthesia used, and in-hospital, 30-day, and 1-year mortality after surgery was obtained from this database.Results: Two hundred and fifty-eight patients were identified for analysis. The mean patient age was 79.7 years, and 71.7% of the patients were women. In-hospital, 30-day, and 1-year postoperative mortality was 4.3%, 12.4%, and 22.9%, respectively, and no differences in mortality or cardiovascular complications were found between patients who received epidural anesthesia and those who received PNB. More patients with dementia or delirium were given PNB. No statistically significant differences were found between groups for other comorbidities or intraoperative parameters. The most common complications were acute cardiovascular events (23.6%, electrolyte disturbances (20.9%, and hypoxemia (18.2%. Patients

  5. Observation and Nursing of Combined Spinal Epidural Anesthesia Painless Labor%腰硬联合麻醉无痛分娩的观察与护理

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    秦仙荣

    2014-01-01

    Objective: to analyze the obstetrics and Gynecology combined spinal epidural anesthesia ef ect of childbirth. Methods: our hospital obstetrics and Gynecology painless childbirth, and to observe the implementation of nursing care. Results: the combined spinal epidural anesthesia epidural analgesic ef ect, quick ef ect, lit le influence on mother and infant. Conclusion:the grass-roots hospitals in combined spinal epidural anesthesia for painless childbirth method, can reduce maternal does not bear the pain for the cesarean delivery rate.%目的:分析妇产科腰硬联合麻醉分娩的效果。方法总结我院妇产科无痛分娩实施情况、和观察护理情况。结果腰硬联合麻醉无痛分娩止痛效果好,起效快,对母婴影响小。结论基层医院开展腰硬联合麻醉无痛分娩方法,可减少产妇不忍受疼痛要求剖宫产的概率。

  6. The comparison of anesthesia effect of lung surgery through video-assisted thoracic surgery: A meta-analysis

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    Jing-Dong Ke

    2015-01-01

    Conclusion: These results indicated that epidural anesthesia can save operating time and postoperative hospital stay time. But epidural anesthesia and general anesthesia have the same effect on complications.

  7. The behavioral assessment and alleviation of pain associated with castration in beef calves treated with flunixin meglumine and caudal lidocaine epidural anesthesia with epinephrine.

    Science.gov (United States)

    Currah, Jan M; Hendrick, Steven H; Stookey, Joseph M

    2009-04-01

    The objectives of this study were 1) to determine the effects of flunixin megulmine in combination with caudal epidural anesthesia as a postoperative analgesic in beef calves following surgical castration, and 2) to consider stride length and pedometry as potential behavioral assessment tools for detecting postcastration pain. Surgical castration was performed in 101 beef calves randomly assigned to 3 treatment subgroups: 1) castration without anesthesia (SURG); 2) castration following lidocaine with epinephrine caudal epidural anesthesia (SURG + EPI); 3) castration following lidocaine with epinephrine caudal epidural anesthesia and flunixin meglumine (SURG + EPI + F). Several outcomes, including pedometer counts, changes in stride length, subjective visual assessment of pain, instantaneous scan sampling of the calves' postoperative activities, and the amount of movement and vocalization during the castration procedure, were measured to identify and quantify pain. The results indicated that stride length and the number of steps taken by calves after castration appear to be good measures of pain. Significant differences found between treatment groups for stride length and visual assessments suggest that flunixin meglumine can be considered to provide visible pain relief up to 8 hours postcastration.

  8. The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

    Institute of Scientific and Technical Information of China (English)

    Fei Xiao; Wen-Ping Xu; Yin-Fa Zhang; Lin Liu; Xia Liu; Li-Zhong Wang

    2015-01-01

    Background:Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery.This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia.Methods:Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized,double-blinded,dose-ranging study.Patients received 6,8,10,12,or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil.Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation.The 50% effective dose (ED50) and 95% effective dose (ED95) were calculated with a logistic regression model.Results:ED50 and ED95 ofintrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA) were 8.28 mg (95% confidence interval [CI]:2.28-9.83 mg) and 12.24 mg (95% CI:10.53-21.88 mg),respectively.Conclusion:When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery,the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg,respectively.In addition,this local anesthetic is unsuitable for emergent cesarean delivery,but it has advantages for ambulatory patients.

  9. 局麻与硬膜外麻醉腹股沟疝修补术的临床对比研究%Local anesthesia and epidural anesthesia clinical comparative study of inguinal hernia repair

    Institute of Scientific and Technical Information of China (English)

    郑欣; 王宝

    2014-01-01

    目的:探讨局麻和硬膜外麻醉下行无张力疝修补术的疗效。方法:选择海盐县人民医院2010年12月到2011年12月所实施的无张力疝修补术患者60例,其中局麻组30例,硬膜外麻醉组30例。结果:局麻组患者在术后疼痛程度,术后住院天数以及平均住院费用都优于硬膜外麻醉组,而平均手术时间及术后并发症无显著差异。结论:局麻下无张力疝修补术简便易行,疗效肯定,术后疼痛轻,住院费用低,值得在临床上推广,尤其在基层医院。%Objective:to study the anesthesia and epidural anesthesia downlink without tension hernia repair effect.Methods:choice of haiyan county peo-ple's hospital in December 2010 to December 2011,the implementation of 60 patients with without tension hernia repair,30 cases with local anesthesia group,epidural anesthesia group 30 cases.Results:local anesthesia group of patients in postoperative pain,postoperative hospitalization days and average hospitalization expenses were better than epidural anesthesia group,while the average operation time and postoperative complications had no significant difference.Conclusion:easy without tension hernia repair under local anesthesia,curative effect,light postoperative pain,hospitalization expense is low,is worth popularizing in clinic,especially in basic-level hospitals.

  10. Impact of general versus epidural anesthesia on early post-operative cognitive dysfunction following hip and knee surgery

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    Mandal Sripurna

    2011-01-01

    Full Text Available Background : Post-operative cognitive dysfunction is the subtle cerebral complication temporally seen following surgery. The aim of this study was to compare the influence of either general anesthesia (GA or epidural anesthesia (EA on the early post-operative neurocognitive outcome in elderly (>59 years subjects undergoing hip and knee surgery. Methods : A total of 60 patients were recruited in a prospective, randomized, parallel-group study, comparable by age and sex. They were enrolled and randomized to receive either EA (n = 30 or GA (n = 30. All of them were screened using the Mini Mental State Examination (MMSE, with components of the Kolkata Cognitive Screening Battery. The operated patients were re-evaluated 1 week after surgery using the same scale. The data collected were analyzed to assess statistical significance. Results : We observed no statistical difference in cognitive behavior in either group pre-operatively, which were comparable with respect to age, sex and type of surgery. Grossly, a significant difference was seen between the two groups with respect to the perioperative changes in verbal fluency for categories and MMSE scores. However, these differences were not significant after the application of the Bonferroni correction for multiple analyses, except the significant differences observed only in the MMSE scores. Conclusions : We observed a difference in cognitive outcome with GA compared with EA. Certain aspects of the cognition were affected to a greater extent in this group of patients undergoing hip and knee surgery.

  11. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases Paraplegia e hipertensão craniana após anestesia epidural: relato de 4 casos

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    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.Quatro pacientes que receberam anestesia epidural apresentaram mielopatia de longa evolução; em três ocorreu paraplegia completa e um apresentou uma síndrome medular lombo-sacra com retenção urinária. Todos os pacientes se queixaram de intensas dores radiculares imediatamente após a cessação do efeito analgésico da lidocaína. Dois pacientes apresentaram uma reação meningítica asséptica no líquido cefalorraqueano nas primeiras 24 horas. A paraplegia tornou-se completa em 2 a 10 meses após a anestesia; dois pacientes tiveram hipertensão craniana severa. Em alguns casos, senão em todos, esta afecção apresenta uma evolução em duas etapas, caracterizadas por meningite asséptica imediata, seguida, depois de um período silencioso de poucos meses, de sinais de aracnoidite adesiva espinal e intracraniana. A hipertensão intracraniana foi controlada por derivação ventriculo-peritoneal; em 2 pacientes houve melhora transit

  12. EPIDURAL ANESTHESIA FOR CESAREAN SECTION IN ATRIAL SEPTAL DEFECT WITH PULMONARY HYPERTENSION

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    Rashmi

    2015-07-01

    Full Text Available Pregnant patients with atrial septal defect (ASD with pulmonary hypertension , occasionally present for anaesthesia . These patients are considered high risk for anaesthesia due to increased chances of per i operative cardiovascular complications . Anaesthesia requires intensive cardiovascular mo nitoring and maintenance of stable pulmonary and systemic haemodynamics . Here is a case of second gravida for LSCS which was managed under epidural anaesthesia successfully

  13. "COMPARATIVE STUDY OF ONSET AND DURATION OF ACTION OF 0.5% BUPIVACAINE AND A MIXTURE OF 0.5% BUPIVACAINE AND 2% LIDOCAINE FOR EPIDURAL ANESTHESIA"

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    F. Z

    2004-09-01

    Full Text Available Local anesthetic solutions are frequently mixed to take advantage of the useful properties of each drug but the medical literature is surprisingly deficient in well controlled studies about the onset and duration of action of these mixtures for epidural anesthesia. A total of 32 patients scheduled for elective operation were enrolled in this prospective randomized controlled study; in group I, 16 patients received 15 ml solution containing bupivacaine 0.5% and lidocaine 2% as a single injection epidural anesthesia after 3 ml test dose containing 15 mcg epinephrine; in group II, 16 patients received 15 ml bupivacaine 0.5% with the same technique. The times from injection of the test dose to the onset of sensory anesthesia at inguinal ligament and umbilicus and the time of termination of anesthesia at the maximum sensory level and two levels regression of anesthesia level were checked with pinprick test. The results were compared with two sample t test. Times to onset of sensory block in L1 and T10 levels (mean±SD were 14.87±3.1 min and 21±3.37 min in group I and 17.12±2.18 min and 24.9±2.54 min in group II, respectively (P< 0.025 and P< 0.001, respectively. Times to termination of sensory anesthesia at the maximum level of anesthesia and two dermatomes regression were 75.12±8.26 min and 87.8±7.01 min in group I and 116.37±22.4 min and 134.87±21.64 min in group II, respectively ( P= 0 and P=0,respectively. Mixing lidocaine 2% with bupivacaine 0.5% in a 1:1 ratio compared to 0.5% bupivacaine solution results in significantly more rapid initiation and termination of sensory block.

  14. 腰硬联合麻醉和硬膜外麻醉在早期妊娠孕妇的急性阑尾炎麻醉中的应用比较%Comparison of the Application of Combined Spinal Epidural Anesthesia and Epidural Anesthesia in Early Pregnancy with Acute Appendicitis in Pregnant Women

    Institute of Scientific and Technical Information of China (English)

    黄高廷; 陈琳敏; 陈梓轩; 蔡朝贤

    2016-01-01

    目的:探析腰硬联合麻醉和硬膜外麻醉在早期妊娠孕妇的阑尾炎麻醉中的应用价值。方法整群选取2015年8月—2016年3月因急性阑尾炎需急行手术的56例早期妊娠孕妇,按照麻醉方式的不同,随机分为观察组和对照组。其中观察组予以腰硬联合麻醉,共28例;对照组病例应用硬膜外麻醉,共28例。观察并比较两组患者的麻醉效果﹑患者与胎儿的血流动力学情况以及麻醉不良反应的发生情况。结果观察组患者麻醉有效率100.00%,对照组患者麻醉有效率78.57%;观察组患者发生不良反应发生率3.57%,对照组患者不良反应发生率21.43%,与采用硬膜外麻醉的对照组相比,予以腰硬联合麻醉的观察组患者麻醉总有效率更高(P0.05)。结论罹患急性阑尾炎的早期妊娠孕妇采用腰硬联合麻醉对孕妇以及胎儿安全性较高,麻醉效果确切,临床推广价值较高。%Objective To study the value of combined spinal epidural anesthesia and epidural anesthesia in the early preg-nancy of pregnant women. Methods Group selection a total of 2015August to 2016 March due to acute appendicitis should be sped surgery and treated of 56 cases of early pregnant women, according to the mode of anesthesia, were randomly divid-ed into the observation group and the control group. The observation group was given combined spinal epidural anesthesia, 28 cases; control group were used epidural anesthesia, 28 cases. Occurrence of anesthetic effect were observed and com-pared between the two groups of patients and the hemodynamics of patients with fetal and adverse reaction conditions. Re-sults Patients in the observation group anesthesia effectiveness 100.00%, control group anesthesia efficiency 78.57%;obser-vation group patients and the incidence of adverse reactions was 3.57%, control group, the adverse reaction rate was 21.43%, and the epidural anesthesia group and the control group was compared to be combined

  15. COMPARISON OF EPIDURAL ANESTHESIA AND POSTOPERATIVE ANALGESIA WITH ROPIVACAINE AND FENTANYL IN OFF - PUMP CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED, CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Kaushal

    2014-01-01

    Full Text Available BACKGROUND: Our aim was to assess the efficacy of thoracic epidural anesthesia followed by postoperative epidural infusion with ropivacaine and Fentanyl in off - pump coronary bypass grafting. INTRODUCTION : In cardiosurgical patients, high thoracic epidural anesthesia (EA with local anesthetics and opioids can provide effective analgesia and reduce the number of perioperative complications. However, the use of EA in coronary surgery is controversial, and it is still unclear whether EA influences lung fluid balance , cardiopulmonary function and clinical outcome in OPCAB. Thus, the method requires further evaluation and its potential benefits in coronary patients should be weighed against its risks. MATERIALS AND METHODS : A prospective study was performed in 4 0 patients undergoing coronary artery bypass surgery who received high thoracic epidural analgesia. Group 1 received thoracic epidural 0.2% ropivacaine (bolus 10 ml, 10 min before starting surgery while group 2 pts. received Fentanyl 2 mcg/ml (bolus 10 ml , 10 min before starting surgery, then rate of epidural infusion adjusted between 3 - 8 ml/ hr. of the same concentration according to response. The Regimens aimed at a visual analog scale (VAS score < or = 4/10 . Hemodynamic parameters and blood gases were measured from extubation till 24 h after OPCAB. RESULTS : O utcome measures included the incidence of Visual Analogue Score (VAS < or =4/10, infusion rate adjustments and side - effects. Patients receiving ropivacaine were less likely to experience pain < or =4/10 (P' = 0.002; the infusion rate was lower (P' = 0.024; required less rate adjustments (P' = 0.001; a less need for noradrenaline (P' = 0.001 and antiemetic drugs (P' = 0.001. There were no significant differences between the groups for sedation s cores or the incidence of respiratory depression. CONCLUSION : This study suggests that ropivacaine 0.2% may be superior to fentanyl 2 microg/ml. We found a reduced number of

  16. Effect of thoracic epidural anesthesia on oxygen delivery and utilization in cardiac surgical patients scheduled to undergo off-pump coronary artery bypass surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

    Full Text Available To evaluate the effect of thoracic epidural anesthesia (TEA on tissue oxygen delivery and utilization in patients undergoing cardiac surgery. This prospective observational study was conducted in a tertiary referral heart hospital. A total of 25 patients undergoing elective off-pump coronary artery bypass surgery were enrolled in this study. All patients received thoracic epidural catheter in the most prominent inter-vertebral space between C7 and T3 on the day before operation. On the day of surgery, an arterial catheter and Swan Ganz catheter (capable of measuring cardiac index was inserted. After administering full dose of local anesthetic in the epidural space, serial hemodynamic and oxygen transport parameters were measured for 30 minute prior to administration of general anesthesia, with which the study was culminated. A significant decrease in oxygen delivery index with insignificant changes in oxygen extraction and consumption indices was observed. We conclude that TEA does not affect tissue oxygenation despite a decrease in arterial pressures and cardiac output.

  17. Posttraumatic Stress Disorder After High-Dose-Rate Brachytherapy for Cervical Cancer With 2 Fractions in 1 Application Under Spinal/Epidural Anesthesia: Incidence and Risk Factors

    Energy Technology Data Exchange (ETDEWEB)

    Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria); Czajka-Pepl, Agnieszka [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Ponocny-Seliger, Elisabeth [Department of Psychology, Sigmund Freud Private University Vienna, Vienna (Austria); Scharbert, Gisela; Wetzel, Léonore [Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Nout, Remi A. [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands); Sturdza, Alina [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Dimopoulos, Johannes C. [Metropolitan Hospital, Athens (Greece); Dörr, Wolfgang; Pötter, Richard [Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/General Hospital of Vienna, Vienna (Austria); Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna (Austria)

    2014-06-01

    Purpose: To investigate the psychological consequences of high-dose-rate brachytherapy with 2 fractions in 1 application under spinal/epidural anesthesia in the treatment of locally advanced cervical cancer. Methods and Materials: In 50 patients with locally advanced cervical cancer, validated questionnaires were used for prospective assessment of acute and posttraumatic stress disorder (ASD/PTSD) (Impact of Event Scale–Revision), anxiety/depression (Hospital Anxiety and Depression Scale), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Cervical Cancer 24), physical functioning (World Health Organization performance status), and pain (visual analogue scale), before and during treatment and 1 week and 3 months after treatment. Qualitative interviews were recorded in open format for content analysis. Results: Symptoms of ASD occurred in 30% of patients 1 week after treatment; and of PTSD in 41% 3 months after treatment in association with this specific brachytherapy procedure. Pretreatment predictive variables explain 82% of the variance of PTSD symptoms. Helpful experiences were the support of the treatment team, psychological support, and a positive attitude. Stressful factors were pain, organizational problems during treatment, and immobility between brachytherapy fractions. Conclusions: The specific brachytherapy procedure, as performed in the investigated mono-institutional setting with 2 fractions in 1 application under spinal/epidural anesthesia, bears a considerable risk of traumatization. The source of stress seems to be not the brachytherapy application itself but the maintenance of the applicator under epidural anesthesia in the time between fractions. Patients at risk may be identified before treatment, to offer targeted psycho-social support. The patients' open reports regarding helpful experiences are an encouraging feedback for the treatment team; the reported stressful

  18. Epidural Anesthesia with Different Concentration of Chloroprocaine in Children%氯普鲁卡因在小儿硬膜外麻醉中的应用

    Institute of Scientific and Technical Information of China (English)

    朱诗利; 张溪英; 吕志平; 安频; 邝日裕; 屈双权

    2012-01-01

    Objective To study the feasibility and the lowest effective concentration of chloroprocaine for epidural anesthesia in children. Methods 60 pediatric patients undergoing lower abdomen or perineal operation under epidural combined general anesthesia were randomly assigned to 1% chloroprocaine group, 1.5% chloroprocaine group and 2% chloroprocaine group, with 20 cases each. The patients all received epidural puncture after inspiring sevoflurane, and corresponding concentration of chloroprocaine 8 ~ 10 mg/kg were injected into epidural space. HR, NBP, RR, SpO2, the anesthetic effect, and the total amount of intravenous anesthetics were observed and recorded. Results Comparing with group A and B, the vital signs in group C were more stable; the onset time and the analgesia time was more shorter and the algesthesia recovery time was longer; the dose of intravenous anesthetics in group C was least. The differences were significant. Conclusion 2% chloroprocaine for epidural anesthesia in children retains a longer anaesthesia time than the concentration of 1.5% and 1% chloroprocaine. There is no need to boost intravenous anesthetics. The anesthesia effects is satisfactory and without any obviously adverse effect. It is the lowest effective concentration for epidural anesthesia in children.%目的 研究氯普鲁卡因用于小儿硬膜外麻醉的可行性与最低有效浓度. 方法 60例在硬膜外复合全麻下行下腹部或会阴部手术的患儿,随机分为1%、1.5%和2%氯普鲁卡因组,每组20例.吸入七氟烷麻醉后行硬膜外穿刺,硬膜外腔分别注入相应浓度的氯普鲁卡因8~10 mg/kg.观察记录患儿各时间点的HR、NBP、RR、SpO2及麻醉效果、静脉麻醉药总量. 结果 C组患者的生命体征较A、B两组更平稳,C组的起效时间和疼痛消失时间短于其他两组,痛觉恢复时间长于其他两组,静脉麻醉药用量C组最小,差异有显著性. 结论 2%氯普鲁卡因

  19. 不同麻醉方法用于剖宫产术的成本分析%Cost of continuous epidural anesthesia and general anesthesia for caesarean section

    Institute of Scientific and Technical Information of China (English)

    许敏; 魏昕; 柴小青; 潘建辉

    2014-01-01

    目的:比较分析剖宫产中应用椎管内麻醉或全身麻醉的成本消耗,为医疗成本运作和医疗政策制定提供临床参考数据。方法回顾我院择期行子宫下段剖宫产术的患者(212例),按其接受的麻醉方法分为椎管内麻醉组(连续硬膜外麻醉,SA组,106例)及全身麻醉组(喉罩下全麻,GA组,106例),对麻醉的直接成本进行了评估。从麻醉数据库中统计麻醉中使用的药品及耗材,根据麻醉相关时间及麻醉人员薪酬计算人员成本,并计算相关比例。结果剖宫产中应用全身麻醉直接麻醉成本及非人员麻醉成本均高于连续硬膜外麻醉(P<0.05),人员成本则是连续硬膜外麻醉高于全身麻醉(P<0.05),全身麻醉的药品及耗材成本明显高于连续硬膜外麻醉(P<0.05),连续硬膜外麻醉的诱导时间及持续时间较长(P<0.05),两组患者术后住院天数差异无统计学意义(P>0.05)。结论椎管内麻醉的直接成本较低,但是人员成本相对较高。麻醉方法的选择并不影响患者术后住院天数。%Objective To analyze the costs of continuous epidural anesthesia and general anesthesia for caesarean section and pro-vide clinical reference data for health behaviors and health policy makers.Methods The clinical data of 212 patients (aged 22~35 years) who received elective cesarean section surgery from to July to December in 2012 in our hospital were retrospectively analysed.The patients were divided into the spinal anesthesia group(continuous epidural anesthesia,SA group,n=106)and the general anesthesia group(LMA un-der general anesthesia,GA group,n=106 )according to their method of anesthesia.Direct costs were measured on detailed data of the re-sources used during anaesthetic procedures from the anesthesia record.Costs related to anaesthetic staff work were calculated based on per ca-pita remuneration and duration of

  20. 硬膜外辅助全麻与静吸全麻下100例消化道肿瘤患者的麻醉可行性对比%A comparative study of the feasibility of epidural assisted anesthesia and isoflurane anesthesia in 100 patients with gastrointestinal cancer

    Institute of Scientific and Technical Information of China (English)

    鲁竞; 熊桂林

    2012-01-01

    Objective To compare the clinical efficacy and adverse effects of epidural assisted anesthesia with isoflurane surgery under general anesthesia in patients with gastrointestinal tumors, and provide better anesthesia for future surgery. Methods A total of 100 gastrointestinal cancer patients of our hospital who underwent surgery were selected, and they were randomly divided into isoflurane anesthesia group and epidural - assisted group. Patients received endotracheal intubation under general anesthesia. On the basis of general anesthesia, the epidural - assisted group received lidocaine for epidural anesthesia. The extubation time after surgery, postoperative nausea and vomiting, arrhythmias and blood pressure were compared in the two groups. The efficacy of two kinds of anesthetic methods was assessed. Results Extubanon time after anesthesia in the epidural - assisted group was shorter than that in the isoflurane anesthesia group. There were leas postoperative complications in the epidural - assisted group than in the isoflurane anesthesia group. Conclusion Isoflurane general anesthesia combined with lidocaine and epidural anesthesia can obtain a satisfactory anesthetic effect on gastrointestinal cancer patients.%目的 比较硬膜外辅助全麻与静吸全麻下消化道肿瘤患者手术的临床疗效和不良反应,为今后手术患者提供更好的麻醉方法.方法 选取本院就诊行手术治疗的消化道肿瘤患者100例,按照随机原则分为静吸全麻组和硬膜外辅助组.2组均使用气管内插管进行全麻,硬膜外辅助组在全麻的基础上使用利多卡因进行硬膜外阻滞,比较2组在手术完毕后拔管时间,以及术后的恶心呕吐、心律失常、血压升高的不良反应情况,综合评定2种麻醉方法的疗效.结果 硬膜外辅助组麻醉后的拔管时间明显比静吸全麻组短,术后发生并发症的情况少于静吸全麻组.结论 对消化道肿瘤患者采用静吸全麻复合利多卡因

  1. 硬膜外麻醉和全身麻醉对高龄患者腹部术后谵妄的影响%Assessment on Deliration of Old Age Patients after Operation with General Anesthesia and Epidural Anesthesia

    Institute of Scientific and Technical Information of China (English)

    吴莉; 郭春燕; 薛明明

    2013-01-01

    Objective To compare the influence of general anesthesia and epidural anesthesia on the operative deliration of old age patients. Methods All 120 patients undergoing major abdominal surgery in our hospital from 2010.1 -2012.1 were selected and divided into two groups:general anesthesia group(60 cases) and epidural anesthesia group(60 cases). During and after operations,the levels of ECG,MV,MAP,HR,SpO2 ,PEtCO2 and deliration in two groups were observed. Results During and after operations, the levels of ECG, HR, MV, SpO2, PEtCO2 in two groups have no significance differences ( P > 0.05), but MAP has significance difference( P <6.01). The delirium formation rate of general anesthesia group(56.0% ) is higher than epidural anesthesia group(26.0% ) after operations(P < 0.05 ). Conclusion The delirium formation rate of general anesthesia is higher than epidural anesthesia group;therefore,we should select appropriate anesthetic techniques to reduce the incidence of postoperative delirium.%目的 探讨硬膜外麻醉和全身麻醉对高龄患者腹部术后谵妄的影响差异.方法 选择2010年1月-2012年1月进行腹部手术的患者120例,随机分为两组,硬膜外麻醉组60例,其中男性33例,女性27例,手术时采用硬膜外麻醉法.全身麻醉组60例,其中男性31例,女性29例,手术时采用全身麻醉法.观察术中ECG、MV、MAP、HR、SPO2、PEtCO2,并观察术后1~3d的谵妄发生率,比较二者差异.结果 结果显示,术中全身麻醉组MAP显著升高,硬膜外麻醉组无明显变化或略低,两组比较差异有统计学意义(P<0.05),其余指标差异无统计学意义(P>0.05).全身麻醉组术后谵妄发病率为56.0%,高于硬膜外麻醉组(26.0%),差异具有统计学意义(P<0.05).结论 全身麻醉对于高龄患者术后谵妄的影响较大,硬膜外麻醉影响较小,因此应该选取适宜的麻醉方法以降低术后谵妄的发病率.

  2. Doppler sonographic examination of uterine and placental perfusion in cows in the last month of gestation and effects of epidural anesthesia and isoxsuprine.

    Science.gov (United States)

    Kim-Egloff, C; Hässig, M; Bruckmaier, R; Bleul, U

    2016-03-15

    The massive increase in size of the fetus and uterus in the last trimester is accompanied by an increasing demand for nutrients and oxygen, and it is assumed that this demand is met by increasing uterine and fetal perfusion. The goals of this study were to measure the perfusion of the uterine arteries and the placentomes in the last month of gestation and to investigate the effect of epidural anesthesia and isoxsuprine on perfusion. During the last month of gestation, eight Braunvieh cows underwent nine color Doppler sonographic examinations of the uterine arteries to determine diameter (DM), pulse rate (PR), resistance index, time-averaged maximum blood flow velocity (TAMV), and blood flow volume (BFV), and power-mode Doppler sonography was used to determine perfusion of placentomes. The PR increased (P perfusion and the color pixel grading (Cp) increased by 10.1% (P perfusion and the Cp of the placentomes by 18.1% and 18.3% in the gravid horn and by 10.2% and 24.2% in the nongravid horn. Blood flow variables changed little in the last month of gestation. However, epidural anesthesia and isoxsuprine caused changes in uterine and placentome perfusion that suggest improvement of placental nutrient and oxygen supply to the fetus.

  3. Comparison of the clinical effect of combined spinal epidural anesthesia and epidural anesthesia for labor analgesia%腰麻联合硬膜外麻醉与硬膜外麻醉用于分娩镇痛的临床效果比较

    Institute of Scientific and Technical Information of China (English)

    陈日亮

    2015-01-01

    目的:比较腰麻联合硬膜外麻醉(CSEA)与硬膜外麻醉(CEA)在分娩镇痛中的临床效果。方法选择2013年12月-2015年1月医院接受分娩镇痛的足月、单胎、头位初产妇60例,根据麻醉方式不同分为腰麻联合硬膜外麻醉(CSEA 组)和单纯硬膜外麻醉(CEA 组)各30例。观察2组孕妇麻醉起效时间、麻醉至手术开始时间、痛觉恢复时间、运动恢复时间、术中孕妇视觉模拟疼痛评分(VAS)、不良反应发生率、新生儿1min Apgar 评分。结果与CEA 组比较,CSEA 组麻醉起效时间、麻醉至手术开始时间较短,而痛觉恢复时间、运动恢复时间及术中孕妇视觉模拟疼痛评分(VAS)长于或优于 CEA 组,比较差异均有统计学意义(P ﹤0.05);2组不良反应发生率以及新生儿1min Ap-gar 评分比较差异无统计学意义(P ﹥0.05)。结论腰麻联合硬膜外麻醉时间短于单纯应用硬膜外麻醉,但恢复时间较长,临床可视患者情况而应用。%Objective To compare the clinical effect of lumbar anesthesia combined with epidural anesthesia (CSEA)and epidural anesthesia(CEA)for labor analgesia. Methods Select 60 cases of pregnant women in labor analgesia. According to different anesthesia,60 cases of pregnant women were divided into CSEA group and CEA group,30 cases in each group. The onset time of anesthesia,the onset time of anesthesia,the recovery time of pain,recovery time of pain,the visual an-alog pain score(VAS),the incidence of adverse reactions,and the Apgar 1min score of neonates were observed in the 2 groups. Results Compared with group CSEA,the onset time of anesthesia,the onset time of anesthesia,the recovery time of pain,recovery time of exercise,and the visual analog pain score(VAS)of pregnant women were significantly higher than those in CEA group,The difference was statistically significant(P ﹤ 0. 05);There was no significant difference in the incidence of

  4. Application of the epidural anesthesia in labor analgesia%硬膜外麻醉在分娩镇痛中的应用

    Institute of Scientific and Technical Information of China (English)

    王娟; 王昌合; 曲珣

    2014-01-01

    Objective:To explore the clinical effects of the epidural anesthesia in labor analgesia,and its effects on stages of labor and pregnancy outcome of maternal and child. Methods:Two hundred and sixteen natural childbirth puerperas with vaginal delivery, full term,single fetus,vertex presentation and no pregnancy complications and anesthesia contraindications,were randomly divided into the observation group and control group. The labor analgesia in observation group and control group were treated with epidural block anesthesia and non-drug,respectively. The delivery pain,duration of second and third labor,postpartum hemorrhage and Apgar scoring of neonate in two groups were observed. Results:The degree of delivery pain in observation group was significantly lower than that in control group(P0. 05). Conclusions:The epidural anesthesia is an ideal method in labor analgesia, which can accelerate labor progress,and is safe and worthy of spreading.%目的:探讨硬膜外麻醉用于分娩镇痛的临床效果及对产程、母婴分娩结局的影响。方法:选取自然分娩的产妇216例,全部足月、单胎、头位,无妊娠并发症,无麻醉禁忌证,评估经阴道分娩无困难者,随机分为观察组和对照组各108例,观察组采用硬膜外麻醉分娩镇痛,对照组采用非药物性分娩镇痛。观察2组产妇分娩疼痛的程度、第二产程和第三产程时间、产后出血量及新生儿Apgar评分。结果:观察组产妇分娩期疼痛程度明显低于对照组(P0.05)。结论:硬膜外阻滞麻醉用于分娩镇痛是较为理想的方法,对母婴均有较高的安全性,可加速产程进展,值得推广。

  5. Combined Spinal Epidural Anesthesia,Epidural and Subarachnoid Block in Cesarean Section Clinical Comparative Study%腰-硬联合阻滞、硬膜外阻滞及蛛网膜下腔阻滞用于剖宫产的临床效果

    Institute of Scientific and Technical Information of China (English)

    岳琪

    2015-01-01

    Objective To explore the application of caesarean waist-epidural,epidural anesthesia,spinal anesthesia clinical results,so as to explore the best anesthetic approach.Methods From 2012 January to 2014 May in our hospital admissions of cesarean section in 151 cases,were randomly divided into spinal epidural group 51 cases,50 cases of subarachnoid epidural group,50 cases in group.The maternal spinal epidural group were given combined spinal epidural anesthesia epidural treatment,groups of mothers given epidural anaesthesia treatment group given anesthesia,inferior maternal subarachnoid;observed and recorded before anesthesia,after anesthesia of 3 groups of maternal blood pressure and heart rate,and 3 groups of maternal anesthesia onset time,block effect,lead score pul the reaction and neonatal Apgar.Results The onset time,block effect,holding relatively complications and postoperative anesthesia puling reaction of the 3 groups,combined spinal epidural anesthesia used in cesarean section clinical effect is obviously better than that of epidural and subarachnoid block,the difference was statisticaly significant(P0.05). Conclusion The use of combined spinal epidural anesthesia in cesarean overal better.%目的:探讨剖宫产中应用腰-硬联合阻滞、硬膜外阻滞、蛛网膜下腔阻滞的临床效果,获取最佳麻醉方式。方法选取2012年1月至2014年5月我院接诊剖宫产产妇151例,随机分为腰-硬组51例、硬膜组50例、下腔组50例。其中腰-硬组产妇给予腰-硬联合麻醉处理,硬膜组产妇给予硬膜外麻醉处理,下腔组产妇给予蛛网膜下腔麻醉处理;观察记录麻醉前、麻醉后3组产妇的血压与心率情况,以及3组产妇麻醉起效时间、阻滞效果、牵拉反应和新生儿Apgar评分情况。结果3组产妇的麻醉起效时间、阻滞效果、牵拉反应及术后并发症等比较,腰-硬联合阻滞运用于剖宫产临床效果明显优于硬膜外阻滞及蛛网膜

  6. EPIDURAL COMBINED INTRAVENOUS ANESTHESIA AND TOTAL INTRAVENOUS ANESTHESIA IN UPPER ABDOMINAL SURGERY%硬膜外复合静脉全麻与全凭静脉麻醉在上腹部手术中的比较

    Institute of Scientific and Technical Information of China (English)

    朱洪远; 刘充卫; 姜华华

    2011-01-01

    [目的]比较硬膜外复合静脉全麻与全凭静脉麻醉对上腹部手术患者血流动力学、静脉麻醉药用量、术后苏醒、躁动及术后疼痛的影响.[方法]80例择期行上腹部手术患者完全随机分为硬膜外复合全麻组(A组)与全凭静脉麻醉组(B组).观察记录不同时间点两组患者血流动力学、静脉麻醉药用量、术后苏醒时间、躁动例数及术后疼痛VAS评分.[结果]两组患者术前术中血流动力学变化比较,差异无统计学意义.拔管后B组患者MAP和HR明显比A组增加,差异有统计学意义(P<0.05).A组患者丙泊酚、芬太尼、顺苯阿曲库铵用量明显比B组少,差异有统计学意义(P<0.01),术后清醒早,拔管时间明显缩短、躁动例数明显减少、术后镇痛良好.[结论]胸段硬膜外复合静脉全麻用于上腹部手术是一种安全、经济、有效并利于患者术后恢复快通道麻醉的首选麻醉方法.%[Objective] To compare the epidural combined intravenous anesthesia and total intravenous anesthesia on hemodynamics, drug dosage, intravenous anesthesia postoperative effects of waking up, restlessness and postoperative pain of patients with upper abdominal surgery. [Methods] 80 patients with elective abdominal operation on a row totally were randomly divided into epidural combined with General anesthesia Croup (group A) and total intravenous anaesthesia group (Group B). We recorded the blood flow dynamics in patients with two groups at various points the dosage, intravenous anesthesia, postoperative recovery time, number of restlessness and postoperative VAS pain score. [ Results] We compared the hemodynamic changes in patients of the two groups before surgery, and there was significant difference between the two groups. MAP and HR in Group B after extubation significantly increased than the group A (P < 0.05). The propofol, fentanyl and CIS-Atracurium dosage of benzene in Group A were significantly lower than in the B group

  7. Anesthesia for fetoscopic intervention

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2014-01-01

    Full Text Available This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed.

  8. 胸段硬膜外麻醉的研究进展及应用%Research Progress and Application of Thoracic Epidural Anesthesia

    Institute of Scientific and Technical Information of China (English)

    冯志佳; 郭慕真; 孙颖; 席宏杰

    2012-01-01

    硬膜外应用局麻药为手术提供麻醉与镇痛,同时胸段硬膜外麻醉与镇痛也被广泛应用于心脏,大血管,胸部和腹部的手术中.它不仅可以加快病人麻醉后的苏醒,而且可以提供很好的术后镇痛.除了上述优点,许多基础及临床研究发现硬膜外麻醉还有许多其它方面的作用,如:减轻神经内分泌系统的应激反应、减少围术期并发症的发生,以及通过暂时性的阻滞胸交感神经提供心肺及胃肠道的保护作用,改善免疫和凝血功能.本文就近年来胸段硬膜外麻醉应用及研究进展作一综述.%The epidural administration of local anaesthetic agents was primarily designed to provide perioperative anaesthesia and analgesia. Meanwhile, thoracic epidural anaesthsia (TEA) and analgesia are practiced extensively by many anaesthesiologists for cardiac, thoracic and abdominal surgery. Not only can it speed up awakening after anesthesia, and can provide good postoperstive analgesia. However, many experimental and clinical studies have shown that epidural anaesthesia may have effects far beyond pain relief. Regional anaesthesia may decrease the neuroendocrine stress response and therefore reduce the number of perioperative complications. Furthermore, transient thoracic sympathectomy by TEA has been suggested to offer protective cardiac, pulmonary and gastrointestinal effects as well as positive immunological and coagulation properties. The technique is thus thought to have a significant impact on the outcome of major surgical procedures. This review will focus on research progress and application of thoracic epidural anesthesia.

  9. 患者硬膜外注射不同浓度左旋布比卡因的药代动力学%Pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    马民玉; 王承海; 冉菊红

    2010-01-01

    Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes, aged 35-59 years and scheduled for elective radical resection of rectal or colon carcinoma under general anesthesia combined with epidural block, were randomly divided into 2 groups (n=10 each):group Ⅰ (receiving 0.75% levobupivacaine) and group Ⅱ (receiving 0.5% levobupivacaine). Epidural block was performed at L1-2 interspace. Group Ⅰ and Ⅱ received epidural 0.75% and 0.5% levobupivacaine 2 mg/kg (containing adrenaline 5 μg/kg)injected slowly over 2 min, respectively. And 30 min later, general anesthesia was induced with y-hydroxybutyrate 60-80 mg/kg and remifentanil 1-2μg/kg. Tracheal intubation was facilitated with succinylcholine 1-1.5 mg/kg and the patients were mechanically ventilated. Anesthesia was maintained with inhalation of nitrous oxide (N2 O) and O2 (1:1) and continuous infusion of remifentanil 0.01-0.1μg·kg-1·min-1 and intermittent intravenous boluses of atracurium. Sensory and motor blocks were assessed after epidural levobupivacaine. Blood samples were taken from the central vein at 0, 10, 20, 30, 45, 60, 90, 120, 210, 300, 420,540, 660 and 840 min, respectively, after epidural administration for determination of plasma concentrations of levobupivacaine by high performance liquid chromatography.Results The plasma concentration-time curves of levobupivacaine were fitted to a two-compartment open model in the two groups and there were no significant differences in the pharmacokinetic profiles between the two groups. The onset time of sensory and motor blocks was shorter and the duration of the two blocks was longer with 0.75% levobupivacaine as compared with 0.5%levobupivacaine. The incidences of nausea and vomiting and hypotension were low and no severe cardiovascular and neurological side-effects developed.Conclusion The pharmacokinetic parameters do not

  10. 咪唑安定辅助硬膜外阻滞的临床研究%Clinical study of midazolam in epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    唐晓宁; 陈萍

    2001-01-01

    Objective:Clinical study of midazolam sedative action, anti-anxiety,decrease entrails pain,and the influence of haemodynamic and respiratory under epidural anesthesia. Methods:40 patients were divided randomly into two groups(N=20).Group Ⅰwas injected midazolam 0.05/mg.kg,then continuos transfusion 0.05mg/kg.h by micropump. Group Ⅱwas injected fentanyl 1 ug/kg and droperidol 0.05mg/kg. Results: The group Ⅰhave significant better sedadive action, anti-anxiety, decrease entrails pain than the Ⅱ group, P<0.05. Both two groups have no significant influence on haemodynamic and respiratory, P>0.05. Conclusions: Midazolam can increase sedative action, anti-anxiety,decreaes entrails pain,have no significant influence on haemodynamic and respiratory under epidural anesthesia. It is can safety used in epidural anesthesia.%目的:研究咪唑安定用于硬膜外麻醉时的镇静、抗焦虑、消除内脏牵拉反应痛及对呼吸、循环的影响。方法:硬膜外麻醉下行下腹部手术病人40例,随机分为咪唑安定(Ⅰ)组和氟芬合剂(Ⅱ)组,每组20例。Ⅰ组:咪唑安定负荷剂量0.05mg/kg,然后用0.05mg/kg.h行泵持续输注。Ⅱ组:氟派啶0.05kg,芬太尼1ug/kg肌注。结果:Ⅰ组的镇静、抗焦虑、消除内脏牵拉反应痛的作用明显强于Ⅱ组,P<0.05。两组对血流动力学及呼吸均无明显影响,P>0.05。结论:咪唑安定能安全的辅助于硬膜外麻醉,能有效的增强镇静、抗焦虑和消除内脏牵拉痛,对呼吸和血流动力学无明显影响。

  11. Clinical application of epidural anesthesia anodyne labor%硬膜外麻醉镇痛分娩的临床应用

    Institute of Scientific and Technical Information of China (English)

    王凤双

    2015-01-01

    Objective:To observe the curative effect of epidural anesthesia method to relieve labor analgesia.Methods:74 vaginal delivery pregnant women with epidural anesthesia analgesia were selected from February 2012 to April 2013 as the experimental group.80 pregnant women with natural vaginal delivery were selected at the same time as the control group.The pregnant woman pain levels,stages of labor maternal and child situations of two groups were observed.Results:The analgesia effective rate of the experimental group was 95.60% ,which was significantly better than 2.5% of the control group(P0.05).Conclusion:The painless childbirth that epidural anesthesia anodyne labor has significant effect and clinical popularization value.%目的:观察硬膜外麻醉法缓解分娩镇痛的疗效。方法:2012年2月-2013年4月收治硬膜外麻醉镇痛阴道分娩孕妇74例,作为试验组。选择同一时期自然阴道分娩孕妇80例,作为对照组。观察两组孕妇疼痛级别、产程及母婴状况。结果:试验组镇痛有效率(95.60%)显著优于对照组(2.50%)(P<0.05)。同时观察到试验组顺产率(90.54%)明显高于对照组(75.00%)(P<0.05),平均生产时间(产程)[(463±124)min]显著短于对照组[(603±153)min](P<0.05)。两组产后母婴并发症差异无统计学意义(P>0.05)。结论:硬膜外麻醉镇痛分娩效果显著,具有临床推广价值。

  12. Clinical Observation of Lumbar Anesthesia Combined with Epidural Anesthesia for Cesarean Section%腰麻联合硬膜外麻醉用于新式剖宫产术的临床观察

    Institute of Scientific and Technical Information of China (English)

    孙建波; 邓佳

    2015-01-01

    选择80例剖宫产产妇随机分为两组,分别行腰麻联合硬膜外麻醉(Combinedspinal/epiduralanesthesia,CSEA)与连续硬膜外麻醉(Continuousepiduralanesthesia,CEA)。比较两种方法在新式剖宫产中的麻醉效果,副作用,对血流动力学的影响及新生儿Apgar评分。结果表明起效时间,局麻药用量,运动神经阻滞CSEA组优于CEA组,而不良反应,血流动力学变化,新生儿Apgar评分,两组无显著差异性。因此认为CSEA是新式剖宫产较合适的麻醉方法。%Eighty cesarean section parturients were randomly divided into two groups, CSEA (combined spinal/eidural anesthesia) group and CES (continuous epidural anesthesia) group, 40 patients each. Their block ef ects, newborn Apgar scores and hemodynamic changes are compared. It shows that the CSEA group has lower anesthesia dosage and shorter onset time, more satisfying neuromascular block and higher blocking levels than the group CEA does. However,the side ef ects, the hemodynamic changes and the Apgar scores of two groups of not remarkable dif erences . Therefore thought CSEA is new style splits the palace to produce the appropriate anaesthesia method.

  13. Optimal dose of an anesthetic in epidural anesthesia and its effect on labor duration and administration of vacuum extractor and forceps.

    Science.gov (United States)

    Cutura, N; Soldo, V; Milovanović, S R; Orescanin-Dusić, Z; Curković, A; Tomović, B; Janković-Raznatović, S

    2011-01-01

    This study examined the factors that influence the optimal dose of epidural anesthesia (EA), its effect on labor duration, and the frequency of vacuum and forceps administration at the end of delivery. The study group included 100 women who underwent vaginal delivery with EA with administration of 0.125% bupivacaine. A control group included 100 vaginally delivered women, without EA administration. In both groups delivery was stimulated by syntocinon. The level of labor pain influenced the optimal bolus dose of EA more than the body mass. However, the maintenance dose was influenced by both of these factors equally. Labor in the study group was somewhat shorter. In the group with EA the percentage of forceps and vacuum extractor application was twice that in the control group. There was no difference in average value of 5-minute Apgar scor in newborns.

  14. Comparison of laryngeal mask anesthesia and epidural anesthesia in the operation of the school-age children%喉罩全麻与硬膜外麻醉在学龄儿术中的应用比较

    Institute of Scientific and Technical Information of China (English)

    程峰; 李家宽; 郑立东; 王涛

    2014-01-01

    目的:比较喉罩全麻与硬膜外麻醉用于学龄小儿手术的效果与安全性。方法:选择60例ASAⅠ级拟行腹部或下肢手术的患儿,随机分为喉罩组(L组)和硬膜外组(C组),每组30例。观察患儿术中生命体征、苏醒时间、PACU停留时间、围术期并发症。结果:在T1、T2、T3,L组SpO2显著优于C组(P<0.05)。C组T1时HR与T0比较明显增快,并且快于L组T1时间点(P<0.05)。 L组苏醒时间、PACU停留时间明显短于C组(P<0.05),L组呛咳、呼吸抑制发生率明显低于C组(P<0.05)。结论:喉罩可安全地用于学龄儿童的麻醉,尤其对呼吸道的管理明显优于硬膜外麻醉。%Objective:To compare the safety and efficacy of laryngeal mask anesthesia and epidural anesthesia for school-age children. Methods:Sixty children with ASAⅠundergoing abdominal or lower extremity operation, were randomly divided into laryngeal mask general anesthesia group(group L) and epidural anesthesia group (group C). De-mographic data,heart rate, non-invasive blood pressure, pulse oximeter oxygen satutraion were recorded for each child. In addition, time fromtermination of surgery to emergence and duration of stay in the PACU, side effects were recorded. Results:In T1, T2, T3, group L SpO2 was significantly superior to group C. Group C T1 HR and T0 is signifi-cantly faster, and faster than T1 group L. The emergence time and duration of stay in the PACU of group C were sig-nificantly shorter than those of group L. The incidence of cough and respiratory inhibition in the C group were signifi-cantly higher than that in the group L. Conclusion:Laryngeal mask anesthesia can be safely used for children, espe-cially for the management of respiratory tract was obviously better than that of epidural anesthesia.

  15. Study on the dose of bupivacaine for combined spinal- epidural anesthesia in caesarean section%腰硬联合麻醉剖宫产术中布比卡因剂量的临床进展

    Institute of Scientific and Technical Information of China (English)

    徐敏; 董有静; 苑妍新

    2010-01-01

    Although bupivacaine for combined spinal-epidural anesthesia (CSEA) in cesarean section is widely used ,its optimal dose in spinal anesthesia for cesarean section is still difficult to determine. There are four methods in the literature to make maternal hemodynamic parameters more stable and to lower incidence of side-effects while providing equally effective anesthesia.The four methods include a low dose spinal anesthesia combined with epidural anesthesia, an adjusted dose of local anaesthetic for spinal anaesthesia according to body height and weight, epidural volume extension (EVE) by an epidural injection of physiological saline solution and a low-dose local anesthetic-opioid spinal anesthesia. The most optimal one among the 4 methocls are still worthy of further study.%布比卡因腰硬联合麻醉(combined spinal-epidural anesthesia,CSEA)在剖宫产中的应用较多,但其腰麻用于剖宫产术的最佳剂量较难确定,通过阅读文献发现有4种方法分别为给予小剂量腰麻,把腰麻限制在低位节段,通过硬膜外追加利多卡因来加强麻醉效果;根据身高与体重调节腰麻的剂量;通过硬膜外注射盐水来减少腰麻剂量;通过布比卡因腰麻复合阿片类药物来减少腰麻剂量,可使母体血液动力学相对稳定,副作用发生率低,麻醉效果好,但在这4种给药方法中,究竟哪一种能使剖宫产患者血液动力学最稳定、麻醉效果最好、副作用最少,还有待于进一步研究.

  16. Effect of Continuous Epidural Anesthesia on Labor Process in Painless Delivery%无痛分娩中实施持续硬膜外麻醉对产程的影响探究

    Institute of Scientific and Technical Information of China (English)

    刘美艳

    2015-01-01

    目的:探讨持续硬膜外麻醉在无痛分娩中的临床应用及其对产妇产程的影响。方法选取我院2013年1月~2014年12月接收的产妇642例,平均分为观察组和对照组,观察组采用持续硬膜外麻醉,对照组采用自然分娩方法。结果同对照组相比,观察组顺产率高于对照组(P<0.05);观察组活跃期和第二产程低于对照组(P<0.05);同对照组相比,产后出血、胎儿窒息和胎儿宫内窘迫发生率的差异不显著(P>0.05)。结论持续硬膜外麻醉能有效缓解产妇分娩时的疼痛,缩短产妇产程。%Objective To investigate the clinical application of continuous epidural anesthesia in painless delivery. Methods 642 cases maternal were chosen in our hospital in January 2013~December 2014, were randomly divided into the control groupand the observation group. The observation group used continuous epidural anesthesia, the control group using the continuous epidural anesthesia. Results Compared with the control group, the natural labour rate of observed group were signiifcantly higher than that in the control group (P0.05). Conclusion Continuou epidural anesthesia can effectively relieve the pain during delivery, shorten the labor process.

  17. General Anesthesia Combined With Epidural Anesthesia on Elderly Patients With Single Lung Ventilation Intrapulmonary Shunt and Arterial Oxygenation%全麻复合硬膜外麻醉对老年患者单肺通气肺内分流及动脉氧合的影响

    Institute of Scientific and Technical Information of China (English)

    王福杰; 周英娟

    2016-01-01

    Objective Discuss on general anesthesia combined with epidural anesthesia on elderly patients with single lung ventilation pulmonary artery shunt and oxygenation.Methods Randomly selected from May 2013 to December 2015 in our hospital 60 elderly patients with clinical data,depending on the anesthesia,60 patients were divided into two groups, ]one group for the general anesthesia. Group 2 to 1.0% lidocaine anesthesia combined with epidural anesthesia group,30 cases in each. Compared the two groups before the single-lung ventilation lung,single lung ventilation 10 min,20 min,30 min, 40 min of arterial blood gases and arterial oxygenation.Results Arterial oxygen pressure and flow and ventilation points when comparing the two groups,had declined. Epidural anesthesia group decreased more efective than general anesthesia group,compared to the diference was statisticaly significant(P<0.05).Conclusion Anesthesia combined with epidural anesthesia in elderly patients with reduced single-lung ventilation pulmonary shunt,reduced arterial oxygen tension.%目的:探讨全麻复合硬膜外麻醉对老年患者单肺通气肺内分流及动脉氧合的影响。方法随机选择我院2013年5月~2015年12月我院收治的60例行开胸手术的老年患者临床资料,根据不同麻醉方式把60例患者分成2组,1组为全麻组,2组为全麻复合1.0%利多卡因硬膜外麻醉组,每组各30例。比较2组单肺肺通气前、单肺通气10 min、20 min、30 min、40 min的动脉血气及动脉氧合。结果两组单肺通气时动脉氧分压与分流量与通气前对比,均有所下降,全麻复合组下降效果优于单纯全麻组,对比差异有统计学意义(P<0.05)。结论全麻复合硬膜外麻醉减少老年患者单肺通气肺内分流,降低动脉血氧分压。

  18. The observation of the effect of difficulties in epidural anesthesia caused by spinal deformity%脊柱畸形致困难硬膜外麻醉效果观察

    Institute of Scientific and Technical Information of China (English)

    许鸿英

    2015-01-01

    Objective:To investigate the effect of epidural anesthesia for patients with spinal deformity.Methods:32 patinets who completed the spinal deformity difficult to epidural anesthesia were given adult lower abdominal and lower limb operation.In addition,32 adults whose lumbar was normal abdominal had the lower abdominal and lower limb operation to do the comparison. We compared the effect of both anesthesia and the change of physiological indicators.Results:The duration of anaesthesia, anesthetic effect,the sensory recovery time after operation,complications of anesthesia and the changes of Vt,Rf,BR,SpO2 before and after anesthesia compared with the patients with spine normal without obvious difference.Conclusion:The anesthesia effect and its function changes of epidural use in spinal deformity patients is similar to the normal people,therefore,the epidural anesthesia in the various regions of upper abdominal and lower limb operation is feasible.%目的:探讨硬膜外麻醉对于脊柱畸形患者的效果。方法:收治脊柱畸形致困难硬膜外麻醉患者32例,均为成人下腹及下肢手术,另外选取32例腰椎正常无疾患成人进行下腹及下肢手术比较,对比两者麻醉效果及各项生理指标的变化。结果:麻醉的持续时间、麻醉效果、术后感觉恢复时间、麻醉并发症和麻醉前后的Rf、Vt、BR、SpO2的变化与脊柱正常患者差异无统计学意义。结论:硬膜外麻醉应用于脊柱畸形患者时的效果及其各功能的指标变化与正常人相近,因此,上腹部及下肢的各部位手术选择硬膜外麻醉是可行的。

  19. Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Gielen, M.J.M.; Giele, J.L.P.

    2006-01-01

    Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the

  20. Gene expression in term placentas is regulated more by spinal or epidural anesthesia than by late-onset preeclampsia or gestational diabetes mellitus

    Science.gov (United States)

    Lekva, Tove; Lyle, Robert; Roland, Marie Cecilie Paasche; Friis, Camilla; Bianchi, Diana W.; Jaffe, Iris Z.; Norwitz, Errol R.; Bollerslev, Jens; Henriksen, Tore; Ueland, Thor

    2016-01-01

    Pre-eclampsia (PE) and gestational diabetes mellitus (GDM) are common complications of pregnancy, but the mechanisms underlying these disorders remain unclear. The aim was to identify the extent of altered gene expression in term placentas from pregnant women with late-onset PE and GDM compared to controls. RNAseq identified few significantly differentially regulated genes in placental biopsies between PE, GDM, or uncomplicated pregnancy (n = 10 each group). Five genes were altered in placentas from PE including 4 non-coding genes and Angiopoietin 2 (ANGPT2). No genes were significantly regulated by GDM. In contrast, many genes were significantly regulated by fetal, maternal and delivery-specific variables, particularly spinal and epidural anesthesia. We selected ANGPT2 and Chemokine (C-X-C motif) ligand 14 (CXCL14) to test with qPCR in a larger set of placentas (n = 475) and found no differences between the groups. However, regression analysis revealed a stronger association between placental ANGPT2 and CXCL14 mRNA expression and fetal, maternal and delivery-specific variables than diagnostic group. To conclude, the gene expression in term placentas are highly affected by fetal, maternal and delivery specific variables. Few regulated genes were found in late-onset PE and GDM placentas, which may suggest that these conditions could be more affected by maternal factors. PMID:27405415

  1. Comparison of influence of high thoracic epidural anesthesia and central analgesia on hemodynamic during on-bypass coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    V. A. Sobokar

    2015-06-01

    Full Text Available Objective. Despite some advantages, the use of high thoracic epidural anesthesia (HTEA during cardiac operations may be discouraged by fear of adverse hemodynamic effects. Aim. To compare the hemodynamic effects of HTEA and central analgesia (CA during on-bypass CABG. Methods. 132 patients were assigned into two groups – study group (n = 85, where the surgery was carried out under HTEA and control group (n = 47 - where the surgery was carried out under CA. Data of the intraoperative monitoring and trans-oesophageal cardiac ultrasound - cardiac index (CI, stroke index (SI, ejection fraction (EF and index of systemic vascular resistance (ISVR were obtained. Results. After induction and sternotomy patients in the study group had higher EF - 57(53, 65% vs 54 ± 7% (p = 0,013 and 55 ± 8 vs 52 ± 9%, (p = 0,031. After sternotomy CI and SI in the study group were also higher, respectively 2,42 (2,0;3,1 vs 2,23±0,63 l · min-1 · m-2, (p = 0,041 and 43 (34;46 vs 37±10 ml · m-2 (p = 0.014. Conclusion. We concluded that HTEA has advantages over CA by its influence on hemodynamics.

  2. Comparison of the Effects of General Anesthesia and Epidural Combined Anesthesia on Postoperative Early Cognitive Function in Elderly Patients with Postoperative Epidural Analgesia%全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响比较

    Institute of Scientific and Technical Information of China (English)

    隋金玲; 邓蓉蓉

    2015-01-01

    Objective To probe into the effect of general anesthesia and epidural combined anesthesia on postoperative early cognitive function in elderly patients with postoperative epidural analgesia. Methods 115 patients who accepted heart operation treatments in our hospital from January, 2011 to December, 2014 and these patients were randomly divided into the control group and the observation group.In the observation group of 60 patients were received general anesthesia and epidural combined anesthesia and postoperative epidural analgesia while in the control group of 55 patients were received general anesthesia and intravenous analgesia after surgery. Then, the postoperative neurological and mental function and other indicators of two groups of patients were observed and the early postoperative cognitive function of patients was comparative analyzed.Results The incidence of cognitive dysfunction seven days after surgery in the observation group and control group was 51.67% (31/60) and 49.09% (27/55).Conclusion After non cardiac surgery, the elderly patient wil have some early cognitive dysfunction due to surgical operation and education, while the effect of epidural anesthesia and epidural anesthesia on early cognitive function in elderly patients is not obvious.%目的:探讨全身麻醉与硬膜外复合麻醉继以术后硬膜外镇痛对老年患者非心脏手术后早期认知功能的影响。方法选择2011年01月~2014年12月在我院进行非心脏手术的老年患者115例分为对照组和观察组,观察组60例患者接受全身麻醉与硬膜外复合麻醉和术后硬膜外镇痛,对照组55例患者仅接受全身麻醉和术后静脉镇痛。观察两组患者术后神经及精神功能等各项指标,就患者术后早期认知功能情况作对比分析。结果观察组和对照组患者在术后七天的认知功能障碍发生率为51.67%(31/60)、49.09%(27/55)。结论在进行非心脏手术后,老年患者会因外科手

  3. 硬外麻醉镇痛对分娩影响的临床观察%Clinical Study of the Effect of Epidural Anesthesia on Relieving Labor Pain

    Institute of Scientific and Technical Information of China (English)

    赵雅绯; 张晓薇

    2001-01-01

    目的:探讨硬外麻醉的产科镇痛对产痛、产程、分娩方式、新生儿和产后出血的影响。方法:选择80例头位,无产科、麻醉禁忌证的自愿接受镇痛的初产妇(观察组),在宫口开大2~3 cm时,给予硬外麻醉,并与同期条件相似,未给予任何镇痛方法的80例初产妇进行对照(对照组),比较两组产痛、产程时间、分娩方式、产后出血及对胎儿的影响。结果:观察组镇痛有效率与对照组相比,统计学有极显著意义(P0.05)。结论:硬外麻醉镇痛可达到分娩镇痛,加速产程,利于宫口扩张,对新生儿无不良影响,在进一步改进方法,减少手术产率的基础上可推广应用。%To investigate the effects of epidural analgesia on labor pain, labor process, delivery mode, newborns and postpartum hemorrhage. Methods: 80 cases who were free of any obstetric complications and anesthesia contraindication were selected for the study group. Epidural anesthesia was applied when cervix dilated for about 2-3 cm. Another 80 pregnant women with similar obstetric condition were selected as control group and no analgesia was applied. The labor pain, duration, delivery mode, postpartum hemorrhage and the fetal status of the two groups were compared. Result: In the study group,epidural anesthesia showed good effect on relieving labor pain and shortening the active stage of labor course. There was no difference in the incidence of neonatal asphyxia and postpartum hemorrhage between the two groups. Conclusion: Epidural anesthesia is useful in relieving labor pain, accelerating labor course and produce no side effect on fetus.

  4. Efficacy comparison of combined spinal epidural anesthesia and epidural anesthesia in the scarred uterus during cesarean section%腰麻-硬膜外联合麻醉和硬膜外麻醉在瘢痕子宫剖宫产术中的比较

    Institute of Scientific and Technical Information of China (English)

    裘剑波; 裘宁辉; 刘超; 林家燕; 张毅

    2012-01-01

    Objective To compare the anesthetic effect and safety of combined spinal epidural anesthesia (CSEA) and epidural anesthesia (EA) in the scarred uterus during cesarean section.Methods One hundred and twenty cases of the scar uterine pregnant woman aged 23-42,were randomly divided into two groups,EA group (60 cases)and CSEA group(60 cases).In each group,patient were given EA or CSEA before cesarean section,and the ECG,BP,HR,RR and SpO2 were monitored.The pain disappear plane by acupuncture was determined,and the sensory block onset time (when the sensory block parts have fever or numbness after the drug delivery time) was recorded.The lower limb motor block effects were indentified by the improved Browage grading,the Apgar scores of the newborns were recorded and the adverse reactions such as headache,vomiting after anesthesia were observed.Results The sensory block onset time of EA group was significantly slower than that of CSEA group (P < 0.05),the pain disappear plane of CSEA group was higher than that of EA group (P < 0.05),the limb motor block effect of EA group was much lower than that of CSEA group (P < 0.01).Because of insufficient anesthesia,7 cases in EA group could not tolerate the surgery,and had to add assisted local infiltration anesthesia or intravenous analgesics to complete the operation,2 of them changed to general anesthesia.None of the patients in CSEA group had assisted intravenous analgesics or changed to general anesthesia,the anesthetic effect was significantly better than EA group (P <0.01).There were no cases of headache or neurological complications occurred in CSEA group after anesthesia.The Apgar scores of the newborns when the baby was delivered and 1 min after birth in CSEA group were significantly better than those in EA group (P < 0.05),and there was no significant difference in the Apgar scores 5 min or 10 min after birth between the two groups (P > 0.05).Conclusions By small doses of anesthetics,strictly controling the

  5. Effect analysis of the implementation of combined spinal epidural anesthesia by bupivacaine%布比卡因实施腰硬联合麻醉的效果分析

    Institute of Scientific and Technical Information of China (English)

    毛胜良

    2015-01-01

    Objective:To explore the sedative effect and value of the implementation of combined spinal epidural anesthesia by bupivacaine.Methods:120 patients with hypogastric operation were selected.They were randomly divided into two groups.They were given the implementation of combined spinal epidural anesthesia before surgery.The control group were given 1%ropivacaine anesthesia,the observation group were given 0.75% bupivacaine anesthesia.The analgesic onset times,analgesia duration times at T10 and total analgesic times of patients in two groups were compared.Results:The analgesia duration time at T10 and total analgesic time of the control group were significantly less than those of the observation group(P<0.05).Conclusion:Bupivacaine in the implementation of combined spinal epidural anesthesia can achieve an ideal analgesic effect.It can effectively reduce the pain degree of patients,and help to complete the operation smoothly.%目的:探讨布比卡因实施腰硬联合麻醉的镇痛效果及价值。方法:收治下腹部手术患者120例,随机分为两组,均在术前实施腰硬联合麻醉。对照组采用1%罗哌卡因麻醉,观察组采用0.75%布比卡因麻醉。比较两组患者的镇痛起效时间、T10处镇痛持续时间与总镇痛时间。结果:对照组 T10处镇痛持续时间与总镇痛时间均明显少于观察组(P<0.05)。结论:布比卡因在实施腰硬联合麻醉时能够取得理想镇痛效果,可有效减轻患者的疼痛程度,有助于顺利完成手术。

  6. 罗哌卡因腰硬联合麻醉在剖宫产中的临床效果分析%The clinical effect analysis of ropivacaine combined spinal epidural anesthesia in cesar-ean section

    Institute of Scientific and Technical Information of China (English)

    刘治刚

    2015-01-01

    AIM: To investigate the clinical effects of ropiva⁃caine combined spinal epidural anesthesia in cesarean section. METHODS:A total of 56 cases of puerpera accepting cesarean section in our hospital from February 2014 to February 2015 in our hospital were selected as research object, and were randomly divided into observation group ( n=28) and control group ( n=28) . Patients in control group were treated with bupivacaine and lumbar epidural anesthesia, the observation group were given ropivacaine combined spinal epidural anesthesia. The onset time, duration of analgesia, analgesic effect and adverse reactions of two groups were compared. RESULTS: The onset time of anesthesia, dura⁃tion of anesthesia effect, VAS score and other indicators of obser⁃vation group had no significant difference when compared with the control group ( P>0.05) , but the incidence of adverse reactions of the observation group was 7. 14%, and that of the control group was 21. 43%, with statistically significant difference between the two groups(P<0.05).CONCLUSION: Despite the anaesthesia effects of the two groups had no significant difference, the analge⁃sic effect of ropivacaine combined spinal epidural anesthesia was much better than bupivacaine for combined spinal epidural anes⁃thesia in cesarean section, because of its higher security. It is worth clinical promotion.%目的:探讨罗哌卡因腰硬联合麻醉在剖宫产中的临床效果.方法:选择2014-02/2015-02在我院行剖宫产的产妇56例,随机分为对照组(n=28)和观察组(n=28),对照组给予布比卡因和腰硬联合麻醉,观察组给予罗哌卡因腰硬联合麻醉.比较两组产妇阻滞起效时间、镇痛维持时间、镇痛效果及不良反应情况.结果:观察组产妇麻醉阻滞起效时间、麻醉效果持续时间、VAS评分等指标与对照组相比差异无统计学意义(P>0.05);但观察组产妇不良反应发生率(7.14

  7. Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica Estudio comparativo entre la anestesia epidural torácica y la anestesia general en mastectomia oncológica Comparative study between thoracic epidural block and general anesthesia for oncologic mastectomy

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    esthetic breast surgeries but reports of its use in mastectomies with axillary exploration are very rare. The present study compared this technique with general anesthesia in oncologic surgeries of the breasts. METHODS: Forty patients were divided in two groups. The epidural group (n = 20 underwent epidural thoracic block with bupivacaine and fentanyl associated with sedation with midazolam. The other group (n = 20 underwent conventional general anesthesia with propofol, atracurium, and fentanyl, and maintenance with O2 and isoflurane. Duration of the surgery, the need for intraoperative complementation of anesthesia or sedation, and intraoperative hemodynamic parameters were recorded. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, analgesic consumption, adverse effects, and satisfaction with the anesthetic techniques were recorded. RESULTS: Both groups were similar and differences in the duration of the surgery were not observed. Complementary sedation was necessary in 100% of the patients who underwent epidural block and complementary sedation with infiltration of local anesthetic in the axilla in 15% of the patients in this group. The rate of hypertension was more frequent in the group of patients who underwent general anesthesia, while hypotension was more frequent in the epidural group. Pruritus was observed in 55% of the patients in the epidural group. Nausea (30% and vomiting (45% were more frequent in the general anesthesia group. The quality of postoperative analgesia was better in the epidural group, which also presented lower consumption of analgesics; the length hospitalization in this group was also lower. CONCLUSIONS: Epidural block has some advantages when compared with general anesthesia and can be considered an anesthesia option in oncologic mastectomies with axillary lymph node dissection.

  8. Unusual case of persistent Horner's syndrome following epidural anaesthesia and caesarean section.

    Science.gov (United States)

    Goel, Shubhra; Burkat, Cat Nguyen

    2011-01-01

    This is a rare case of persistent Horner's syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) of head, neck, and chest were unremarkable. Medline search using terms Horner's, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner's syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner's syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner's syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  9. Unusual case of persistent Horner′s syndrome following epidural anaesthesia and caesarean section

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

    Full Text Available This is a rare case of persistent Horner′s syndrome following epidural anesthesia and Caesarean section. A 33-year-old female presented with persistent ptosis and miosis following epidural anesthesia and Caesarian section several months prior. Magnetic resonance imaging (MRI/magnetic resonance angiography (MRA of head, neck, and chest were unremarkable. Medline search using terms Horner′s, epidural, spinal anesthesia, delivery, childbirth, Caesarian, and pregnancy identified 31 articles describing Horner′s syndrome in obstetric epidural anesthesia, of which 11 were following Caesarean section. The increased incidence of Horner′s syndrome in the setting of epidural anesthesia in pregnancy may be related to epidural venous engorgement and cephalic spread of the local anaesthetic, with disruption in the oculosympathetic pathway. It is important to include recent epidural anesthesia within the differential diagnosis of acute Horner′s syndrome in a postpartum female. Rarely, the ptosis may be permanent and require surgical intervention.

  10. Paraplegia After Thoracic Epidural Steroid Injection.

    Science.gov (United States)

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.

  11. 腰麻-硬膜外联合麻醉在肥胖妇女子宫全切术的应用价值分析%Application value analysis of combined spinal epidural anesthesia on obey women Hysterectomy

    Institute of Scientific and Technical Information of China (English)

    李晓东

    2014-01-01

    目的:研究腰麻-硬膜外联合麻醉CSEA在肥胖妇女子宫全切术的应用效果。方法行子宫全切术肥胖妇女患者90例作为研究对象,对照组采用传统硬膜外麻醉,观察组采用新型的CSEA,以麻醉时间、手术时间、局部麻醉药物用量来评判麻醉效果,并于麻醉完成后观察两组患者的不良反应。结果对照组的麻醉时间、手术时间、硬膜外局麻药物用量分别为(16.34±4.21)min、(98.32±14.67)min、(29.52±6.28)mL,观察组分别为(6.78±1.47)min、(69.42±16.12)min、(6.14±3.78)mL,观察组麻醉效果明显优于对照组(P<0.05);观察组患者头痛4例、尿潴留3例,腰痛2例,对照组头痛6例,尿潴留5例,腰痛2例,两组不良反应总例数比较差异有统计学意义(P<0.05)。结论 CSEA是值得在基层医院推广使用的麻醉方案。%Objective To study the application results of combined spinal epidural anesthesia on obey women Hysterectomy. Methods Women underwent hysterectomy 90 cases for the study of obesity, the control group using traditional epidural anesthesia, the observation group using the CESA , operation time, amount to an average of epidural anesthesia drugs bureau effects and adverse reactions observed in both groups of patients after anesthesia is complete.Results The control group of anesthesia time, operative time, epidural drug dosage bureau was (16.34±4.21)min, (98.32±14.67)min, (29.52±6.28)mL, observation group were (6.78±1.47)min, (69.42±16.12)min, (6.14±3.78)mL, anesthetic effect observation group than the control group (P<0.05);observation group were headache in 4 cases, 4 cases of hypotension, bradycardia 2 cases, 6 cases of the control group headache,5 cases of hypotension, bradycardia 2 cases, two cases of adverse reactions total number of significant differences (P<0.05). Conclusion CSEA is worth in the primary hospital program to promote the use of anesthesia.

  12. 患者硬膜外注射不同浓度左旋布比卡因的药代动力学%Pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    马民玉; 王承海; 冉菊红; 阚全程; 马君志

    2008-01-01

    目的 探讨患者硬膜外注射不同浓度左旋布比卡因的药代动力学.方法 择期行结肠癌根治术、经腹或腹会阴直肠癌根治术患者20例,ASA Ⅰ或Ⅱ级,年龄35~59岁,随机分为0.75%左旋布比卡因组(Ⅰ组)和0.5%左旋布比卡因组(Ⅱ组),每组10例.麻醉方法为腰段硬膜外阻滞联合全麻.经L1,2硬膜外穿刺成功后,分别经2 min注入0.75%或0.5%左旋布比卡因2 mg/kg.硬膜外注药结束后30 min内记录感觉和运动阻滞效果,记录不良反应发生情况.于注药后即刻、注药后10、20、30、45、60、90、120、210、300、420、540、660和840 min时取中心静脉血3 ml,采用高效液相色谱法测定血浆左旋布比卡因浓度,绘制血浆左旋布比卡因浓度-时间曲线,计算2组药代动力学参数.结果 2组血浆左旋布比卡因浓度-时间曲线均符合二房室开放模型;2组药代动力学参数比较差异均无统计学意义(P>0.05).结论 0.75%和0.5%左旋布比卡因2mg/kg腰段硬膜外阻滞安全性高,血浆药物浓度-时间曲线均符合二房室开放模型,两者药代动力学特性无差异.%Objective To investigate the pharmacokinetics of different concentrations of levobupivacaine for lumbar epidural anesthesia.Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes aged 35-59 yr scheduled for elective rectum or colon cancer operation under general anesthesia combined with epidural block were randomly divided into 2 groups(n=10 each):group Ⅰ 0.75% levobupivacaine and group Ⅱ 0.5% levobupivacaine.Epidural block was performed at L1-2 interspace.Group Ⅰ and Ⅱ received epidural 0.75% and 0.5% levobupivacalne 2 mg/kg(containing adrenaline 5 μg/kg)injected slowly over 2 min respectively.Thirty minutes after epidural levobupivacaine,general anesthesia was induced withγ-hydroxybutyrate 60-80 mg/kg,and remifentanil 1-2 μg/kg.Tracheal intubation was facilitated with succinyl choline 1-1.5 mg/kg and the patients were mechanically

  13. 盐酸氯普鲁卡因用于连续硬膜外麻醉的临床观察%The Effective Observation of Hydrochloroprocaine in Continuous Epidural Anesthesia

    Institute of Scientific and Technical Information of China (English)

    田华

    2012-01-01

    目的:观察3% 盐酸氯普鲁卡因在连续硬膜外麻醉中的有效性和安全性.方法:60 例在L2~3间隙连续硬膜外麻醉下行腹部及以下手术患者随机分为利多卡因组(对照组,n=30) 和盐酸氯普鲁卡因组(实验组,n=30),分别注入2% 利多卡因和3% 盐酸氯普鲁卡因,术中观察心率( HR) 、血压(BP) 、呼吸频率(R) 、脉搏血氧饱和度(SpO2)的变化,记录麻醉后痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间、感觉阻滞平面上界、麻醉质量评分及有无不良反应.结果:两组麻醉前后HR 、BP 、R、SpO2变化一致,组间比较无显著差异.实验组的痛觉消失时间、运动阻滞时间、痛觉恢复时间、运动恢复时间与对照组比较,差异具有显著性(P<0.05).两组感觉阻滞平面相当,差异无显著性.两组麻醉质量0分加1分所占例数的百分比分别为90% 和93%.麻醉效果均满意.两组患者均无不良反应.结论:3 % 盐酸氯普鲁卡因起效快、阻滞效果好、恢复快、无明显不良反应,能安全用于连续硬膜外麻醉.%Objective:To investigate the efficacy and safety of 3%chloroprocaine hydrochloride in continuous epidural anesthesia. Methods:60 patients undergoing abdominal or the following surgery in continuous epidural anesthesia were randomly divided into two:lidocaine group (control group, n=30) and chloroprocaine hydrochloride group (experimental group, n=30), which were individually injected into 2% lidocaine and 3%chloroprocaine hydro chloride, The change of heart rate (HR),blood pressure (Bp), respiratory rate (R),oxygen saturation (SpO2) was observed and recorded;The pain disappeared time, motor block time,pain recovery time, sports recovery time,sense block plane ascending boundary,anesthesia quality grade,having or having not adverse reaction after anesthesia were determined. Results:The change of HR, BP, R, Sp02of the two groups was consistent and the two groups showed no

  14. Applied Research of Cesarean Section in Pre-expansion before the Treatment of Anaesthesia Under Epidural Anesthesia%麻醉前预扩容在硬膜外麻醉下剖宫产的应用研究

    Institute of Scientific and Technical Information of China (English)

    叶芸; 陈小希

    2014-01-01

    目的:临床观察硬膜外麻醉下剖宫产麻醉前液体扩容的临床效果.方法:选择硬膜外麻醉下择期单胎剖宫产的足月产妇共90例,随机分为3组(n=30),A组为麻醉前静脉输注6%羟乙基淀粉130/0.4氯化钠注射液组;B组为麻醉前静脉输注乳酸钠林格液组,C组为不用麻醉前预扩容组,每组各30例.3组均无术前用药.观察3组产妇麻醉后收缩压(SBP)、舒张压(DBP)、心率(HR)的变化,及新生儿 Apgar评分,发生恶心呕吐及麻黄素的使用等情况.结果:A、B两组麻醉后低血压的发生率、麻黄素的使用均低于C组,差异有统计学意义(P<0.05),且 A组血流动力学较 B 组更稳定.新生儿 Apgar 评分3组间差异无统计学意义(P>0.05).结论:在硬膜外麻醉下剖宫产麻醉前使用液体扩容能降低术中低血压的发生率,减少麻黄素的使用,对新生儿无不良影响,且胶体液的这种效果优于晶体液.%Objective:To observe,under epidural anesthesia,the clinical effect of liquid volume expan-sion before the treatment of anaesthesia during cesarean section.Methods:60 pregnancies of the normal full-term birth from singleton caesarean section under epidural anesthesia were randomly divided into three groups,which were named A,B and C group respectively (n=30 cases/per group).Group A were those for intravenous infusion of 6% hydroxyethyl starch and 130/0.4 sodium chloride injection before anesthesia,B were those for intravenous infusion of Sodium Lactate Ringer's inj ection before anesthesia,and C were those for no pre-expansion before anesthesia,three groups were no preoperative medication.We provided a brief observation of changes of systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR), and neonatal Apgar score,the usage of nausea and vomiting and ephedrine among three groups of post-anes-thesia maternal.Results:Group A and B were lower than that of group C on the comparison in incidence

  15. 全程陪伴联合硬膜外阻滞麻醉用于分娩镇痛的护理%Pain relief efficacy by combined epidural block anesthesia with accompanied delivery during the entire labor process

    Institute of Scientific and Technical Information of China (English)

    程凤英; 许孟希

    2014-01-01

    Objective:To assess the pain relief efficacy and nursing outcomes by accompanied delivery throughout the entire labor process with epidural block analgesia.Methods:One hundred and eight primiparae expected analgesic labor were included as observational group managed by combined epidural block anesthesia and whole labor process support by a midwife,and another 100 primiparae without any analgesia at the corresponding period were included as control subjects.Two groups were compared regarding the analgesic effects,maternal and birth outcomes.Results:The analgesic effect achieved in 90.74% of the women managed by combined epidural block anesthesia and whole labor process support of a midwife .Although the observational group re-quired more dosage of oxytocin than the controls (P0.05).Conclusion:Combined epidural block analgesia with active nursing support throughout the entire labor process may produce significant pain relief effects and improve the quality of delivery .%目的:观察全程陪伴分娩联合硬膜外阻滞分娩镇痛的镇痛效果,探讨其护理意义。方法:将108名要求分娩镇痛的初产妇作为观察组,全程专责陪伴分娩联合硬膜外阻滞分娩镇痛,同期内100名无分娩镇痛要求的初产妇配以传统模式分娩作为对照组,不使用任何镇痛药物。比较两组产妇的镇痛效果及分娩结局母儿情况。结果:全程专责陪伴分娩联合镇痛产妇镇痛效果达90.74%;观察组催产素使用率较对照组高(P<0.05);产程无明显差异性(P>0.05);产后出血及新生儿窒息无明显差异性(P>0.05)。结论:硬膜外分娩镇痛效果明显,全程专责陪伴积极的护理措施有助降低分娩痛苦,提高分娩的质量。

  16. Analysis of 80 cases of Doula combined with Epidural anesthesia in labor analgesia%导乐陪伴联合硬膜外麻醉镇痛分娩80例分析

    Institute of Scientific and Technical Information of China (English)

    张锦华

    2014-01-01

    Objective:To discuss the effectiveness of Doula combined with epidural anesthesia in labor analgesia. Methods: 80 cases of primipara without obvious cephalopelvic disproportion , pregnancy complications or pregnancy complications were selected,they were performed Doula and epidural anesthesia when their cervix open 2-3cm,anal-gesic effect,labor,mode of delivery ,blood losing after delivery,and Apgar's score were recorded.Results: All the cases have good effect of analgesics, high rate of natural delivery , shorter labor,low rate of neonatal asphyxia,and no adverse reaction .Conclusion: Doula combined with epidural anesthesia in labor analgesia can significantly reduce the labor pain, the cesarean section rate ,shorten the labor and reduce bleeding, but does not increase the rate of neonatal as-phyxia, or has side effects on mother and child,so it is worth widely applied .%目的:探讨导乐陪伴联合硬膜外麻醉用于分娩镇痛的效果。方法:选择80例无明显头盆不称,无妊娠并发症和妊娠合并症的初产妇,宫口开大2~3cm时施行导乐陪伴及硬膜外麻醉镇痛,记录镇痛效果、产程、分娩方式、产后出血及新生儿Apgar评分等。结果:所有产妇镇痛效果良好,阴道自然分娩率高,总产程缩短,新生儿窒息率低,无不良反应。结论:导乐陪伴联合硬膜外阻滞镇痛分娩,可显著减轻产时疼痛,降低剖宫产率,缩短产程,减少出血量,但不增加新生儿窒息率,对母婴无副作用,值得推广应用。

  17. Analysis of Application of Continuous Epidural Block Anesthesia in Painless Labor%连续硬膜外阻滞麻醉在无痛分娩中的应用分析

    Institute of Scientific and Technical Information of China (English)

    李晓燕; 范亚会

    2016-01-01

    目的:分析连续硬膜外阻滞麻醉在无痛分娩中的应用价值。方法选取我院在2013年6月~2015年6月收治的110例孕足月产妇为研究对象,随机分成观察组和对照组,观察组采取连续硬膜外阻滞麻醉,对照组常规分娩,对比两组产妇的产后症状。结果观察组0级疼痛72.7%高于对照组的40.0%,3级疼痛率1.8%低于对照组21.8%,差异有统计学意义(P<0.05)。结论对于孕足月产妇而言,进行连续硬膜外阻滞麻醉,可以提升阵痛效果,保证了产妇和新生儿的安全。%Objective To analyze the value of application of continuous epidural block anesthesia in the painless labor.MethodsFrom June 2013 to June 2015, 110 cases of pregnant women in our hospital were selected as the research object and randomly divided into observation group and the control group. Observation group adopt continuous epidural block anesthesia, control group take natural childbirth, to compare maternal postpartum symptom of two groups.Results The level of 0 of pain rate about observation group was 72.7%, which was higher than that of control group 40.0%, the level of 3 of pain rate was 1.8%, which was lower than that of the control group 21.8%, the difference was statistically signiifcant (P<0.05).Conclusion For pregnant women, continuous epidural block anesthesia can improve the effect of pain, to ensure the safety of mothers and newborns.

  18. 全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响%Effects of general anesthesia and epidural anesthesia on the short-term cognitive function in the elderly patients after orthopedics surgery

    Institute of Scientific and Technical Information of China (English)

    夏燕飞; 黄浩; 周嘉莉; 罗妙妙

    2012-01-01

    Objective To study the influence of general anesthesia and epidural anesthesia on postoperative short-term cognitive function in the elderly patients undergoing orthopedics surgery.Methods 120 patients with hip joint displacement or internal fixation after femur fracture and American Society of Anesthesiology Ⅰ and Ⅱ were randomly divided into general anesthesia and epidural anesthesia groups(n=60 for each group).Artery blood pressure(ABP)and heart rate were recorded before operation,pre-operation after anesthesia,during 30 min operation,during main operation and at operation end.Cognitive function was detected by mini-mental state(MMS)before induction of anesthesia and 6 h,12 h,24 h and 72 h after anesthesia.Results There were no differences in ABP and heart rate during operation between the two groups(P>0.05).The scores of MMS in general anesthesia group at 6 h(26.5±0.5),12 h(25.4±0.7)and 24 h(27.4±0.3)were decreased as compared with pre-induction of anesthesia(29.5 ± 0.3)(P< 0.05),while no difference was found at 72 h(29.3±0.3).The scores of MMS in epidural anesthesia group at 6 h(26.6±0.4)and 12 h(25.6±0.8)were lower(P<0.05),while had no difference at 24 h(29.1±0.4)and 72 h (29.5±0.4)(P>0.05)as compared with pre-induction of anesthesia(29.4±0.4).At 24 h after anesthesia,the MMS scores were higher in epidural anesthesia group(29.1±0.4)than in general anesthesia group(27.4±0.3)(P<0.01).Conclusions General anesthesia may contribute to more obvious influences on cognitive function than epidural anaesthesias within 12h after operation in the elderly patients undergoing orthopedics surgery.%目的 观察全身麻醉和硬膜外麻醉对老年骨科患者术后短期认知功能的影响. 方法 选择全髋关节置换或股骨骨折切复内固定手术患者120例,美国麻醉医师协会(ASA)病情分级Ⅰ、Ⅱ级,数字抽签随机分为全身麻醉组和硬膜外麻醉组各60例.记录术前、麻醉后手术前、手术30 min、主

  19. Evaluation of Combined General Epidural Anesthesia in 62 Cases of Gynecological Laparoscopic Operation Anesthesia%硬膜外复合全麻在62例妇科腹腔镜手术中的麻醉效果评价

    Institute of Scientific and Technical Information of China (English)

    李英杰

    2014-01-01

    Objective To study anaesthesia effect of the combined general epidural anesthesia in gynecological laparoscopic operation. Methods From 2010 October to 2014 April, 102 cases in our hospital for gynecological laparoscopic operation were divided randomly into the control group (40 cases) and observation group (62 cases). The control group were used conventional general anesthesia, the observation group were treated by general anesthesia combined with epidural anesthesia, comparing and analyzing hemodynamic changes in patients in the two group, postoperative the recovery time and the excellent and good rate of uterine relaxation degree. Results The two groups were observed before and after induction, mean arterial pressure and heart rate fiuctuation, recovery time and uterine relaxation rate in patients in observation was significantly better than the control group, P<0.05, the difference was statistically significant. Conclusion Through general epidural anesthesia in gynecological laparoscopic operation, intraoperative mean arterial pressure and heart rate are stable, uterine relaxation degree is good, and have faster postoperative recovery.%目的:研究硬膜外复合全麻在妇科腹腔镜手术中…的麻醉效果。方法选取2010年10月~2014年4月于本院进行妇科腹腔镜手术治疗的102例患者,分为对照组40例和观察组62例,对照组患者采用普通全麻进行麻醉,观察组患者采用硬膜外复合全麻进行麻醉,观察两组患者术中…血流动力学变化,术后苏醒时间及子宫松弛度优良率,对比并分析两组患者的麻醉效果。结果两组比较,观察组患者诱导前后的平…均动脉压和心率波动较小,苏醒时间和子宫松弛良好率明…显优于对照组,P <0.05,差异具有统计学意义。结论硬膜外复合全麻在妇科腹腔镜手术中…的麻醉效果较好,术中…平…均动脉压和心率均较平…稳,子宫松弛度良好,术后苏醒快。

  20. 局部神经阻滞麻醉与腰硬联合麻醉下治疗腹股沟疝临床效果观察%Clinical Effect of Local Nerve Block Anesthesia and Epidural Anesthesia in the Treatment of Inguinal Hernia

    Institute of Scientific and Technical Information of China (English)

    荣学武

    2015-01-01

    目的:探究局部神经阻滞麻醉和腰硬联合麻醉对腹股沟疝的临床治疗效果。方法将我院收治的88例腹股沟疝患者作为此研究中的研究对象,按照麻醉方法的不同分为观察组以及对照组,并将局部神经阻滞麻醉与腰硬联合麻醉应用其中,比较两组患者的相关指标。结果观察组通过麻醉之后其手术用时、手术中出血量、伤口感染以及复发率低于对照组,采用统计学软件分析后可知两组间存在统计学意义(P<0.05)。结论腹股沟疝患者应采用局部神经阻滞麻醉其操作过程较为简单,同时具备一定的安全可靠性。%Objective To explore the efficacy of local nerve block anesthesia and epidural anesthesia in the treatment of inguinal hernia.Methods88 patients in our hospital inguinal hernia patients in this study as the object of study,according to different methods of anesthesia were divided into observation group and control group,and the local nerve block anesthesia and epidural anesthesia in which the two groups were compared the relevant indicators.Results The anesthesia after the adoption of its operation time,blood loss,wound infection and recurrence rate was significantly lower than the control group, after the analysis shows that the use of statistical software exists between the two groups was statisticaly significant(P<0.05).ConclusionInguinal hernia patients should use local nerve block anesthesia its operation is simple,but with a certain security and reliability.

  1. Compared With Local Anesthesia in Inguinal Hernia Tension-Free Repairsurgery With Epidural Anesthesia%硬膜外麻醉与局部麻醉在腹股沟疝无张力修补术中的应用比较

    Institute of Scientific and Technical Information of China (English)

    李晓耕; 董俊云

    2015-01-01

    ObjectiveTo anesthesia and local anesthesia in inguinal hernia tension-free repair surgery comparison of epidural.Methods The clinical data of 102 cases of inguinal hernia patients.Results Local anesthesia group in operation time, postoperative ambulation time, time of hospitalization and medical costs were lower than the control group.Conclusion Without local anesthesia for treatment of patients with tension-free repair of inguinal hernia, the effect is better.%目的:对硬膜外麻醉与局部麻醉在腹股沟疝无张力修补术中的应用效果进行比较。方法回顾分析102例腹股沟疝患者的临床资料。结果局麻组患者手术时间、术后下床活动时间、住院时间均以及医疗费用均低于对照组。结论对行腹股沟疝无张力修补术治疗的患者实施局部麻醉,效果较好。

  2. Analysis Effect of 120 Cases With Continuous Epidural Anesthesia for Labor Analgesia on Birth Process%持续硬膜外阻滞麻醉分娩镇痛对产程的影响120例分析

    Institute of Scientific and Technical Information of China (English)

    何红霞

    2015-01-01

    Objective To analysis the effect of continuous epidural anesthesia for labor analgesia on birth process.Methods Clinical data of 120 cases with continuous epidural anesthesia for labor analgesia and 120 cases without continuous epidural anesthesia for labor analgesia were respectively analyzed. birth process, pain, satisfaction, and adaptability of two groups were compared.ResultsPain, satisfaction, and adaptability scores of two groups,P<0.01, had difference statistically significance. In non pillow before entering the basin of maternal, the average time of miyaguchi 2 cm wide to full of labor analgesia group was longer than non-labor analgesia group,P<0.01, had difference statistically significance. In outlet diameter < BPD, the second stage of labor of labor analgesia group was longer than non-labor analgesia group,P<0.01, had difference statistically significance.Conclusion Continuous epidural anesthesia for labor analgesia can release maternal pain, and improve maternal degree of cooperation and satisfaction, and with less effect on birth process.%目的分析持续硬膜外阻滞麻醉分娩镇痛对产程的影响。方法回顾性分析采用持续硬膜外阻滞麻醉分娩产妇120例及选择分娩镇痛的产妇120例的临床资料。比较两组产妇产程、产程过程的疼痛程度、满意度、配合度情况。结果两组产程疼痛程度、分娩过程中配合度评分、产程过程的满意度评分比较,P<0.01,差异具有统计学意义。非枕前位入盆的产妇,镇痛组产妇平均宫口开大2 cm到开全时间长于未镇痛产妇,P<0.01,差异具有统计学意义。出口横径<双顶径的产妇,镇痛组第二产程时间长于未镇痛组的产妇,P<0.01,差异具有统计学意义。结论持续硬膜外阻滞麻醉分娩镇痛能够缓解产妇疼痛程度,提高产妇配合度及满意度,对产程的影响较小。

  3. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  4. 右美托咪定联合丙泊酚的硬膜外麻醉及镇静效果比较%Epidural anesthesia and sedation effect of dexmedetomidine combined with propofol

    Institute of Scientific and Technical Information of China (English)

    陆军

    2015-01-01

    目的:观察分析右美托咪定联合丙泊酚的硬膜外麻醉及镇静效果。方法随机选取苏州市立医院北区2012年6月至2014年12月的98例硬膜外麻醉手术患者的临床资料进行回顾性分析。其中使用右美托咪定硬膜外麻醉患者49例为右美托咪定组,右美托咪定联合丙泊酚硬膜外麻醉患者49例为联合组。统计分析两组患者镇静起效时间和苏醒时间,并观察两组患者麻醉前(T0)、维持麻醉5 min(T1)、麻醉30 min(T2)、手术结束(T3)四个时段的 Ramsay 镇静评分及平均动脉压(MAP)和心率(HR)情况。统计两组患者术中和术后不良反应情况。结果联合组患者的镇静起效时间和苏醒时间均明显短于右美托咪定组患者(P <0.05)。T0时两组患者 Ramsay 镇静评分比较差异未见统计学意义(P >0.05),T1、T2和 T3时段联合组患者的 Ramsay 镇静评分均明显低于右美托咪定组,与镇静满意分数接近( P <0.05)。T0时、T1时两组患者 MAP 比较差异未见统计学意义(P >0.05),T2和 T3时联合组患者 MAP 均明显低于右美托咪定组(P <0.05)。T0时、T3时两组患者 HR 比较差异未见统计学意义(P >0.05),T1时和 T2时联合组患者 HR 均低于右美托咪定组(P <0.05)。两组患者术中术后不良反应发生率比较差异未见统计学意义(P >0.05)。结论右美托咪定联合丙泊酚进行硬膜外麻醉时镇静效果更佳,患者不良反应少,安全性高,苏醒快,有利于手术进行。%Objective To observe and analyze the epidural anesthesia and sedation effect of dexmedetomidine combined with propofol. Methods The clinical data of 98 patients underwent epidural anesthesia in the municipal hospital of Suzhou from June 2012 to December 2014 were retrospectively analyzed. Fourty nine patients with epidural anesthesia by dexmedetomidine were dexmedetomidine group,and another

  5. 椎管开放对硬膜外腔局麻药药效动力学的影响%Effect of vertebral canal opening on pharmacodynamics of local anesthesia in epidural space

    Institute of Scientific and Technical Information of China (English)

    邓伟

    2014-01-01

    Objective To investigate the pharmacodynamic changes in local epidural anesthetic and correlated factors before and after epidural space opening during vertebral canal surgery. Methods 120 patients who underwent vertebral canal operation under epidural anesthesia from January 2008 to December 2010 in Anyang City People's Hospital in Henan Provincial were selected. A self control study method was applied to persistently monitor the patients' vital signs〔heart rate variance(HRV),mean arterial pressure(MAP),heart rate(HR),saturation of blood oxygen(SpO2)〕,and the subjective manifestations of patients,the appraisal of surgeon about the surgical local situation(the degree of skeletal muscle relaxation,neural reflex,the ooze blood and so on),the changes in movement (primarily Aαnerve fiber),feeling(primarily Aδnerve fiber),skin temperature(primarily non-myelinated nerve fiber C)within the scope of anesthesia,the dosage of local anesthetic used and the incidence of local anesthetic toxicity were record before and after epidural cavity opening. Results There were no statistical significant differences in vital signs before and after epidural cavity opening in this group of patients. After the opening of epidural space,the local use of anesthetic dosage and the incidence of local anesthetic toxicity were obviously higher than those before the opening〔lidocaine(mg/h):911.23±15.58 vs. 460.19±10.82,ropivacaine(mg/h):13.35±0.19 vs. 5.24±0.17, the incidence of local anesthetic toxicity:67.5%vs. 1.2%,all P<0.01〕,the anesthesia plane(skeletal muscle laxity, feeling,skin temperature)was poorer than that before the opening of epidural space〔the anesthetic plane before the opening was(4.0±1.7),(10.7±1.5),(12.0±1.6)segments respectively,after opening was(2.0±1.8),(10.2±1.3), (12.6±1.9)segments〕,after epidural space opening,the correlations among the three planes(movement sensation disjointed)were worse than those before the epidural space opening

  6. 罗哌卡因蛛网膜下腔麻醉联合硬膜外麻醉在剖宫产手术中的应用%Lumbar Hemp Joint ROM pp Because the Use of Epidural Anesthesia in Cesarean Section

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    王波; 袁军

    2013-01-01

    目的::探究与分析罗哌卡因蛛网膜下腔麻醉(腰麻)联合硬膜外麻醉在剖宫产手术中的安全性和可行性,为临床治疗提供切实可靠的科学依据。方法:随机选取来我院就诊的剖宫产孕妇50例,ASA级,平均分为两组,实验组采取腰麻联合硬膜外麻醉(CSEA),对照组采取单独进行硬膜外麻醉(CEA),每组50例,观察两组在起效时间、肌松效果、阻滞平面、牵拉反应及术中血压变化。结果:术后结果表明,腰麻联合硬膜外麻醉的起效速度要明显快于单独进行硬膜外麻醉,且牵拉反应明显减少,肌松和镇静的效果较好。结论:罗哌卡因腰麻联合硬膜外麻醉可以应用于剖宫产手术,具有安全性和可靠性。%Objective:To explore and analyze the pp kayin lumbar hemp combined epidural anesthesia in cesarean section surgery the feasibility,safety and provide practical and reliable scientific basis for clinical treatment.Methods:Randomly selected 50 cases of cesarean section in pregnant women of our hospital,ASAⅠ~Ⅱlevel,average divided into two groups,experimental group adopted lumbar hemp combined epidural anesthesia (CSEA),control group take separate with epidural anesthesia (CEA),50 cases in each group,observe two groups in effective time,muscle relaxant effect,block surface,draw reaction and intraoperative blood pressure changes.Lumbar hemp. Results:The postoperative results show that the combined effect of epidural anesthesia significantly faster in separate with epidural anesthesia,and retraction of the reaction significantly reduced muscle relaxant and calming effect is better.Conclusion:Luo pp kayin lumbar hemp combined epidural anesthesia can be applied to cesarean section surgery,has the security and reliability.

  7. 右美托咪定用于俯卧位硬膜外麻醉患者镇静的临床观察%Clinical observation of Dexmedetomidine for sedation of patients with epidural anesthesia in prone position

    Institute of Scientific and Technical Information of China (English)

    陈素丽; 杨辉; 赵祉阳

    2014-01-01

    Objective To observe the feasibility and safety of epidural anesthesia applied with Dexmedetomidine seda-tion in patients undergoing percutaneous nephrolithotomy operation in prone position. Methods 40 patients in Beijing Aerospace General Hospital from April to August 2012, ASA Ⅰ-II, scheduled to percutaneous nephrolithotomy and epidural anesthesia, were randomly divided into two groups:Dexmedetomidine group (group D) and control group (group C), with 20 cases in each group. After 10 minutes of prone position was placed, in patients of group D, Dexmedetomidine was slowly infused at dose of 0.5 μg/kg in 10 minutes (loading dose), then maintain a starting dose of 0.2 μg/(kg·h) infusion. Every 10 minutes for a richmond agitation-sedation scale (RASS) score, according to the score, Dexmedetomi-dine dose corresponding changes of 0.1μg/(kg·h) to maintain the RASS score at-2. Patients in group C were not given any intravenous sedation agent. RASS scores at different timing, respiratory rate and general vital signs of the two groups were recorded. Arterial blood was draw at epidural plane after fixation (T1), prone position after 10 minutes (T2) and intravenous medication reaches a predetermined depth of sedation after 10 minutes (T3) for blood gas analysis. The surgery comfortable satisfaction of patients was assessed after operation for 24 hours. Postoperative complications within 24 hours were recorded. Results During the operation, RASS score in group D was significantly lower than group C (P 0.05);after T3, the blood pressure and heart rate in the patients of group D were gradually decreased, MAP and HR in group D were lower than those in group C (P0.05);镇静开始后,D组患者血压逐渐下降,心率减慢,D组平均动脉压、心率均低于C组(P<0.01);D组患者术中满意度显著高于C组(P<0.05),术后并发症显著低于C组(P<0.01)。结论右美托咪定可安全用于俯卧位经皮肾镜取石术硬膜外麻醉患者的静脉

  8. Use of local or epidural anesthesia in inguinal hernia repair: a randomized trial%局部麻醉和硬膜外麻醉在腹股沟疝无张力修补术中的对照研究

    Institute of Scientific and Technical Information of China (English)

    杨斌; 梁明娟; 张育超; 陈双

    2008-01-01

    目的 探讨局部麻醉和硬膜外麻醉下行腹股沟疝修补术的疗效与安全性. 方法 2004年1月至2006年12月我院收治的269例腹股沟疝患者,按数字表法随机分为两组,143例采用局部浸润麻醉,126例采用硬膜外麻醉,比较分析两组临床资料. 结果 局部麻醉组在手术(加麻醉)时间、下床时间、住院天数及费用方面均明显少于硬膜外麻醉组(P0.05).两组患者的伤口及阴囊并发症发生率差异无统计学意义(P>0.05).硬膜外麻醉组术中平均动脉压下降,术后恶心、呕吐、尿潴留发生率显著高于局部麻醉组(P0.05). 结论 局部麻醉下行腹股沟疝修补手术简单、安全、经济、可靠,是更为理想的麻醉方式.%Objective To investigate the efficacy and safety of local anesthesia and epidural anesthesia in tension-free repair of inguinal hernia. Methods Between January 2004 and December 2006, 269 patients underwent inguinal hernia repair were randomly divided into two groups, receiving local anesthesia (143 cases) and epidural anesthesia (126 cases). The clinical data from the two groups were analyzed retrospectively. Results The operation time, ambulation time, length of hospital stay and cost of hospitalization in local anesthesia group were significantly less than those in epidural anesthesia group( P < 0. 05 ). No significant differences were found in intra-operative use of ancillary sedation drugs, postoperative recovery situation, pain scores and operation-correlated complications between the two groups. The occurrence of postoperative anaesthetic complication rate was also significantly lower in local anesthesia group (P < 0. 05 ). One case of recurrence occurred in each group during postoperative follow-up period. Conclusion Tension-free inguinal hernia repair under local anesthesia is a simple, safe, economical, effective procedure and superior to epidural anesthesia.

  9. Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75% na anestesia peridural Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia

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    Paula Fialho Saraiva Salgado

    2008-04-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi avaliar as características clínicas da anestesia peridural realizada com ropivacaína associada à dexmedetomidina. MÉTODOS: Quarenta pacientes submetidos à correção cirúrgica de hérnia inguinal ou varizes de membros inferiores sob anestesia peridural participaram deste estudo. Os pacientes foram divididos em: Grupo Controle (n = 20, ropivacaína 0,75%, 20 ml (150 mg; e Grupo Dexmedetomidina (n = 20, ropivacaína 0,75%, 20 ml (150 mg, mais dexmedetomidina, 1 µg.kg-1. As variáveis estudadas foram: tempo de latência do bloqueio sensitivo, dermátomo máximo de anestesia, tempo de duração dos bloqueios analgésico e motor, intensidade do bloqueio motor, nível de sedação, variáveis hemodinâmicas, analgesia pós-operatória e ocorrência de efeitos colaterais. RESULTADOS: A dexmedetomidina não influenciou o tempo de latência da anestesia nem o nível máximo do bloqueio sensitivo (p > 0,05, mas prolongou o tempo de duração dos bloqueios analgésico e motor (p 0,05. A ocorrência de efeitos colaterais (tremor, náuseas e SpO2 0,05. CONCLUSÃO: Há sinergismo evidente entre a dexmedetomidina e a ropivacaína na anestesia peridural sem que haja elevação da morbidade relacionada a associação dos fármacos.BACKGROUND: This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. METHODS: Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20, 0.75% ropivacaine, 20 ml (150 mg; and Dexmedetomidine Group (n = 20, 0.75% ropivacaine, 20 ml (150 mg, plus dexmedetomidine, 1 mg.kg-1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia

  10. Study on effect of combined intravenous and inhalation general anesthesia or combined spinal epidural anesthesia in laparoscopic opera-tion for inguinal hernia%腹股沟疝患者采用腹腔镜手术治疗中静吸复合全身麻醉与腰硬联合麻醉的对比研究

    Institute of Scientific and Technical Information of China (English)

    钱建学; 须挺

    2015-01-01

    Objective To compare the effect of combined intravenous and inhalation general anesthesia and combined spinal epidural an-esthesia applied in laparoscopic operation for treatment of patients with inguinal hernia. Methods Eighty patients with inguinal hernia were trea-ted with laparoscopic operation,the application of combined spinal and epidural anesthesia in 40 patients as observation group,and application of combined intravenous and inhalation general anesthesia in 40 cases as control group,and the effect of anesthesia in these two groups had been com-pared. Results The Ramsay scores of patients with grade I in observation group were significantly lower than those of control group,and Ramsay scores in patients with grades II ~ IV in observation group were significantly higher than those of control group,and the difference was statistically significant( P < 0. 05). The onset time of anesthesia and awake time in patients of observation group were lower than those of patients in control group,and the difference was statistically significant( P < 0. 05). Conclusion Epidural anesthesia is good in laparoscopic operation for patients with inguinal hernia,with short onset time and shorter awake time,hence it is worthy for clinical application.%目的:对比静吸复合全身麻醉和腰硬联合麻醉在腹股沟疝腹腔镜手术治疗的麻醉效果。方法选取需进行腹腔镜手术治疗的腹股沟疝患者80例,其中应用腰硬联合麻醉患者40例作为观察组,应用静吸复合全身麻醉40例作为对照组,观察两组麻醉效果。结果①观察组患者 Ramsay 评分为 I 级患者明显少于对照组,而 II ~ IV 级患者明显多于对照组,差异有统计学意义( P <0.05);②观察组患者麻醉起效时间、清醒时间明显低于对照组,差异有统计学意义( P <0.05)。结论硬联合麻醉对腹腔镜手术腹股沟疝患者麻醉效果好,起效时间短,术后清醒快,值得在临床上推广应用。

  11. Safety and advantage analysis of waist-epidural anesthesia in painless childbirth%腰-硬膜联合麻醉在无痛分娩中的可行性及优势分析

    Institute of Scientific and Technical Information of China (English)

    周家影

    2015-01-01

    Objective To analyze the safety and advantage of waist-epidural anesthesia in painless childbirth. Methods 55 cases of primipara with waist-epidural anesthesia in painless childbirth in our hospital from April 2012 to March 2014 were selected as experimental group,and 55 primipara who were not taken with painless childbirth in our hospital at the same period were selected as control group.The analgesic effect,including labor duration,manner of delivery,post-partum hemorrhage,voiding time and newborns of the two groups was observed. Results The effect of anesthesia in the experimental group was better than that of control group,it was mainly 0,1 level of pain,it was mainly 1 and 2 level of pain in control group, the percentage of pain in 0,1 level in experimental group was higher than that of control group,3 level was lower than that of control group,the difference was significant (P<0.05).The first labor of experimental group was shorter than that of control group,the difference was significant (P<0.05). Conclusion Waist-epidural anesthesia can decrease delivery time with good safety,and should be widely used in clinic.%目的:探讨腰-硬膜联合麻醉在无痛分娩中的可行性及优势。方法选取2012年4月~2014年3月本院采用腰-硬膜联合麻醉镇痛分娩的初产妇55例,设为实验组;选取同期实施无镇痛分娩的55例产妇设为对照组。对比两组产妇的疼痛等级、产程时间、分娩方式及分娩结局。结果实验组镇痛效果明显优于对照组,主要为0、1级疼痛,对照组主要为1、2级疼痛,两组3级疼痛均较少;实验组产妇0级、1级的百分率明显高于对照组,3级的百分率低于对照组,差异有统计学意义(P<0.05)。实验组第一产程明显短于对照组,差异有统计学意义(P<0.05)。结论腰-硬膜联合麻醉用于分娩镇痛,可明显减轻分娩疼痛,缩短第一产程,对产妇及新生儿无明显影响,是一种安全有效的无痛分娩方法,值得临床推广。

  12. Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

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    H.A. El Gendy

    2014-07-01

    Conclusion: Adding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.

  13. Prolongation of lidocaine-induced epidural anesthesia by medium molecular weight hyaluronic acid formulations: pharmacodynamic and pharmacokinetic studies in the rabbit.

    Science.gov (United States)

    Doherty, M M; Hughes, P J; Korszniak, N V; Charman, W N

    1995-04-01

    We evaluated the utility of medium molecular weight hyaluronic acid for prolonging the local anesthetic activity of lidocaine in a rabbit model of epidural analgesia. Equiviscous formulations were prepared as either a physical mixture of lidocaine hydrochloride and sodium hyaluronate (where drug release occurred via diffusion) or as a lidocaine-hyaluronate complex (where drug release occurred via diffusional and electrostatic processes). The novel hyaluronic acid formulations were functionally evaluated, relative to lidocaine solution, in an intact, conscious rabbit model. The hyaluronate formulations were well tolerated. The duration of sensory block and loss of weight-bearing was prolonged twofold by the lidocaine-hyaluronate complex relative to the solution (P lidocaine plasma concentration-time data indicated that the rate of drug absorption from the lidocaine-hyaluronate complex was decreased fourfold relative to the solution (P hyaluronic acid may offer advantages for the prolongation of epidural analgesia.

  14. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study FNx01

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    Saeid Abrishamkar

    2011-01-01

    Full Text Available Background: Low Back Pain (LBP and radicular leg pain (RLP after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. Methods: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1, methylprednisolone acetate (group2 and normal saline (control group. The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS. Results: Of 66 patients, 53% were female and 47% male. The average (SE LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. Conclusions: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.

  15. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study*

    Science.gov (United States)

    Abrishamkar, Saeid; Rafiei, Ahmad Reza; Sabouri, Masih; Moradi, Siamak; Tabesh, Homayoun; Rahmani, Payman; Hekmatnia, Ali; Torkashvand, Mostafa; Eshraghi, Noorolah; Baghershahi, Ghasem

    2011-01-01

    BACKGROUND: Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. METHODS: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS). RESULTS: Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. CONCLUSIONS: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery. PMID:22091284

  16. Application of a small dose of Fentanyl adding into epidural anesthesia in cesarean section%局麻药复合小剂量芬太尼硬膜外麻醉在剖宫产术中的应用

    Institute of Scientific and Technical Information of China (English)

    邬小南; 陈耀兵; 郑鹤秀

    2012-01-01

    目的 观察剖宫产术硬膜外麻醉局麻药中加入小剂量芬太尼对麻醉效果的影响.方法 218例ASA Ⅰ~Ⅱ级足月单胎头位妊娠产妇硬膜外麻醉下行剖宫产术,随机分为A组(观察组)109例和B组(对照组)109例.选择L2~3行硬膜外穿刺,试验量2%利多卡因4 ml,5 min无脊麻征象后,A组分次追加含2 μg/ml芬太尼的2%利多卡因及0.75%罗哌卡因各5 ml,B组则分次追加2%利多卡因及0.75%罗哌卡因各5ml,根据阻滞平面可再追加相应局麻药,直至无痛平面达T8后开始手术.记录阻滞平面达T8所需时间、初次剂量、最高阻滞平面及局麻药作用持续时间;于切皮、进腹、取胎及缝皮时记录VAS评分,监测并记录麻醉前、注药后5 min、15 min、30 min、术毕时SBP、DBP、HR、SpO2;观察进腹及取胎时的牵拉反应以及新生儿出生后1 min、5 min Apgar评分.结果 A组在切皮和进腹时VAS评分明显低于B组(P<0.05),而取胎和缝皮时两组差异无统计学意义(P>0.05);最高阻滞平面两组相当,而阻滞平面达T8所需时间和初次剂量A组明显少于B组(P<0.05);麻醉作用持续时间A组明显比B组长(P<0.01),牵拉反应A组明显轻于B组(P<0.05),而BP、HR、SpO2及新生儿Apgar评分两组间差异无统计学意义(P>0.05).结论 局麻药复合小剂量芬太尼硬膜外麻醉可以明显缩短麻醉起效时间,减少局麻药用量,增强麻醉效果,且对新生儿无明显影响,可以安全地用于产科麻醉.%Objective To observe the anesthetic effect of epidural anesthesia adding a small dose of Fentanyl in cesarean section. Methods 218 cases of ASA Ⅰ ~ Ⅱ class full-term pregnancy, maternal fetal head position single with epidural anesthesia for cesarean section were randomly divided into group A (study group 109 cases) and group B (control group 109 patients). L2~3 accepted epidural puncture, amount of 2% Lidocaine 4ml,5min after no signs of spinal

  17. Improved Epidural Anesthesia in 66 Cases of Spinal Tuberculosis and Dia-betes Patients Observation%改良硬膜外麻醉在66例脊柱结核并糖尿病患者中的应用观察

    Institute of Scientific and Technical Information of China (English)

    郜雪慧; 周伟

    2015-01-01

    目的:观察改良硬膜外麻醉在脊柱结核并糖尿病患者中的应用效果。方法选取132例脊柱结核并糖尿病患者按随机数字表法分成研究组和对照组各66例。对照组行常规硬膜外麻醉,研究组给予改良硬膜外麻醉。对比两组的麻醉效果、并发症及术后血糖水平。结果两组麻醉效果优良率无明显差别(P>0.05);研究组并发症发生率低于对照组(P0.05)。结论改良硬膜外麻醉在脊柱结核并糖尿病患者中应用临床疗效好,安全性高。%Objective To observe the improvement of epidural spinal tuberculosis and diabetes application effect. Methods 132 cases of spinal tuberculosis and diabetes patients were randomly divided into study group and control group of 66 cases. Routine epidural anesthesia group, study group received epidural anesthesia improved. Compared two groups of anesthesia, complications, and blood glucose levels. Results There was no anesthetic effect two good rate significant difference(P>0.05); morbidity study group than the control group (P0.05) postoperative blood glucose levels. Conclusion The modi-fied epidural anesthesia tuberculosis and diabetes clinical application is effective in the spine and safe.

  18. The effects of local anesthesia and epidural anesthesia on immune function in patients undergoing benign breast tumor surgery%局部浸润麻醉和硬膜外麻醉对乳腺良性肿瘤切除患者免疫功能的影响

    Institute of Scientific and Technical Information of China (English)

    季蒙; 陶军; 王庆利; 黎笔熙

    2013-01-01

    Objective To investigate the effects of local anesthesia and epidural anesthesia on immune function in patients undergoing benign breast tumor surgery.Methods 62 patients undergoing benign breast tumor surgery were selected and divided into two groups,local anesthesia group (n =31),epidural anesthesia group (n=31).Peripheral vein blood was obtained before anaesthesia(T1),at 30 rain(T2),60 min (T3)and 90 min(T4)during anaesthesia for detecting CD3+,CD4+,CD8+,and natural killer cells by flow cytometry,IL-12,IFN-γ,IL-4,TNF-α by ELISA,lgG,lgA,lgM by immunodiffusion.Results In epidural anesthesia group,the level of lgG,lgA and lgM at T1 reduced compared with those at T0(P<0.05).There were significant different in the level of lgG,lgA and lgM at T1 between two groups(P<0.05).In epidural anesthesia group,at T2 and T3,CD4+ increased and natural killer cells decreased significantly compared with those at T1 (P<0.05).In local anesthesia group,the level of IL-12,IFN-γ and TNF-α at T3 increased compared with those at T0(P<0.05).There were significant different in the level of IL-12,IFN-γ and TNF-α at T3 between two groups(P<0.05).Meanwhile,there were significant different in the level of TNF-α at T2 between two groups(P<0.05).Conclusion This study indicates that local anesthesia has less effects on immune function than that of epidural anesthesia in patients undergoing benign breast tumor surgery.%目的 比较局部浸润麻醉和硬膜外麻醉对乳腺良性肿瘤切除患者免疫功能的影响.方法 将入选的62例行乳腺良性肿瘤切除患者随机分成硬膜外麻醉组和局部浸润麻醉组各31例,分别测定麻醉前(T0)及麻醉后30 min(T1)、60 min(T2)及90 min(T3)的血清T细胞亚群自然杀伤细胞、免疫蛋白浓度以及细胞因子浓度,并对测定结果进行统计学比较.结果 硬膜外麻醉组在T1时的lgG、lgA及lgM水平均较T0明显降低(P<0.05),且在T1时硬膜外麻醉组的lgG、lgA及lgM水平也

  19. Effect of epidural anesthesia using ropivacaine combined with remifentanil on del ivery%罗哌卡因复合瑞芬太尼硬膜外麻醉对产妇分娩的影响

    Institute of Scientific and Technical Information of China (English)

    程雯

    2016-01-01

    目的::探讨罗哌卡因复合瑞芬太尼对有无痛分娩要求产妇进行硬膜外麻醉的镇痛效果及安全性。方法:选取本院妇产科拟行无痛分娩产妇80例(镇痛组,采用罗哌卡因复合瑞芬太尼行硬膜外镇痛)、80例未采用任何镇痛措施的分娩妇女作为对照组,两组产妇均在同一组助产医护人员的帮助下进行分娩,观察两组分娩过程的疼痛、分娩结局等指标差异。结果:两组 T0时刻 VAS 评分比较,差异无统计学意义(P >0.05);在镇痛后 T1、T2、T3、T4、T5、T6时刻镇痛组的 VAS 评分均低于对照组,差异具有统计学意义(P 0.05);两组的分娩方式、新生儿体重、第1分钟及第5分钟 Apgar 评分比较,差异均无统计学意义(P >0.05)。结论:罗哌卡因复合瑞芬太尼对有无痛分娩要求产妇进行硬膜外麻醉能够显著的减轻产妇的分娩疼痛,同时不会对分娩过程及新生儿造成不良影响。%[ABSTRACT]Objective:To study the analgesic effect and security of epidural anesthesia in maternal who have painless childbirth requirements and treated with ropivacaine epidural analgesia combined with remifentanil.Methods:Obstetrics and gynecology scheduled for painless delivery of maternal were selected.80 cases treated with ropivacaine epidural analgesia com-bined with remifentanil as analgesic group.80 cases did not use any analgesia of childbirth women as controls group.Different index of childbirth pain and birth outcomes were observed during childbirth in two groups.Midwifery were the same staff throughout this study.Results:VAS score of T0 time was not statistically significant between analgesia group and control group (P >0.05);VAS scores of T1,T2,T3,T4,T5,T6 moments in analgesia group were significantly lower than control group (P 0.05).Mode of delivery,birth weight,1 min Apgar,5 min Apgar scores between the two groups were not significantly different (P >0.05 ).Conclusion

  20. Catheter-related epidural abscesses -- don't wait for neurological deficits.

    NARCIS (Netherlands)

    Royakkers, A.A.; Willigers, H.; Ven, A.J.A.M. van der; Wilmink, J.T.; Durieux, M.; Kleef, M. van

    2002-01-01

    Epidural abscess is a rare but serious complication of epidural anesthesia for peri- and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and

  1. Clinical observation of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery%瑞芬太尼全麻复合硬膜外麻醉用于开胸手术的临床观察

    Institute of Scientific and Technical Information of China (English)

    王全胜; 岳谦

    2010-01-01

    Objective To investigate the effect and safety of remifentanil anaesthesia combined with epidural anesthesia in thoracic surgery. Methods Two hundred patients, ASA Ⅰ - Ⅱ grade, undergoing thoracotmy were randomly allocated to two groups:Remifentanil group (group R) and Fentanyl group (group F). Two groups were given combined general-epidural anesthesia. Patients in group R received remifentanil. Group F received fentanyl. The blood pressure, heart rate, blood oxygen saturation and plasma cortisol were measured before the operation (T0), 1 min (T1) and 5 min (T2) after tracheal intubation, skin incision(T3) and 5 min after the operation (T4). The endotracheal extubation time and conscious recovery were recorded. Results Compared with group R, the incidence of endotracheal intubation reaction in group F is significantly higher (group F-14/26,53.8% ;group R-4/26,15.4% ;P<0.05 ).All the patients in group R were extubated and recovered conscious completely at 7 min after operation. 6 patients in group F were extubated at 25 min after operation and 3 of them recovered recognition completely one hour later. Conclusion Remifentanil have a faster recovery after surgery than fentanyl, and it can effectively inhibit tracheal intubation stress response. Remifentanil anaesthesia combined with epidural anesthesia can provide perfect acesodyne and maintain steady circulation.%目的 观察瑞芬太尼全麻复合硬膜外麻醉在开胸手术中的应用效果和安全性. 方法 200例择期行开胸手术患者,ASA Ⅰ~Ⅱ级,按完全随机分组方法分为两组,瑞芬太尼组(R组)与芬太尼组(F组),均采用硬膜外复合气管插管全麻,R组与F组分别采用瑞芬太尼和芬太尼麻醉,观察术前(T0)、气管插管后1 min(T1)、5 min(T2)、切皮(T3)和术后5 min(T4)的血压、心率、血氧饱和度和血中皮质醇水平,记录术后拔管时间及患者的认知能力恢复情况. 结果 两组气管插管反应发生率相比较,F组(14

  2. Influence of painless labor by combined spinal-epidural anesthesia on delivery mode%腰硬联合麻醉无痛分娩对分娩方式的影响

    Institute of Scientific and Technical Information of China (English)

    徐冠英

    2012-01-01

    目的 探讨腰硬联合麻醉无痛分娩对分娩方式选择的影响.方法 选择在德州市妇幼保健院经阴试产的初产妇628例,其中接受腰硬联合麻醉无痛分娩252例为观察组,未接受无痛分娩的376例为对照组,比较两组间的疼痛程度、产程时间和社会因素剖宫产情况.结果 观察组疼痛程度显著轻于对照组(χ2=430.18,P<0.01),观察组社会因素剖宫产率显著低于对照组(10.53% vs 59.72%,χ2=14.56,P<0.01),观察组第一产程时间明显短于对照组(5.73±1.01h vs 7.90±1.38h,t=19.757,P<0.05).结论 开展腰硬联合麻醉无痛分娩可显著减轻疼痛、缩短产程,提高自然分娩率,降低社会因素剖宫产率.%Objective To explore the influence of painless labor by combined spinal-epidural anesthesia on selection of delivery mode. Methods Altogether 628 primipara taking trial vaginal labor were selected from Dezhou Municipal Maternal and Child Health Hospital, including 252 cases accepting combined spinal-epidural anesthesia ( observation group ) and 376 cases of not accepting it ( control group ). The pain degree, duration of labor and social factors of cesarean section of two groups were compared. Results The pain degree in observation group was significantly weaker than that in control group (X2 =430. 18,P < 0. 01 ). The rate of cesarean section caused by social factors in observation group was significantly lower than that in control group ( 10. 53% vs 59. 72% ,X2=14. 56, P <0. 01 ). And the duration of first stage of labor was obviously shorter than that of control group ( 5.73 ± l.0lh vs 7. 90 ± 1. 38h, t = 19. 757,P <0.05 ). Conclusion Painless labor by combined spinal-epidural anesthesia can effectively relieve pain, shorten stage of labor, improve natural birth rate and reduce the rate of cesarean caused by social factors.

  3. 腹部手术硬全联合麻醉术后谵妄的影响因素%The Inlfuencing Factors of Postoperative Delirium in Continuous Epidural Block Combined with General Anesthesia with Tracheal Intubation on Abdominal Operation

    Institute of Scientific and Technical Information of China (English)

    曾晓燕; 李正芬

    2013-01-01

    目的:分析腹部手术硬全联合麻醉患者术后谵妄的影响因素。方法:采用病例对照研究方法,选择腹部手术硬全联合麻醉患者,根据患者术后3天内是否发生谵妄分为病例组和对照组,以单因素分析联合多因素分析方法研究患者术后发生谵妄的影响因素。结果:患者术后谵妄发生率4.95%,患者均在术后24 h内发病;高龄、手术时间>2h、术后疼痛评分>2分、肺部慢性疾病史、饮酒史是患者术后发生谵妄的危险因素。结论:对高龄、既往患有肺部慢性疾病、手术时间长的患者,术后密切监测电解质、血气,防治肺部感染的发生,以降低患者术后谵妄的发生率。%Objective:To analysis the influencing factors of postoperative delirium in continuous epidural block combined with general anesthesia with tracheal intubation on abdominal operation. Methods:The case control study were used, continuous epidural block combined with general anesthesia with tracheal intubation on abdominal operation patients were selected, was divided into case group and control group according to the delirium of patients after 3 days, study the influence factors of postoperative delirium in patients by single factor analysis and multiple factor analysis.Results:The incidence rate of delirium was 4.95%in patients, the patients were onset within 24h;senility, operation time≥2h, postoperative pain score>2, chronic lung disease, drinking history were risk factors of postoperative delirium for patients.Conclusion:In the light of elderly patients, who suffered from chronic lung disease, long operation time of patients, postoperative close monitoring of electrolytes, blood gas analysis, prevention and treatment of pulmonary infection, to reduce the incidence of postoperative delirium in elderly patients .

  4. Anestesia peridural lombar ou bloqueio do plexo lombar combinados à anestesia geral: eficácia e efeitos hemodinâmicos na artroplastia total do quadril Anestesia epidural lumbar o bloqueo del plexo lumbar combinados con la anestesia general: eficacia y efectos hemodinámicos en la artroplastia total de la cadera Epidural lumbar block or lumbar plexus block combined with general anesthesia: efficacy and hemodynamic effects on total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-12-01

    avanzada y de las enfermedades asociadas a los pacientes. El objetivo del estudio, fue evaluar si el bloqueo del plexo lumbar combinado con la anestesia general, equivale a la anestesia epidural lumbar en cuanto a la eficacia del bloqueo nociceptivo, efectos hemodinámicos secundarios, dificultad en su ejecución e influencia en el sangramiento operatorio en pacientes sometidos a la ATC. MÉTODO: Pacientes estado físico ASA I a III que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. En el grupo Epidural, se realizó la anestesia epidural lumbar continua con la ropivacaína a 0,5% 10 a 15 mL. En el grupo Lumbar, fue realizado el bloqueo del plexo lumbar por la vía posterior con ropivacaína a 0,5% 0,4 mL.kg-1. Todos los pacientes fueron sometidos a la anestesia general. Se estudiaron: la dificultad en la ejecución de los bloqueos, su eficacia y los efectos hemodinámicos secundarios. RESULTADOS: Cuarenta y un pacientes fueron incluidos en el estudio. El tiempo para la ejecución del bloqueo epidural fue menor, pero el número de intentos en colocar la aguja fue similar en los dos grupos. El bloqueo epidural fue más eficaz. En el grupo Lumbar, se registró un aumento de la presión arterial diastólica y media (PAM y en el doble producto. Después de la incisión, el consumo anestésico durante la operación fue mayor. Posteriormente al bloqueo, la PAM fue menor en los 50, 60 y 70 minutos después de la realización del bloqueo epidural. El sangramiento fue parecido en los dos grupos. CONCLUSIONES: La técnica epidural promovió un bloqueo nociceptivo más eficaz sin asociarse a la inestabilidad hemodinámica, cuando se le combinó con la anestesia general. El bloqueo del plexo lumbar fue una técnica útil en combinación con la anestesia general cuando la anestesia epidural estuvo contraindicada.BACKGROUND AND OBJECTIVES: Anesthesia for total hip arthroplasty (THA is a challenge due to the advanced age and associated diseases of patients. The objective

  5. Analgesia de parto: estudo comparativo entre anestesia combinada raquiperidural versus anestesia peridural contínua Analgesia de parto: estudio comparativo entre anestesia combinada raqui-peridural versus anestesia peridural continua Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto de Figueiredo Côrtes

    2007-02-01

    proporcionado un rápido e inmediato alivio del dolor. Estudios clínicos con mayor número de casos son necesarios para evaluar diferencia en la incidencia de cesarianas.BACKGROUND AND OBJECTIVES: Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl. METHODS: Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between analgesia and complete cervical dilation, duration of the expulsive phase, maternal hemodynamic parameters, and vitality of the newborn. Possible complications, such as respiratory depression, maternal hypotension, pruritus, nausea, and vomiting were also evaluated. The Student t test was used to compare the means and the Chi-square test was used to compare the number of pregnancies and type of labor. RESULTS: There were no statistically significant differences between both groups regarding the length of time between the beginning of analgesia and complete cervical dilation, as well as regarding the duration of the expulsive phase, incidence of cesarean section related to the analgesia, maternal hemodynamic parameters, and vitality of the newborn. CONCLUSIONS: Both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. Clinical studies with a larger number of patients are necessary to

  6. 腰麻联合硬膜外麻醉在老年患者下腹部手术中的应用%The applications of combined spinal and epidural anesthesia in elder following abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    崔中璐; 柴小青

    2013-01-01

    Objective To evaluale the clinical efficacy and safely of combined spinal and epidural aneslhesia ( CSEA) in elder palienls who undertahen lower abdominal surgery. Methods 80 elderly patienls (ASA class Ⅱ - Ⅲ ) scheduled for selective abdominal surgery were allocated randomly to eilher conlinuous epidural aneslhesia(CEA) group or combined spinal and epidural aneslhesia (CSEA) group( n =40, each group) . MAP, HR and SpO2 were recorded in the first hour after aneslhesia. The onset lime, sensory block level, perfect lime, quality of aneslhesia and the side effects such as headache were observed after operation. Results The two groups of bleeding had no significant difference. But the downtrend of blood pressure in CSEA group and bradycardia were significantly less than those in CEA group( P <0. 05) . The two groups reported no headache. The onset time and perfect time of anesthesia in CSEA group were significantly shorter than those in CEA group( P <0. 01) . The effect of anesthesia in CSEA group( 100% ) was better than CEA group( 80% ) . The anesthetic highest level under T8 did not differ between the two groups. Con- clusion CSEA is a safe and effective melhod for the elder palienls underlahen lower abdominal surgery.%目的 研究腰硬联合麻醉用于老年患者下腹部手术的可行性和安全性.方法择期拟行下腹手术老年患者80 例,ASAⅡ~Ⅲ级,随机分成连续硬膜外阻滞(CEA)组和腰硬联合麻醉(CSEA)组,每组40例.记录麻醉后1 h内平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO2)的变化,并观察起效时间、麻醉平面、麻醉完善时间、麻醉效果,术后随访有无头痛等副作用.结果 两组出血量差异无统计学意义,CSEA组血压下降、心动过缓明显少于CEA组(P<0.05),术后均无头痛.CSEA组起效时间、阻滞完善时间明显短于CEA组(P<0.01),CSEA组麻醉效果优良者100%,CEA组麻醉效果优良者80%,CSEA组效果优良者明显高于CEA组(P<0.05),两

  7. Influence of epidural anesthesia labor on mothers and infants%硬膜外麻醉镇痛分娩对母婴影响探讨

    Institute of Scientific and Technical Information of China (English)

    邓正刚

    2014-01-01

    Objective To discuss the effects of epidural analgesia labor on mothers and infants. Methods The puerperae, who were hospitalized from January 2009 to November 2013,were divided into two groups:the observation group(n=138) accepted analgesia delivery,and the control group(n=147) were without any analgesic drugs. The delivery time,delivery mode,postpar-tum haemorrhage,neonatal asphyxia and fetal distress in the two groups were observed respectively. Results The delivery time of the observation group was shorter than that of the control group with statistically significant difference (P0.05). Conclusion Epidural analgesia can shorten delivery time and allevi-ate pain with high security,so it can be promoted and popularized clinically.%目的:探讨硬膜外麻醉镇痛分娩对母婴的影响。方法将2009年1月至2013年11月入院分娩的产妇分为两组,观察组138例为接受镇痛分娩的产妇,对照组147例为不使用任何镇痛药物的产妇。分别观察比较两组产妇的分娩时间、分娩方式、产后出血量、新生儿窒息、胎儿窘迫情况。结果观察组产妇的分娩时间长于对照组,差异有统计学意义(P0.05)。结论分娩中应用硬膜外麻醉镇痛技术能够延长分娩时间、减轻疼痛,可在临床上大力推广应用。

  8. Cronobiología en anestesia epidural Obstétrica: Efecto de la noche sobre el índice de complicaciones Cronobiology in obstetric epidural anesthesia: consequences of the sleep deprivation among anestresiologist in the complications rate

    Directory of Open Access Journals (Sweden)

    F. Martínez-Jiménez

    2006-03-01

    Full Text Available Introducción: Los efectos del trabajo continuado y nocturno sobre la atención y la incidencia de complicaciones en desarrollo habitual de las labores del médico han sido previamente estudiados, aunque con resultados poco concluyentes. Objetivo: Comparar la incidencia de complicaciones, durante la punción, en el curso del bloqueo, como consecuencia de una analgesia incompleta y evaluar las diferencias que existen entre el día y la noche definiendo día como el periodo entre 9:00 y 21:59 h y noche: de 22:00 a 8:59 h. Material y métodos: Hemos realizado un estudio de los bloqueos recogidos en nuestra base de datos informatizada de pacientes a quienes se practicó algún bloqueo central para analgesia del parto realizados en un hospital universitario de grado 4, con atención durante las 24 horas, durante un periodo de 2 meses. Resultados: Se ha estudiado un total de 1097 pacientes, homogéneas en su distribución (variables demográficas y obstétricas, entre el día y la noche. El número de pacientes a las que se les practica un bloqueo analgésico para trabajo de parto no muestra diferencias entre el día y la noche. No hemos encontrado diferencias en la incidencia de complicaciones en la punción ni de analgesia incompleta, deficiente o necesidad de re-punción. Conclusiones: Parece que el cansancio o la falta de sueño no influyen en la incidencia de complicaciones en la analgesia para el trabajo de parto en una unidad de atención las 24 horas. Probablemente, los médicos se ven incentivados por la realización de una tarea interesante.Introduction: Sleep deprivation effects in vigilance, performance and complications have been previously studied in general population and in medical tasks too. Results from these studies weren’t definitive. Aim: Our objective is to compare the number of complications during the epidural puncture itself, (haematic, paresthesias, accidental dural puncture and others during the analgesia period (lateral

  9. 连续腰麻与腰-硬联合麻醉用于下肢手术的临床对比研究%Clinical comparative study of continuous spinal anesthesia and combined epidural-spinal anesthesia used for lower limb surgery

    Institute of Scientific and Technical Information of China (English)

    浦鹏飞; 阎位明; 桑达; 艾莎杜

    2012-01-01

    Objective To explore the clinical anesthetic effect, postoperative complications of continuous spinal anesthesia, through the continuous spinal anesthesia (CSA) and combined epidural-spinal anesthesia (CESA) used for lower limb surgery. Methods 70 patients who underwent lower limb surgery were collected and randomly divided into CSA group and CESA group, with 35 cases in each group. Both groups were punctured at L2_3 or L3_4 vertebral gap, after the success of the CSA group, spinocath tube were placed 1-2 cm to subarachnoid and then injected 0.5% Levobupivacaine 1.2 mL, for the CESA group injected 0.5% Levobupivacaine 2 mL through the needle who within the needle of combined epidural-spinal anesthesia, then placed a catheter 3-4 cm to the head-end epidural through the needle. The changes of blood pressure and heart rate parameters, sensory and motor block parameters, the Bromage score, plus the adjuvant drugs, adverse reactions and complications of patients before anesthesia and after anesthesia between the two groups were observed and recorded. Results Between two groups, the minimum value of mean arterial pressure after anesthesia was significantly decreased than preoperative (P 0.05); the adverse reactions and auxiliary medicine dosage in CESA group were significantly more than those in CSA group (P < 0.05). Conclusion Continuous spinal anesthesia applied in lower limb operation has good effects of anesthesia, hemodynamic stability, strong controllability and less adverse reactions, etc, especially for elderly patients with lower limb operation.%目的 旨在通过应用连续腰麻(CSA)和腰-硬联合麻醉(CESA)行下肢手术的对比,探讨CSA的临床麻醉效果、术后并发症等情况.方法 收集拟行骨科下肢手术的患者70例,随机分为CSA组和CESA组,各35例.两组患者均选择L2~3或L3~4椎间隙穿刺,成功后CSA组向蛛网膜下腔置入Spinocath管1~2 cm并注入0.5%左旋布比卡因1.2 mL,CESA组通过腰-硬联合麻

  10. The safety and feasibility of dezocing in gynecological laparoscopy under epidural anesthesia%地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中的应用

    Institute of Scientific and Technical Information of China (English)

    郑雁; 刘玲玲; 叶秀清

    2012-01-01

    AIM: To investigate the safety and feasibility of dezozine in gynecological lapa-raoscopy under epidural anesthesia. METHODS; Sixty ASA I or II patients, aged 18-55 yr, undergoing gynecological laparoscopy surgery, were randomly divided into 2 groups (n = 30 each): Dezocing group (group D) and Fentanyl group (group F). PeTCO2 and Ramsay sedation scales were recorded at the time points followed: pre-anesthesia ( T0), 10 min after administration (T1) instantly after pneumoperitoneum (T2), 30 min (T3) and 60 min (T4) after pneumoperitoneum, 5 min after eliminating pneumoperitoneum (T5). The incidences of side effects such as nausea, vomiting, algor and respiratory depression was observed. RESULTS:Ramsay seda- tion scales were not statistically different between the two groups. D group's PEt CO2 was lower than of F group at the time points of T3 and T4. The incidences of nausea, vomiting and respiratory depression were higher in F group (P<0. 05). CONCLUSION: Dezocine has significant advantages over fentanyl to assist epidural anesthesia in gynecological laparoscopy with respect to reduce discomfort during pneumoperitoneum, better analgesia and sedation, less side effects.%目的:探讨地佐辛辅助硬膜外麻醉在妇科腹腔镜手术中应用的可行性.方法:选择硬膜外麻醉下行妇科腹腔镜手术患者60例,ASA Ⅰ~Ⅱ级,年龄18~55岁,手术时间均不超过两个小时,随机均分为地佐辛组(D组)和芬太尼组(F组).记录给药前(T0)、给药后10 min (T1)、气腹后即刻(T2)、气腹后30 min(T3)、气腹后60 min(T4)、气腹消除后5 min(T5)的呼气末二氧化碳分压(PET CO2)及Ramsay镇静评分.观察两组患者出现恶心、呕吐、寒颤、呼吸抑制(呼吸频率低于8次/min或脉搏血氧饱和度(SpO2)低于90%)等不良反应的发生率.结果:两组患者的Ramsay镇静评分无统计学差异,T3、T4时点D组PFTCO2低于F组(P<0.05),恶心、呕吐、呼吸抑制的发生率F组明显高于D组.结论

  11. 右美托咪定和可乐定硬膜外给药对硬膜外罗哌卡因麻醉效果的影响%The influence of epidural dexmedetomidine and clonidine on ropivacaine epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    裘学; 张兆平; 房宁宁; 顾美蓉; 姚敏; 孙国华

    2013-01-01

    Objective The aim of this study was to evaluate the efficacy of epidural dexmedetomidine (Dex) and clonidine on ropivacaine epidural anesthesia.Methods Seventy-five patients ASA Ⅰ or Ⅱ,aged 55 y-65 y,scheduled for elective vaginal hysterectomy under epidural anesthesia with ropivacaine were randomly allocated into three groups:patients in group RD were administered 15 ml of 0.75% epidural ropivacaine and 100 μg of Dex,while group RC received admixture of 15 ml of 0.75%ropivacaine and 100 μg of clonidine,and group C received 15 ml of 0.75% ropivacaine and saline.Results The patient in group RD exhibited an earlier onset of sensory analgesia at T10 [(8.5±2.4) min] as compared to group RC and group C [(10.4±3.4) min and (12.7±4.3) min].Dex not only provided a higher dermatomal spread but also helped in achieving the maximum sensory anaesthetic level in a shorter period [(13±4) min compared to clonidine (15±4) min and (18±4) min].Bromage scale 3 was achieved earlier in group RD [(18±5) min] than in group RC and group C [(21±4) min and (24±4) min,P<0.05].Less tramadol consumed in group RD [(87±17) mg] than that in group RC and in group C [(101±21) min and (146±19) mg,P<0.01] for postoperative analgesia of 24 h(P<0.05).Sedation scores in group RD and group RC were better than in group C(P<0.05).The incidence of shivering was lower in group RD and group RC than that in group C (P<0.05).Respiratory depression was not observed in each group.Conclusions Epidural Dex may reinforce the effect of epidural anaesthesia with ropivacaine and analgesia.Dex is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia,stable cardio-respiratory parameters and a prolonged post-operative analgesia.%目的 比较右美托咪定(dexmedetomidine,Dex)和可乐定硬膜外给药对罗哌卡因阻滞效果的影响. 方法 全组75例患者美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄55岁~65岁,拟行阴式

  12. 两点穿刺法在硬膜外腔-腰椎蛛网膜下腔阻滞联合麻醉中的应用%Application of two puncture in epidural cavity of lumbar subarachnoid space block anesthesia

    Institute of Scientific and Technical Information of China (English)

    房建

    2012-01-01

    目的 探讨两点穿刺法在硬膜外腔-腰椎蛛网膜下腔阻滞麻醉(简称腰硬联合麻醉)中应用效果.方法 回顾性分析50例应用两点穿刺法腰硬联合麻醉进行的经腹全子宫切除术患者的临床资料,统计分析心电图、心率、血氧饱和度、血压等变化情况,采用改良Bromage评分法判断运动神经阻滞情况及麻醉质量.结果 50例均顺利完成手术,无需改变麻醉方式.运动神经阻滞及麻醉质量优良率为100%,腹肌及宫颈肌肉松弛质量优良率为100%,镇痛完全.无呼吸困难、胸闷、头疼等发生,术中补液量约1500 ml,手术时间( 135.0 ±4.5)min.48例患者血流动力学状态(SpO2、HR、BP)保持稳定,2例患者在麻醉后10 min后出现血压下降,静脉注射麻黄碱10 mg后恢复正常.术后患者均痊愈,无麻醉后神经系统并发症.结论 两点穿刺法腰硬联合麻醉应用于全子宫切除术,麻醉效果确切,术后并发症少,应值得推广.%Objective To explore the effect of two puncture during epidural cavity of lumbar subarachnoid space block anesthesia( referred to as combined spinal-epidural anesthesia).Methods Clincal dato of 50 cases of application,two puncture method combined spinal-epidural anesthesia for abdominal hysterectomy Electrocardiogram,heart rate (HR),oxygen saturation,blood pressure (BP) changes were analyed were retrospectively analyzed.using modified Bromage scoring method to determine motor nerve block and the quality of anesthesia.Results 50 cases were successfully completed operation,without changing the mode of anesthesia.Motor nerve block anesthesia and quality excellent rate was 100%,the abdominal and cervical muscle relaxation quality excellent rate was 100%,analgesia was completely.No difficulty in breathing,chest tightness,headache,intraoperative fluid infusion about 1500ml,operation time ( 135.0 ± 4.5 ) min.48 patients hemodynamic status ( SpO2,HR,BP) remained stable,2 patients after

  13. 腰-硬联合麻醉用于老年全髋关节置换术的可行性及安全性评价%Feasibility and safety of spinal- epidural anesthesia (CSEA) for older total hip arthroplastyevaluation

    Institute of Scientific and Technical Information of China (English)

    董万超

    2011-01-01

    目的 探讨腰-硬联合麻醉(CSEA)用于老年全髋关节置换术的可行性及安全性.方法 58例老年全髋关节置换术患者随机分为腰-硬联合麻醉组(CSEA组)和连续硬膜外麻醉组(CEA组),每组各29例.分别监测麻醉前(T)、麻醉后15min(T)、30min(T)、60min(T)、90min(T)及120rain(T)的收缩压(SBP)、舒张压(DBP)、心率(HR)和血氧饱和度(SpO)变化.记录麻醉起效时间及手术时间,评价麻醉效果.结果 两组SBP和DBP均较麻醉前显著下降(P<0.01),两组间各时间点相比,差异无显著性(P>0.05).CEA组和CSEA组麻醉起效时间分别为(5.1±1.5)min和(12.9±3.8)min,二者差异有统计学意义(P<0.05).两组手术时间差异无统计学意义(P>0.05).CEA组和CSEA组麻醉优良率分别为86.21%和100%,CSEA组明显优于CEA组(P<0.05).结论 腰-硬联合麻醉用于老年全髋关节置换术,起效迅速,阻滞完善,肌松满意,并发症少,血流动力学平稳,可达到安全可靠的麻醉效果.%Objective To investigate the combined spinal - epidural anesthesia (CSEA) for total hip arthroplasty elderly feasibility and safety.Methods Totally 58 elderly patients with total hip arthroplasty were randomly divided into combined spinal - epidural anesthesia ( CSEA group) and continuous epidural anesthesia group (CEA group) , 29 patients in each group.Were monitored before anesthesia ( T0) , after anesthesia 15min ( T1 ) , 30min ( T2 ) , 60min ( T3 ), 90min (T4) and 120min (T5) of the systolic blood pressure (SBP) , diastolic blood pressure (DBP) , heart rate (HR) and oxygen saturation (SpO2) changes.Record time of anesthesia and operation time of onset, evaluation of anesthetic effects.Results SBP and DBP were significantly decreased than those before anesthesia ( P < 0.01 ), compared between the two groups at each time point, the difference was not significant (P > 0.05).CEA group and the CSEA group The onset time was (5.1 ± 1.5) min and ( 12.9 ±3.8) min, the

  14. Study on the postmortem distribution of bupivacaine in epidural anesthesia death dogs%布比卡因在硬膜外麻醉致死犬体内的分布

    Institute of Scientific and Technical Information of China (English)

    张高勤; 武夺; 贠克明; 张大明

    2009-01-01

    Objective To establish the model of bupivacayne epidural anesthesia death, and investigate the distribution of bupivacayne in epidural anesthesia death dogs.Methods Eighteen male dogs were randomly allocated to three groups. Six dogs were given a dose of 5 mg/kg body weight of bupivacaine hydrochloride by the subarachonid anesthesia tube at an even speed in five minutes, while the other six in the second group were given 15 mg/kg, the last three dogs in control group were given 15 mg/kg weight of physiological salt solution. The vital signs from beginning of the administration to the death were recorded by a biological function system. The cerebrum, cerebrospinal fluid (CSF) in lateral ventricle, spinal cord (cervical spinal cord, thoracic spinal cord, lumbar spinal cord and sacrum spinal cord), heart, lung, liver, spleen, kidney, bile, urine, heart blood, peripheral blood, muscle in injection location and muscle in no injection location were collected and analyzed immediately after the death. These samples were extracted by ethyl ether. Analysis was performed with a GC equipped with a NPD and a GC/MS. The qualitative analysis was based on retention time in the chromatographic system coupled with the ion fragmentation spectrum in the mass spectrometer. The quantitative analysis was on an internal standard method. Results The bupivacaine concentrations detected in sacrum spinal cord, cervical spinal cord, thoracic spinal cord, lumbar spinal cord, kidney, cerebrum and CSF were much higher in the 5mg/kg group. While in 15mg/kg group the concentrations detected in cervical spinal cord, thoracic spinal cord, lumbar spinal cord, sacrum spinal cord and CSF were much higher. Conclusion There was a relationship between the poisoning symptom, postmortem distribution and the administration dose, which may provide some evidences for the investigation of suspected epidural anesthesia accident case.%目的 建立布比卡因硬膜外麻醉致死的动物模型,探讨其在致

  15. Influence of general anesthesia combined with epidural block on gas exchang during one-lung ventilation in patients undergoing thoracic surgery%硬膜外阻滞复合全麻对单肺通气期间气体交换的影响

    Institute of Scientific and Technical Information of China (English)

    赵念峰; 杨建香; 刘功俭

    2008-01-01

    Objective To evaluate the effects of general anesthesia combined with throacic epidural block on pulmonary gas ex-change during one-lung ventilation in patients undergoing thoracic surgery. Methods Eighty patients of ASA Ⅰ-Ⅱ undergoing electivethroacic surgery were randomly divided into two Groups (n = 40 ) receiving combined genera] anesthesia with throacic epidural block(group A ) or general anesthesia (group B ). MAP, HR, SpO2, PETCO2, VT, Paw were monitored at both bronps. Arterial andmixed vein blood gas were analyzed and Qs/Qt ,A-aDO2,Vd/Vt were calculated in both groups at 20 rain ( T1 ) before one-lung ventila-tion and 30 min( T2 ), 60 min( T3 ), as well as 120 min ( T4 ) after one-lung ventilation. Results In both groups, Paw and Qs/Qt in-creased while PaO2 decreased significantly at T2-4, ( P0.05);与B组相比,A组T2-4时的Qs/Qt增加(P0.05).结论 单肺通气期间硬膜外阻滞复合全麻对肺换气功能有影响,使Qs/Qt增加,PaO2下降,A-aDO2增大;对肺泡通气功能指标Vd/Vt影响甚微.

  16. 地佐辛对胆囊切除术内脏牵拉反应的观察%To observe the curative effect of dezocine on the visceral traction reaction in abdominal cholecystectomy under epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    吴庆玲

    2014-01-01

    Objective:To observe the curative effect of dezocine on the visceral traction reaction in abdominal cholecystectomy under epidural anesthesia Methods:Select 60 patients ,ASAⅠ-Ⅱ grade, undergoing abdominal cholecystectomy in continuous epidural anesthesia. They were randomly divided into two groups, respectively named dezocine group (group D) and fentanyl group (group F), 30 cases in each. The two groups were given 2 min intra-venously before skin incision respectively dezocine 0.1mg/kg and fentanyl 1-2ug/kg, and inhale oxygen by mask, monitored conventionally. The inhibition effect of the visceral traction reaction was evaluated, and observe the inci-dence of pain, nausea and vomiting. Time observation points were preoperative (T1), 5min after skin incision (T2), 15min after skin incision (T3), pulling gallbladder (T4),after cholecystectomy (T5). Results:Compared with group F , BP and HR in group D remained more stable, with statistical significance ( P<0.05 );In the aspect of gallbladder traction reaction, the incident in the group D was lower than that in the group F, and there was statistically significant ( P<0.05 ). Conclusion:Dezocine can provide a good analgesic effect ,also have a lot of advantages in the aspect of the visceral trac-tion, so it can reduce the incidence of nausea and vomiting. But the optimal dose and the optimal time tests are needed in the further study to prove the best effect.%目的:观察地佐辛对硬膜外麻醉下经腹胆囊切除术内脏牵拉反应的疗效。方法:选择60例欲行经腹胆囊切除术的患者,ASAⅠ~Ⅱ级,拟施连续硬膜外麻醉,随机分为地佐辛组(D组)和芬太尼组(F组),各30例。两组均在切皮前2min静脉分别给以地佐辛0.1mg/kg,芬太尼1~2ug/kg,常规检测,并对牵拉反应抑制效果进行评估,观察患者恶心、呕吐、疼痛等发生率。观察记录点分别为术前(T1),切皮后5min(T2),切皮后15min(T3

  17. Clinical analysis of effect of combined spinal - epidural anesthesia in labor analgesia%腰硬联合麻醉分娩镇痛临床效果分析

    Institute of Scientific and Technical Information of China (English)

    李如霞; 柯善高; 徐晓俊; 朱桃花

    2011-01-01

    目的 分析腰硬联合麻醉分娩镇痛对母儿的影响,并比较芬太尼和舒芬太尼的效果.方法 选择2010年3~9月行分娩镇痛的192例初产妇,与同期未行镇痛的98例(对照1组)和开展分娩镇痛前107例(对照2组)初产妇比较.结果 与对照1、2组比,镇痛组第二产程和活跃期时间延长,缩宫素使用率高,产钳助产率高,新生儿1 min Apgar评分轻度窒息率升高,差异有统计学意义(P<0.05);因胎儿窘迫剖宫产率、第三产程时间组间比较差异无统计学意义(P>0.05).镇痛组较对照1组,第一产程时间、因头盆不称剖宫产率、产后出血量差异明显(P<0.05).使用芬太尼及舒芬太尼镇痛产妇,副作用主要是皮肤瘙痒,前者虽高于后者,但无统计学意义(P>0.05).结论 腰硬联合麻醉分娩镇痛效果确切,镇痛药对新生儿评分稍有影响,但预后良好.%Objective To analyze the effect of combined spinal - epidural anesthesia (CSEA) for labor analgesia and the impact on mothers and children and to compare the effects of fentanyl and sufentainl. Methods From march 2010 to september 2010 192 primiparity with labor analgesia were choosed, and 98 cases without analgesia in the same period ( control 1 group) , and 107 cases before labor analgesia (control 2 group) for comparison. Results Compared with the 1 and 2 groups, the duration of the second stage of labor and active phase in the analgesia group were longer, the rates of oxytocin use and forceps delivery were higher, and one minute Apgar score newborn asphyxia increased slightly, and there were significant differences (P < 0. 05 ); cesarean section rate of fetal distress, the labor time of the third stage had no significant differences ( P > 0.05 ) in groups. Compared with the 1 group, the labor time of the first stage, the rate of cephalopelvic disproportion cesarean section, the volume of postpartum hemorrhage had significant differences (P <0.05 ). Side effect is

  18. Epidural abscess caused by Streptococcus milleri in a pregnant woman

    Directory of Open Access Journals (Sweden)

    Bearman Gonzalo

    2005-11-01

    Full Text Available Abstract Background Bacteria in the Streptococcus milleri group (S. anginosus, S. constellatus, and S. intermedius are associated with bacteremia and abscess formation. While most reports of Streptococcus milleri group (SMG infection occur in patients with underlying medical conditions, SMG infections during pregnancy have been documented. However, SMG infections in pregnant women are associated with either neonatal or maternal puerperal sepsis. Albeit rare, S. milleri spinal-epidural abscess in pregnancy has been reported, always as a complication of spinal-epidural anesthesia. We report a case of spinal-epidural abscess caused by SMG in a young, pregnant woman without an antecedent history of spinal epidural anesthesia and without any underlying risk factors for invasive streptococcal disease. Case presentation A 25 year old pregnant woman developed neurological symptoms consistent with spinal cord compression at 20 weeks gestation. She underwent emergency laminectomy for decompression and was treated with ceftriaxone 2 gm IV daily for 28 days. She was ambulatory at the time of discharge from the inpatient rehabilitation unit with residual lower extremity weakness. Conclusion To our knowledge, this is the first reported case of a Streptococcus milleri epidural abscess in a healthy, pregnant woman with no history of epidural anesthesia or invasive procedures. This report adds to the body of literature on SMG invasive infections. Treatment of SMG spinal-epidural abscess with neurologic manifestations should include prompt and aggressive surgical decompression coupled with targeted anti-infective therapy.

  19. Hematoma após anestesia peridural: tratamento conservador. Relato de caso Hematoma posterior a la anestesia peridural: tratamiento conservador. Relato de caso Hematoma after epidural anesthesia: conservative treatment. Case report

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2007-04-01

    ó las sensibilidades térmica y dolorosa y la regresión total del bloqueo motor. En la 12ª hora, deambulaba y refería dolor en la herida operada. El hematoma peridural no se visualizó en una nueva tomografía computadorizada en la 14ª hora después del inicio del tratamiento. La paciente recibió alta hospitalaria 86 horas después del inicio del tratamiento conservador, sin comprometimiento neurológico. Una tomografía computadorizada de control después de 7 meses, mostró el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervención quirúrgica en casos específicos. La evaluación de la progresión o estabilización del comprometimiento neurológico, particularmente después de la 8ª hora posterior a la punción peridural, es esencial para la elección del tratamiento.BACKGROUND AND OBJECTIVES: Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000. It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT: Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale, reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural

  20. Comparative Study of the Effect of Local Anesthesia,Epidural Tension-free Hernia Repair and Laparoscopic Total Extraperitoneal Hernia Repai r%局麻、硬膜外麻开放式无张力疝修补术与腹腔镜全腹膜外疝修补术的疗效对比研究

    Institute of Scientific and Technical Information of China (English)

    李群华; 金万亮; 邓孙林; 刘凯; 盘毅辉; 郭建业

    2014-01-01

    目的:研究局麻、硬膜外麻下开放式无张力疝修补术与腹腔镜全腹膜外疝修补术(TEP)治疗成人腹股沟疝的疗效对比。方法:回顾性分析本院2009年8月-2014年3月诊治的87例成人腹股沟疝患者的临床资料,根据患者的经济情况和病情等选择不同术式,其中23例行局麻下疝修补的患者作为局麻组,36例硬膜外麻下行无张力疝修补术的患者作为硬膜外麻组,28例行腹腔镜全腹膜外疝修补的患者作为腹腔镜组。观察比较三组患者的手术时间、术后下床时间、总住院时间、术后疼痛时间、住院费用、术后并发症和术后复发率等指标。结果:三组患者手术均成功。手术时间以硬膜外麻组时间最短,腹腔镜组时间最长(P0.05);三组均无近期复发病例。结论:三种术式各有最佳适应证和优缺点,应个体化选择疝修补术,腹腔镜腹股沟疝修补术有良好的发展前景。%To study the contrast effect of local anesthesia,epidural anesthesia for open tension-free hernia repair and laparoscopic total extraperitoneal hernia repair(TEP)in the treatment of adult inguinal hernia. Method:The clinical data of 87 patients with adult inguinal hernia in our hospital from August 2009 to March 2014 were retrospectively analyzed,selected different surgery according to the patient’s economic conditions and disease,23 patients with hernia repair under local anesthesia were selected as local anesthesia group,36 patients with tension-free hernia repair under epidural anesthesia were selected as epidural anesthesia group,28 patients with laparoscopic total extraperitoneal hernia repair were selected as the laparoscopic group.The operation time,postoperative ambulation time, hospitalization time,postoperative pain,hospitalization expenses,postoperative complications and recurrence rate of the three groups were observed and compared.Result:Three groups of patients with

  1. [History and Technique of Epidural Anaesthesia].

    Science.gov (United States)

    Waurick, Katrin; Waurick, René

    2015-07-01

    In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique.

  2. 潜伏期硬膜外阻滞分娩镇痛临床分析%A clinical analysis of epidural anesthesia in latency of labor for labor analgesia

    Institute of Scientific and Technical Information of China (English)

    尹春艳; 毛邱娴; 郭云怀; 张玲

    2011-01-01

    Objective To explore clinical characteristics and feasibility of epidural anesthesia parturition analgesia in latency (labor analgesia in brief). Methods 272 term primiparae with cephalic presentation who tried to deliver vaginally were divided into 3 groups according to their willings: group A ( n = 92, who didn't receive any analgesia in delivery), group B ( n = 85, who received labor analgesia in active stage of labor when their external cervical orifice dilated to 3cm) and group C ( n = 95, who received labor analgesia in latency when the external cervical orifice opened to 1 ~2cm). The term primiparae in groups B and C received catheter setting in epidural space plus parturient controlled analgesia (CSE + PCA ) for labor analgesia. The labor duration, pattern of delivery, incidences of postpartum hemorrhage and neonatal asphyxia of primiparae were compared among the three groups. Results The duration of latency of primiparae in group C (345 + 58 min) was shorter than that in group A (386 + 98 min) and group B ( 388 + 79 min) ( F = 9.77, P =0. 001 ), and the duration of active stage of labor of primiparae in group A ( 219 + 69 min) was longer than that in group B ( 147 + 59 min)and group C ( 141 + 72 ) ( F = 37.99, P < 0. 001 ). The proportion of primiparae in group A who were given oxytocin in delivery( 19.6% )was less than that in group B ( 80.0% ) and group C ( 85.3% ), the differences were statistically significant (X2 = 28. 9544, P <0. 0001 ). Among the three groups, there were no significant differences in durations of the second and the third stages of labor, rates of cesarean section, forceps delivery and spontaneous delivery, incidence of neonatal asphyxia and amount of postpartum hemorrhage ( all P >0.05 ). Conclusion Labor analgesia starting from latency of labor can effectively shortens duration of labor pain. Increased use of oxytocineffectively shortens durations of latency and active stages of labor. It does not increase the

  3. Epidural fentanyl decreases the minimum local analgesic concentration of epidural lidocaine

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; ZHENG Yue-ying; FENG Zhi-ying; CHEN Chao-qin; ZHU Sheng-mei

    2012-01-01

    Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly,but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration(MLAC)of lidocaine is not known.We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions:lidocaine,or lidocaine plus fentanyl 1 μg/ml,2 μg/ml,or 3 μg/ml.The first patient in each group was administered 1% lidocaine weight by volume;subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments.Efficacy was assessed using a visual analog pain scale,and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes.The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery,respectively.Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785%(95%C/0.738-0.864).A significant dose-dependent reduction was observed with the addition of fentanyl:the MLAC of lidocaine with fentanyl at 2 μg/ml was 0.596%(95%Cl 0.537-0.660)and 0.387% with fentanyl at 3 μg/ml(95%Cl 0.329-0.446,P<0.001).Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

  4. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

    Directory of Open Access Journals (Sweden)

    Wei Xiao

    2015-01-01

    Full Text Available Background: Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress. The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT with LiDCO rapid system can improve well-being of both HDP parturient and their babies. Methods: Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited. After loading with 10 ml/kg lactated Ringer′s solution (LR, parturient were randomized to the GDFT and control group. In the GDFT group, individualized fluid therapy was guided by increase in stroke volume (ΔSV provided via LiDCO rapid system. The control group received the routine fluid therapy. The primary endpoints included maternal hypotension and the doses of vasopressors administered prior to fetal delivery. The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events. Results: The severity of HDP was similar between two groups. The total LR infusion (P < 0.01 and urine output (P < 0.05 were higher in the GDFT group than in the control group. Following twice fluid challenge tests, the systolic blood pressure, mean blood pressure, cardiac output and SV in the GDFT group were significantly higher, and the heart rate was lower than in the control group. The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01. There were no differences in the Apgar scores between two groups. In the control group, the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05, and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05 than in the GDFT group. Conclusions: Dynamic responsiveness guided fluid therapy with the LiDCO rapid system

  5. Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

    Institute of Scientific and Technical Information of China (English)

    Wei Xiao; Qing-Fang Duan; Wen-Ya Fu; Xin-Zuo Chi; Feng-Ying Wang; Da-Qing Ma; Tian-Long Wang

    2015-01-01

    Background:Hypotension induced by combined spinal epidural anesthesia in parturient with hypertensive disorders of pregnancy (HDP) can easily compromise blood supply to vital organs including uteroplacental perfusion and result in fetal distress.The aim of this study was to investigate whether the goal-directed fluid therapy (GDFT) with LiDCOrapid system can improve well-being of both HDP parturient and their babies.Methods:Fifty-two stable HDP parturient scheduled for elective cesarean delivery were recruited.After loading with 10 ml/kg lactated Ringer's solution (LR),parturient were randomized to the GDFT and control group.In the GDFT group,individualized fluid therapy was guided by increase in stroke volume (ASV) provided via LiDCOrapid system.The control group received the routine fluid therapy.The primary endpoints included maternal hypotension and the doses ofvasopressors administered prior to fetal delivery.The secondary endpoints included umbilical blood gas abnormalities and neonatal adverse events.Results:The severity of HDP was similar between two groups.The total LR infusion (P < 0.01) and urine output (P < 0.05) were higher in the GDFT group than in the control group.Following twice fluid challenge tests,the systolic blood pressure,mean blood pressure,cardiac output and SV in the GDFT group were significantly higher,and the heart rate was lower than in the control group.The incidence of maternal hypotension and doses of phenylephrine used prior to fetal delivery were significantly higher in the control group than in the GDFT group (P < 0.01).There were no differences in the Apgar scores between two groups.In the control group,the mean values of pH in umbilical artery/vein were remarkably decreased (P < 0.05),and the incidences of neonatal hypercapnia and hypoxemia were statistically increased (P < 0.05) than in the GDFT group.Conclusions:Dynamic responsiveness guided fluid therapy with the LiDCOrapid system may provide potential benefits to

  6. [Spontaneous epidural hematoma after open heart surgery: case report].

    Science.gov (United States)

    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M

    1999-11-01

    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

  7. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne;

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...

  8. Clinical effect of ropivacaine combined with spinal-epidural anesthesia in anorectal surgery%罗哌卡因腰麻-硬膜外联合麻醉用于肛肠手术的疗效分析

    Institute of Scientific and Technical Information of China (English)

    方传奇

    2015-01-01

    目的 观察罗哌卡因腰麻-硬膜外联合麻醉方法用于肛肠手术的临床效果,并评价该方法的安全性.方法 回顾性分析我院2010年1月至2013年12月期间进行肛肠手术82例患者的临床资料,应用随机数字表将患者分为丁哌卡因组和罗哌卡因组,每组各41例.均采用以腰部L3、L4间隙作为穿刺点的腰麻-硬膜外联合麻醉方法,丁哌卡因组和罗哌卡因组患者分别以0.2 ml/s的速度推注0.375%的丁哌卡因2ml和罗哌卡因溶液2ml.比较两组患者的麻醉满意度以及麻醉效果.结果 两组患者麻醉后进行手术期间均未再追加药物,手术完成顺利.两组患者感觉阻滞起效时间、最大感觉阻滞平面以及感觉阻滞持续时间比较差异无统计学意义(P均>0.05);但罗哌卡因组感觉最大运动阻滞程度评分[(1.8±0.4)分]较丁哌卡因组[(2.9±0.3)分]低,且运动阻滞起效时间晚[(9.8±0.6) min与(3.5±0.4)min],两组比较差异有统计学意义(t=2.4236、t=2.4265,P均<0.05).对于麻醉的满意度无显著性差异,麻醉程度均能满足施行手术的肌松要求.结论 罗哌卡因腰麻-硬膜外联合麻醉方法用于肛肠手术能够满足围术期无痛无感的要求,值得在肛肠手术时借鉴应用.%Objective To explore and analysis the clinical effect of ropivacaine combined with spinalepidural anesthesia in anorectal surgery and to evaluate the safety of this method.Methods We retrospective analyzed the clinical information of 82 patients who conducted with selective anorectal surgery in the First People's Hospital of Shangqiu from January 2010 to December 2013.The patients were randomly divided into bupivacaine group and ropivacaine group,and each group of 41 cases.Both groups took the way of combined with spinal-epidural anesthesia to waist L3/L4 point gap.Bupivacaine and ropivacaine group were traited at a rate of 0.2 ml/s bolus of 0.375% bupivacaine and ropivacaine solution of 2 ml

  9. Anestesia peridural com lidocaína isolada ou associada à clonidina: efeito cardiorrespiratório e analgésico em cães Epidural anesthesia with lidocaine alone or combinated with clonidine: cardiopulmonary and analgesic effects in dogs

    Directory of Open Access Journals (Sweden)

    Renata Navarro Cassu

    2010-10-01

    Full Text Available Analgesia satisfatória tem sido relatada com a administração peridural de agonistas adrenérgicos em associação aos anestésicos locais. Objetivou-se, com este trabalho, avaliar o efeito analgésico e cardiorrespiratório da lidocaína isolada ou associada à clonidina via peridural lombossacra em cães. Seis cães foram submetidos a dois tratamentos, com intervalo mínimo de 15 dias entre cada avaliação. No tratamento L, foi empregada lidocaína 2% com vasoconstrictor (5mg kg-1 e, no tratamento C, a clonidina (10µg kg-1 foi associada à lidocaína, de modo a perfazer um volume final de 0,25ml kg-1. Os animais foram tranquilizados com acepromazina (0,05mg kg-1 IV e mantidos sob anestesia com isofluorano em máscara facial durante a punção do espaço peridural. Foram mensuradas: frequência cardíaca (FC, parâmetros eletrocardiográficos (ECG, frequência respiratória (f, pressão arterial sistólica (PAS, gases sanguíneos, temperatura retal (T, duração e extensão do bloqueio anestésico. A estatística foi realizada com análise de variância, teste de Tukey e teste t pareado (PSatisfactory analgesia has been related with epidural 2 adrenoceptor agonists in combination with local anesthetics. The aim of this study was to compare the analgesic and cardiopulmonary effects of lidocaine or lidocaine-clonidine epidural injections in healthy dogs. Dogs were randomly assigned to two groups of six animals each. The L group received lidocaine (5mg kg-1 L and the C group lidocaine plus clonidine (10µg kg-1 C. Preanaesthetic medication was carried out with acepromazine (0.05mg kg-1 IV. Anaesthesia was induced and maintained with isoflurane by facial mask for epidural injection. Heart rate (HH, electrocardiography (ECG, respiratory rate (RR, systolic arterial blood pressure (SAP, rectal temperature (RT, blood gases, duration of anesthesia and sensitive block level were investigated. Statistical analysis was performed with ANOVA, Tukey test

  10. Impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function in patients with abdominal surgery%硬膜外复合全麻对腹部手术患者血液循环及免疫功能的影响

    Institute of Scientific and Technical Information of China (English)

    马海燕

    2013-01-01

    目的 探讨硬膜外复合全麻对腹部外科手术患者血流循环及免疫功能的影响.方法 将90例行腹部手术患者随机分成实验组(应用硬膜外复合全麻)和对照组(单纯应用全身麻醉),每组45例.记录并比较2组的血流动力学及免疫功能的变化情况.结果 实验组术毕时、术后12h及术后1、2d的SBP、DBP、HR、SpO2波动幅度均明显小于对照组(P<0.05);实验组术后6h及术后1、3、5、7d的CD3+、CD4+、CD4+/CD8+水平下降幅度均明显小于对照组(P<0.05).结论 硬膜外复合全麻较单纯全麻对患者的血流循环及免疫功能的影响更小,临床应用于腹部外科手术麻醉的前景良好.%Objective To investigate the impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function in patients with abdominal surgery.Methods Ninety patients with abdominal surgery were randomly divided into two groups,treatment group (n =45) and control group (n =45).The control group was given general anesthesia only,and the treatment group was given epidural anaesthesia combined with general anesthesia.The changes of hemodynamic and the immune function in both groups were observed and compared.Results The fluctuation range of SBP,DBP,HR,SpO2 in the end of operation,12 hours after operation,ld and 2ds after operation in the treatment group were significantly less than the control group (P < 0.05).The decline of CD3+,CD4+,CD4+/CD8+ 6 hours after operation,1d,3 ds,5 ds and 7 ds after operation in the treatment group were significantly less than the control group (P < 0.05).Conclusion The impact of epidural anaesthesia combined with general anesthesia on hemodynamics and immune function is significantly smaller in patients with abdominal surgery,and the epidural anaesthesia combined with general anesthesia has good prospects in abdominal surgery.

  11. Anestesia peridural torácica para cirurgia plástica de mama em paciente portadora de miastenia gravis: relato de caso Anestesia peridural torácica para cirugía plástica de mama en paciente portadora de miastenia gravis: relato de caso Thoracic epidural anesthesia for mammaplasty in myasthenia gravis patient: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2005-06-01

    epidural anesthesia for cosmetic mammaplasty. CASE REPORT: Female patient, 51 years old, with myasthenia gravis and submitted to thoracic epidural anesthesia with bupivacaine and fentanyl. There was no respiratory depression. Patient was discharged 36 hours later. CONCLUSIONS: Our case suggests epidural anesthesia as a single technique for myasthenia gravis patients, without mandatory tracheal intubation.

  12. 罗哌卡因复合芬太尼硬膜外麻醉分娩镇痛对子痫前期患者母婴的影响研究%Influence of RopiVacaine Combined with Fentanyl for Epidural Anesthesia on Patients with Preeclampsia

    Institute of Scientific and Technical Information of China (English)

    杨沫; 魏东红; 王岩岩

    2015-01-01

    Objective To observe the effect of ropivacaine combined with fentanyl for epidural anesthesia analgesia for patients with preeclampsia pregnancy outcome. Methods 156 patients from January 2011 to January 2015 with high blood pressure during pregnancy were selected,including 86 cases of epidural anesthesia group ( study group ) and 70 cases without labor analgesia group ( control group ) . Results In the study group,94. 18% ( mild and moderate pain ) were significantly higher than those in the control group ( 25. 71%) ,the difference was significant ( P 0. 05 ) . Research group of vaginal eutocia rate 69. 77% ( highest ) ,was significantly higher than that of the control group ( 60. 00%) ,the difference was statisti-cally significant ( P 0. 05) and 1 Apgar (5 min) min after birth. Conclusion Ropivacaine combined with fentanyl for epidural anesthesia used in labor analgesia in patients with preeclampsia, analgesic effect,little side effect and the incidence of low influence on neonatal, can prevent the further deterioration of hypertension, reduce the complications in patients with preeclampsia,improve the delivery rate of pregnant women with hypertension.%目的 观察罗哌卡因复合芬太尼硬膜外麻醉分娩镇痛对于子痫前期患者母婴结局的影响.方法 选取2011年1月至2015年1月医院收治的妊娠期高血压选择经阴道分娩产妇156例,其中硬膜外麻醉组(研究组)86例,无分娩镇痛组(对照组)70例.结果 研究组易耐受产痛者(轻度+中度疼痛者)占94. 18%,明显高于对照组的 25. 71% ( P 0. 05 ) .结论 罗哌卡因复合芬太尼硬膜外麻醉分娩镇痛应用于子痫前期患者,有镇痛效果好、对新生儿影响小、不良反应发生率低等优点,可阻止高血压进一步恶化,减少患者产时并发症,提高产妇经阴道分娩率.

  13. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  14. 参附注射液对肺叶切除术患者血流动力学及血气分析指标的影响%Effect of Shenfu Injection on Hemodynamics and Blood Gas Analysis in Patients Undergoing Lobectomy of Lung combined Epidural Block and General Anesthesia

    Institute of Scientific and Technical Information of China (English)

    李晓征; 李界平; 王强; 于海芳; 张芸

    2012-01-01

    目的:探讨参附注射液对全麻复合胸段硬膜外阻滞下行肺叶切除术患者血流动力学及血气分析指标的影响.方法:将60例拟在胸段硬膜外阻滞复合全麻下肺叶切除术病人,随机双盲法分为参附组(n=30)及对照组(n=30),参附组在麻醉诱导前静脉输注参附注射液1.5 mL/kg;对照组以同样速度输注等量的生理盐水.结果:与对照组相比,参附组的MAP、HR在诱导后5 min(T1)、手术探查时(T2)、单肺通气30 min(T3)、单肺通气60 min(T4)及关胸前冲洗胸腔时(T5)升高(P< 0.05),术中麻黄碱、阿托品的使用量及输液总量减少(P< 0.05),PaO2在T3、T4 时较对照组升高(P< 0.05),麻醉药物用量等两组比较无差异(P> 0.05).结论:参附注射液对胸段硬膜外阻滞复合全麻下肺叶切除术患者血流动力学变化具有稳定作用,可改善单肺通气期间血气分析指标.%Objective To investigate the effect of Shenfu Injection on hemodynamics and blood gas analysis in patients undergoing lobectoiny oi lung combined thoracic epidural block and general anesthesia.Methods A double blind trail was conducted on 60 patients undergoing lobectomy of lung combined thoracic epidural block and general anesthesia.The patients were randomly divided into Shenfu Injection group (n=30) and control group (n=30). In the Shenfu Injection group, 1.5 mL/kg Shenfu Injection diluted with 250 mL saline were given before anesthesia introduction. In the control group, equal saline were given at the same time. The following indexes were observed: (1) MAP,HR and CVP at the time before anesthesia introduction (TO), after anesthesia introduction for 5 minutes(T1), surgical exploration(T2),after one-lung ventilation for 30 minutes(T3), after one-lung ventilation for 60 minutes(T4), rinse chest(T5) and the end of operation(T6).(2)the dose of atropine and ephedrine, the amount of intraoperative transfusion,blood loss, urine volume and duration of surgery.(3) the

  15. Can low dose spinal anesthesia combined with ultrasound guided bilateral ilioinguinal-iliohypogastric nerve blocks avoid use of additional epidural catheter in high risk obstetric cases? Our experience from two cases.

    Science.gov (United States)

    Bhakta, P; Sharma, P K; Date, R R; Mohammad, A K

    2013-01-01

    Critical obstetric cases associated with cardiac pathology may pose real challenge for anaesthesiologist during Caesarean section. Meticulous perioperative care and suitable selection of anaesthesia technique are the key to successful outcome. Single shot spinal anaesthesia is not used any more because of serious haemodynamic consequence. Progressive and controlled epidural local anaesthetic injection is mostly used in such cases. But recently combined spinal epidural anaesthesia and continuous spinal anaesthesia are suggested due to better precise control of haemodynamics and quicker onset. However, institution of such complex technique may require time which may not be feasible in emergency situations. Use of bilateral ilioinguinal-iliohypogastric nerve block along with low dose spinal anaesthesia may obviate the need of additional epidural catheter in such complicated cases. We hereby present our experience from two cases.

  16. SURVEY ON CLINICAL STUDY OF COMPOUND ACUPUNCTURE ANESTHESIA IN RESENT 10 YEARS IN CHINA

    Institute of Scientific and Technical Information of China (English)

    秦必光; 胡北喜; 等

    2002-01-01

    In the present paper,the authors make a review on the progresses of acupuncture anesthesia(AA) from (1)historical development,(2)research on acupuncture combined with local anesthesia;(3)research on acupuncture combined with epidural anesthesia;and (4)research on acupuncture combined with general anesthesia.Compound acupuncture anesthesia provides a new anesthetic measure for surgical operations and has a definits analyesic effect and many advantages,and should be investigated further.

  17. 拉玛泽减痛分娩法联合可行走式腰硬麻醉在分娩镇痛中的临床观察%Clinical observation of Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia in labor analgesia

    Institute of Scientific and Technical Information of China (English)

    李利波; 刘明; 梁丽芬

    2014-01-01

    目的:研究拉玛泽减痛分娩法联合可行走式腰硬联合麻醉的镇痛效果及其对母儿的影响。方法选择初产妇300例,随机分为实验组(拉玛泽联合可行走式腰硬联合麻醉组)、对照组(可行走式腰硬联合麻醉组)各150例,对两组产妇的疼痛程度、总产程时间、产后2h出血量、钳产率及新生儿窒息率等指标进行比较。结果实验组产妇分娩时的疼痛较对照组减轻,总产程时间缩短,产后2h出血量减少,钳产率和新生儿窒息率降低,差异有统计学意义(P<0.05)。结论拉玛泽减痛分娩法联合可行走式腰硬联合麻醉能够有效减轻分娩疼痛,缩短产程,减少产后出血,降低钳产率和新生儿窒息率,值得临床应用推广。%Objective To explore the analgesic effect of Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia and its effect on mother and child. Methods 300 primiparas were selected and randomly allocated to an experimental group (Lamaze childbirth method plus combined spinal and epidural ambulatory anesthesia group) and a control group (combined spinal and epidural ambulatory anesthesia group), with 150 in each group. Indices such as pain degree, total stage of labor, amount of bleeding 2 hours after delivery, rate of forceps delivery and rate of neonatal asphyxia were compared between the two groups. Results Pain in the experimental group was milder than that in the control group during labor, total stage of labor was shorter, the amount of bleeding 2 hours after delivery was smaller, and rates of forceps delivery and neonatal asphyxia were lower than those in the control group. The differences were statistically significant (P<0.05). Conclusion Lamaze childbirth method of pain relief plus combined spinal and epidural ambulatory anesthesia helps effectively reduce labor pain, shorten the stage of labor, lower the amount of postpartum bleeding

  18. Study on clinical application of Lamaza delivery method combined with spinal-epidural anesthesia analgesia for labor analgesia%拉玛泽分娩法联合腰硬联合阻滞分娩镇痛的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    宁丰; 韦凤莲; 周霓

    2012-01-01

    Objective: To explore the clinical effect of Lamaza delivery method combined with spinal - epidural anesthesia analgesia for labor analgesia. Methods: A total of 400 primiparous women were selected and divided into group A ( Lamaza delivery method combined with spinal - epidural anesthesia analgesia) , group B ( Lamaza delivery method) , group C ( spinal - epidural anesthesia analgesia) , and group D ( Doula labor, control group) , 100 primiparous women in each group; the degrees of pain during delivery, stages of labor, delivery modes, indications of cesarean section, doses of oxytocin, amount of postpartum hemorrhage, neonatal Apgar scores in the four groups were observed. Results; Compared with the other three groups, the degree of pain during delivery in group A relieved significantly, the stages of labor shortened, the rate of spontaneous delivery increased, the rate of cesarean section decreased, the dose of oxytocin increased, there were statistically significant difference in the above - mentioned indexes (P 0. 05 ) . Conclusion: Lamaza delivery method combined with spinal -epidural anesthesia analgesia used for labor analgesia can effectively relieve labor pain, shorten stages of labor, increase the rate of spontaneous delivery, and reduce the rate of cesarean section, which doesnt affect the amount of postpartum hemorrhage and neonatal Apgar score, but it can increase the dose of oxytocin.%目的:探讨拉玛泽分娩法联合腰硬联合阻滞分娩镇痛在分娩中应用的临床效果.方法:选择400例初产妇,分为拉玛泽联合腰硬联合阻滞分娩镇痛组(A组)、拉玛泽组(B组)、腰硬联合阻滞分娩镇痛组(C组)和导乐陪伴组(对照组D组),每组100人,观察产妇产时疼痛程度、产程时间、分娩方式、剖宫产指征、缩宫素使用、产后出血、新生儿Apgar评分等.结果:A组产妇与其他3组比较,产时疼痛程度明显减轻,产程时间缩短,自然分娩率上升,剖宫产率下降,缩宫素

  19. Clinical observation of combined spinal and epidural anesthesia combined with propofol used in laparoscopic surgery of indirect inguinal hernia%腰硬联合麻醉复合丙泊酚用于腔镜下腹股沟斜疝手术的临床观察

    Institute of Scientific and Technical Information of China (English)

    曹强; 叶太财; 周良军

    2014-01-01

    目的:探讨腰硬联合麻醉复合丙泊酚用于腹股沟斜疝手术的可行性。方法抽取80例于2011年10月~2013年10月在我院行腔镜下腹股沟斜疝手术的患者,美国麻醉师协会(ASA)分级Ⅰ~Ⅱ级,随机分成两组:腰硬联合麻醉复合丙泊酚组,40例(治疗组),腰硬联合麻醉复合芬太尼、氟哌利多组,40例(对照组),对比分析两组的治疗效果和不良反应的发生率。结果治疗组的术中MAP、HR、SpO2较术前有明显下降,与同期的对照组数据比较差异有统计学意义(P<0.01),从不良反应来看,治疗组的不良反应发生率明显低于对照组,组间比较差异有统计学意义(P<0.05)。结论腰硬联合麻醉复合丙泊酚可以安全有效地用于腔镜下腹股沟斜疝手术,同时优于芬太尼、氟哌利多,值得在临床上推广。%Objective To explore the feasibility of combined spinal and epidural anesthesia combined with propofol used in the surgery of indirect inguinal hernia. Methods 80 patients who received laparoscopic surgery of indirect inguinal hernia in our hospital from October 2011 to October 2013 were selected. They were classified by the American Society of Anesthesiologists(ASA) as status 1 to 2, and randomly allocated to two groups:40 patients in combined spinal and epidural anesthesia combined with propofol group (treatment group) and 40 patients in combined spinal and epidural anesthesia combined with fentanyl and droperidol (control group). Curative effect and incidence of adverse events were compared and analyzed between the two groups. Results MAP, HR and SpO2 during the surgery in the treatment group reduced significantly compared to those before the surgery, and the difference was statistically significant compared to the data in the control group during the same period (P<0.01). Incidence of adverse events in the treatment group was significantly lower than that in the control group

  20. Effect of high epidural anesthesia on interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy%高位硬膜外阻滞对扩张型心肌病患者白细胞介素6及可溶性白细胞介素2受体的影响

    Institute of Scientific and Technical Information of China (English)

    李秀玉; 辛晓敏; 刘凤岐

    2005-01-01

    治疗组治疗后可溶性白细胞介素2受体水平[(1 086.68±1.34)ng/L]低于治疗前[(1 328.01±1.51)ng/L,(t=2.145,P<0.05)].常规治疗组治疗前后可溶性白细胞介素2受体水平相似[(1473.33±1.66)ng/L(1 331.07±1.52)ng/L,t=-1.06,P>0.05].结论:高位硬膜外阻滞治疗后细胞因子白细胞介素6及可溶性白细胞介素2受体水平都明显下降,而常规治疗组未见此效果,表明高位硬膜外阻滞治疗对细胞因子有良好的调节作用,优于常规治疗.高位硬膜外阻滞对细胞因子的调节作用与其阻滞效应中的全面抑制心脏交感神经,抑制交感神经对体液免疫系统的激活及阻断其恶性循环有关.%BACKGROUND: Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of interleukin-6mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function. OBJECTIVE: To observe the changes of interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy after high epidural anesthesia treatment. DESIGN: A case-controlled analysis. PARTICIPANTS: Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventianal treatment group. High epidural anesthesia group consisted of 22patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females,who received physical examination at the same period. INTERVENTIONS: Patients with dilated

  1. Comparison of dexmedetomidine and propofol given Combined spinal-epidural anesthesia laparoscopic hernia repair applications%腰硬联合麻醉腹腔镜疝修补术中应用右美托咪定与丙泊酚的比较

    Institute of Scientific and Technical Information of China (English)

    李梦良; 纪宇; 胡志向

    2015-01-01

    目的:比较腰硬联合麻醉腹腔镜疝修补术中应用右美托咪定与丙泊酚对患者安全性、有效性以及对呼吸循环功能的影响。方法选择应用右美托咪定辅助腰硬联合麻醉腹腔镜疝修补患者60例,性别不限,平均年龄62±4岁,ASA分级Ⅰ-Ⅱ级,设为A组;选择应用丙泊酚辅助腰硬联合麻醉腹腔镜疝修补术患者60例,性别不限,平均年龄63±3岁,ASA分级Ⅰ-Ⅱ级,设为B组。比较两组患者在术中不同时段的血压、心率、脉搏氧饱和度、有无躁动和注药后呼吸暂停情况。结果两种麻醉方法均能满足手术需要,患者均能顺利安全的度过围术期,但A组患者术中较B组呼吸循环功能更加平稳,躁动和注药后呼吸暂停次数也明显少于B组。结论右美托咪定能产生镇静、镇痛和抗交感作用,同时具有可唤醒的特点,在辅助腰硬联合麻醉腹腔镜疝修补术中安全有效,并且能使术中患者的呼吸循环功能更加平稳,减少躁动次数,在锥管内麻醉腹腔镜手术中将有更加广阔的应用价值。%Objective To compare Combined spinal-epidural anesthesia laparoscopic hernia repair application security, effectiveness and impact of dexmedetomidine and propofol given to patients with respiratory and circulatory functions. Methods Application dexmedetomidine given Combined spinal-epidural anesthesia assisted laparoscopic hernia repair in 60 patients, male or female, mean age 62 ± 4 years old, ASA gradeⅠ -Ⅱ grade, Make A Group;select propofol auxiliary CSEA 60 cases of laparoscopic hernia repair patients, male or female, mean age 63 ± 3 years old, ASA gradeⅠ -Ⅱ grade, to group B. Two groups were compared in different time intraoperative blood pressure, heart rate, pulse oximetry, with or without agitation and apnea after injection case. Results Both methods can meet the surgery requires anesthesia, the patient can successfully secure through

  2. Comparison of entire anaesthesia and high epidural anesthesia with plexus brachialis nerves block during the operation of breast cancer%全麻和高位硬膜外联合臂丛麻醉在乳腺癌手术中的比较

    Institute of Scientific and Technical Information of China (English)

    任保入; 刘兆荣; 展瑞静

    2010-01-01

    Objective To observe the effect of breath and circulation and the incidence rate of complication during the breast cancer radical correction with this two methods of anaesthesia. Methods To select 120 patients,all definite diagnosed breast cancer,ASAⅠ-Ⅱdegree,and divided into two groups(group A and group B)at random. Group A received tracheal intubation balanced anesthesia;Group B received high epidural anesthesia with plexus brachialis nerves block. Results The patients of group A with a correspondence MAP and HR after anaesthesia;while MAP decrease(P<0.05) and HR step down (P<0.05) on the patients in group B,compare with group A has obvious statistical significance.The incidence rate of respiratory depression in group B was high, all the SpO2 after anaesthesia, the time of cutting skin and after cut skin 10 min under the base value. None respiratory depression in group A, especially SpO2 temporal descend because of intravenous injection the ketamine when ablate axillary nodes. The rate of awareness in group B, admove ephedrine and atropinic are all higher than that in group A(P<0.05).Conclusions Received tracheal intubation balanced anesthesia in the breast cancer radical correction has several good quality,such as safety, the effect of anesthesia is precisely,an equability haemodynamics;hemodynamics during the operation, to avoid respiratory depression and epidural hematoma;extradural hematoma and other complication originated by the epidural anesthesia.%目的 观察两种不同的麻醉方法用于乳腺癌根治术对呼吸循环功能的影响以及并发症的发生率.方法 选择诊断明确的乳腺癌患者120例,ASAⅠ~Ⅱ级,随机分为两组.A组66例采用气管插管静脉复合麻醉,B组54例采用高位硬膜外麻醉联合臂丛神经阻滞.结果 A组患者麻醉后平均动脉压(MAP)、心率(HR)相对平稳;B组患者麻醉后MAP下降,HR减慢,与A组比较差异有统计学意义(P<0.05).B组患者麻醉后呼吸抑制发生率

  3. Epidural anesthesia combined with remifentanil and propofol intravenous injection in 15 patients underwent Da Vinci robotic radical resection of esophageal cancer%硬膜外阻滞复合全身静脉麻醉应用于15例达芬奇手术机器人食管癌根治术的麻醉体会

    Institute of Scientific and Technical Information of China (English)

    陈浩飞; 李伟彦

    2012-01-01

    Objective: To summarize the epidural anesthesia combined with remifentanil and propofol intravenous injection, in the Da Vinci surgical robot assisted radical resection of esophageal cancer. Methods : Fifteen patients underwent selective robotic radical resection of esophageal cancer. All the patients were generally anesthetized using epidural anesthesia combined with remifentanil and propofol intravenous injection. The patients were intubated with double lumen endobronchial tube after anesthesia induction following epidural puncture, and underwent one-lung ventilation during intrathoracic operation. The blood gas, respiratory and hemodynamics parameters were monitored throughout the whole procedure. Results : All the 15 patients passed through the robotic surgery, and there was no conversion of thoracotomy occurred. The mean PaO2 and PaCO2 after anesthesia induction were (202.4±55.3) mmHg and (37.8±4.1) mmHg, and the mean PaO2 and PaCO2 30 minutes after one lung ventilation were (113.2±33.3) mmHg and (44.4±3.1) mmHg respectively. The anesthesia, operative and carbon dioxide pneumothorax duration were (245.4±40.7) min, (228.3±41.1) min and (210.3±33.1) min respectively. All the patients had (28.1±7.7) mmHg of blood pressure drop when the thorax was inflated with carbon dioxide, which was rectified by fast colloid injection and vasoactive agents. The patient-controlled epidural analgesia was applied and the patients were then transferred to PACU with single lumen intubation. Conclusion: Except that fast-track anesthesia can maintain adequately deep anesthesia and stable hemodynamics, and thus lessen surgical related stress and palliate postoperative pain, fast-track anesthesia can accelerate postoperative consciousness and muscular tension recovery, which may facilitate early extubation. As an important component of fast tract surgery, fast-track anesthesia is safe and reliable during the procedure the robotic surgery.%目的:总结硬膜外阻滞复合全

  4. 盐酸右美托咪定用于膝关节镜手术患者腰硬联合麻醉的临床分析%Clinical analysis of dexmedetomidine hydrochloride be used in spinal-epidural anesthesia for patients with knee ar-throscopic surgery

    Institute of Scientific and Technical Information of China (English)

    张军

    2016-01-01

    Objective:To investigate the effects of spinal-epidural anesthesia combined with dexmedetomidine hydrochloride in knee arthroscopic surgery process.Methods:88 patients who were treated by knee arthroscopy surgery were selected.They were grouped according to the sequence of operation treatment,the single number as the control group,the double number as the observation group.The control group patients combined with physiological saline intravenous drip before surgery.The patients in the observation group was combined with dexmedetomidine hydrochloride intravenous infusion anesthesia.Results:The scale score, VAS score,ramsay sedation score of the observation group were significantly better than those of the control group(P<0.05). Conclusion:Spinal-epidural anesthesia combined with dexmedetomidine hydrochloride in knee arthroscopic surgery can improve the emotion index and sedation index score significantly,and no additional adverse reactions.%目的:探讨腰硬联合麻醉结合盐酸右美托咪定在膝关节镜手术过程中的麻醉效果。方法:收治行膝关节镜手术治疗的患者88例,根据手术治疗先后顺序分组,单号为对照组,双号为观察组,对照组患者在手术前结合生理盐水进行静脉滴注,观察组患者则结合盐酸右美托咪定静脉滴注进行麻醉。结果:观察组患者 Scale 评分、VAS 评分、Ramsay镇静评分均显著优于对照组(P<0.05)。结论:在膝关节镜手术中的腰硬联合麻醉结合盐酸右美托咪定能够显著改善其相关情绪指标和镇静指标评分,同时无附加不良反应。

  5. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove

    1995-01-01

    Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of cen...... frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections. Comment in: J Hosp Infect. 1997 Mar;35(3):245....

  6. 脊髓硬膜外联合麻醉下全髋关节置换手术促进LBP和sCD14的表达%LBP and sCD14 expressions after total hip replacement surgery performed during combined spinal/epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    张娇

    2013-01-01

    目的 探讨脊髓硬膜外联合麻醉对全髋关节置换手术后患者血清LBP和sCD14表达的影响.方法 选择2011年7月至2012年6月期间接受脊髓硬膜外联合麻醉下全髋关节置换手术的患者7例,采用ELISA检测手术前、手术后1h、手术后1天、手术后3天和手术后6天所有患者血清LBP和sCD14质量浓度,另外检测红细胞比容,并计算LBP和sCD14相对于红细胞比容的校正质量浓度.结果 术前和术后1h患者血清LBP质量浓度和校正质量浓度均无显著差异(P=0.376),术后1、3d和6d血清LBP质量浓度均显著高于手术前,校正质量浓度也均显著高于手术前.术前、术后1h、1、3d和6d患者血清sCD14质量浓度均无显著性差异,而术后1h、术后1、3d和6d患者血清sCD14校正质量浓度均显著高于术前.结论 脊髓硬膜外联合麻醉会促进全髋关节置换手术引起的创伤激起的炎症反应,从而促进LBP和sCD14的表达.%Surgical trauma can provoke host innate immune response, in which pattern recognition receptor (PRR) recognizes the danger signals including the pathogenic lipopolysaccharide (LPS) and peptidoglycan, and then cause a series of inflammatory reactions. Toll like receptor 4 (TLR4) is one of the most conservative PRR recognizing LPS, which needs the involvement of LBP and CD14. This study was designed to investigate the effects of total hip replacement surgery during epidural anesthesia on patients' serum LBP and sCD14 levels. Seven patients, who received total hip replacement operation with spinal epidural anesthesia, were enrolled in the study. ELISA was performed to quantify the serum LBP and sCD14 concentration before surgical operation, and 1 h, 1 day, 3 days and 6 days after operation. To correct for hemodilution, each parameter was adjusted for hematocrit. Results showed that there was no apparent difference of LBP concentration and the corrected concentration between preoperational patients and patients 1 h

  7. Effect of midazolam combining dezocine or fentanyl on visceral traction reaction during appendectomy under epidural anesthesia%咪达唑仑复合地佐辛与芬太尼对硬膜外麻醉下阑尾牵拉反射作用的观察

    Institute of Scientific and Technical Information of China (English)

    李丹; 刘会长

    2013-01-01

    Objective To observe the effect of midazolam combining dezocine or fentanyl on inhibiting visceral traction reaction during appendectomy under epidural anesthesia. Methods A total of 120 ASA Ⅰ ~ Ⅱ patients undergoing appendectomy under epidural anesthesia( age 18 ~ 56 years, weight 45 ~85 kg)were randomly divided into group A,B and C( n = 40 ). At 5 min before operation, group A were given midazolam( 0. 04 mg/kg )by intravenous injection, group B were given midazolam( 0. 04 mg/ kg )and fentanyl( 2 μg/kg )by intravenous injection and group C were given midazolam( 0. 04 mg/kg )and dezocine ( 0. 15 mg/kg )by intravenous injection. The vital signs including MAP,HR and SpO2 were recorded at the time points of 5 min before operation, cutting the skin, opening the peritoneum and pulling the appendix. The visceral traction reaction and respiratory inhibition were evaluated during operation. Results Hemodynamics of group B and C were more stable than group A( P <0. 05 ). Excellent rates of group B and C were higher than group A( P <0. 05 ). Respiratory inhibition of group B was more than group A and C( P < 0.05 ). Conclusion Midazolam combining dezocine or fentanyl are significantly effective on inhibiting visceral traction reaction during appendectomy under epidural anesthesia, but midazolam combining dezocine are safer because of the relatively weak inhibition of respire.%目的 探讨咪达唑仑分别复合地佐辛与芬太尼对抑制硬膜外麻醉下阑尾牵拉反射的作用.方法 选择阑尾切除术患者120例,ASAⅠ~Ⅱ级,将患者随机分为A、B、C 3组(每组40例),行硬膜外麻醉.术前5min,A组静注咪达唑仑0.04mg/kg;B组静注咪达唑仑0.04mg/kg和芬太尼2μg/kg;C组静注咪达唑仑0.04mg/kg和地佐辛0.15mg/kg.记录3组患者切皮前5min、切皮时、打开腹膜时、牵拉阑尾时的平均动脉压、心率、氧饱和度值,评估牵拉阑尾时患者的临床反应和术中呼吸抑制情况.结果 与A组比较,B、C

  8. Analysis of 108 cases of anesthesia for labor analgesia with ropivacaine epidural fentanyl%罗呱卡因联合芬太尼硬膜外阻滞麻醉用于分娩镇痛108例分析

    Institute of Scientific and Technical Information of China (English)

    李丽; 孙建群

    2014-01-01

    Objective To investigate the ropivacaine epidural anesthesia combined with fentanyl analgesia effect and the impact on the safety of mother and child,the incubation period to analyze the feasibility of labor analgesia.Methods Voluntary requirements of lumbar epidural anesthesia for labor analgesia of 108 cases of women in the observation group,did not implement the same period 100 cases of mater-nal pain control group.Comparison of two maternity analgesia,duration of labor,use of oxytocin,neonatal asphyxia,and postpartum hemor-rhage.Analgesic timing of different latencies group active phase group were compared childbirth labor time,oxytocin use,neonatal asphyxia, and postpartum hemorrhage.Results The visual analog scale (Visual analogue scale,VAS)scores were significantly lower than the control group (P0.05);between the timing of different analgesic latencies group and active group of neo-natal asphyxia,postpartum hemorrhage,duration of labor was not statistically significant (P>0.05).Conclusion Ropivacaine fentanyl an-algesia epidural anesthesia effect is good,no adverse effects on mother and child,the incubation period analgesia feasible to meet the needs of the entire production process,is worthy of further promotion.%目的:探讨罗呱卡因联合芬太尼硬膜外阻滞麻醉分娩镇痛的效果及对母儿安全性的影响,潜伏期进行分娩镇痛可行性的分析。方法选择自愿要求硬膜外阻滞麻醉分娩镇痛的108例产妇为观察组,同期未实施镇痛的100例产妇为对照组。比较两组产妇分娩镇痛效果、产程时间、催产素使用、新生儿窒息及产后出血情况。镇痛时机的选择不同的潜伏期组与活跃期组,比较两组分娩产程时间、催产素使用、新生儿窒息及产后出血情况。结果观察组视觉模拟评分明显低于对照组(P<0.05),但增加催产素使用率(P<0.05);两组新生儿窒息、产后出血、产程时间比较差异无统计

  9. Analysis of therapeutic effect of epidural anesthesia open tension-free hernia repair in the treatment of adult inguinal hernia%硬膜外麻醉开放式无张力疝修补术治疗成年人腹股沟疝的疗效分析

    Institute of Scientific and Technical Information of China (English)

    李德全

    2014-01-01

    Objective:To investigate the clinical effect of epidural anesthesia open tension-free hernia repair in the treatment of adult inguinal hernia.Methods:68 adult patients with inguinal hernia who admitted to the surgical operation for treating were selected from February 2012 to March 2014.We retrospected analyzed of them.They were divided into the observation group(n=36) and the control group(n=32) according to the operation treatment method of patients.The observation group were treated with epidural anesthesia open tension-free hernia repair in treatment,and the control group were treated with the traditional hernia repair in the treatment.We observed and compared the operation time,postoperative pain intensity,postoperative ambulation time, postoperative hospital stay,postoperative complications and recurrence occurrence of the two groups.Result:The surgery time, postoperative pain intensity,postoperative ambulation time and postoperative hospital stay of the patients of the observation group were significantly better than those of the patients in the control group(P<0.05);the incidence of postoperative complications and the relapse rate of the observation group patients were lower than those of the control group patients(P<0.05).Conclusion:Epidural anesthesia open tension-free hernia repair can shorten the operation time,reduce the intensity of pain treatment,and reduce the complications and postoperative recurrence of the phenomenon occurred.It is better than the traditional hernia repair,so it is worth the clinical promotion.%目的:探讨硬膜外麻醉开放式无张力疝修补术治疗成年人腹股沟疝的临床疗效。方法:2012年2月-2014年3月收治行外科手术治疗的腹股沟疝成年患者68例,对其进行回顾性分析,根据患者采取的手术治疗方式分为观察组(n=36)和对照组(n=32),观察组采用硬膜外麻醉开放式无张力疝修补术治疗,对照组采用传统疝修补术治疗。观察并比较两组

  10. 瑞芬太尼辅助腰椎-硬膜外麻醉用于急诊剖宫产手术的临床观察%Clinical observation of remifentanil assisted lumbar-epidural anesthesia in emergency caesarean operation

    Institute of Scientific and Technical Information of China (English)

    秦树国; 张乐; 赵明; 陈文丽; 刘森

    2014-01-01

    目的:观察瑞芬太尼辅助腰椎-硬膜外麻醉减轻患者疼痛及对新生儿Apgar评分和新生儿娩出时SpO2影响。方法剖宫产产妇120例随机分为两组,每组60例,选用L3~4间隙, B-D型腰椎-硬膜外联合穿刺确认成功后,用25 G腰穿针行蛛网膜下腔穿刺,见脑脊液回流后注入腰麻药0.75%的盐酸布比卡因1.2 ml,向头侧置入导管3.5 cm,麻醉平面控制在T10, A组为对照组,术中不辅助瑞芬太尼。B组为观察组,手术开始时静脉滴注瑞芬太尼1.0μg/(kg·h)。结果手术患者牵拉痛VAS评分B组显著低于A组,差异有统计学意义(P0.05),两组患者术中恶心呕吐等不良反应比较,差异无统计学意义(P>0.05)。结论小剂量的瑞芬太尼辅助腰椎-硬膜外麻醉是可行的,能减轻牵拉疼痛及对新生儿Apgar评分和新生儿娩出时SpO2影响极小,对母婴是安全的。%Objective To observe the influence of remifentanil assisted lumbar-epidural anesthesia on reducing pain and Apgar score and SpO2 of newborns. Methods A total of 120 cases undergone caesarean section were randomly divided into two group, and each group contained 60 cases. After confirmed success of L3~4 clearance and B-D lumbar-epidural puncture, 25 G spinal needle was conducted for subarachnoid puncture. 1.2 ml of 0.75%anesthetic bupivacaine hydrochloride was injected after cerebrospinal fluid reflow. Insertion catheter was set cephalad for 3.5 cm. The level of anesthesia was controlled at T10. Group A was the control group and received no assisted remifentanil during operation. Group B, as the observation group, was injected by 1.0μg/(kg·h) of remifentanil at the beginning operation. Results The dragging pain VAS score of group B was obviously lower than that of group A, and the difference had statistical significance (P0.05). The difference was no statistically significant between the adverse reactions, such as nausea and vomiting, of the two groups (P>0.05). Conclusion Lumbar-epidural

  11. 老年高血压患者全膝关节置换中硬膜外复合小剂量静脉麻醉的安全性%Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension

    Institute of Scientific and Technical Information of China (English)

    张威强; 徐贯杰; 杨立新; 李通华; 张晓林; 张雯璟

    2015-01-01

    BACKGROUND:Elderly hypertensive patients often associated with organ and tissue ischemia. Al kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia. OBJECTIVE:To explore the application security of epidural combined with smal dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients. METHODS:A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with smal dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia, 10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION:Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P  目的:探讨硬膜外复合小剂量静脉麻醉在老年高血压全膝关节置换中的应用安全性。  方法:从2013年12月至2014年12月河北医科大学附属第三医院收治的老年高血压关节置换患者中选择64例,随机分为对照组和观察组,每组32例,分别给予全凭静脉麻醉和硬膜外复合小剂量静脉麻醉。测定麻醉前、麻醉诱导后、麻醉后10 min

  12. Comparison on the influence of different doses Bupivacaine combined with pinal-epidural anesthesia for hemorheology of parturient underwent caesarean section%不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学影响比较

    Institute of Scientific and Technical Information of China (English)

    李静

    2012-01-01

    Objective To compare the influence of different doses bupivacaine combined with spinal -epidural anesthesia for hemorheology of parturient underwent caesarean section. Methods 84 parturient underwent caesarean section with spinal-epidural anesthesia in our hospital from October 2009 to October 2011 were selected as research object, and they were divided into group A and group B with 42 cases in each group, the group A were given 7.0 mg 0.75% Bupivacaine, the group B were given 9.0 mg 0.75% Bupivacaine, then the incidence of adverse reactions and hemorheology indexes before and after the anesthesia at 5, 15, 30 min of two groups were detected and compared. Results The after the anesthesia at 5, 15, 30 min of group B were all lower than those of group A (all P 0.05). Conclusion The influence of 9.0 mg 0.75% Bupivacaine for hemorheology of parturient underwent caesarean section is more obvious, and it can sig nificantly improve blood circulation status of parturient and the security is higher, so it is more suitable for cesarean section.%目的 比较不同剂量布比卡因腰硬联合麻醉对剖宫产产妇血液流变学的影响.方法 选取2009年10月~2011年10月于本院进行采用腰硬联合麻醉进行剖宫产的84例产妇为研究对象,将其分为A组与B组,每组各42例.A组采用7.0 mg的0.75%布比卡因进行麻醉,B组采用9.0 mg的0.75%布比卡因进行麻醉,后将两组产妇不良反应发生率及麻醉前及麻醉后5、15、30 min的血液流变学指标进行检测及比较.结果 B组麻醉后5、15、30 min的各项血液流变学指标低于A组(均P < 0.05),而两组患者不良反应发生率比较差异无统计学意义(P > 0.05).结论 9.0 mg的0.75%布比卡因对剖宫产产妇的血液流变学影响更为明显,可显著改善产妇的血液循环状态,且安全性也较高,故更适用于剖宫产术.

  13. Metaraminol target-control ed infusion in the elderly combined spinal-epidural anesthesia postoperative consciousness (POCD) effect%间羟胺靶控输注对老年人腰硬联合麻醉术后意识(POCD)的影响

    Institute of Scientific and Technical Information of China (English)

    王军; 刘春萍; 陈新莉

    2013-01-01

      目的探讨间羟胺依照目标剂量靶控输注对老年人腰硬联合麻醉髋关节手术后意识(认知功能)的影响。方法:择期行髋关节手术老年病人40例,年龄65~85岁,体重(42~60kg),身高(152~165cm),ASAⅡ~Ⅲ级,随机分2组(n=20):生理盐水输注组(0组)和间羟胺输注组(OG组),两组均监测MAP/HR/ECG/Spo2,分别评估麻醉中,术后72小时平均动脉压、心率的改变。采用简易智力状态检查法(MMSE),评估两组老年病人术后72小时认知功能。结果与麻醉前比较,术后48小时内(O组)有3例(15%)出现认知功能障碍,但术后72小时恢复。而(OG组)术后72小时内没有出现认知功能障碍者。结论间羟胺目标剂量靶控输注对老年人腰硬联合麻醉髋关节手术后意识(认知功能)起积极保护作用。%Objective To explore the target dose of metaraminol in accordance with target control ed infusion combined spinal-epidural anesthesia in elderly hip consciousness after the operation (cognitive) effect. Methods: 40 patients undergoing elective hip operation in aged patients, age 65~85 years old, weight (42~60kg), height (152~165cm), ASA Ⅱ ~Ⅲ grade, were randomly divided into 2 groups (n=20): normal saline infusion group (group 0) and metaraminol infusion group (OG group), two groups were monitored MAP/HR/ECG/Spo2, respectively, in 72 hours of anesthesia, changes in mean arterial pressure, heart rate after operation. Using mini mental state examination (MMSE), assessment of two groups of elderly patients after 72 hours of cognitive function. Results compared with those before anesthesia, 48 hours after operation (O group) and 3 cases (15%) of cognitive dysfunction, but after 72 hours of recovery. And (group OG) without cognitive impairment after 72 hours. Conclusion metaraminol target dose of target control ed infusion combined spinal-epidural anesthesia in elderly hip consciousness

  14. Awake caudal anesthesia for inguinal hernia operations: successful use in low birth weight neonates.

    Science.gov (United States)

    Geze, S; Imamoğlu, M; Cekic, B

    2011-09-01

    Neonates with inguinal hernia face a relatively high risk of incarcerated hernia and bowel obstruction and this therefore requires surgical treatment. Complications following general anesthesia even for minor surgery are more common in low birth weight neonates than in term neonates. Caudal epidural anesthesia without adjunct general anesthesia has been recommended for neonates to reduce the risk of postoperative complications. The successful application of awake caudal anesthesia with levobupivacaine for inguinal hernia repair in 15 low birth weight neonates is reported. Single dose caudal epidural anesthesia was administered for inguinal hernia surgery to avoid complications associated with general anesthesia. Caudal block was performed with 2.5 mg/kg body weight (BW) levobupivacaine. Caudal anesthesia can be recommended as an effective technique for avoiding postoperative anesthetic complications in low birth weight neonates.

  15. [General anesthesia for two patients taking methylphenidate (Ritalin)].

    Science.gov (United States)

    Kasuga, Takaho; Meno, Aki; Honda, Masahiro; Momoeda, Kanako; Nagase, Masaki; Hanaoka, Kazuo

    2008-06-01

    We experienced anesthesia care for two patients taking methylphenidate (Ritalin), which is a central nervous system stimulant of amphetamine analogues, usually administered for narcolepsy or refractory depression. The proper dose of methylphenidate is 20-60 mg per day. General anesthesia with epidural anesthesia was administered to both cases for total hip replacement. One patient could discontinue taking methylphenidate five days before the operation, but the other patient could not. Both cases needed more anesthetics than usual on induction, but very stable condition could be maintained during and after the operations. We consider that it is possible to perform general anesthesia safely for patients taking a usual dose of methylphenidate.

  16. 不同剂量芬太尼和左旋布比卡因硬膜外阻滞用于剖宫产术%Epidural anesthesia with different dosage of fentanyl and levobupivacaine for cesarean section

    Institute of Scientific and Technical Information of China (English)

    张兆平; 顾美蓉; 姚敏; 孙国华

    2009-01-01

    Objective The aim of this study was to evaluate the effectiveness of different dosage of fentanyl and levobupivacaine for cesarean section.Methods Sixty women undergone elective caesarean section under epidural auaesthesia were randomised into three groups to receive either 2 ml of saline or 50 or 75 micrograms of fentanyl in 2 ml volume added to 8 ml of 0.75% levobupivacaine.Results Both of fentanyl intensified the epidural anaesthesia and reduced patient discorofort during the operation.There was no difference between the groups in the condition of the neonates as assessed by the Apgar score.Conclusion The results suggest that 50 micrograms of fentanyl added to 0.75% levobupivacaine increases patient comfort and improves the quality of epidural anaesthesia for caesarean section,and that adding 75 micrograms does not give further advantage.%目的 比较不同剂量芬太尼和左旋布比卡因硬膜外麻醉对剖宫产产妇和胎儿的影响.方法 60例产妇ASA Ⅰ或Ⅱ级,22~34岁.随机分为三组,每组20例.Ⅰ组:0.75左旋布比卡因8 ml+生理盐水2 ml(对照),Ⅱ组:0.75左旋布比卡因8 ml+芬太尼50 μg+生理盐水至10 ml和Ⅲ组:0.75左旋布比卡因8 ml+芬太尼75 μg+生理盐水至10 ml(观察).结果 芬太尼两组分别能够增强硬膜外左旋布比卡因的镇痛效果,明显改善产妇术中不适反应和提高麻醉质量.对新生儿Apgar评分无明显影响.50 μg和75 μg芬太尼组镇痛效果无明显差异.结论 50 μg芬太尼可明显增强左旋布比卡因硬膜外麻醉效能,改善产妇术中不适和提高麻醉质量,75 μg 芬太尼未见明显优势.

  17. Lumbar epidural catheter placement in the presence of low back tattoos: a review of the safety concerns.

    Science.gov (United States)

    Welliver, Dawn; Welliver, Mark; Carroll, Tammy; James, Peggy

    2010-06-01

    Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. Does the placement of epidural catheters risk the introduction of tattoo pigment dyes into the epidural space through the process of coring? Are there specific risks associated with tattoo dyes and epidural needle placement? We performed a comprehensive review of the literature using multiple search databases with the intent to form guidelines for practice using a level of evidence taxonomy. The available evidence does not identify any specific risks associated with epidural catheter placement through low back tattoos, although tissue coring with tissue transport to deeper sites has been confirmed. Continued investigation is necessary before comprehensive practice guidelines regarding the practice of placing epidural needles and catheters through lumbar tattoos can be developed. We suggest avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.

  18. Anestesia peridural contínua para cesariana em paciente com arterite de Takayasu: relato de caso Anestesia peridural continua para cesárea en paciente con arteritis de Takayasu: relato de caso Continuous epidural anesthesia for cesarean section in a patient with Takayasu’s arteritis: case report

    Directory of Open Access Journals (Sweden)

    Aloísio Cerqueira Buettel

    2002-06-01

    ína a 0,5% con epinefrina (1:200.000, a intervalos de 5 en 5 minutos hasta un total de 100 mg, asociándose 2 mg de morfina y 100 µg de fentanil. CONCLUSIONES: La anestesia peridural contínua con dosis tituladas de bupivacaína a 0,5% con epinefrina puede ser utilizada en pacientes con Arteritis de Takayasu, tomándose las medidas de precaución con portadoras de esa enfermedad.BACKGROUND AND OBJECTIVES: Continuous epidural anesthesia with titrated doses of local anesthetics is safe and effective for patients not tolerating blood pressure fluctuations. This report aimed at presenting a case in which continuous epidural anesthesia for Cesarean section in a patient with Takayasu’s arteritis was successfully induced. CASE REPORT: Primiparous patient, 25 years old, 63 kg, Takayasu’s arteritis, 34 to 35 weeks of gestation, acute fetal distress, blood pressure = 155/85, HR = 92, no carotid, upper and right lower limb pulse. Patient had only left palpable popliteal pulse. Epidural continuous anesthesia was induced with 25 mg titrated doses of 0.5% bupivacaine with epinephrine (1:200.000, in 5-minute intervals, up to a total dose of 100 mg with 2 mg morphine and 100 µg fentanyl. CONCLUSIONS: Continuous epidural anesthesia with titrated doses of 0.5% bupivacaine may be used in patients with Takayasu’s arteritis, provided all precaution measures are taken with such patients.

  19. Effects of double-barreled and single-barreled epidural block anesthesia on nervous behavior of neonates%双管硬膜外阻滞和单管硬膜外阻滞麻醉对新生儿神经行为的影响

    Institute of Scientific and Technical Information of China (English)

    罗正勇; 李溥; 何锴; 涂兵; 何明波; 张永国

    2011-01-01

    目的:探讨双管硬膜外阻滞和单管硬膜外阻滞麻醉对新生儿神经行为的影响.方法:选取58例孕妇为研究对象,随机分成2组,双管硬膜外阻滞麻醉组(双管组)和单管硬膜外阻滞麻醉组(单管组),比较两组新生儿1 min和5min Apgar评分、神经行为评分、出生后4天的体重及产妇β-内啡肽含量变化.结果:①新生儿Apgar评分:双管组新生儿Apgar评分与单管组比较,差异无统计学意义(P>0.05);②NACS评分:双管组被动肌张力、主动肌张力、一般反应评分及NACS总分明显高于单管组,差异有统计学意义(P<0.01);③新生儿体重变化:两组母乳喂养新生儿体重在出生即刻、出生后1、2、3天差异均无统计学意义(P>0.05);两组新生儿出生后3天内均发生了明显的生理性脱水,出生后1、2、3天的体重低于出生即刻(P<0.05);出生后1、2、3天体重减轻量双管组少于单管组,出生后1天的体重减轻量差异无统计学意义(P>0.05),出生后2、3天差异有统计学意义(P<0.05).④β-内啡肽:两组术前24 hβ-内啡肽比较,差异无统计学意义(P>0.05).术后24h,双管组β-内啡肽含量明显高于单管组(P<0.01).结论:双管硬膜外阻滞对新生儿神经行为及适应能力无影响,该方法用于临床无痛分娩安全可靠.%Objective: To explore the effects of double - barreled and single - barreled epidural block anesthesia on nervous behavior of neonates. Methods: 58 pregnant women were selected as study objects, then they were divided into two groups randomly: double -barreled epidural block anesthesia group (double - barreled group) and single - barreled epidural block anesthesia group ( single - barreled group) . One minute and five minutes Apgar scores, nervous behavior scores, body weights on the fourth day after birth, changes of β - en-dorphin content of pregnant women in the two groups were compared. Results: ①Neonatal Apgar scores: there was

  20. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  1. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  2. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  3. Apakah Epidural Preemtif Menghambat Stres Pembedahan dengan Sempurna?

    Directory of Open Access Journals (Sweden)

    Muh. Rumli Ahmad

    2013-09-01

    Full Text Available Preemptive analgesia is initiating an analgesic regimen before the onset of the noxious stimulus. Damages to the tissue caused by surgical trauma generate noxious response conveyed to the central nervous system (CNS by two pathways, neural pathway and circulatory pathway. This study is a double- blinded clinical trial that included 48 patients undergoing lower extremity orthopedic surgery. The subjects were divided into two groups: group I (n=24 received 10 mL bupivacaine 0.25% from epidural route, and group II (n=24 received 10 mL NaCl 0.9% from epidural route as the control group before induction of anesthesia. Both groups were anesthetized under general anesthesia. Group I received 5 mL bupivacaine 0,5% every 90 minutes and group II received 5 mL NaCl 0,9 with similar time intraoperatively. Post-operatively, both groups received continuous bupivacaine 0,25% 4 mL/ hour until 24 hours after surgery. Measurements of cytokine levels: tumor necrosis factor-α (TNF-α, interleukin- 1β (IL-1β, IL-6 and IL-10 were done before induction of anesthesia, in the early post-operative period, at 4, 8, and 24 hours after surgery. Group I showed lower level proinflammatory cytokines level compared with group II but the difference was not statistically significant (p>0.05. The level of anti-inflammatory cytokine was higher in group I, but the difference was not statistically significant (p>0.05. Pain intensity at 4 hours, 8 hours, 24 jam hours post operative was lower significantly (p0.05 excepst at early postoperative period (p<0.05. Generally, preemptive epidural analgesia was able to suppress the cytokine responses, but not completely. In conclusion, preemptive epidural analgesia is associated with better analgesia and better hemodynamic stability compared without preemptive epidural, but unable to suppress the production of proinflammatory and anti-inflammatory cytokines.

  4. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  5. Ketamina epidural en cirugía de hemiabdomen inferior Epidural ketamine in low abdominal surgery

    Directory of Open Access Journals (Sweden)

    S. F. González-Pérez

    2006-04-01

    Full Text Available Introducción: La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mezcla racémica de enantiómeros R (- y S (+. En la década de los años 80 comienza la administración humana de la ketamina por vía epidural. A partir de entonces se han presentado disímiles investigaciones para justificar su acción analgésica en este espacio con varias hipótesis: 1 supresión específica laminar de las astas dorsales, 2 mediación por el sistema opioide endógeno y sustancia gris periacueductal, y 3 bloqueo de los canales del calcio por antagonismo no competitivo de los receptores N-metil-d-aspartato. Objetivo: Demostrar la eficacia de la ketamina por vía epidural como analgésico postoperatorio en la cirugía de hemiabdomen inferior. Material y Método: Se realizó un ensayo clínico aleatorizado y prospectivo en una muestra de 50 pacientes operados de hernia inguinal electiva. Los pacientes fueron divididos en dos grupos, un grupo tratado con 50 mg de ketamina y otro grupo al que se le administró una dosis de 2 mg de morfina liofilizada. Resultados: la ketamina por vía epidural en una dosis de 50 mg proporciona una analgesia adecuada por un período de al menos de 6 horas. La morfina brinda una analgesia por encima de las 18 horas. Conclusión: La ketamina por vía epidural es menos efectiva que la morfina desde el punto de vista analgésico, pero es una alternativa importante pues permite disminuir la dosis de morfina si se combinan ambos fármacos o se asocia a anestésicos locales.Introduction: Ketamine is a drug used for induction and maintenance of anesthesia, exists as a racemic mixture of R- and S+-enantiomers. Epidural ketamine starts to human administration about 80’ years. After that, various studies have been published about the mechanism of analgesic action of ketamine: lamina-specific suppression of dorsal-horn unit activity (1, opiate agonist at

  6. Effect of thoracic epidural anesthesia with bupivacaine on arterial oxygenation during one-lung ventilation%食管癌术中硬膜外阻滞对单肺通气期间动脉氧合的影响∗

    Institute of Scientific and Technical Information of China (English)

    蒋大明; 王丽君; 顾连兵

    2014-01-01

    目的:探讨食管癌手术采取全麻复合硬膜外阻滞麻醉时对单肺通气( OLV)期间动脉氧合的影响。方法选择60例行经左胸食管癌根治术患者( ASAIII级),随机分为静脉全麻复合硬膜外阻滞麻醉组( A组,30例)和仅静脉全麻组( B组,30例)。两组患者分别于OLV前( T1)、OLV 15min( T2)、OLV 30min( T3)抽取桡动脉血和混合静脉血行血气分析,计算通气/血流比(Qs/Qt)值。结果在T2和T3时,A组氧分压(PaO2)分别为(219�3±48�2)mmHg和(174�7±37�6)mmHg,显著低于B组的(268�1±81�2)mmHg和(221�6±87�0)mmHg。在OLV期间,A组的Qs/Qt显著高于B组(P<0�05),各时间点A组血压均显著低于B组( P<0�05)。结论全麻复合硬膜外阻滞麻醉时会引起食管癌患者术中血压下降,而且会引起OLV期间肺内分流的增加和氧分压的降低。%Objective To study the effects of thoracic epidural anesthesia(TEA) with bupivacaine on oxygenation, shunt fraction during one-lung ventilation( OLV) . Methods Sixty patients who had prolonged periods of OLV for elective thoracic surgery for esophageal cancer were randomized into two groups. Thirty patients ( group A) were anesthetized with propofol/atracurium/epidural thoracic bupivacaine 0�5%. In another 30 patients ( group B) , fentanyl/propofol/atracurium anesthesia was used. A double-lumen en-dotracheal tube was inserted, and mechanical ventilation with 100% oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with two-lung ventilation, 15 and 30 min after OLV ( OLV+15 and OLV+30, respectively) in all patients. PaO2, venous central oxygen tension, arterial and central venous oxygen saturation, venous admixture per-centage (Qs/Qt) were measured. Results The mean values for PaO2 during OLV in the group A after 15min with (219�3±48�2)mm-Hg and 30min with

  7. Anesthesia Management of a Patient with Kearn%u2019s - Sayre Syndrome

    Directory of Open Access Journals (Sweden)

    Biricik Çakmak

    2013-03-01

    Full Text Available Kearn’s Sayre Syndrome is a multi-system mitochondrial myopathy which has rarely seen. We report a patient with Kearn’s Sayre syndrome who had laparoscopic cholesistectomy and pyeloplasty operation under combined spinal epidural anesthesia and importance of anesthesia management of this syndrome.

  8. Anesthesia Management of a Patient with Kearn%u2019s - Sayre Syndrome

    OpenAIRE

    Biricik Çakmak

    2013-01-01

    Kearn’s Sayre Syndrome is a multi-system mitochondrial myopathy which has rarely seen. We report a patient with Kearn’s Sayre syndrome who had laparoscopic cholesistectomy and pyeloplasty operation under combined spinal epidural anesthesia and importance of anesthesia management of this syndrome.

  9. Epidural catheter fragment entrapment: a case report

    Directory of Open Access Journals (Sweden)

    Mohammadi M

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous. "n"nCase presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic."n"nConclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.

  10. 芬太尼增强左旋布比卡因硬膜外阻滞效果的临床研究%The clinical observation of fentanyl reinforcement effect of epidural anesthesia with levobupivacaine

    Institute of Scientific and Technical Information of China (English)

    张兆平; 姚敏; 顾美蓉; 孙国华

    2009-01-01

    目的 观察和比较不同剂量芬太尼和左旋布比卡因硬膜外麻醉用于骨科下肢手术.方法 60例骨科下肢手术患者,ASA Ⅰ或Ⅱ级,年龄22~60岁.随机分为三组,每组20例.Ⅰ组:为0.75左旋布比卡因10 ml+生理盐水2 ml(对照),Ⅱ组:为0.75左旋布比卡因10 ml+芬太尼50μg+生理盐水至12 ml和Ⅲ组:为0.75左旋布比卡因10 ml+芬太尼75μg+生理盐水至12 ml(观察).结果 芬太尼两组分别能够增强硬膜外左旋布比卡因的镇痛效果,同时明显改善患者术中不适反应和提高麻醉质量.50μg和75μg芬太尼组镇痛效果无统计学差异.结论 50μg芬太尼可明显增强左旋布比卡因硬膜外麻醉效果,改善术中患者不适和提高麻醉质量,75μg芬太尼未见明显优势.%Objective The aim of this study was to evaluate the effectiveness of different dosage of fen-tanyl plus levobupivacaine for lower limb surgery. Methods A total of 60 patients who were ASA Ⅰ or Ⅱ, and who were subjected to surgery of lower limbs with epidural anaesthesia were randomised into three groups to re-ceive either 2 ml of saline or 50 or 75 micrograms of fentanyl in 2 ml volume added to 10 ml of 0.75% levobupivaeaine. Results Both doses of fentanyl intensified the epidural anaesthesia and reduced patients dis-comfort during the operation. The lack of motor blockade(MB) as evaluated by the modified Bromage scale was significantly higher in the levobupivacaine plus fentanyl groups than in the levobupivacaine group. Mild pruritus not requiring treatment was more common in fentanyl groups than in the saline group. Conclusion The results suggest that 50 micrograms of fentanyl added to 0. 75% levobupivacaine increases patient comfort and improves the quality of epidural anaesthesia for lower limb surgery, and that adding 75 micrograms does not give further advantage.

  11. Spinal and Intracranial Epidural Abscess

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2009-03-01

    Full Text Available Presentation, epidemiology, diagnosis and treatment of spinal epidural abscess (SEA and intracranial epidural abscess (ICEA are reviewed by researchers at The John's Hopkins University School of Medicine, Baltimore, MD, and Universidad de Santander, Columbia.

  12. Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso Uso del bloqueo combinado raquiepidural durante cirugía de colon en paciente de alto riesgo: relato de caso Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2009-12-01

    éter epidural (20G fue introducido cuatro centímetros en dirección cefálica. La sedación se obtuvo con dosis fraccionadas de 1 mg de midazolam (total de 6 mg. La bupivacaína a 0,5% se administró en bolo de 25 mg a través del catéter dos horas después de la anestesia subaracnoidea. No hubo necesidad de aplicar vasopresor ni atropina. CONCLUSIONES: Este caso nos demuestra que la raquianestesia segmentaria puede ser una técnica anestésica para la operación gastrointestinal con respiración espontánea.BACKGROUND AND OBJECTIVES: Combined spinal epidural anesthesia (CSEA has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration. CASE REPORT: Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 µg of morphine were injected in the subarachnoid space. The epidural catheter (20G was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg. A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used. CONCLUSIONS: This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

  13. Clinical Observation of Midazolam's Sedative Effect and Anterograde Amnesia Effect on Gynecologic Surgery Patients Undergoing Spinal-Epidural Anesthesia%咪唑安定联合腰硬联合麻醉对妇科手术患者镇静和术后遗忘效果观察

    Institute of Scientific and Technical Information of China (English)

    谢锐捷; 刘少芬; 张松林; 房瑞林; 陈铭君; 莫坚

    2013-01-01

    Objective:To explore the sedative effects and anterograde amnesia effect of midazolam intravenous injection used before combined spinal-epidural anesthesia on calming down the patients and their forgetting degree of procedure.Method:200 ASA Ⅰ-Ⅱpatients scheduled for gynecologic surgery under spinal-epidural anesthesia were included in the study.Patients were randomly assigned into two groups with 100 cases each.Group A used midazolam while Group B used 0.9% sodium as control.Group A used midazolam (0.lmg/kg) as intravenous injection 30 minutes before anesthesia while group B used 2ml 0.9% sodium as control.Record and compare the patients' sedative effect before operation began and the forgetting degree 24 hours after operation finished.Result:According to the Ramsay standard,the patients in group A have significant better sedative effect than group B since operation started (P<0.05).In group A the transient global amnesia rate of was 97% while the transient partial amnesia rate was 3%.Meanwhile,the transient global amnesia rate,the transient partial amnesia rate and the unforgotten rate were 68,25% and 7% in Group B separately.There was a significant difference between two groups (P<0.05).Conclusions:Midazolam (0.1mg/kg) as intravenous injection 30 minutes before anesthesia can reduce the patients' worries and horrors.It not only helps to keep patients sedative but also cooperate with anesthesia and controlling body position.It has good calm and amnesia effects on anesthesia and procedure.%目的:本文旨在观察咪唑安定联合腰硬联合麻醉对妇科手术患者术后镇痛遗忘效果.方法:将200例ASA Ⅰ~Ⅱ级腰硬联合麻醉下行妇科手术患者随机分为两组:咪唑安定组(A组)和对照组(B组).两组患者分别于麻醉前30分钟静脉注射咪唑安定0.1 mg/kg和0.9%生理盐水2mL.观察用药前后病人镇静情况,镇静分级,对麻醉和手术操作的遗忘程度和病人的心理状态.结果:根

  14. Peridural torácica alta associada ou não à peridural torácica baixa em pacientes ambulatoriais: implicações clínicas Peridural torácica alta asociada o no a la peridural torácica baja en pacientes ambulatoriales: implicaciones clínicas High thoracic epidural anesthesia associated or not to low thoracic epidural anesthesia in outpatient procedures: clinical implications

    Directory of Open Access Journals (Sweden)

    Djalma Sperhacke

    2004-08-01

    así como en los miembros superiores e inferiores. MÉTODO: Treinta y dos pacientes, estado físico ASA I y II, sin molestia pulmonar broncoespástica, en actividad y peso corporal igual o superior a 50 kg, fueron sometidos a 21 bloqueos peridurales torácicos aislados en T2-T3 y las 11 restantes, a bloqueos peridurales torácicos en T11-T12, con ropivacaína a 7,5% (45 a 90 mg asociada al sufentanil (10 a 20 µg. Repercusiones hemodinámicas, respiratorias y motoras en los miembros superiores e inferiores fueron evaluadas respectivamente, sobre monitorización no invasiva, espirometria, fuerza de preensión de la mano y escala de Bromage. RESULTADOS: La media de duración de las cirugías mamarias fue de 105 min con depresión motora de los miembros superiores (p BACKGROUND AND OBJECTIVES: Hemodynamic changes are easily controlled under low or median thoracic epidural block. Since high thoracic epidural block (T2-T3 often affects brachial plexus roots (C4 C5-T1(T2, some of them responsible for phrenic nerve formation (C3-C4-C5, potential motor repercussions on this nerve are to be expected. Our study performed during cosmetic surgeries under isolated segmental epidural block in T2-T3 or associated to segmental epidural block in T11-T12, has evaluated motor repercussions on respiratory dynamics, upper and lower limbs. METHODS: Participated in this study 32 patients physical status ASA I and II, without active bronchospastic pulmonary disease and body weight equal to or above 50 kg, 21 of whom were submitted to isolated thoracic epidural blocks in T2-T3 and the remaining patients (11 were submitted to a combined thoracic epidural blocks in T11-T12 with 7.5% ropivacaine (45 to 90 mg associated to sufentanil (10 to 20 µg. Hemodynamic, respiratory and upper and lower limbs motor repercussions were evaluated by noninvasive monitoring, spirometry hand grasping strength and Bromage score, respectively. RESULTS: Mean mammary surgeries duration was 105 minutes with upper

  15. Ropivacaína em bloqueio peridural torácico para cirurgia plástica Ropivacaína en bloqueo peridural torácico para cirugía plástica Thoracic epidural anesthesia with ropivacaine for plastic surgery

    Directory of Open Access Journals (Sweden)

    José Roberto Nociti

    2002-04-01

    resultados del bloqueo peridural torácico con ropivacaína a 0,5% asociado a sedación con infusión continua de propofol en cirugía plástica. MÉTODO: Participaron del estudio sesenta pacientes del sexo femenino con edades entre 18 y 62 años, estado físico ASA I ó II, sometidas a cirugías plásticas combinadas envolviendo mama, abdomen, glúteos, lipoaspiración. Después de punción peridural en T9-T10 óT10-T11, recibieron 40 ml de solución de ropivacaína a 0,5% y sufentanil 15 µg. Dosis subsecuentes de anestésico local fueron administradas a través de catéter cuando necesarias. La sedación fue obtenida con infusión venosa continua de propofol 40 a 50 µg.kg-1.min-1. Fueron evaluadas las características de instalación y regresión del bloqueo, la evolución de los parámetros hemodinámicos y respiratorios, la incidencia de eventos adversos. RESULTADOS: El nivel superior de bloqueo sensorial fue T2 en 52 pacientes (86,6%, C4 en 4 (6,6% e T3 en 4 (6,6%. La media para el tiempo de latencia fue 9,1 ± 8,2 minutos. Se obtuvo bloqueo motor grado 2 en 61,7% de las pacientes y grado 1 en 38,3%. La media para el tiempo de regresión completa del bloqueo motor fue 377,9 ± 68,5 minutos. La media para el tiempo de la primera queja espontanea de dolor fue 965,1 ± 371,3 minutos. Los valores medios de PAS, PAD, PAM y FC decrecieron significativamente en relación al control a partir de los 15 min después de la inyección de anestésico local, caracterizando anestesia hipotensiva. Trece pacientes (21,7% que presentaron PAS BACKGROUND AND OBJECTIVES: Thoracic epidural blockade is a method of hypotensive anesthesia able to reduce bleeding during surgery. This non-comparative study aimed at evaluating the results of thoracic epidural blockade with 0.5% ropivacaine associated to propofol continuous infusion sedation in plastic surgery. METHODS: Participated in this study 60 female patients aged 18 to 62 years, physical status ASA I or II, scheduled for combined plastic

  16. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove;

    1995-01-01

    of central nervous system infection of at least 0.7% at Odense University Hospital. This degree of infection is of the same magnitude as that reported for intravascular devices. We found that the patients with generalized symptoms of infection had been catheterized for a longer time, and were older than......Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence...... patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more...

  17. Application Effect of Combined Spinal Epidural Anesthesia in Cesarean Section%腰硬联合麻醉在剖宫产中的应用效果分析

    Institute of Scientific and Technical Information of China (English)

    杨忠

    2015-01-01

    目的:分析腰硬联合麻醉(CSEA)在剖宫产中的应用效果。方法将我院93例剖宫产产妇按麻醉方式不同将其分为对照组(n=46)和观察组(n=47),对照组采用硬膜外麻醉(CEA),观察组采用CSEA麻醉,比较两组麻醉效果、起效时间、肌肉松弛程度及不良反应发生率。结果与对照组相比,观察组起效时间更短、麻醉效果更佳、肌肉松弛更明显、不良反应发生率更低(<0.05)。结论宫产中实施腰硬联合麻醉具有起效快、效果好、并发症少等优点。%Objective To explore the ef ect of CSEA for cesarean delivery.Methods 93 cases of cesarean delivery women were randomly divided into the control group (n=46)and the observation group (n=47).The control group used CEA,the observation group used CSEA.Compare the anesthesia ef ect,working time,degree of muscle relaxation and incidence of adverse reactions of two groups.Results Compared with the control group,the anesthesia ef ect,working time,degree of muscle relaxation and incidence of adverse reactions were bet er ( <0.05).Conclusion Application the CSEA in cesarean section has quick ef ect,good ef ect,less complication,etc.

  18. Combined spinal-epidural anaesthesia Gynecologic operation anesthesia to Applieation%脊麻-硬膜外联合阻滞在妇科手术麻醉中的应用

    Institute of Scientific and Technical Information of China (English)

    卢忠旭

    2004-01-01

    目的:通过观察脊麻-硬膜外联合阻滞(combined spinal-epidural anaesthesia,CSEA)在妇科手术麻醉中的实施情况,以便为扩大该项技术在临床麻醉中的应用提供资料.方法:选择择期妇科手术的成年患者60例,随机分为A、B两组,A组为CSEA组(n=30),B组为连续硬膜外组(n=30).麻醉阻滞效果及肌松效果由术者判断,共分四级:优、良、中、差.同种评分法由患者评定术中镇痛情况.结果:A组T8绝对平面出现时间明显短于B组(P<0.01);低血压发生例数明显少于B组(P<0.01),A组肌松满意率96.7%;B组初始为70%,二次硬膜外给药后为96.7%.A组所有患者对术中镇痛效果均感满意,B组为9例手术初始有较明显的牵拉感,5例主诉有轻度牵拉感A、B组患者均无主诉头痛.结论:CSEA可为妇科手术提供非常满意的麻醉效果,技术先进,操作过程简单,易于掌握,值得推广.

  19. 小剂量去氧肾上腺素预防剖宫产患者腰-硬联合麻醉后低血压效果观察%Effects of low-dose of phenylephrine in prevention of hypotension after combined spinal-epidural anesthesia in cesarean patients

    Institute of Scientific and Technical Information of China (English)

    路喻清; 李欣; 杨远东; 冯阳阳; 张向东

    2015-01-01

    Objective To observe the clinical effects of low-dose of phenylephrine in prevention of hypotension after combined spinal-epidural anesthesia ( CSEA) in cesarean patients .Methods Sixty cases of cesarean patients ( ASA I-Ⅱ) were randomly divided into two groups with 30 cases in each group: phenylephrine group ( group A ) and control group (group B).After the CSEA, patients in the two groups all received the liquid coload .For group A, phenylephrine was in-jected within 15 min.The changes of mean arterial pressure ( MAP) and heart rate ( HR) in the two groups were observed and compared before and after anesthesia .At the same time, complications, such as fidget, shiver and vomiting were also recorded.Newborns 1 min and 5min Apgar scores were estimated.Results MAPs in the group A, and HR of the two groups before and after anesthesia were stable (all P>0.05), while MAP was reduced in the group B 10 min after anesthe-sia (P0.05).Conclusion Low-dose of phenylephrine could effectively prevent hypotension of cesarean patients after CSEA and has a few obvious adverse reactions .%目的:观察小剂量去氧肾上腺素预防剖宫产患者腰—硬联合麻醉后低血压的临床效果。方法将拟行剖宫产术的60例患者随机为A、B组各30例,采用腰—硬联合麻醉后,两组均给予液体同步负荷,A组同时应用去氧肾上腺素。观察两组麻醉前后平均动脉压( MAP)和心率( HR)变化及术中情况,记录不良反应发生情况,并于新生儿出生1、5 min进行Apger评分。结果麻醉前后A组MAP及两组HR变化平稳,P均>0.05;B组MAP在麻醉10 min后下降,P<0.05。 A组低血压发生率低于B组,新生儿出生1 min的Apgar评分高于B组,P均<0.05。两组鞘内注药至胎儿娩出时间、手术时间、术中输液量及新生儿出生5 min 的 Apgar 评分比较, P 均>0.05。结论小剂量去氧肾上腺素可有效预防剖宫产患者腰—硬联合麻醉后低血

  20. A comparison between combined nerve block and spinal and epidural anesthesia for knee arthroscopy in elderly patients%联合神经阻滞与腰硬联合麻醉用于老年患者膝关节镜手术的比较

    Institute of Scientific and Technical Information of China (English)

    王新华

    2009-01-01

    [Objective] To compare the efficiency of combined lumbar plexus and sciatic nerve block and spinal and epidu-ral anesthesia for knee arthroscopy in elderly patients. [Methods] sixty old patients , 68 ~ 81years old, ASA Ⅰ~Ⅲ, scheduled for knee arthroscopic surgery were randomly divided into groups N and SEA. In group N patient s were under-gone lumbar plexus combined sciatic nerve block with the help of nerve stimulator. In group SEA, patient s were under-gone Spinal and epidural anesthesia. MAP, HR, onset time and duration of sensory and motor block and analgesia time were compared. [Results] The onset time of sensory and motor nerve block of group SEA was shorter than that of group N (P < 0.05), and the duration of group N was longer than that of group SEA (P < 0.05) . The patients' MAP, HR of group SEA were smoother than that of group N (P < 0.05) . [Conclusions] Combined nerve block for knee arthroscopy in elderly patients will produce a better anesthetic effect, a more smooth MAP and HR and a longer analgesia time.%[目的]老年患者膝关节镜手术中应用神经刺激仪定位下的腰丛联合坐骨神经阻滞与腰硬联合麻醉的麻醉效果的比较.[方法]60例拟行单侧膝关节镜手术的老年患者,年龄68~81岁,ASA Ⅰ~Ⅲ级,随机分为腰丛联合坐骨神经阻滞(N)和腰硬联合麻醉(SEA)两组.N组采用神经刺激仪定位下的腰丛和坐骨神经阻滞麻醉,SEA组行腰麻联合硬膜外麻醉.比较两组在不同时间段的NAP、HR、感觉、运动神经阻滞评分及镇痛时间.[结果]N组在手术过程中的MAP、HR较SEA组平稳;SEA组感觉、运动阻滞起效时间更短(P<0.05),N组感觉、运动阻滞维持时间更长(P<0.01).[结论]联合神经阻滞用于老年患者膝关节镜手术,麻醉效果良好,对血液动力学影响小,且镇痛维持时间长.

  1. Inquiry Right Dexmedetomidine Hydrochloride Used in Knee Arthroscopy Patients Epidural Anesthesia%探究盐酸右美托咪定在膝关节镜手术患者行腰硬联合麻醉中的应用

    Institute of Scientific and Technical Information of China (English)

    刘玲玲

    2016-01-01

    目的:探究与分析盐酸右美托咪定在膝关节镜手术患者行腰硬联合麻醉中的应用。方法选取我院自2014年3月~2016年3月收治的90例接受膝关节镜的患者,采取随机数字表法分为对照组与观察组,每组各45例,对照组未给予盐酸右美托咪定做术前处理,观察组给予盐酸右美托咪定做术前处理,对比两组患者Ramsay镇静评分、Scale评分及VAS评分。结果对照组Ramsay镇静评分、Scale运动神经阻滞评分、VAS评分分别为(2.78±0.42)分、(1.38±0.03)分、(1.34±0.23)分,观察组Ramsay镇静评分、Scale运动神经阻滞评分、VAS评分分别为(4.32±0.09)分、(0.37±0.04)分、(0.12±0.03)分,观察组与对照组相比Ramsay镇静评分较高,Scale运动神经阻滞评分及VAS评分较低,差异具有统计学意义(P<0.01)。结论将盐酸右美托咪定应用于膝关节镜手术患者的腰硬联合麻醉中临床效果显著,镇静镇痛效果更好。%Objective To explore and analyze right dexmedetomidine hydrochloride in patients undergoing arthroscopic knee surgery epidural anesthesia applications.Methods 90 cases in our hospital from receiving knee arthroscopy patients from March 2014 to March 2016 admitted taking randomly divided into a control group and the observation group, 45 cases in each group, the control group not given the right pyrimidine hydrochloride Meituo do preoperative treatment, observation group were given the right care pyrimidine hydrochloride by treatment before surgery, compared two groups of patients Ramsay sedation score, Scale score and VAS score.ResultsControl Ramsay sedation score, Scale motor nerve block score, VAS score were (2.78±0.42), (1.38±0.03), (1.34±0.23) points, and observation group Ramsay sedation score, Scale motor nerve block score, VAS score were (4.32±0.09), (0.37±0.04), (0.12±0.03) points, respectively; Ramsay sedation score of the observation group

  2. 硬膜外麻醉下腹腔镜全腹膜外疝修补术治疗成人腹股沟疝体会%On the treatment of adult inguinal hernia by laparoscopic totally extraperitoneal prosthesis in epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    金万亮; 李群华; 邓孙林; 盘毅辉; 郭建业

    2014-01-01

    Objective To summarize the advantages of laparoscopic totally extraperitoneal prosthesis (TEP) in epidural anesthesia, and to probe into the security, feasibility, effectiveness and the operation method of TEP. Methods The means was to look back on and analyze the clinical data of the TEP operations on 26 patients with inguinal hernia. Among these operations 6 were on direct hernia, 20 were on indirect hernia. 22 were on unilateral hernia, 4 are on bilateral hernia, within which 2 are recurrent hernia. Results The total 30 TEP operations on the 26 patients were all successful. As to the time of the operations, it ranges from 40 minutes to 110 minutes. The length of hospital stay ranges from 3 days to 8 days, which was 4.6 days on average. Main complications include 1 case of hematoma of the scrotum and 2 cases of groin pain. During the 3 to 12 months of follow-up visits, no relapse was found. Conclusion TEP in epidural anesthesia has many advantages. It is secure and feasible. It has little interference to the enterocoelia. Patients can recover soon and have a shorter hospital stay. Besides, less pain may occur and there is a lower recurrence rate.%目的:总结硬膜外麻醉下腹腔镜全腹膜外疝修补术(TEP)的优点。探讨TEP手术的安全性、可行性、有效性及手术方法。方法回顾性分析26例腹股沟疝患者行TEP手术的临床资料。直疝6例,斜疝20例。单侧疝22例,双侧疝4例,其中复发疝2例。结果26例腹股沟疝患者手术均成功,包括双侧疝共进行30例次TEP手术,均在40~110min完成,住院天数3~8d,平均4.6d。术后有1例出现阴囊内血肿,2例出现腹股沟区疼痛。随访3~12个月,无一例复发。结论硬膜外麻醉下行TEP具有手术安全可靠、对腹腔干扰小,术后恢复快、住院时间短,疼痛发生少、复发率低等优点。

  3. A comparison of combined spinal-epidural anesthesia with isobaric levobupivacaine and hyperbaric bupivacaine for cesarean sections%等比重左旋布比卡因和重比重布比卡因腰硬联合麻醉用于剖宫产手术的效果比较

    Institute of Scientific and Technical Information of China (English)

    李军; 魏志英; 段思源; 刘晶

    2015-01-01

    Objective It is to investigation the efficacy and safety of combined spinal -epidural anesthesia ( CSEA) with i-sobaric levobupivacaine and hyperbaric bupivacaine for cesarean sections .Methods Sixty primiparaes ( ASAⅠ Ⅱ) sched-ualed for elective caesarean section were divided into two groups with 30 cases each.Isobaric levobupivacaine group (LFgroup) received 0.5%isobaric levobupivacaine 10mg;Hyperbaric bupivacaine group ( BFgroup) received 0.5% hyperbaric bupiva-caine10mg.Sensory and motor block characteristics of the groups were assessed with pinprick and Bromage scale ; Hemody-namic changes and side effects were observed and recorded in both groups .Results The time to reach maximum dermatome for the sensory block, time to regression and time to regress to T12 dermatome was found to be significantly long in Group BF .It was observed that in Group BF , the evolution of the motor block was faster and lasted longer .Whereas hypotension , bradycar-dia and nausea were less in Group LF(P<0.05).Conclusion Since motor block time is shorter, and side effects like hypo-tension, bradycardia and nausea are less ,levobupivacaine for combined spinal-epidural anesthesia can be a good alternative in cesarean sections .%目的:评估0.5%等比重左旋布比卡因10 mg与0.5%重比重布比卡因10 mg腰硬联合麻醉用于剖宫产的临床效果。方法将60例ASAⅠ~Ⅱ级择期剖宫产的产妇随机分为2组,每组30例。 LF组用0.5%等比重左旋布比卡因10 mg进行腰硬联合麻醉;BF组用0.5%重比重布比卡因10 mg腰硬联合麻醉。用针刺皮肤法和改良运动阻滞(Bromage)分级法评估2组感觉和运动阻滞情况,观察并记录2组血流动力学变化和不良反应发生情况。结果 LF组达到最大感觉阻滞时间、感觉阻滞消退时间以及感觉阻滞消退平面达T12的时间均短于BF组,BF组运动阻滞发展的更快,持续时间更长;LF组低血压、心动过缓、恶心

  4. Ropivacaína, articaína ou combinação de ropivacaína e articaína em anestesia peridural para cesariana: estudo randomizado, prospectivo e duplo-cego Ropivacaína, articaína o la combinación de ropivacaína y articaína en la anestesia epidural para cesárea: estudio aleatorio, prospectivo y doble ciego Ropivacaine, articaine or combination of ropivacaine and articaine for epidural anesthesia in cesarean section: a randomized, prospective, double-blinded study

    Directory of Open Access Journals (Sweden)

    Derya Arslan Yurtlu

    2013-02-01

    ína al 0,75% (Grupo R vía catéter epidural. Se registraron el tiempo de inicio del bloqueo sensorial hasta T10-T6 y el nivel máximo de bloqueo; el tiempo para la regresión de los segmentos del nivel máximo de bloqueo sensorial y el tiempo de inicio y duración del bloqueo motor. La necesidad de analgésicos adicionales en el intra y en el postoperatorio, también se registró. RESULTADOS: Los datos demográficos fueron parecidos. Los tiempos de inicio del bloqueo sensorial hasta los niveles T10 y T6 fueron significativamente menores en los grupos A y AR, en comparación con el Grupo R (p BACKGROUND AND OBJECTIVES: Initiation of epidural anesthesia with long-lasting local anesthetics consumes a significant amount of time, which could be problematic in busy obstetric anesthesia suites. We have hypothesized that a combination of articaine and ropivacaine provides faster onset and even an early recovery of sensory-motor block characteristics. METHODS: Sixty term parturients scheduled to have elective cesarean section were randomly allocated into three groups to receive either 20 mL 2% articaine (Group A, 10 mL 2% articaine + 10 mL 0.75% ropivacaine (Group AR or 20 mL 0.75% ropivacaine (Group R via lumbar epidural catheter. The onset time of sensory block to T10, T6 and maximum sensory block level, time to two segments regression from maximum sensory block level, onset time and duration of motor block were all recorded. Intraoperative and postoperative additional analgesic requirements were also recorded. RESULTS: Demographic data were similar. The onset times of sensorial block to T10 and T6 were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05. The onset times of motor block were similar in all groups, but a more intense motor block was observed in Group R (p < 0.05. Two segments regression time and motor block durations were significantly shorter in Groups A and AR in comparison with Group R (p < 0.05. Intraoperative supplementary

  5. 蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉用于子痫前期患者的安全性%Safety of combined spinal epidural anesthesia in patients with preeclampsia undergoing cesarean section

    Institute of Scientific and Technical Information of China (English)

    陈秀斌; 刘志强

    2012-01-01

    出后即刻的HR的下降值的差异无统计学意义(P>0.05).子痫CSEA组麻醉开始至神经阻滞平面达第8胸椎的时间与健康CSEA组的差异无统计学意义(P>0.05).子痫CSEA组的补液量为(600.0±66.9) mL,显著少于健康CSEA组的(1 062.5±101.1)mL(P<0.01).子痫CSEA组发生低血压2例,健康CSEA组为3例,两组间的差异无统计学意义(P>0.05).所有患者术后均未发生头痛.结论 子痫前期患者采用CSEA与CEA的血流动力学变化是相似的,且CSEA用于子痫前期患者是安全、有效的.%Objective To evaluate the feasibility and safety of combined spinal epidural anesthesia (CSEA) in patients with preeclampsia undergoing cesarean section. Methods From September 2010 to May 2011. 40 preeclampic patients underwent elective cesarean section under CSEA (n = 20) and continuous epidural anesthesia (CEA, n =20), respectively. Another 20 healthy parturients received CSEA and were enrolled into the healthy-CSEA group in the same period. The systoiic blood pressure (SBP) , diastolic blood pressure (DBP) and heart rate (HR) were measured at each time point (before anesthesia, immediately after anesthesia, 5 mins after anesthesia, 10 mins after anesthesia, and immediately after delivery). The duration from induction of anesthesia to sensory block to T8 plane, intraoperative fluid infusion, and the incidence of intraoperative hypotension and postoperative headache were recorded. Results There were no significant differences in age and body mass index (BMI) among the three groups (P>0.05). There were no significant differences in baseline SBP, DBP and HR between preeclampsia-CSEA group and preeclampsia-CEA group ( P > 0. 05) . Neither were the decreased values of HR, SBP and DBP at each time point between the two groups (P>0. 05) . The duration from anesthesia induction to sensory block to T8 in the preeciampsia-CSEA group was significantly shorter than that in the preeclampsia-CEA group ([4. 3 ± 0. 8] min vs

  6. Technique of fiber optics used to localize epidural space in piglets.

    Science.gov (United States)

    Ting, Chien-Kun; Chang, Yin

    2010-05-24

    Technique of loss-of-resistance in epidural block is commonly used for epidural anesthesia in humans with approximately 90% successful rate. However, it may be one of the most difficult procedures to learn for anesthesia residents in hospital. A two-wavelength (650 nm and 532 nm) fiber-optical method has been developed according to the characteristic reflectance spectra of ex-vivo porcine tissues, which are associated with the needle insertion to localize the epidural space (ES). In an in-vivo study in piglets showed that the reflected lights from ES and its surrounding tissue ligamentum flavum (LF) are highly distinguishable. This indicates that this technique has potential to localize the ES on the spot without the help of additional guiding assistance.

  7. Effects of etidocaine administered epidurally on changes in somatosensory evoked potentials after dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H;

    1991-01-01

    The effect of lumbar epidural anesthesia with similar volumes (approximately 20 ml) of 1% and 1.5% etidocaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients...

  8. Effect of Combined General-epidural Anesthesia with Different Concentrations of Lidocaine on Old Patients for Intrapulmonary Shunt during One-lung Ventilation%全麻复合不同浓度利多卡因高位硬膜外麻醉对老年患者单肺通气期间肺内分流的影响

    Institute of Scientific and Technical Information of China (English)

    王玲玲; 田阿勇; 马虹; 王俊科

    2011-01-01

    Objective To evaluate the effects of general anesthesia combined with throacic epidural anesthesia with different concentrations of lidocaine on old patients for intrapulmonary shunt during one-lung ventilation. Methods 115 patients with ASA physical status of I - II undergoing electively throacic surgery were randomly divided into three groups to epidurally receive saline(Group S,n=38),1.0%(Group L 1.0,n=39) and 1.6%(Group L 1.6,n=38) lidocaine.Arterial and venous blood gas analysis were recorded and Qs/Qt was calculated in three groups before anesthesia, 15min after two-lung ventilation and 15,45min after one-lung ventilation.Results During the period of one-lung ventilation,Qs/Qt in three groups was increased and PaO2 decreased significantly(P < 0.01) compared with that during two-lung ventilation.At 15 and 45min after one-lung ventilation,Qs/Qt was larger and PaO2 was less in Group L 1.6 than those in Group S(P < 0.05).However,Qs/Qt and PaO2 in Group L 1.0 showed no significant difference compared with those in Group S.During operation,heart rate and blood pressure in Group L 1.0 and Group L 1.6 was remarkably slow(P < 0.05),while heart rate and blood pressure in Group L 1.6 were lower than those in Group L 1.0.Conclusion During one-lung ventilation,combined general-thoracic epidural block with higher dose of lidocaine may result in a increase of Qs/Qt and a decrease of PaO2,but not with lower dose of lidocaine.%目的 探讨全麻复合不同浓度利多卡因高位硬膜外麻醉对老年患者单肺通气期间肺内分流(Qs/Qt)的影响.方法 择期开胸手术患者115例随机分为三组:全麻组(S组)、全麻-硬膜外1.0%利多卡因阻滞组(L 1.0组)和全麻-硬膜外1.6%利多卡因阻滞组(L 1.6组).三组患者分别于麻醉前、双肺通气15min、单肺通气15、45min时采动脉血及混合静脉血行血气分析,并计算出Qs/Qt等.结果 单肺通气时,三组患者Qs/Qt较双肺通气时显著增加(P<0.01),PaO2

  9. Application of combined spinal-epidural anesthesia and analgesia in patients with hypertension during pregnancy%腰-硬联合阻滞镇痛在合并妊娠期高血压疾病产妇中的应用

    Institute of Scientific and Technical Information of China (English)

    于坚伟; 鲁花丽

    2016-01-01

    Objective To explore the safety and effectiveness of combined spinal-epidural anesthesia ( CSEA) and analgesia in the application of patients with hypertension during pregnancy. Methods 175 patients with pregnancy-induced hypertension syndrome and preeclampsia treated in grand hospital of Shanxian County from January 2012 to December 2015 were selected. Patients were divided into labor analgesia group (105 cases) and control group (70 cases) according to whether accepted combined spinal-epidural anesthesia and analgesia. Patients in the two groups were given the same blood pressure control and production process management, and patients in labor analgesia group were treated by combined spinal-epidural anesthesia for labor analgesia after 4 cm. Observational index including the women 's general situation, average arterial pressure in labor and birth process at each time point, delivery, maternal and infant complications and treatment situation. Results Compared to control group, patients in labor analgesia group had lower average arterial pressure at 60 min[(103. 7 ± 5. 7)mmHg vs (118. 2 ± 5. 5)mmHg], 120 min after active period[(104. 7 ± 4.3)mmHg vs (119.3 ±5.1)mmHg], the second stage of labor[(107.8 ±5.3)mmHg vs (114.8 ±6.1)mmHg], postpartum 120 min[(98.2 ±5.9)mmHg vs (103.8 ±6.7)mmHg] (P<0.05). The cesarean section rate of patients in labor analgesia group was 19. 0 %, lower than that in control group (34. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had longer time of second stage of labor[(50. 3 ± 20. 5)min vs (42. 1 ± 19. 9)min] and higher rate of oxytocin use(60. 0 % vs 44. 3 %) (P<0. 05). Compared to control group, patients in labor analgesia group had lower rate of headache(6. 7 % vs 18. 6 %) and dizziness and antihypertensive therapy(12. 4% vs 38. 6%)(P<0. 05). Conclusion CSEA analgesia can reduce the cesarean section rate of patients with pregnancy-induced hypertension syndrome and preeclampsia, reduce puerperal

  10. Effect of dexmedetomidine in the elderly patients at combined spinal -epidural anesthesia with lower abdominal surgery%不同剂量右美托咪定对腰-硬联合麻醉下高龄患者下腹部手术的影响

    Institute of Scientific and Technical Information of China (English)

    林武万; 陈科展; 黄秋立

    2016-01-01

    目的:探讨不同剂量右美托咪定对腰-硬联合麻醉下高龄患者下腹部手术的镇静效果的影响。方法:选取年龄≥65岁的腰-硬联合麻醉下行腹部手术的患者120例,随机分为右美托咪定组(D1、D2、D3组)及咪达唑仑组(M组)。分别记录患者麻醉前(T0)、用药后5 min(T1)、30 min(T2)、60 min(T3)Ramsay 评分及记录术中、术后出现不良反应的例数。结果:D1、D2、D3组及 M组在 T1~T3时 Ramsay 评分显著高于同组 T0时的评分,差异有统计学意义(P<0.05);在 T1~T3时,D2、D3的 Ramsay 评分均高于 M组,差异有统计学意义(P <0.05);与 M组相比,D1、D2、D3组的不良反应(心动过缓、恶心呕吐)显著减少,差异有统计学意义(P <0.05)。结论:右美托咪定辅助高龄患者腰-硬联合麻醉下腹部手术时可产生理想镇静状态,其不良反应较少,其中以0.3~0.5μg/kg 为初始剂量,以0.3μg/(kg·h)进行维持为宜。%Objective To investigate the effect of different doses of dexmedetomidine in the elderly patients at combined spi-nal -epidural anesthesia with lower abdominal surgery.Method 120 elderly patients at combined spinal -epidural anesthesia with lower abdominal surgery were chosen into DEX group(group D1、D2、D3)and midazolam group.Ramsay sedation score were evaluated at time points of before(T0 )、5 min(T1 )、30 min(T2 )、60 min(T3 )after treatment.The side effects in these patients were also recorded.Results Compared with T0 in all group,ramsay sedation score increased significantly at T1 ~T3 ,the difference was statistically significant (P <0.05).In group D2 and D3,ramsay sedation score were increased significantly at T1 ~T3 com-pared with group M,the difference was statistically significant (P <0.05).The side effect(bradycardia、nausea and vomiting) were more happened in group M,the difference was statistically significant (P

  11. Effects of high thoracic epidural anesthesia on ventricular remodeling and expression of β_3-adrenoceptor in rats with heart failure induced by acute myocardial infarction%上胸段硬膜外阻滞对心肌梗死后心力衰竭大鼠心室重构及β_3肾上腺素能受体的影响

    Institute of Scientific and Technical Information of China (English)

    陈国忠; 王庆祥; 吴晓智; 刘韧; 江鹤群

    2009-01-01

    目的 观察上胸段硬膜外阻滞对大鼠心肌梗死后心室重构和心功能的影响,并探讨其机制.方法 模型成功的大鼠随机分为假手术组(S组,n=12)、心力衰竭组(CHF组,n=24)和硬膜外阻滞组(HTEA组,n=24).硬膜外置管术后24 h S组和CHF组于硬膜外腔注入9 g/L生理盐水(100μl/kg,2次/d,连续4周).HTEA组于硬膜外腔注入1.25 g/L布比卡因(100 μl/kg,2次/d,连续4周).4周后行超声心动图测定左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)左室射血分数(LVEF)和左室短轴缩短率(LVES);测量心脏和左心室质量,计算心脏指数(HW/BW)和左心室指数(LVW/BW);左室心肌组织HE和Masson染色;RT-PCR测定左室心肌β_3AR和eNOSmRNA;免疫组织化学检测左室心肌β_33AR表达.结果 LVEDD和LVESD:HTEA组较CHF组明显缩小(P<0.01);LVEF和LVFS:HTEA组较CHF组明显增加(P<0.05).HW/BW和LVW/BW:CHF组和HTEA组均明显大于s组(P<0.01),但HTEA组较CHF组明显减小(P<0.01).心肌病理学形态学显示:CHF组心肌细胞变性、萎缩,心肌纤维紊乱、断裂,胶原纤维明显增多,HTEA组心肌细胞变性明显减少,非梗死区心肌纤维化明显改善;与CHF组相比,HTEA组β_3AR和eNOS mRNA表达明显减少(P<0.01).结论 HTEA治疗可以改善或减缓急性心肌梗死后大鼠的左室重构和心功能,可能与其下调β_AR表达有关.%Objective To investigate the effect of high thoracic epidural anesthesia on ventricular remodeling and cardiac function in rats with heart failure induced by myocardial infarction, and to investigate their mechanism. Methods Rats that had been established successively model were randomly divided into S group (n = 12) , HTEA group and CHF group (24/group). 9. 0 g/L normal sodium 100 μl/kg was injected to epidural cavity twice a day separately in group S and group CHF. 1. 25 g/L bupivacaine 100 μl/kg was injected to epidural cavity twice a day in group HTEA. Epidural injection was started 24 hrs

  12. COMPA RATIVE EVALUATION OF INTRATHECAL, EPIDURAL AND INTRAVENOUS BOLUS SUFENTANIL FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERY

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    Sudhakar

    2015-06-01

    Full Text Available In clinical experience sufentanil is more effective when given epidurally than intrathecally and intravenously. To test this hypothesis we compare the analgesic characteristic of 10μgm of epidural, intrathecal and intravenous single shot sufenta nil for pain relieve after elective lower limb surgeries. A randomized double blind trial was conducted on 60 patients who were under - going elective lower limb surgery in epidural anesthesia with bupivacaine. In recovery room as soon as pain score higher than 3 on the scale of 10 on visual analogue score was reported 10μgm intravenous, intrathecal and epidural was given respectively. We concluded that epidural sufentanil is better as compared to intrathecal and intravenous in terms of duration of pain reli ef, vital complications and side effects for post - operative pain relief.

  13. Clinical Application of Combined Spinal-epidural Anesthesia in Caesarean Section%腰硬联合麻醉在剖宫产手术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    顾文荣

    2010-01-01

    目的 探讨腰硬联合麻醉在剖宫产手术中的应用.方法 选择腰硬联合麻醉(spinalepidual anesthesia,CSEA)和单独硬膜外麻醉(EA)两组患者,CSEA组选择L2-3间隙侧入法,脊麻用药为0.75%布比卡因1.5 mL,EA组选择L2-3间隙穿刺,硬膜外腔用药为2%利多卡因15~25 mL.结果 CSEA组麻醉起效较EA组快,术中的牵拉反应发生率CSEA组明显低于EA组.结论 腰硬联合麻醉选腰2~3穿刺为剖宫产手术的较佳的麻醉方法 .

  14. Persistent post-dural-puncture headache treated with epidural infusion of dextran.

    Science.gov (United States)

    Aldrete, J A

    1994-05-01

    A retrospective review was done on medical records of 13 patients with persistent post-dural-puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post-laminectomy syndrome after "wet taps" while performing epidural blocks. In two patients post-dural-puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran-40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD +/- 0.79). In five patients headache ceased in less than five hours. Nausea and photo-phobia subsided earlier. Patients with post-dural-puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran-40.

  15. Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças Anestesia peridural contínua con ropivacaína a 0,2% asociada a anestesia general para cirugía del abdomen superior en niños Continuous epidural anesthesia with 0.2% ropivacaine associated to general anesthesia for upper abdominal surgery in children

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    Jyrson Guilherme Klamt

    2003-04-01

    el grupo Propofol, sin embargo, la intensidad y duración de la sedación fueron mayores en ese grupo en relación al grupo Sufentanil. Los escores de recuperación fueron similares en los dos grupos. Después de 3 horas en la SRPA, todos los pacientes habían llegado a los criterios de transferencia para las enfermarías. Hipotensión arterial transitoria fue observada en 2 pacientes del grupo Sufentanil. CONCLUSIONES: La combinación de la anestesia peridural torácica continua con ropivacaína a 0,2% (1,5 ml.kg-1 asociada a la infusión de propofol promueve anestesia efectiva y segura para cirugías abdominales altas en niños. El ritmo de infusión de propofol y el tiempo de sedación fueron reducidos con la adición de sufentanil.BACKGROUND AND OBJECTIVES: Several anesthetic techniques have been proposed for different pediatric surgeries to promote postoperative analgesia, among other advantages. This study aimed at evaluating propofol infusion rate and postanesthetic recovery of children submitted to upper abdominal surgeries under epidural anesthesia with 0.2% ropivacaine associated to general anesthesia with propofol or propofol plus sufentanil. METHODS: Participated in this study 26 children physical status ASA I, II and III, aged 0 to 4 years, were scheduled to upper abdominal surgeries under thoracic epidural anesthesia (T7-T8 with 0.2% ropivacaine (1.5 ml.kg-1. They were randomly distributed in two groups: Propofol (propofol infusion and Sufentanil (propofol infusion plus 1 µg.kg-1 sufentanil. Propofol infusion rates were 20 and 10 mg.kg-1.h-1 for the Propofol and Sufentanil groups, respectively, adjusted to maintain blood pressure in approximately 20% of baseline values and withdrawn 10 to 15 minutes before estimated surgery completion. Postanesthetic recovery was evaluated by a modified Aldrete-Kroulik scale and sedation was evaluated by a 5 grade score. RESULTS: Techical difficulties excluded two children of each group. Infusion rate was significantly

  16. Comparação entre raquianestesia, bloqueio combinado raqui-peridural e raquianestesia contínua para cirurgias de quadril em pacientes idosos: estudo retrospectivo Comparación entre raquianestesia, bloqueo combinado raqui-peridural y raquianestesia continua para cirugías de cuadril en pacientes ancianos: estudio retrospectivo Comparison between spinal, combined spinal-epidural and continuous spinal anesthesias for hip surgeries in elderly patients: a retrospective study

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2002-06-01

    pacientes ancianos durante cuatro años, para determinar las posibles ventajas y desventajas de las tres técnicas. MÉTODO: Fueron evaluadas 300 fichas siendo que: 100 pacientes recibieron raquianestesia simple (Grupo 1, 100 recibieron bloqueo combinado raqui-peridural (Grupo 2 y 100 recibieron raquianestesia continua (Grupo 3 en los últimos cuatro años. Todos los bloqueos fueron realizados en decúbito lateral izquierdo. Fueron evaluados: suceso de punción, nivel de analgesia, bloqueo motor de miembros inferiores, calidad de la anestesia, necesidad de complementación, incidencia de fallas, parestesias, cefalea pós-punción, alteraciones cardiovasculares, confusión mental y delirium, transfusión sanguínea y mortalidad. RESULTADOS: No existe diferencia significativa entre los grupos en relación a la edad, peso y sexo. Los pacientes del grupo 2 fueron menores de que los del grupo 1 y 3. Las dosis utilizadas fueron de 15,30 mg de bupivacaína en el grupo 1; 23,68 mg en el grupo 2 y 10,10 mg en el grupo 3. No fue encontrada diferencia significativa (p BACKGROUND AND OBJECTIVES: There are still many questions involving study designs, data analyses and samples size which regard to the demonstration of the benefits of regional anesthesia on patients outcome. Database analysis and data acquisition in general cost less and require less time as compared to large randomized controlled trials. This retrospective study compares continuous spinal anesthesia, combined spinal-epidural and single shot spinal anesthesia for hip surgery in elderly patients during a 4-year period, to determine possible advantages and disadvantages of the three techniques. METHODS: Anesthetic records of 100 patients receiving spinal anesthesia (Group 1, 100 patients receiving combined spinal-epidural block (Group 2 and 100 patients receiving continuous spinal anesthesia (Group 3 over a 4-year period were analyzed. All blockades were performed with patients in the left lateral position. Evaluated

  17. Chlorhexidine Gluconate Dressings Reduce Bacterial Colonization Rates in Epidural and Peripheral Regional Catheters

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    Klaus Kerwat

    2015-01-01

    Full Text Available Introduction. Bacterial colonization of catheter tips is common in regional anesthesia and is a suspected risk factor for infectious complications. This is the first study evaluating the effect of CHG-impregnated dressings on bacterial colonization of regional anesthesia catheters in a routine clinical setting. Methods. In this prospective study, regional anesthesia catheter infection rates were examined in two groups of patients with epidural and peripheral regional catheters. In the first group, regional anesthesia was dressed with a conventional draping. The second group of patients underwent catheter dressing using a CHG-impregnated draping. Removed catheters and the insertion sites were both screened for bacterial colonization. Results. A total of 337 catheters from 308 patients were analysed. There was no significant reduction of local infections in either epidural or peripheral regional anesthesia catheters in both CHG and conventional groups. In the conventional group, 21% of the catheter tips and 41% of the insertion sites showed positive culture results. In the CHG-group, however, only 3% of the catheter tips and 8% of the insertion sites were colonised. Conclusion. CHG dressings significantly reduce bacterial colonization of the tip and the insertion site of epidural and peripheral regional catheters. However, no reductions in rates of local infections were seen.

  18. 硬膜外腔小剂量罗哌卡因用于高龄高危患者骨科下肢手术麻醉分析%Effect of small dose of epidural anesthesia with ropivacaine on high-risk elderly patients with operation of lower limb in department of orthopedics

    Institute of Scientific and Technical Information of China (English)

    张继晨

    2016-01-01

    Objective TO investiGate tHe effect Of smaLL dOse Of epiduraL anestHesia WitH rOpivacaine On HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb in department Of OrtHOpedics. Methods FrOm September 2012 tO NOvember 2014,tHe cLinicaL data Of 210 HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb Were retrOspectiveLy anaLyzed. Results THe anestHesia effect Of LOWer Limb surGery in HiGH-risK eLderLy patients Of 0. 75% rOpivacaine Were better tHan tHat Of 0. 894% rOpivacaine and 0. 6% rOpivacaine,incLudinG tHe LenGtH Of time Of Onset Of anestHesia,tHe resistance mOvement LaG time,sensOry bLOcK time,BrOmaGe scOre,tHere Were siGnificant differences(P﹤0. 05). 0. 75% rOpivacaine GrOup Of LOWer Limb OrtHOpedic surGery Was superiOr tO 0. 894% rOpivacaine GrOup and 0. 6% rOpivacaine GrOup in DBP, HR,SPO2 ,SBP durinG anestHesia,tHere Were siGnificant differences( P﹤0. 05). Conclusions EpiduraL 0. 75% rOpiva-caine Has siGnificant effect On HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb in department Of OrtHOpedics,and pLays a cruciaL rOLe On tHe deveLOpment Of epiduraL anestHesia,WitH far-reacHinG cLinicaL siGnificance,sO it is WOrtHy Of cLinicaL triaLs and prOmOtiOn.%目的:探讨硬膜外腔小剂量罗哌卡因用于高龄高危患者骨科下肢手术麻醉的临床效果。方法选取2012年9月至2014年11月收治的210例高龄高危下肢手术患者,对其临床资料进行系统的回顾分析。结果0.75%罗哌卡因组的高龄高危患者骨科下肢手术麻醉效果在多方面均优于0.894%罗哌卡因组和0.6%罗哌卡因组,包括麻醉起效时长、运动阻滞时间、感觉阻滞时间、BrOmaGe评分,组间比较差异有统计学意义(P﹤0.05)。0.75%罗哌卡因组骨科下肢手术麻醉的舒张压(DBP)、心率(HR)、脉搏血氧饱和度( SPO2)、收缩压( SBP)、BrOmaGe评分与0.894%罗哌卡因、0.6%罗哌卡因组相比具有明显的优势,组间比较差异有统计学意义( P﹤0

  19. Update on epidural analgesia during labor and delivery.

    Science.gov (United States)

    Lurie, S; Priscu, V

    1993-05-01

    Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.

  20. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

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    Weijun Wang

    2016-01-01

    Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.

  1. Traumatic epidural hematoma in children.

    Science.gov (United States)

    Rocchi, Giovanni; Caroli, Emanuela; Raco, Antonino; Salvati, Maurizio; Delfini, Roberto

    2005-07-01

    The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.

  2. Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer

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    Mir MC

    2013-10-01

    Full Text Available Maria C Mir,1 Binoy Joseph,1 Rona Zhao,1 Damien M Bolton,1 Dennis Gyomber,1 Nathan Lawrentschuk1,21University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, VIC, Australia; 2Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, VIC, AustraliaObjectives: Our objectives were to analyze the effectiveness of epidural anesthesia in patients who underwent open retropubic radical prostatectomy (RRP at our institution over the past decade, and to examine subsequent oncologic outcomes, comparing those receiving with those not receiving epidural anesthesia.Methods: A comprehensive database of all patients undergoing RRP from November 1996 to December 2006 was analyzed; 354 patients underwent RRP at our institution and were divided into those receiving or not receiving an epidural. An independent pain management team scoring technical success found epidural technique to be consistent. Oncological outcome was an endpoint of our study, comparing both analysis groups. We classed prostate-specific antigen (PSA recurrence after RRP as a serum PSA ≥ 0.2 ng/mL at any stage of postoperative follow-up. Complications were recorded to 30 days using the modified Clavien system, and full statistical analyses were undertaken.Results: Records were available for 239 men; we observed a decreased trend in the use of epidural for pain management, along with a decrease in average hospital stay and an overall epidural success rate of 64%. When dividing data into RRP with and without epidural, we found a median hospital stay of 7 days for patients receiving an epidural compared with 6 days for those not receiving an epidural. The differences were statistically significant (P < 0.048 and remained so after adjusting for complications (P < 0.0001. Regarding oncological outcome, PSA recurrence was further analyzed in this cohort. Percentage of recurrence was higher (14.8% for patients receiving an epidural than for the non-epidural group (4.8%. The

  3. Bilateral assymetric epidural hematoma

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    Edmundo Luis Rodrigues Pereira

    2015-01-01

    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  4. Aspergillus spinal epidural abscess

    Energy Technology Data Exchange (ETDEWEB)

    Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  5. Portable optical epidural needle-a CMOS-based system solution and its circuit design.

    Science.gov (United States)

    Gong, Cihun-Siyong Alex; Lin, Shih-Pin; Mandell, M Susan; Tsou, Mei-Yung; Chang, Yin; Ting, Chien-Kun

    2014-01-01

    Epidural anesthesia is a common anesthesia method yet up to 10% of procedures fail to provide adequate analgesia. This is usually due to misinterpreting the tactile information derived from the advancing needle through the complex tissue planes. Incorrect placement also can cause dural puncture and neural injury. We developed an optic system capable of reliably identifying tissue planes surrounding the epidural space. However the new technology was too large and cumbersome for practical clinical use. We present a miniaturized version of our optic system using chip technology (first generation CMOS-based system) for logic functions. The new system was connected to an alarm that was triggered once the optic properties of the epidural were identified. The aims of this study were to test our miniaturized system in a porcine model and describe the technology to build this new clinical tool. Our system was tested in a porcine model and identified the epidural space in the lumbar, low and high thoracic regions of the spine. The new technology identified the epidural space in all but 1 of 46 attempts. Experimental results from our fabricated integrated circuit and animal study show the new tool has future clinical potential.

  6. Portable optical epidural needle-a CMOS-based system solution and its circuit design.

    Directory of Open Access Journals (Sweden)

    Cihun-Siyong Alex Gong

    Full Text Available Epidural anesthesia is a common anesthesia method yet up to 10% of procedures fail to provide adequate analgesia. This is usually due to misinterpreting the tactile information derived from the advancing needle through the complex tissue planes. Incorrect placement also can cause dural puncture and neural injury. We developed an optic system capable of reliably identifying tissue planes surrounding the epidural space. However the new technology was too large and cumbersome for practical clinical use. We present a miniaturized version of our optic system using chip technology (first generation CMOS-based system for logic functions. The new system was connected to an alarm that was triggered once the optic properties of the epidural were identified. The aims of this study were to test our miniaturized system in a porcine model and describe the technology to build this new clinical tool. Our system was tested in a porcine model and identified the epidural space in the lumbar, low and high thoracic regions of the spine. The new technology identified the epidural space in all but 1 of 46 attempts. Experimental results from our fabricated integrated circuit and animal study show the new tool has future clinical potential.

  7. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    Science.gov (United States)

    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U

    2013-01-01

    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  8. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  9. Difference observation of catheterization before and after combined spinal-epidural anesthesia in patients of Caesarean Section%腰硬联合麻醉前后留置导尿对剖宫产患者的影响观察

    Institute of Scientific and Technical Information of China (English)

    印夏微

    2011-01-01

    Objective To explore the difference of catheterization before and after anaesthesia in patients of Caesarean Section.Methods One hundred Caesarean Section patients undergoing Combined Spinal- epidural Anesthesia M were divided into two groups randomly.Fifty patients of observation group were accepted detaining urethral catheterization after anaesthesia.Fifty patients of control group were accepted detaining urethral catheterization before anaesthesia.The heart rate,blood pressure, pain rating and success rates of first catheterization were observed.Results The heart rate, blood pressure, and pain rating of observation group were lower than the control group.Success rates of first catheterization in observation group was 98%, the control group was 82%.Conclusions It is better to take catheterization after anaesthesia in patients of Caesarean Section.%目的 探讨对剖宫产患者在麻醉前后留置导尿的影响.方法 选择100例在腰硬联合麻醉前后的剖宫产患者,随机分为观察组和对照组各50例.对照组患者在麻醉前行导尿术,观察组患者在麻醉后行导尿术,比较两组患者留置导尿前后心率、血压变化,疼痛分级以及一次性置管的成功率.结果 与基础值比较,对照组患者在留置导尿后心率、血压均明显增加,而观察组增加不明显;对照组疼痛感受明显高于观察组;一次置管成功率对照组为82%,观察组为98%.结论 剖宫产患者宜麻醉后留置导尿.

  10. Re-discussion about the effects of aspirin on surgery and spinal epidural anesthesia during the perioperative period%再谈围术期服用阿司匹林对手术和椎管内麻醉的影响

    Institute of Scientific and Technical Information of China (English)

    汪涛; 王茹; 严志勇; 钱燕宁

    2016-01-01

    Background There are no specific,widely accepted recommendations for the perioperative management of patients with cardiovascular disease (CVD) receiving antiplatelet therapy,and performing neuraxial anesthesia in patients receiving antiplatelet therapy is controversial due to the increased risk of spinal epidural hematoma.Objective To review the mechanism of action of aspirin and the clinical literature for relationships among aspirin dosage,efficacy,and safety.Content With a high prevalence of CVD,the appropriate perioperative management of high-risk patients treated with aspirin is a common clinical problem for surgeons and anesthetists.For this reason,many treatment decisions have to be made for patients with CVD who need cardiac and non-cardiac surgery.Trend Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding,and recommended approaches aim to simplify patient management and minimize negative clinical outcomes by multidisciplinary teams.%背景 对患有心血管疾病(cardiovascular disease,CVD)正在进行抗血小板治疗的患者,目前不仅无具体的、可被接受的围术期管理建议,而且对该类患者行椎管内麻醉存在争议,因接受抗血小板治疗可增加硬膜外血肿的风险. 目的 对阿司匹林的作用机制及其剂量、临床疗效与安全性关系进行综述. 内容 随着CVD患病率的不断增加,对接受阿司匹林治疗的高风险患者给予恰当的围手术期管理,是外科医师和麻醉医师共同面对的一个临床问题.为此,对需要行心血管或非心血管手术的CVD患者,必须在临床作出诸多治疗决策. 趋向 围术期抗凝治疗是以对血栓和出血事件的风险评估为依据的,应通过多学科协作来实现简化患者管理和最小化临床不良结局的治疗目标.

  11. [Continuous spectrum analysis during anesthesia and the recovery period in infants under 1 year of age].

    Science.gov (United States)

    Meyer, P; Bensouda, A; Mayer, M N; Barrier, G

    1989-01-01

    Continuous spectral EEG activity monitoring has been used in adults as a monitor of brain activity during anesthesia. It has not been used in infants. We studied 22 infants less than 7 months old undergoing minor surgery. Halothane alone or minimal Halothane anesthesia associated with caudal epidural anesthesia were used. Life-Scan analysis, in spite of wide individual variations, allowed us to detect infraclinical hypoxia episodes, it provided informations about operative confort, depth of anesthesia and added in the post-operative period an objective criteria to clinical evaluation of pain. A wide use of such a monitoring is warranted in infants.

  12. Effect of epidural anesthesia combined with remifentanil-propofol in radical hysterectomy for cervical cancer%硬膜外阻滞复合雷米芬太尼-丙泊酚应用于宫颈癌根治术的效果观察

    Institute of Scientific and Technical Information of China (English)

    李秀满; 王立祥

    2011-01-01

    D reflected increasing more obvious than that in group R (P<0.05). ② Comparing with group R, the dizziness, headaches, restlessness, and the degree of satisfaction of group D were statistically difference in the postoperative period (P< 0.05). Conclusion Epidural anesthesia combined with remifentanil undergoing radical hysterectomy could provide an even better solution on patient's regaining consciousness and the degree of comfort.

  13. Epidural block and neostigmine cause anastomosis leak

    Directory of Open Access Journals (Sweden)

    Ataro G

    2016-05-01

    Full Text Available Getu Ataro Department of Anesthesia, Jimma University, Jimma, EthiopiaI read the article by Phillips entitled, “Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions”, published in the journal of Open Access Surgery with enthusiasm and found it crucial for perioperative management of patients with gastrointestinal (GI surgery, particularly anastomosis. I appreciate the author’s exhaustive search of literature and discussion with some limitation on review basics like methodology, which may affect the reliability of the review findings. The effects of risk factors for anastomosis leak, such as malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique, were well discussed.1 However, from anesthesia perspective, there are some other well-studied risk factors that can affect healing of anastomosis wound and cause anastomosis leak. Among others, the effect of neostigmine and epidural block has been reported in many studies since half a century ago. View the original paper by Phillips

  14. [Pressure Ulcer Caused by Long-term Keeping of the Same Body Position during Epidural Labour Analgesia].

    Science.gov (United States)

    Naruse, Satoshi; Uchizaki, Sakiko; Mimura, Shinichiro; Taniguchi, Mizuki; Akinaga, Chieko; Sato, Shigehito

    2016-06-01

    We report the case of a 34-year-old woman (height: 153 cm, weight : 62.4 kg, non-pregnant weight : 52 kg, uniparous) without underlying diseases who developed pressure ulcer due to keeping a similar body position during long-term epidural delivery. Induction of childbirth was started in gestational week 40, causing reduction of fetal heart rate, which improved after adoption of a right lateral recumbent position. Severe contractions occurred and epidural labour analgesia was started. The fetal heart rate decreased again and induction of childbirth was suspended, but the right lateral recumbent position was maintained. Epidural administration was continued due to persistent contractions. Next morning, induction of childbirth was restarted and birth occurred in approximately 6 hours. The right lateral recumbent position was maintained for approximately 20 hours. At childbirth, a pressure ulcer was present in the intertrochanteric part of the right femur. The causes included insufficient knowledge of medical staff about the risk of pressure ulcer during epidural delivery, and no position change. A decreased sensation and blocked motor nerve caused by epidural anesthesia might have accelerated pressure ulcer development. This case suggests that preventive measures against pressure ulcer are required in epidural anesthesia in pregnant women.

  15. ClassicTM喉罩用于老年患者腰-硬联合阻滞术中镇静的临床研究%CLINICAL RESEARCH ON THE APPLICATION OF LARYNGEAL MASK IN ELDERLY PATIENTS UNDERWENT EPIDURAL-SPINAL ANESTHESIA FOR INTRAOPERATIVE SEDATION

    Institute of Scientific and Technical Information of China (English)

    黄泽波; 罗文报

    2011-01-01

    [目的]评估ClassicTM喉罩(LMA)用于老年患者腰-硬联合阻滞未中镇静的临床效果与可行性.[方法]选择在腰-硬联合阻滞下行下腹部或下肢手术的老年患者40例,年龄60~80岁,其中男22例,女18例,随机分为2组.两组患者蛛网膜下腔均给以0.5%布比卡因重比重混合液2.5 ml.首次静脉注射丙泊酚l mg,kg-1后以10 μg·kg-1,min-1速度持续泵注镇静.面罩组(M组)使用密闭面罩吸氧;喉罩组(LMA组)使用ClassicTM LMA连接麻醉机开放模式吸氧.监测并记录两组患者未前、术中呼吸,循环及动脉血气情况.[结果]LMA组术中SpO2均值为(99.3±1.1)%,出现SpO2< 95%共计2例,面M组相应分别为(97.7±1.6)%,13例,差异有统计学意义(P<0.05).LMA组辅助通气次数以及术中舌后坠例数与M组差异有统计学意义(P<0.05).术中lMA组的pH,PO2,PC02与M组差异有统计学意义(P<0.05).[结论]ClassicTM喉罩用于老年患者腰-硬联合阻滞下术中镇静,利于保持呼吸循环平稳,且安全可行.%[Objective] To evaluate the effect of laryngeal mask in elderly patients underwent epidural-spinal anesthesia for intraoperative sedation. [Methods] 40 ASA II-III patients undergoing selected bythus or lower extremity surgery were divided into 2 groups randomly. After the infusion of 0.5% bupivacaine mixture of heavy specific gravity of 2.5 ml were injected into subarachnoid space. Patients of group facemask (Group M,) inspired oxygen 3L·min-1) through facemasks of anaesthesia apparatuses, after propofol lmg·kg-1 were injected and assisted ventilati·n for 1 min, continuous infusion rate of propofol was l0μg·kg-1·min-1. Patients in group Laryngeal Mask Airway (Croup LMA,) were inserted Classic LMA in digital technique after propofol lmg·kg-1 were injected, and inspired oxygen (3L·mkr-1) through LMA that connected anaesthesia apparatuses. Group LMA were assisted ventilation for 1 min, and continuous infusion rate of

  16. Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica Estudio comparativo entre bupivacaína a 0,25% y ropivacaína a 0,2% en anestesia peridural para cirugía de tórax Comparison between 0.25% bupivacaine and 0.2% ropivacaine in epidural anesthesia for thoracic surgery

    Directory of Open Access Journals (Sweden)

    Marcus Vinícius Martins Novaes

    2001-12-01

    ventilatorios de la anestesia peridural torácica con bupivacaína a 0,25% y ropivacaína a 0,2% asociada a anestesia general en pacientes sometidos a toracotomia. MÉTODO: Participaron de este estudio prospectivo, comparativo y aleatorio, cuarenta pacientes divididos en dos grupos de veinte. Cada grupo recibió un volumen de 10 ml de anestésico local, por vía peridural torácica. Grupo B (Bupivacaína 0,25% y el Grupo R (Ropivacaína 0,2%. El bloqueo peridural fue realizado con los pacientes en decúbito lateral, punción paramediana y catéter para inyección de los fármacos A seguir, todos los pacientes recibieron anestesia general con IOT. Fueron analizados parámetros hemodinámicos y ventilatorios en 9 momentos. RESULTADOS: La presión arterial sistólica fue menor en el momento 5 y la presión arterial diastólica en los momentos 1 y 5, ambas en el grupo B. La necesidad de efedrina para corregir hipotensión arterial fue de 8/20 en el grupo B, contra 6/20 en el grupo R. La presión de pico en las vías aéreas superiores fue siempre mas elevada en el grupo R y los valores de la CAM del isoflurano fueron mas elevados en los momentos 5 y 6 también en el Grupo R. CONCLUSIONES: La técnica combinada peridural torácica y anestesia general se mostró eficaz y segura en los pacientes sometidos a toracotomia. Cuando se utilizó bupivacaína, la diminución de la presión arterial fue mayor y la presión máxima en las vías aéreas fue menor de que cuando fue utilizada ropivacaína.BACKGROUND AND OBJECTIVES: Combined general/epidural anesthesia has been used for several surgical procedures. Little has been published in the literature about its use in thoracic surgery. This study aimed to evaluate hemodynamic and ventilatory effects of combined general/epidural anesthesia with 0.25% bupivacaine and 0.2% ropivacaine in patients submitted to thoracotomy METHODS: Participated in this prospective, comparative and randomized study 40 patients divided in two groups of 20. Each

  17. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    -point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given...

  18. Estudo comparativo entre bupivacaína (S75-R25 e ropivacaína em bloqueio peridural para analgesia de parto Estudio comparativo entre la bupivacaína (S75-R25 y la ropivacaína en bloqueo epidural para analgesia de parto A comparative study between bupivacaine (S75-R25 and ropivacaine in spinal anesthesia for labor analgesia

    Directory of Open Access Journals (Sweden)

    Celso Schmalfuss Nogueira

    2010-10-01

    las repercusiones maternas y fetales con el uso de la bupivacaína (S75-R25 y de la ropivacaína cuando se usan para la analgesia de parto por bloqueo epidural. MÉTODOS: Realizamos un ensayo clínico prospectivo, encubierto y randomizado, con 49 pacientes gestantes a término, que presentaban bajo riesgo, con indicación de parto vaginal, y una edad entre los 15 y los 35 años, ASA I o II distribuidas en dos grupos: GI - bupivacaína (S75-R25 0,25%; GII - ropivacaína a 0,20%. RESULTADOS: Quedó evidenciada la diferencia estadísticamente significativa entre los dos grupos, 30 minutos después de la administración de la epidural, siendo que las puntuaciones de dolor fueron más elevadas en el grupo que utilizó la ropivacaína. No se encontraron diferencias estadísticas significativas en cuanto a la latencia de la analgesia, nivel sensorial del bloqueo, volumen del anestésico local, dosis de rescate, duración del parto y de la analgesia, frecuencia de parto instrumental, alteraciones hemodinámicas, puntuaciones de Apgar o pH del cordón umbilical e incidencia de eventos adversos. CONCLUSIONES: El uso de la bupivacaína (S75-R25 y la ropivacaína para la analgesia de parto, proporcionó buenas condiciones para la realización de la anestesia epidural con pequeñas incidencias de eventos adversosBACKGROUND AND OBJECTIVES: Spinal anesthesia is used for relief of pain during labor and it is associated with low indices of complications. Studies with levorotatory enantiomers of local anesthetics demonstrate higher safety due to the lower cardiotoxicity. The objective of this study was to evaluate the latency and duration of analgesia and maternal and fetal repercussions with bupivacaine (S75-R25 and ropivacaine in spinal anesthesia for labor analgesia. METHODS: A prospective, double-blind, randomized clinical assay was undertaken with 49 labouring parturients with low risk, with indication of vaginal delivery, ages 15 to 35 years, ASA I or II, divided into two groups

  19. [Epidural emphysema complicating bronchial asthma].

    Science.gov (United States)

    Rouetbi, N; Ben Saad, A; Joobeur, S; Skhiri, N; Cheikh Mhamed, S; Mribah, H; El Kamel, A

    2012-12-01

    Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.

  20. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Hjortsø, N C; Stage, J G

    1994-01-01

    cholecystectomy improves pain relief in the immediate postoperative period, compared to intramuscular morphine. Pulmonary and endocrine-metabolic function is not changed to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects.......BACKGROUND AND OBJECTIVES. The study investigates the effects of combined perioperative continuous epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine, compared with intermittent systemic morphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory...... function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy. METHODS. Thirty-two patients scheduled for cholecystectomy, performed through a minilaparotomy, were randomized to receive general anesthesia with pre- and postoperative thoracic (T7-9) epidural analgesia...

  1. Correlation between Pleth variability index and hypotension after combined spinal epidural anesthesia for cesarean section%Pleth变异性指数与蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉下剖宫产术中低血压的相关性

    Institute of Scientific and Technical Information of China (English)

    陈秀斌; 朱慧琛; 忻纪华; 陈杰

    2013-01-01

    Objective To investigate the correlation between Pleth variability index (PVI) and hypotension after combined spinal epidural anesthesia (CSEA) for cesarean section.Methods Fifty American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ parturients scheduled for cesarean section were enrolled in this study.Systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) were measured after the parturients arrived in the operation room and smoothly breathed for 5 min.Perfusion index (PI) and PVI were monitored by Masimo Radical 7.CSEA was induced with isobaric 0.75% ropivacaine 1.5 mL.During the 15 minutes after anesthesia,SBP,DBP,MAP and HR were measured per 2.5 min.The maximal difference between the indices and baseline was calculated.Hypotension (SBP<90 mmHg or MAP<60 mmHg,1 mmHg=0.133 kPa) occurred in 23 parturients (group Ⅰ),and blood pressure remained normal in another 27 ones (group Ⅱ).Results There were no significant differences in terms of parturients' age,body height,body mass index,gestational weeks,abdominal circumference or neonate body weight between the two groups (P>0.05).Neither were the baseline SBP,DBP,MAP nor HR between the two groups (P>0.05).The PVI in group Ⅰ was significantly higher than group Ⅱ (22.61 ± 4.92 vs.15.48 ± 3.33,P =0.000).Linear regression analysis showed that PVI before anesthesia was negatively correlated with the maximal differences of SBP,DBP and MAP (r=-0.590,-0.502 and-0.651,P<0.05),and was not correlated with HP (r=-0.113,P>0.05).Area under curve was 0.915 when PVI was used for boundary value.With PVI more than 18.5 as the occurrence of hypotension in the limit,the sensitivity of PVI was 0.87 and specificity was 0.852.Conclusion PVI can predict the occurrence of hypotension after CSEA in cesarean section.%目的 探讨麻醉前Pleth变异性指数(PVI)与蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉(CSEA)下剖宫产术中

  2. Magnesium in obstetric anesthesia and intensive care.

    Science.gov (United States)

    Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

    2017-02-01

    Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

  3. Obesity and Anesthesia

    Science.gov (United States)

    ... Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Obesity and Anesthesia More than one-third of Americans ... Sleep Apnea, a chronic medical problem common with obesity, can present with serious breathing problems before, during, ...

  4. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: info@sambahq.org Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  5. Epidural injections for back pain

    Science.gov (United States)

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... be pregnant What medicines you are taking, including herbs, supplements, and other drugs you bought without a ...

  6. A Study of Fetomaternal Outcome of Epidural Analgesia During Labour

    Directory of Open Access Journals (Sweden)

    Shital H Halvadia

    2013-04-01

    Full Text Available Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%, forceps delivery in 4 patients (5%, ventouse in 14 patients (17.5% and caesarean section in 16 patients (20%. At one minute majority of the babies (n 63, 78.75% had Apgar score of more than 7, only 5 babies (6.25% had Apgar score less than 4, and 12 babies (15% had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5% had Apgar score of more than 7, only one baby (1.25% had Apgar score less than 4, and 5 babies (6.25% had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient. [Natl J Med Res 2013; 3(2.000: 184-186

  7. Antibacterial activity of epidural infusions.

    Science.gov (United States)

    Coghlan, M W; Davies, M J; Hoyt, C; Joyce, L; Kilner, R; Waters, M J

    2009-01-01

    The incidence of epidural abscess following epidural catheterisation appears to be increasing, being recently reported as one in 1000 among surgical patients. This study was designed to investigate the antibacterial activity of various local anaesthetics and additives, used in epidural infusions, against a range of micro-organisms associated with epidural abscess. The aim was to determine which, if any, epidural infusion solution has the greatest antibacterial activity. Bupivacaine, ropivacaine and levobupivacaine crystals were dissolved and added to Mueller-Hinton Agar in concentrations of 0.06%, 0.125%, 0.2%, 0.25%, 0.5% and 1%. Fentanyl, adrenaline and clonidine were also mixed with agar in isolation and in combination with the local anaesthetics. Using a reference agar dilution method, the minimum inhibitory concentrations were determined for a range of bacteria. Bupivacaine showed antibacterial activity against Staphylococcus aureus, Enterococcus faecalis and Escherichia coli with minimum inhibitory concentrations between 0.125% and 0.25%. It did not inhibit the growth of Pseudomonas aeruginosa at any of the concentrations tested. Levobupivacaine and ropivacaine showed no activity against Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa, even at the highest concentrations tested, and minimal activity against Escherichia coli (minimum inhibitory concentrations 0.5% and 1% respectively). The presence of fentanyl, adrenaline and clonidine had no additional effect on the antibacterial activity of any of the local anaesthetic agents. The low concentrations of local anaesthetic usually used in epidural infusions have minimal antibacterial activity. While the clinical implications of this in vitro study are not known, consideration should be given to increasing the concentration of bupivacaine in an epidural infusion or to administering a daily bolus of 0.25% bupivacaine to reduce the risk of epidural bacterial growth.

  8. Polytrauma and continue epidural anesthesia. A case presentation.

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    Roberto Travieso Peña

    2005-04-01

    Full Text Available This is a 62 year-old hypertensive patient who was admitted at the Intensive Care Unit of the ¨Dr. Gustavo Aldereguí­a Lima¨ hospital with multiple trauma in the skull, thorax abdomen and extremities. Left and right pleurothomy was performed by bilateral hemonoumothorax. The patient presented hemodynamic inestability so he needed vasoactive suport and an adequate management of the support of volume. The follow up revealed pain that didn´t alliviate with the habitual treatment, which seemed to worsen with treatment. Peridural anaesthesia was applied and it revealed clinical and ventilatory stability and avoided the deleterious effect of pain. The patient was discharged from the intensive care service without sequelae.

  9. A comparative study of magnesium sulfate vs dexmedetomidine as an adjunct to epidural bupivacaine

    Science.gov (United States)

    Shahi, Vaibhav; Verma, Anil Kumar; Agarwal, Apurva; Singh, Chandra Shekhar

    2014-01-01

    Background and Aims: This prospective, randomized, double-blind study was undertaken to establish the effect of addition of magnesium or dexmedetomidine, as an adjuvant, to epidural bupivacaine in lower limb surgeries. Materials and Methods: One hundred and twenty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower limb surgeries were enrolled to receive either magnesium sulfate (Group M) or dexmedetomidine (Group D) along with epidural bupivacaine for surgical anesthesia. All the study subjects received an epidural anesthesia with 14 ml of 0.5% bupivacaine along with either MgSO4 50 mg (Group M) or dexmedetomidine 0.5 μg/kg (Group D) or saline (Group C). The onset of motor and sensory block, duration of block, hemodynamic parameters, and any adverse events were monitored. Results: Analgesia in the postoperative period was better in Group D, duration of sensory and motor blockade was significantly prolonged in Group D and incidence of sedation was more in Group D. Conclusion: Hence, addition of dexemedetomidine to epidural bupivacaine can be advantageous with respect to increased duration of motor and sensory blockade and arousable sedation. PMID:25425781

  10. 剖宫产术-硬脊膜刺破后头痛-可逆性后部白质脑病综合征%Reversible posterior leukoencephalopathy syndrome (RPLS) in a postpartum woman after postdural puncture headache following combined-spinal epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    耿志宇; 冯佳; 王东信

    2011-01-01

    可逆性后部白质脑病综合症(reversible posterior leukoencephalopathy syndrome,RPLS)是一少见的具有多种临床表现的综合征,临床症状包括头痛、高血压、意识障碍、视觉改变和癫痫发作.此文报道1例剖宫产术后发生的RPLS.患者28岁,女性,因"停经40+6周,慢性高血压合并妊娠"入院.剖宫产术后出现头痛、高血压、癫痫发作及双眼右侧视野偏盲,经脑部核磁检查确诊为RPLS,予镇静、降压、脱水及解痉治疗2周后症状完全缓解,复查脑部磁共振(MRI)结果 正常出院.该病确诊的主要依据是MRI具有特征性改变:双侧大脑半球后部枕叶和顶叶白质异常信号.此病多数预后良好,经积极降压和抗癫痫治疗病情迅速好转,故称"可逆性".但是也可能因诊断延迟或治疗不当而发生"不可逆"的脑损伤如脑水肿、脑梗塞甚至脑疝死亡.%Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare clinical syndrome, which is manifested clinically by headache, seizure, altered mental status, and a spectrum of visual deficits ranging from visual neglect to cortical blindness. We present a case of postpartu women who developed RPLS after combined -spinal epidural anesthesia which was complicated by a postdural puncture headache. The patient was treated with magnesium sulfate, midazolam, mannitol and carbamazepine for seizure control and prophylaxis. Blood pressure was controlled with labetolol and nicardipine. The patient was discharged home two weeks later with no neurologic deficit, and repeated magnetic resonance imaging (MRI) showd normal. Cerebral MRI served as a diagnostic method for RPLS. The hallmark feature is bilateral symmetrical vasogenic edema in the territories of the posterior cerebral circulation (occipital and posterior parietal lobes). If promptly recognized and treated, symptoms and neuroradiographic changes are reversible when blood pressure is controlled. However, if the diagnosis is

  11. Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

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    A. L. M. J. van der Knijff-van Dortmont

    2016-01-01

    Full Text Available SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.

  12. Anesthesia considerations in the obese gravida.

    LENUS (Irish Health Repository)

    Tan, Terry

    2011-12-01

    Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly in the event of an emergency cesarean section, thus avoiding a general anesthesia, which has exceedingly high risks in the obese parturient. Successful management of the obese patient necessitates a comprehensive strategy that encompasses a multidisciplinary and holistic approach from all care-providers.

  13. Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy

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    Sandeep Kundra

    2014-01-01

    Full Text Available Background: Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use. Materials and Methods: One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests. Results: Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg as compared to group II (24.80 ± 6.009 mg. Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P 0.01. Conclusion: Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.

  14. Neurologic deficits and arachnoiditis following neuroaxial anesthesia.

    Science.gov (United States)

    Aldrete, J A

    2003-01-01

    Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.

  15. Topical anesthesia

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    Mritunjay Kumar

    2015-01-01

    Full Text Available Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

  16. The half-effective target effect-site concentration of propofol required to inhibit the body movement during pneumoperitoneum at totally extraperitoneal prosthesis under combined spinal-epidural anesthesia%异丙酚辅助腰硬联合麻醉在腹腔镜疝修补术中气腹时患者体动反应的半数有效效应室靶浓度

    Institute of Scientific and Technical Information of China (English)

    胡志向; 韩希文; 王庆亮

    2011-01-01

    Objective:To determine the half-effective target effect-site concentration (EC50) of propofol required to inhibit the body movement during pneumoperitoneum at totally extraperitoneal prosthesis (TEP) under combined spinal-epidural anesthesia ( CSEA). Methods:Fifty ASA Ⅰ or I patients of both sexes, BMI < 30 kg/m2, undergoing laparoscopic TEP were randomly divided into 5 groups according to the different target effect-site concentration of propofol ( n = 10 ): group S1 ( 1. 0 ng/ml ), group S2( 1.5 ng/ml), group S3 ( 2.0 ng/ml) , group S4 ( 2.5 ng/ml ), group S5 ( 3.0 ng/ml ). The pneumoperitoneum was established as soon as the patients lost consciousness, pneunoperitoneum pressure was about 10 mmHg. The response was defined as positive when body movement occurrod (cough and swallowing were excluded). The ECho of propofol required to inhibit the body movement during 10 mmHg CO2 pneumoperitoneum and 95% confidence interval (C[) were calculated by Bliss method. Results :The EC50 of propofol required to inhihit the body movement during 10 mmHg CO2 pneumoperitoneum at laparoscopn TEP under CSEA is 2.23 ng/ml and 95% Cl was 1.80-3.31 ng/ml. Conclusions: The EC50 of propofol required to inhibit the body movement during pneumoperitoneum at laparoscopic TEP under CSEA is 2.23 ng/ml.%目的:确定异丙酚辅助腰麻联合硬膜外麻醉(combined spinal-epidural anesthesia,CSEA)在建立气腹时患者体动反应的半数有效效应室靶浓度(EC50).方法:选择异丙酚辅助行腹腔镜完全腹膜外疝修补术(totally extraperitoneal prosthesis,TEP)患者50例,性别不限,BMI<30 kg/m2,ASAⅠ级或Ⅱ级,随机均分为S1 组、S2 组、S3 组、S4 组和S5 组(n=10),异丙酚效应室靶浓度分别1.0、1.5、2.0、2.5、3.0 ng/ml.患者意识消失建立腹膜外气腹后,压力维持10 mmHg,患者发生体动反应(咳嗽和吞咽动作除外)为阳性反应.采用Bliss法计算异丙酚辅助CSEA在TEP术中建立气腹时患者体动反应的EC50

  17. Exacerbation of preexisting neurological deficits by neuraxial anesthesia: report of 7 cases.

    Science.gov (United States)

    Aldrete, J Antonio; Reza-Medina, Marisela; Daud, Olga; Lalin-Iglesias, Silvia; Chiodetti, Gustavo; Guevara, Uriah; Wikinski, Jaime A; Torrieri, Alberto

    2005-06-01

    We undertook this case series to determine if preexisting neurological disease is exacerbated by either spinal or epidural anesthesia. In the website of the Arachnoiditis Foundation, we posted an offer to advise anesthesiologists in cases of neurological problems after either of these techniques was used. Contacts were made first by way of the Internet, confirmed by telephone, and maintained by fax, e-mail, or by special mail. Patients here described were cared for and observed by one of the authors, in a hospital, in Argentina or in Mexico. A total of 7 adult, ASA physical status I and II patients, including 3 men and 4 women, with subtle symptoms of neurological disease before anesthesia, are described. Two patients had continuous lumbar epidural anesthesia, 3 had spinals; in 2 more, attempted epidural blocks led to accidental dural puncture and were converted to subarachnoid anesthetics. All patients accepted neuraxial anesthesia without informing the anesthesiologists that they had mild neurological symptoms before surgery. Because anesthesiologists did not specifically inquire about subclinical neurological symptoms or prior neurological disease, anesthesiologists are advised to carefully inquire about prior neurological disease whether neuraxial anesthesia techniques are considered.

  18. Anesthesia for off-pump coronary artery bypass surgery

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    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  19. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report

    Directory of Open Access Journals (Sweden)

    Ranger Cavalcante da Silva

    2006-04-01

    drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural.BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who, in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be

  20. Epidural Naloxone to Prevent Buprenorphine Induced PONV

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    Ashok Jadon

    2008-01-01

    Full Text Available Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combina-tion gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

  1. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  2. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  3. [Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].

    Science.gov (United States)

    Miyamoto, Tatsuhito; Nakatani, Toshihiko; Narai, Yasuhiro; Sakakibara, Manabu; Hashimoto, Tatsuya; Saito, Youji

    2014-03-01

    A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.

  4. Low-dose spinal neostigmine further enhances the analgesic effect of spinal bupivacaine combined with epidural dexamethasone, following orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2014-01-01

    Full Text Available Background: Opioids are considered mainstream for combined spinal-epidural anesthesia, but frequently limited by adverse effects. The aim of this study was to examine whether low-dose spinal neostigmine, epidural dexamethasone or their combination enhances analgesia from spinal bupivacaine without adverse effects. Materials and Methods : A total of 60 patients undergoing orthopedic surgery were randomized to one of four groups and evaluated for 24-h after surgery for analgesia (time to first rescue analgesic and rescue analgesic consumption. Patients received 15 mg bupivacaine plus the test drug intrathecally (saline or 1 microgram (μg neostigmine. The epidural test drug was either saline or 10 mg dexamethasone. The Control group (CG received spinal and epidural saline. The Neostigmine group (NG, spinal neostigmine and epidural saline; the Dexamethasone group (DG, spinal saline and epidural dexamethasone; and the Neostigmine-dexamethasone group (NDG, spinal neostigmine and epidural dexamethasone. Results: The CG (282 ± 163 min and NG (524 ± 142 min were similar in their times to first rescue analgesic and analgesic consumption. The time to first rescue analgesic was longer for the DG (966 ± 397 min compared with CG and NG (P < 0.0002, and the DG had less ketoprofen consumption and lower overall visual analogue scale-pain sores compared with CG and NG (P < 0.0005. Addition of 1 mg-neostigmine (NDG resulted in longer time to rescue analgesic (1205 ± 303 min; P < 0.02 and lower ketoprofen consumption (P < 0.05 compared to DG. Sporadic cases of vesical catheterization and emesis were observed, however adverse effects were similar among groups. Conclusion: Spinal 1 microgram (μg neostigmine further enhanced analgesia from spinal bupivacaine combined with epidural dexamethasone, without increasing the incidence of adverse effects.

  5. 咪达唑仑伍用不同镇痛药在腰-硬联合麻醉下妇科经腹手术中的应用%Application of combined spinal-epidural anesthesia by midazolam combined with different pain-killers for abdomen operation in gynecological patients

    Institute of Scientific and Technical Information of China (English)

    凌敏

    2012-01-01

    目的观察比较咪达唑仑伍用不同静脉镇痛药在腰-硬联合麻醉(CSEA)下妇科经腹手术中的镇静镇痛效果和安全性.方法择期妇科手术80例,均行腰-硬联合麻醉,根据咪达唑仑联合不同镇痛药随机分为4组:芬太尼组(FM组)、哌替啶组(PM组)、布托啡诺组(BM组)、地佐辛组(DM组).4组患者均在切皮前15 min静脉缓慢推注咪达唑仑0.05 mg/kg,随后分别在FM组予芬太尼1 μg/kg,PM组予哌替啶0.8 mg/kg,BM组予布托啡诺0.04 mg/kg,DM组予地佐辛0.1 mg/kg缓慢静脉推注.术中患者Ramsay镇静评分小于2分者,酌情追加咪达唑仑和各组镇痛药,剂量为首次的1/2~2/3.记录4组患者切皮时(T0)、打开腹膜上腹腔撑开器时(T1)、分离结扎盆腔脏器时(T2)、术毕清理腹腔时(T3)、关闭腹膜时(T4)和缝皮时(T5)的Ramsay镇静评分;记录4组术中舌后坠、呼吸抑制、低血压、心动过缓、牵拉痛发生率;术后24 h内随访,记录4组患者对手术操作过程的遗忘程度及头晕、嗜睡、恶心呕吐、寒战发生率.结果 FM、PM组在T0-T5各时点Ramsay镇静评分均明显高于BM和DM组(P 0.05);术后24 h内随访,4组完全遗忘率均明显高于无遗忘率和不全遗忘率(P 0.05).结论布托啡诺或地佐辛伍用咪达唑仑辅助腰-硬联合麻醉下行妇科手术,术中镇静镇痛效果好,完全遗忘率高,生命体征平稳,术后不良反应少,较芬太尼或哌替啶与咪达唑仑配伍更安全有效.%Objective To observe the efficacy and safety of mitigation and analgesia of combined spinal-epidural anesthesia (CSEA) by midazolam combined with different pain-killers in gynecological patients undergoing abdomen operation. Methods Eighty gynecological patients undergoing elective abdomen operation by CSEA were randomly divided into four groups according to different pain-killers combined with midazolam: fentanyl group(FM group), pethidine group(PM group), butorphanol group(BM group) and

  6. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Asad ABBAS

    2013-06-01

    disorders of the spinal cord, in Davidoff RA (ed: Handbook of the Spinal Cord.Infections and Cancer, Vol 5. New York: Marcel Dekker, 1986, pp 271-273.8. Blount J, Doughty K, Tubbs RS, Wellons JC, Reddy A, Law C, et al. In utero spontaneous cervical thoracicepidural hematoma imitating spinal cord birth injury. Pediatr Neurosurg 2004;40:23-7.9. Iguchi T, Ito Y, Asai M, Ito J, Okada N, Murakami M. [A case of spontaneous spinal epidural hematoma]. No ToHattatsu 1993;25:267-70. Review. Japanese.10. Nagel MA, Taff IP, Cantos EL, Patel MP, Maytal J, Berman D. Spontaneous spinal epidural hematoma in a7-year-old girl. Diagnostic value of magnetic resonance imaging. Clin Neurol Neurosurg 1989;91:157-60.11. Metzger G, Singbartl G. Spinal epidural hematoma following epidural anesthesia versus spontaneous spinalsubdural hematoma. Two case reports. Acta Anaesthesiol Scand 1991;35:105-7.12. Patel H, Garg BP. Increasing irritability with sudden onset of flaccid weakness. Semin Pediatr Neurol 1996;3:192-7.13. Tewari MK, Tripathi LN, Mathuriya SN, Khandelwal N, Kak VK. Spontaneous spinal extradural hematomain children. Report of three cases and a review of the literature. Childs Nerv Syst 1992;8:53-5. Review.14. Pecha MD, Able AC, Barber DB, Willingham AC. Outcome after spontaneous spinal epidural hematoma in children: case report and review of the literature. Arch Phys Med Rehabil 1998;79:460-3. Review.

  7. Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion

    Science.gov (United States)

    Hasanin, Ahmed M.; Mokhtar, Ali M.; Amin, Shereen M.; Sayed, Ahmed A.

    2017-01-01

    Background and Aims: Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations. Subjects and Methods: Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups. Results: Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75], P = 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2], P = 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5], P = 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 s P = 0.00). Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method. PMID:28217056

  8. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five......-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given.......01). Mean duration of sensory blockade was significantly longer (P less than 0.005) in the patients with chronic pain than in surgical patients (13.1 +/- 1.2 and 8.5 +/- 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine infusion...

  9. Comparison on the influence of different anesthesia methods for oxygen metabolism and hemodynamics of patients with infective shock

    Institute of Scientific and Technical Information of China (English)

    Ma Jie

    2016-01-01

    Objective:To observe and compare the influence state of general anesthesia and general anesthesia combined with epidural anesthesia for the oxygen metabolism and hemodynamics of patients with infective shock, in order to provide evidence for the selection of anesthesia methods of the patients with infective shock.Methods:A total of 42 patients with infective shock in hospital from April 2013 to December 2015 were randomly divided into control group and observation group by the principle of random allocation, 21 cases in control group were with general anesthesia, 21 cases in observation group were with general anesthesia integrated with epidural anesthesia, then the oxygen metabolism and hemodynamics indexes of two groups before the anesthesia and at 20min during the operation, at 10min after the operation were compared.Results: The oxygen metabolism parameters including SvO2, CjvO2 and VO2 were respectively (64.81±5.99)%, (94.24±5.32) mL/L, (136.16±8.32) mL/min•m2 and (67.20±6.08)%, (95.10±5.40) mL/L, (133.15±8.17) mL/min•m2, and they were all better than (60.11±5.81)%, (90.11±5.04) mL/L, (145.15±9.38) mL/min•m2 and (63.24±5.95)%, (92.23±5.18) mL/L, (142.24±9.11) mL/min•m2 of control group, the hemodynamics indexes were all better than those of control group.Conclusion: The influence state of general anesthesia integrated with epidural anesthesia or the oxygen metabolism and hemodynamics of patients with infective shock are better than those of general anesthesia, so the application value of general anesthesia integrated with epidural anesthesia in the patients are relatively higher.

  10. Comparison of Sympathomimetics in the Correction of Arterial Hypotension during Combined Anesthesia

    Directory of Open Access Journals (Sweden)

    D. B. Borisov

    2012-01-01

    Full Text Available Objective: to make a comparative assessment of hemodynamic parameters when correcting combined anesthesia-induced arterial hypotension with dopamine, adrenaline, mesatone, or noradrenaline. Subjects and methods. A prospective study enrolled patients who had undergone prosthetic hip replacement under combined lumbar epidural (ropivacaine/general (sevoflurane anesthesia. Intravenous sympathomimetic infusion was initiated when the mean blood pressure decreased below 55 Hg mm. Cardiac index (CI and systemic vascular resistance index (SVRI were calculated by impedance cardiography. Fifty-six subjects (14 in each group were selected for analysis. Results. During the study, CI remained in the normal range for all sympathomimetics. When adrenaline was administered, there was an obvious tendency to maintain blood pressure due to heart rate (HR with preserved low SVRI. The use of mesatone caused a considerable reduction in HR. No statistically significant differences were found between the dopamine and noradrenaline groups in any of the study stages. The start of infusion of these agents was attended by SVRI normalization and HR maintenance within 60—70 beats per minute. Conclusion. The infusion of dopamine, adrenaline, mesatone, or noradrenaline to correct arterial hypotension resulting from combined epidural block/general anesthesia with sevoflurane ensures maintenance of CI within the normal range. That of noradrenaline and dopamine was ascertained to have a more balanced impact on HR and systemic vascular resistance. Key words: combined anesthesia, epidural block, hemodynamics, sympathomimetics, adrenaline, dopamine, mesatone, noradrenaline.

  11. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  12. Evidence for using air or fluid when identifying the epidural space.

    Science.gov (United States)

    Sanford, Curtis L; Rodriguez, Ricardo E; Schmidt, James; Austin, Paul N

    2013-02-01

    Lumbar epidural analgesia is frequently employed to provide pain relief for women during labor. Anesthesia providers use various methods to identify the epidural space. Some providers use air, some use fluid, and others use a combination of air and fluid during the loss of resistance technique. Loss of resistance to air has been speculated to result in a lesser quality of analgesia compared with loss of resistance to only fluid. A search strategy focusing on preappraised sources was used to locate evidence from interventional and observational studies. Four evidence sources were located, including a systematic review with meta-analysis of 4 older studies. The evidence reviewed was inconclusive in determining whether a difference in analgesia quality results from the use of air or fluid during the loss of resistance technique. Future studies should include an adequate number of subjects and address other problems such as operator experience, observer blinding, equivalence of subject characteristics, outcomes definition and measurement, and composition of epidural solution. Providers should consider other factors when selecting loss of resistance medium, such as the reported complications of large amounts of air injected into the epidural space and surrounding structures.

  13. Effect of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on maternal lactation

    Institute of Scientific and Technical Information of China (English)

    Hu Feng; Bao-Xia Chen; Xi Ren; Hong-Xia Zhu

    2016-01-01

    Objective:To observe the effect of application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section on the lactation and neonates.Methods:The puerpera who were underwent cesarean section with different analgesia methods were observed. The included puerpera were performed with the cesarean section under combined spinal epidural anesthesia. A total of 30 puerpera who were given ropivacaine in combined with sufentanil epidural analgesia after operation were served as the observation group, while 30 cases who were intermittently given intramuscular injection of pethidine after operation were served as the control group. The postpartum analgesic effects in the two groups were observed. The radioimmunoassay was used to detect the plasma PRL level. The postpartum colostrum time, 24 h lactation number, and NBNA scores in the two groups were compared.Results:The postoperative VAS score in the observation group was significantly lower than that in the control group (P<0.05), while the plasma PRL level was significantly higher than that in the control group (P<0.05). The postoperative colostrum time in the observation group was significantly earlier than that in the control group (P<0.05), while the lactation number was significantly greater than that in the control group (P<0.05).Conclusions:Application of ropivacaine in combined with sufentanil epidural analgesia after cesarean section can effectively alleviate the postoperative pain, and improve the lactation, with no obvious adverse reactions on the neonates and reliable effects.

  14. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  15. [Automated anesthesia record system].

    Science.gov (United States)

    Zhu, Tao; Liu, Jin

    2005-12-01

    Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency.

  16. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Nygård, Eigil; Sørensen, Lars H; Hviid, Lamia B;

    2004-01-01

    OBJECTIVE: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). DESIGN AND SETTING......: The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. PARTICIPANTS: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. INTERVENTIONS: In this 2 x 2 factorial-designed study the patients were...... randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single...

  17. Plasma concentration and cardiovascular effects of lidocaine during continuous epidural administration in dogs anesthetized with isoflurane.

    Science.gov (United States)

    Sakonju, Iwao; Maeda, Kenichi; Karasawa, Koichi; Tadokoro, Toshiyuki; Kakuta, Tomoko; Takase, Katsuaki

    2011-03-01

    The cardiovascular effects of continuous epidural administration (CEA) of lidocaine were investigated in anesthetized dogs. Loading epidural injections of 2, 4, or 6 mg/kg of lidocaine were followed by CEA with 1, 2, or 3 mg/kg/hr lidocaine, respectively, for 2 hr under 2.0% isoflurane anesthesia. Heart rate, direct blood pressure, cardiac index, and stroke volume decreased dose-dependently during CEA, whereas systemic vascular resistance did not significantly differ with dose, and no characteristic changes were observed in any groups. Plasma lidocaine concentration reached a steady state during CEA and increased in a dose-dependent manner. Circulatory suppression caused by lidocaine CEA was not attributable to peripheral vasodilation, but rather to the direct cardiac action of systemic lidocaine absorption from the peridural space.

  18. Bacteriological Profile of Epidural Catheters

    Directory of Open Access Journals (Sweden)

    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  19. [General anesthesia for a pregnant patient with PAPA syndrome].

    Science.gov (United States)

    Ohno, Seika; Ariyama, Jun; Tsujita, Miki; Ueshima, Hironobu; Imanishi, Hirokazu; Terao, Kazuhisa; Mieda, Tsutomu; Kitamura, Akira

    2014-08-01

    A 31-year-old female, with 22 weeks of pregnancy, presented with sudden onset of severe headache. CT scan showed diffuse subarachnoid hemorrhage. A cerebral angiogram showed dissecting aneurysm of right cerebral artery. To obliterate the aneurysm and prevent rupture, the patient underwent coil embolization via an endovascular approach under general anesthesia because the procedure under sedation with local anesthesia was too risky for re-bleeding. The patient has been diagnosed as PAPA syndrome. Although the arthritis was now stable and she was taking no drug, remarkable osteoarthritis was observed. The cervical spine X ray demonstrated no cervical ankylosis. As patient was sedated with propofol, airway examination could not be done except noticing thyromental distance of seven centimeters. Patient's trachea was intubated using Macintosh size #3 laryngoscope blade and a 7.0 non-styletted tracheal tube at the first attempt without any problems (Cormack grade I). Anesthesia was maintained with sevoflurane, fentanyl and remifentanil. After the end of endovascular surgery, the patient was transferred to the intensive care unit under mechanical ventilation. She was weaned from mechanical ventilation 2 days later but consciousness was unclear. Right incomplete paralysis was also observed. MRI revealed vasospasm on the bilateral internal carotid artery. The patient underwent percutaneous tansluminalangioplasty coil and intraarterial injection of fasudil hydrochloride under local anesthesia. The consciousness recovered fully and the paralysis was improved. The patient delivered the baby by Caesarean sections under combined spinal and epidural anesthesia at 36 weeks without any problems with both the mother and baby.

  20. Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

    Directory of Open Access Journals (Sweden)

    Basile Júnior Roberto

    1999-01-01

    Full Text Available The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scans showed hyperintense signal.

  1. 硬膜外联合腰麻在泌尿科微创手术中的应用效果观察%The application effect of Epidural combined with lumbar anaesthetizing in urological minimally invasive surgery

    Institute of Scientific and Technical Information of China (English)

    袁春梅; 罗明; 谢伦雄; 罗小玲

    2015-01-01

    目的:为了探讨硬膜外联合腰麻在泌尿科微创手术中的应用效果。方法选取156例泌尿科微创手术患者为研究对象,随机对患者进行分组,分成硬-腰联合麻醉组和连续硬膜外麻醉组。对两组患者的麻醉起效时间、用药总量以及临床整体麻醉效果进行观察和比较。结果(1)硬-腰联合麻醉组患者的麻醉起效时间短于连续硬膜外麻醉组,麻醉药物用量少于连续硬膜外麻醉组;(2)硬-腰联合麻醉组患者的麻醉效果优秀比例显著高于连续硬膜外麻醉组。结论临床针对泌尿科实施微创手术的过程中,采用硬膜外联合腰麻的临床麻醉效果显著,是临床应用于泌尿科微创手术中的理想麻醉方式之一。%Objective To investigate the application of epidural combined with lumbar anaesthetizing in urological minimally invasive surgery.Methods Chose 156 cases of urological minimally invasive surgery patients as the research object, and randomly divided into hard -waist joint anesthesia group and continuous epidural anesthesia group.Total anesthesia working time in patients, medication and clinical overall anaesthesia effect were observed and compared.Results Hard -waist joint anesthesia group present short effective time than continuous epidural anesthesia group, however, the dosage of anesthetic was less than the continuous epidural anesthesia group.Good proportion of anesthesia effect in Hard -waist joint anesthesia group was significantly higher than continuous epidural anesthesia group.Conclusions Epidural combined with lumbar anaesthetizing is an ideal anesthesia method in clinical minimally invasive surgery.

  2. Idiopathic Spinal Epidural Abscess: A Case Report

    Directory of Open Access Journals (Sweden)

    Chaitali Biswas

    2011-11-01

    Full Text Available Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

  3. Idiopathic Spinal Epidural Abscess: A Case Report

    OpenAIRE

    Chaitali Biswas; Anirban Pal; Saswata Bharati; Nitesh Sinha

    2011-01-01

    Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA) with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

  4. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

    Directory of Open Access Journals (Sweden)

    Armando Bedoya

    2010-01-01

    Full Text Available Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  5. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

    OpenAIRE

    Bedoya, Armando; Gentilesco, Bethany

    2010-01-01

    Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  6. The modifying effect of anesthetic technique on the metabolic and endocrine responses to anesthesia and surgery

    DEFF Research Database (Denmark)

    Kehlet, H

    1988-01-01

    and the widespread use of the term "stress free anesthesia" in surgery is therefore not valid. However, continuous administration of local anesthetic agents in the epidural space is the most effective technique in so far as reduction of the stress response is concerned. The clinical implication of a variable...... reduction in the stress response to surgery by different anesthetic techniques remains largely unsettled, since only few controlled studies have been published on the clinical effects of pain relief and general anesthesia. However, a vast amount of data exist from controlled studies comparing regional...... anesthesia with local anesthetics and general anesthesia. The cumulative experience from these studies have demonstrated an advantageous effect on postoperative morbidity parameters such as blood loss, postoperative thromboembolic complications, pulmonary infective complications, gastrointestinal motility...

  7. Articaine: a review of its use for local and regional anesthesia

    Directory of Open Access Journals (Sweden)

    Snoeck M

    2012-06-01

    Full Text Available Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.Keywords: articaine, regional anesthesia, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability, neurotoxicity

  8. Epidural levobupivacaine alone or combined with different morphine doses in bitches under continuous propofol infusion

    Directory of Open Access Journals (Sweden)

    V.B. Albuquerque

    2015-08-01

    Full Text Available The aim of this study was to assess the cardiopulmonary, analgesic, adverse effects, serum concentration of cortisol and plasma levels of levobupivacaine and morphine in bitches undergoing propofol anesthesia and epidural analgesia with levobupivacaine alone or combined with morphine. This was a randomized 'blinded' prospective clinical study using 32 adult bitches weighing 9.8±4.1kg that were admitted for elective ovariohysterectomy. Twenty minutes after administration of acepromazine and midazolam, anesthesia was induced with propofol (4mg kg-1 and maintained by a continuous rate infusion (CRI. Each animal was randomly assigned to one of four epidural groups: GL = levobupivacaine alone (0.33mg kg-1; GLM0.1 = levobupivacaine and morphine (0.1mg kg-1; GLM0.15 = levobupivacaine and morphine (0.15mg kg-1; and GLM0.2 = levobupivacaine and morphine (0.2mg kg-1. Variables obtained during anesthesia were heart rate, respiratory rate, systolic, mean and diastolic arterial blood pressures, oxyhemoglobin saturation, inspired oxygen fraction, end-tidal carbon dioxide tension, blood gases, serum cortisol, and plasma levels of levobupivacaine and morphine. The onset and duration times of the blockade were recorded. Arterial pressures were significantly increased in all groups at the times of ovarian pedicle clamping. There was a decrease in pH, together with an increase in both PaO2and PaCO2 over time. Serum cortisol levels were increased in TESu compared to TB, T30 and TR. Limb spasticity, muscle tremors, opisthotonos and diarrhea were observed in some animals during propofol infusion and ceased with the end of CRI. Reactions happened at different moments and lasted for different periods of time in each individual. Epidural with levobupivacaine alone or combined with morphine allowed for ovariohysterectomy to be performed under low propofol infusion rates, with minimal changes in cardiovascular variables and in serum cortisol levels. Adverse effects were

  9. Assessment of fetal antioxidant and oxidant status during different anesthesia techniques for elective cesarean sections

    Directory of Open Access Journals (Sweden)

    Safinaz Karabayirli

    2015-01-01

    Full Text Available Background: We aimed to investigate the effects of general, spinal and epidural anesthesia on fetal total antioxidant status (TAS and total oxidant status (TOS, and oxidative stress index (OSI during elective cesarean section in this study. Materials and Methods: Forty-seven parturients scheduled for elective cesarean section were randomly allocated into three groups: Group spinal (n = 15, group epidural (n = 17, and group general (n = 15, This prospective randomized study was performed in Faculty of Medicine, Turgut Ozal University, Turkey. After the baby was delivered; TAS, TOS levels, and arterial blood gases parameters were analyzed in an umbilical arterial blood sample. OSI values are calculated by a ratio of TOS to the TAS. Results: The levels of TAS and TOS in umbilical arterial blood sample were not statistically different among three. However, OSI values were significantly different among the three groups (P = 0.042. Median OSI values is 24 (interquartile range [IQR], 2-37 in group spinal, 19 (IQR, 4-44 in group epidural, and 8 (IQR, 4-36 in group general. There was no significant difference in OSI values in the comparison of group spinal with group general and group epidural, but it was significantly lower in group general when compared with group epidural with Bonferroni correction (P = 0.017. Umbilical cord arterial blood gas values (pH, PaCO 2 , PaO 2 , SaO 2 , HCO 3 , and CtO 2 , glucose, lactate, and hemoglobin levels were similar in three groups. Conclusion: General anesthesia may be more favorable than epidural in those undergoing cesarean section when fetal oxidative status gains importance.

  10. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  11. A CLINICAL STUDY OF CAUDAL EPIDURAL ANAESTHESIA FOR TRANSURETHRAL RESECTION OF PROSTATE

    Directory of Open Access Journals (Sweden)

    Satyendra S

    2015-07-01

    Full Text Available In the Urological surgery, the most commonly performed procedure in Transurethral Resection of Prostate. Most of these patients are elderly above the age of 60 years with various systemic problems. The common problem includes cardiovascular disorder, chronic obstructive pulmonary diseases and various old age problems. These patients present as a challenge to anaesthesiologists because they are high risk patients for endoscopic surgeries. Various worker since many years tried different type of anesthesia procedure. The regional techniques have been proved to be safe and less risky. It includes spinal, lumbar epidural, combined spinal epidural and caudal epidural. The caudal epidural block have been used by many workers for TURP in elderly patients since so many years. The Present study includes 50 patients of ASA grade I, II, III including cardiovascular problem, COPD, and other spinal deformities, scheduled for TURP. After pre anesthetic checkup and through investigation, caudal epidural block were given by standard technique. Observation and results were recorded by observing the onset and duration of analgesia, level of block, any side effects. The changes in pulse rate, blood pressure, SPO 2 , ECG were closely monitored throughout the procedure. The observation showed that 60% of patients having co - existing diseases and most of them having chronic Hypertension (30%, onset of analgesia was 10 - 15 mins in 30 patients. Motor blockade by modified bromage scale was observed and found that 45 patients ( 90% has MBS - O. There were no significant changes observed in PR, BP, R/R, ECG and SPO 2 throughout the procedure in all patients. Response to total procedure was found excellent in 40 patients ( 80%. There were no significant complication observed in maximum number of patients. Only 5 patients had complained of nausea and vomiting, which was successfully treated by antiemetics

  12. Reversible posterior leukoencephalopathy syndrome after cesarean section under combined spinal epidural anesthesia: report of 2 cases%腰麻联合硬膜外麻醉下剖宫产术后可逆性后部白质脑病综合征(RPLS)两例报道

    Institute of Scientific and Technical Information of China (English)

    唐帅; 王志玮; 王长明

    2015-01-01

    本文报道2例和妊娠相关的初始症状头痛,在麻醉手术后发作或加重,最终确诊为可逆性后部脑病综合征(RPLS)的诊疗过程,应注意与腰麻后头痛及妊娠高血压综合征重度子痫相鉴别.%Cephalalgia in two patients,which were related to pregnancy,attacked or aggravated after anesthesia and operation,finally were diagnosed reversible posterior leukoencephalopathy syndrome (RPLS).It should be paid attention to distinguish it from cephalalgia after spinal anesthesia and severe preeclampsia of hypertension syndrome induced by pregnancy.

  13. Articaine: a review of its use for local and regional anesthesia

    OpenAIRE

    Snoeck M

    2012-01-01

    Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects wer...

  14. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

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    Siddiqui A

    2016-05-01

    Full Text Available Asad Siddiqui,1 Andrew Tse,2 James E Paul,3 Peter Fitzgerald,4 Bernice Teh,51Department of Anesthesia, University of Toronto, Toronto, 2Department of Anesthesia, University of Ottawa, Ottawa, 3Department of Anesthesia, 4Department of Surgery, McMaster University, Hamilton, Ontario, Canada; 5Canterbury Anesthetic Services, Victoria, Australia Introduction: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure. Methods: Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12 received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21 received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39 received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10, with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or

  15. 全麻对剖宫产胎儿影响的临床研究%Clinical study of the influence of general anesthesia on cesarean delivery fetus

    Institute of Scientific and Technical Information of China (English)

    李莉; 苏利

    2014-01-01

    Objective To compare the influence of general anesthesia and combined spinal-epidural anesthesia on neonatal Apgar score. Methods A total of 65 cases of single pregnancy to full term undergone cesarean section were taken as study subjects. There were 32 cases in the general anesthesia group received general anesthesia due to intraspinal anesthesia taboo, and the other 33 cases in the combined spinal-epidural anesthesia group received combined spinal-epidural anesthesia. The fetal childbirth time, birth weight, and apgar score at 1 min and 5 min were recorded. Results Apgar score at 1 min of general anesthesia group and combined spinal-epidural anesthesia group were (9.5±0.8) points and (9.8±0.6) points respectively, and there was no significant difference between the two groups (P>0.05). Apgar scores at 5 min were all 10 points in the two groups. Conclusion General anesthesia and combined spinal-epidural anesthesia have no obviously variant influences on fetus.%目的:比较剖宫产施行全身麻醉(全麻)和腰硬联合麻醉对新生儿Apgar评分的影响。方法选择足月单胎妊娠行择期剖宫产的产妇65例,椎管内麻醉禁忌而需使用全麻的剖宫产为全麻组32例,其余33例行腰硬联合麻醉作为腰硬联合麻醉组。记录胎儿娩出时间,新生儿体重和1、5 min的Apgar评分。结果全麻组和腰硬联合麻醉组新生儿1 min的Apgar评分分别为(9.5±0.8)分、(9.8±0.6)分,两组差异无统计学意义(P>0.05)。5 min Apgar评分均为10分。结论全麻和硬联合麻醉对胎儿的影响没有明显差异。

  16. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.

  17. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

    OpenAIRE

    2006-01-01

    La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was com...

  18. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

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    Gisela Di Stilio

    2006-08-01

    Full Text Available La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess.

  19. 浅谈椎管内麻醉的特点%The Characteristics of Spinal Canal Anesthesia

    Institute of Scientific and Technical Information of China (English)

    王勇

    2015-01-01

    To discuss spinal canal anesthesia. The spinal canal anesthesia includes subarachnoid block(lumbar hemp),epidural space block. It could adjust the subarachnoid block(lumbar hemp),the epidural space block anesthesia centesis,anesthesia drug use and the adjustment of the anesthesia plane and complications. Spinal canal anesthesia surgery for lower limbs extremity,which can provide perfect analgesia and muscle relaxant. The sympathetic nerve block can provide good perfusion status for limb reattachment surgeries.%探讨椎管内麻醉患者的临床麻醉方法。椎管内麻醉包括蛛网膜下腔阻滞(腰麻)、硬膜外腔阻滞。对蛛网膜下腔阻滞(腰麻)、硬膜外腔阻滞的麻醉的穿刺术,局麻用药及麻醉平面的调节。椎管内麻醉多用于下肢手术,可提供完善的镇痛和肌松,伴发的交感神经阻滞可为肢体再植手术提供良好的灌注状态。

  20. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

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    Fabiano Timbó Barbosa

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE: To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT: The search was performed in Pubmed (January 1966 to December 2012, Embase (1974 to December 2012, The Cochrane Library (volume 10, 2012 and Lilacs (1982 to December 2012 databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS: The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.

  1. Successful medical treatment of spinal epidural abscess.

    Science.gov (United States)

    Xiao, Bo-Ren; Wang, Chih-Wei; Lin, Jung-Chung; Chang, Feng-Yee

    2008-04-01

    Spinal epidural abscess is a rare but potentially fatal disease. A 67-year-old female suffered fever and painful swelling of the right knee and lower leg for one week. Both synovial fluid and blood cultures yielded methicillin-sensitive Staphylococcus aureus. Low back pain developed and fever was sustained despite the administration of intravenous oxacillin. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed spinal epidural abscess from T12 to S1. Because of severe hypoalbuminemia and general anasarca and followed by exploratory laparotomy for massive duodenal bleeding, she did not receive surgical intervention for the spinal epidural abscess. After intravenous administration of oxacillin 2 g 4-hourly for 12 weeks, she recovered and follow-up MRI confirmed the efficacy of the medical treatment. She remained well at 1-year follow-up. In a patient with minimal neurological deficit or surgical contraindication, spinal epidural abscess can be successfully treated with a medical regimen.

  2. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  3. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  4. [Anesthesia for ambulatory patients].

    Science.gov (United States)

    Landauer, B

    1975-11-13

    The specific problems of outpatient anesthesia are discussed with respect to the patient's condition, the anesthesist's qualification and pharmacological properties of anesthetics used. Methohexitone seems to be the best choice for induction. Problems may arise from the use of Propanidid, Ketamin and Diazepam. Nitrousoxide and Enflurane are a suitable completion. Endotracheal intubation, if needed, is facilitated by Suxamethonium, which is rapidly eliminated. Practical aspects of timing, premedication, induction, maintenance and ending of anesthesia are pointed out. After 1-2 hours the patient can be allowed to leave the hospital accompanied by a responsible person. Driving a car is not recommended before 24 hours have elapsed since anesthesia.

  5. Tratamiento epidural del dolor en isquemia vascular periférica: Parte II. Revisión bibliográfica basada en la evidencia del tratamiento epidural en la isquemia vascular periférica Epidural pain treatment in peripheral vascular ischemia: (II

    Directory of Open Access Journals (Sweden)

    M.J. Orduña González

    2009-04-01

    érica de base vasoespástica e inflamatoria y la trombosis de pequeños vasos son procesos susceptibles de obtener el máximo efecto terapéutico, tanto analgésico como trófico, de la administración epidural de anestésicos locales; b para determinados pacientes con isquemia crítica no reconstruible de extremidades, la neuroestimulación epidural medular puede representar la última opción terapéutica para evitar la amputación de la extremidad, con un aceptable alivio de dolor asociado, y c todavía hay mitos acerca del uso de la analgesia epidural aplicada a la isquemia arterial periférica, como su posible efecto protector de complicaciones sistémicas en procedimientos anestésicos de revascularización o su papel en la analgesia preventiva postamputación, que no se han podido demostrar con los estudios científicos existentes.Introduction: Peripheral arterial ischemia can be caused by several diseases that compromise limb vascularization, leading to pain and disability and impairing quality of life. Critical ischemia produces substantial morbidity and mortality, as well as chronic pain. Objective: To perform a critical literature review of scientific publications on epidural analgesia to control pain due to peripheral vascular ischemia and on its vascular trophic effects, to compare this treatment modality with other analgesic techniques, and to describe several epidural analgesia strategies and their results. Material and methods: We searched MEDLINE for articles on epidural analgesia and pain in the context of peripheral arterial ischemia to gather data for subsequent critical analysis, following the criteria of evidence-based medicine. Results: a Analgesia with epidural drug infusion in limb ischemia only reached level 4 evidence in the present review; b lumber epidural anesthesia for surgical revascularization of the lower extremities is associated with lower rates of postoperative thrombosis and revascularization reinterventions than general anesthesia

  6. Single dose oral clonidine premedication does not enhance postoperative, single low dose epidural morphine analgesia in hysterectomy patients.

    Science.gov (United States)

    Oofuvong, Maliwan; Chanvej, Laksamee; Thongsuksai, Paramee

    2005-03-01

    In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

  7. Spinal epidural abscess in brucellosis.

    Science.gov (United States)

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen

    2013-09-26

    Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.

  8. Anesthesia & Down Syndrome

    Science.gov (United States)

    ... tests used to verify existence and severity of valvular heart disease. Unfortunately, not all adults with Down syndrome will ... exams without sedation or anesthesia. Suspected existence of valvular heart disease must be communicated to the anesthesiologist prior to ...

  9. Comparative evaluation of dexmedetomidine and fentanyl for epidural analgesia in lower limb orthopedic surgeries

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    statistical comparison (P<0.001. Incidence of nausea and vomiting was significantly high in the RF group (26% and 12%, while incidence of dry mouth was significantly higher in the RD group (14% (P<0.05. Conclusions: Dexmedetomidine seems to be a better alternative to fentanyl as an epidural adjuvant as it provides comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged post-op analgesia, lower consumption of post-op LA for epidural analgesia, and much better sedation levels.

  10. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  11. Spinal epidural abscess penetrating into retroperitoneal space in patient with diabetes mellitus type 2: early diagnosis and treatment requirement.

    Science.gov (United States)

    Grabysa, Radosław; Moczulska, Beata

    2008-01-01

    Spinal epidural abscess (SEA) is a rare condition with very serious prognosis. Predisposing factors for SEA include bacterial infections, immunocompromised states such as diabetes mellitus, intravenous drug abuse, alcoholism, AIDS, as well as spinal surgery and modern techniques of epidural anesthesia. The most common causative agent for SEA is Staphylococcus aureus. The typical clinical signs of SEA are back pain, fever and neurologic dysficit. Magnetic resonance (MR) of the spine and vertebral column is the best imaging diagnostic method in suspected cases. Emergency surgical decompression combined with intravenous antibiotics is the therapeutic method of choice. Conservative treatment may be appropriate in selected patients. Unless the typical presentation of SEA correct diagnosis of this illness is often overlooked and not considered initially. It delays suitable management and leads to poor outcome. We report a classic case of SEA in a woman with a history of diabetes mellitus.

  12. Neuropatía periférica tras el parto: Implicaciones de la anestesia epidural Peripheral neuropathy after delivery implications for epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    S. Velázquez

    2006-05-01

    Full Text Available La incidencia de lesiones neurológicas de miembros inferiores en la práctica obstétrica es del 0,08% y 0,92%. La incidencia de complicaciones neurológicas asociadas a la técnica epidural ha sido estimada en 2 casos de cada 10.000 epidurales. Durante los últimos años, con la generalización de la analgesia epidural para el trabajo de parto, es posible que algunas de las neuropatías sean atribuidas a esta técnica, olvidando que hay otros mecanismos de lesión en estas situaciones. Presentamos el caso de una paciente primigesta de 21 años de edad y 139 cm de altura sin antecedentes de interés, que 24 horas tras una epidural para parto y un expulsivo prolongado resuelto con fórceps, desarrolla un "pie caído", que evolucionó a la resolución funcional completa. El pie caído puede darse como consecuencia de una lesión del nervio peroneo, del ciático, o de una raíz del plexo lumbo-sacro. La clínica unida al uso de pruebas como la resonancia magnética (RNM y el electromiograma (EMG, ayudan en el diagnóstico diferencial de la lesión. Parece necesario el estudio del las neuropatías relacionadas con el parto para descartar su relación con la técnica anestésica empleada. Con frecuencia, estas lesiones se deben a mecanismos ajenos a la analgesia-anestesia epidural, si bien debemos procurar minimizar su incidencia con la realización de punciones a niveles adecuados, evitando la inyección de anestésicos cuando existen parestesias, valorando los factores de riesgo en obstetricia y, una vez producida la lesión, con un seguimiento clínico estrecho.Postpartum neurological damage occurs in the obstetric practice with an incidence between 0.08-0.92%. Neurological damage secondary to epidural technique is about 2:10,000. In last years, epidural anesthesia has become a generalized practice in obstetrics. Because of it, sometimes, the postpartum neurological damage can be attributed to epidural analgesia, forgetting other mechanisms. We

  13. Newborns from deliveries with epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    Avramović Lidija

    2010-01-01

    Full Text Available Introduction. The use of epidural anaesthesia in delivery with the purpose to reduce pain and fear in a pregnant woman has the influence on the physiological status of the woman in childbirth and the course of delivery. From the epidural space of the pregnant woman, one part of free anaesthetic comes in the foetal circulation through the mother's circulation and placenta and connects with the foetal proteins. A lower value of albumins and serum proteins in the foetal circulation give bigger free fraction of anaesthetic which is accumulated in the foetal liver, brain and heart full of blood. Objective. The aim of the study was to examine the influence of epidural anaesthesia on the newborn. Methods. Retrospective study of 6,398 documents of newborns was performed in our Clinic of Gynaecology and Obstetrics 'Narodni front' during 2006. The first group was made of 455 newborns from deliveries with epidural anaesthesia and the second was the control group of 5,943 remaining newborns. In both groups we analysed the following: sex, week of gestation, weight, Apgar score, measure of care and resuscitation, perinatal morbidity and then the obtained results were compared. Results. Most of deliveries were vaginal without obstetric intervention (86.6%. The number of deliveries finished with vacuum extractor (4.6% was statistically significantly bigger in the group with epidural anaesthesia than in the control group. Most of the newborns in the first group were born on time (96.5% in 39.0±1.0 week of gestation and with foetal weight 3448±412 grammes. There was no statistical significance in Apgar score between both groups. Epidural anaesthesia does not increase the degree of the newborn's injury. Lower pH of blood was found in the newborns from deliveries with vacuum extractor or operated on (the Ceasarean section. Conclusion. Application of epidural anaesthesia decreases duration of delivery and has no adverse effects on the newborn and hypoxic

  14. Investigation of the Effects of Continuous Low-Dose Epidural Analgesia on the Autonomic Nervous System Using Hilbert Huang Transform

    Directory of Open Access Journals (Sweden)

    Wei-Ren Chuang

    2010-01-01

    Full Text Available Effects of continuous low-dose epidural bupivacaine (0.05-0.1% infusion on the Doppler velocimetry for labor analgesia have been well documented. The aim of this study was to monitor the activity of the autonomic nervous system (ANS for women in labor based on Hilbert Huang transform (HHT, which performs signal processing for nonlinear systems, such as human cardiac systems. Thirteen pregnant women were included in the experimental group for labor analgesia. They received continuous epidural bupivacaine 0.075% infusion. The normal-to-normal intervals (NN-interval were downloaded from an ECG holter. Another 20 pregnant women in non-anesthesia labor (average gestation age was 38.6 weeks were included in the comparison group. In this study, HHT was used to decompose components of ECG signals, which reflect three different frequency bands of a person's heart rate spectrum (viz. high frequency (HF, low frequency (LF and very low frequency (VLF. It was found that the change of energy in subjects without anesthesia was more active than that with continuous epidural bupivacaine 0.075% infusion. The energy values of the experimental group (i.e., labor analgesia of HF and LF of ANS activities were significantly lower (P < 0.05 than the values of the comparison group (viz. labor without analgesia, but the trend of energy ratio of LF/HF was opposite. In conclusion, the sympathetic and parasympathetic components of ANS are all suppressed by continuous low-dose epidural bupivacaine 0.075% infusion, but parasympathetic power is suppressed more than sympathetic power.

  15. Curriculum development for an advanced regional anesthesia education program: one institution's experience from apprenticeship to comprehensive teaching.

    Science.gov (United States)

    Ouanes, Jean-Pierre P; Schwengel, Deborah; Mathur, Vineesh; Ahmed, Omar I; Hanna, Marie N

    2014-02-01

    Results of recent attitude survey studies suggest that most practicing physicians are inadequately treating postoperative pain. Residents in anesthesia are confident in performing lumbar epidural and spinal anesthesia, but many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes to a comprehensive model that prepares residents to perform a wider array of blocks in postgraduate practice. Here, we describe one institution's approach to creating a standardized, advanced regional anesthesia curriculum for residents that follows the six core competencies of the ACGME. Residents received training in anatomy dissection, ultrasound-guided regional anesthesia, traditional nerve stimulation techniques, problem-based learning and simulation sessions, oral board presentation sessions, and journal club sessions. Residents kept a detailed log for their use of peripheral nerve block procedures. We have now redesigned and implemented an advanced regional anesthesia program within our institution to provide residents with experience in regional anesthesia at a competent level. Resident's knowledge in regional anesthesia did improve after the first year of implementation as reflected in improvements between the pre- and post-tests. As the advanced regional anesthesia education program continues to improve, we hope to demonstrate levels of validity, reliability, and usability by other programs.

  16. Depth of the thoracic epidural space in children.

    NARCIS (Netherlands)

    Masir, F.; Driessen, J.J.; Thies, K.C.; Wijnen, M.H.W.A.; Egmond, J. van

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epid

  17. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  18. Anesthesia for cesarean delivery in a patient with large anterior mediastinal tumor presenting as intrathoracic airway compression

    Directory of Open Access Journals (Sweden)

    Yatish Bevinaguddaiah

    2014-01-01

    Full Text Available Anterior mediastinal mass is a rare pathology that presents considerable anesthetic challenges due to cardiopulmonary compromise. We present a case that was referred to us in the third trimester of pregnancy with severe breathlessness and orthopnea. An elective cesarean delivery was performed under combined spinal epidural anesthesia with a favorable outcome. We discuss the perioperative considerations in these patients with a review of the literature.

  19. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  20. Curative Efficacy of Tension Free Repair in Inguinal Hernia Under Local Anesthesia%腹股沟斜疝在局麻下行无张力修补术后疗效观察

    Institute of Scientific and Technical Information of China (English)

    刁英怀

    2015-01-01

    目的:评价腹股沟斜疝在局麻下行无张力修补术后疗效。方法局麻下手术84例纳入局麻组,硬膜外麻醉下手术73例纳入硬膜外组,对比相关指标。结果局麻组时间相关指标、总费用、并发率均低于硬膜外组,差异具有统计学意义(P<0.05)。结论局麻有助于改善患者短期预后,加速患者康复,减轻医疗负担。%Objective To evaluate the eficacy of tension free inguinal hernia repair surgery under local anesthesia.Methods Operation of 84 patients included in the local anesthesia group,epidural anesthesia during the operation of 73 patients included in the epidural group,compared related indicators.ResultsThe relevant indicators,local anesthesia group,with the total cost of the time were lower than the rate of epidural anesthesia group,the diference was statisticaly significant(P< 0.05).Conclusion Local anesthesia is helpful to improve the short-term prognosis of patients,accelerate the rehabilitation of patients,reduce the medical burden.

  1. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    Science.gov (United States)

    Ruiz Picazo, David; Ramírez Villaescusa, José

    2016-01-01

    Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis. PMID:27069704

  2. Solitary Spinal Epidural Metastasis from Gastric Cancer

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    Taisei Sako

    2016-01-01

    Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

  3. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  4. Risk management in anesthesia.

    Science.gov (United States)

    Cabrini, L; Levati, A

    2009-11-01

    Anesthesia is considered a leading discipline in the field of patient safety. Nevertheless, complications still occur and can be devastating. A substantial portion of anesthesia-related adverse events are preventable since risk factors can be detected and eliminated. Risk management (RM) in anesthesia includes preventive and remedial measures to minimize patient anesthesia-related morbidity and mortality. RM involves all aspects of anesthesia care. Classically, the following four steps are needed to prevent critical incidents or to learn from them: (1) detection of problems, (2) assessment, (3) implementation of solutions, and (4) verification of effectiveness. Problems and solutions can be identified into the fields of structures, processes and personnel. Authoritative agencies like the World Health Organization, the World Federation of Societies of Anesthesiologists, the Section and Board of Anesthesiology of the European Union of Medical Specialties and the Italian Scientific Society of Anesthesiologists (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva SIAARTI) have proposed initiatives addressing safety in the operating room. The central role of a well-trained, constantly present anesthesiologist and the usefulness of checklists have been highlighted. Cost cutting and production pressure in medical care are potential threats to safety. A shared knowledge of the best standards of care and of the potential consequences of unscrupulous actions could make the daily management of conflicting interests easier. A correctly applied RM can be a powerful, highly beneficial aid to our practice.

  5. Anesthesia for thoracic surgery: A survey of middle eastern practice

    Directory of Open Access Journals (Sweden)

    Abdelazeem Eldawlatly

    2012-01-01

    Full Text Available Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV, anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, P<0.05; 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube (DLT as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker (BB in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05. Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice.

  6. MAGNESIUM SULPHATE VS CLONIDINE AS AN ADJUVANT TO 0.5% BUPIVACAINE IN EPIDURAL ANAESTHESIA FOR PATIENTS UNDERGOING LOWER LIMB SURGERIES: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Anand Masih

    2015-09-01

    Full Text Available Epidural anesthesia is a safe and inexpensive technique with the advantage of providing surgical anesthesia and prolonged postoperative pain relief. To address the problems of limited duration of action and to improve the quality of analgesia intra - operatively and postoperatively, various adjuvants have been added to bupivacaine. The present study is designed to evaluate the effect of magnesium sulphate vs clonidine as an adjunct to 0.5% Bupivacaine in epidural anesthesia for patients undergoing lower limb surgeries in terms of onset, duration and degree of sensory and motor block, sedation and pain. 90 patients of age group 18 - 60 years of ASA grade I & II of either sex undergoing lower limb surgeries were included in this prospective study who were randomly allocated into three groups . Group A received bupivacaine 0.5%(19ml +normal saline 0.9% (1.0ml, Group B received bupivacaine 0.5%(19ml+magnesium sulphate 50mg dissolved in 0.9% normal saline (1.0ml and Group C received bupivacaine 0.5%(19ml +clonidine 150μgm(1.0ml. Assessments of sensory block were performed at 5, 10, 15, 20, 25, 30 min and then every 10 min until the return of normal sensation. . Assessment of motor block were performed immediately after the assessment of sensory block until the return of normal motor function. The onset and end of all degrees of motor blocks were assessed bilaterally according to the Modified Bromage scale. Duration of analgesia, patient’s satisfaction, duration of motor block and adverse effects were assessed and recorded. We concluded that co - administration of epidural magnesium sulphate 50 MG with bupivacaine 0.5% produces predictable rapid onset of surgical anesthesia without any side - effects, and addi tion of clonidine 150μgmto epidural bupivacaine 0.5% produces prolonged duration of anesthesia with sedation. The results of our study suggest that magnesium may be a useful alternative as an adjuvant to epidural bupivacaine as clonidine .

  7. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... the epidural to the birth, and the relationship to the midwife. Place of origin: The labor ward, Aalborg Sygehus Nord, Aalborg. The homes of the women. Method: Field study and interviews. Nine women were observed from the establishment of the epidural until birth. They were interviewed the day after the birth...

  8. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.

  9. Spinal epidural hematoma; Spinales epidurales Haematom

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2012-05-15

    Spinal epidural hematoma is an accumulation of blood in the potential space between the dura and bone. On unenhanced computed tomography epidural hemorrhage appears as a high-density spinal canal mass with variable cord compression. Magnetic resonance imaging is the modality of choice for evaluating spinal epidural hematoma and can demonstrate the extent of the hematoma and degree of cord compression. When treated surgically the outcome depends on the extent of preoperative neurological deficits and on the operative timing interval. (orig.) [German] Das spinale epidurale Haematom ist eine Blutansammlung zwischen Dura und Knochen. Die klinische Praesentation ist aehnlich dem akuten Bandscheibenvorfall, die Symptomatik ist allerdings in der Regel progredient. In der CT stellt sich ein frisches Haematom hyperdens dar. Die MRT ist die Methode der Wahl zur Diagnose spinaler epiduraler Haematome und kann die Ausdehnung sowie auch das Ausmass der Kompression darstellen. Die wichtigste Differenzialdiagnose vom epiduralen Haematom ist das epidurale Empyem. (orig.)

  10. Traumatic cervical epidural hematoma in an infant

    Directory of Open Access Journals (Sweden)

    Vithal Rangarajan

    2013-01-01

    Full Text Available An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4 to the first dorsal (D1 vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient′s paraplegia improved dramatically in 48 hours. According to the author′s literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.

  11. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulović Danilo

    2005-01-01

    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  12. Rapidly Progressive Spontaneous Spinal Epidural Abscess

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    Abdurrahman Aycan

    2016-01-01

    Full Text Available Spinal epidural abscess (SEA is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  13. Rapidly Progressive Spontaneous Spinal Epidural Abscess.

    Science.gov (United States)

    Aycan, Abdurrahman; Aktas, Ozgür Yusuf; Guzey, Feyza Karagoz; Tufan, Azmi; Isler, Cihan; Aycan, Nur; Gulsen, İsmail; Arslan, Harun

    2016-01-01

    Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  14. Effect of different anesthesia and analgesia methods on theT lymphocyte subsets, cytokines and stress hormone level in patients with breast cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Yan Ma; Xi-Qiang He; Geng Wang

    2015-01-01

    Objective: To explore the effect of different anesthesia and analgesia methods on the T lymphocyte subsets, cytokines and the levels of the stress hormone in patients with breast cancer surgery.Methods: 86 cases of breast cancer were divided into two groups by random digits table, control group of 43 cases with total intravenous anesthesia, and the observation group of 43 cases with total intravenous anesthesia combined with epidural anesthesia and postoperative underwent analgesia. The T lymphocyte subsets, cytokines and the levels of the stress hormone were detected before and after operation and compared. Results:CD3+, CD4+ and CD4+/CD8+ of the two groups at T1 or T2 were significantly lower than those at T0, and those in the observation group were significantly lower than the control group, and the difference between the two groups has statistical significance. IL-6, CRP and TNF-α levels of the two groups at T1, T2 or T3 were significantly higher than those at T0, and those in the observation group were significantly lower than the control group, and the difference between the two groups has statistical significance. Each index of two groups at T4 were restored to T0, and the differences were no statistically significant. The cortisol levels of two groups at T1 or T2 were significantly increased compared with T0, and the increase in the observation group was less than that of the control group, the difference between the two groups has statistical significance. The cortisol levels of two groups at T4 were restored to T0, and the differences were no statistically significant.Conclusion:Epidural analgesia after the intravenous anesthesia combined with epidural anesthesia for breast cancer cure patients has lighter immunosuppression and stress reaction, has less influence on inflammatory factors, is an ideal anesthesia and analgesia.

  15. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    Science.gov (United States)

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.

  16. Postoperative epidural hematoma. Five cases of epidural hematomas developed after supratentorial craniotomy on the contralateral side

    Energy Technology Data Exchange (ETDEWEB)

    Sato, M. (Shiga Univ. of Medical Science, Ohtsu (Japan)); Mori, K.; Handa, H.

    1981-10-01

    Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

  17. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  18. Local anesthesia: a review.

    Science.gov (United States)

    Malamed, S F; Sykes, P; Kubota, Y; Matsuura, H; Lipp, M

    1992-01-01

    Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.

  19. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  20. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

    Holt, H M; Gahrn-Hansen, B; Andersen, S S

    1996-01-01

    coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose...

  1. MRI features of spinal epidural angiolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Su; Hu, Chun Hong; Wang, Xi Ming; Dai, Hui [Dept. of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu (China); Hu, Xiao Yun; Fang, Xiang Ming [Dept. of Radiology, Wuxi People' s Hospital Affiliated to Nanjing Medical University, Jiangsu (China); Cui, Lei [Dept. of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu (China)

    2013-10-15

    To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

  2. MRI features of epidural extramedullary hematopoiesis

    Energy Technology Data Exchange (ETDEWEB)

    Alorainy, Ibrahim A. E-mail: alorainy@ksu.edu.sa; Al-Asmi, Abdullah R.; Carpio, Raquel del

    2000-07-01

    A case of {beta}-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed.

  3. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Neely, John C. [Marshall University School of Medicine, Huntington, WV (United States); Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Crone, Kerry R. [Cincinnati Children' s Hospital Medical Center, Division of Neurosurgery, Cincinnati, OH (United States)

    2008-03-15

    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma. (orig.)

  4. Estudo comparativo entre bupivacaína a 0,5% e mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural Estudio comparativo entre bupivacaína a 0,5% y mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% en anestesia peridural Comparative study between 0.5% bupivacaine and 0.5% enantiomeric mixture of bupivacaine (S75-R25 in epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Rosane Fossatti Gonçalves

    2003-04-01

    analgésico en el período pós-operatorio fue superior para el grupo S75-R25, comparado al grupo Bupivacaína (596 ± 436 minutos versus 463 ± 270 minutos, respectivamente; p = 0,04572. La incidencia de efectos adversos fue semejante entre los grupos. CONCLUSIONES: La mezcla enantiomérica de bupivacaína (S75-R25 presentó mayor tiempo analgésico y menor grado de bloqueo motor, comparada con la solución de bupivacaína racémicaBACKGROUND AND OBJECTIVES: A bupivacaine formulation containing 25% of R(+ and 75% of S(- isomer has been used because its anesthetic properties with less toxicity than the racemic bupivacaine. This study aimed at evaluating the racemic bupivacaine as compared to B25/75 in epidural anesthesia. METHODS: Participated in this study 44 patients who were distributed in two groups (n = 22, namely Bupivacaine and S75-R25. Patients were premedicated with intravenous midazolam. Epidural anesthesia was induced at L3-L4 or L2-L3 interspace with 16 to 24 ml of the anesthetic solution. Group Bupivacaine received 0.5% bupivacaine with vasoconstrictor. Group S75-R25 received the enantiomeric mixture of 0.5% bupivacaine with vasoconstrictor. The following parameters were evaluated: lower limb temperature before and after epidural block, blockade onset, type of sensation referred by the patient, possible sensory failures, metameric sensory level and motor block level. Time for first analgesic request in the PACU was also recorded. RESULTS: Forty-one patients completed the study. Groups were demographically similar. Perioperative midazolam dose, epidural anesthetic volume, blockade onset, sensory failures at pinprick, lower limb temperature in different moments, type of paresthesia sensation and anesthetic depth in dermatomes were similar between groups. Motor block was less intense in group S75-R25 (p = 0.0117 as compared to group Bupivacaine. Time to first postoperative analgesic dose was longer for group S75-R25 as compared to group Bupivacaine (596 ± 436

  5. Effect of Different Anesthesia on Deep Venous Thrombosis after Orthopedic Surgery%不同麻醉方法对骨科手术患者深静脉血栓形成的影响

    Institute of Scientific and Technical Information of China (English)

    姚杰; 孟尽海; 王文娟; 刘斐; 吴燕; 王春生

    2013-01-01

    Objective To investigate the effects of different anesthesia on deep venous thrombosis (DVT) after orthopedic surgery. Methods Charts from consecutive patients who underwent orthopedic surgery from January 1 , 2008, to December 31 , 2010, at a large Chinese teaching hospital were reviewed using standardized case report forms. The incidence of DVT after orthopedic surgery in general anesthesia, spinal - epidural anesthesia and regional block anesthesia were compared. Results This investigation included 4892 patients and 204 patients developed DVT (incidence = 4.17% ). The incidence of DVT in the group of general anesthesia was higher than in those of spinal - epidural anesthesia, regional block anesthesia and no anesthesia (P 0.05). The counts of white blood cell, neutrophil and monocyte of the group after general anesthesia were higher than those of spinal - epidural anesthesia and regional block anesthesia(P<0. 05 ). Conclusion The incidence of DVT in the group of general anesthesia is higher than spinal -epidural anesthesia. In addition, regional block anesthesia and no anesthesia were similar. Inflammatory cell in the group of general anesthesia are higher than that in group of spinal - epidural anesthesia, regional block anesthesia and no anesthesia.%目的 研究不同麻醉方法对深静脉血栓(DVT)的影响.方法 以4892例骨科住院患者病例资料为研究对象进行回顾性分析,比较全身麻醉组、椎管内麻醉组、区域阻滞组DVT的发生率.结果 4892例患者中204例发生DVT,总发生率为4.17%,全麻组DVT的发生率高于椎管内组、区域阻滞组和未行麻醉组(P<0.01);椎管内组DVT的发生率高于区域阻滞组(P<0.05).区域阻滞组和未行麻醉组DVT的发生率相当,差异无统计学意义(P>0.05).全身麻醉组患者术后白细胞、中性粒细胞、单核细胞计数高于椎管内麻醉组和区域阻滞麻醉组(P<0.05).结论 全身麻醉后患者深静脉血栓的发生率最高,

  6. Anesthesia management of caesarean section for pregnant women complicated with Takayasu’s arteritis%合并大动脉炎产妇行剖宫产术的围术期管理

    Institute of Scientific and Technical Information of China (English)

    孙杰; 曾鸿; 王永清; 赵扬玉

    2016-01-01

    SUMMARY Takayasu’s arteritis is a rare,idiopathic,chronic inflammatory disease.Its course is un-predictable,but slow progression is usual,leading to stenosis,occlusion,or aneurismal degeneration of the aorta or its major branches.We present the anesthesia management of pregnancy in four women ad-mitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu’s arteritis and review this disease with special reference to natural history,diagnostic criteria, classification,prognostic factors,and anesthesia considerations.Anesthesiological data were retrospec-tively analyzed for clinical manifestations,anesthesia process,perioperative complications,and pregnan-cy outcome.One patient received only epidural anesthesia,while the other three patients received com-bined spinal and epidural anesthesia (CSEA).Surgeries for all the four patients were successful with sta-ble vital signs.We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diag-nosed with Takayasu’s arteritis.CSEA and continuous epidural block could be both used as anesthesio-logical method in patients with Takayasu’s arteritis.During the surgery,to avoid rapid hemodynamic fluctuations and protect the major organs’function is very essential to allow for a satisfactory outcome.

  7. Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?

    Directory of Open Access Journals (Sweden)

    Amir Poya Zanjani

    2015-01-01

    Full Text Available Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team′s experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.

  8. Muscle relaxant or prone position, which one unfastened the entrapped epidural catheter?

    Science.gov (United States)

    Zanjani, Amir Poya; Mirzashahi, Babak; Emami, Ali; Hassani, Motahareh

    2015-01-01

    Some nonsurgical steps have been introduced to remove an entrapped catheter. But occasionally, the majority of them fail, and we are forced to extract the catheter through an invasive procedure. This article depicts our team's experience on the issue. When we found that the inserted epidural catheter was entrapped, we performed all recommended noninvasive maneuvers to release the catheter, but no progress was achieved. Therefore, after obtaining informed consent, we induced anesthesia and changed her to a prone position to explore her back. The intact catheter was removed easily in this stage. The authors believe, in this process, it would have been better if they had tried pulling the catheter in a prone position as a preliminary step. Furthermore, pulling the catheter in a prone position after injecting a muscle relaxant appeared to be more effective and saved the patient from the scheduled surgery.

  9. Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep

    Directory of Open Access Journals (Sweden)

    Durej M.

    2012-01-01

    Full Text Available The aim of the study was to test the hypothesis that epidural administration of morphine with bupivacaine provides more intense and sufficient perioperative analgesia compared with parenterally administrated butorphanol during orthopaedic surgery. Sheep were assigned to group C (control group, 6 sheep and group E (epidural, 5 sheep. Sheep from group C were pre-medicated with midazolam (0.3 mg/kg, i.m. and butorphanol (0.2 mg/kg, i.m.. Propofol was used for induction of general anesthesia in both groups. Sheep from group E were pre-medicated with midazolam, but without butorphanol. Sacrococcegeal epidural analgesia with morphine (0.1 mg/kg and bupivacaine (1 mg/kg was performed. We detected a significant increase in heart rate (19%, p=0.021 during surgery in group C. Two hours after surgery, the heart rate was 14.9% lower than prior to surgery in group E (p=0.017. In group E, throughout the surgery, we measured an insignificant increase in respiratory rate of 1.99%. In the same group, 120 minutes post surgery, we measured an increase in respiratory rate of 14.7%, while in group C there was a smaller increase of only 10.9%. The result from both groups was insignificant (p>0.05. The consumption of isoflurane in group C was higher than in group E by 27.3% (p=0.0043. The mean MAC was in group C higher by 27.6% as it was in group E (0.75% ± 0.25, 0.95 ± 0.3 in Group E and C, respectively. This distinction, according to the Mann-Whitney test, was not significant (p=0.329.

  10. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study

    Directory of Open Access Journals (Sweden)

    Jasleen Kaur

    2014-01-01

    Full Text Available Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B. Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB and bupivacaine + fentanyl (BF. B (0.5% 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory

  11. Vecuronium and fentanyl requirement in abdominal surgery under combined epidural-general anaesthesia and general anaesthesia alone.

    Science.gov (United States)

    Hossain, M; Hoq, M F; Rahman, M S; Yeasmeen, S; Ahmed, A; Huda, M R; Rahman, M M

    2012-01-01

    Individual effect of epidural block and general anaesthesia is well established in the field of anaesthesiology. But adequate literature is yet not available to give decisive answer regarding the requirement of muscle relaxants and opioid analgesic when the two methods are combined together. In the present study, sixty patients, aged 18-50 years of both sexes with ASA (American Society of Anesthesiologists) grading I and II scheduled to undergo for major abdominal surgery were assigned randomly into two groups (30 in each group), where Group A received general anesthesia and Group B received combined epidural-general anesthesia. The patients with combined technique, epidural catheter tip were placed between T9-10. Ten ml of 0.125% bupivacaine was administered through the epidural catheter. Peripheral nerve stimulator was used to monitor neuromuscular transmission and subsequently to administer incremental dose of neuromuscular blocking drugs. All the patients were pre-medicated with fentanyl (2μg/kg) to reduce intubation reflex. Then the patients of both groups were pre-oxygenated for 3 minute and anaesthesia was induced with thiopental sodium 3-5 mg/kg body weight. Endotrachial intubation was facilitated by vecuronium 0.1mg/kg body weight. Anaesthesia was maintained with 60% N2O in O2 and halothane (0.4 to 0.8%). Fentanyl was given in incremental dose of 0.5 μg/kg to maintain an adequate analgesia. The vecuronium was given at the dose of 0.02 mg/kg, when TOF return to 25% of the base line. The mean±SD requirement of vecuronium in general anaesthesia group was 0.0016±0.00013 mg/kg/min and whereas in combined epidural-general anaesthesia, it was 0.0011±0.00014 mg/kg/min. The requirement of fentanyl was 0.71μg/kg/hr in general anaesthetic group whereas in combined group it was 0.31μg/kg/hr. These findings prompt us to place optimal dosing guidelines so as to avoid overdosing and thus delay recovery and help to get the excellent outcome of the surgery.

  12. Novel use of epidural catheter: Air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma

    Science.gov (United States)

    Doctor, JR; Solanki, SL; Patil, VP; Divatia, JV

    2016-01-01

    Osteoid osteoma (OO) is a benign bone tumor, with a male-female ratio of approximately 2:1 and mainly affecting long bones. Ten percent of the lesions occur in the spine, mostly within the posterior elements. Treatment options for OO include surgical excision and percutaneous imaging-guided radiofrequency ablation (RFA). Lesions within the spine have an inherent risk of thermal damage to the vital structure because of proximity to the neural elements. We report a novel use of the epidural catheter for air injection for the neuroprotection of nerves close to the OO of the spine. A 12-year-old and 30 kg male child with an OO of the L3 vertebra was taken up for RFA. His preoperative examinations were within normal limits. The OO was very close to the L3 nerve root. Under general anesthesia, lumbar epidural catheter was placed in the L3-L4 space under imaging guidance. Ten ml of aliquots of air was injected under imaging guidance to avoid injury to the neural structures due to RFA. The air created a gap between neural elements and the tumor and served as an insulating material thereby protecting the neural elements from damage due to the RFA. Postoperatively, the patient did not develop any neurological deficit. PMID:27375396

  13. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  14. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case......Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  15. Anesthesia for thoracoscopic surgery

    OpenAIRE

    Conacher I

    2007-01-01

    Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therape...

  16. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  17. Pathophysiological Substantiation of Epidural Administration of Tenoxicam in Dorsalgia Treatment

    OpenAIRE

    Yastrebov D.N.; Shpagin М.V.; Artifexov S.B.

    2012-01-01

    The aim of the investigation is to assess the efficiency of Tenoxicam epidural administration, and represent pathophysiological substantiation of new techniques of dorsalgias treatment. Materials and Methods. There have been examined 75 patients with intense lumbar pain syndrome who underwent epidural pharmacotherapy of pain syndrome. The 1st group (n=50) had epidural Tenoxicam introduction, by 20 mg in 10–20 ml of saline solution, the control group (n=25) was given the combination of cor...

  18. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus...... on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children....... The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps...

  19. Clinical evaluation of postoperative analgesia provided by ketoprofen associated with intravenous or epidural morphine in bitches undergoing ovariosalpingohysterectomy

    Directory of Open Access Journals (Sweden)

    Gabriela Carvalho Aquilino Santos

    2015-04-01

    Full Text Available Multimodal analgesia refers to the practice of combining multiple analgesic drug classes or techniques to target different points along the pain pathway. The objective of this work was to evaluate clinically if ketoprofen associated or not with intravenous or epidural morphine provided adequate postoperative analgesia in bitches undergoing ovariosalpingohysterectomy (OSH. Forty healthy female dogs, weighing 10.7±6.0 kg, sedated with acepromazine (0.05mg kg –1.iv, induced with propofol (5 mg.kg-1. iv and maintained with isoflurane anesthesia, were distributed into four groups of 10 animals each. After stabilization of inhalation anesthesia, the bitches in Miv and CMiv groups received 0.2 mg.kg-1 of morphine intravenously diluted in 10ml of saline; whereas Mep and CMep groups received 0.1mg.kg-1 of epidural morphine. Thirty minutes after premedication, 2.0mg.kg-1.im of ketoprofen was administered in groups CMiv and CMep. Heart and respiratory rate, systolic blood pressure, and rectal temperature were measured. The degree of analgesia was assessed by a blind study in the following 6 hours after surgery, using a descriptive scale and a scale composed by physiologic and behavioral parameters. An statistical analysis was performed using the Tukey-Kramer test and nonparametric Kruskal-Wallis test, with statistical significance of 5%. There was no important difference between the four groups regarding postoperative analgesia, heart and respiratory rate, systolic blood pressure and rectal temperature. According to the results it can be concluded that the use of ketoprofen associated with intravenous or epidural morphine provided adequate and safe analgesia in the first six hours of postoperative in bitches undergoing ovariohysterectomy, suggesting that there was no analgesic potentiation when both agents were combined.

  20. Serratia marcescens spinal epidural abscess formation following acupuncture.

    Science.gov (United States)

    Yang, Chih-Wei; Hsu, Shun-Neng; Liu, Jhih-Syuan; Hueng, Dueng-Yuan

    2014-01-01

    The formation of spinal epidural abscess following acupuncture is very rare. We herein report the case of a 54-year-old woman who presented with progressive low back pain and fever with a root sign. She underwent surgical decompression, with an immediate improvement of the low back pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture. The characteristics of spinal epidural abscess that develop after acupuncture and how to prevent such complications are also discussed.

  1. Lab in a needle for epidural space identification

    Science.gov (United States)

    Carotenuto, B.; Micco, A.; Ricciardi, A.; Amorizzo, E.; Mercieri, M.; Cutolo, A.; Cusano, A.

    2016-05-01

    This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.

  2. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  3. Anesthesia of the geriatric equine

    Directory of Open Access Journals (Sweden)

    Doherty TJ

    2012-08-01

    Full Text Available Reza Seddighi, Thomas J DohertyDepartment of Large Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, University of Tennessee, Knoxville, TN, USAAbstract: Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.Keywords: geriatric, equine, anesthesia

  4. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “general”, “local”, or “topical” anesthesia is necessary ...

  5. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    Science.gov (United States)

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

  6. Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Clark K. Choi

    2013-01-01

    Full Text Available Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

  7. CT in thrombosed dilated posterior epidural vein

    Energy Technology Data Exchange (ETDEWEB)

    Bammatter, S.; Schnyder, P.; Preux, J. de

    1987-05-01

    The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to L5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the English, French and German literature revealed no prior radiological reports of a similar condition.

  8. Delayed emergence after anesthesia.

    Science.gov (United States)

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G

    2015-06-01

    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  9. Nurse anesthesia and multiculturalism.

    Science.gov (United States)

    Horton, B J; Waugaman, W R

    1996-01-01

    Program directors from 90 accredited nurse anesthesia programs in the United States and Puerto Rico were surveyed concerning multicultural issues. This article summarizes the identified needs of clients and student nurse anesthetists from culturally diverse backgrounds. Noteworthy findings include the perception that clients were more disadvantaged than students because of differences in socioeconomic status; the fact that about half of the programs provided students with instruction on cultural differences; and the observation that specific units of instruction within courses were the most frequent way of giving instruction in this subject area.

  10. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  11. Anesthesia and pulmonary hypertension.

    Science.gov (United States)

    McGlothlin, Dana; Ivascu, Natalia; Heerdt, Paul M

    2012-01-01

    Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with pulmonary hypertension due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Preoperative risk assessment and successful management of patients with pulmonary hypertension undergoing cardiac surgery involve an understanding of the pathophysiology of the disease, screening of patients at-risk for pulmonary arterial hypertension, analysis of preoperative and operative risk factors, thorough multidisciplinary planning, careful intraoperative management, and early recognition and treatment of postoperative complications. This article will cover each of these aspects with particular focus on the anesthetic approach for non-cardiothoracic surgeries.

  12. Anesthesia for geriatric patients.

    Science.gov (United States)

    Deiner, S; Silverstein, J H

    2011-02-01

    The number of elderly surgical patients will be increasing in Italy. Slowly, anesthesiologists are developing the expertise to care for these patients. The information available to apply to these cases is now the topic of a number of anesthesia textbooks dedicated to the elderly. In this article, we review some of the more recent findings and provide some tips to help guide the care of elderly patients. It is hoped that practitioners will use this information to improve the care of these patients and conduct additional research to further improve care in the future.

  13. [Anesthesia and bodybuilding].

    Science.gov (United States)

    Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

    2008-05-01

    A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

  14. 三种麻醉方式在剖宫产术中的效果比较及对胎儿的影响%Effect comparison of three anesthesia methods in caesarean section and its influence on infants

    Institute of Scientific and Technical Information of China (English)

    刘碧华; 蒲江北

    2012-01-01

    Objective To compare the effect of epidural anesthesia, combined spinal-epidural anesthesia and general anesthesia in caesarean section and its influence on infants. Methods 210 pregnant women were divided into group E (epidural anesthesia), group C (combined spinal-epidural anesthesia) and group I (general anesthesia) with 70 patients in each group. The onset time of anaesthesia, Apgar and NBNA scores of newborn and adverse reaction were compared between three groups. Results The onset time of anaesthesia in group E was much slower than that in group C and group I (P 0.05); Apgar and NBNA scores of newborn and adverse reaction were no statistical difference among three groups (P > 0.05). Conclusion Combined spinal-epidural anesthesia is an ideal anesthesia method in caesarean with short onset time and a good effect. Three methods all have no influence for newborn.%目的 比较单纯硬膜外麻醉、腰麻-硬膜外联合麻醉和全身麻醉在剖宫产术的麻醉效果及对胎儿的影响.方法 将本院行剖宫产的210例孕妇分为E组(单纯硬膜外麻醉)、C组(腰麻-硬膜外联合麻醉)和I组(静脉麻醉),比较三组麻醉起效时间、麻醉阻滞效果、新生儿Apgar评分和NBNA评分以及不良反应.结果 三组麻醉起效时间从慢到快依次为E组、C组和I组,差异有统计学意义(P 0.05);三组新生儿Apgar评分、NBNA评分和不良反应发生率比较,差异无统计学意义(P > 0.05).结论 腰麻-硬膜外联合麻醉起效时间短,麻醉效果佳,是剖宫产的理想麻醉方法,三组麻醉方法对新生儿均无不良影响.

  15. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

    Science.gov (United States)

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-07-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  16. Extensive spinal epidural abscess as a complication of Crohn's disease.

    Science.gov (United States)

    Smith, Chez; Kavar, Bhadrakant

    2010-01-01

    A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

  17. Minimally invasive treatment of multilevel spinal epidural abscess.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Maurer, Adrian J; Rabb, Craig H

    2013-01-01

    The use of minimally invasive tubular retractor microsurgery for treatment of multilevel spinal epidural abscess is described. This technique was used in 3 cases, and excellent results were achieved. The authors conclude that multilevel spinal epidural abscesses can be safely and effectively managed using microsurgery via a minimally invasive tubular retractor system.

  18. Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion

    OpenAIRE

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-01-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  19. Remifentanilo vs. bloqueo central epidural para control del dolor postoperatorio en cirugía vascular de urgencias Remifentanyl versus epidural central blockade for the management of postoperative pain in emergency vascular surgery

    Directory of Open Access Journals (Sweden)

    A. Quirante

    2004-12-01

    Full Text Available El correcto tratamiento del dolor postoperatorio constituye una prioridad dentro de los objetivos del anestesiólogo. En pacientes con patología vascular severa quirúrgica, el tratamiento analgésico efectivo se suele realizar mediante bloqueo continuo epidural. Sin embargo, la administración de analgésicos, tanto opiáceos como no opiáceos, por vía intravenosa, es una alternativa a la vía epidural cuando esta es desestimada. Caso clínico: Presentamos el caso de un paciente varón de 63 años portador de un bypass fémoro-poplíteo a primera porción en miembro inferior izquierdo, el cual es intervenido quirúrgicamente y con carácter urgente tras el diagnóstico de falso aneurisma séptico de arteria iliaca izquierda con rotura de anastomosis fémoro-poplítea. Se optó por una anestesia general basada en la analgesia con remifentanilo frente a bloqueo central epidural dado el carácter urgente de la cirugía y la ingesta habitual de antiagregantes plaquetarios. Se planificó como estrategia analgésica postoperatoria la administración de remifentanilo a dosis sedoanalgésicas (Introduction: The appropriate management of postoperative pain is a priority among the objectives of the anesthesiologist. In patients with severe surgical vascular pathology, an effective analgesic treatment is usually provided with epidural continuous blockade. However, the intravenous administration of analgesics, either opiates or non opiates, is an alternative to the epidural route when this has to be dismissed. Clinical case: We present the case of a 63-years old male patient carrying a femoro-popliteus bypass in the first portion of the left lower limb that underwent emergency surgery after being diagnosed of a false septic aneurysm in the left iliac artery with breakage of the femoro-popliteus anastomosis. General anesthesia based on remifentanyl was decided instead of epidural central blockade due to the urgent nature of the surgery and the regular

  20. Anesthesia and cor triatriatum

    Directory of Open Access Journals (Sweden)

    Federica Scavonetto

    2014-01-01

    Full Text Available Aims and Objectives: Cor triatriatum sinistrum (CTS and cor triatriatum dextrum (CTD are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative course of patients with CT. Materials and Methods: A computerized search of a medical record database was conducted to identify patients with a clinical diagnosis of uncorrected CTD and CTS undergoing surgical procedures. Descriptive statistics were used. Results: We identified 12 adult patients with asymptomatic CTS (n = 7 and CTD (n = 5 who underwent 23 anesthetics. There were no perioperative complications which could be attributed directly to the anatomy of CT. Conclusions: Our observation and review of the literature suggest that patients with asymptomatic CT typically tolerate anesthesia and surgical procedures well.

  1. Mismatch responses in the awake rat: evidence from epidural recordings of auditory cortical fields.

    Directory of Open Access Journals (Sweden)

    Fabienne Jung

    Full Text Available Detecting sudden environmental changes is crucial for the survival of humans and animals. In the human auditory system the mismatch negativity (MMN, a component of auditory evoked potentials (AEPs, reflects the violation of predictable stimulus regularities, established by the previous auditory sequence. Given the considerable potentiality of the MMN for clinical applications, establishing valid animal models that allow for detailed investigation of its neurophysiological mechanisms is important. Rodent studies, so far almost exclusively under anesthesia, have not provided decisive evidence whether an MMN analogue exists in rats. This may be due to several factors, including the effect of anesthesia. We therefore used epidural recordings in awake black hooded rats, from two auditory cortical areas in both hemispheres, and with bandpass filtered noise stimuli that were optimized in frequency and duration for eliciting MMN in rats. Using a classical oddball paradigm with frequency deviants, we detected mismatch responses at all four electrodes in primary and secondary auditory cortex, with morphological and functional properties similar to those known in humans, i.e., large amplitude biphasic differences that increased in amplitude with decreasing deviant probability. These mismatch responses significantly diminished in a control condition that removed the predictive context while controlling for presentation rate of the deviants. While our present study does not allow for disambiguating precisely the relative contribution of adaptation and prediction error processing to the observed mismatch responses, it demonstrates that MMN-like potentials can be obtained in awake and unrestrained rats.

  2. fek Penambahan Deksametason 5 mg pada Bupivakain 0,5% terhadap Mula dan Lama Kerja Blokade Sensorik Anestesia Epidural untuk Operasi Ortopedi Ekstremitas Bawah

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    Irwan

    2015-08-01

    Full Text Available Lower extremity orthopedic surgery performed with regional epidural anesthesia was still have weakness which is long onset of time. This study was conducted to determine the onset time and duration time of sensory blockade epidural anesthesia between the use of dexamethasone 5 mg addition to 0.5% bupivacaine for lower limb orthophedic surgery. The study was using randomized controlled blind method on 32 ASA I–II patients undergoing lower limb orthopedic surgery under epidural anesthesia. Consecutive sampling and random allocation of block of permutation groups was applied. In group I, dexamethasone 5 mg was added to bupivacaine 0.5% 15 mL while in group II NaCl 1 mL was added to bupivacaine 0.5% 15 mL. The results were statistically tested using t-test and Mann-Whitney test. It was shown that the onset time of sensory blockade was not significantly faster when dexamethasone was added in bupivacaine 0.5%, 13.56 minutes versus 14.31 minutes (p=0.27. The duration time of sensory blockade in dexamethasone in bupivacaine 0.5% group was longer 399.81 minutes, compared to the bupivacaine 0.5% group, 227.43 minutes (p=0.00. In conclusions, the addition of dexamethasone 5 mg to bupivacaine 0.5% 15 mL does not produced faster onset time. However, the duration sensory blockade time is longer than bupivacaine 0,5% 15 mL is used.

  3. Citrobocter kasori spinal epidural abscess: a rare occurrence.

    Science.gov (United States)

    Kumar, Ashok; Jain, Pramod; Singh, Pritish; Divthane, Rupam; Badole, C M

    2013-01-01

    Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.

  4. Should we abandon regional anesthesia in open inguinal hernia repair in adults?

    Science.gov (United States)

    Bakota, B; Kopljar, M; Baranovic, S; Miletic, M; Marinovic, M; Vidovic, D

    2015-09-17

    Inguinal hernia repair is a common worldwide surgical procedure usually done in the outpatient setting. The purpose of this systematic review is to make an evidence-based meta-analysis to determine the possible benefits of regional (neuraxial block) anesthesia compared to general anesthesia in open inguinal hernia repair in adults. Cochrane Library, Medline, EMBASE, CINAHL, SCI-EXPANDED, SCOPUS as well as trial registries, conference proceedings and reference lists were searched. Only randomized controlled trials (RCT) that compare neuraxial block (spinal or/and epidural) anesthesia (NABA) and general anesthesia (GA) were included. Main outcome measures were postoperative complications, urinary retention and postoperative pain. Seven RCTs were included in this review. A total of 308 patients were analyzed with 154 patients in each group. Overall complications were evenly distributed in NABA and in GA group [OR 1.17, 95 % CI (0.52-2.66)]. Urinary retention was statistically less frequent in GA group compared to NABA group [OR 0.25, 95 % CI (0.08-0.74)]. Movement-associated pain score 24 h after surgery was significantly lower in NABA group [SMD 5.59, 95 % CI (3.69-7.50)]. Time of first analgesia application was shorter in GA group [SMD 8.99, 95 % CI 6.10-11.89]. Compared to GA, NABA appears to be a more adequate technique in terms of postoperative pain control. However, when GA is applied, patients seem to have less voiding problems.

  5. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.

    Science.gov (United States)

    Bremer, Andrew A; Darouiche, Rabih O

    2004-01-01

    Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.

  6. 经尿道前列腺电切术中的临床麻醉应用分析%Clinical Study on Anesthesia Application in Transurethral Resection Operation

    Institute of Scientific and Technical Information of China (English)

    李艳红

    2015-01-01

    Objective To explore clinical anesthesia application method and its effect in transurethral resection operation. Methods We chose 40 patients who were operated with transurethral resection in hospital from January 2014 to January 2015 and separated them into study group and control group according to different anesthesia approaches,twenty patients in study group were given spinal combined with epidural anesthesia treatment,while 20 patients in control group were epidural anesthesia treatment only and then observed and compared anesthesia effects between two groups. Results Patients’anesthesia taking-effect time and anesthesia blocking-improvement time in study group were much shorter than counterparts in control group (P<0.05);besides,anesthesia effect in study group was much better(P<0.05);so,there was a differential between anesthesia effects in two groups. Conclusion Spinal combined with epidural anesthesia is of efficiency in transurethral resection operation,it is conducive for rapid anesthesia taking-effect time and anesthesia blocking-improvement.%目的:研究经尿道前列腺电切术中的临床麻醉方式及应用效果。方法搜集2014年1月~2015年1月我院实施经尿道前列腺电切术40例,按照不同临床麻醉方式将其分成实验组与对照组,各20例,给予实验组腰硬联合麻醉,给予对照组硬膜外麻醉,观察两组麻醉效果,并对比分析。结果实验组麻醉起效、阻滞完善所需时间较短(P<0.05),麻醉效果较好(P<0.05),差异显著。结论经尿道前列腺电切术中应用腰硬联合麻醉,起效快,且阻滞完善。

  7. Low-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.

    Science.gov (United States)

    Zeng, X Z; Xu, Y M; Cui, X G; Guo, Y P; Li, W Z

    2014-03-01

    Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). The C group received epidural 0.75% levobupivacaine 12 ml with 1 ml of isotonic sodium chloride solution, while the D group received epidural 0.75% levobupivacaine 12 ml with 1 ml (0.5 µg/kg) of dexmedetomidine. Haemodynamic changes, onset time and duration of sensory and motor block, muscle relaxation score, verbal rating score for pain, sedation score and the total postoperative analgesic consumption were evaluated. Sensory blockade duration was longer in the D group than in the C group (P=0.01). The incidence of motor block and the muscle relaxation score were significantly higher in the D group compared with the C group (P=0.01). Compared with the C group, pain scores were significantly lower in the first four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was significantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 µg/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.

  8. Extensive spinal epidural abscess complicated with hydrocephalus

    Directory of Open Access Journals (Sweden)

    Balan Corneliu

    2015-12-01

    Full Text Available Spinal epidural abscess is a rare but severe infection requiring prompt recognition in order to have a favorable outcome and appropriate treatment, mainly surgical. We present one of the largest extensions of such abscess in literature, involving the whole spine. No surgical treatment was tempted due to the involvement of 19 levels but antibiotics. The evolution of the lesion was complicated with hydrocephalus, by mechanism of cervical block of CSF flow, and needed first external derivation and later ventriculo-peritoneal drainage.

  9. Absceso epidural cervical por peptostreptococcus anaerobius

    OpenAIRE

    Fernandez Garcia, L.; Machado Baldasano, A.; Villanueva Pareja, F.; García de Quevedo Puerta, D.; Marfil Romero, M.

    1996-01-01

    Se presenta 1 caso de infección con absceso epidural a nivel cervical producido por un Peplostreptococcus anaerobius en 1 paciente en el que se realizó previamente una artrodesis C6-C7 por una hernia discal cervical. En la literatura no se han encontrado referencias bibliográficas de casos similares, por la etiología y la localización. Se discute la importancia de las infecciones por bacterias anaerobias en patología osteoarticular, métodos diagnósticos, así como su abordaje te...

  10. Bupivacaína levógira a 0,5% pura versus mistura enantiomérica de bupivacaína (S75-R25 a 0,5% em anestesia peridural para cirurgia de varizes Bupivacaína levógira a 0,5% pura versus mezcla enantiomerica bupivacaína (S75-R25 a 0,5% en anestesia peridural para cirugía de várices Plain 0.5% levogyrous bupivacaine versus 0.5% bupivacaine enantiomeric mixture (S75-R25 in epidural anesthesia for varicose vein surgery

    Directory of Open Access Journals (Sweden)

    José Delfino

    2001-12-01

    inferiores. La casuística, entretanto, no es aún suficiente para permitir conclusiones definitivas.BACKGROUND AND OBJECTIVES: The cardiotoxic effect of racemic bupivacaine (50:50 is still the major safety-related variable for regional blocks requiring higher concentrations and volumes. Recent animal studies suggested that the manipulation of racemic bupivacaine enantiomers could contribute for a better therapeutic efficacy by decreasing its potential toxicity. This study aimed at evaluating the efficacy of 0.5% bupivacaine enantiomeric mixture (S75-R25 as compared to plain S(-100% bupivacaine in lumbar epidural anesthesia for varicose vein surgery. METHODS: Participated in this randomized double-blind study 30 female patients aged 15 to 65 years, physical status ASA I or II scheduled for elective lower limb varicose vein surgery, who were allocated into two groups: S75-R25 Group - 20 ml (100 mg of 0.5% (S75-R25 bupivacaine; and Levogyrous Group - 20 ml (100 mg of 0.5% plain S(-100 bupivacaine without adjuvants. Characteristics of sensory and motor block as well as the incidence of side effects were investigated. RESULTS: Significant demographic differences and a longer surgical time were found in the S75-R25 Group. Faster spread and lower analgesic effects of the isomeric mixture were statistically significant. Motor block was significantly deeper in the S75-R25 Group. Side effects were negligible for both groups. CONCLUSIONS: Fewer side effects, good patients acceptance and the lack of post-operative transient neurological symptoms point towards the safety of both solutions in lumbar epidural anesthesia for elective varicose vein surgery. The sample, however, is still small for final conclusions.

  11. Differential effects of controlled hypotension on gastric intramucosal pH and post-operational gastrointestinal functional under two different anesthesia methods

    Institute of Scientific and Technical Information of China (English)

    Guanglei Wang; Junli Cao; Gongjian Liu

    2008-01-01

    Objective: To observe the effects of controlled hypotension on gastric intramucosal pH and post-operational gastrointestinal functions using two specific anesthesia methods. Methods: Thirty patients(ASA Ⅱ)scheduled for ectomy of hepatocarcinoma, were randomly assigned to two groups: epidural block combined with intravenous anesthesia group(E group) and inhalation anesthesia group(G group). Gastric PgCO2 and pHi were monitored at different time points, before theintravenous induction of controlled hypotension, after 1 h and 2 h, and 1 h after the termination of controlled hypotension. In the meanwhile, the artery blood gas was analyzed. Results: There was no significant difference in blood gas indexes between E group and G group. However, pHi decreased significantly after 1 h and 2 h of controlled hypotension(P<0.05), and during the same periods PgCO2 increased significantly(P<0.05 or P<0.01), the time of bowel movement and defecating deferred significantly shorter in G group patients, when compared with E group patients. Conclusion: Epidural block in combination with general anesthesia can improve gastrointestinal blood flow during controlled hypotension and facilitates post-operational recovery of gastrointestinal functions.

  12. Anesthesia in Operations for Congenital Hip Dislocation in Children%小儿髋脱位手术的麻醉

    Institute of Scientific and Technical Information of China (English)

    鲁纯新; 金鸣苍

    1984-01-01

    This paper discusses the anesthetic management in 122 operations for congenital dislocation of the hip in children. Comparison was made between continuous epidural (46),ether(60)and ketamin(16)anesthesias. Observation of the elevation of blood pressure during the operation showed that BP was the highest in ketamin group and when compared with the other two methods, P <0.05.The ether group had markedly increased pulse rate with p<0.01.Duzing the operation the epidural group showed little change in BP and pulse and respiration was also stable whether during or after the operation. With ether anesthesia, the induction phase was prolonged and endotracheal intubation was often required. In addition, it brought on marked acceleration in respiration and pulse during the operation and delayed recovery of consciousness. While BP was elevated in the ketamin group, respiration and pulse were more stable than in ether group and consciousness recovered earlier. Besides, its medication was simple and there was no need for intubation. To sum up, epidural anesthesin should be rated as first of the three. But ketamin is recommendable for general anesthesia.%@@ 先天性髋脱位为常见的小儿骨科疾病,除了较小婴儿可用闭合复位蛙式石膏固定方法外,多需手术治疗.现将有关此种手术的麻醉方法选择和术中失血量的测定的几点体会介绍如下: 临床资料 121例,男32例,女89例,其中1例先后施行二次手术,共122次麻醉.

  13. [Regional anesthesia and cancer immunology].

    Science.gov (United States)

    Igarashi, Toru; Mori, Katsuya; Inoue, Kei; Suzuki, Takeshi; Morisaki, Hiroshi

    2013-09-01

    Regional anesthesia has been widely applied as an excellent method for perioperative analgesia. Recent studies suggested that regional anesthesia is a promising approach to minimize the risk of surgical site infection and postoperative cancer recurrence, subsequently providing the benefits to the long-term outcome. In particular, it is of great interest that regional anesthesia might be able to reduce cancer recurrence. In cancer patients, innate immunity against cancer could be depressed, resulting in the predisposition to evoke metastasis. Besides, during the perioperative periods, tumor immunity is significantly depressed due to surgical pain, activation of sympathetic nervous system, inflammatory responses, and others. In this review article, we discuss the tumor immunity during the perioperative period, with focus on the alterations of tumor immunity and regional anesthesia.

  14. Transverse myelitis following spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Jha Sanjeev

    2006-01-01

    Full Text Available Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

  15. Analgesia epidural para parto en la gestante obesa Epidural analgesia for labour in obese patients

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    E. Guasch

    2006-10-01

    Full Text Available La obesidad es un problema global de salud en continuo aumento en el mundo desarrollado. Dado que la incidencia de la obesidad es mayor en mujeres que en hombres, los anestesiólogos con especial dedicación a la obstetricia, tendrán mayor oportunidad de enfrentarse a este tipo de pacientes. Nuestro objetivo es determinar la dificultad en la realización de la técnica epidural para analgesia de parto y analizar la incidencia de complicaciones ocurridas durante la punción en las gestantes obesas, así como evaluar la eficacia de la analgesia epidural en este grupo de pacientes en un estudio observacional retrospectivo de todos los bloqueos epidurales para analgesia de parto realizados en un hospital universitario de nivel 4 durante un periodo de cuatro años. Se ha estudiado un total de 13616 pacientes, clasificándolas según el índice de masa corporal en Kg./m² (IMC. En las pacientes no obesas (IMCObesity is an increasing global health problem in Developer countries. As its incidence is grater in women than men, obstetric anesthesiologists wil be envolved in the care of the obese patient more often. Our aim is to study punction dificulties in obese parturients requiring epidural analgesia for labor, and to compare punction complications between obese and non obese parturients as analgesic efficacy between obese and non obese patients in a retrospective observational study among all the epidural analgesic blocks performed in a universitary hospital in a four years period. We studied 13616 patients, who were classified according to body mass index in Kg/m² (BMI. In the non obese group patients (BMI<30; first attempt epidural success was achieved in 76,5%. Mild obese patients (BMI 30-32, severe obese (BMI 33-39 and morbid obese (BMI≥40, the percents were 69, 3%, 63,2% y 47,4% respectively. The comparison among obese and non obese patients was significati-vely different (p<0,001. Punction complications did not show differences among groups

  16. ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

    Institute of Scientific and Technical Information of China (English)

    Fei Xiao; Wen-Ping Xu; Xiao-Min Zhang; Yin-Fa Zhang; Li-Zhong Wang; Xin-Zhong Chen

    2015-01-01

    Background:Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated,and there is no indwelling epidural catheter or contraindication to spinal anesthesia.However,the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients.This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery.Methods:Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized,double-blinded,dose-ranging study.Patients received 4 mg,6 mg,8 mg,or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil.Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section.The ED50 and ED95 were calculated with a logistic regression model.Results:ED50 and ED95 ofintrathecal bupivacaine for successful spinal anesthesia were 5.67 mg (95% confidence interval [CI]:5.20-6.10 mg) and 8.82 mg (95% CI:8.14-9.87 mg) respectively.The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg (P < 0.05).The sensory block was significantly different among groups 10 minutes after intrathecal injection (P < 0.05).The use of lidocaine in Group 4 mg was higher than that in other groups (P < 0.05).The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups (P < 0.05).The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups (P < 0.05).The satisfaction of muscle relaxation in Group 4 mg was lower than other groups (P < 0.05).There was no significant difference in patients' satisfaction and the newborns

  17. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  18. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

    Directory of Open Access Journals (Sweden)

    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

  19. Acute cervical epidural hematoma: case report

    Directory of Open Access Journals (Sweden)

    BORGES GUILHERME

    2000-01-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.

  20. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

    Directory of Open Access Journals (Sweden)

    Nathaniel H. Greene

    2015-01-01

    Full Text Available Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD on computed tomography (CT to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P35 changed this relationship (P=0.007. The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs>0.9. Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

  1. Anesthesia for outpatient female sterilization.

    Science.gov (United States)

    Fishburne, J I

    1983-04-01

    This issue of the Bulletin deals with the principles of anesthesia for outpatient female sterilization with emphasis on techniques for laparoscopy and minilaparotomy. General anesthesia techniques provide analgesia, amnesia, and muscle relaxation and are particularly useful for managing the anxious patient. Disadvantages include increased expense, need for specialized equipment, and highly trained personnel, and delayed recovery. Complications, though relatively rare, can be life-threatening and include aspiration of stomach contents, hypoxia, hypercarbia, hypotension, hypertension, cardiac arrhythmias, cardiorespiratory arrest, and death. There is no single preferred technique of general anesthesia, athough most anesthetists employ methods that allow rapid recovery of faculties, enabling the patient to be discharged soon after surgery. To accomplish this end, light anesthesia with sodium thiopental induction and nitrous oxide maintenance is often used. Short duration muscle relaxation with an agent such as succinylcholine supplements this technique. Other techniques include light anesthesia with inhalational anesthetic agents and the use of intravenous ketamine. Local anesthesia augmented by systemic and/or inhalational analgesia is supplanting general anesthesia techniques for laparoscopy in many locales. This approach is also particularly well-suited for minilaparotomy in developing countries, where it has achieved its greatest popularity. The local technique carries with it reduced morbidity and mortality but may not entirely relieve discomfort. The primary danger of local anesthesia is respiratory depression due to excessive narcosis and sedation. The operator must be alert to the action of the drugs and should always use the minimal effective dose. Although toxicity due to overdosage with local anesthetic drugs is occasionally experienced, allergic reactions to the amide-linkage drugs such as lidocaine or bupivacaine are exceedingly rare. For outpatient

  2. CLINICAL STUDY OF PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH TETRACAINE HYDROCHLORIDE AFTER PULMONARY LOBECTOMY

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 李勇; 叶铁虎; 任洪智; 黄宇光; 罗爱伦

    2003-01-01

    Objective.To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia(PCEA)after pulmonary lobectomy. Methods. Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group(22 patients)or ropivacaine group(21 patients). In the tetracaine group,0.15% tetracaine was used for postoperative PCEA,while 0.3% ropivacaine was used in the ropiva-caine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visual analogue scale(VAS). Forced expired volume at the 1st second(FEV1.0),forced vital capacity(FVC),FEV1.0/ FVC and peak expired flow(PEF)were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study. Results. VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation,pulmonary function was reduced in both groups. However,there were no significant differences between the percentage of the changes of FEV1.0,FEV1.0/FVC and PEF in the two groups. There were also no significant differences between the percentage of the changes of heart rate,mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief.Conclusions. The analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in pa-tient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.

  3. Randomized trial of epidural vs. subcutaneous catheters for managing pain after modified Nuss in adults

    Science.gov (United States)

    Temkit, M’hamed; Ewais, MennatAllah M.; Luckritz, Todd C.; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley D.; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.

    2016-01-01

    Background Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients’ pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. Conclusions Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management. PMID:27621865

  4. Adenotomy under general anesthesia.

    Science.gov (United States)

    Vokurka, J; Jakoubková, S; Vít, Z; Drahokoupilová, M

    1989-01-01

    Experience obtained from adenotomy (AT) under general anesthesia using Ketamin hydrochloride (Ketalar, Narkamon) in children are presented in this paper. The authors had used intramuscular premedication with Prothazin, Dolsin and Atropin at the first stage, then they shifted to oral administration of a combination of Diazepam, Theadryl and Atropin. Ketamin may be applied intravenously in the dosage of 1.0 to 1.5 mg/kg of body weight in most children. Where it is not possible, a triple dose into the muscle is used. A total of 2,266 AT were performed. About 70% of patients were calm during the operation, once a suspected aspiration was considered but it was not confirmed. The main contribution of the method is 100% amnesia of the surgery made. The procedure is a compromise between a requirement for minimal traumatization of the child's psyche by the intervention and the resources available, particularly the need of personnel at the majority of otorhinolaryngo-logical departments nowadays.

  5. COMPARISON OF PATIENT CONTROLLED EPIDURAL ANALGESIA WITH CONTINUOUS EPIDURAL INFUSION FOR LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sumaiah Tahseen

    2016-07-01

    Full Text Available We conducted a study to compare the efficacy and safety of Patient Controlled Epidural Analgesia (PCEA with that of Continuous Infusion of Epidural Analgesia (CIEA for maintenance of labour analgesia and evaluated the quality of analgesia and obstetric and safety outcomes. METHODS The study was a hospital-based prospective, randomised control trial on 80 parturients who had a normal antenatal period. Each parturient received 500-1000 mL lactated ringer solution Intravenously (IV prior to initiating epidural blockade. Epidural catheter placement was performed in a standard manner and all patients received an initial dose of 8-10 mL bupivacaine 0.25%. Parturients self-administered 0.125% bupivacaine with fentanyl 2.5 µg/mL using PCA pumps programmed as follows: 4 mL bolus with a 20 mins Lockout Interval (LI. Group B received CIEA of 8 mL 0.125% bupivacaine with fentanyl 2.5/mL. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, analgesic supplements, bupivacaine and fentanyl consumption. RESULTS Data from 80 patients showed no differences among groups in pain relief. Maternal satisfaction was greater in PCEA group. Anaesthetic interventions by way of supplemental doses of Bupivacaine and Fentanyl in the PCEA group were minimal (4 and 2 vs 25 and 12 P <0.001 compared to CEI group. PCEA group received less local anaesthetic (5.2 vs 9.4 p <0.001 and few patients in PCEA group had motor weakness compared to CEI group (6 vs 17 p <0.05. Both methods were safe for mother and newborn. CONCLUSION Patients who received PCEA required less anaesthetic interventions, required lower doses of local anaesthetic, fentanyl and have less motor weakness than those who received CEI.

  6. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

    Directory of Open Access Journals (Sweden)

    Torsten Kluba

    2010-04-01

    Full Text Available This prospective study aimed to compare the efficacy of epidural (EDA versus intravenous (PCA application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal post-operative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

  7. 不同麻醉方式在腹股沟疝无张力修补手术中的应用比较%Clinical observation on tension-free inguinal hernia repair under different anesthesia

    Institute of Scientific and Technical Information of China (English)

    陈锐森

    2011-01-01

    Aim:To study the efficiency and benefit of tension-free inguinal hernia repair with local anesthesia compared with epidural block anesthesia. Methods: All of the 132 cases were performed tension-free hernioplasty with mesh-plug made of PP. Seventy-eighty cases were treated under local anesthesia and the other 54 cases were treated with epidural block anesthesia. And the operating time, postoperative complications such as retention of urine, wound pain, postoperative time staying in bed, hospitalization costs and recurrence were observed. Results: Compared with the epidural block anesthesia group, the local anesthesia group had shorter operating time, less postoperative complications such as retention of urine,lower costs and shorter postoperative time staying in bed(P <0. 05). Conclusion:The tension-free inguinal hernia repair under local anesthesia compared with epidural block anesthesia had many benefits such as less postoperative complications, shorter postoperative time staying in bed and lower hospitalization costs. And it had less side effect on the whole body, thus it is especially suitable for old patients.%目的:比较局部麻醉和硬膜外麻醉在腹股沟无张力疝修补术中的应用.方法:将我院2008年1月至2010年12月收治的单侧腹股沟疝病例132例随机分组对比,观察腹股沟疝患者行疝环充填式无张力修补术后的早期自主活动、进食、排尿以及住院时间等情况,局麻组78例(n=78),硬膜外组54例(n=54).结果:在局麻下行疝环充填式无张力疝修补术较之硬膜外麻醉有更宽的手术指征,且术后进食早,下床早,排尿困难明显降低,住院时间缩短,费用也较低(P<0.05).结论:在局麻下行疝环充填式无张力疝修补术,是一种对人体生理功能干扰小、术后恢复快、并发症少、简单易掌握适合老年患者的方法之一.

  8. ESTRATEGIA ANESTÉSICA PARA LA CIRUGÍA CON EL CORAZÓN LATIENDO. CINCO AÑOS DE EXPERIENCIA EN EL CARDIOCENTRO ERNESTO CHE GUEVARA / Anesthesia strategy for surgery with beating heart. Five years of experience at the “Ernesto Che Guevara” Cardiology Hospital

    Directory of Open Access Journals (Sweden)

    Ignacio R. Fajardo Egozcue

    2009-06-01

    Full Text Available Introduction and Objectives: The anesthesia in coronary surgery, using high sustained doses of fentanyl, leads to protracted postoperative extubation and stay. The assessment of an anesthesiastrategy for coronary surgery without extracorporeal circulation, in order to reduce the use of opioids and make possible an early extubation and a shorter post-surgical stay, was the objective of thiswork. Methods: 732 patients who underwent surgical myocardial revascularization without heartlung machine, from February 2003 to December 2007, using general anesthesia with intermittent boluses of fentanyl, with or without associated epidural anesthesia, were studied. Results: 625 surgical operations with general anesthesia in boluses and 107 adding peridural anesthesia were carried out. The average amount of fentanyl was 34.7 ml per patient in the first group and 24.9 ml when adding peridural anesthesia. Twenty seven patients were extubated in the operating room. The total average time was 8.6 hours (8.8 hours in the group where the anesthesia in boluses wasused and 6.7 hours for those with peridural anesthesia associated. The total average stay at the Intensive Care Unit was 40.1 hours. Conclusions: The intermittent anesthesia reduced the amount of fentanyl used in 86.6 percent when compared to the high sustained doses reported in a previous study. This made possible the early extubation of the patients, which increased due to the use of peridural anesthesia, and a decrease in average stay of the patient at the Intensive Care Unit.

  9. Considering symptomatic spinal epidural lipomatosis in the differential diagnosis.

    Science.gov (United States)

    Alvarez, Adriana; Induru, Raghava; Lagman, Ruth

    2013-09-01

    Spinal epidural lipomatosis (SEL) is the abnormal accumulation of normal fat within the spinal canal. It is more frequent in those patients receiving chronic glucocorticoid therapy or in cases of endogenous hypercortisolism states. We report a case of SEL in a patient with metastatic prostate cancer with history of steroid treatment as part of his chemotherapy regimen, presenting with clinical manifestations of partial cord compression. Magnetic resonance imaging images of the lumbar spine revealed the presence of epidural tumor suspicious for metastatic disease. Operative findings were consistent with epidural lipomatosis. Spinal epidural lipomatosis is a rare condition that needs to be included in the differential diagnosis of patients with risk factors, presenting with symptomatic cord compression.

  10. Spinal epidural abscess in a patient with piriformis pyomyositis

    Directory of Open Access Journals (Sweden)

    Gerald S Oh

    2016-01-01

    Conclusion: A 19-year-old male presented with a holospinal epidural abscess (C2 to sacrum originating from piriformis pyomyositis. The multilevel cord abscess was emergently decompressed, leading to a marked restoration of neurological function.

  11. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  12. Symptomatic Epidural Gas-containing Cyst from Intervertebral Vacuum Phenomenon.

    Science.gov (United States)

    Yun, Sung Min; Suh, Bumn Suk; Park, Jin Su

    2012-12-01

    Vacuum disc phenomenon is a collection of gas in the intervertebral disc space but rarely causes nerve compression. However, some rare type of vacuum phenomenon in the spinal canal may bring about posterior gas displacement within the epidural space. The authors describe two patients with symptomatic epidural gas-containing cyst that seem to be originating from vacuum phenomenon in the intervertebral disc, causing lumbosacral radiculopathy. Radiographic studies demonstrated intervertebral vacuum phenomenon and accumulation of gas in the lumbar epidural space compressing the dural sac and the nerve root. The nerve root in both patients was compressed by gas containing cyst that was surrounded by thin walled capsule separable from the gaseous degenerated disc space. The speculative mechanism of the nerve root compression is discussed. The possibility of gas containing cyst should be considered in case of the nerve root compression in which epidural gas is present.

  13. Estudo comparativo entre bupivacaína a 0,5%, mistura enantiomérica de bupivacaína (S75-R25 a 0,5% e ropivacaína a 0,75% associadas ao fentanil em anestesia peridural para cesarianas Estudio comparativo entre bupivacaína a 0,5%, mezcla enantiomérica de bupivacaína (S75-R25 a 0,5% y ropivacaína a 0,75% asociadas al fentanil en anestesia peridural para cesáreas Comparative study between 0.5% bupivacaine, 0.5% enantiomeric mixture of bupivacaine (S75-R25 and 0.75% ropivacaine, all associated to fentanyl, for epidural cesarean section anesthesia

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Figueiredo Côrtes

    2003-04-01

    /fetal repercussions of 0.5% bupivacaine, enantiomeric 0.5% bupivacaine (S75-R25 and 0.75% ropivacaine, all associated to fentanyl, in epidural cesarean section anesthesia. METHODS: Participated in this study 90 full-term pregnant women, physical status ASA I, submitted to elective cesarean section under epidural anesthesia, who were divided into tree groups: group I - 23 ml racemic 0.5% bupivacaine with epinephrine; Group II -23 ml enantiomeric 0.5% bupivacaine (S75-R25 with epinephrine; Group III - 23 ml of 0.75% ropivacaine. Fentanyl (2 ml was associated to local anesthetics in all groups. The following parameters were evaluated: onset, analgesia duration, sensory and motor block degree, time to hysterotomy and delivery, quality of muscle relaxation and anesthesia, maternal hemodynamic and respiratory changes, newborn vitality (evaluated through Apgar score and cord-blood gases analysis, and side-effects. RESULTS: There were no differences among groups, except for anesthesia quality. In groups with predominant levo-enantiomer fraction were clinically worse with the need for anesthetic complementation in three cases. Analgesia duration was longer in the ropivacaine group. CONCLUSIONS: Enantiomeric mixture 0.5% bupivacaine (S75-R25 and 0.75% ropivacaine for epidural anesthesia have provided as good conditions as racemic 0.5% bupivacaine for the surgical act. Newborn repercussions have shown that all solutions were equally safe.

  14. Sciatica caused by a dilated epidural vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Petre, C.; Wilms, G. [Dept. of Radiology, Catholic University of Leuven (Belgium); Plets, C. [Dept. of Neurosurgery, Catholic University of Leuven (Belgium)

    1999-02-01

    We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.) With 1 fig., 4 refs.

  15. Efficacy of caudal epidural injection of lidocaine, xylazine and xylazine plus hyaluronidase in reducing discomfort produced by electroejaculation in bulls.

    Science.gov (United States)

    Pagliosa, Ronaldo C; Derossi, Rafael; Costa, Deiler S; Faria, Fabio J C

    2015-11-01

    To test the hypothesis that epidural administration of lidocaine, xylazine or xylazine plus hyaluronidase provides reduced pain and stress during electroejaculation in bulls, eight 30-month-old Nellore bulls received saline solution (control), 2% lidocaine, 2% xylazine or 2% xylazine plus hyaluronidase injected into the first intercoccygeal (Co1-Co2) epidural space in randomized order. Heart rate, respiratory rate, mean arterial pressure, analgesia, animal behavior and motor blockade were evaluated before treatment and at predetermined intervals during and after treatment. Pain and stress were scored subjectively, and semen quality was evaluated. The onset of anesthetic action was significantly faster with lidocaine (3.0 ± 1.2 min) than with xylazine or xylazine plus hyaluronidase (8.9 ± 1.5 and 5.5 ± 2.6 min, P=0.021 and P=0.012, respectively), and the onset of anesthesia with xylazine plus hyaluronidase was significantly faster than that with xylazine alone (P=0.032). Treatment with xylazine or xylazine plus hyaluronidase resulted in less discomfort than treatment with lidocaine, as indicated by animal behavior. Changes in heart rate, respiratory rate and arterial pressure were within acceptable limits. Penile protrusion and semen emission occurred in all animals during all four treatments. Our results suggest that xylazine plus hyaluronidase reduced discomfort during electroejaculation more effectively than xylazine or lidocaine alone. Further experiments are necessary to determine whether electroejaculation with xylazine plus hyaluronidase is feasible for obtaining semen from Nellore bulls unaccustomed to being handled or restrained.

  16. [Factors justifying the choice of labor epidural analgesia by nulliparous women: experience at a maternity center in Antananarivo, Madagascar].

    Science.gov (United States)

    Ramorasata, J A C; Raveloson, N E; Randriamahavonjy, R; Tohaina, D; Keita, H

    2011-10-01

    Epidural analgesia is the most effective method for pain relief during labor. This 10-year exploratory descriptive study on factors underlying women's decisions to request or refuse labor epidural analgesia (LEA) was carried out at a level III maternity hospital in Antananarivo, Madagascar. All patients underwent a pre-anesthesia check-up (PAC) between 32 and 34 weeks of amenorrhea. During the PAC, a questionnaire was administered to determine socio-economic aspects, level of education, and knowledge about labor pain and LEA. In addition, LEA was proposed and patients were asked to explain their reasons for accepting or refusing the procedure. The purpose of this report was to describe the factors underlying acceptance or refusal of EA by nulliparous women. A total of 41 nulliparous women were included. Fourteen (34.14%) accepted LEA and 27 (63.86%) refused. Mean age was 27 years in the acceptance group and 25 years in the refusal group. No patient had good knowledge about LEA. Nulliparous women that accepted EA had a higher socio-economic level, expected stronger labor pain, were better informed about EA, and expressed greater confidence in medical care. In addition to economic aspects, the main reasons for refusing EA involved fear and family background.

  17. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient; Linfoma epidural primario sin afectacion vertebral en un paciente VIH positivo

    Energy Technology Data Exchange (ETDEWEB)

    Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A. [Hospital General Universitari Vall d`Hebron. Barcelona. (Spain)

    1999-05-01

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin`s lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs.

  18. Combined Spinal Epidural versus Epidural Sufentanil and Bupivacaine in Labour (Clinical and Histological comparative Study

    Directory of Open Access Journals (Sweden)

    Nagia M. Abd El Moeti, *Zinab B. Youssef, *Soaad S. Abd El Aal

    2006-12-01

    Full Text Available Introduction:- Regional analgesia provides excellent pain relif in labour. This study was designed to compare combined spinal eqidural (CSE versus epidural block using a narcotic (sufentanil and local anaesthetic bupivacaine regarding their effects on progress of labour, method of delivery, pain relif, side effects and neonatal outcome. Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study. The women were randomly allocated to receive either CSE or epidural ( 20 patient of each . In CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block, were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous blood gases. Maternal and neonatal side effects were observed. The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control group (A injected intrathecally with saline, group (B injected intrathecally with 1.5ug/kg sufentanil (low dose, and group (C injected intrathecally with 7.5ug/kg sufentanil (high dose, the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and stained for histological evaluation. Results:- The clinical study showed that no difference between the 2 groups for the degree of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of analgesia was faster with CSE technique, more patient satisfaction and more pruritis. The histological results revealed that no detectable significant neurotoxic changes with the use of small dose of intrathecal sufentanil but mild changes occurred with high

  19. A randomised controlled trial using the Epidrum for labour epidurals.

    LENUS (Irish Health Repository)

    Deighan, M

    2015-03-01

    The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9\\/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3\\/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

  20. Epidural fibrosis after permanent catheter insertion and infusion.

    Science.gov (United States)

    Aldrete, J A

    1995-11-01

    Forty-six permanent epidural catheters and life-port units were implanted in 43 patients with severe, recurrent low back pain who had been considered not to be candidates for surgical intervention and in whom other therapeutic modalities had failed. Eight cases developed epidural fibrosis (EF). For analgesia, patients received either infusions with preservative-free solutions of fentanyl and bupivacaine or daily boluses of morphine and bupivacaine. Catheters remained from 75 days to 433 days. Signs of EF appeared from 21 days to 320 days after implantation. Pain at injection or resistance to injection were initial manifestations of EF, followed by poor, and eventually, nil analgesic effect. The epidural catheters were made of either polyamide, silicone, or polyurethane. Epidurograms revealed encapsulation, narrowing, and loculation of epidural space with gradually reduced spread of the contrast material. The occurrence of EF limits the permanency of implanted epidural catheters. The infusate does not cause this complication, which appears to be a foreign body reaction due to the presence of the catheter in the epidural space.

  1. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  2. Spinal epidural abscess treated with antibiotics alone.

    Science.gov (United States)

    Pathak, Ashish; Singh, Poonam; Gehlot, Prateek; Dhaneria, Mamta

    2013-04-30

    Spinal epidural abscess (SEA) is a rare clinical condition among children. Most patients do not present with classical signs. A 13-year-old boy without any predisposing factors presented with paraparesis, bladder and bowel involvement. MRI spine demonstrated an SEA at the C7 and D1 levels on both sides of the midline with cord oedema at the C2-3 to C6 level with minimal marrow oedema in the C6 vertebral body. We treated the patient with antibiotics (ceftriaxone and vancomycin) alone. The patient showed excellent response with only minimal residual gait disturbance at the end of 6 weeks of antibiotic therapy. This is the first paediatric report of complete recovery of a patient at clinical stage 4 following antibiotic treatment alone from India. However, caution should be exercised to closely monitor the patient's recovery as any progression in the neurological state warrants surgery.

  3. Effect of clonidine premedication on postoperative sore throat and hoarseness after total intravenous anesthesia.

    Science.gov (United States)

    Maruyama, Koichi; Yamada, Takeshi; Hara, Katsumi

    2006-01-01

    To determine the effect of oral clonidine premedication on postoperative sore throat and hoarseness, we evaluated the incidence and severity of each of these complications in patients who underwent elective surgery in the supine position. The subjects were 82 patients, American Society of Anesthiologists (ASA) status I-III, aged 15-82 years. They were premedicated with either 150 microg oral clonidine and 20 mg raftidine (clonidine group; n = 41) or with 20 mg raftidine only (control group; n = 41) 2 h before anesthesia induction. General anesthesia was maintained with propofol, ketamine, fentanyl, and vecuronium, with or without epidural anesthesia. Postoperative sore throat and hoarseness were evaluated immediately after surgery and on the day after surgery. The incidences of sore throat and hoarseness tended to be higher in the clonidine group than in the control group; however, the difference did not reach statistical significance. There were no significant differences in the severity of these symptoms between the two groups. In conclusion, oral premedication with 150 microg clonidine did not prevent postoperative sore throat or hoarseness, and may have exacerbated these symptoms.

  4. Stabilizing membrane domains antagonizes anesthesia

    CERN Document Server

    Machta, Benjamin B; Nouri, Mariam; McCarthy, Nicola L C; Gray, Erin M; Miller, Ann L; Brooks, Nicholas J; Veatch, Sarah L

    2016-01-01

    Diverse molecules induce general anesthesia with potency strongly correlated both with their hydrophobicity and their effects on certain ion channels. We recently observed that several anesthetics inhibit heterogeneity in plasma membrane derived vesicles by lowering the critical temperature ($T_c$) for phase separation. Here we exploit conditions that stabilize membrane heterogeneity to test the correlation between the anesthetic potency of n-alcohols and effects on $T_c$. First we show that hexadecanol acts oppositely to anesthetics on membrane mixing and antagonizes ethanol induced anesthesia in a tadpole behavioral assay. Second, we show that two previously described `intoxication reversers' raise $T_c$ in vesicles and counter ethanol's effects in vesicles, mimicking the findings of previous electrophysiological measurements. Third, we find that hydrostatic pressure, long known to reverse anesthesia, also raises $T_c$ in vesicles with a magnitude that counters the effect of an anesthetic at relevant concen...

  5. Marsupial, insectivore, and chiropteran anesthesia.

    Science.gov (United States)

    Pye, G W

    2001-01-01

    This article covers the manual restraint and anesthesia of marsupials, insectivores, and chiroptera. Marsupials commonly kept as pets in the U.S. [e.g., eastern gray kangaroos (Macropus giganteus), Bennett's wallabies (Macropus rufogriseus), and sugar gliders (Petaurus breviceps)] are covered in detail. Marsupial species kept in zoological parks [e.g., Tasmanian devils, koalas (Phascolarctos cinereus), and common wombats (Vombatus ursinus)] are covered in less detail. Of the insectivores, only the African hedgehog (Atelerix albiventris) and the European hedgehog (Erinaceus europaeus) are commonly kept as pets and, consequently, the insectivore section concentrates on discussing these two species. The section on chiropteran anesthesia is divided into two broad categories: the megachiropterans (flying foxes and fruit bats) and the microchiropterans (insectivorous bats). Most of the information on the species covered in this article is anecdotal, and this should be kept in mind when using the anesthesia protocols described.

  6. Estimating the Incidence of Suspected Epidural Hematoma and the Hidden Imaging Cost of Epidural Catheterization: A Retrospective Review of 43,200 Cases

    Science.gov (United States)

    Henneman, Justin P.; Sandberg, Warren S.

    2013-01-01

    Introduction Hematoma associated with epidural catheterization is rare, but the diagnosis might be suspected relatively frequently. We sought to estimate the incidence of suspected epidural hematoma after epidural catheterization, and to determine the associated cost of excluding or diagnosing an epidural hematoma through radiologic imaging. Methods We conducted an electronic retrospective chart review of 43,200 patient charts using 4 distinct search strategies and cost analysis, all from a single academic institution from 2001 through 2009. Charts were reviewed for use of radiological imaging studies to identify patients with suspected and confirmed epidural hematomas. Costs for imaging to exclude or confirm the diagnosis were related to the entire cohort. Results In our analysis, over a 9-year period that included 43,200 epidural catheterizations, 102 patients (1:430) underwent further imaging studies to exclude or confirm the presence of an epidural hematoma—revealing 6 confirmed cases and an overall incidence (per 10,000 epidural blocks) of epidural hematoma of 1.38 (95% CI 0, 0.002). Among our patients, 207 imaging studies, primarily lumbar spine MRI, were performed. Integrating Medicare cost expenditure data, the estimated additional cost over a 9-year period for imaging and hospital charges related to identifying epidural hematomas nets to approximately $232,000 or an additional $5.37 per epidural. Discussion About 1 in 430 epidural catheterization patients will be suspected to have an epidural hematoma. The cost of excluding the diagnosis, when suspected, is relatively low when allocated across all epidural catheterization patients. PMID:23924685

  7. EEG entropy measures in anesthesia

    Directory of Open Access Journals (Sweden)

    Zhenhu eLiang

    2015-02-01

    Full Text Available Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs’ effect is lacking. In this study, we compare the capability of twelve entropy indices for monitoring depth of anesthesia (DoA and detecting the burst suppression pattern (BSP, in anesthesia induced by GA-BAergic agents.Methods: Twelve indices were investigated, namely Response Entropy (RE and State entropy (SE, three wavelet entropy (WE measures (Shannon WE (SWE, Tsallis WE (TWE and Renyi WE (RWE, Hilbert-Huang spectral entropy (HHSE, approximate entropy (ApEn, sample entropy (SampEn, Fuzzy entropy, and three permutation entropy (PE measures (Shannon PE (SPE, Tsallis PE (TPE and Renyi PE (RPE. Two EEG data sets from sevoflurane-induced and isoflu-rane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, phar-macokinetic / pharmacodynamic (PK/PD modeling and prediction probability analysis were applied. The multifractal detrended fluctuation analysis (MDFA as a non-entropy measure was compared.Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline vari-ability, higher coefficient of determination and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an ad-vantage in computation efficiency compared with MDFA.Conclusion: Each entropy index has its advantages and disadvantages in estimating DoA. Overall, it is suggested that the RPE index was a superior measure.Significance: Investigating the advantages and disadvantages of these entropy indices could help improve current clinical indices for monitoring DoA.

  8. Double balloon enteroscopy examinations in general anesthesia

    Institute of Scientific and Technical Information of China (English)

    Laszlo; Zubek; Lena; Szabo; Peter; Laszlo; Lakatos; Janos; Papp; Janos; Gal; Gabor; Elo

    2010-01-01

    AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the differen...

  9. Evaluate the Clinical Effects of Different Anesthesia Methods Hypertensive Disease of Pregnancy in Cesarean Section%妊娠高血压疾病剖宫产术不同麻醉方式的临床效果评价

    Institute of Scientific and Technical Information of China (English)

    陈丽蓉; 赵丽丽; 唐秦; 倪忆媚; 杨明

    2014-01-01

    目的:比较妊娠高血压疾病剖宫产术不同麻醉方式的临床效果差异,探讨适合的麻醉方法。方法选择2010年1月至2012年12月210例妊娠高血压疾病剖宫产的产妇作为研究对象,根据个体不同的病情给予不同药物进行镇静、解痉、利尿、降血压、改善心功能等治疗,按患者不同血容量或凝血功能状态,对其施行不同的麻醉方式。结果采用单纯硬膜外麻醉30例,腰麻-硬膜外联合麻醉170例,静脉麻醉10例;均顺利完成手术。单纯硬膜外麻醉在起效慢,平均(735.34±125.56)s、麻醉效果不满意,总有效83.33%;腰麻-硬膜外联合麻醉组低血压发生率较高为17.65%;静脉麻醉组新生儿 Apgar 评分(8.86±0.50)与其他两组(9.01±0.42)、(8.93±0.42)相比偏低,但无显著差异(P >0.05)。结论腰麻-硬膜外联合在妊娠高血压疾病剖宫产手术中优势明显,是一种较好的麻醉方法,对于各种原因未能成功实施椎管内麻醉及重症产妇,可选择静脉麻醉。%Objective Clinical effect comparison between hypertensive disorder complicating pregnancy cesarean section of different methods of anesthesia, investigate the anesthesia methods. Method Choose January 2010-December 2012 210 cases of pregnant women with cesarean section of the disease of hypertension as the research object, according to the individual condition given different drugs for sedation, antispasmodic, diuretic, reducing blood pressure, improve heart function in patients with different treatment, blood volume or coagulation status, on the implementation of the different ways of anesthesia. Results 30 cases with single epidural anesthesia, combined spinal-epidural anesthesia 170 cases, 10 cases of intravenous anesthesia were successfully completed operation. Epidural anesthesia in the slow onset, averaged (735.34±125.56) s, the anesthetic effect is not satisfactory, the total effective 83

  10. The thermodynamics of general anesthesia

    CERN Document Server

    Heimburg, T; Heimburg, Thomas; Jackson, Andrew D.

    2006-01-01

    It is known that the action of general anesthetics is proportional to their partition coefficient in lipid membranes (Meyer-Overton rule). This solubility is, however, directly related to the depression of the temperature of the melting transition found close to body temperature in biomembranes. We propose a thermodynamic extension of the Meyer-Overton rule which is based on free energy changes in the system and thus automatically incorporates the effects of melting point depression. This model provides a quantitative explanation of the pressure reversal of anesthesia. Further, it explains why inflammation and the addition of divalent cations reduce the effectiveness of anesthesia.

  11. Spinal epidural abscess following glossectomy and neck dissection: A case report

    OpenAIRE

    Esther Cheng; Eric Thorpe; Richard Borrowdale

    2016-01-01

    Introduction: Spinal epidural abscess is an uncommon but potentially life threatening entity that rarely occurs after otolaryngology procedures. Presentation of case: We report a case of a diabetic patient who presented with a lumbar spinal epidural abscess eight days after head and neck oncologic surgery. Magnetic resonance imaging revealed an L4 spinal epidural abscess. Cultures from the spinal epidural abscess, blood, urine, and the previous neck incision grew Klebsiella pneumoniae. The...

  12. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    Energy Technology Data Exchange (ETDEWEB)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C. [Department of Radiology, University of Pisa, Via Roma 67, I-56 100 Pisa (Italy); Pifferi, M.; Baldini, G. [Department of Pediatrics, University of Pisa, Pisa (Italy)

    1997-12-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.) With 2 figs., 9 refs.

  13. EFFICACY OF TRANSFORAMINAL EPIDURAL STEROID INJECTION IN LUMBOSACRAL RAD