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Sample records for anesthesia spinal

  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. Transverse myelitis following spinal anesthesia

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    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.

  3. Spinal morphine anesthesia and urinary retention.

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    Mahan, K T; Wang, J

    1993-11-01

    Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.

  4. Transient Neurological Symptoms after Spinal Anesthesia

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    Zehra Hatipoglu

    2013-02-01

    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  5. Testing haptic sensations for spinal anesthesia.

    LENUS (Irish Health Repository)

    2011-01-01

    Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts\\' perceptions of the equivalent clinical events.

  6. Phrenic nerve blocage with spinal anesthesia for laparoscopic Nissen fundoplication

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    Murat Dursun

    2015-06-01

    Full Text Available In this case, we describe a patient having laparoscopic Nissen fundoplication (LNF under spinal anesthesia with phrenic nerve blockade. It’s emphasized that in this type of operations, spinal anesthesia may be an alternative method rather the general anesthesia and the resulting shoulder pain in laparoscopic surgery performed under spinal anesthesia can be prevented by phrenic nerve blockade. J Clin Exp Invest 2015; 6 (2: 186-188

  7. Low dose spinal anesthesia for knee arthroscopy

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    Lakhin R.E.

    2015-06-01

    Full Text Available Objective: to evaluate the nature of unilateral spinal anesthesia using various modes of administration of low doses of hyperbaric bupivacaine. Materials and Methods. Prospectively, the randomized study included 56 patients undergoing knee arthroscopy. In the control group bupivacaine of 5mg was administered simultaneously, in the main group — fractionally by 2.5 mg. The development of thermal and pain blocks from different sides was investigated. The data were statistically processed. Results. In the control group, the positioning of the patient usually began after the entire dose of anesthetic had been administered. In the case of temperature paresthesia in the area of the sacral segments of the full anesthesia throughout underlying limb was not always achieved. In 6 cases of block was not sufficient. In the main group patient positioning was performed after the administration of 2.5 mg of anesthetic and evaluate temperature paresthesia and in 2 cases the total dose was increased to 7.5 mg. The successful development of sensory block at fractional administration was significantly higher than in the single-step introduction. Conclusion. Temperature paresthesia occurs within the first minute and is an early predictor of developing spinal anesthesia. The area of arising paresthesia shows preferential distribution of the anesthetic. In the application of low dose local anesthetic the desired upper level of anesthesia via the patient positioning and dose adjustment may be achieved.

  8. A case of acute spinal intradural hematoma due to spinal anesthesia

    Institute of Scientific and Technical Information of China (English)

    Josu M Avecillas-Chasn; Jordi A Matias-Guiu; Gustavo Gomez; Javier Saceda-Gutierrez

    2015-01-01

    Spinal intradural hematoma is a rare complication of diagnostic lumbar puncture or spinal anesthesia. This complication could be overlooked with devastating neurological consequences due to a delay in diagnosis. Here, we reported a case of a patient with a lumbar spinal intradural hematoma as a result of a difficult spinal anesthesia.

  9. Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

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    S.M.R. Rabani

    2010-01-01

    Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

  10. Total Extraperitoneal Preperitoneal Laparoscopic Hernia Repair Using Spinal Anesthesia

    OpenAIRE

    2006-01-01

    Background: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP)....

  11. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  12. [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.

  13. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

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    Luiz Eduardo Imbelloni

    2014-01-01

    Full Text Available Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO 2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T 3 . Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher′s exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89% patients. There were significant differences in time to reach T 3 , obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher

  14. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  15. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    2015-01-01

    BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  16. Comparison of Anesthesia Quality for Arthroscopic Knee Surgery: Combined Sciatic Femoral Block and Unilateral Spinal Anesthesia

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    Sinem Sarı

    2015-08-01

    Full Text Available Objective: We aimed to evaluate the quality of anesthesia of combined sciatic and femoral 3-in-1 nerve blocks (CSFB and unilateral spinal anesthesia technique with low-dose levobupivacaine in outpatients undergoing knee arthroscopy surgery. Materials and Methods: Forty American Society of Anesthesiologists (ASA physical status I-II patients were randomly allocated into two groups and unilateral spinal anesthesia with low-dose levobupivacaine (group S, n=20 or CSFB (group B, n=20 was performed. Besides the quality of anesthesia, anesthetic effectiveness, hemodynamic values, duration of the technique application, maximum motor and sensorial block levels and durations, the first analgesics need, and total analgesic consumptions during postoperative 24 hours and determined complications were compared between the two groups. Results: The quality of anesthesia was better in group S, no patient received either sedation or analgesic intraoperatively while first analgesic need and number of patient was higher (p=0.014, p<0.001, p=0.032 respectively. The duration of technical application was shorter while maximum motor and sensorial block levels were higher in group S (p<0.0001, p=0.008, p<0.001 respectively. Motor block duration was significantly longer in group B (p<0.0001. Conclusion: We concluded that CSFB practice is an effective anesthetic alternative for unilateral spinal anesthesia. Introduction

  17. Dexmedetomidine for the prevention of shivering during spinal anesthesia

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    Burhanettin Usta

    2011-01-01

    Full Text Available PURPOSE: The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. METHODS: Sixty patients (American Society of Anesthesiologists physical status I or II, aged 18-50 years, scheduled for elective minor surgical operations under spinal anesthesia with hyperbaric bupivacaine, were enrolled. They were administered saline (group C, n = 30 or dexmedetomidine (group D, n = 30. Motor block was assessed using a Modified Bromage Scale. The presence of shivering was assessed by a blinded observer after the completion of subarachnoid drug injection. RESULTS: Hypothermia was observed in 21 patients (70% in group D and in 20 patients (66.7% in group C (p = 0.781. Three patients (10% in group D and 17 patients (56.7% in group C experienced shivering (p = 0.001. The intensity of shivering was lower in group D than in group C (p = 0.001. Time from baseline to onset of shivering was 10 (5-15 min in group D and 15 (5-45 min in group C (p = 0.207. CONCLUSION: Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.

  18. Determination of Rate of Hearing Changes After Spinal Anesthesia

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    F Omidi

    2008-07-01

    Full Text Available Introduction: Hearing loss after surgery is reported rarely. Its prevalence rate is different and reported to be between 3-92%. Hearing loss is often subclinical and not diagnosed without audiometry. The aim of this study was to determine rate of hearing changes after spinal anesthesia in patients undergoing surgery with spinal anesthesia. Methods: In this descriptive study, forty male patients scheduled for repair of inguinal hernia under spinal anesthesia were selected by simple sampling method. Before surgery, audiometry was performed for both the ears of the patients. Audiomatery was performed again by the audiometry specialist on day one, five, fifteen and two months after surgery. Results: Hearing loss was observed in 13 (32.5% patients. Hearing loss in 12 patients (92% was in low hearing frequency range and 1 patient (8% was in mid hearing frequency. Hearing loss in 8 patients (61% was ipsilateral and in 5 patients (39% was bilateral. Hearing loss in 9 patients (69% on 5th day and 2 patients (5/15% on 15th day resolved spontaneously. Conclusion: Results of this study conformed that hearing loss after spinal anesthesia is not a serious problem and can resolve spontaneously. It seems that there is relationship between hearing loss and headache.

  19. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery

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    Seyyed Mostafa Moosavi Tekye

    2014-06-01

    Full Text Available Introduction: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to the intra- and postoperative advantages and complications of each technique. Material and methods: Spinal anesthesia was induced with 0.5% hyperbaric bupivacaine and a 25-G Quincke needle (Dr. J in two groups of patients with physical status ASA I-II who had been admitted for orthopedic surgeries. In group A, dural puncture was performed with the patient in a seated position using 2.5 cm3 of hyperbaric bupivacaine. Each patient was then placed in the supine position. In group B, dural puncture was performed with the patient in the lateral decubitus position with 1.5 cm3 of hyperbaric bupivacaine. The lower limb was the target limb. The speed of injection was 1 mL/30 s, and the duration of time spent in the lateral decubitus position was 20 min. Results: The demographic data were similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group A (p = 0.00. The duration of motor and sensory block was shorter in group B (p < 0.05. The success rate for unilateral spinal anesthesia in group B was 94.45%. In two patients, the spinal block spread to the non-dependent side. The incidence of complications (nausea, headache, and hypotension was lower in group B (p = 0.02. Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during orthopedic surgery on a lower limb. Patients were more satisfied with this technique as opposed to the conventional approach. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.

  20. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

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    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

  1. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

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    Lucía Vizcaíno-Martínez

    2014-01-01

    Full Text Available Objective: The aim was to evaluate general anesthesia (GA plus ilioinguinal nerve block (IIB versus spinal anesthesia (SA in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001 and at discharge (P < 0.001 in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001, with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

  2. Is it possible to predict hypotension during onset of spinal anesthesia in elderly patients?

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Haarmark, Christian; Kanters, Jørgen K

    2009-01-01

    STUDY OBJECTIVE: To evaluate the sensitivity and specificity of various predictors of hypotension during onset of spinal anesthesia in elderly patients. DESIGN: Prospective study. SETTING: 32 ASA physical status I, II, and III patients, aged >or=60 years, scheduled for elective lower limb surgery...... with spinal anesthesia. INTERVENTIONS: Patients received spinal anesthesia with 10-17.5 mg of bupivacaine. No prophylactic ephedrine or fluid preloading was used. MEASUREMENTS: A 5-minute baseline was recorded and during onset of spinal anesthesia, hemodynamic changes were measured every 10 seconds from...

  3. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

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    Donmez T

    2016-10-01

    Full Text Available Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA. To date, no reports compare the efficacy of spinal anesthesia (SA with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods: Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I or the SA TEP group (Group II. Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg and fentanyl (10 µg were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results: All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001 and 4 h (P=0.002 after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020. Conclusion: TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better

  4. Lidocaine for prolonged and intensified spinal anesthesia by coadministration of propranolol in the rat.

    Science.gov (United States)

    Chen, Yu-Wen; Chu, Chin-Chen; Chen, Yu-Chung; Hung, Ching-Hsia; Li, Yung-Tsung; Wang, Jhi-Joung

    2011-09-26

    Although the coadministration of lidocaine with propranolol interferes with the metabolic profile (pharmacokinetics), its pharmacodynamics is still unclear. In this report, we investigate whether propranolol can potentiate the effect of lidocaine. Rats received spinal anesthesia with lidocaine co-injected with propranolol. After intrathecal injections of drugs in rats, three neurobehavioral examinations (motor function, proprioception, and nociception) were performed. We showed that lidocaine and propranolol elicited a spinal blockade in motor function, proprioception, and nociception. Propranolol at the dose of 0.82 μmol/kg produced no spinal anesthesia. Co-administration of lidocaine [50% effective dose (ED(50)) or ED(95)] and propranolol (0.82 μmol/kg) produced greater spinal anesthesia than lidocaine (ED(50) or ED(95)), respectively. These preclinical findings demonstrated that propranolol and lidocaine displayed spinal anesthesia. When combined with propranolol, lidocaine elicited a supra-additive effect of spinal anesthesia.

  5. COMPARATIVE STUDY OF SPINAL ANESTHESIA AND GENERAL ANESTHESIA IN CHILDREN UNDERGOING SURGERIES BELOW UMBILICUS

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    Ashish

    2014-09-01

    Full Text Available AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group. Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

  6. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

    Science.gov (United States)

    Donmez, Turgut; Erdem, Vuslat Muslu; Sunamak, Oguzhan; Erdem, Duygu Ayfer; Avaroglu, Huseyin Imam

    2016-01-01

    Background Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). To date, no reports compare the efficacy of spinal anesthesia (SA) with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I) or the SA TEP group (Group II). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg) and fentanyl (10 µg) were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (Pinguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better patient satisfaction than GA. PMID:27822053

  7. The Study of Oral Clonidine Effect in Duration of Spinal Anesthesia with Lidocaine and Its Complications

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    M. Baalbaki

    2003-07-01

    Full Text Available There are many kinds of intervention to prolong the duration of spinal anesthesia which one of them is preoperation oral drugs. The purpose of this study was determination of clonidine effects in duration of spinal anesthesia and its complications. This study was a double - blinded randomized controlled clinical trial in 40-60 years old males of Mobasher and Ekbatan hospitals in Hamadan. In this study there were 40 cases candidated for spinal anesthesia and we divided them to 2 groups i.e. test and control then the results were recorded on questionnaire sheets. The test cases were prescribed 0.2 mg clonidine P.O. preoperatively and their duration of spinal anesthesia prolonged 11 minutes averagely and decreased its complications related to control prescribed placebo. Hence , the result showed preparation oral clonidine prolongs the duration of spinal anesthesia and decreases its complications like hypotention , nausea and vomiting.

  8. Meningitis tras anestesia espinal Meningitis after a spinal anesthesia

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    A. L. Vázquez-Martínez

    2008-03-01

    Full Text Available La meningitis post-punción es una importante complicación de la anestesia espinal. Describimos el caso de un varón de cuarenta y seis años que ingresó para tratamiento quirúrgico de una hernia umbilical, la cirugía se realizó bajo anestesia intradural. Tras la intervención el paciente comenzó con un cuadro clínico compatible con meningitis, que se confirmó tras examen del líquido cefalorraquídeo. Se trató con antibióticos a pesar de la no identificación de gérmenes, siendo la evolución favorable. El diagnóstico etiológico de una meningitis iatrogénica no siempre es posible, pero siempre debemos tener en cuenta esta posibilidad. En este artículo queremos revisar la situación actual del problema, especialmente la profilaxis y la actitud terapéutica.Post-dural puncture meningitis is a serious complication of spinal anesthesia. We describe the case of a forty six years old male who was admitted for surgical intervention of an umbilical hernia, performed under spinal anesthesia. After surgery the patient developed a clinical syndrome compatible with meningitis, the diagnosis was confirmed by examination of the cerebrospinal fluid. Broad-spectrum antibiotics were started although spinal cultures were negatives, and the patient's clinical course was favourable. The meningitis differential diagnosis may be difficult, but we must think about this possibility. In this case report ,we want to check the present situation, specially the prevention and medical treatment.

  9. Isobolographic analysis of caramiphen and lidocaine on spinal anesthesia in rats.

    Science.gov (United States)

    Chen, Yu-Wen; Chu, Chin-Chen; Chen, Yu-Chung; Wang, Jhi-Joung; Hung, Ching-Hsia

    2010-01-18

    The aims of the study were to evaluate the spinal anesthetic effect of caramiphen and also assess spinal anesthetic interactions of caramiphen with lidocaine. Lidocaine, a common local anesthetic, was used as control. Dose-dependent responses of intrathecal caramiphen on spinal anesthesia were compared with lidocaine in rats. The interactions of caramiphen with lidocaine were evaluated via an isobolographic analysis. Caramiphen and lidocaine produced a dose-dependent local anesthetic effect as spinal anesthesia. On a 50% effective dose (ED(50)) basis, the spinal anesthetic effect of caramiphen was more potent than lidocaine (P<0.01 for each comparison). Co-administration of caramiphen with lidocaine produced an additive effect. Caramiphen and lidocaine are known to have local anesthetic effects as spinal anesthesia in rats. The spinal anesthetic effects of adding caramiphen to lidocaine are similar to the combinations of other anesthetics with lidocaine.

  10. Laparoscopic cholecystectomy under continuous spinal anesthesia in a patient with Steinert's disease

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    Mariana Correia

    2016-04-01

    Full Text Available ABSTRACT Steinert's disease is an intrinsic disorder of the muscle with multisystem manifestations. Myotonia may affect any muscle group, is elicited by several factors and drugs used in general anesthesia like hypnotics, sedatives and opioids. Although some authors recommend the use of regional anesthesia or combined anesthesia with low doses of opioids, the safest anesthetic technique still has to be established. We performed a continuous spinal anesthesia in a patient with Steinert's disease undergoing laparoscopic cholecystectomy using 10 mg of bupivacaine 0.5% and provided ventilatory support in the perioperative period. Continuous spinal anesthesia was safely used in Steinert's disease patients but is not described for laparoscopic cholecystectomy. We reported a continuous spinal anesthesia as an appropriate technique for laparoscopic cholecystectomy and particularly valuable in Steinert's disease patients.

  11. Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery

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    Rahman Abbasivash

    2016-01-01

    Conclusion: At the doses of ephedrine and phenylephrine administered in this trial, phenylephrine was better to prevent hypotension during hip fracture surgery with spinal anesthesia. Higher frequency of hypotension was observed in the ephedrine group.

  12. Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia.

    Science.gov (United States)

    Jo, Youn Yi; Lee, Dongchul; Jung, Wol Seon; Cho, Noo Ree; Kwak, Hyun Jeong

    2016-10-04

    BACKGROUND Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. MATERIAL AND METHODS One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. RESULTS Hypotension occurred more frequently in the midazolam group (Pmidazolam sedation.

  13. 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.

  14. Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

    OpenAIRE

    2010-01-01

    Beyazit ZencirciKahramanmaras, TurkeyBackground: Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth.Case presentation: A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was succes...

  15. 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...

  16. Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia

    OpenAIRE

    2015-01-01

    Background During sedation with dexmedetomidine, a dose adjustment may be needed based on the invasiveness of the procedure, the patient's general condition, and their age. We aim here to determine the effective dose (ED) of dexmedetomidine to induce an adequate depth of sedation in elderly patients undergoing spinal anesthesia. Methods In this study, 47 patients aged 65 years or older, American Society of Anesthesiologists physical status I or II, undergoing spinal anesthesia were included. ...

  17. A comparison of side effects and cost for spinal andgeneral anesthesia in geriatric patients

    OpenAIRE

    E. Nasiri; R.Nemat; F. Sohail Arshadi; R.A.Mohammadpour

    2006-01-01

    AbstractBackground and purpose: There is still debate regarding advantages and disadvantages of regional versus general anesthesia techniques. Some studies suggested that regional anesthesia technique probably reduces postoperative morbidity and mortality.In this retrospective historical cohort study, we compared the cost-effectiveness for spinal and general anesthesia in elderly patients.Materials and methods : A total of 120 medical records of elderly participants whom underwent general or ...

  18. Unanticipated cardiac arrest under spinal anesthesia: An unavoidable mystery with review of current literature.

    Science.gov (United States)

    Kumari, Anita; Gupta, Ruchi; Bajwa, Sukhminder Jit Singh; Singh, Amrinder

    2014-01-01

    Cardiac arrest during anesthesia and perioperative period is a matter of grave concern for any anesthesiologist. But such mishaps have been reported for one reason or the other in the literary sciences. We are reporting the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in two young and healthy patients. Fortunately, these patients were successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. Occurrence of such cases needs timely reporting and exploring all the possible causes of these unusual and possibly avoidable events. The present case reports are an important addition to a series of recently published mishaps that occurred during spinal anesthesia in young and healthy patients.

  19. The Effect of Ondansetron and Dexamethasone on Nausea and Vomiting under Spinal Anesthesia

    Science.gov (United States)

    Kalani, Navid; Zabetian, Hasan; Sanie, Mohammad Sadegh; Deylami, Mansour; Radmehr, Mohammad; Sahraei, Reza; Kargar Jahromi, Hossein; Kooti, Wesam

    2017-01-01

    BACKGROUND During abdominal surgery under regional anesthesia, nausea may happen due to several contributing factors. This study compared the effects of ondansetron and dexamethasone on nausea and vomiting under spinal anesthesia. METHODS One hundred and twenty patients of 15 to 35 years old with ASA class I and II were enrolled. Before administering either ondansetron or dexamethasone, blood pressure and heart rate of the patients were recorded. The patients received 70 mg of 5% lidocaine for spinal anesthesia. Patients who received 6 mg of ondansetron were considered as group A, while group B received 8 mg of dexamethasone. The level of nausea and vomiting, blood pressure, heart rate and respiratory rate of each patient was measured at 1, 5, 10, 15 and 30 minutes after spinal anesthesia and during recovery (every 5 minutes). RESULTS There was a significant difference between nausea and vomiting between the two groups after spinal anesthesia within the first and fifth minutes. There was no significant difference between nausea and vomiting between the two groups within 10, 15 and 30 minutes and during recovery at 5, 10, 15 and 30 minutes. CONCLUSION Dexamethasone and ondansetron were shown to equally reduce the incidence of nausea and vomiting under spinal anesthesia and can be recommended as a good choice for prevention of nausea and vomiting during surgeries. PMID:28289619

  20. Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

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    Sunder Goyal

    2012-08-01

    Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg pneumoperitoneum and under spinal anesthesia over a span of one and a half years. Injection bupivacaine (0.5% was used for spinal anesthesia. All ports were made in a head-down position to avoid hypotension. Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases. Results: We successfully performed the operations in 145 patients without major complications. Spinal anesthesia was converted to general anesthesia in five patients due to severe shoulder pain. Age varied between 21 and 75 years. Duration of operation time (skin to skin was between 40 and 80 minutes. Twenty-nine patients complained of right shoulder pain. Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam. Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia. Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia. [Arch Clin Exp Surg 2012; 1(4.000: 224-228

  1. Evaluation of latent period of temperature sensitivity in traditional and unilateral spinal anesthesia

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    Lakhin R.E.

    2015-09-01

    Full Text Available Objective: evaluation of the differences in the level of temperature, sensory and motor blockade during the various techniques of spinal anesthesia. Materials and Methods. Prospectively the randomized study included 70 patients. In the group with conventional spinal anesthesia (n=35 15mg of bupivacaine injected quickly. In the group with unilateral spinal anesthesia (n=35 7.5mg of bupivacaine administered slowly, at a rate of 1 ml per minute. We studied the level of temperature and time, sensory and motor blockade. The data are statistically processed. Results. Reduced thermal sensitivity recorded in an average of 48 seconds as a unilateral spinal anesthesia group and the control group. Subarachnoid administration of 7.5 mg of hyperbaric bupivacaine resulted in the development of a complete motor blockade underlying lower extremity in only 16 patients (45.7%. Conclusion. Using lower dosages of bupivacaine for unilateral spinal anesthesia lowers the threshold concentration of the local anesthetic in the subarachnoid space, resulting in slower motor neuron blockade and it is not total in more than 50% of cases.

  2. Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

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    Kulkarni, Kalpana Rajendra; Naik, Amruta Girish; Deshpande, Sunetra Girish

    2016-01-01

    Background: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia. Aims: We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section. Methods: A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P Apgar score were better in group E than in group P delivered babies. Conclusion: Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery. PMID:27746565

  3. PREDICTORS OF ATTITUDE OF PARTURIENTS SELECTED FOR CESAREAN SECTION TOWARD SPINAL ANESTHESIA

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    M.R. Afhami

    2004-11-01

    Full Text Available There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. Statistical programs used were Student’s t test and Chi square for demographic characteristics. The most important factors which influenced patients’ attitude were nausea and vomiting (27%, fear of pain (34%, fear of needle puncture (15% and discomfort during return of sensory and motor functions (6%. Being awake during surgery and witnessing birth of neonate were the most pleasant stages of anesthesia (19%. It seems that providing enough and appropriate information about the procedure at preoperative visit can increase acceptance of this regional anesthetic technique.

  4. Combined spinal and general anesthesia is better than general anesthesia alone for laparoscopic hysterectomy

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    Poonam S Ghodki

    2014-01-01

    Full Text Available Context: Spinal anesthesia (SA was combined with general anesthesia (GA for achieving hemodynamic stability in laparoscopic hysterectomy. Aims: The aim of our study was to evaluate the impact of SA combined with GA in maintaining hemodynamic stability in laparoscopic hysterectomy. The secondary outcomes studied were requirement of inhaled anesthetics, vasodilators, and recovery profile. Settings and Design: We conducted a prospective, randomized study in ASAI/II patients posted for laparoscopic hysterectomy, who were willing to participate in the study. Materials and Methods: Patients were randomly assigned to receive SA with GA (group SGA or plain GA (group GA. Group SGA received 10 mg bupivacaine (heavy for SA. GA was administered using conventional balanced technique. Maintenance was carried out with nitrous oxide, oxygen, and isoflurane. Comparison of hemodynamic parameters was carried out during creation of pneumoperitoneum and thereafter. Total isoflurane requirement, need of vasodilators, recovery profile, and regression of SA were studied. Statistical analysis used: Descriptive statistics in the form of mean, standard deviation, frequency, and percentages were calculated for interval and categorical variables, respectively. One-way analysis of variance (ANOVA was applied for noting significant difference between the two groups, with chi-square tests for categorical variables and post-hoc Bonferroni test for interval variables. Comparison of heart rate (HR, mean arterial pressure (MAP, SPO2, and etCO2 was done with Student′s t-test or Mann-Whitney test, wherever applicable. Results: Patients in group SGA maintained stable and acceptable MAP values throughout pneumoperitoneum. The difference as compared to group GA was statistically significant (P < 0.01. Group GA showed additional requirement of metoprolol (53.33% and higher concentration of isoflurane (P < 0.001 to combat the increased MAP. Recovery was early and quick in group SGA as

  5. Effect of phenylephrine vs. ephedrine on frontal lobe oxygenation during caesarean section with spinal anesthesia

    DEFF Research Database (Denmark)

    Foss, Visti T; Christensen, Robin; Rokamp, Kim Z

    2014-01-01

    BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether that is th......BACKGROUND: During caesarean section spinal anesthesia may provoke maternal hypotension that we prevent by administration of phenylephrine and/or ephedrine. Phenylephrine is however reported to reduce the near infrared spectroscopy-determined frontal lobe oxygenation (ScO2) but whether...... that is the case for patients exposed to spinal anesthesia is not known. OBJECTIVES: To evaluate the impact of phenylephrine vs. ephedrine on ScO2during caesarean section with spinal anesthesia in a single center, open-label parallel-group study with balanced randomization of 24 women (1:1). Secondary aims were...... anesthesia, ephedrine maintains frontal lobe oxygenation and maternal heart rate with a similar increase in fetal heart rate as elicited by phenylephrine. TRIAL REGISTRATION: Clinical trials NCT 01509521 and EudraCT 2001 006103 35....

  6. Hyperbaric oxygen therapy in sudden sensorineural hearing loss following spinal anesthesia: case reports.

    Science.gov (United States)

    Carneiro, Sandra N; Guerreiro, Ditza V; Cunha, Anita M; Camacho, Óscar F; Aguiar, Isabel C

    2016-01-01

    The management of sudden sensorineural hearing loss following spinal anesthesia is currently an open problem. Several strategies have been used with variable results and, to the best of our knowledge, there are no prior accounts in the literature on the use of hyperbaric oxygen therapy in the treatment of this complication. We report two cases of acute onset of unilateral hearing loss after spinal anesthesia, with significantly improved results after hyperbaric oxygen therapy. A hypothesis on the possible mechanism behind this complication is discussed. A relation is established between hyperbaric oxygen therapy and this hypothetical mechanism, in order to explain successful results in the reported cases.

  7. Intracranial subdural hematoma after spinal anesthesia for cesarean section: Case report and review of literature

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    Uma Srivastava

    2014-01-01

    Full Text Available Subdural hematoma (SDH is a rare but serious complication of spinal anesthesia. We report a case of intracranial SDH in a patient developing 11 days after spinal anesthesia for cesarean section. The patient complained of headache on the 2nd post-operative day that was relieved by analgesics, bed rest and hydration. Later she presented with severe headache, vomiting, dizziness, dysarthria, irritability and somnolence. Diagnosis of the left sided SDH was confirmed radiologically and treated surgically. The patient recovered completely. The report highlights the need of considering the possibility of SDH in patients when postdural puncture headache is prolonged or recurs after a headache free period with neurological symptoms.

  8. 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.

  9. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia.

    Science.gov (United States)

    Wang, Jinguo; Li, Hongqin; Ma, Haichun; Wang, Na

    2016-01-01

    Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

  10. Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients

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    Alaa Abdel aziz Niazi

    2015-01-01

    Conclusion: Urinary retention is more common after spinal than general anesthesia in orthopedic patients. Adding narcotics to the local anesthetics intrathecally causes more incidence of postoperative urinary retention, which may delay patients discharge and transabdominal ultrasonography is a reliable, noninvasive, inexpensive and simple method to measure bladder volume postoperatively.

  11. EFFECT OF NITROUS OXIDE INHALATION ON CHANGES IN SENSORY BLOCK IN PATIENTS UNDERGOING SPINAL ANESTHESIA

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    SEYED JALAL HASHEMI

    2003-03-01

    Full Text Available Introduction: Spinal Anesthesia is a successful method for most surgical procedures on lower extremities and lower abdomen. Occasionally the duration of sensory blockade is shorter than the duration of the surgical procedures resulting in painful stress and discomfort. In one research, inhalation of N2O during spinal anesthesia provided analgesic effects and enhanced the level of sensory blockade. Our study evaluated the effects of N2O on the duration of sensory blockade in spinal anesthesia. Methods: In this double blind randomized controlled clinical trial, 80 adult patients who were candidates for lower extremity or lower abdominal surgery were randomly divided into two group received 500k N2O plus 50% O2 by inhalation and control group received 02 without N2O. Block level and the duration of T6 and T10 blockade were determined mean, systolic and diastolic blood pressures and heart rate recorded. Statistical analysis was performed by t-test. Results: The duration of sensory blockade above T6 and T10 levels in patients receiving N2O plus O2 was significantly superior to that in the control group (P < 0.05. The mean changes in the heart rate and systolic, diastolic, and mean arterial blood pressures, were not significantly different between two groups. Discussion: Our results, show that N2O inhalation during spinal anesthesia enhances the duration of sensory block making this technique more piratical and appropriate. It also provided move homodynamic stability any adverse effects.

  12. Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia

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    Jinguo Wang

    2016-01-01

    Full Text Available Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP. Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS, and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

  13. Safe spinal anesthesia in a woman with chronic renal failure and placenta previa

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    Beyazit Zencirci

    2010-05-01

    Full Text Available Beyazit ZencirciKahramanmaras, TurkeyBackground: Chronic renal failure is strongly associated with poor pregnancy outcome. Women dependent on hemodialysis before conception rarely achieve a successful live birth.Case presentation: A 31-year-old multiparous Turkish woman was scheduled for cesarean section under spinal anesthesia at 37 weeks and five days’ gestation because of hemorrhage due to secondary placenta previa. Spinal anesthesia with 8 mg of hyperbaric bupivacaine was successfully performed. Invasive blood pressure, central venous pressure, and heart rate were stable during the surgery. The mother returned to regular hemodialysis on the first postoperative day.Conclusion: Pregnancy is uncommon in women with chronic renal failure requiring chronic dialysis. Rates of maternal hypertension, pre-eclampsia, anemia, and infection in the pregnant chronic dialysis patient are high. However, our findings suggest that with careful, close, and effective monitoring preoperatively and intraoperatively, spinal anesthesia can be safely performed for cesarean section in patients undergoing hemodialysis.Keywords: chronic renal failure, pregnancy, spinal anesthesia, hemodialysis, placenta previa

  14. The addition of lidocaine to bupivacaine does not shorten the duration of spinal anesthesia

    DEFF Research Database (Denmark)

    Jacobsen, Jon; Husum, Bent; Staffeldt, Henrik

    2011-01-01

    The duration of spinal anesthesia with bupivacaine is often too long for day surgery. A recent study of patients presenting for transurethral surgery suggested that the addition of a small amount of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of the sensory and motor...

  15. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

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    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  16. The stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients.

    Science.gov (United States)

    Zhu, Li; Tian, Chun; Li, Min; Peng, Ming-Qing; Ma, Kun-Long; Wang, Zhong-Lin; Ding, Jia-Hui; Cai, Yi

    2014-11-01

    Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine.

  17. Investigating the Effects of Adding Fentanyl to Bupivacaine in Spinal Anesthesia of Opium-addicted Patients

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    H Satari

    2014-10-01

    Full Text Available Introduction: Spinal anesthesia in opium-addicted patients can be associated with many complications. Hence, this study aimed to investigate sensory and motor block characteristics, duration of postoperative analgesia, hemodynamic and side effects by adding Fentanyl to bupivacaine in spinal Anesthesia of opium-addicted patients. Methods: In a double-blind randomized clinical trial, 60 American society of Anesthesiology (ASA class I and II opium-addicted patients under spinal anesthesia in lower abdominal and lower limb operations were randomly classified into two groups of spinal anesthesia with bupivacaine and bupivacaine-fentanyl. Clinical symptoms, side effects, the duration of sensory and motor block, initiation of analgesia requirement and sensory block were assessed. Results: The study results indicated no significant difference between bupivacaine and bupivacaine-fentanyl groups in regard with demographic, side effects, blood pressure and heart rate, though a significant difference was observed in respiratory rate 5min, 10min, 45min, 75min and 90 min after block. Duration of sensory (100.33 to 138.83 and motor block (93.43 to 107.66 and , initiation of analgesia requirement (165.33 to 187.76 was significantly longer in bupivacaine-fentanyl, though initiation of sensory block (8.83 to 4.93 was significantly longer in bupivacaine. Conclusion: Addition of fentanyl to bupivacaine in spinal anesthesia increases the duration of sensory and motor block and initiation of analgesia requirement in opium-addicted patients and also decreases initiation of sensory block in these patients.

  18. [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.

  19. EFFECT OF ORAL CLONIDINE PREMEDICATION ON THE ONSET AND DURATION OF SPINAL ANESTHESIA WITH HYPERBARIC BUPIVACAINE

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    Shruthi

    2014-09-01

    Full Text Available BACKGROUND: Spinal anesthesia is the most common technique used for lower abdominal surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence in our study, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status. METHODS: Prospective randomized, double – blinded placebo, control study, two groups of thirty patients each were selected. One group (Group C received 150μg clonidine tablets and the other group (Group B received placebo, 90 minutes before anesthesia. Primary outcome were sedation, onset and duration of sensory and motor blockade. Hemodynamic and other effects of the study drug were the secondary outcomes. RESULT: It was observed that clonidine premedication resulted in higher incidence of moderate sedation, hastens the onset of sensory block but has no effect on the onset of motor blockade. It prolonged the duration of sensory and motor blockade. Clonidine at a dose of 150μg is not associated with any greater change in heart rate and blood pressure following spinal anesthesia. CONCLUSION: We conclude that oral clonidine premedication,in patients with hyperbaric bupivacaine hastesns the onset of sensory block and prolongs the duration of sensory and motor anesthesia with moderate sedation.

  20. Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia

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    Suman Chattopadhyay

    2014-01-01

    Full Text Available This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5% patients underwent spinal anesthesia (SA and 27 (15.5% patients had general anesthesia (GA. Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P<0.001. Patients receiving GA had a higher mortality (25.9% versus 1.4%; P<0.001. The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P<0.01 and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P<0.05. To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

  1. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: A comparative study

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    Pratibha Jain Shah

    2016-01-01

    Full Text Available Background and Aims: There has been a paradigm shift of focus toward quality of spinal anesthesia with sedation being an integral aspect of this regional anesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anesthesia. Material and Methods: A total of 120 patients of age group 18-60 years of American Society of Anesthesiologists grade I & II, posted for surgeries under spinal anesthesia were randomly divided in to three groups (n = 40 each; Group D received infusion of dexmedetomidine 1 μg/kg over 10 min followed by maintenance infusion of 0.5 μg/kg/h. Group P received infusion of propofol 6 mg/kg/h for 10 min followed by the infusion maintenance of 2.5 mg/kg/h. Group C (control group received normal saline. Level of sedation (using observer′s assessment of alertness/sedation score, pain intensity (by visual analogue scale, onset and recovery from sedation, hemodynamic changes, and overall patient′s satisfaction were assessed. Results: The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001 however intraoperative sedation (level 4, and overall patient′s satisfaction was significantly better with dexmedetomidine group (p < 0.05. Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs. 139.60 ± 3.03 min; P = 0.0013. Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05. Conclusion: Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient′s satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during spinal anesthesia.

  2. Comparison between general anesthesia and spinal anesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial

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    Writuparna Das

    2015-01-01

    Full Text Available Background: Laparoscopy though minimally invasive produces significant hemodynamic surge and neuroendocrine stress response. Though general anesthesia (GA is the conventional technique, now-a-days, regional anesthesia has been accepted for laparoscopic diagnostic procedures, and its use is also being extended to laparoscopic surgeries. Objective: The aim was to compare the hemodynamic surge and neuroendocrine stress response during laparoscopic cholecystectomy (LC under GA and spinal anesthesia (SA in American Society of Anesthesiologists (ASA PS 1 patients. Materials and Methods: Thirty ASA physical status I patients, aged 18-65 years were randomly allocated into two equal groups of 15 each. Group A received GA with controlled ventilation. Patients were preoxygenated for 5 min with 100/5 oxygen, premedicated with midazolam 0.03 mg/kg intravenous (i.v, fentanyl 2 mcg/kg i.v; induction was done with thiopentone 3-5 mg/kg i.v; intubation was achieved after muscle relaxation with 0.5 mg/kg atracurium besylate i.v. Anesthesia was maintained with 1-2% sevoflurane and N2O:O2 (60:40 and intermittent i.v injection of atracurium besylate. Group B SA with 0.5% hyperbaric bupivacaine and 25 μg fentanyl along with local anesthetic instillation in the subdiaphragmatic space. Mean arterial pressure, heart rate (HR, oxygen saturation, end tidal carbon-dioxide were recorded. Venous blood was collected for cortisol assay before induction and 30 min after pneumoperitoneum. All data were collected in Microsoft excel sheet and statistically analyzed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA. All numerical data were analyzed using Student′s t-test and paired t-test. Any value <0.05 was taken as significant. Results: Mean arterial pressure and mean HR and postpneumoperitoneum cortisol level were lower in group B than group A though the difference was not statistically significant in hemodynamic parameters but significant in case of cortisol

  3. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

    OpenAIRE

    Walid Hamed Nofal; Mohamed Sidky Mahmoud; Azza Atef Abd Al Alim

    2014-01-01

    Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placeb...

  4. Lumbar spinal anesthesia with cervical nociceptive blockade. Critical review of a series of 1,330 procedures

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    Percio Ramón Becker Benitez

    2016-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT: Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION: Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.

  5. Black esophagus (acute esophageal necrosis) after spinal anesthesia.

    Science.gov (United States)

    Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viaño López, P M

    2014-01-01

    Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

  6. Producing patient-avatar identification in animation video information on spinal anesthesia by different narrative strategies.

    Science.gov (United States)

    Høybye, Mette Terp; Vesterby, Martin; Jørgensen, Lene Bastrup

    2016-06-01

    Visual approaches to health information reduce complexity and may bridge challenges in health literacy. But the mechanisms and meanings of using animated video in communication with patients undergoing surgery are not well described. By comparing two versions of a two-dimensional animated video on spinal anesthesia, this study tested the patient-avatar identification within two different narrative models. To explore the perspectives of total hip arthroplasty, we employed qualitative methods of interviews and ethnographic observation. The animated presentation of the spinal anesthesia procedure was immediately recognized by all participants as reflecting their experience of the procedure independent of the narrative form. The avatar gender did not affect this identification. We found no preference for either narrative form. This study supports the potential of animation video in health informatics as a didactic model for qualifying patient behavior. Animation video creates a high degree of identification that may work to reduce pre-surgical anxiety.

  7. Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia.

    LENUS (Irish Health Repository)

    2012-12-27

    STUDY OBJECTIVE: To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment. DESIGN: Prospective interventional study. SETTING: Academic medical center. SUBJECTS: 27 medical interns inexperienced in the technique of spinal anesthesia or dural puncture and within 12 months of graduating from medical school, were randomly assigned to a conventional or a simulator-based teaching course of spinal anesthesia: 13 were recruited to the Conventional Group (CG) and 14 to the Simulator Group (SG). MEASUREMENTS: A SenseGraphic Immersive workbench and a modified Phantom desktop with shutter glasses were used to create a teaching environment. Outcomes of teaching were assessed in two phases within three weeks of the teaching course: Phase I consisted of a written examination followed by assessment on the simulator. A global rating scale and a task-specific checklist were used. Phase II (for those participants for whom a suitable opportunity arose to perform spinal anesthesia under supervision within three wks of the teaching course) consisted of structured observation of clinical performance of the procedure in the operating room. Participants were assessed by independent, study-blinded experts. Student\\'s two-tailed impaired t-tests were used to compare the parametric outcomes (P < 0.05 was considered significant). MAIN RESULTS: All participants completed the written test successfully with no difference between groups. Ten participants from CG and 13 from SG completed the simulator-based testing performing similarly in terms of the global rating scale. Five participants in CG and 6 in SG proceeded to clinical testing. On the global rating scale, interns in SG scored higher than those in CG. They performed similarly according to the task-specific checklist. CONCLUSIONS: Overall, no difference was measured between those taught with

  8. Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery

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    Nadia Bani-hashem

    2011-01-01

    Full Text Available Objectives: Spinal anesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic. Intrathecal local anesthetics have limited duration. Different additives have been used to prolong spinal anesthesia. The effect of corticosteroids in prolonging the analgesic effects of local anesthetics in peripheral nerves is well documented. The purpose of this investigation was to determine whether the addition of dexamethasone to intrathecal bupivacaine would prolong the duration of sensory analgesia or not. Methods: We conducted a randomized, prospective, double-blind, case-control, clinical trial. A total of 50 patients were scheduled for orthopedic surgery under spinal anesthesia. The patients were randomly allocated to receive 15 mg hyperbaric bupivacaine 0.5% with 2 cc normal saline (control group or 15 mg hyperbaric bupivacaine 0.5% plus 8 mg dexamethasone (case group intrathecally. The patients were evaluated for quality, quantity, and duration of block; blood pressure, heart rate, nausea, and vomiting or other complications. Results: There were no signification differences in demographic data, sensory level, and onset time of the sensory block between two groups. Sensory block duration in the case group was 119±10.69 minutes and in the control group was 89.44±8.37 minutes which was significantly higher in the case group (P<0.001. The duration of analgesia was 401.92±72.44 minutes in the case group; whereas it was 202±43.67 minutes in the control group (P<0.001. The frequency of complications was not different between two groups. Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications.

  9. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

    OpenAIRE

    2016-01-01

    Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). ...

  10. The influence of high spinal anesthesia on sensitivity to midazolam sedation.

    Science.gov (United States)

    Ben-David, B; Vaida, S; Gaitini, L

    1995-09-01

    We tested whether a high spinal anesthesia may alter the susceptibility to the soporific effects of sedatives. Twenty ASA grade I and II women undergoing elective abdominal hysterectomy were randomly allocated into two groups. Patients in Group I were given a subarachnoid injection of 12 mg hyperbaric tetracaine and those patients who after 10 min had a sensory level of T4-6 (10 patients) were included in the study. Ten additional patients (Group II) received no spinal injection. Induction of anesthesia was performed on all patients by injecting 1 mg of midazolam intravenously every 30 s until the patient failed to respond to three repeated commands to squeeze the anesthetist's hand. This was considered the induction dose or end-point for the purposes of the study. Patients were then given a neuromuscular blocker, ventilated with oxygen, nitrous oxide, and a volatile anesthetic, tracheally intubated, and maintained under general anesthesia for the remainder of the operation. The dose of midazolam administered to the point of patient failure to respond to command was 7.6 +/- 0.72 mg SEM for Group I and 14.7 +/- 1.16 mg SEM for Group II, (P < 0.0001). These results support the conclusion that patients having a high spinal anesthetic are more sensitive to the sedative effects of midazolam.

  11. The Effect of Acupressure on Nausea and Vomiting after Cesarean Section Under Spinal Anesthesia

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    Heydar Noroozinia

    2013-03-01

    Full Text Available Postoperative nausea and vomiting (PONV is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section (C/S under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups (acupressure vs control groups. Subjects in the acupressure group received constant pressure by a specific wrist elastic band (without puncture of the skin on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1st, 2nd and 3rd two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery

  12. The effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia.

    Science.gov (United States)

    Noroozinia, Heydar; Mahoori, Alireza; Hasani, Ebrahim; Gerami-Fahim, Mohsen; Sepehrvand, Nariman

    2013-04-06

    Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section (C/S) under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups (acupressure vs control groups). Subjects in the acupressure group received constant pressure by a specific wrist elastic band (without puncture of the skin) on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1st, 2nd and 3rd two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery.

  13. [Acute rhabdomyolysis after spinal anesthesia for knee arthroscopy].

    Science.gov (United States)

    Bouché, P M; Chavagnac, B; Cognet, V; Banssillon, V

    2001-08-01

    We report an observation of acute rhabdomyolysis of gluteus maximum muscles occurring in a non-obese patient installed in supine position that underwent knee arthroscopy under spinal anaesthesia. The patient had insulin-dependent diabetes melitus with documented microangiopathy. The interest of this observation resides in the occurrence of the syndrome after a short period of time (one hour) of installation in the supine position in a patient that did not have any of the generally described risk factors of rhabdomyolysis.

  14. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

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    Anıl İçel Saygı

    Full Text Available CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50 and spinal anesthesia (n = 50 groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036 and gas discharge time (P = 0.049 were significantly greater and 24th hour hemoglobin difference values (P = 0.001 were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively, urine volume at the first postoperative hour (P < 0.001 and median Apgar score at the first minute (P < 0.0005 were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042, in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

  15. 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.

  16. Music and ambient operating room noise in patients undergoing spinal anesthesia.

    Science.gov (United States)

    Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

    2005-05-01

    Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia.

  17. Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial

    Science.gov (United States)

    Atashkhoei, Simin; Abedini, Naghi; Pourfathi, Hojjat; Znoz, Ali Bahrami; Marandi, Pouya Hatami

    2017-01-01

    Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S. Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher’s exact test, one-way ANOVA, Mann-Whitney U-test, and student’s t test. Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant (40.47% vs. 61.9%, P=0.08). The duration of hypotension was shorter in the study group (1.6±7.8 min vs. 7.4±12.5 min, P=0.004). The dose of ephedrine was lower in the study group (2.4±6.6 mg vs. 5.3±10.7 mg, P=0.006). The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 (16.66%) of hyperbaric groups (P=0.006). None of the neonates had Apgar score≤7 at 5 min of delivery (P=1.0). Sensory and motor block duration was shorter in the study group (P=0.01). Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S. Trial Registration Number: IRCT201401287013N7

  18. Comparison of co-administration of clonidine and pethidine with bupivacaine during spinal anesthesia

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    Farnad Imani

    2011-05-01

    Full Text Available Background: The aim of this study was to evaluate using the combination of pethidine and clonidine in order to produce synergistic effect for blocking of pain pathways in spinal cord and decrease the adverse effects of each drug and comparison it with bupivacaine.Materials and Method: This is a randomized double blind controlled clinical trial which was approved by the ethics committee of Iran University of Medical Sciences. Fifty patients (25 patients in each groups in ASA class 1 or 2 which were selected for surgery on lower limbs, entered into the study. The patients were randomly allocated in two groups and received following regimens: CP (spinal anesthesia with combination of clonidine 0.75 µgr/kg and pethidine 0.75 mg/kg and B (spinal anesthesia with bupivacaine 0.5%, 15 mg.Results: The onset time of sensory block on T10 in group CP (5.9±1.6 min was significantly less than group B (9.2±2.3 min [p<0.001]. The time to complete motor block in group CP (38.8±5.7 min was significantly longer than group B (19.6±4.7 min [p<0.001]. The time to the first analgesic request was significantly longer in the group CP (11.6±2 h than the group B (6±0.8 h [p<0.001]. Mean drop in the systolic blood pressure in group CP (22.6%±2.4% was significantly more than group B (11%±4.3% (p<0.001.Conclusion: It is recommended to use bupivacaine for anesthesia in operations on pelvis and lower limbs but it is better to co-administer clonidine and pethidine in patients who must be avoided from raising blood pressure and heart rate and with less than two hours operation time

  19. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study

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    Chilkunda N Dinesh

    2014-01-01

    Full Text Available Background and Objectives: The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. Materials and Methods: One hundred American Society of Anesthesiologists (ASA physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 μg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 μg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. Results: The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D (220.7 ± 16.5 min compared to group C (131 ± 10.5 min (P < 0.001. The level of sensory block was higher in group D (T 6.88 ± 1.1 than group C (T 7.66 ± 0.8 (P < 0.001. The duration for two-dermatomal regression of sensory blockade (137.4 ± 10.9 min vs. 102.8 ± 14.8 min and the duration of sensory block (269.8 ± 20.7 min vs. 169.2 ± 12.1 min were significantly prolonged in group D compared to group C (P < 0.001. Intraoperative Ramsay sedation scores were higher in group D (4.4 ± 0.7 compared to group C (2 ± 0.1 (P < 0.001. Higher proportion of patients in group D had bradycardia (33% vs. 4% (P < 0.001, as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C (P < 0.001. Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative

  20. Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series

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    Muhammad Babar Khan

    2014-01-01

    Full Text Available Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia. Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS and Oswestry Disability Index (ODI scores. Results: Five patients had interlaminar decompressions for stenosis alone, while two patients had laminectomies for debulking of tumors. The mean duration of surgery was 79.8 ± 16.6 min, the mean estimated blood loss was 157.1 ± 53.4 ml, the mean dose of local anesthetic was 1.9 ± 0.7 mg/kg, and the mean length of hospital stay after surgery was 3.2 ± 1.2 days. There were no intraoperative complications. The surgery resulted in improved VAS and ODI scores consistent with significant improvement in pain (P = 0.017 and functionality (P = 0.011. Conclusions: Performing spinal surgery under local anesthesia is a safe and effective alternative when patient′s major comorbidities preclude a general anesthetic. For all the seven patients studied, spinal surgery, performed under a local anesthetic, resulted in a statistically significant reduction in pain and improvement in function.

  1. 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。

  2. Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success

    Science.gov (United States)

    Nouralizadeh, Akbar; Pakmanesh, Hamid; Basiri, Abbas; Aayanifard, Mohammad; Soltani, Mohammad Hossein; Tabibi, Ali; Sharifiaghdas, Farzaneh; Ziaee, Seyed Amir Mohsen; Shakhssalim, Naser; Valipour, Reza; Narouie, Behzad; Radfar, Mohammad Hadi

    2016-01-01

    Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504 ± 350 mm2. The mean duration of surgery was 43 ± 21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate. PMID:27242949

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

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    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.

  4. Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

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    Fabio Gori

    2010-01-01

    Full Text Available Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear. Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded. Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine 131±42 min, seated 106±29 min, =.02. Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

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

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    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.

  6. Sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery

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    Ersoy, Ayşın; Kara, Deniz; Ervatan, Zekeriya; Çakırgöz, Mensure; Kıran, Özlem

    2015-01-01

    Objectives: To compare midazolam and propofol sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery with bispectral index monitoring. Methods: This prospective and randomized study was completed in the Department of Anesthesiology, Okmeydani Training and Research Hospital, Istanbul, Turkey between February 2013 and December 2014. Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun. In Group II, 1 mg/kg bolus propofol was given within 10 minutes, and then 1-3 mg/kg/hr infusion was begun. The systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, peripheral oxygen saturation values, respiratory rate, and Wilson’s 5-stage sedation score were recorded at 15-minute intervals. At the end of the operation, the recovery time and surgeon satisfaction were recorded. Results: The recovery times for patients in Group I were found to be longer than in Group II (p<0.05). The respiration rate in patients in Group I at the start of surgery, 15th minute of surgery, and after surgery were lower than in Group II (p<0.05). Conclusion: We conclude that propofol is more reliable in terms of hemodynamic stability than midazolam, as it causes less respiratory depression and faster recovery in the propofol group. PMID:26446330

  7. Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury.

    Science.gov (United States)

    Takatsuki, Akiko; Ohtsuka, Masahide

    2012-12-01

    In this case series study, we prospectively examined whether it might be possible to check the effect of spinal anesthesia (SA), based on the disappearance of lower extremity reflexes and spasticity, in patients with spinal cord injury (SCI), in whom the effect cannot be confirmed by the pinprick test or by using the Bromage scale. In 40 patients with chronic, clinically complete cervical SCI who were scheduled to receive SA, pre-anesthetic examination revealed that the Babinski sign, patellar tendon reflex, and spasticity (assessed using the Ashworth scale) were all positive in 31 patients, while two of these three pre-anesthetic assessment parameters were positive in eight patients. The effect of SA in these 39 patients (97.5 %) was confirmed by demonstrating the absence of both the Babinski sign and patellar tendon reflex and loss of spasticity after SA. Our results suggested that the effect of SA can be confirmed by the disappearance of the Babinski sign and patellar tendon reflex and loss of spasticity in most patients with complete cervical SCI, although determination of the level of the block is difficult. In conclusion, loss of the Babinski sign, patellar tendon reflex, and spasticity might be useful for checking the effect of SA in cervical SCI patients.

  8. Spinal Anesthesia and Minimal Invasive Laminotomy for Paddle Electrode Placement in Spinal Cord Stimulation: Technical Report and Clinical Results at Long-Term Followup

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    S. Sarubbo

    2012-01-01

    Full Text Available Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients’ discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients’ satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months, 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.

  9. Investigation of some factors affecting the sensory level of spinal anesthesia: position, baricity, temperature, needle direction and speed of injection

    NARCIS (Netherlands)

    R. Stienstra

    1990-01-01

    textabstractThe purpose of the studies to be presented was to investigate different factors influencing spinal anesthesia with bupivacaine 0.5 %. More specifically, the first study investigated the differences in intrathecal distribution as measured by the maximum sensory level of blockade between t

  10. Subclinical neuropathy in diabetic patients: a risk factor for bilateral lower limb neurological deficit following spinal anesthesia?

    Science.gov (United States)

    Angadi, Darshan S; Garde, Ajit

    2012-02-01

    Total knee arthroplasty performed under spinal or general anesthesia is a common successful orthopedic procedure. Nonetheless, in patients with diabetes mellitus this procedure can present unique challenges to orthopedic surgeon and anesthesiologist alike. We describe a case of an elderly male diabetic patient who developed bilaterally symmetrical lower limb neurological deficit following an uneventful total knee arthroplasty performed under spinal anesthesia. Postoperative nerve conduction study with electromyography confirmed symmetrical extensive denervation of lower limb muscles, including low-voltage fibrillation potentials and positive sharp waves. These findings were consistent with a preexisting neuropathy, thereby suggesting a subclinical neuropathy as a potential risk factor for this neurological complication. Our case highlights the fact that patients with longstanding comorbidities, namely peripheral vascular disease and diabetes mellitus, may be at an increased risk of neurological injury following regional anesthesia. Hence, we believe that preoperative evaluation of diabetic patients should include neurophysiological studies to identify subclinical neuropathy and minimize the risk of neurological injury.

  11. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  12. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  13. 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.

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

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    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

  15. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

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    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  16. Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.

    Science.gov (United States)

    Samanta, Sukhen; Samanta, Sujay; Ghatak, Tanmoy; Grover, V K

    2014-05-01

    Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.5% 1.8 mL plus 25 μg of fentanyl was used for anesthesia. Chest ultrasonography (US) and transthoracic echocardiography (TTE) were used for monitoring purposes. Spinal-induced preload reduction improved the pulmonary edema, as evidenced by chest US. Chest US and TTE helped in fluid management.

  17. [Central hemodynamic changes in children reoperated on for congenital spinal cord hernia using balanced anesthesia based on midasolam and propofol].

    Science.gov (United States)

    Diordiev, A V; Kontakevich, M M; Il'in, A V; Kusakin, V V; Ostreĭkov, I F

    2005-01-01

    The central hemodynamics was studied and analyzed in 51 patients reoperated on for congenital spinal cord hernia under balanced anesthesia based on midasolam and proforol. The procedure for anesthesiological provision of replastic repair of operated spinal hernia, which is based on propofol of bolus administration of midasolam with a hypnotic appliance, was found to cause no negative hemodynamic effects. When the benzodiazepine antagonist flumazenyl is used, the interval between the end of surgery and tracheal extubation is virtually identical in the propofol and midasolam groups since the intravenous injection of flumazenyl induces a drastic awakening effect.

  18. Using General Anesthesia plus Muscle Relaxant in a Patient with Spinal Muscular Atrophy Type IV: A Case Report.

    Science.gov (United States)

    Liu, Xiu-Fen; Wang, Dong-Xin; Ma, Daqing

    2011-01-01

    Spinal muscular atrophy (SMA) is a rare genetic disease characterized by degeneration of spinal cord motor neurons, which results in hypotonia and muscle weakness. Patients with type IV SMA often have onset of weakness from adulthood. Anesthetic management is often difficult in these patients as a result of muscle weakness and hypersensitivity to neuromuscular blocking agents as shown by (Lunn and Wang; 2008, Simic; 2008, and Cifuentes-Diaz et al.; 2002). Herein we report a case of anesthetic management of a patient with SMA type IV for mammectomy and review some other cases of SMA patients receiving different kinds of anesthesia.

  19. Evaluation of the Effect of Intravenous Lidocaein Infusion on Postoperative Analgesia after Cesarean Section under Spinal Anesthesia

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    M. H. Bakhshaei

    2013-04-01

    Full Text Available Introduction & Objective: Many surgical patients still experience moderate to severe pain after surgery despite efforts to administer new drugs and techniques. Postoperative analgesia clearly enhances patient’s satisfaction and facilitates earlier mobilization and rehabilitation. lidocaein has been introduced as part of post operative pain management and clinical studies revealed analgesic actions in patients with chronic neuropathic pain. Our goal in this study was to determine the effect of intravenous lidocaein on post operative pain of women under-going cesarean section under spinal anesthesia. Materials & Methods: In this double blinded clinical trial study, 72 patients candidate for Ce-sarean section under spinal anesthesia were randomly selected and divided in two groups. In the case group, infusion of1.5 mg/kg lidocaein and in the control group infusion of the same volume normal saline started 15 minutes before the beginning of operation. After spinal anes-thesia with definite technique in both groups, infusion of 1.5 mg/kg/h lidocaein in case group and the same volume normal saline in the control group was administered and continued till 0.5 hour after finishing the operation. Data including systolic and diastolic blood pressure, heart rate, analgesic score according VAS and using of analgesic drugs were recorded during 24 hours after the operation. Results: Pain intensity according to VAS score in the time 2,6,12 hours post operation were significantly lower in the case group ( P2= 0.05, P6 = 0.01, P12= 0.05 .Analgesic consumption in form of suppository & IV,24 hours after surgery, was significantly lower in the case group.(P=0.001. Conclusion: Lidocaein infusion can decrease pain intensity & analgesic consumption after ce-sarean section under spinal anesthesia. (Sci J Hamadan Univ Med Sci 2013; 20 (1:9-14

  20. Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

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    Walid Hamed Nofal

    2014-01-01

    Full Text Available Background: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH, also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS under spinal anesthesia. Materials and Methods: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Results: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05. Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05. The incidence of sedation was more in gabapentin group 11 (26.19% versus placebo group 3 (6.81%. Neonatal outcomes were statistically insignificant between both groups. Conclusion: Pre-operative administration of gabapentin has no effect on incidence of (PDPH but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby.

  1. Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia: A randomized double-blind study

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    Velayudha Sidda Reddy

    2013-01-01

    Full Text Available Background: Alpha 2 -adrenergic agonists have synergistic action with local anesthetics and may prolong the duration of sensory, motor blockade and postoperative analgesia obtained with spinal anesthesia. Aim: The objectives of this study are to compare and evaluate the efficacy of intravenous dexmedetomidine premedication with clonidine and placebo on spinal blockade duration, postoperative analgesia and sedation in patients undergoing surgery under bupivacaine intrathecal block. Materials and Methods: In this prospective, randomized, double-blind placebo-controlled study, 75 patients of the American Society of Anesthesiologists status I or II, scheduled for orthopedic lower limb surgery under spinal anesthesia, were randomly allocated into three groups of 25 each. Group DE received dexmedetomidine 0.5 μgkg−1 , group CL received clonidine 1.0 μgkg−1 and placebo group PL received 10 ml of normal saline intravenously before subarachnoid anesthesia with 15 mg of 0.5% hyperbaric bupivacaine. Onset time and regression times of sensory and motor blockade, the maximum upper level of sensory blockade were recorded. Duration of postoperative analgesia and sedation scores along with side effects were also recorded. Data was analyzed using analysis of variance or Chi-square test, and the value of P < 0.05 was considered statistically significant. Results: The sensory block level was higher with dexmedetomidine (T4 ± 1 than clonidine (T6 ± 1 or placebo (T6 ± 2. Dexmedetomidine also increased the time (243.35 ± 56.82 min to first postoperative analgesic request compared with clonidine (190.93 ± 42.38 min, P < 0.0001 and placebo (140.75 ± 28.52 min, P < 0.0001. The maximum Ramsay sedation score was greater in the dexmedetomidine group than other two groups (P < 0.0001. Conclusion: Premedication with intravenous dexmedetomidine is better than intravenous clonidine to provide intraoperative sedation and postoperative analgesia during bupivacaine

  2. 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

  3. SPINAL ANESTHESIA A BETTER AND EFFECTIVE ALTERNATIVE TO GENERAL ANEASTHESIA IN SPINE SURGERIES: A PROSPECTIVE OPEN LABEL SINGLE ARM STUDY

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    Kumar Babu

    2014-11-01

    Full Text Available : INTRODUCTION: In all practical purposes various thoraco lumbar and lumbar surgeries like discectomy, laminectomy and spinal fusion procedures are usually performed under general anesthesia (GA. Our aim of this study is to assess whether spinal anesthesia is a better and effective alternative to general anesthesia in terms of economic advantage and functional recovery with both intra and post-operative heamodynamic stability. METHODS: In our study hundred patients with age group 25-45 yrs within the ASA criteria of class I-III were enrolled. All patients were randomly selected based on age, sex, ASS criteria, duration of surgery, heart rate (HR, mean arterial pressure (MAP, blood loss, previous history of risk factors and co morbidities. The severity of postoperative pain based on visual analogue scale (VAS and use of analgesics post operatively, were recorded. RESULTS: There were 41 males and 59 females. The mean age of the patient was 39.28±9.27 yrs. Six patients had hypertension, 11 with diabetes. Patients with ASA Grade I and II and III were 60, 34 and 6 respectively. There were no episodes of air way compromises, 2 patients had spinal aneasthesia failures, no incidence of post dural puncture headache, 3 patients had mean blood pressure fluctuations among them, one patient had post-operative paraperesis due to hematoma treated by immediate decompression, and 13 patients had usage of propofol sedation in terms of comfort. The duration of surgery (range was 77.25±22.44 min (40-120 Severity of postoperative pain after four hours of surgery on VAS was 3.24±0.46. Twenty two patients (22% required analgesics. Two patients had post-operative vomiting. CONCLUSIONS: In our study we have considered that spinal anesthesia for advantages such as less blood loss, intra operative blood pressure and heart rate changes, postoperative pain, quick functional recovery and lower incidence of pulmonary complications. Additionally, during spinal anesthesia

  4. 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

  5. Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: a review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine.

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    Krings-Ernst, Ilana; Ulrich, Sven; Adli, Mazda

    2013-10-01

    Monoamine oxidase-(MAO)-inhibitors are a treatment of last resort in treatment resistant depression, which is regarded as a condition of increased psychiatric risk. General and regional anesthesia for elective surgery during use of long-term MAO-inhibitors remains a matter of debate because of an increased risk of drug interactions and decreased sympathetic stability. A series of case reports and new comparative studies reveal the safety of anesthesia/analgesia in non-cardiac surgery without discontinuation of the MAO-inhibitor if best effort is made for maintenance of sympathetic homeostasis and if known drug interactions are avoided. Very few reports with severe adverse incidents have been noted. Severe cardiovascular morbidity, a contraindication of MAO-inhibitors, probably contributed to peri- and postoperative complications. According to new studies, the risk of pharmacokinetic drug interactions is lower for tranylcypromine than for phenelzine. In the present case, a 66-year-old psychiatric patient on permanent treatment with 20 mg/day tranylcypromine was admitted for forefoot surgery. Anesthetic premedication consisted of 7.5 mg oral midazolam. Intravenous midazolam (0.5 mg) was dispensed for intraoperative sedation. After local anesthesia of the puncture site with 30 mg isobar prilocaine, spinal anesthesia was achieved by a single shot of 13.5 mg hyperbar bupivacaine (0.5%) intrathecally. Postoperative regional and general analgesia were accomplished by a peripheral nerve block with 50 mg isobar bupivacaine as well as oral etoricoxib and oxycodone. No peri- or postoperative complications were encountered. It is concluded that general or regional anesthesia for noncardiac surgery without discontinuation of MAO-inhibitor treatment may be a safe intervention after careful evaluation of an individual's perioperative and psychiatric risk. The increased psychiatric risk in patients treated with MAO-inhibitors outweighs the increased, however manageable

  6. COMPARISON OF INTRAVENOUS MAGNESIUM AND PLACEBO ADMINISTRATION ON POSTOPERATIVE PAIN AND ANALGESIC CONSUMPTION DURING SPINAL ANESTHESIA FOR INGUINAL HERNIA REPAIR

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    Olapour A

    2013-06-01

    Full Text Available Previous studies have suggested that magnesium may be a useful adjuvant to postoperative analgesia. We investigated efficacy of intravenous infusion of magnesium sulfate during spinal anesthesia to reduce post-operative pain and opioid consumption in patients undergoing inguinal hernia surgery.We randomly divided one hundred patients’ age 18-55 years old and ASA class I-II undergoing inguinal surgery into two groups. The magnesium group (Group M received magnesium sulfate 50 mg/kg in 100 ml normal saline intravenously within 10 minutes and 15 mg/kg/h by continuous infusion during the operation in one hour. The control group (Group S received the same amount of normal saline without magnesium sulfate. All patients received spinal anesthesia. Postoperative pain scores, meperidine consumption, and motor block were evaluated during 24 hours after surgery.Postoperative pain scores were significantly lower in Group M at 2, 3, 4 and 6 hours after surgery (P<0.05. Motor block was longer in Group M (P<0.05. Cumulative postoperative meperidine consumptions were also significantly lower in Group M at 24 h after surgery (P<0.05. 12% nausea and 26% flashing have been reported in Group M. A bolus and intravenous infusion of magnesium sulfate administration during spinal anesthesia improves postoperative analgesia. IRCT201201088645N1.

  7. [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.

  8. Study of the Effect of Dexamethasone and Normal Saline in Reducing Headache after Spinal Anesthesia in Cesarean Section

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    K Tavakol

    2007-10-01

    Full Text Available Introduction & Objective: Post dural puncture headache (PDPH is a bothersome complication of spinal anesthesia specially in young parturient women after cesarean, which causes not only psychotic and somatic problems, but also increases hospital costs due to delay in patients discharge from hospital. The purpose of this study was to determine the effect of dexamethasone in improvement of complications of PDPH after spinal anesthesia in cesarean section. Materials & Methods: This is a randomised clinical trial in which 35 cases of parturient women, aged 21-44 years, who developed pain in head (PDPH, lumbar, shoulder, or more than one site due to spinal anesthesia after cesarean section in spite of consumption of NSAID drug, opoid, bed rest, rehydration. They received intravenously drip dexamethasone 0.2mg/kg (maximum 16mg in one liter of normal saline for 2 hours. Visual analogue scale (0=no pain, 10=most unbearable pain for patients before and after dexamethasone therapy was used and recorded. Results: The most common complaints of patients were headache (87.5%, low back pain (56.2%, shoulder and neck pain (25%. Results showed that mean of VAS pain score before tretment was 6.5±1.8 and decreased to 1.6±1.2 after treatment indicating a decrease of 77% in pain among the subjects. Conclusion: The advantage of dexamethasone therapy in comparisn with routine supportive therapy is the greater rapidity in pain relief and earlier release of patients from hospital.

  9. The Effect of Subcutaneous Ketamine Infiltration on Postoperative Pain in Elective Cesarean Section under Spinal Anesthesia

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    N. Manouchehrian

    2015-01-01

    Full Text Available Introduction & Objective: Appropriate analgesia after cesarean section helps women feel more comfortable and increase the mobility of the mother's and also their ability to take better care of their newborns. The purpose of this study was to investigate the effects of subcutaneous infiltration of ketamine on postoperative pain reduction and hemodynamic status of patients after elective cesarean section. Materials & Methods: This study was designed as a double blinded prospective, randomized clinical trial and 60 cases of women undergoing elective cesarean section under spinal anes-thesia were randomly assigned into two groups. For 30 cases in the ketamine group, infiltra-tion of subcutaneous ketamine 0.5 mg / kg was administered after closure of surgical inci-sion. 30 patients in the placebo group received subcutaneous infiltration of saline. During the patient's recovery time and after transferring to the ward, the VAS of pain and vital signs were continuously assessed. if VAS ? 3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. Prescribed number of suppositories and pethidine dosage were compared. The complications, such as hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded and compared. Statistical analysis was performed by SPSS16 software and ?2 and t-test. P< 0.05 was considered statistically significant in all of the cases. Results: In the course of systolic blood pressure, heart rate and arterial blood oxygen satura-tion during the first 24 hours, no significant differences were mentioned between the two groups. At the time of arrival to the recovery room and 30 minutes later, the mean VAS was not significantly different in the groups. However, the mean VAS at 1, 2 , 4 , 6 , 8 and 12 hours after surgery were significantly lower in the ketamine group (0.61±059 than in the sa-line group (3.37±096 (P<0.001. The mean

  10. A COMPARATIVE STUDY OF BUPIVACAINE AND BUPIVACAINE WITH CLONIDINE UNDER SPINAL ANESTHESIA IN PATIENT FOR TOTAL ABDOMINAL HYSTERECTOMY

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    Manuraj

    2015-02-01

    Full Text Available BACKGROUND: Bupivacaine is the most commonly used drug for spinal anesthesia . To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenoreceptor agonist with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine and buprenorphine have shown effectiveness in i ntensifying spinal anesthesia. AIM: This study is designed to evaluate the effectiveness of spinal blockade by adding 50μgm clonidine to bupivacaine. SET TINGS AND DESIGN: This a prospective, randomized , comparative clinical study involved 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years undergoing elective hysterectomy under spinal anesthesia after approval from hospital ethics committee with written an d inform ed consent of patients. MATERIALS AND METHODS: 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years selected for the study are divided in two groups of 30 each. Group B (Bupivacaine group patients will receive intrathecally 0.5% hyperbaric bupivacaine 4 ml (Total 4 ml whereas Group C (Clonidine group patient will receive intrathecally 0.5% hyperbaric bupivacaine 3. 5 ml + 50μg (Total 4 ml. The onset time to reach peak sensory and motor level, post - operative analgesia , hem odynamic changes, and side effects were recorded. RESULTS: The onset of sensory and motor blockade was faster in the group C compared to group B [137.60 seconds and 112.22 seconds] (p<0.001, [231.80 seconds and 165.1 seconds] (p<0.001. Duration of sensor y block, motor block and postoperative analgesia [221.4 minutes in group B vs. 362.84 minutes in group C] (P<0.001, was significantly prolonged in group C. There were no significant hemodynamic changes in both the groups. CONCLUSION: Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without significant hemodynamic side

  11. 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.

  12. A comparative study on the efficacy of dexmedetomidine and tramadol on post-spinal anesthesia shivering

    Science.gov (United States)

    Kundra, Tanveer Singh; Kuthiala, Gaurav; Shrivastava, Anupam; Kaur, Parminder

    2017-01-01

    Background: Shivering is a common postanesthesia adverse event with multiple etiologies. At present tramadol is a widely used drug for the control of shivering. However, tramadol may cause a lot of nausea and vomiting. Hence, the need to find a better drug with less of side effects. The aim of this study was to compare the efficacy of dexmedetomidine and tramadol in the treatment of post-spinal anesthesia (SA) shivering as well as to compare their side-effect profile. Materials and Methods: This prospective, double-blind, randomized controlled trial was conducted in a tertiary care hospital. A total of 100 patients having shivering after SA were enrolled, out of which fifty received dexmedetomidine (Group A) and 50 received tramadol (Group B). The response rate, time to cessation of shivering and side effects (if any) was noted. All the results were analyzed using Student's t-test and Chi-square test. Results: All patients who received dexmedetomidine as well as tramadol had cessation of shivering. The time to cessation of shivering was significantly less with dexmedetomidine (174.12 ± 14.366 s) than with tramadol (277.06 ± 23.374 s) (P tramadol (16%). Nausea and vomiting was found to be higher in the case of tramadol. On the other hand, dexmedetomidine caused moderate sedation (modified Ramsay sedation score = 3–4) from which the patient could be easily awoken up. Conclusion: Dexmedetomidine offers better results than tramadol with fewer side effects. PMID:28217045

  13. [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.

  14. The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches.

    Science.gov (United States)

    McKenzie, Christine P; Carvalho, Brendan; Riley, Edward T

    2016-01-01

    Intrathecal catheter devices using a catheter-over-needle design and softer flexible material have been introduced to clinical practice with the aim of reducing some of the complications such as postdural puncture headaches and paresthesias seen with previous versions of intrathecal catheters. We present a case series of 5 cesarean deliveries using the Wiley Spinal intrathecal system (Epimed, Johnstown, New York), which was recently approved by the US Food and Drug Administration. The intrathecal catheter system consists of a flexible 23-gauge intrathecal cannula over a 27-gauge pencil-point spinal needle. The placement of the intrathecal catheter was successful in all 5 cases; however, paresthesias in 3 cases and postdural puncture headaches in 2 cases complicated the placement and use of the device. Although the unique catheter-over-needle design facilitates the use of smaller-gauge spinal needles for dural puncture and larger-gauge catheters for medication administration, this case series using the Wiley Spinal suggests that paresthesias and postdural puncture headaches may still limit its widespread utilization. Future studies are needed to determine the true incidence of complications and to determine the role of continuous spinal anesthesia in the obstetric population.

  15. The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section

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    Parisa Golfam

    2016-09-01

    Full Text Available Introduction: Post Dural puncture headache is still a common complication among young women undergone cesarean section, although use of small size spinal needles reduced its prevalence. Several methods have been suggested for prevention and treatment of this side effect; such as complete bed rest, hydration, non-opioid analgesics, caffeine, codeine, which none of them proved to be totally effective. The last option would be epidural blood patch, if headache persist. The aim of this study was evaluation the efficacy of intravenous propofol on post dural puncture headache incidence after cesarean section. Methods: In a randomized clinical trial 120 patients aged 18-45 years old in American Society of Anesthesiologist (ASA class I or II, who had no history of headache, analgesic consumption, substance abuse and drug addiction, candidate for elective cesarean section, were randomly assigned into intervention (propofol and control groups. The anesthesia method for both groups was precisely the same. After spinal anesthesia in the first group 30µg/kg/min of intravenous propofol have been infused slowly. Then at 1, 6, 18, 24 hours and 2nd to 7th days after surgery, anesthesiologist asked groups for presence or absence of headache. The data analyzed with SPSS 16.0 software. Results: Headache incidence rate in the group who receiving propofol was significantly reduced (P.V=0.001. Conclusion: This study showed that 30µg/kg/min of intravenous propofol caused reduced the incidence of post spinal headache in young women undergone elective cesarean section.

  16. Evaluation of the effect of added fentanyl to hyperbaric bupivacaine for spinal anesthesia

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    Mina Jafari-Javid

    2011-01-01

    Full Text Available Background: Potentiating the effect of the intrathecal local anesthetics by intrathecal injection of opiods for intra-abdominal surgeries is known. The objective of this study is to investigate the pain-relieving effects of intrathecal fentanyl to bupivacaine in elective caesarean surgery.Materials and Method: In a double blind clinical trial 60 patients candidate for elective cesarean section. They were studied in two groups. Cases in the control group received 12.5 mg of bupivacaine and in the study group received 8 mg of bupivacaine and 20 µg fentanyl. The parameters taken into consideration were hemodynamic stability, visceral pain, nausea and vomiting, intraoperative shivering, the amount of intraoperative administered dose of fentanyl and ephedrine and postoperative pain. Results: The average blood pressure changes after 5, 10, 20, 60 minutes were lower in the study group. Shivering and ephedrine dose during operation were lower in study group and statistically significant respectively (p=0.01, p=0.001, respectively. Duration of analgesia after operation increased from (115.5±7.5 min in control group to (138.5±9.9 min in study group, but the quality of analgesia during peritoneal manipulation did not change. Pulse rate and vomiting during operation were not statistically different between two groups.Conclusion: Reduction of local anesthetic dose with adding fentanyl may cause hemodynamic stability, increasing the postoperative pain-free time, decrease shivering and vasopressor consumption in spinal anesthesia and reduction of the amount of blood pressure drop during elective cesarean surgery

  17. ORAL CLONIDINE AS A PREMEDICATION IN SPINAL ANESTHESIA: EFFECTS ON THE DURATION OF BLOCK AND HEMODYNAMIC STATUS A RANDOMIZED DOUBLE BLIND CLINICAL TRIAL

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    K MONTAZERI

    2002-12-01

    Full Text Available Introduction. Valuable effects of oral clonidine hemodynamic instability during general anesthesia and prolongation of spinal anesthesia were approved in previous studies. In this study, the effects of clonidine as an oral premedication on the duration of block, hemodynamic status and ephedirine requirements in patients undergoing spinal anesthesia, has been evaluated. Methods. In a double blind controlled clinical trial, sixty patients of ASA class I and II, who were candidates for spinal anesthesia for lower abdominal and lower extremity surgical procedures of less than 90 minutes duration, were randomly divided into two equal groups. In interventional group, clonidine and in another control group placebo, was taken orally, 90 minutes before begining of operation. Blood pressure and pulse rate in predetermined times, the amounts of ephedrine being used, duration of sensory and motor blocks and the block level were compaired. Results. Mean changes in MAP and pulse rate at 10 minutes before and 10 minutes after induction of spinal anesthesia from basic values in the study group was more than control group (P < 0.05. Mean duration of sensory and motor block in the study group was more than the control group (P < 0.001. Mean of the ephedrine requirements in the study group (5.47 ± 7.5rng was more than the control group (1.9 ± 4.97mg (P < 0.05. Block levels was the same (P > 0.05. Discussion. It is implicated that the effect of oral clonidine premedication in prolongation the block time in spinal anesthesia is almost conclusive. But regarding more hemodynamic flactuations in the study group, the results of this study was different from studies that performed with general anesthesia. This may be due to additive effects of spinal anesthesia or inappropriate dose of clonidine. More ephedrine requirements in the study group was due to more hemodynamic instability in this group which may be decreased by modifying the clonidine dose. It is suggested

  18. Safe performance of spinal anesthesia in a critical patient with neurofibromatosis, pectus carinatum, and temporomandibular joint dysfunction: A case report

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    Zencirci Beyazit

    2010-05-01

    Full Text Available Abstract Background Neurofibromatosis is a syndrome caused by the abnormal deposition of neural tissues of the nervous system, endocrine system, visceral structures, and skin. On the other hand, pectus carinatum and temporomandibular joint dysfunction are illnesses that adversly affect the respiratory system and cause additional problems in airway management. Case Presentation Fifty-eight-year-old Turkish male patient had neurofibromatosis, pectus carinatum and temporomandibular joint dysfunction. The case was due to be operated on with the diagnosis of incarcerated umbilical hernia. Spinal anesthesia was successfully performed and the duration of the surgery was 1 hour. No postoperative complications were observed and he was discharged from the hospital on the 3rd post-operative day. Conclusion The anesthetic management of patients with neurofibromatosis requires attention to all possible abnormalities and associated disturbances. Furthermore, the presence of pectus carinatum and temporomandibular joint dysfunction also increase the potential risks. The operation was successfully completed with spinal anesthesia that was carefully applied upon taking the required measures and considering all pathologies that may accompany the case and complications that may occur.

  19. [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.

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

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    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

  1. 25G腰麻针直接用于腰麻的临床观察%25G spinal needle for spinal anesthesia directly to the clinical observation.

    Institute of Scientific and Technical Information of China (English)

    佘凡华; 欧阳静萍

    2011-01-01

    Objective To study the 25G spinal needle directly used in spinal anesthesia, and discuss its feasibility and superiority.Methods 300 patients (ASA Ⅰ ~ Ⅱ )undergoing elective surgery on the lower 1imbs or lower abdomen were randomly divided into three group.A group: use ordinary 22G inclined plane needle.B group: use the needle of combined spinal and epidural anesthesia.C group: 25G spinal needle.Send patients to patients'room when the algesia block level dissipated to T10 after operation.All the patients must in supine position for 24 hours.Postoperative follow-up was 3 days, and telephone follow-up was one month.The duration of analgesia, headache, low back pain, leg pain, and paresthesia were recorded.Results All the groups showed satisfactory anesthesia; these 3 groups showed significant difference when compared with puncture time, it was related to the operator.Postoperative follow-up: the duration of analgesia was no difference among groups; headache, leg pain and paresthesia incidence were highest in group A than others, low back pain incidence were highest in group B than others, and there were no incidence in group C.Conclusion Although the anesthesia puncture is difficult by using 25G spinal needle, there were no incidence of headache and low back pain, it had certain anesthetic effect and fewer complications, so the method is worthy of spreading to application.%目的 探讨直接将25G腰麻针用于腰麻的可行性及优越性.方法 选择择期拟行下肢或下腹部手术,随机分为3组(n=100),A组:普通22G斜面式穿刺针;B组:硬膜外和腰椎联合麻醉穿刺针;c组则直接用套件中的25G细腰穿针进行腰穿.术毕等麻醉平面消散至T10以下后送回病房.交待平卧24h.术后随访3d,1个月后电话随访,记录麻醉消散时间,有无头痛及腰痛、下肢痛或感觉异常.结果 所有患者麻醉效果满意,各组患者腰穿穿刺时间差异有统计学意义,与麻醉医生操作熟练程度有关.术

  2. 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。

  3. 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.

  4. Acute Paraplegia After General Anesthesia

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    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.

  5. Early post-operative relief of pain and shivering using diclofenac suppository versus intravenous pethidine in spinal anesthesia

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    Ali Janpour Ebrahim

    2014-01-01

    Full Text Available Background: Pain and shivering are two challenging components in the post operative period. Many drugs were used for prevention and treatment of them. The aim of this study was to compare the effects of prophylactic prescription of diclofenac suppository versus intravenous (IV pethidine in spinal anesthesia. Materials and Methods: We conducted a multi central, prospective, double-blind, randomized clinical trial on a total of 180 patients who were scheduled for surgery under spinal anesthesia including 60 patients in three groups. Patients were randomly allocated to receive 100 mg sodium diclofenac suppository or 30 mg IV pethidine or placebo. Categorical and continuous variables were analyzed by Chi-square test, t-test, Mann-Whitney and ANOVA or Kruskal-Wallis tests. Results: There was no statistical difference with regard to patient characteristics and hemodynamic indices among the three groups. Nine (15%, 10 (16.65% and 24 (40% of patients in diclofenac, pethidine and control groups reported pain and 2, 2, 7 patients received treatment due to it, respectively (P = 0.01. Prevalence of shivering in pethidine group and diclofenac group was the same and both of them were different from the control group (P < 0.001. Pruritus was repetitive in the pethidine group and was statistically significant (P = 0.036 but, post-operative nausea and vomiting was not significantly different among groups. Conclusion: A single dose of sodium diclofenac suppository can provide satisfactory analgesia immediately after surgery and decrease shivering without remarkable complications. This investigation highlights the role of pre-operative administration of a single dose of rectal diclofenac as a sole analgesic for early post-operative period.

  6. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

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    Fábio Farias de Aragão

    2014-09-01

    Full Text Available Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 μg + 50 μg/min; metaraminol group (0.25 mg + 0.25 mg/min; ephedrine group (4 mg + 4 mg/min. Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes. There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient.

  7. Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

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    Tapobrata Mitra

    2014-01-01

    Full Text Available Background: Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer′s lactate (RL or tetrastarch hydroxyethyl starch (HES or succinylated gelatin (SG in the patients undergoing cesarean section under spinal anesthesia. Materials and Methods: It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP, oxygen saturation was measured. Results: The fall in systolic blood pressure (SBP (<100 mm Hg noted among 5 (15.63%, 12 (37.5% and 14 (43.75% parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. Conclusion: RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor.

  8. Anestesia geral versus raquianestesia para colecistectomia videolaparoscópica Anestesia general versus raquianestesia para colecistectomía videolaparoscópica General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy

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    Luiz Eduardo Imbelloni

    2010-06-01

    posibilidad de realizar la colecistectomía laparoscópica bajo raquianestesia, comparándolo con la anestesia general. MÉTODO: Entre julio del 2007 y septiembre del 2008, 68 pacientes con síntomas de cálculo en la vesícula se incluyeron en el estudio. Pacientes estado físico ASA I y II, fueron aleatoriamente separados para ser operados de colecistectomía laparoscópica con neumoperitoneo con baja presión de CO2 bajo anestesia general (n = 33 o raquianestesia (n = 35. La anestesia general fue realizada con propofol, fentanil, rocuronio, sevoflurano e intubación traqueal. La raquianestesia fue realizada con 15 mg de bupivacaína hiperbárica con 20 µg fentanil hasta que el nivel sensitivo alcanzase T3· Los parámetros intraoperatorios, como el dolor postoperatorio, complicaciones, recuperación, satisfacción del paciente y coste, fueron comparados entre los grupos. RESULTADOS: Todos los procedimientos quirúrgicos se completaron con el método de elección y apenas un paciente fue convertido de la raquianestesia para la anestesia general. El dolor fue significativamente menor em 2, 4 y 6 horas después del procedimiento bajo raquianestesia, comparado con el grupo que recibió anestesia general. El coste de la raquianestesia fue significativamente menor. Todos los pacientes fueron liberados después de 24 horas. En la evaluación del postoperatorio, todos los pacientes quedaron satisfechos con la raquianestesia y recomendarían ese procedimiento. CONCLUSIONES: La colecistectomía laparoscópica con neumoperitoneo en baja presión de CO2 puede ser realizada con seguridad bajo raquianestesia. La raquianestesia estuvo asociada con un mínimo de dolor en el postoperatorio, mejor recuperación y un menor coste que la anestesia general.BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus

  9. [Caudal and spinal anesthesia in sub-umbilical surgery in children. Apropos of 1875 cases].

    Science.gov (United States)

    Aguemon, A R; Terrier, G; Lansade, A; Favereau, J P; Nathan, N; Feiss, P

    1996-01-01

    Caudal and spinal anaesthesia are two techniques widely used in European children. The aim of this retrospective study was to evaluate the applicability of this practice in developing countries. The study concerned 1875 children, 1 day to 17 years old. isobaric 0.5% bupivacaine was used for spinal anaesthesia (n = 730) and mixture a of 1% lidocaine-0.25% bupivacaine with epinephrine 1/200,000 for caudal anaesthesia (n = 1,145). Spinal anaesthesia was performed in neonates and infants (< 3 years) and caudal anaesthesia in children (aged 14 days to 17 years) undergoing urological and lower extremity surgery. No variation of heart rate, blood pressure or blood oxygen saturation (SpO2) were observed during surgery. Failure of the technique was less than 1%. These two regional anaesthesia techniques are easy to perform and are inexpensive. This is advantageous for developing countries.

  10. 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。

  11. Transient unilateral brachial plexopathy and partial Horner′s syndrome following spinal anesthesia for cesarean section

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    Jonathan A Anson

    2014-01-01

    Full Text Available A healthy 21-year-old primigravida presented for elective cesarean section. At 45 min after intrathecal (IT injection of bupivacaine, morphine and fentanyl she developed dysphagia, right sided facial droop, ptosis and ulnar nerve weakness. This constellation of signs and symptoms resolved 2 h later. Based on the time course and laterality of her symptoms, as well as the pharmacologic properties of spinal opioids, we believe her symptoms can be attributed to the IT administration of fentanyl.

  12. Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.

    Science.gov (United States)

    Udani, Ankeet D; Macario, Alex; Nandagopal, Kiruthiga; Tanaka, Maria A; Tanaka, Pedro P

    2014-01-01

    Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  13. Simulation-Based Mastery Learning with Deliberate Practice Improves Clinical Performance in Spinal Anesthesia

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    Ankeet D. Udani

    2014-01-01

    Full Text Available Introduction. Properly performing a subarachnoid block (SAB is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents’ next three patients were evaluated in the operating room (OR. Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P<0.02. The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P<0.03. The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.

  14. DEXAMETHASONE PROPHYLAXIS ON INCIDENCES OF POST-OPERATIVE NAUSEA AND VOMITING (PONV IN PATIENTS UNDERGOING GYNECOLOGICAL SURGERIES UNDER SPINAL ANESTHESIA

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    Chandrashekharappa

    2014-05-01

    Full Text Available BACK GROUND: Nausea and vomiting are the most common distressing symptom in the post-operative period. It can result in delayed hospital discharge and increased hospital cost. The present study was done to assess the effect of dexamethasone prophylaxis on the incidences of nausea and vomiting in post-operative period in patients undergoing gynecological surgeries. MATERIAL AND METHODS: A total number of 66 patients, aged between 20 to 65 years, posted for elective gynecological surgeries under spinal anesthesia were included in the study. Patients were randomized into two groups of 33 patients each, and the study group (group-D received Inj. Dexamethasone 8 mg intravenously as prophylactic antiemetic 1 hour before surgery whereas control group (group-N received normal saline. Post-operatively, the frequency of nausea and vomiting were observed and its influences on postoperative analgesia were also noted. RESULTS: In our study, 4(12.1% patients in group-D and 8(24.2% patients in group-N had nausea and vomiting in the intraoperative period (p value=0.202. 24.2% patients in group-D had vomiting in the postoperative period as compared to 72.7% in group-N and group D patients had significant reduction in incidences of nausea and vomiting in immediate post-operative period compared to group N (p-value 0.016. Accordingly, the mean requirement of rescue antiemetic was less in group- D compared to Group-N. Further, patients in group-D had better VAS scores compared to patients in group-N in post-operative period. CONCLUSION: Use of Dexamethasone prior to subarachnoid block in patients undergoing gynecological surgeries reduces the incidence of nausea and vomiting and the requirement of antiemetic in the postoperative period, and better post-operative analgesia.

  15. The incidence of transient neurologic syndrome after spinal anesthesia with lidocaine or bupivacaine: The effects of needle type and surgical position: brief report

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    Etezadi F

    2011-10-01

    Full Text Available "nBurning Transient Neurologic Syndrome (TNS which was first described by Schneider et al in 1993, is defined as a transient pain and dysesthesia in waist, buttocks and the lower limbs after spinal anesthesia.1,2 The incidence of TNS after spinal anesthesia with lidocaine is reported to be as high as 10-40%.3,4 This prospective study was designed to determine the incidence of TNS with two different types of drugs, lidocaine and bupivacaine, in lithotomy or supine positions as the primary outcomes and to determine the association between two different types of needles and surgical positions with the occurrence of TNS as the secondary outcome."nThe present study was conducted on 250 patients (ASA I-II, aged 18-60 years old, who were candidates for surgery in supine or lithotomy positions. According to the needle type (Sprotte or Quincke and the local anesthetic (lidocaine or bupivacaine all patients were randomly divided into four groups. After establishing standard monitoring, spinal anesthesia was performed in all sitting patients by attending anesthesiologists at L2-L3 or L3-L4 levels. The patients were placed in supine or lithotomy position, in regards to the surgical procedure. During the first three postoperative days, patients were observed for post spinal anesthesia complications, especially TNS. Any sensation of pain, dysesthesia, paresthesia or hyperalgesia in the low back area, buttocks, the anterior or posterior thigh, knees, either foot or both feet were recorded. Moreover, duration of pain, its radiation and its relation to sleep and the patients' position were all carefully considered. Ultimately, the patients' response to opioid (pethidine for analgesia was determined."nThe incidence of TNS was higher when spinal anesthesia was induced with lidocaine (68% vs. 22%, P=0.003. TNS developed in 85% of the patients in lidocaine group and 58% in bupivacaine group after surgery in lithotomy position (P=0.002. In 77 patients pain

  16. A randomized study comparing rectally administered misoprostol after spinal anesthesia versus intramuscular oxytocin for prevention of postpartum hemorrhage in caesarean section

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    Madhuri Alwani

    2014-06-01

    Methods: In a double-blind randomized controlled trial, 200 pregnant women who had cesarean sections were assigned into two groups: to receive either oxytocin intramuscularly or misoprostol rectally after spinal anesthesia. Results: There was no significant difference between the two groups about change in postpartum hemoglobin, need for blood transfusion and incidence of PPH. We also did not observe any significant difference in any side effects. Conclusions: Misoprostol may be considered as an alternative for oxytocin in low resource clinical settings. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 512-515

  17. [Effects of induction of anesthesia on hemodynamics in children with deformities of the spinal cord when turning to the position lying on the belly].

    Science.gov (United States)

    Ul'rikh, G E; Gordeev, V I; Mokhammed Khusseĭn, Ia Ia; Kachalova, E G

    2005-01-01

    The investigation was devoted to assessment of the reaction of blood circulation to turning to the position "lying on the belly" in different variants of induction of anesthesia to children aged from 7 to 17 years having deformities of the spinal cord. The following combinations were compared: Ketamin, Fentanyl, and inhalation with nitrous oxide; Propofol and Fentanyl; Thiopental, Clofelin, Fentanyl and inhalation with nitrous oxide; Propofol, Clofelin and Fentanyl. The minimal changes in blood circulation were found to occur when using the combination of Thiopental, Clofelin and Fentanyl.

  18. A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome

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    Neerja Bhardwaj

    2013-01-01

    Results: The umbilical pH was comparable in all the three groups (P > 0.05. The mean SBP from spinal block until delivery was similar over time for all the three groups. The incidence of reactive hypertension was more in group M (P < 0.05 than in group E and group P. Total drug consumption to meet target blood pressure till delivery was 39.3 ± 14.6 mg in group E, 1.7 ± 0.9 mg in group M, and 283.6 ± 99.8 mcg in group P. The incidence of nausea and vomiting was comparable in the three groups. Conclusion: All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anesthesia for cesarean section without any detrimental effects on fetal and maternal outcome.

  19. Intramuscular Administration of Drotaverine Hydrochloride Decreases Both Incidence of Urinary Retention and Time to Micturition in Orthopedic Patients under Spinal Anesthesia: A Single Blinded Randomized Study

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    Dariusz Tomaszewski

    2015-01-01

    Full Text Available Purpose. Postoperative urinary retention (POUR increases the duration of hospitalization and frequency and risk of urinary bladder catheterization. The objective of this study was to analyze the efficacy of intramuscularly administered drotaverine hydrochloride in the prevention of POUR in orthopedic patients. Methods. Two hundred and thirty patients 17–40 years of age undergoing lower limb orthopedic procedures under spinal anesthesia were enrolled in the study. The study group received 40 mg of drotaverine hydrochloride intramuscularly; the second group was the control. The main outcome measure was (1 the time to micturition and (2 the incidence of urinary bladder catheterization and time to catheterization. Results. Two hundred and one patients of 230 enrolled participants completed the study. Compared to the control group, the male patients in study group exhibited a shorter time to spontaneous micturition (441 versus 563 minutes, 95% CI of the difference of means between 39 and 205 minutes and a lower incidence of urinary bladder catheterization (4/75 versus 10/54 (RR 0.29, 95% CI: 0.1–0.87; P=0.0175. Conclusions. Intramuscular administration of drotaverine hydrochloride decreased the time to spontaneous micturition and decreased the incidence of urinary bladder catheterization in male patients who underwent orthopedic surgery under spinal anesthesia. This trial is registered with NCT02026427.

  20. Combined use of hyperbaric and hypobaric ropivacaine significantly improves hemodynamic characteristics in spinal anesthesia for caesarean section: a prospective, double-blind, randomized, controlled study.

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    ZheFeng Quan

    Full Text Available To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study.Parturients (n = 136 undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A or hyperbaric ropivacaine (Group B. Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis.Group A had a lower level of sensory blockade (T6 [T6-T7] and longer time to achieve T8 sensory blockade level (8 ± 1.3 min than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P < 0.001, both. The incidence rates for hypotension, nausea, and vomiting were significantly lower in Group A (13%, 10%, and 3%, respectively than Group B (66%, 31%, and 13%; P < 0.001, P = 0.003, P = 0.028.Combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade.Chinese Clinical Trial Register ChiCTR-TRC-13004622.

  1. High Spinal Anesthesia for Reductive Mammaplasty: a Three Years Experience Anestesia espinal alta para mastoplastia reductora. Experiencia de tres años

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    Néstor Parets Correa

    2012-05-01

    Full Text Available

    Background: High spinal neuraxial anesthesia is a controversial issue when used in surgery. Objective: To describe the results of the application of high spinal neuraxial anesthesia in reductive mammaplasty surgery. Methods: A descriptive study was conducted at the Dr. Gustavo Aldereguía Lima General University Hospital of Cienfuegos from June 2006 to June 2009. It included 90 patients who underwent surgery with high spinal neuraxial anesthesia. The following variables were analyzed: age, body mass index, HbO2 saturation, blood pressure, heart rate, use of preemptive analgesia, postoperative analgesia behavior, satisfaction level, complications, surgical technique and duration of surgery and anesthesia application. Results: 50% of patients were between 35 and 44 years old; 46, 7% were overweight; 80% had surgery for breast hypertrophy; reductive mastopalstia was performed in 97, 8% of cases; no patients presented rates of high blood pressure before or after the application of anesthesia; 41.1% showed low levels of blood pressure after anesthesia; heart rate was low in 31, 1% of cases after the application of anesthesia and high in 4, 4%. Postoperative analgesia was good in 87, 8% of patients, there was no ventilatory complication and 100% of patients expressed their satisfaction with the anesthetic technique. Conclusions: The application of this anesthetic technique can successfully develop surgeries with minimal risks and complications for patients.

    Fundamento: la aplicación de anestesia neuroaxial espinal alta en las intervenciones quirúrgicas resulta un tema controversial. Objetivo: describir los resultados de la aplicación de anestesia neuroaxial espinal alta en intervenciones quirúrgicas para mastoplastia reductora. Métodos: estudio descriptivo realizado en el Hospital General Universitario

  2. 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

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    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

  3. Spinal anesthesia in children

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    Norma Sueli Pinheiro Módolo; Yara Marcondes Machado Castiglia

    2001-01-01

    JUSTIFICATIVA E OBJETIVOS: Tem aumentado muito o emprego da anestesia subaracnóidea em crianças, principalmente neonatos com risco de desenvolver apnéia neonatal. O objetivo deste trabalho foi rever as diferenças anatômicas, fisiológicas e farmacológicas desta técnica em crianças. CONTEÚDO: A anestesia subaracnóidea em crianças, apesar de ter sido técnica empregada desde o início do século XX, teve sua popularidade diminuída com o advento dos anestésicos inalatórios e bloqueadores neuromuscul...

  4. 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.

  5. Evaluation of spinal anesthesia blockade time with 0.5% hyperbaric bupivacaine, with or without sufentanil, in chronic opioid users: a randomized clinical trial

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    Mostafa Sadeghi

    2016-08-01

    Full Text Available Abstract Objective: The primary outcome of this study was to evaluate the effect of adding sufentanil to hyperbaric bupivacaine on duration of sensory blockade of spinal anesthesia in chronic opioid users in comparison with non-addicts. Methods: Sixty patients scheduled for orthopedic surgery under spinal anesthesia were allocated into four groups: group 1 (no history of opium use who received intrathecal hyperbaric bupivacaine along with 1 mL saline as placebo; group 2 (no history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]; group 3 (positive history of opium use who received intrathecal bupivacaine along with 1 mL saline as placebo and group 4 (positive history of opium use who received intrathecal bupivacaine along with 1 mL sufentanil [5 µg]. The onset time and duration of sensory and motor blockade were measured. Results: The duration of sensory blockade in group 3 was 120 ± 23.1 min which was significantly less than other groups (G1 = 148 ± 28.7, G2 = 144 ± 26.4, G4 = 139 ± 24.7, p = 0.007. The duration of motor blockade in group 3 was 145 ± 30.0 min which was significantly less than other groups (G1 = 164 ± 36.0, G2 = 174 ± 26.8, G4 = 174 ± 24.9, p = 0.03. Conclusions: Addition of 5 µg intrathecal sufentanil to hyperbaric bupivacaine in chronic opioid users lengthened the sensory and motor duration of blockade to be equivalent to blockade measured in non-addicts.

  6. Effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclamptic undergoing elective cesarean section under spinal anesthesia

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    Nashwa S. Elzayyat

    2014-07-01

    Full Text Available This study was designed to investigate and compare the effect of preoperative Mg sulfate infusion on serum cardiac troponin (cTn in moderate preeclampsia undergoing elective cesarean section. A total of fifty parturients having moderate preeclampsia scheduled for elective cesarean section were included. They were randomly allocated into two equal groups 25 each, magnesium group (GMg received preoperative magnesium sulfate infusion and control group (GC then both received spinal anesthesia, serum troponin measured preoperative then at 6, 12 and 24 h postoperative. Mean arterial pressure and heart rate were also recorded. Baseline serum cardiac troponin was higher above normal and was comparable at the rest of times in both groups. Mean arterial pressure readings were significantly lower in GMg compared to GC at induction of spinal, skin incision and skin closure (P < 0.05 and were comparable at the rest of times. Serum cardiac troponin (cTn levels were comparable in parturients received magnesium sulfate infusion preoperatively with those did not receive magnesium sulfate.

  7. 全麻下俯卧位脊柱手术护士与麻醉师的护理配合体会%Nursing cooperation experience of nurse and anesthesiologist in spinal operation at prone position under general anesthesia

    Institute of Scientific and Technical Information of China (English)

    纪阴心

    2014-01-01

    本文总结了全身麻醉下俯卧位脊柱手术护士与麻醉师的护理配合体会,包括麻醉前、麻醉中及麻醉后护理配合。认为巡回护士协助麻醉师妥善的固定气管插管和维护全麻肌松后的呼吸循环神经系统至关重要,减少了因手术体位的改变所致的并发症的发生,保证了麻醉平稳,手术顺利进行。%In this paper,the author has summarized the nursing cooperation experience of nurse with anesthesiologist in spinal operation at prone position under general anesthesia,including before anesthesia,during anesthesia and after anesthesia nursing cooperation.We think that it is very important of the itinerate nurse assisting the anesthesiologist to properly secure endotracheal intubation and maintaining respiration,circulation and nerve systems after muscle relaxation under general anesthesia,which can reduce the complications caused by posture change of operation,and ensure the stable anesthesia and operation smoothly.

  8. 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

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    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

  9. Anestesia subaracnóidea em crianças Anestesia subaracnóidea en niños Spinal anesthesia in children

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    Norma Sueli Pinheiro Módolo

    2001-12-01

    apnea neonatal. El objetivo de este trabajo fue rever las diferencias anatómicas, fisiológicas y farmacológicas de esta técnica en niños. CONTENIDO: La anestesia subaracnóidea en niños, a pesar de haber sido técnica empleada desde el inicio del siglo XX, tuvo su popularidad diminuida con el adviento de los anestésicos inhalatorios y bloqueadores neuromusculares, para ser nuevamente rescatada en 1979. Las características favorables de esta técnica en pediatría son relativas a la estabilidad cardiovascular, en niños de hasta 8 anos de edad, a la analgesia satisfactoria y al relajamiento muscular. Los anestésicos mas utilizados en niños son la tetracaína y la bupivacaína, cuyas dosis son ajustadas tomándose por base el peso corporal. Esta técnica es limitada por la duración relativamente corta, debiendo ser utilizada para procedimientos quirúrgicos que no ultrapasen 90 minutos, también por su analgesia al llegar y al pós-operatorio. Las complicaciones son as mismas encontradas en el paciente adulto, incluyendo cefalea por punción dural e irritación radicular transitoria. Las indicaciones son varias: en cirugías de abdomen inferior, genitales, miembros inferiores, región perineal y, en algunos casos, incluso en cirugías torácicas. Su empleo tiene particular interés en los recién-nacidos prematuros, por causa del riesgo de presentar la apnea de la prematuridad. CONCLUSIONES: La anestesia subaracnóidea en niños es técnica relativamente segura, con pocas complicaciones y puede ser considerada como opción para anestesia general, principalmente en los recién-nacidos prematuros con riesgo de presentar complicaciones respiratorias en el pós-operatorio.Background and Objectives: Pediatric spinal anesthesia has gained popularity mainly as an alternative to general anesthesia in pre-term neonates at risk for developing neonatal apnea. This study aimed at evaluating anatomic, physiologic and pharmacological differences of the technique in children

  10. 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。

  11. Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure Ensaio clínico randomizado comparando raquianestesia com anestesia local, associadas à sedação para o fechamento de colostomia em alça

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    Rone Antônio Alves de Abreu

    2010-09-01

    Full Text Available CONTEXT: Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES: Randomized clinical trial to compare the results from these two techniques. METHODS: Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25 and using local anesthesia (n = 25. Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin. Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS: Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS: Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.CONTEXTO: Estudos recentes têm demonstrado que a anestesia local para o fechamento de colostomia em alça é tão segura quanto a raquianestesia para estes procedimentos. OBJETIVOS: Comparar os resultados do fechamento de colostomia em alça usando essas duas técnicas. MÉTODOS: Cinquenta pacientes foram randomizados para o fechamento de colostomia em alça sob raquianestesia (n = 25 e anestesia local (n = 25. No pré-operatório, o cólon foi avaliado por colonoscopia e o preparo intestinal foi realizado com solução oral de manitol a 10% e limpeza com solução salina fisiológica através do orifício distal da colostomia. Todos os

  12. 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

  13. 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

  14. Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly

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    Sultan Sherif

    2010-01-01

    Full Text Available Context: Little is known about the relationship between sedative drugs used preoperatively and postoperative delirium. Melatonin is a drug used to sedate patients preoperatively and is hypothesized by recent works to have a curative effect on postoperative delirium. Aims: The incidence of postoperative delirium will be tested if affected by three different sedative drugs including melatonin. Settings and Design: Controlled randomized double-blind study. Patients and Methods: Three-hundred patients aged>65 years scheduled for hip arthroplasty under spinal anesthesia were randomly distributed to one of the four groups. Group 1 (control received nothing for sedation. Group 2 (melatonin received 5 mg melatonin. Group 3 (midazolam received 7.5 mg midazolam. Group 4 (clonidine received 100 μg clonidine. These medications were given orally at sleep time at night of operation and another dose 90 min before operative time. Patients who developed postoperative delirium received 5 mg of melatonin 9 pm for three successive days in a trial to treat delirium. Statistical Analysis Used: Statistical analysis was done using the SPSS Software (version 13. Results: Total of 222 patients completed the study. Percentage of postoperative delirium in the control group was 32.65% (16/49 patients. The melatonin group showed a statistically significant decrease in the percentage of postoperative delirium to 9.43% (5/53 patients. Melatonin was successful in treating 58.06% of patients suffered postoperative delirium (36/62 patients with no difference between different groups. Conclusions: Postoperative delirium is affected with the drug used for preoperative sedation. Melatonin was successful in decreasing postoperative delirium when used preoperatively and in treating more than half of patients developed postoperative delirium when used for three postoperative nights.

  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 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.

  16. 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

  17. 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。

  18. The effects of sevoflurane inhalation anesthesia and spinal canal anesthe-sia on cognitive function in patients with urinary surgery in the elderly%七氟醚吸入全麻和椎管内麻醉对老年泌尿外科手术患者认知功能的影响

    Institute of Scientific and Technical Information of China (English)

    蔡云亮; 王新; 潘春杰; 朱红; 陈文

    2014-01-01

    Objective To observe the effects of sevoflurane inhalation anesthesia and spinal canal anesthesia on cogni-tive function in patients with urinary surgery in the elderly. Methods Researched 68 patients that undergoing elective urinary surgery in elderly patients, and then randomly divided into the sevoflurane inhalation anesthesia group (group A) and spinal canal anesthesia group (group B). The two groups were recorded time of anesthesia operation, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred, at last used the simple mental state examination (MMSE) to evaluate two groups of patients with 1 d before anesthesia and postoperative 1 d, 3 d, 7 d cognitive function. Results Two groups of anesthesia operation in time, surgical blood loss and transfusion volume, low blood pressure and the number of hypoxemia occurred had no significant differences(P>0.05). Two groups of postoper-ative 1 d, 3 d MMSE score were significantly lower than before operation, and the group A was significantly lower than group B, the differences were statistically significant(P 0.05); The incidence of POCD postoperative 1 d and 3 d in groupA were significantly higher than that of group B, with significant difference (P0.05). Conclusion Sevoflurane inhalation anesthesia is spinal canal anesthesia cognitive dysfunction occurred more often in patients with elderly urinary surgery.%目的:探讨七氟醚吸入全麻和椎管内麻醉对老年泌尿外科手术患者认知功能的影响。方法研究68例择期泌尿手术的老年患者随机均分为七氟醚吸入全麻组(A组)和椎管内麻醉组(B组),分别记录两组麻醉时间、手术出血量、术中输液量、低血压和低氧血症发生次数,同时采用简易精神状况检查量表(MMSE)评估两组患者麻醉前1d及术后1d、3d、7d的认知功能。结果两组麻醉时间、手术出血量、术中输液量、低血压和低氧血症发生次数比较

  19. Discussion on spinal anesthesia dosage of elderly patients in the open operation of femoral neck and intertrochanter fracture%老年股骨颈、粗隆间骨折手术脊麻用药剂量探讨

    Institute of Scientific and Technical Information of China (English)

    费建平; 雷月; 张代玲

    2015-01-01

    Objective To explore reasonable medication doses of the elderly during femoral neck and intertrochanteric fractures open surgery,allofthepatientsadoptcombinedspinal-epiduralanesthesia(CSEA).Methods 52ASAⅠ~Ⅲpa-tients undergoing femoral neck and intertrochanteric fractures open surgery were randomly divided into two groups according to the different medication doses A group (10mg) 29 cases.B group(≤8mg) 23 cases.They were treated with L-bupivacaine 10mg(group A) and L-bupivacaine do not exceed 8 mg(group B),To observe adverse events of circulation and respiration caused by spinal anesthesia with different doses in elderly patients .At last,elderly patients are given reasonable dose in spinal anesthesia.Results In different age groups,the heart rate,diastolic blood pressure after spinal anesthesia was no statistically significant(P>0.05).After completion of spinal anesthesia ,systolic blood pressure decreased significantly within 30min,the difference was statistically significant (P0.05).The pain relief rate was 100%,all patients can successfully complete the surgery .The pain relief rate of A group and B group has no statistically significant (P>0.05).The blood circulation fluctuation rate of B group (21.7%,5/23) was lower than that of A group(65.5%,19/29),the difference was statistically significant (P0.05).The arrhythmia,respiratory depression and additional epidural medication rate of 2 group was no statistically significant(P>0.05).Conclusion Patients aged 75 years and older,≤6mg L-bupivacaine spinal anesthesia is more safe .In patients younger than 75 years old,the right spinal anesthesia dosage is not more than 8mg of L-bupivacaine.At the same time, Its were also important to preoperative treatment of basic diseases ,prolong anesthesia induction period ,try to shorten the opera-tion time.At last,we should renamed the meaning of “the anesthesia induction period” of elderly patients with spinal ,in order to actively processing cycle fluctuations after

  20. 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

    adverse reactions and the Apgar 1min score of neonates between the 2 groups(P ﹥ 0. 05). Conclusion The anesthesia time of combined spinal anesthesia with epidural anesthesia was shorter than that of epidural anesthesia,but the recovery time was lon-ger. Clinical can choose according to the patient's condition.

  1. 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

  2. 蛛网膜下腔神经阻滞麻醉对兔脊髓神经元形态及c-fos蛋白表达的影响%Effects of spinal nerve block anesthesia on morphology of spinal cord nerve cells and expression of c-fos in rabbits

    Institute of Scientific and Technical Information of China (English)

    张勇; 李霞; 甘子明

    2011-01-01

    目的:观察蛛网膜下腔神经阻滞麻醉对兔脊髓神经细胞的生物学影响.方法:选用健康新西兰大白兔30只,随机分为实验组和对照组.每组15只.基础麻醉后实验组用5 g/L布比卡冈进行蛛网膜下腔神经阻滞麻醉(腰麻),对照组用生理盐水代替局麻药.于麻醉后30 min灌注取材,HE染色观察2组兔L5-7节段脊髓神经元形态的变化,免疫组化法检测脊髓神经元中c-fos蛋白的表达.结果:与对照组相比,实验组L5-7节段脊髓灰质后角Ⅲ、Ⅳ板层的小圆细胞及前角Ⅸ板层外侧大多角细胞胞质中均有尼氏体减少、神经元c-fos蛋白阳性细胞数减少[(68.9±1.4) vs (12.3±1.6),t=60.352,P<0.001]和脊髓软脊膜分层或断裂现象(P<0.001).结论:蛛网膜下腔神经阻滞麻醉后,兔脊髓相应节段的神经细胞功能受到抑制,脊髓软脊膜有分层或断裂现象.%Aim: To obsereve the effect of spinal nerve block anesthesia on morphology of spinal cord nerve cells and expression of c-fos in rabbits. Methods :Thity healthy New Zealand white rabbits were randomly divided into experimental and control group,15 in each group. After basal anesthesia,the rabbits in the experimental group were given 5 g/L bupiva-caine for subarachnoid nerve block anesthesia( spinal anesthesia for short) ,and those in the control group were given normal saline. After 30 minutes, spinal cord samples were prepared. HE staining and immunohistochemistry were used to observe the morphological changes of neurons and the expression of c-fos,respectively. Results;Compared with those of the control group, Nissl bodies reduced and nuclear bias in the horn of lumbosacral spinal cord gray matter III , IV plate layer of small round cells and anterior horn of the lateral lamina mostly IX horn cells in experimental group. The expression of c-fos protein in the control group was higher than that in the experimental group [ (68. 9 ±1.4) vs ( 12. 3 ± 1. 6) , t = 60. 352, P < 0

  3. Clinical observation of preventive effect of buprenorphine on shivering following Spinal anesthesia%布托啡诺预防脊髓麻醉后寒战反应的临床观察

    Institute of Scientific and Technical Information of China (English)

    郭瑶; 李妍; 黄威; 孟凌新

    2012-01-01

    目的 观察布托啡诺对脊髓麻醉后寒战反应发生的预防作用.方法 选择ASA I~Ⅱ级择期行子宫全切或次全切除患者90例,随机分为3组,每组30例.分别在脊髓麻醉后,切皮前静脉滴注2 mL布托啡诺0.5 mg(B1组)、布托啡诺0.3 mg(B2组)和生理盐水(C组).观察3组寒战反应及恶心、呕吐、嗜睡等不良反应的发生率.结果 B1、B2组和C组寒战例数分别为1、3、10例.B1组与其他两组相比,差异有统计学意义.结论 布托啡诺0.5 mg单次静脉注射,可以有效预防脊髓麻醉后的寒战反应.%Objective To observe the preventive effects of different doses of buprenorphine on shivering fol lowing spinal anesthesia. Methods 90 ASA Ⅰ ~ Ⅱ patients undergoing selective hysterectomy were allocated into 3 groups randomly,30 patients in each group. 2 mL of buprenorphine 0. 5 mg,buprenorphine 0. 3 mg and neutral saline were administered intravenously in the 3 groups after spinal anesthesia respectively. The incidence of shivering and side effects including nausea,vomiting and drowsiness were observed and recorded. Results There were 1 ,3,10 cases of shivering in group Bl, group B2 and group C respectively, with significant difference between group Bl and the other two groups. Conclusion Buprenorphine 0. 5 mg is effective to prevent shivering after spinal anesthesia.

  4. 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。

  5. Anesthesia for an elderly female with a rare congenital heart disease – A case report

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    Bassant M. Abdelhamid

    2016-10-01

    The patient had future neck femur, arthroplasty under hemi spinal anesthesia. After one month she presented to us with dislocated joint, and hemiarthroplasty under hemispinal anesthesia was done again.

  6. Effect of low dose of intrathecal pethidine on the incidence and intensity of shivering during cesarean section under spinal anesthesia: a randomized, placebo-controlled, double-blind clinical trial

    Science.gov (United States)

    Shami, Shoaleh; Nasseri, Karim; Shirmohammadi, Mousa; Sarshivi, Farzad; Ghadami, Negin; Ghaderi, Ebrahim; Pouladi, Mokhtar; Barzanji, Arvin

    2016-01-01

    Introduction Shivering is among the unpleasant and potentially harmful side effects of spinal anesthesia. The aim of this randomized double-blind clinical trial was to compare the antishivering effect of two different doses of intrathecal pethidine on the incidence and intensity of shivering and other side effects in patients who underwent cesarean section. Methods In this study, 150 parturient females scheduled for nonemergent cesarean section were randomly allocated to three groups. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg), plus 0.5 mL of 0.9% saline in the standard group (S group), and the same dose of bupivacaine with 5 mg (P5 group) or 10 mg of pethidine (P10 group). Demographic and surgical data, incidence and intensity of shivering (primary outcome), hemodynamic indices, forehead and core temperatures, maximum sensory level, Apgar scores, and adverse events were evaluated by a blinded observer. Results There were no significant differences between the three study groups regarding the demographic and surgical data, hemodynamic indices, core temperatures, and maximum sensory level (P>0.05). The incidence and intensity of shivering were significantly less in the P5 and P10 groups (P<0.001) when compared with the S group. There were no significant differences between groups for secondary outcomes, except pruritus, which was more common in the P5 and P10 groups when compared with the S group (P=0.01). Conclusion Low dose of intrathecal pethidine is safe, and can decrease the incidence and intensity of shivering during cesarean section, without having major side effects. PMID:27703328

  7. 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

  8. 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.

  9. 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

  10. Inguinal hernioraphy under local anesthesia in the elderly patients

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    Nurettin Kahramansoy

    2012-12-01

    Full Text Available Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years and theyounger. Anesthesia methods, additional anesthesia requirementand complications were compared.Results: Of totally 177 patients, 30.5% were elderly.Operation type, anesthesia method and score of operationalrisk differed between groups. The percentage of comorbidity (55.6% in the elderly was significantly high (p<0.001. Among elderly, the frequency of co morbidity wasslightly higher in patients who had local anesthesia comparedto spinal and general anesthesia. Patients in youngand middle ages preferred to be operated less under localanesthesia (34.1% compared to elderly (70.4%. Therewas one case (2.6% converted to general anesthesiaas an additional anesthesia in the elderly group. Postoperativecomplications were slight more frequent in elderly.These cases were five in number (31.3% and were operatedunder spinal or general anesthesia (p=0.002.Conclusions: The frequency of co morbidity and riskscore of operation (ASA category rise in the elderly.However, inguinal hernioraphy can be performed underlocal anesthesia without complication and conversion togeneral anesthesia.Key words: Inguinal hernia; aged; comorbidity; local anesthesia

  11. COMPARATIVE STUDY OF 6% HYDROXYETHYL STARCH (450/0 . 7 AND RINGER’S LACTATE AS PRELOADING FLUID FOR PREVENTION OF HYPOTENSION DURING SPINAL ANESTHESIA IN ELECTIVE CESAREAN DELIVERY

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    Javid

    2015-09-01

    Full Text Available We compared the efficacy of volume preloading with Ringer’s Lactate and Hydroxyethyl starch (HEAS 6% 450/0 . 7 on the onset and incidence of spinal - induced hypotension in elective cesarean delivery . 60 healthy parturients scheduled for elective cesarean se ction under spinal anesthesia were selected for the study . Group A was preloaded with 1000ml of RL while as group B preloaded with 500ml of 6% HEAS (450/0 . 7 over a period of 10 minutes just prior to the administration of spinal anaesthesia . Immediately af ter the preloading period, subarachnoid block was instituted with 2 . 5ml of Bupivacaine 0 . 5% (heavy at L3 - L4 or L4 - L5 interspace using 26 Gauge Quinke’s spinal needle in sitting position . The patient were then positioned supine with left lateral tilt . Ade quate block was obtained and height of block was tested by pinprick method using blunt needle . Hypotension following spinal anaesthesia was treated with 6 mg bolus doses of Ephedrine and additional rapid infusion of Ringer’s lactate solution . All were admi nistered supplemental oxygen 5L/min by venturi mask throughout the period of surgery . Intraoperatively, heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were monitored every 2 minutes for the first 20 minutes and eve ry 5 minutes thereafter till the end of surgery . Spo2 and ECG were monitored continuously throughout the period of surgery . In addition, height of the block, amount of blood loss, amount of vasopressor required, and amount of i . v fluids used intraoperative ly and any allergic reactions to i . v fluids were noted . All parturients received 10 IU of oxytocin i . v infusion after delivery of baby . These observations were analyzed to get information on the onset and incidence of hypotension, intraoperative requiremen ts of Ephedrine, and i . v fluids, and incidence of adverse effects like nausea and / or vomiting . The incidence of hypotension in group A was 60

  12. 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.

  13. [Anesthesia for cesarean section in patients with fetal anomaly].

    Science.gov (United States)

    Nakano, S; Tashiro, C; Nishimura, M; Ueyama, H; Uchiyama, A; Kubota, A; Suehara, N

    1991-05-01

    Twenty-two cases of Cesarean section due to fetal anomaly diagnosed prenatally were reviewed in terms of the anesthetic managements. In 6 cases, diazepam 0.3 mg.kg-1, which provides fetal anesthesia for surgery scheduled immediately after birth, was administered intravenously to the mothers with/without fentanyl (2 general anesthesia and 4 regional anesthesia). The diagnosis of their fetuses was congenital diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, gastroschisis or omphalocele. No fetal anesthesia was performed in the other 16 cases (15 spinal anesthesia and 1 general anesthesia). Seven of their fetuses were diagnosed as hydrops. Since the general condition of the diseased newborn is known to be deteriorated after receiving various stress and aerophagia, fetal anesthesia in Cesarean delivery has the advantage of stress reduction and prevention of aerophagia. When the newborn is considered to need immediate neonatal resuscitation or intensive care including surgery, fetal anesthesia may be a choice of anesthetic technique.

  14. 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

  15. 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...

  16. 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.

  17. Baixas doses de bupivacaína hipobárica para raquianestesia unilateral Dosis bajas de bupivacaína hipobárica para raquianestesia unilateral Low hypobaric bupivacaine doses for unilateral spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2003-09-01

    con el paciente en decúbito lateral, con el miembro a ser operado vuelto para arriba, y 3,3 ml de bupivacaína hipobárica fueron inyectados en la velocidad de 1 ml a cada 15 segundos. Bloqueo sensitivo y motor (picada de aguja y escala de 0 a 3 fueron comparados entre los lados que serian operados y el contralateral. RESULTADOS: Los bloqueos motor y sensitivo entre el lado operado y el contralateral fueron significativamente diferentes en todos los tiempos evaluados. Raquianestesia unilateral fue obtenida en 75% de los pacientes. Estabilidad hemodinámica fue observada en todos los pacientes. Ningún paciente desarrolló cefalea pos-raquianestesia. CONCLUSIONES: La bupivacaína hipobárica a 0,15% en dosis de 5 mg proporciona un predominante bloqueo unilateral. Veinte minutos son suficientes para su instalación. La principal ventaja de la raquianestesia unilateral es la estabilidad hemodinámica.BACKGROUND AND OBJECTIVES: The possibility to achieve unilateral spinal anesthesia with 0.15% bupivacaine was studied with the purpose of minimizing hemodynamic changes, limiting the cephalad dispersion of the anesthetic and promoting a faster recovery. METHODS: Twenty ASA I - II patients undergoing orthopedic surgeries were given spinal 0.15% hypobaric bupivacaine through a 27G Quincke needle. Dural puncture was performed with patients in the lateral position, with the limb to be operated upwards, and 3.3 ml (5 mg hypobaric bupivacaine were injected at the rate of 1 ml.15 s-1. Sensory and motor block (pinprick and 0 to 3 scale were compared between operated and contralateral sides. RESULTS: Motor and sensory block in operated and contralateral sides were significantly different in all evaluated times. Unilateral spinal anesthesia was achieved in 75% of patients. All patients remained hemodynamically stable, and no one developed post-dural puncture headache. CONCLUSIONS: Hypobaric bupivacaine (5 mg is able to provide a predominant unilateral block with the patient being

  18. 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

  19. 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

  20. Effect of continuous spinal anesthesia with Spinocath catheter for labor analgesia on mothers and infants%Spinocath导管鞘内连续给药分娩镇痛对母婴的影响

    Institute of Scientific and Technical Information of China (English)

    宁丰; 韦凤莲; 周霓; 林红; 唐雨帆

    2012-01-01

    目的:观察Spinocath导管鞘内连续给药分娩镇痛对孕妇及胎儿的影响.方法:选择80例初产妇随机分为分娩镇痛组(A组)和对照组(B组)各40例,观察产妇的生命体征、产程时间、分娩方式、宫缩情况、缩宫素使用情况、产后出血、胎心监护、脐血流、羊水性状、新生儿Apgar评分、脐动脉血气分析.结果:两组在生命体征、产程时间、产后出血、胎心监护、脐血流、羊水性状、新生儿Apgar评分、脐动脉血气分析方面比较差异无统计学意义(P>0.05);A组剖宫产率较B组低,A组自然分娩率、出现宫缩乏力及缩宫素使用比B组高,差异有统计学意义(P<0.05).结论:微量舒芬太尼Spinocath导管鞘内连续给药分娩镇痛对母婴无不良影响,但要注意预防出现子宫收缩乏力.%Objective: To observe the effect of continuous spinal anesthesia with Spinocath catheter for labor analgesia on pregnant women and fetuses. Methods: Eighty primiparous women were selected and randomly divided into labor analgesia group (group A) and control group ( group B) , 40 women in each group; the observation indexes included vital signs, stages of labor, delivery modes, uterine contraction, usage of oxytocin, postpartum hemorrhage, fetal heart rate monitoring, umbilical blood flow, characteristics of amniotic fluid, neonatal Apgar score, blood gas analysis of umbilical artery. Results: There was no statistically significant difference in vital signs, stages of labor, postparlum hemorrhage, fetal heart rate monitoring, umbilical blood flow, characteristics of amniotic fluid, neonatal Apgar score, blood gas analysis of umbilical artery between the two groups ( P > 0. 05 ) . The cesarean section rate in group A was lower than that in group B; the rate of spontaneous delivery, the incidence of uterine inertia, and utilization rate of oxytocin in group A were statistically significantly higher than those in group B (P < 0. 05) . Conclusion

  1. 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

  2. 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, ...

  3. 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 | ...

  4. 腰丛-坐骨神经阻滞与腰麻在老年患者膝关节置换围术期的对比分析%Comparison of lumbar plexus-sciatic nerve block and spinal anesthesia on elderly patients with knee joint sur-gery during the perioperative period

    Institute of Scientific and Technical Information of China (English)

    黄文锋; 陈杰; 包晓航; 杜智勇; 黄河; 李洪; 杨天德

    2016-01-01

    Objective To compare and analyze the clinical application of lumbar plexus combined with sciatic nerve block and spinal anesthesia for elderly patients with knee joint surgery.Methods A total of 77 elderly patients with ASAⅠ ~Ⅲ undergoing single knee re-placement surgery were randomly divided into combined group which recieved lumbar plexus combined with sciatic nerve block and spinal an-esthesia group.The baseline values,blood pressure and heart rate at multiple time points,the block area and duration,the volume of intraoper-ative fluid,and other indexes of adverse reaction were observed.Results The MAP,SBP and DBP in the spinal anesthesia group after the op-eration have changed significantly at the time of T1,T2 and T3.The operating of anesthesia in the combined group was shorter than that of spi-nal anesthesia group.The rate of adverse reactions in combined group was significantly lower than that inspinal anesthesia group.Conclusion The spinal anesthesia can be satisfied for operation requirements,but it will cause the unstable circulation and varied adverse reactions.Lum-bar plexus combined with sciatic nerve block is safe and effective with less adverse reactions,less disturbance of hemodynamics,which is much better for the old or the patients with coagulation abnormalities combined heart and lung disease.%目的:对比分析腰丛联合坐骨神经阻滞与腰麻在老年患者膝关节手术中的应用,探讨两者在老年患者膝关节置换术围手术期的优缺点。方法77例老年单膝关节置换术患者,ASA Ⅰ~Ⅲ级,按麻醉方式不同分为腰丛神经阻滞联合坐骨神经阻滞组(联合组)和腰麻组,观察并纪录麻醉前基础值,以及麻醉后、切皮时、术中放置骨水泥后、手术结束时的血压、心率、阻滞区域及维持时间、术中输液量、围术期不良反应等指标。结果腰麻组患者在麻醉后 MAP、SBP、DBP 在 T1、T2、T3时间点波动明显,联合组麻醉

  5. 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.

  6. 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.

  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. 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.

  9. 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

  10. Recurrent spinal adhesive arachnoiditis: a case report

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    James Pitágoras de Mattos

    1988-03-01

    Full Text Available Spinal adhesive arachnoiditis is not an uncommon disease, usually having a monophasic course. We studied an atypical patient with recurrent spinal adhesive arachnoiditis nine years after intrathecal anesthesia and the first attack of the disease. Also noteworthy was the favorable evolution after surgery.

  11. 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

  12. 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

  13. Isobolographic analysis of interaction between nisoxetine- and mepivacaine-induced spinal blockades in rats.

    Science.gov (United States)

    Leung, Yuk-Man; Chu, Chin-Chen; Kuo, Chang-Shin; Chen, Yu-Wen; Hung, Ching-Hsia; Wang, Jhi-Joung

    2014-02-01

    Although nisoxetine has been shown to elicit cutaneous (peripheral) anesthesia, spinal (central) anesthesia with nisoxetine was not exposed. The aim of this study was to examine spinal anesthesia of nisoxetine and its influence on the antinociceptive action of mepivacaine. We compared nisoxetine with an established local anesthetic mepivacaine for spinal anesthesia after rats were intrathecally injected with drugs. The drugs were spinally administered alone as well as in combination, and their potencies were compared via dose-response curves and isobolographic analysis. We showed that nisoxetine, as well as mepivacaine elicited spinal anesthesia in dose-dependent manners. On a 50% effective dose (ED₅₀) basis, the spinal block effect of nisoxetine in motor function, proprioception, and nociception [0.99 (0.91-1.10), 0.85 (0.76-0.95), 0.82 (0.74-0.89)] was more potent (P < 0.05) than that of mepivacaine [1.28 (1.21-1.34), 1.14 (1.07-1.22), 0.99 (0.93-1.05)], respectively. Furthermore, the nociceptive/sensory blockade (ED₅₀) was greater than the motor blockade in both nisoxetine and mepivacaine groups (P < 0.05). Saline group (vehicle) produced no spinal anesthesia. Coadministration of nisoxetine with mepivacaine displayed an additive effect. Our data reported nisoxetine produced significant anesthesia at spinal level, and additive interaction with the local anesthetic, mepivacaine. Intrathecal nisoxetine elicited more potent spinal anesthesia than mepivacaine.

  14. Advanced Restoration Therapies in Spinal Cord Injury

    Science.gov (United States)

    2015-07-01

    including but not limited to traumatic brain injury , Alzheimer’s disease, cerebrovascular insults, and leukodystrophy. SECTION 2 – KEYWORDS Spinal...Spinal Cord Injury Annual Report to change our proposed anesthesia method from isofluorane to medetomidine. We have made the appropriate changes and...McKinley, W., and Tulsky, D. (2004). Late neurologic recovery after traumatic spinal cord injury . Arch Phys Med Rehabil 85, 1811-1817. Lorenz, D.J

  15. Raquianestesia posterior para cirurgias anorretais em regime ambulatorial: estudo piloto Raquianestesia posterior para cirugías anorrectales en régimen ambulatorial: estudio piloto Restricted dorsal spinal anesthesia for ambulatory anorectal surgery: a pilot study

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    Luiz Eduardo Imbelloni

    2004-12-01

    sometidos a la raquianestesia con solución hipobárica de bupivacaína a 0,15% a través de aguja 27G Quincke para cirugías anorrectales. La punción subaracnóidea fue realizada con el paciente en decúbito ventral con auxilio de un cojin en su abdomen para corregir la lordosis lumbar y el espacio intervertebral. RESULTADOS: El bloqueo sensitivo fue logrado en todos los pacientes. Su dispersión varió de T10 a L2 con moda en T12. Apenas tres pacientes presentaron algún grado de bloqueo motor. La duración del bloqueo fue de 122,17 ± 15,35 minutos. Estabilidad hemodinámica fue observada en todos los pacientes. Ningún paciente desarrolló cefalea después de punción de la dura-máter. CONCLUSIONES: Seis miligramos de bupivacaína a 0,15% en solución hipobárica proporcionaron un bloqueo predominantemente sensitivo, cuando inyectados en decúbito ventral. Las principales ventajas son la rápida recuperación, estabilidad hemodinámica y satisfacción del paciente, siendo una buena indicación para anestesia ambulatorial.BACKGROUND AND OBJECTIVES: The increasing number of ambulatory procedures requires anesthetic methods allowing patients to be discharged soon after surgery completion. Currently, anorectal procedures are performed in inpatient settings. This study aimed at evaluating the feasibility of performing these procedures in outpatient settings with low hypobaric bupivacaine doses. METHODS: Participated in this study 30 patients physical status ASA I and II, submitted to spinal anesthesia with 0.15% hypobaric bupivacaine with 27G Quincke needle for anorectal procedures. Spinal puncture was performed with patients in the prone position with the help of a pad under the abdomen to correct lumbar lordosis and the vertebral interspace. RESULTS: Sensory block was obtained in all patients. Sensory block spread varied T10 to L2 (mode = T12. Only three patients presented motor block. Blockade length was 122.17 ± 15.35 minutes. No hemodynamic changes were observed in

  16. The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

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    Dilsen Ornek

    2010-01-01

    Full Text Available OBJECTIVE: We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries. MATERIALS AND METHOD: Sixty geriatric outpatient cases, with ASA II-III physical status and requiring shortduration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA and selective spinal anesthesia (Group SSA. Group GA (n = 30 received propofol 2 mg kg-1 (until loss of eyelash reflex, remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg /kg-1 /min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30 received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time. RESULTS: Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05, whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups. CONCLUSION: While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.

  17. Raquianestesia contínua com altas doses de anestésicos locais Raquianestesia continua con altas dosis de anestésicos locales Continuous spinal anesthesia with high dose of local anesthetics

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    Luiz Eduardo Imbelloni

    2010-10-01

    éteres intermediarios (catéter por fuera de la aguja y por su baja incidencia de cefalea y síntomas neurológicos, la técnica ha venido ganando credibilidad. El objetivo de este caso es relatar la posible seguridad del uso del nuevo catéter con una gran dosis de bupivacaína hiperbárica al 0,5% con glucosa al 1,6% asociada a la lidocaína al 2% hiperbárica y con glucosa al 1,6%. RELATO DEL CASO: Paciente masculino, de 78 años, 85 kg, 168 cm, estado físico ASA III, hipertenso, con coronariopatía e insuficiencia renal crónica. Candidato a cirugía de voluminosas hernias inguinales bilateral y umbilical, siendo sometido durante una semana a neumoperitoneo para crear espacio. Posteriormente a la venoclisis con catéter 18G, monitorización con cardioscopio, presión arterial no invasiva y oximetria de pulso, fue sedado con 1 mg de midazolam y fentanil 100 µg por vía venosa y colocado en decúbito lateral izquierdo. Sometido a la raquianestesia continua por vía mediana en L3-L4, y conjunto de aguja cortante 27G con catéter 22G. La dosis total de anestésico utilizada en el procedimiento fue 25 mg de bupivacaína al 0,5% (hiperbárica con glucosa al 1,6% y 160 mg de lidocaína al 2% (hiperbárica con glucosa al 1,6% y morfina (100 µg. Paciente con seguimiento hasta el 30º día sin quejidos neurológicos. CONCLUSIONES: Recientemente, la mala distribución del anestésico local a través de microcatéter, se atribuyó a una causa del síndrome de cola de caballo. Este relato de caso mostró que, con la administración de altas dosis de anestésicos hiperbáricos a través del nuevo catéter, no hubo una mala distribución ni el riesgo de síndrome de cola de caballoBACKGROUND AND OBJECTIVES: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter and its low incidence of headaches and neurological symptoms, the technique has

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

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    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.

  19. 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.

  20. [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.

  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. 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

  3. 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

  4. 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

  5. Avaliação da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study

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    Guilherme de Castro Santos

    2011-10-01

    Full Text Available OBJETIVO: Comparar a qualidade da analgesia (intensidade da dor e consumo de analgésicos e o tempo de alta hospitalar dos pacientes que receberam ou não bloqueio ilioinguinal (II e ílio- hipogástrico (IH pós-incisão associado à infiltração da ferida operatória com ropivacaína 0,75% em cirurgia de herniorrafia inguinal, sob raquianestesia. MÉTODOS: Foi realizado estudo prospectivo, aleatório, duplo-cego com 34 pacientes submetidos à herniorrafia inguinal. Eles foram divididos em dois grupos: controle (C e bloqueio II e IH (B. O grupo C (n = 17 recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica e o grupo B (n = 17 recebeu raquianestesia com 15 mg de bupivacaína 0,5% hiperbárica em associação com bloqueio II e IH (10 mL de ropivacaína 0,75% e infiltração da ferida cirúrgica (10 mL de ropivacaína 0,75%. Foram registrados os dados antropométricos, intensidade da dor pela escala analógica visual (EAV e número de doses de analgésicos (dipirona, cetorolaco e nalbufina no pós-operatório imediato, assim como o tempo de alta hospitalar. RESULTADOS: A EAV em repouso três horas após o término do procedimento e o tempo de hospitalização foram significativamente menores no grupo B em comparação com o grupo C (p OBJECTIVE: This study was designed to evaluate analgesia (pain intensity and analgesic consumption and the time of discharge of patients who underwent ilioinguinal (II and iliohypogastric (IH nerve block associated with wound infiltration with 0.75% ropivacaine, or not, after inguinal hernia repair surgery under spinal anesthesia. METHODS: This was a prospective, randomized, double-blind study with 34 patients undergoing inguinal hernia repair. Patients were divided into two groups: control (C and II and IH nerve block (B. Group C (n = 17 received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine and Group B (n = 17 received spinal anesthesia with 15 mg hyperbaric 0.5% bupivacaine associated

  6. SPINAL ANAESTHESIA VERSUS GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

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    Prasad

    2014-02-01

    Full Text Available INTRODUCTION: Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. MATERIALS & METHODS: 60 healthy patients were randomized under spinal anesthesia (n=30 & General Anesthesia (n=30 . Hyperbaric 3ml bupivacaine plus 25mcg fenta nyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post - operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance , drugs or con verted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. RESULTS: None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 6patients under spinal anesthesia had right shoulder pain , 2 patients were converted to GA and 4 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post - operative pain reli ef in spinal group. All the patients were comfortable and surgeons satisfied. CONCLUSION: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesth esia without limiting recovery , but require cooperative patient , skilled surgeon , a gentle surgical technique and an enthusiastic anesthesiologist

  7. 潜伏期行椎管内阻滞麻醉分娩镇痛对孕妇妊娠结局与新生儿预后的影响%The Effect of Incubation Period Line Block Anesthesia Intra-Spinal Canal Labor Analgesia on Pregnant Women Pregnancy Outcome and Neonatal Prognosis

    Institute of Scientific and Technical Information of China (English)

    贾利红; 王文凯; 陈艳丽

    2015-01-01

    目的:潜伏期行椎管内阻滞麻醉分娩镇痛对孕妇妊娠结局与新生儿预后的影响。方法:选取2013年1月-2014年3月本院通过麻醉分娩镇痛的孕妇174例,依据随机分配原则分为潜伏组和对照组,两组孕妇均给予常规椎管内阻滞麻醉分娩镇痛治疗,对照组孕妇在宫口开大高于3 cm时给予实施,潜伏组孕妇在宫口扩张1~2 cm时给予实施,在孕妇宫口开始扩张时应用视觉模拟疼痛评分法(VAS)对孕妇进行疼痛评估,统计分析所有孕妇产程时间、疼痛情况、分娩结局和围产儿结局。结果:潜伏组产妇第一、第二产程时间明显短于对照组,宫口扩张60 min内各时点VAS评分明显低于对照组,差异均有统计学意义(P<0.05);潜伏组产妇分娩结局明显优于对照组,差异有统计学意义(P<0.05);潜伏组产妇产后围产儿结局明显优于对照组,差异有统计学意义(P<0.05)。结论:潜伏期行椎管内阻滞麻醉分娩镇痛方式可有效缩短产妇产程时间,快速缓解产妇疼痛,有助于实现产程无痛分娩,增强产妇自然分娩的信心,对降低剖宫产率有积极作用。同时改善孕妇妊娠结局和围产儿结局,有利于提高新生儿预后水平,值得临床作进一步推广。%Objective:To discuss the effect of incubation period line block anesthesia intra-spinal canal labor analgesia on pregnant women pregnancy outcome and neonatal prognosis.Method:174 pregnant women with incubation period line block anesthesia intra-spinal canal labor analgesia were selected from January 2013 to March 2014 in our hospital, according to the random distribution, all patients were divided into latent group and the control group. Two groups of pregnant women were given the conventional block anesthesia labor analgesia intra-spinal canal treatment, the control group of pregnant women in the palace mouth up higher than 3 cm given

  8. Comparison of Sedation With Local Anesthesia and Regional Anesthesia in Transurethral Resection of Prostate (TURP

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    H Aghamohammadi

    2008-12-01

    Full Text Available ABSTRACT: Introduction & Objective: Transurethral Resection of Prostate (TURP is usually performed under regional or general anesthesia. An alternative to conventional anesthesia is performing of TURP under local anesthetic infiltration with sedation. The aim of this study was to evaluate the efficacy and complication of sedoanalgesia in TURP. Material & Methods: In a prospective clinical trial from September 2006 to December 2007, 60 patients (30 in each group with prostate hypertrophy, candidate for TURP, were randomly assigned into two groups. In the first group, standard spinal anesthesia was done. In the second group, five minutes before the operation, 25 mgs of diazepam plus 25-50 mgs of pethedine was intravenously administered followed by injection of 10 ml lidocaine 2% gel in the urethra and the skin in the suprapubic area was anesthetized with 2 ml of 1% lidocaine. Using a 22 gauge nephrostomy needle, the suprapubic skin was punctured and the needle was directed toward prostate apex and 10-20ml of 1% lidocaine was injected at the serosal aspect of the rectal wall. For dorsal nerve block, 5-10ml of 1% lidocaine was injected at penopubic junction, and then a standard TURP was performed. Patients were switched to another anesthetic technique if the selected technique failed. Severity of pain was assessed by visual analogue scale. Results: The average prostate size was 25 grs (range10-50grs in the local anesthetic group (group 1 and 27.5 grs (range 10-50 grs in the spinal group (group2. In the local anesthetic group, 82.3% had no or mild pain while moderate to severe pain was reported in 16, 7% of the patients. In the group with spinal anesthesia, these were 93.1% and 6.9% respectively. Intolerable pain was observed in 23.3% and 13.8% of groups 1 and 2 respectively (p>0.05. Two patients in spinal group and 5 in local anesthetic group (3 due to severe pain and 2 for unsatisfaction required conversion to general anesthesia or receiving

  9. Effect of different doses of phenylephrine on parturient and neonate during spinal anesthesia for cesarean section%不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响

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    张辉; 孟凡民; 张加强; 杜献慧; 齐艳艳; 姚翔燕

    2012-01-01

    目的 观察不同剂量去氧肾上腺素静脉注射对腰麻下剖宫产产妇及新生儿的影响.方法 择期腰麻剖宫产单胎产妇60例,随机均分为三组,在蛛网膜下腔注入0.5%重比重布比卡因2.5 ml,鞘内注药后立即静脉泵注去氧肾上腺素150 μg(P1组)、300 μg(P2组)或等量生理盐水(C组)各3 ml,速率1 ml/mi1若发生低血压时追加去氧肾上腺素100μg.监测并记录产妇SBP、DBP、HR、每搏输出量(SV)和心输出量(CO),以及低血压、高血压、恶心呕吐及心动过缓的发生次数.记录新生儿Apgar评分,并取脐带动静脉血行血气分析.结果 与入室后比较,腰麻后1、5 min C组SBP、DBP明显降低(P<0.05),P1、P2组无显著变化;腰麻后1、5min和分娩前1 min P1、P2组HR明显减慢,C组仅在分娩前1 min显著减慢(P<0.05);腰麻后1、5 min R2组SV显著升高,腰麻后5min C组显著降低(P<0.05),且腰麻后5 min P1、P2组明显高于C组(P<0.05);腰麻后5 min和分娩前1 min P1、P2组CO显著降低(P<0.05),分娩前1 min C组也显著降低(P<0.05).P1组和P2组低血压的发生率显著低于C组(P<0.05).P1组和P2组分别有1例和3例高血压.结论 小剂量去氧肾上腺素静脉输注能减少分娩前产妇低血压的发生率,对母体和胎儿影响较小.%Objective To observe the effects of different doses of phenylephrine on parturient and neonate during spinal anesthesia for cesarean section. Methods Sixty singleton gestation parturients, ASA Ⅰor Ⅱ and scheduled for elective cesarean section under spinal anesthesia were randomly divided into three groups ( n = 20); group P1: phenylephrine 150 μg, group P2: phenylephrine 300 jig. group C: saline. Immediately after spinal anesthesia, phenylephrine or saline was infused at the rate of 1 ml/min for 3 min. Additional phenylephrine 100 pig was applied in the presence of hypotension. SBP, DBP, HR, SV, CO were recorded. The frequency of hypotension, nausea and

  10. 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.

  11. Hernioplastías inguinales con anestesia exclusivamente local / Inguinal Hernioplasties With Local Anesthesia

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    Coturel A

    2015-11-01

    Full Text Available Lichtenstein inguinal hernia repair was described in 1974 by Irving Lichestein, who proposed a free tension surgical treatment. Currently this technique is performed anesthetic spinal block. However, many studies marke benefits of local anesthesia: prolonged postoperative analgesia, inexpensive, easy to perform and safe in patients at high risk. A retrospective observational study was performed. The inguinal hernia repair with only local anesthesia is a feasible technique, with similar results regarding recurrence. It has no specific complications of spinal anesthesia. Performed a randomized missing on costs, pain and quality of life postoperatively prospective analysis

  12. 围手术期心理暗示对妇科椎管内麻醉手术患者心理因素的影响%Perioperative psychological hints on gynecologic the spinal canal anesthesia surgery patients psychological factors

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    杨润亭; 杨淑霞; 薛淑英

    2012-01-01

    Objective With SCL-90 scale evaluation perioperative psychological hints on gynecologic the spinal canal anesthesia surgery patients psychological factors.Methods The random sampling method,276 patients with spinal canal anesthesia to the control group and the patients into gynecological the control group,receive the traditional preoperative, during,and after the traditional nursing care,except to the psychological suggestion, with SCL-90 scale measurement two groups of patients psychological state.Results In the experimental group in somatization,interpersonal relationship,dep ression,anxiety,fear and other psychological status significantly better than the control group.Conclusion Gynecologic intraspinal anesthesia patients in peri operation period to implement psychological suggestion therapy can alleviate patients' fear,depression,anxiety and other psychological symptoms,enhancing patient safety through operation of confidence.%目的 用SCL - 90量表评价围手术期心理暗示对妇科椎管内麻醉手术患者心理因素的影响.方法 采用随机抽样的方法,将276例需椎管内麻醉的妇科患者分为对照组和实验组,对照组接受传统术前、术中、术后护理,实验组除传统护理外给予心理暗示,用SCL - 90量表测量两组病人心理状态.结果 实验组在躯体化、人际关系、抑郁、焦虑、恐惧等方面心理状态明显好于对照组.结论 对妇科椎管内麻醉患者围手术期实施心理暗示疗法能减轻患者抑郁、恐惧、焦虑等心理症状,增强了患者安全度过手术期的信心.

  13. 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。

  14. Baixa dose de bupivacaína isobárica, hiperbárica ou hipobárica para raquianestesia unilateral Baja dosis de bupivacaína isobara, hiperbara o hipobara para anestesia raquidea unilateral Low dose isobaric, hyperbaric, or hypobaric bupivacaine for unilateral spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2007-06-01

    anestesia raquidea unilateral puede presentar ventajas principalmente en pacientes en régimen ambulatorial. Baja dosis de la solución anestésica, velocidad lenta de la inyección espinal y la posición lateral facilitan la obtención de la distribución unilateral en la anestesia raquidea. Se compararon las soluciones isobara, hiperbara e hipobara de bupivacaína para obtener la anestesia raquidea unilateral en pacientes sometidos a intervenciones quirúrgicas ortopédicas en régimen ambulatorial. MÉTODO: Ciento cincuenta pacientes fueron aleatoriamente separados en tres grupos para recibir 5 mg de bupivacaína a 0,5% isobara (Grupo Iso o 5 mg de bupivacaína a 0,5% hiperbara (Grupo Hiper o 5 mg de bupivacaína a 0,15% hipobara (Grupo Hipo. Las soluciones se administraron en el interespacio L3-L4 con el paciente en la posición lateral y permaneciendo en esa posición por 20 minutos. La anestesia sensitiva se evaluó por el test de la picada de la aguja. El bloqueo motor evaluado por la escala modificada de Bromage. Los dos bloqueos se compararon con el lado no operado y también entre sí. RESULTADOS: Se notó una diferencia significativa entre el lado operado y no operado en todos los tres grupos a los 20 minutos, pero se obtuvo una mayor frecuencia de anestesia raquidea unilateral con las soluciones hiperbara e hipobara de bupivacaína. Se observó bloqueo sensitivo y motor en 14 pacientes del Grupo Iso, 38 pacientes en el Grupo Hiper y 40 pacientes en el Grupo Hipo. No ocurrieron alteraciones hemodinámicas en ningún paciente. No se observó cefalea postpunción ni síntomas neurológicos transitorios. CONCLUSIONES: La anestesia raquidea con soluciones hipobara e hiperbara proporcionaron una mayor frecuencia de unilateralidad. Tras 20 minutos la solución isobara de bupivacaína se movió en el LCR resultando en apenas 28% de anestesia raquidea unilateral.BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has its advantages, especially in patients undergoing

  15. 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

  16. Baixas doses de bupivacaína a 0,5% isobárica para raquianestesia unilateral Bajas dosis de bupivacaína a 0,5% isobárica para raquianestesia unilateral Low isobaric 0.5% bupivacaine doses for unilateral spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2004-06-01

    bupivacaína se moviliza dentro del LCR después de 20 minutos, resultando en un bloqueo unilateral en apenas 28% de los pacientes. La principal ventaja de la raquianestesia unilateral es la estabilidad hemodinámica y su rápida regresión, pudiendo ser una nueva opción para cirugía ambulatorial.BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia may be advantageous, especially in the outpatient setting. Low local anesthetic doses, slow spinal injection rate and the lateral position have been related to the easiness of inducing unilateral spinal anesthesia. This study aimed at investigating the possibility of inducing unilateral spinal anesthesia with isobaric 0.5% bupivacaine. METHODS: Spinal anesthesia with 1 mL isobaric 0.5% bupivacaine (5 mg was induced through 27G Quincke needle in 25 physical status ASA I and II patients undergoing orthopedic procedures. Dural puncture was performed with patients in lateral decubitus with the limb to be operated facing upwards. One mililiter of isobaric bupivacaine was injected in 30 seconds. Sensory and motor blocks were compared between the operated and the contralateral side. RESULTS: Motor and sensory blocks on operated and contralateral sides were significantly different in all studied moments. All patients presented surgical anesthesia in the operated limb. At 20 minutes, nine patients presented sensory block in the contralateral side; at 40 minutes they were 18 and at 60 minutes they were 17 patients. So, unilateral block was present in seven patients (28% and bilateral block was present in the remaining 18 patients (72%. No patient developed post-dural puncture headache. CONCLUSIONS: Isobaric bupivacaine (5 mg provides predominant unilateral block after 20 minutes in the lateral position. Isobaric bupivacaine moves in the CSF after 20 minutes resulting in just 28% unilateral blocks. Major advantages of unilateral spinal anesthesia are hemodynamic stability and short duration and it might be a new alternative for

  17. [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.

  18. COMPARATIVE STUDY OF 0.5% BUPIVACAINE AND 0.5% BUPIVACAINE WITH CLONIDINE (30μg FOR SPINAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Shilpashri

    2015-09-01

    Full Text Available In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenceptor agonist has potent central antinoceptive properties with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Lo w doses of clonidine have shown effectiveness in intensifying spinal anesthesia. Hence this study was done in our institute to evaluate the efficacy of spinal anesthesia with clonidine added to hyperbaric bupivacaine in elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. This prospective, single center parallel group, double blind study conducted over a span of 1 year with 100 patients, was effective in proving that Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without producing significant hemodynamic side effects and with mild sedation.

  19. 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.

  20. 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 ...

  1. Efeitos da associação da clonidina à bupivacaína hiperbárica na anestesia subaracnóidea alta Efectos de la asociación de la clonidina a la bupivacaína hiperbárica en la anestesia subaracnoidea alta Effects of clonidine associated to hyperbaric bupivacaine during high-level spinal anesthesia

    Directory of Open Access Journals (Sweden)

    José Reinaldo Cerqueira Braz

    2003-09-01

    sinergismo entre dosis diferentes de clonidina, de 45 y 75 µg, y bupivacaína hiperbárica en las características y en los efectos hemodinámicos del bloqueo subaracnoideo alto (T4. MÉTODO: En estudio aleatorio y duplamente encubierto, fueron evaluados 60 pacientes estado físico ASA I, sometidos a cirugía del abdomen inferior y miembros inferiores. Los pacientes fueron sometidos a anestesia subaracnoidea, con bupivacaína hiperbárica a 0,5% (17,5 mg - 3,5 ml más la asociación de las siguientes drogas: grupo Control (n = 20 - solución fisiológica (0,5 ml; grupo Clon 45 (n = 20 - clonidina, en la dosis de 45 µg (0,3 ml, asociada a la solución fisiológica (0,2 ml; grupo Clon 75 (n = 20 - clonidina, en la dosis de 75 µg (0,5 ml. La cirugía solamente fue realizada cuando el nivel del dermátomo atingido por el bloqueo analgésico fue de T4. RESULTADOS: A latencia de los bloqueos analgésico y motor de la anestesia subaracnóidea no discordó significativamente entre los grupos (p > 0,05. Ambas dosis de clonidina prolongaron, de manera significativa, la duración del bloqueo analgésico en T8 y del bloqueo motor grado 3 (determinado por la escala modificada de Bromage (p 0,05. Ambas dosis de clonidina prolongaron la analgesia pos-operatoria (intervalo de tiempo decorrido entre el bloqueo subaracnoideo y la primera solicitación de analgésico por el paciente en el pos-operatorio (p BACKGROUND AND OBJECTIVES: Published data suggest that clonidine, an alpha2-adrenergic agonist, in association with bupivacaine, may increase the incidence of intraoperative hypotension and bradycardia during high-level spinal anesthesia. This study aimed at determining the synergistic potential of two clonidine doses (45 and 75 µg and hyperbaric bupivacaine on characteristics and hemodynamic effects of high-level (T4 spinal anesthesia. METHODS: Participated in this randomized double-blind study, 60 ASA I patients scheduled for lower abdominal and limb surgery. Spinal anesthesia was

  2. 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

  3. 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.

  4. Expansão volêmica em raquianestesia para cesariana: comparação entre cristalóide ou colóide Expansión volemica en raquianestesia para cesárea: comparación entre cristaloide y coloide Preload during spinal anesthesia for cesarean section: comparison between crystalloid and colloid solutions

    Directory of Open Access Journals (Sweden)

    Mônica Maria Siaulys Capel Cardoso

    2004-12-01

    media de tres valores sucesivos de presión arterial sistólica (PAS. La PS fue medida a cada minuto y se administró bolus de 0,2 mg de metaraminol, por vía venosa, para disminución de PS mayor que 10% y bolus de 0,4 mg para disminución de PS mayor que 20%. Al nacimiento se evaluó el índice de Apgar y se realizó gasometria de la arteria umbilical. El análisis estadístico fue hecho con los tests t de Student modificado y para igualdad de las variables (p BACKGROUND AND OBJECTIVES: Maternal hypotension is the most common complication following spinal anesthesia for cesarean section. This study aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to cesarean section under spinal anesthesia following preload with either crystalloid or colloid (modified fluid gelatin. METHODS: Participated in this prospective study 50 term pregnant patients, physical status ASA I, submitted to cesarean section under spinal anesthesia. Patients were randomly allocated into two groups receiving preload as follows: Crystalloid group, 10 mL.kg-1 lactated Ringer; Colloid group, 10 mL.kg-1 colloid (modified fluid gelatin. Control blood pressure was defined as the mean of three successive systolic blood pressure (SBP values. SBP was measured at 1-minute intervals and 0.2 mg intravenous bolus of metaraminol was administered for SBP decrease above 10% of control blood pressure, and 0.4 mg bolus of the same drug for SBP decrease above 20% of control. Apgar score was evaluated after delivery and umbilical artery blood was sent for analysis. Modified Student's t test was used for statistical analysis and p < 0.05 was considered statistically significant. RESULTS: Hypotension 10% (100% and 100% of patients; hypotension 20% (72% and 72% of patients, nausea (4% and 8% of patients; vasopressor consumption (1.67± 0.89 mg and 1.88 ± 0.74 mg and umbilical artery pH (7.25 ± 0.04 and 7.26 ± 0.04, in Crystalloid and Colloid groups, respectively, were

  5. 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

  6. 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

  7. Hernioplastías inguinales con anestesia exclusivamente local / Inguinal Hernioplasties With Local Anesthesia

    OpenAIRE

    2015-01-01

    Lichtenstein inguinal hernia repair was described in 1974 by Irving Lichestein, who proposed a free tension surgical treatment. Currently this technique is performed anesthetic spinal block. However, many studies marke benefits of local anesthesia: prolonged postoperative analgesia, inexpensive, easy to perform and safe in patients at high risk. A retrospective observational study was performed. The inguinal hernia repair with only local anesthesia is a feasible technique, with similar res...

  8. 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

  9. Influence of anesthesia techniques of caesarean section on memory, perception and speech

    Directory of Open Access Journals (Sweden)

    Volkov O.O.

    2014-06-01

    Full Text Available In obstetrics postoperative cognitive dysfunctions may take place after caesarean section and vaginal delivery with poor results both for mother and child. The goal was to study influence of anesthesia techniques following caesarian section on memory, perception and speech. Having agreed with local ethics committee and obtained informed consent depending on anesthesia method, pregnant women were divided into 2 groups: 1st group (n=31 had spinal anesthesia, 2nd group (n=34 – total intravenous anesthesia. Spinal anesthesia: 1.8-2.2 mLs of hyperbaric 0.5% bupivacaine. ТIVА: Thiopental sodium (4 mgs kg-1, succinylcholine (1-1.5 mgs kg-1. Phentanyl (10-5-3 µgs kg-1 hour and Diazepam (10 mgs were used after newborn extraction. We used Luria’s test for memory assessment, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers". Control points: 1 - before the surgery, 2 - in 24h after the caesarian section, 3 - on day 3 after surgery, 4 - at discharge from hospital (5-7th day. The study showed that initially decreased memory level in expectant mothers regressed along with the time after caesarean section. Memory is restored in 3 days after surgery regardless of anesthesia techniques. In spinal anesthesia on 5-7th postoperative day memory level exceeds that of used in total intravenous anesthesia. The perception and speech do not depend on the term of postoperative period. Anesthesia technique does not influence perception and speech restoration after caesarean sections.

  10. 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.

  11. [Hernia repair and local anesthesia. Results of a controlled randomized clinical trial].

    Science.gov (United States)

    Milone, F; Salvatore, G; Leongito, M; Milone, M

    2010-01-01

    In the past, general and spinal anesthesia were used for hernia surgery, but nowadays local anesthesia has become the method of choice for hernia repair, especially in outpatient patients. The one-day surgery is sufficient in the management of this pathology. The advantages of local anesthesia are simplicity, safety, extended postoperative analgesia, early mobilization, lack post-anesthesia effects, and low costs. From January 2004 to December 2008 we observed 297 male patients with inguinal hernia. These patients were divided, with rigorous chronological order of hospital admission, in two study groups, different for anesthetic techniques used. Our controlled randomized clinical trial examines the effectiveness of local anesthesia to reduce the time of hospitalization, without alteration of results, and particularly the degree of satisfaction of patients surgical treated for inguinal hernia.

  12. 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 .

  13. Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura Hematoma después de raquianestesia tratado conservadoramente: relato de caso y revisión de la literatura Conservative treatment of hematoma after spinal anesthesia: case report and literature review

    Directory of Open Access Journals (Sweden)

    Daniel Segabinazzi

    2007-04-01

    objetivo de este trabajo fue describir un caso de hematoma después raquianestesia tratado de forma conservadora y revisar los trabajos en la literatura. RELATO DEL CASO: Paciente del sexo masculino, 73 años, 65 kg, 1,67 m, estado físico ASA III. Fue sometido a raquianestesia para retirada de catéter de diálisis peritoneal. Durante la realización de la punción hubo parestesias en el miembro inferior derecho. Se inyectaron 15 mg de bupivacaína hiperbárica a 0,5% sin vasoconstrictor. Veinte y cuatro horas después de la realización del bloqueo el paciente permanecía con anestesia en silla de montar y con dolor lumbar, y 48 horas después del procedimiento presentó una incontinencia urinaria. La resonancia nuclear magnética demostró la existencia de un proceso expansivo subaracnoideo, con compresión de raíces nerviosas (L4 a S1. Después de la evaluación del neurocirujano, se empieza el tratamiento conservador. El paciente recibió alta hospitalaria el 18° día de postoperatorio asintomático. CONCLUSIÓN: El caso presentado mostró una buena evolución con el tratamiento conservador.BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, and early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain

  14. Comparison on wake-up time of sufentanil and fentanyl on intraoperative wake-up test in general anesthesia patients undergoing spinal correction surgery%舒芬太尼与芬太尼用于全麻下脊柱矫形术中唤醒效果的比较

    Institute of Scientific and Technical Information of China (English)

    吴礼平; 王文军; 彭建明; 高利臣

    2011-01-01

    AIM: To research the effect of sufentanil and fentanyl on intraoperative wakeup time and quality in patients undergoing spinal correction surgery, and to study the operation method of intraoperatie wake-up test of spinal correction surgery, and further evaluate the effect of wake-up test. METHODS: Thirty eight cases of patients with spinal deformity were treated by spinal correction surgery. They were randomly divided into sufentanil group and fentanyl group with 19 patients in each group. The anesthesia induction was begun with intravenous infusion 0.1 mg/kg midazolam, 1.5-2.0 mg/kg propofol, 0. 15-0.20 mg/kg atracurium and 0.2 μg/kg sufentanil or 4.0μg/kg fentanyl. The anesthesia was maintained with continuous pump injection sufentanil 0.1 μg/(kg · h) or fentanyl 1 μg/(kg · h). Atracurium, sufentanil or fentanyl were stopped pump injection in the time of 30 min before needing awakening. The pump injection of propofol in the time of need awakening was stopped, and the process of waking up was begun. The wake-up time and quality were studied. RESULTS: The gender, age, weight and operation time were no statistically significant differences between sufentanil group and fentanyl group during the research. The recovery time of spontaneous breathing, open eyes, instruction moves of sufentanil group were shorter than fentanyl group (P< 0.05). The wake-up quality of sufentanil group was better than fentanyl group (P<0.05). There was 1 case of patients with intraoperative pain and awareness in fentanyl group. Both groups had no other complications. CONCLUSION: This method of intraoperative wake-up test is fast and effective. The wake-up time of the anesthesia which used sufentanil is shorter than those of fentanyl group, and the wake-up quality is higher than the later.%目的:对比研究舒芬太尼与芬太尼对脊柱畸形矫形术中唤醒时间及质量的影响,探讨在脊柱畸形矫形术中唤醒试验的操作方法,评估唤醒效果.

  15. Spinal infections.

    Science.gov (United States)

    Tay, Bobby K-B; Deckey, Jeffrey; Hu, Serena S

    2002-01-01

    Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.

  16. Spinal brucellosis.

    Science.gov (United States)

    Tali, E Turgut; Koc, A Murat; Oner, A Yusuf

    2015-05-01

    Spinal involvement in human brucellosis is a common condition and a significant cause of morbidity and mortality, particularly in endemic areas, because it is often associated with therapeutic failure. Most chronic brucellosis cases are the result of inadequate treatment of the initial episode. Recognition of spinal brucellosis is challenging. Early diagnosis is important to ensure proper treatment and decrease morbidity and mortality. Radiologic evaluation has gained importance in diagnosis and treatment planning, including interventional procedures and monitoring of all spinal infections.

  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. Spinal Stenosis

    Science.gov (United States)

    ... Pharyngitis, Adenitis Syndrome (Juvenile) Polymyalgia Rheumatica Psoriatic Arthritis Raynaud's Phenomenon Reactive Arthritis Rheumatoid Arthritis Scleroderma Sjogren's Syndrome Spinal Stenosis Spondyloarthritis Systemic Lupus Erythematosus (Juvenile) Takayasu's ...

  20. [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.

  1. Study Effect of Different Endotracheal Intubation General Anesthesia in High Cervical Spine Fracture With Cervical Spinal Cord Injury%不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果研究

    Institute of Scientific and Technical Information of China (English)

    刘卫忠

    2015-01-01

    Objective To investigate the effect of different endotracheal intubation and general anesthesia in high cervical spine fracture with cervical spinal cord injury.Methods 75 patients were randomly divided into three groups, and compared the cervical lfexion degree change, intubation time, the time of the exposure and the success rate of one intubation. Results The three groups of intubation time and glottic exposure time,t he laryngeal mask group intubation time and glottis exposure for the longest time, shikani laryngoscope group was the shortest,P0.05, had no difference statistically significance.Conclusion Shikani laryngoscope in high cervical spine fracture with cervical spinal cord injury of tracheal intubation with intubation laryngeal mask and direct laryngoscope has more advantages.%目的 探讨不同气管插管全麻方式应用于高位颈椎骨折伴颈髓损伤的效果.方法 将75例患者随机分为3组,并比较颈椎屈曲度变化、插管时间、声门显露时间和一次插管成功率.结果 3组插管时间和声门暴露时间比较,插管型喉罩组插管时间和声门暴露时间最长,视可尼喉镜组最短,P<0.05,差异具有统计学意义;在暴露声门时,视可尼喉镜组和插管型喉罩组颈椎屈曲度变化低于直接喉镜组,P<0.05,差异具有统计学意义,气管插入后,视可尼喉镜组颈椎屈曲度变化低于直接喉镜组,P < 0.05,差异具有统计学意义.三种方式在一次插管成功率方面对比,P > 0.05,差异不具有统计学意义.结论 视可尼喉镜在高位颈椎骨折伴颈髓损伤气管插管中较插管性喉罩和直接喉镜有更优势.

  2. 0.75%罗哌卡因复合不同剂量舒芬太尼腰麻在剖宫产术中的应用%The effects of 0.75% ropivacaine combined with different dose of sufentanyl on spinal anesthesia in caesarean section

    Institute of Scientific and Technical Information of China (English)

    罗小会; 廖琴; 孙铭阳; 欧阳文

    2012-01-01

    Objective To compare the effects of different dose of sufentanyl combined with low dose of ropivacaine on spinal anesthesia for caesarean section. Methods One hundred and forty-four pregnant women were scheduled for elective caesarean section under combined spinal epidural anesthesia. Patients were allocated into four groups according to the dose of sufentanyl: group A. no sufentanyl , groups B. C and D received 2.5 μg ·5. 0μg or 7.5 μg sufentanyl , respectively. In all groups, the local anaesthetic was used with 1.5 ml 0.75% ropivacaine(11. 25 mg). The maximal level of the sensitive blockade; degree for motor blockade; time of motor blockade regression, duration of analgesia, maternal-fetal side effects were recorded. Results There were no differences in the maximal level of sensitive blockade, degree and duration of motor blockade. Duration of complete analgesia was longer in group C and D than that in group A and H (P<0.05). There were no difference between group C and D on anesthetic efficacy and decreased pain scores. Pruritus was more frequent and severe in group D than in group C. Conclusion The addition of 5 μg sufentanyl to low-dose ropivacaine (11. 25 mg) increases its anaesthetic efficacy during caesarean section and increases duration of analgesia but have little side-effect.%目的 比较小剂量罗哌卡因复合不同剂量舒芬太尼腰麻在剖宫产术中的麻醉效果.方法 腰-硬联合麻醉下行择期剖宫产产妇144例,随机均分为四组,腰麻药为0.75%罗哌卡因1.5ml( 11.25 mg)复合舒芬太尼0μg(A组)、2.5 μg(B组)、5.0μg(C组)、7.5 μg(D组).观察产妇麻醉效果,感觉、运动阻滞程度和时间,产妇血压变化、恶心呕吐、寒战、瘙痒、术后镇痛时间及新生儿Apgar评分等.结果 四组产妇最高阻滞平面、最大运动阻滞评分及运动恢复时间差异无统计学意义.C、D组镇痛时间明显长于A.B组(P<0.05).D组麻醉效果并不明显增强,术后镇痛时间

  3. 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.

  4. 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

  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. 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

  7. 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

  8. 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.

  9. GENERAL ANESTHESIA: IS IT SAFE FOR NEWBORNS, INFANTS AND YOUNG CHILDREN ?

    Directory of Open Access Journals (Sweden)

    Nancheva Jasminka

    2016-07-01

    Full Text Available The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age, can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia. In response to this concerns, the Food and drug administration (FDA and the International Research Society in anesthesia (IARS started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study project is a large, multi-center study based at the Morgan Stanley Children’s Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery. The findings from these studies will help researches to design the safest anesthetic regimens and to develop the new and safer anesthetic drugs for use in pediatric medicine.

  10. 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...

  11. 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.

  12. Effect of dezocine combined with morphine after general anesthesia for spinal fractures on patient-controlled analgesia%地佐辛联合吗啡用于脊柱骨折全麻术后患者自控镇痛的研究

    Institute of Scientific and Technical Information of China (English)

    邓辉铃; 刘文养; 彭思进

    2015-01-01

    目的:探讨地佐辛联合吗啡用于脊柱骨折全麻术后自控镇痛(patient controlled intravenous analgesia ,PCIA)的镇痛效果及不良反应。方法2011年1月至2014年1月我院全麻下行脊柱骨折内固定手术患者90例,采用随机数字法分为观察组及对照组各45例。两组术后均进行 PCIA,对照组予以吗啡,观察组予以地佐辛联合吗啡。比较两组患者术后3、6、12、24、48 h 的视觉模拟评分(VAS)、舒适度评分(BCS)、Ramsay 评分以及不良反应。结果术后3~24 h 各时间点观察组患者的Ramsay 评分均明显高于对照组,差异有统计学意义(P <0.05);两组术后各时点 VAS 评分及 BCS 评分比较差异无统计学意义(P >0.05);观察组并发症发生率为4.44%,明显低于对照组的22.22%,差异有统计学意义(χ2=6.154,P <0.05)。结论吗啡联合地佐辛应用于脊柱骨折术后的静脉镇痛效果良好,且不良反应少,值得推广应用。%Objective To investigate the effect of dezocine combined with morphine after general anesthesia for spinal fracture on patient-controlled analgesia (PCA) and their adverse reactions .Methods Ninety patients underwent spinal fracture internal fixa -tion operation from Jan.2011 to Jan.2014 in our hospital.They were randomly divided into observation and control groups ,45 cases in each group.The control group was given morphine while the observation group was treated with dezocine combined with morphine .The visual analog scale (VAS),Bruggman comfort scale (BCS),Ramesay score and adverse reaction conditions were compared after 3,6, 12,24 and 48 h between the two groups.Results After 3-24 hours of operation,the Ramsay score at different time pints in the observa -tion group was significant higher than that in the control group (P <0.05).There was no significant difference in the VAS score and BCS scores at different time points between the two

  13. 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...

  14. 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

  15. Efeito da clonidina associada à bupivacaína a 0,5% hiperbárica na anestesia subaracnóidea Efecto de la clonidina asociada a la bupivacaína a 0,5% hiperbárica en la anestesia subaracnóidea Effects of combined clonidine and 0.5% hyperbaric bupivacaine on spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Neuber Martins Fonseca

    2001-12-01

    los otros grupos. No hubo diferencia en relación a la sedación y a los parámetros hemodinámicos entre los grupos. El grupo I presentó analgesia prolongada en relación a los demás grupos, confirmado por la menor necesidad de analgésicos en función del tiempo. CONCLUSIONES: La clonidina no alteró la dispersión cefálica y los efectos hemodinámicos del bloqueo subaracnóideo con bupivacaína a 0,5% hiperbárica; sin embargo, fue efectiva en una mejor analgesia observada con cuatro horas después del bloqueo, bien como prolongó el tiempo de anestesia.BACKGROUND AND OBJECTIVES: Clonidine is an imidazolynic compound which exhibits partial alpha2-receptor agonist action, with anxiolytic and hypnotic properties. When spinally administered, it produces selective effects in pain modulation and may prolong surgical anesthesia and motor block. This study aimed at evaluating the effects of combined clonidine and 0.5% hyperbaric bupivacaine on spinal anesthesia. METHODS: Thirth ASA I or II patients off both genders, aged between 16 and 57 years and scheduled to undergo surgical inguinal hernia repair were randomly divided into three groups in this prospective double blind study. After monitoring, patients were sedated with 2 mg venous midazolam 10 minutes before surgery, followed by paramedian spinal puncture (L3-L4 in the left lateral position with a 25G Quincke needle. After CSF confirmation, 1 ml of one of the proposed solutions were injected with 15 mg hyperbaric bupivacaine: Group I - 150 µg clonidine; Group II - 75 µg clonidine + 0.5 ml bi-distilled water; and Group III - 1 ml bi-distilled water. The following parameters were evaluated: sensory block level at 5, 20 and 30 minutes, time for two metamers regression, sedation scores through a 0 to 3 scale, motor block by a modified Bromage’s scale, postoperative pain and analgesics requirement. RESULTS: Demographics and maximum sensory level (mode were similar for all groups. Anesthesia regression and muscle

  16. 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

  17. 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 ...

  18. Spinal Stenosis

    Science.gov (United States)

    ... lower part of the body. It resembles a “horse’s tail” ( cauda equina in Latin). What Causes Spinal ... of the spine fails, it usually places increased stress on other parts of the spine. For example, ...

  19. Spinal Hemangiomas

    Directory of Open Access Journals (Sweden)

    I.A. Norkin

    2010-06-01

    Full Text Available The given article considers the modern view on etiology, pathogenesis, classifications, clinical picture, diagnosis and treatment of spinal hemangiomas. Advantages of vertebroplasty over the other techniques of treatment of studied pathology are presented

  20. Spinal Hemangiomas

    OpenAIRE

    I.A. Norkin; S.V. Likhachev; A.Yu. Chomartov; A.I. Norkin; D.M. Puchinian

    2010-01-01

    The given article considers the modern view on etiology, pathogenesis, classifications, clinical picture, diagnosis and treatment of spinal hemangiomas. Advantages of vertebroplasty over the other techniques of treatment of studied pathology are presented

  1. Spinal Infections

    Science.gov (United States)

    ... infections may occur following surgery or spontaneously in patients with certain risk factors. Risk factors for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, diabetes and obesity. Surgical risk factors ...

  2. Spinal Stenosis

    Science.gov (United States)

    ... risk. Diseases such as arthritis and scoliosis can cause spinal stenosis, too. Symptoms might appear gradually or not at all. They include Pain in your neck or back Numbness, weakness, cramping, or pain in ...

  3. Total intravenous general anesthesia with laryngeal mask airway for transurethral resection of bladder tumor

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To observe the advantage of total intravenous anesthesia for transurethral resection of bladder tumor (TURBT). Methods: Sixty ASA Ⅰ-Ⅱ patients undergoing TURBT were randomly assigned to 2 groups. Spinal anesthesia with 0.75% pure bupivacaine (8-12 mg) was applied to patients in Group Ⅰ (n= 30). Patients in Group Ⅱ (n=30) received total intravenous anesthesia with continuous infusion of Propofol and Remifentanil; and a laryngeal mask was used to ensure the airway and ventilation. BP, HR, SPO2 and pertinent side effects were monitored and recorded. Results: The patients in group Ⅱ experienced more stable hemodynamics than those in group Ⅰ. Obturator nerve reflex was observed in 15 (50.0%) patients in Group Ⅰ, but none (0%) in Group Ⅱ (P<0.01). Conclusion: Total intravenous anesthesia with laryngeal mask is a safe, reliable, controllable and simple manual for patient undergoing TURBT.

  4. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske Kvanner

    2015-01-01

    Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding...... and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non......-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled...

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. [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.

  11. Severe autonomic dysreflexia induced cardiac arrest under isoflurane anesthesia in a patient with lower thoracic spine injury

    Directory of Open Access Journals (Sweden)

    Amit Jain

    2013-01-01

    Full Text Available We present a case of severe autonomic dysreflexia (AD progressing to cardiac arrest and death under isoflurane anesthesia. Though AD in chronic cervical spine injury is a common entity, occurrence of such an event in the stage of flaccid paralysis in lower dorsal spinal cord injury is rare, especially under general anesthesia. Manipulation of urinary bladder catheter under light plane of isoflurane anesthesia might be the precipitating factor. Increasing concentration of isoflurane failed to abort the episode or might have aggravated it. High level of suspicion and vigilance is necessary to prevent, diagnose and treat such a condition.

  12. 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.

  13. 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.

  14. Varicose Vein Stripping Under Low-Dose Spinal Anaesthesia

    Directory of Open Access Journals (Sweden)

    Nalan Muhammedoğlu

    2014-03-01

    Full Text Available Aim: Spinal anesthesia is frequently used for procedures involving the lower limbs. Compared with general anesthesia, low-dose spinal anesthesia is a cost-effective method and has advantages such as avoiding hypotension, longer duration of anesthesia and increased length of hospitalization. The aim of this trial was to compare two different low-dose bupivacaine drug regimens. Methods: Sixty unpremedicated patients were randomly allocated into two groups (n=30. There were no differences between the groups in age, weight, the American Society of Anesthesiologists (ASA physical status classification, gender, and duration of surgery. We performed spinal anesthesia at the L3-4 interspace with the patient in the lateral decubitus position. We administered 6.5 mg (group 1 and 8 mg (group 2 0.5% heavy bupivacaine into the subarachnoid space. We positioned the patient laterally to the operation side for 15 minutes, then, turned to supine position. Motor and sensory block was assessed by the Bromage scale and pinprick test. Results: There were significant differences between the two groups in duration of motor block, but no significant differences in hemodynamic response to spinal anesthesia. None of the patients had intraoperative pain. Five patients in group 1 and 2 patients in group 2 had urinary retention. Conclusion: Our observations suggest that 6.5 mg heavy bupivacaine is efficient and suitable for unilateral varicose veins stripping operation. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 25-8

  15. 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.

  16. Efek Ondansetron Intravena terhadap Tekanan Darah dan Laju Nadi pada Anestesi Spinal untuk Seksio Sesarea

    Directory of Open Access Journals (Sweden)

    Annisa Isfandiary Ismandiya

    2015-08-01

    Full Text Available Hypotension is the most common complication in spinal anesthesia during cesarean sections. One of the prevention efforts includes administering a fluid vasopressor or placing a wedge under the right hip for left uterine displacement. This study aimed to determine the effect of ondansetron 8 mg, 5 minutes before spinal anesthesia, to maintain maternal hemodynamic stability. This double-blind randomized control experimental study was conducted in Dr. Hasan Sadikin General Hospital Bandung during the period of January to March 2014 on 46 pregnant women, American Society of Anesthesiologist (ASA II, who underwent cesarean section with spinal anesthesia. After randomization, the subjects were grouped into two groups: 23 subjects were included in the control group receiving Nacl 0.9% and 23 subjects were included in the ondansetron group receiving 8 mg of ondansetro. Blood pressure and pulse rate were examined every minute until 15 minutes after spinal anesthesia and then every 3 minutes until the operation was complete. Data were analyzed statistically using t test, Mann Whitney Test, and Kolmogorov-Smirnov Test. The results show that there were significant differences in systol presure, average blood pressure, and use of ephedrine between the control and ondansetron group (p<0.05. In conclusion, the provision of 8 mg ondansetron can prevent hypotension and reduce ephedrine use after spinal anesthesia in caesarean section.

  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. 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

  19. 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

  20. Dose-response study of spinal hyperbaric ropivacaine for cesarean section

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin-zhong; CHEN Hong; LOU Ai-fei; L(U) Chang-cheng

    2006-01-01

    Background: Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind,randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods: Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1~L2 vertebral interspace,then lumbar puncture was performed at the L3~L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective ifan upper sensory level to pin prick ofT7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results: ED50 (95% confidence interval)of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23~11.59) mg and ED95 (95% confidence interval) to be 15.39(13.81~23.59) mg. The maximum sensory block levels and the duration of motor block and the rate ofhypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion: The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

  1. Presentation of occult Chiari I malformation following spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Saravanan P Ankichetty

    2012-01-01

    Full Text Available Chiari I malformation (CM-I manifests with tonsillar herniation below foramen magnum. These patients are at high risk of respiratory depression and bulbar dysfunction in the perioperative period with underlying obstructive sleep apnea. However, the safe use of both general and regional anaesthesia has been documented in a known CM-I parturients. We describe the successful management of a patient who had hypercapnic respiratory failure in the post-anaesthetic care unit following an uneventful subarachnoid block for left knee replacement surgery. This patient was retrospectively diagnosed with occult CM-I and moderate to severe obstructive sleep apnea in the postoperative period.

  2. 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

  3. 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.

  4. [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.

  5. 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.

  6. 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....

  7. 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

  8. 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.

  9. 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

  10. Effects of anesthesia type on short-term postoperative cognitive function in obstetric patients following cesarean section

    Science.gov (United States)

    Altun, Celalettin; Borazan, Hale; Şahin, Osman; Gezginç, Kazım

    2015-01-01

    Objective We aimed to compare the effects of general and spinal anesthesia on cognitive functions in pregnant patients undergoing elective cesarean section. Material and Methods Seventy-five American Society of Anesthesiology (ASA) I pregnant patients aged 18–40 years who were scheduled to undergo elective cesarean section were divided into three groups. Group sevoflurane (Group S) and Group desflurane (Group D) were administered general anesthesia, whereas Group regional (Group R) was administered spinal anesthesia. Hemodynamic variables, bispectral index, oxygen saturation were measured at baseline, after induction, spinal injection, and during the surgery. Extubation and eye opening time and Aldrete scores were recorded. Mini-mental state examination, Trieger dot test, and clock drawing test were performed one day before the surgery and repeated at the 1st, 3rd and 24th h postoperatively. Results There was no statistically significant difference among the groups in terms of demographic data and duration of surgery (p>0.05). Durations of anesthesia for Group S, Group R, and Group D were significantly different (pAldrete recovery scores and total remifentanil consumption were significantly higher in Group D than in Group S (p<0.05). Extubation and eye opening times were significantly shorter in Group D than in Group S (p<0.01). According to TDT, statistical significance was found among Group S, Group R, and Group D at the 3rd and 24th h postoperatively (p<0.05), and there was a statistically high significant difference in Groups S and R (p<0.0001). Conclusion We concluded that general anesthesia with sevoflurane or desflurane and spinal anesthesia had no effects on cognitive functions in patients undergoing cesarean operation. PMID:26692772

  11. Learning about Spinal Muscular Atrophy

    Science.gov (United States)

    ... News Release Fischbeck Group Learning About Spinal Muscular Atrophy What is spinal muscular atrophy? What are the ... for Spinal Muscular Atrophy What is spinal muscular atrophy? Spinal muscular atrophy is a group of inherited ...

  12. Spinal Cord Contusion

    Institute of Scientific and Technical Information of China (English)

    Gong Ju; Jian Wang; Yazhou Wang; Xianghui Zhao

    2014-01-01

    Spinal cord injury is a major cause of disability with devastating neurological outcomes and lim-ited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result.

  13. Acquired lumbar spinal stenosis.

    Science.gov (United States)

    Deasy, JoAnn

    2015-04-01

    Lumbar spinal stenosis is the most frequent reason for spinal surgery in patients over age 65 years. In this condition, narrowing of the lumbar spinal canal and nerve root canals leads to painful, debilitating compression of spinal nerves and blood vessels. As the population ages, an increasing number of patients will be diagnosed and treated for lumbar spinal stenosis by primary care providers. This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years.

  14. Estudo comparativo entre efedrina e etilefrina como vasopressor para correção da hipotensão arterial materna em cesarianas eletivas com raquianestesia Estudio comparativo entre efedrina y etilefrina como vasopresor para correción de la hipotensión materna en cesáreas electivas con raquianestesia Ephedrine and etilefrine as vasopressor to correct maternal arterial hypotension during elective cesarean section under spinal anesthesia. Comparative study

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2006-06-01

    grupos iguales. Todas recibieron raquianestesia con bupivacaína, fentanil y morfina. Se les midió la presión arterial no invasiva y la frecuencia cardiaca. Los recién nacidos fueron evaluados con el índice de Apgar. La incidencia de hipotensión arterial, la cantidad de vasopresor necesaria para corrección y los efectos adversos fueron registrados. RESULTADOS: Ocurrió hipotensión arterial materna con frecuencia en los dos grupos, siendo un 68% del grupo etilefrina y un 63% del grupo efedrina. En la mayoría de las embrazadas, se corrigió con la primera dosis del vasopresor, sin diferencia entre los grupos (66% etilefrina, 58% efedrina. La hipotensión arterial necesitó dos o más dosis de vasopresor para ser corregida o se registró hipertensión reactiva en pocas pacientes (un 24% y un 10% del grupo etilefrina y 34% y 8% del grupo efedrina, respectivamente, sin diferencia estadística significativa. No hubo diferencia en los efectos adversos y en las pruebas de los recién nacidos. CONCLUSIONES: Con el método de administración empleado y con las dosis de vasopresor seleccionadas no hubo diferencia entre la efedrina y la etilefrina cuando se utilizaron para corregir la hipotensión arterial materna en cesáreas con raquianestesia.BACKGROUND AND OBJECTIVES: Ephedrine is the most popular vasopressor for obstetrics and etilefrine is widely used in regional anesthesia. This study aimed at comparing ephedrine and etilefrine to correct maternal arterial hypotension during elective Cesarean section under spinal anesthesia. METHODS: Participated in this study 120 pregnant patients who were randomly distributed in two equal groups. All patients received spinal anesthesia with bupivacaine, fentanyl and morphine. Noninvasive blood pressure and heart rate were monitored. Neonates were evaluated by the Apgar score. The incidence of hypotension, the amount of vasopressor needed to correct it and adverse effects were recorded. RESULTS: Maternal hypotension was similar in

  15. Memantine elicits spinal blockades of motor function, proprioception, and nociception in rats.

    Science.gov (United States)

    Chen, Yu-Wen; Chiu, Chong-Chi; Liu, Kuo-Sheng; Hung, Ching-Hsia; Wang, Jhi-Joung

    2015-12-01

    Although memantine blocks sodium currents and produces local skin anesthesia, spinal anesthesia with memantine is unknown. The purpose of the study was to evaluate the local anesthetic effect of memantine in spinal anesthesia and its comparison with a widely used local anesthetic lidocaine. After intrathecally injecting the rats with five doses of each drug, the dose-response curves of memantine and lidocaine were constructed. The potencies of the drugs and durations of spinal anesthetic effects on motor function, proprioception, and nociception were compared with those of lidocaine. We showed that memantine produced dose-dependent spinal blockades in motor function, proprioception, and nociception. On a 50% effective dose (ED50 ) basis, the rank of potency was lidocaine greater than memantine (P < 0.05 for the differences). At the equipotent doses (ED25 , ED50 , ED75 ), the block duration produced by memantine was longer than that produced by lidocaine (P < 0.05 for the differences). Memantine, but not lidocaine, displayed more sensory/nociceptive block than motor block. The preclinical data demonstrated that memantine is less potent than lidocaine, whereas memantine produces longer duration of spinal anesthesia than lidocaine. Memantine shows a more sensory-selective action over motor blockade.

  16. Use of sodium nitroprusside in neurosurgical cases during anesthesia with enflurane.

    Science.gov (United States)

    Vandesteene, A; Mouawad, E; Noterman, J; Deloof, T; Ewalenko, P; Genette, F

    1980-01-01

    In patients operated for cerebral aneurysm or angioma, the same basic method of anesthesia has been used. Premedication consisted of Thalamonal or diazepam. After induction with thiopentone, curarisation with pancuronium and tracheal intubation, anesthesia was maintained with N2O 70%, O2 30% and enflurane 1%. Small doses of fentanyl or Thalamonal were given at the beginning of anesthesia, but no more within 30 minutes before starting controlled hypotension. Adjuvant drugs and methods to reduce intracranial pressure were also used, such as dexamethasone, mannitol and cerebro-spinal fluid subtraction. The approach and dissection of the vascular lesion was done under controlled hypotension with sodium nitroprusside 0.01% solution. The mean dose of sodium nitroprusside to maintain a mean blood pressure at about 50 Torr was 1.37 mcg/kg/min.

  17. 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...

  18. 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

  19. 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。

  20. Perbandingan Efektivitas Pemberian Efedrin Oral Dosis 25 mg dengan 50 mg Preoperatif terhadap Kejadian Hipotensi Pascaanestesi Spinal pada Seksio Sesarea

    Directory of Open Access Journals (Sweden)

    Selly Oktarina Rosita

    2013-12-01

    Full Text Available Oral ephedrine is one alternative to prevent hypotension with less adverse effects. The purpose of this study was to determine the effective dose of oral ephedrine given 30–45 minutes before spinal anesthesia to reduce incidence of hypotension. The research was a single-blind randomized experimental study involving 32 pregnant women, ASA II, who underwent caesarean section with spinal anesthesia at Dr. Hasan Sadikin Hospital Bandung from March to May 2012. Subjects were divided into two groups, 25 mg ephedrine and 50mg ephedrine groups. Data was analyzed using Mann Whitney and chi-square test, p<0.05 was considered significant. Statistical analysis showed there was a significant difference (p=0.049 in incidence of hypotension between 25 mg group and 50mg group. 25mg group required more intravenous ephedrine after spinal anesthesia (p=0.040. The conclusion of this study was that oral 50mg ephedrine given 30–45 minutes before performing spinal anesthesia will reduce the incidence of hypotension after spinal anesthesia in comparison to oral 25mg ephedrine. In 25mg group, the amount of ephedrine intravenous administered is higher compared with 50mg group.

  1. 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...

  2. 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.

  3. 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.

  4. 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...

  5. 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.

  6. 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

  7. A dexmedetomidina para sedação, por via venosa, não interfere com a duração dos bloqueios sensitivo e motor da raquianestesia La dexmedetomidina para sedación, por vía venosa, no interfiere con la duración del bloqueo sensitivo y motor de la raquianestesia Intravenous dexmedetomidine for sedation does not interfere with sensory and motor block duration during spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2006-02-01

    . This study aimed at evaluating the safety and the interference of intravenous dexmedetomidine or midazolam on sensory and motor block duration spinal anesthesia. METHODS: Thirty five adult female patients, physical status ASA I and II, were submitted to spinal anesthesia with hyperbaric 0.5% bupivacaine (15 mg for elective gynecologic surgery. The patients were randomized and distributed in two groups: Group M (n = 17 - sedation with 0.25 µg.kg-1.min-1 midazolam continuous infusion and Group D (n = 18 sedation with 0.5 µg.kg-1.min-1 dexmedetomidine continuous infusion. Infusion rate was adjusted to maintain BIS between 60 and 80. The following parameters were evaluated: SBP, DBP, HR, SpO2, BIS sensory and motor block extension and duration (Bromage scale. RESULTS: There were no statistically significant differences between groups in age, weight, sensory block level, blood pressure and heart rate variation and sensory and motor block duration. CONCLUSIONS: Intravenous dexmedetomidine for sedation has not interfered with hemodynamic parameters, spinal anesthesia sensory and motor block duration or extension and it is a good option for sedation during local/regional anesthesia.

  8. Avaliação da bupivacaína hipobárica a 0,5% na raquianestesia Evaluación de la bupivacaína hipobárica a 0,5% en la anestesia espinal Evaluation of 0.5% hypobaric bupivacaine in spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Marcelo Cursino Pinto dos Santos

    2007-08-01

    paciente o no. Uno de los factores es la densidad del anestésico con relación al líquor, interfiriendo en el número de dermátomos bloqueados y consecuentemente en el nivel del bloqueo simpático y la disminución de la presión arterial (PA. El objetivo del estudio fue el de evaluar la dispersión de la bupivacaína hipobárica a 0,5%, preparada asépticamente en laboratorio y con una densidad controlada y uniforme. MÉTODO: Treinta pacientes, ASA I, II o III, con edad entre 18 y 60 anos, sin comorbidades circulatorias, sometidos a operaciones ortopédicas en el miembro inferior participaron en el estudio. Se sedaron con diazepam 0,03 mg.kg-1, posicionados en decúbito lateral con el lado a ser operado para arriba, y puncionados entre L3-L4, con aguja de Quincke 27G, siendo estandarizados con bisel y a velocidad de inyección. Se evaluaron los niveles sensitivos y motor (escala modificada de Bromage. RESULTADOS: Al final de la operación, de los pacientes (6,6% no presentaron bloqueo motor clasificado como 3 en la escala de Bromage, con el bloqueo sensitivo variando entre T4 y T12. Solamente 12,9% de los pacientes presentaron nivel sensitivo considerado "alto" para la operación propuesta (por encima de T6. La disminución de la presión arterial fue significativa bajo el punto de vista estadístico, sin llegar al 20% por debajo de los valores basales, por tanto sin significancia clínica. La variación de la frecuencia cardiaca no fue significativa. CONCLUSIONES: La bupivacaína hipobárica a 0,5% mostró ser una opción segura, y con pocas repercusiones hemodinámicas para operaciones ortopédicas en los miembros inferiores. La duración promedio observada, de 250 minutos, posibilita la realización de procedimientos ortopédicos de medio porte.BACKGROUND AND OBJECTIVES: Spinal anesthesia may cause hemodynamic changes due to factors related or not to the patient. The density of the anesthetic compared to the CSF, which interferes with the number of dermatomes

  9. Intestinal circulation during inhalation anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.

    1985-04-01

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of /sub 86/Rb and 9-microns spheres labeled with /sup 141/Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO/sub 2/) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines.

  10. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  11. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  12. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  13. The Effect of Intravenous Dexmedetomidine on Spinal Block and Sedation

    Directory of Open Access Journals (Sweden)

    Abdurrahman Ekici

    2015-03-01

    Material and Methods: Our randomised, double-blind study was applied to ASA I-III, 18-75 years old 50 patients scheduled for transurethral surgery. The patients were divided into two groups and spinal anesthesia with 5% levobupivacaine 12.5 mg was administered to all patients. Intravenous dexmedetomidine was received 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group D (n=25. Saline infusion was given 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group S (n=25. Systolic, diastolic and mean arterial pressure, heart rate, peripheral oxygen saturation values, pain and sedation score, the level and duration of motor and sensorial block, recovery and patient comfort score and side effects were recorded. Results: Time to reach maximum block level and duration of spinal anesthesia were longer in Group D than Group S. Sedation scores were significantly higher in Group D than Group S intraoperatively (except 1th minute and postoperatively 10th and 15th minutes. The incidence of side effects, postoperative recovery and patient comfort values were similar between the groups. Conclusion: We found that dexmedetomidine prolongs duration of motor block, provides safe and effective sedation without increasing the incidence of side effect in the patients under spinal anesthesia. [Cukurova Med J 2015; 40(1.000: 55-62

  14. Spinal infections

    Energy Technology Data Exchange (ETDEWEB)

    Tali, E. Turgut E-mail: turguttali@gazi.edu.tr

    2004-05-01

    Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy and myelitis. Radiological evaluations have gained importance in the diagnosis, treatment planning, treatment and treatment monitoring of the spinal infections. Conventional radiographs are usually the initial imaging study. The sensitivity and specificity of the plain radiographs are very low. The sensitivity of CT is higher while it lacks of specificity. Conventional CT has played minor role for the diagnosis of early spondylitis and disc space infection and for follow-up, researches are going on the value of MDCT. MRI is as sensitive, specific and accurate as combined nuclear medicine studies and the method of choice for the spondylitis. Low signal areas of the vertebral body, loss of definition of the end plates and interruption of the cortical continuity, destruction of the cortical margins are typical on T1WI whereas high signal of affected areas of the vertebral body and disc is typical on T2WI. Contrast is mandatory and increases conspicuity, specificity, and observer confidence in the diagnosis and facilitates the treatment planning. Contrast enhancement is the earliest sign and pathognomonic in the acute inflammatory episode and even in the subtle infection then persists to a varying degree for several weeks or months. The outcome of the treatment is influenced by the type of infection and by the degree of neurologic compromise before treatment. There is an increasing move away from surgical intervention towards conservative therapy, percutaneous drainage of abscess or both. It is therefore critical to monitor treatment response, particularly in the immuno-deficient population.

  15. Ocorre alta incidência de células da pele na primeira e terceira gotas do líquido cefalospinal em raquianestesia Ocurre una alta incidencia de células de la piel en la primera y tercera gotas del líquido cefaloespinal en la raquianestesia There is high incidence of skin cells in the first and third drops of cerebrospinal fluid in spinal anesthesia

    Directory of Open Access Journals (Sweden)

    Mário Humberto Curado Taveira

    2013-04-01

    ídeo en 39 pacientes adultos sometidos a la raquianestesia con una aguja 25G Quincke, siendo confeccionadas cuatro láminas: de la primera gota, de la tercera gota, de la aguja y una cuarta lámina control con una gota de suero fisiológico. Las láminas fueron examinadas de forma aleatoria por el patólogo. RESULTADOS: Se identificaron células epiteliales escamosas en 35 (89,7% de las muestras de la primera gota, en 34 (87,2% de la tercera gota y en 24 (61,5% de las agujas espinales. La tercera gota tuvo como promedio un mayor número de células que la primera gota (p = 0,046. Las células epiteliales nucleadas fueron encontradas en una (2,56% de las muestras de la primera gota, en cuatro (10,25% de la tercera gota y en una (2,56% de las agujas espinales. La tercera gota presentó como promedio, un mayor número de células nucleadas que la primera gota sin diferencias estadísticas (p = 0,257. CONCLUSIONES: Encontramos un alto porcentaje de células epiteliales que refluyen en la primera (89,7% y en la tercera (87,2% gotas del líquido cefalorraquídeo y en las agujas utilizadas (61,5%. Y aunque hayamos usado agujas de pequeño calibre, desechables y con un mandril bien adaptado, se encontraron células de la piel.BACKGROUND AND OBJECTIVES: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. METHODS: Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. RESULTS: Squamous epithelial cells were identified in 35 (89.7% samples from the first drop, 34 (87.2% from the third drop, and 24 (61

  16. 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

  17. Anestesia geral após falha da raquianestesia para procedimento de urgência em paciente com mucopolissacaridose: relato de caso Anestesia general después de la falla de la anestesia raquidea para procedimiento de urgencia en paciente con mucopolisacaridosis: relato de caso General anesthesia after failed spinal block for emergency surgery in a patient with mucopolysaccharidosis: case report

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2007-12-01

    in the sitting position. After identifying failure of the spinal block it was changed to general anesthesia. Anesthetic induction consisted of intravenous clonidine, fentanyl and propofol, followed by endotracheal intubation without intercurrences. After a 45-minute surgery, the patient was extubated and transferred to the postanesthetic care unit where he remained under observation for 12 hours, being discharged to the regular ward without intercurrences. CONCLUSIONS: In the case presented here we did not have any difficulties handling the airways. However, this is the main problem in this group of patients and it is up to the anesthesiologist to choose the better technique to guarantee adequate handling of the airways.

  18. Elevation of a patient's trunk and legs does not influence length of stay in the post-anesthesia care unit

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    Otávio Omati

    Full Text Available CONTEXT: Patient recovery time after anesthesia depends on problem-oriented monitoring and individual assessment. OBJECTIVE: To investigate the influence of patient positioning on post-anesthesia recovery time. TYPE OF STUDY: Retrospective. SETTING: Post-anesthesia care unit, Hospital das Clínicas, São Paulo. METHODS: Data were obtained from patients recovering from anesthesia in a supine horizontal position or with their trunk and legs elevated at 30 degrees. Data were recorded every 30 minutes. The start time was considered to be the admission to the unit, and the final measurement was taken when the patient reached an Aldrete-Kroulik index of 10. The length of time until discharge was recorded. RESULTS: 442 patients recovering after general (n = 274 or regional anesthesia (n = 168 were assigned to be kept in a supine position or with their trunk and legs elevated. There was no difference in the medians for non-parametric results, between supine position (75 min, n = 229 and trunk and legs elevated (70 min, n = 213; p = 0.729. Patients recovered faster from regional anesthesia with trunk and legs elevated (70 min than in the supine position (84.5 min, although not significantly (p = 0.097. There was no difference between patients recovering from general anesthesia, no matter the positioning (70 min; p = 0.493. DISCUSSION: Elevated legs may supposedly improve venous return and cardiac output since spinal anesthesia blocks sympathetic system and considering leg-raising has been shown to improve cardiac output from hipovolemia. Our findings did not support this hypothesis. Some limitations included a retrospective collection of data that did not allow randomization for recovery position and the unregistered duration of the exposure to the anesthetic drugs. CONCLUSIONS: There was no difference in anesthesia recovery time in relation to positioning patients supinely or with trunk and legs elevated.

  19. The elderly and general anesthesia

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2010-01-01

    Due to the aging population, the number of elderly patients taking advantage of healthcare services is increasing. A general physical decline of all organ systems and a high frequency of chronic disease accompanying aging.Comorbidity and polypharmacy are therefore common in the elderly. Hence, th......, the administration of general anesthesia to the elderly can be a very challenging task. This paper aims to highlight some of the important issues presented to the elderly undergoing surgery and to suggest some strategies for management....

  20. [Emergencies evolving from local anesthesia].

    Science.gov (United States)

    Kaufman, E; Garfunkel, A; Findler, M; Elad, S; Zusman, S P; Malamed, S F; Galili, D

    2002-01-01

    Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

  1. Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study

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    Mitra Jabalameli

    2012-01-01

    Full Text Available Background: The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia. Materials and Methods: In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer′s Lactate (RL solution (15 ml/kg plus Hemaxel (7 ml/kg preload, 2---RL solution (15 ml/kg preload plus ephedrine (15 mg, IV, bolus, 3---Hemaxel (7 ml/kg preload plus ephedrine (15 mg, IV, bolus. Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups. Results: The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH. Conclusion: Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.

  2. [Anesthesia in ophthalmology (author's transl)].

    Science.gov (United States)

    Gemperlé, M

    1977-02-01

    General anesthesia in ophthalmological surgery has become a great fashion. However there are still many problems especially in intraocular surgery. The eye with normal intraocular pressure generally needs no special technique. Most of the usual anesthesia produce a slight hypotonia with the exception of Succinylcholine, whose effect is contrary. Unfortunately this is not the case in eyes with pathologically increased intraocular pressure as in the different forms of glaucoma. Eye surgeons and anesthesists therefore look for solutions to this problem which in principle consist in the application of medicaments, which not seldom are rather agressive. The controlled hypotension by ganglion blockers, the curarisation in the state of being awake, the rapid perfusion of solutions with high osmotique effect (isolated or associated) represent such measures. The one has the disadvantage to be applied during so-called subvigile anesthesias where the security that the patient is asleep is rather doubtful; the other has the disadvantage that it requires a rapid perfusion of solutions with highly osmotic effect. It goes without saying that these conditions represent risks especially if one considers that the candidates for this type of intervention very often are senile persons with prearious cardiovascular equilibrium, with insufficient renal function and with insufficient arterial cerebral circulation. These are some of the problems which are to be discussed.

  3. Subarachnoid versus General Anesthesia in Penile Prosthetic Implantation: Outcomes Analyses

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    Gerard D. Henry

    2012-01-01

    Full Text Available The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure’s perceived success. In analyzing surgical outcomes, assessment of the anesthetic for postoperative pain and side effects should be included. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. Fifty-seven patients were included in final analysis. Patients who had more than one procedure that day or who used chronic pain medication were excluded. The type and amount of each drug used for each respective side effect (within the first 24 hours after procedure were compared to determine relative benefit. Twenty patients received general anesthesia (denoted herein as “GA” and 37 received spinal (or also known as subarachnoid anesthesia (denoted herein as “SA”. Patients receiving GA had significantly greater (P<0.0001 occurrence and amount of intravenous pain treatment than those receiving SA. Patients with SA required less intravenous pain medication and less treatment for nausea/emesis.

  4. SPLIT SKIN GRAFT HARVESTING UNDER LOCAL ANESTHESIA INFILTRATION VERSUS TOPICAL LOCAL ANESTHESIA

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    Shahi

    2014-04-01

    Full Text Available OBJECTIVE: To compare the effectiveness of topical local anesthesia using PRILOX cream versus local anesthesia infiltration using lignocaine and adrenaline in harvesting split skin graft. METHODS: A prospective study of 58 patients requiring split skin graft was carried. One group comprising 29 patients underwent harvesting of split skin graft under topical local anesthesia using PRILOX cream while the other group had local anesthesia infiltration using lignocaine and adrenaline. RESULTS: There were no significant differences between the 2 groups in terms of operating time, per operative pain, post-operative pain and post-operative requirement of analgesia. There was significant difference in time and pain during administration of local anesthesia and patient’s acceptability/ satisfaction with method of anesthesia. CONCLUSION: Topical local anesthesia using PRILOX cream can be used effectively for harvesting of split skin graft and is good alternative to local anesthesia infiltration.

  5. Spinal Cord Dysfunction (SCD)

    Data.gov (United States)

    Department of Veterans Affairs — The Spinal Cord Dysfunction (SCD) module supports the maintenance of local and national registries for the tracking of patients with spinal cord injury and disease...

  6. Tethered Spinal Cord Syndrome

    Science.gov (United States)

    ... roots may be cut to relieve pain. In adults, surgery to free (detether) the spinal cord can reduce the size ... is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord ...

  7. Extradural spinal meningioma: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Sato, N. [Department of Diagnostic Radiology, Yale University School of Medicine, P. O. Box 20 8042, New Haven, CT 06520-8042 (United States); Sze, G. [Department of Diagnostic Radiology, Yale University School of Medicine, P. O. Box 20 8042, New Haven, CT 06520-8042 (United States)

    1997-06-01

    We report a case of extradural spinal meningioma with pathologically proven features of malignant transformation. The MRI findings of extradural spinal meningioma and differences in the findings from intradural meningiomas are discussed. (orig.). With 1 fig.

  8. Spinal cord abscess

    Science.gov (United States)

    ... drugs The infection often begins in the bone ( osteomyelitis ). The bone infection may cause an epidural abscess ... Boils Cerebral spinal fluid (CSF) collection Epidural abscess Osteomyelitis Pulmonary tuberculosis Sepsis Spinal cord trauma Swelling Review ...

  9. Spinal Muscular Atrophy

    Science.gov (United States)

    Spinal muscular atrophy (SMA) is a genetic disease that attacks nerve cells, called motor neurons, in the spinal cord. These cells communicate with your voluntary muscles - the ones you can control, like in your ...

  10. Spinal Cord Diseases

    Science.gov (United States)

    ... damages the vertebrae or other parts of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such as meningitis and polio Inflammatory diseases Autoimmune diseases Degenerative diseases such as amyotrophic lateral sclerosis and spinal ...

  11. Spinal Cord Injuries

    Science.gov (United States)

    ... forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures or ... down on the nerve parts that carry signals. Spinal cord injuries can be complete or incomplete. With a complete ...

  12. Spinal Muscular Atrophy (SMA)

    Science.gov (United States)

    ... Your 1- to 2-Year-Old Spinal Muscular Atrophy (SMA) KidsHealth > For Parents > Spinal Muscular Atrophy (SMA) A A A What's in this article? ... Outlook en español Atrofia muscular espinal Spinal muscular atrophy, or SMA, is an inherited condition that causes ...

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

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    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.

  14. Articaine and lidocaine for maxillary infiltration anesthesia.

    Science.gov (United States)

    Vähätalo, K.; Antila, H.; Lehtinen, R.

    1993-01-01

    This study was undertaken to compare the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain DS) and lidocaine with 1:80,000 epinephrine (Xylocain-Adrenalin) for maxillary infiltration anesthesia. Twenty healthy dental student volunteers were included in this double-blind study. Each subject received 0.6 mL of each test solution at different times. Infiltration anesthesia was performed on the upper lateral incisor. The onset and duration of anesthesia were monitored using an electric pulp tester. No statistically significant differences were seen in the onset and duration of anesthesia between the articaine and lidocaine solutions. PMID:7943919

  15. Fully Automated Anesthesia, Analgesia and Fluid Management

    Science.gov (United States)

    2016-09-05

    General Anesthetic Drug Overdose; Adverse Effect of Intravenous Anesthetics, Sequela; Complication of Anesthesia; Drug Delivery System Malfunction; Hemodynamic Instability; Underdosing of Other General Anesthetics

  16. 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.)

  17. 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,

  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. 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.

  20. Dexmedetomidine: Expanding role in anesthesia

    Directory of Open Access Journals (Sweden)

    Jyotsna S Paranjpe

    2013-01-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical ′ideal′ sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction.

  1. [Carotid endarterectomy under local anesthesia].

    Science.gov (United States)

    Kuz'min, A L; Belov, Iu V

    2001-01-01

    Results of carotid endarterectomy (CEAE) in 193 patients with different degree of cerebrovascular insufficiency were analyzed. All the patients were men with carotid atherosclerosis (age from 39 to 68 years, mean age 53.6 +/- 0.4). A total of 253 CEAEs were performed under local anesthesia (60 patients underwent consecutive bilateral operations). In early postoperative period 3 patients died, one of them--of ischemic stroke due to thrombosis of internal carotid artery on the side of the operation. Non-fatal stroke was in 1 patient. There were no intraoperative cerebral complications. This testifies to reliability of cerebral circulation control through direct contact with patient.

  2. Presbycusis: reversible with anesthesia drugs?

    Science.gov (United States)

    Kocher, Carl A

    2009-02-01

    Age-related hearing impairment, or presbycusis, is a degenerative condition not currently treatable by medication. It is therefore significant that the author, as a patient, experienced a reversal of high-frequency hearing loss during a 2-day period following abdominal surgery with general anesthesia. This report documents the surgery and the subsequent restoration of hearing, which was bilateral and is estimated to have exceeded 50dB at 4kHz. A possible role is noted for anesthetic agents such as lidocaine, propofol, or fentanyl. This experience may hold a clue for research toward the development of medical treatments for presbycusis.

  3. Partial intravenous anesthesia in cats and dogs.

    Science.gov (United States)

    Duke, Tanya

    2013-03-01

    The partial intravenous anesthesia technique (PIVA) is used to lower the inspired concentration of an inhalational anesthetic by concurrent use of injectable drugs. This technique reduces the incidence of undesirable side-effects and provides superior quality of anesthesia and analgesia. Drugs commonly used for PIVA include opioids, alpha-2 adrenergic agonists, injectable anesthetic agents, and lidocaine. Most are administered by intravenous infusion.

  4. Orbital exenteration under trigeminal block: An innovative method of regional anesthesia

    Directory of Open Access Journals (Sweden)

    Manjunath Timmappa Bhat

    2013-01-01

    Full Text Available Orbital exenteration is a disfiguring operation involving the removal of the entire contents of the orbit, with or without the eyelids. It is widely felt that such extensive surgery can only be performed under general anesthesia. We report our experience with a patient who underwent orbitalexenteration under trigeminal block with intravenous sedation. A 68-year-old male patient was diagnosed to have orbital cellulitis (mucormycosis, uncontrolled diabetes mellitus, ischemic heart disease, dilated cardiomyopathy with severe left ventricular systolic dysfunction with severe pulmonary artery hypertension, and nephropathy. We decided to avoid general anesthesia for such a high-risk patient with many co-morbid illnesses. We gave trigeminal block using a 22-G spinal needle with local anesthetic solution of bupivacaine 0.5% by classic approach. A standard exenteration was performed and the patient tolerated the procedure well with no complications.

  5. Unexpected High Sensory Blockade during Continuous Spinal Anesthesiology (CSA in an Elderly Patient

    Directory of Open Access Journals (Sweden)

    R. Ketelaars

    2012-01-01

    Full Text Available A 98-year-old woman presented for a hemiarthroplasty of the left hip. Because of her age and cardiac and pulmonary co-existing diseases we decided to provide adequate regional anesthesia by continuous spinal anesthesia. Fragmented doses of isobaric bupivacaine 0.5% were administered through a system consisting of a spinal catheter connected to an antimicrobial filter. After an uneventful surgical procedure, prior to removal of the catheter, this system was flushed with 10 mL of normal saline in order to try to prevent post-dural-puncture headache. After arrival at the postanesthesia care unit and fifteen minutes after removal of the catheter the patient suffered an unexpected high thoracic sensory blockade and hypotension requiring treatment. The continuous spinal anesthesia technique can be used in selected cases to be able to administer local anesthetic agents in a slow and controlled manner to reach the desired effect. The risk of post-dural-puncture headache using this technique in elderly patients is very low and therefore precludes the need to try to prevent it. We have described a potentially dangerous complication of flushing a bupivacaine-filled system into the spinal canal of an elderly patient resulting in an undesirable high sensory blockade.

  6. Opioid Actions in Primary-Afferent Fibers—Involvement in Analgesia and Anesthesia

    Directory of Open Access Journals (Sweden)

    Tsugumi Fujita

    2011-01-01

    Full Text Available Opioids inhibit glutamatergic excitatory transmission from the periphery by activating G-protein coupled opioid receptors in the central terminals of primary-afferent neurons in the spinal substantia gelatinosa, resulting in antinociception. Opioid receptor activation in the peripheral terminals of primary-afferent neurons inhibits the production of action potentials in response to nociceptive stimuli given to the periphery, leading to antinociception. Opioids also exhibit a local anesthetic effect without opioid receptor activation in peripheral nerve fibers. This review article will focus on analgesia and anesthesia produced by the actions of opioids on primary-afferent fibers.

  7. International Spinal Cord Injury

    DEFF Research Database (Denmark)

    Dvorak, M F; Itshayek, E; Fehlings, M G;

    2015-01-01

    of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure-stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each...... spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it. CONCLUSION: The International SCI Spinal Interventions and Surgical Procedures Basic Data Set......STUDY DESIGN: Survey of expert opinion, feedback and final consensus. OBJECTIVE: To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set. SETTING: International working group. METHODS...

  8. [A Case of General Anesthesia for a Cardiac Transplanted Patient Undergoing Inguinal Hernia Repair under Laparoscopic Surgery].

    Science.gov (United States)

    Inoue, Mitsuko; Hayashi, Yasue; Fujita, Yuki; Shimizu, Motoko; Hotta, Arisa; Nakamoto, Ai; Yoshikawa, Noriko; Ohira, Naoko; Tatekawa, Shigeki

    2016-04-01

    A 52-year-old man was scheduled for the repair of inguinal hernia recurrence. When he was 48 years of age, he received a heart transplantation due to severe heart failure resulting from ischemic heart disease. When he was 50 years old, he suffered from inguinal hernia, and it was repaired under spinal anesthesia. During this surgery, he experienced pain because of the inadequate effect of anesthesia, but his blood pressure and heart rate were stable. We suspected that this was because of denervation of the heart. On hernia repair for inguinal hernia recurrence, general anesthesia was chosen, induced with midazolam, rocuronium, and fentanyl and maintained with sevoflurane, rocuronium, fentanyl, and remifentanil. The blood pressure was mostly stable during anesthesia, but we noted an increase in the heart rate when the trachea was intubated and extubated and when surgical incision started. This phenomenon may indicate reinnervation of the transplanted heart. We could safely manage anesthesia without invasive monitoring because the transplanted heart functioned favorably and surgery was minimally invasive.

  9. Influence of anesthesia technique at cesarean section on newborn state assessment and on uterus contraction

    Directory of Open Access Journals (Sweden)

    Олексій Олегович Волков

    2015-09-01

    Full Text Available Anesthetics and anesthesia in whole have an influence on intrauterine state of fetus. All substances that are injected to a pregnant for anesthesia penetrate in organism of fetus in some quantity. It is considered that halogened inhalation anesthetics can moderate the birth activity of uterus and its tonus in quiescence depending on concentration.Aim of research: to study the techniques of anesthesia (inhalation, total intravenous, spinal of cesarean section for assess the state of newborn and uterus contraction.Materials and methods. There were examined 95 women on term of pregnancy 37–42 weeks in 2013–2014 years who underwent cesarean section. They were divided into 3 groups depending on technique of anesthesia. I group (n=30 included women who underwent inhalation anesthesia. The second one (n=34 included women who underwent the total intravenous anesthesia. The third group – the random women (n=31 who underwent the spinal anesthesia. The state of newborns was detected on Apgar score on 1 and 5 minutes after birth. The quality of postnatal uterus contraction was assessed depending on the need of an amount of injected oxytocin and necessity to add another uterotonic preparation after fetus extraction.Results and discussion. At analysis of the state of newborn on Apgar score on 1 minute in 1 group were received 7,73±0,09 point, in 2 group this indicator was 7,4±0,14 point without statistic difference with 1 group (р=0,06. In 3 group points reached 7,55±0,17, without statistic difference with both (р=0,36, and 2 groups (р=0,50. At analysis of the state of newborn on Apgar on 5 minute statistic difference between the groups also was not established. In the 1 group this indicator reached 8,69±0,9 point, in 2 group – 8,47±0,12point, the difference with the first group was unreliable (р=0,16. In 3 group an assessment on Apgar on 5 minute was 8,64±0,12, without statistic difference with 1 and 2 groups (р=0,76 and р=0

  10. Evaluation of the Analgesic Efficacy of Melatonin in Patients Undergoing Cesarean Section Under S pinal Anesthesia: A Prospective Randomized Double-blind Study

    Science.gov (United States)

    Beigom Khezri, Marzieh; Delkhosh Reihany, Morteza; Oveisy, Sonia; Mohammadi, Navid

    2016-01-01

    Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of three groups of 40 each to receive melatonin 3 milligram (mg) (group M3), melatonin 6 mg (group M6) or placebo (group P) sublingually 20 min before the spinal anesthesia. The time to first analgesic request, analgesic requirement in the first 24 h after surgery, hemodynamic variables, anxiety scores nd the incidence of adverse events were recorded. The duration of anesthesia and analgesia didn’t show significant differences between three groups. Total analgesic request during 24 h after surgery was different among the three groups (P = 0.035). The incidence of headache in group M6 was significantly higher than others (P<0.001). However, after adjusting headache between groups of the study, we were unable to show the significant difference in the total analgesic request during 24 h after surgery among the three groups (p = 0.058). Although premedication of patients with 3 mg sublingual melatonin prolonged time to first analgesic request after cesarean delivery compared to placebo group, the difference was not statistically significant. Meanwhile increasing dose of melatonin to 6 mg failed to enhance analgesia and also increase the incidence of headache in patients undergoing cesarean section under spinal anesthesia.

  11. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  12. Mortality in anesthesia: a systematic review

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz

    2009-01-01

    Full Text Available This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s, study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

  13. Success rates and complications of awake caudal versus spinal block in preterm infants undergoing inguinal hernia repair: A prospective study

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    Mahin Seyedhejazi

    2015-01-01

    Full Text Available Background: Inguinal hernia is a common disease in preterm infants necessitating surgical repair. Despite the increased risk of postoperative apnea in preterm infants, the procedure was conventionally performed under general anesthesia. Recently, regional anesthesia approaches, including spinal and caudal blocks have been proposed as safe and efficient alternative anesthesia methods in this group of patients. The current study evaluates awake caudal and spinal blocks in preterm infants undergoing inguinal hernia repair. Materials and Methods: In a randomized clinical trial, 66 neonates and infants (weight <5 kg undergoing inguinal hernia repair were recruited in Tabriz Teaching Children Hospital during a 12-month period. They were randomly divided into two equal groups; receiving either caudal block by 1 ml/kg of 0.25% bupivacaine plus 20 μg adrenaline (group C or spinal block by 1 mg/kg of 0.5% bupivacaine plus 20 μg adrenaline (group S. Vital signs and pain scores were documented during operation and thereafter up to 24 h after operation. Results: Decrease in heart rate and systolic blood pressure was significantly higher in group C throughout the study period (P < 0.05. The mean recovery time was significantly higher in group S (27.3 ± 5.5 min vs. 21.8 ± 9.3 min; P = 0.03. Postoperative need for analgesia was significantly more frequent in group S (75.8% vs. 36.4%; P = 0.001. Failure in anesthesia was significantly higher in group S (24.4% vs. 6.1%; P = 0.04. Conclusion: More appropriate success rate, duration of recovery and postoperative need of analgesics could contribute to caudal block being a superior anesthesia technique compared to spinal anesthesia in awaked preterm infants undergoing inguinal hernia repair.

  14. EXTRADURAL ANESTHESIA WITH AND WITHOUT KETAMIN: A DOUBLE BLIND RANDOMIZED CLINICAL TRIAL

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    R TALA KOUB

    2001-09-01

    Full Text Available Introduction. Extradural anesthesia is a successfull procedure in many operations.This is also a suitable and elective anesthetic procedure in many operations have particular hemodynamic conditions. Hence the onset time on this of anesthesia is slow and the degree of sensory and motor block is relatively variable in many cases, this procedure is not accepted by anesthesiologists and surgeons. So, inspite of its priority in many cases, it is less used. Thegoal of this study is to achieve a practical and effective solution to shorten the onset of analgesia and increasing analgesic duration which studies adding ketamin to bupivacain in extradural anesthesia. Methods. This study is a double blinded randomized clinical trial. Forty adult patients in class 1 and 2 of ASA who have been candidate for elective lower limb or lower abdominal surgery in Al-zahra and Kashani medical center in 1998 were selected. Without receiving any premedications, all of the patients received 500 CC ringer lactated solution before onset of anesthesia and they were divided into 2 groups. Group 1 received 20 cc of 0.5 percent bupivacain+0.5cc of 0.9 percent normal saline. Group 2 (interventional received 20 cc of 0.5 percent bupivacain + 0.5 cc of Ketamin (25mg. The onset of sensory block and the duration of sensory and motor block were measured and compared in both groups. Results. The onset of sensory block in interventional group was shorter than in controlled group. The duration of sensory block in interventional group was longer than in controlled group. The duration of the motor block was longer in controlled group than interventional group (P < 0.05. Discussion. Adding ketamin to bupivacain results in earlier onset and longer duration of analgesia in extradural anesthesia. This effect may be due to the inhibitory effect of the ketamin on posterior nerve root activity in spinal cord which can be an effective mechanism of ketamin in making analgesia.

  15. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

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    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  16. Alzheimer’s disease and anesthesia

    Directory of Open Access Journals (Sweden)

    Marie-Amélie ePapon

    2011-01-01

    Full Text Available Cognitive disorders such as post-operative cognitive dysfunction, confusion, and delirium, are common following anesthesia in the elderly, with symptoms persisting for months or years in some patients. Alzheimer's disease (AD patients appear to be particularly at risk of cognitive deterioration following anesthesia, and some studies suggest that exposure to anesthetics may increase the risk of AD. Here, we review the literature linking anesthesia to AD, with a focus on the biochemical consequences of anesthetic exposure on AD pathogenic pathways.

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

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    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.

  18. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  19. Estudo comparativo entre ropivacaína a 0,5% e bupivacaína a 0,5% ambas hiperbáricas, na raquianestesia Estudio comparativo entre ropivacaína a 0,5% y bupivacaína a 0,5% ambas hiperbáricas, en la raquianestesia Spinal anesthesia with 0.5% hyperbaric ropivacaine and 0.5% hyperbaric bupivacaine: a comparative study

    Directory of Open Access Journals (Sweden)

    Afonso Cláudio dos Reis e Carvalho

    2002-11-01

    (50% de los pacientes en el grupo R vs 30% en el grupo B; tiempo para regresión completa del bloqueo sensorial (178,5 ± 65,2 vs 181 ± 26,9 minutos; tiempo para regresión completa del bloqueo motor (192 ± 50,7 vs 162,5 ± 37,8 min; tiempo para la primera queja espontánea de dolor (183,9 ± 37,1 vs 206,5 ± 46,6 minutos. CONCLUSIONES: En este estudio las características clínicas del bloqueo subaracnóideo con ropivacaína o bupivacaína hiperbáricas en dosis equipotentes fueron semejantes. Los datos parecen confirmar observaciones anteriores de que en estas condiciones la potencia de la ropivacaína es aproximadamente igual a la mitad de aquella de la bupivacaína.BACKGROUND AND OBJECTIVES: Spinal anesthesia with ropivacaine has been proven safe both in experimental and clinical studies. On the other hand, ropivacaine is approximately half as potent as bupivacaine in spinal anesthesia when both drugs are used in hyperbaric solutions. This study aimed at comparing clinical spinal block features obtained with hyperbaric ropivacaine or bupivacaine in equipotent doses. METHODS: Twenty ASA I or II patients, aged 20 to 60 years, scheduled for elective surgeries of lower limbs, perineum and inguinal hernioplasty, were randomly allocated into two groups . Group R (n = 10 were given 4 ml 0.5% hyperbaric ropivacaine and Group B (n = 10 were given 2 ml of 0.5% hyperbaric bupivacaine intratecally. Puncture was performed with a 25G needle in the sitting position. Monitoring consisted of SBP, DBP, MBP, HR, ECG and SpO2. Sensory and motor block onset and recovery times, hemodynamic and respiratory changes, and the incidence of adverse effects were recorded. RESULTS: There were no differences between groups in demographics data, sensory block onset (174.4 ± 75.9 vs. 191 ± 51.7 s, motor block onset (373.6 ± 214.6 vs. 240 ± 60 s, upper level of sensory block T8 - T10 (90% of group R patients vs. 70% of group B, motor block grade 3 (50% of group R patients vs. 30% of group B

  20. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  1. Dependent Prior: An Application in Spinal Anaesthesia Drug Therapy on SBP in Cesarean patients.

    Directory of Open Access Journals (Sweden)

    Atanu Bhattacharjee

    2013-12-01

    Full Text Available Cesarean section is widely used operation procedure in the world. The regional anesthesia is preferred than general anesthesia. The risk of fetus is higher in general than in regional anesthesia. The drug treatment effect on regional anesthesia plays an important role to control the systolic blood pressure (SBP during the surgery. The goal of this work is to know the effective drug to control the SBP among cesarean anesthetic patients. The dependent prior with Bayesian approach is applied in the binary response data set. The secondary data in anesthesia has been applied to compare the two drug treatments, viz. (1 Phenylephrine and (2 Ephedrine, in cesarean patients with spinal anesthesia. In both drug groups the mean of SBP has been found controlled over the duration of the surgery. No rapid changes of SBP level among the patients are observed. At the end of study it is found that the means of SBP cesarean anesthetic patients are found higher in Phenylephrine group. The Bayesian dependent prior is found to offer effective tool for drug treatment effect comparison. The drug treatment effect Ephedrine is found to be more effective to control the SBP over the duration of surgery than Phenylephrine.

  2. [The choice of a pediatric anesthesia ventilator].

    Science.gov (United States)

    Kern, D; Larcher, C; Cottron, N; Ait Aissa, D; Fesseau, R; Alacoque, X; Delort, F; Masquère, P; Agnès, E; Visnadi, G; Fourcade, O

    2013-12-01

    The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.

  3. Anesthesia in a Baird's tapir (Tapirus bairdii).

    Science.gov (United States)

    Trim, C M; Lamberski, N; Kissel, D I; Quandt, J E

    1998-06-01

    A Baird's tapir (Tapirus bairdii) was satisfactorily immobilized on two occasions with i.m. detomidine (0.065-0.13 mg/kg) and butorphanol (0.13-0.2 mg/kg). On the second occasion, anesthesia was induced by i.v. administration of ketamine (2.2 mg/kg). Twenty minutes later, endotracheal intubation was performed after an additional i.v. injection of ketamine (1.5 mg/kg). Anesthesia was maintained with isoflurane, which provided excellent conditions for radiology and surgery. Anesthesia was associated with hypoxemia when the tapir was allowed to breathe air and with hypoventilation. Mean arterial pressure remained satisfactory. No antagonist drugs were administered, and recovery from anesthesia was rapid and smooth.

  4. Anesthesia: What to Expect (For Parents)

    Science.gov (United States)

    ... a wide variety of modern medicines and monitoring technology to make sure that kids are stable and as comfortable as possible before, during, and after their ... Parents MORE ON THIS TOPIC Anesthesia Basics Types of ...

  5. Glioblastoma with spinal seeding

    Energy Technology Data Exchange (ETDEWEB)

    Fakhrai, N.; Fazeny-Doerner, B.; Marosi, C. [Clinical Div. of Oncology, Dept. of Medicine I, Univ. of Vienna (Austria); Czech, T. [Dept. of Neurosurgery, Univ. of Vienna (Austria); Diekmann, K. [Dept. of Radiooncology, Univ. of Vienna (Austria); Birner, P.; Hainfellner, J.A. [Clinical Inst. for Neurology, Univ. of Vienna (Austria); Prayer, D. [Dept. of Neuroradiology, Univ. of Vienna (Austria)

    2004-07-01

    Background: extracranial seeding of glioblastoma multiforme (GBM) is very rare and its development depends on several factors. This case report describes two patients suffering from GBM with spinal seeding. In both cases, the anatomic localization of the primary tumor close to the cerebrospinal fluid (CSF) was the main factor for spinal seeding. Case reports: two patients with GBM and spinal seeding are presented. After diagnosis of spinal seeding, both patients were highly symptomatic from their spinal lesions. Case 1 experienced severe pain requiring opiates, and case 2 had paresis of lower limbs as well as urinary retention/incontinence. Both patients were treated with spinal radiation therapy. Nevertheless, they died 3 months after diagnosis of spinal seeding. Results: in both patients the diagnosis of spinal seeding was made at the time of cranial recurrence. Both tumors showed close contact to the CSF initially. Even though the patients underwent intensive treatment, it was not possible to keep them in a symptom-free state. Conclusion: because of short survival periods, patients deserve optimal pain management and dedicated palliative care. (orig.)

  6. Spinal arteriography: a primer

    Institute of Scientific and Technical Information of China (English)

    David A KUMPE

    2005-01-01

    Spinal arteriography is an esoteric procedure that is seldom performed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the procedure should be aware of, especially about spinal dural arteriovenous fistulae (SDAVF).

  7. Spinal pain in adolescents

    DEFF Research Database (Denmark)

    Aartun, Ellen; Hartvigsen, Jan; Wedderkopp, Niels

    2014-01-01

    BACKGROUND: The severity and course of spinal pain is poorly understood in adolescents. The study aimed to determine the prevalence and two-year incidence, as well as the course, frequency, and intensity of pain in the neck, mid back, and low back (spinal pain). METHODS: This study was a school...

  8. Investigations Regarding Anesthesia during Hypovolemic Conditions.

    Science.gov (United States)

    1983-09-25

    supplier (J.G. Boswell Co.) artificially inseminates all swine, thus breeding is exactly controlled, and genetic make-up known and reproducible. Their...the facility is not required thus eliminating unproductive quarantine time and diminishing housing costs. Since our supplier artificially insem...this .ouiu be beneficial % hen iniucing anesthesia during . hypovole.iia. I.en used tor induction of anesthesia ouring hypovolemia, ketamine incrcases

  9. Single-lung ventilation in pediatric anesthesia.

    Science.gov (United States)

    Choudhry, Dinesh K

    2005-12-01

    Single-lung ventilation is requested for an increasing spectrum of surgical procedures in infants and children. A clear understanding of the physiology of single-lung ventilation, the techniques of lung separation, and the technical skill necessary to apply these techniques are essential for an anesthesiologist practicing thoracic anesthesia. This article focuses on various devices available for single-lung ventilation in the pediatric age group, the relevant respiratory physiology, and the strategies that optimize oxygenation during one-lung anesthesia.

  10. Mobile anesthesia: Ready, set, pack, and go

    OpenAIRE

    Khayata, Issam; Bourque, Jesse

    2012-01-01

    Introduction: Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might ha...

  11. Advances in local anesthesia in dentistry.

    Science.gov (United States)

    Ogle, Orrett E; Mahjoubi, Ghazal

    2011-07-01

    Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

  12. Anesthesia and analgesia for geriatric veterinary patients.

    Science.gov (United States)

    Baetge, Courtney L; Matthews, Nora S

    2012-07-01

    The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

  13. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia,Intensive Care and Pain in China, sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the young anesthetists in China.

  14. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia.Intensive Care and Pain in China. sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the.young anesthetists in China.

  15. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  16. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  17. Human spinal motor control

    DEFF Research Database (Denmark)

    Nielsen, Jens Bo

    2016-01-01

    interneurons and exert a direct (willful) muscle control with the aid of a context-dependent integration of somatosensory and visual information at cortical level. However, spinal networks also play an important role. Sensory feedback through spinal circuitries is integrated with central motor commands...... and contributes importantly to the muscle activity underlying voluntary movements. Regulation of spinal interneurons is used to switch between motor states such as locomotion (reciprocal innervation) and stance (coactivation pattern). Cortical regulation of presynaptic inhibition of sensory afferents may focus...... the central motor command by opening or closing sensory feedback pathways. In the future, human studies of spinal motor control, in close collaboration with animal studies on the molecular biology of the spinal cord, will continue to document the neural basis for human behavior. Expected final online...

  18. Potential anesthesia protocols for space exploration missions.

    Science.gov (United States)

    Komorowski, Matthieu; Watkins, Sharmila D; Lebuffe, Gilles; Clark, Jonathan B

    2013-03-01

    In spaceflight beyond low Earth's orbit, medical conditions requiring surgery are of a high level of concern because of their potential impact on crew health and mission success. Whereas surgical techniques have been thoroughly studied in spaceflight analogues, the research focusing on anesthesia is limited. To provide safe anesthesia during an exploration mission will be a highly challenging task. The research objective is thus to describe specific anesthesia procedures enabling treatment of pre-identified surgical conditions. Among the medical conditions considered by the NASA Human Research Program Exploration Medical Capability element, those potentially necessitating anesthesia techniques have been identified. The most appropriate procedure for each condition is thoroughly discussed. The substantial cost of training time necessary to implement regional anesthesia is pointed out. Within general anesthetics, ketamine combines the unique advantages of preservation of cardiovascular stability, the protective airway reflexes, and spontaneous ventilation. Ketamine side effects have for decades tempered enthusiasm for its use, but recent developments in mitigation means broadened its indications. The extensive experience gathered in remote environments, with minimal equipment and occasionally by insufficiently trained care providers, confirms its high degree of safety. Two ketamine-based anesthesia protocols are described with their corresponding indications. They have been designed taking into account the physiological changes occurring in microgravity and the specific constraints of exploration missions. This investigation could not only improve surgical care during long-duration spaceflights, but may find a number of terrestrial applications in isolated or austere environments.

  19. 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.

  20. Perioperative spinal cord infarction in nonaortic surgery: report of three cases and review of the literature.

    Science.gov (United States)

    Hobai, Ion A; Bittner, Edward A; Grecu, Loreta

    2008-06-01

    Paraplegia caused by a spinal cord infarction (SCI) is a devastating perioperative complication, most often associated with aortic and spine surgery. We present two other clinical scenarios in which perioperative SCI may occur. They happened during surgical procedures performed with epidural anesthesia, in the presence of several specific risk factors such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution. Second, SCI may occur during episodes of postoperative hypotension in patients with a history of aortic aneurysms.

  1. Transient cortical blindness as a complication of posterior spinal surgery in a pediatric patient.

    Science.gov (United States)

    Nathan, Senthil T; Jain, Viral; Lykissas, Marios G; Crawford, Alvin H; West, Constance E

    2013-09-01

    Postoperative vision loss after spinal surgery is a well-known but devastating complication that may result from direct ocular ischemia, embolism to the central retinal artery, ischemic optic neuropathy, or occipital cortical ischemia. The occipital cortex is situated in the posterior border zone of the middle and posterior cerebral arteries and is susceptible to ischemic damage. Transient cortical blindness as a cause of postoperative vision loss has never been reported after spine surgery in a child. We report an 11-year-old female patient with muscular dystrophy who underwent posterior spinal fusion and instrumentation under hypotensive anesthesia for scoliosis who developed transient cortical blindness.

  2. Comparison of Bolus Phenylephrine, Ephedrine and Mephentermine for Maintenance of Arterial Pressure during Spinal Anesth

    Directory of Open Access Journals (Sweden)

    B Bhattarai

    2010-03-01

    Full Text Available INTRODUCTION: Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine. METHODS: The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. Group P received bolus of Phenylephrine 25 microgram, where as group E received Ephedrine 5mg and Group M received Mephentermine 6mg. RESULTS: It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine. Neonatal APGAR score were similar in all three groups. CONCLUSIONS: All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration. Keywords: APGAR, ephedrine, hypotension, mephentermine, phenylephrine, spinal anesthesia.

  3. Proximal spinal muscular atrophy: current orthopedic perspective

    Directory of Open Access Journals (Sweden)

    Haaker G

    2013-11-01

    Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management

  4. [Application of Non-intubated Anesthesia in VATS].

    Science.gov (United States)

    Dai, Xiaotan; Song, Pingping; Zhang, Baijiang

    2016-05-20

    Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper.

  5. The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

    Institute of Scientific and Technical Information of China (English)

    Shengsong Huang; Minbin Yu; Jie Lian; Min Fan; Changyu Qiu

    2003-01-01

    Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5% Alcaine eye drops combined with subconjunctival anesthesia with 2% Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes(85.2%) were painless (Grade I ), 50 eyes (14.0%) were slight painful (Grade Ⅱ ), and 3 eyes (0.8%) were more painful (Grade Ⅲ ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow visual fields and poor visual ability.Conclusion: Topical anesthesia combined with subconjunctival anesthesia is effective,safe and simple anesthesia alternative in routine anti-glaucomatous surgery, especially for the glaucoma patients at the late stage with narrow visual fields and poor visual ability. It is worthy of being applied widely.

  6. 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

  7. CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma

    Institute of Scientific and Technical Information of China (English)

    LIU Chen; LIU Xiao-guang; ZHU Bin; YUAN Hui-shu; HAN Song-bo; MA Yong-qiang

    2011-01-01

    Background This study evaluated the feasibility,efficacy and safety of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma.Methods Two patients suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia.Lesions located in sacral vertebrae and cervical vertebrae,which were adjacent to nerve root and spinal canal respectively.Tumors were treated under 90°C radiofrequency temperature lasting 4 minutes by an electrode placement.Visual analog scale was used to evaluate the pain improvement.Results No complications were observed pre- and post-operation.Patients recovered to normal activities immediately and achieved complete pain relief in 24 hours.No symptoms were recurrent in 5 months and 4 months follow up.Mild scoliosis has been recovered in case 2.Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe,effective and has more clinical benefits.The long-term outcome needs further observation.

  8. Survey of international regional anesthesia fellowship directors

    Directory of Open Access Journals (Sweden)

    Lansdown AK

    2013-07-01

    Full Text Available Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results: The survey response rate was 66% (45/68. Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion: This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. Keywords: anesthesia, regional, fellowship, education

  9. Spinal Cord Injury Map

    Science.gov (United States)

    ... Videos by Topic and Question Videos by Family Relationship Videos by Experts Resources The Short List Government Programs Family and Caregiver Support Financial Help Active Lifestyle Advocacy Employment and Education Adaptive Technology Recent Medical Research Good Things to Read Spinal ...

  10. Spinal Cord Injury 101

    Science.gov (United States)

    ... Videos by Topic and Question Videos by Family Relationship Videos by Experts Resources The Short List Government Programs Family and Caregiver Support Financial Help Active Lifestyle Advocacy Employment and Education Adaptive Technology Recent Medical Research Good Things to Read Spinal ...

  11. Spinal Cord Injury

    Science.gov (United States)

    ... indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel ...

  12. Extradural Spinal Arachnoid Cysts

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-11-01

    Full Text Available A 14-year-old boy with multiple spinal arachnoid cysts and paraplegia, and 37 similar cases in the literature are reviewed by neurosurgeons and radiologist at Univ of Sao Paulo, Brazil.

  13. Spinal curves (image)

    Science.gov (United States)

    There are four natural curves in the spinal column. The cervical, thoracic, lumbar, and sacral curvature. The curves, along with the intervertebral disks, help to absorb and distribute stresses that occur from everyday activities such as walking or from ...

  14. Spinal dysraphism: MRI evaluation

    Directory of Open Access Journals (Sweden)

    Ramacharya

    2015-08-01

    Conclusion: Thus we conclude that Spinal dysraphism were common in young females, with commonest anomaly being vertebral anomaly (Spina bifida, commonest location is lumbar region, Diastematomyelia common in young aged female. Magnetic resonance imaging is an accurate, noninvasive, safe and advanced modality for evaluation of the congenital spinal disorders and help in better management of these patients with prompt and accurate diagnosis. [Int J Res Med Sci 2015; 3(8.000: 1937-1941

  15. Are urological procedures in tetraplegic patients safely performed without anesthesia? a report of three cases

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2012-02-01

    Full Text Available Abstract Background Some tetraplegic patients may wish to undergo urological procedures without anaesthesia, but these patients can develop autonomic dysreflexia if cystoscopy and vesical lithotripsy are performed without anaesthesia. Case presentation We describe three tetraplegic patients, who developed autonomic dysreflexia when cystoscopy and laser lithotripsy were carried out without anesthesia. In two patients, who declined anaesthesia, blood pressure increased to more than 200/110 mmHg during cystoscopy. One of these patients developed severe bleeding from bladder mucosa and lithotripsy was abandoned. Laser lithotripsy was carried out under subarachnoid block a week later in this patient, and this patient did not develop autonomic dysreflexia. The third patient with C-3 tetraplegia had undergone correction of kyphoscoliotic deformity of spine with spinal rods and pedicular screws from the level of T-2 to S-2. Pulmonary function test revealed moderate to severe restricted curve. This patient developed vesical calculus and did not wish to have general anaesthesia because of possible need for respiratory support post-operatively. Subarachnoid block was not considered in view of previous spinal fixation. When cystoscopy and laser lithotripsy were carried out under sedation, blood pressure increased from 110/50 mmHg to 160/80 mmHg. Conclusion These cases show that tetraplegic patients are likely to develop autonomic dysreflexia during cystoscopy and vesical lithotripsy, performed without anaesthesia. Health professionals should educate spinal cord injury patients regarding risks of autonomic dysreflexia, when urological procedures are carried out without anaesthesia. If spinal cord injury patients are made aware of potentially life-threatening complications of autonomic dysreflexia, they are less likely to decline anaesthesia for urological procedures. Subrachnoid block or epidural meperidine blocks nociceptive impulses from urinary bladder

  16. Modeling spinal cord biomechanics

    Science.gov (United States)

    Luna, Carlos; Shah, Sameer; Cohen, Avis; Aranda-Espinoza, Helim

    2012-02-01

    Regeneration after spinal cord injury is a serious health issue and there is no treatment for ailing patients. To understand regeneration of the spinal cord we used a system where regeneration occurs naturally, such as the lamprey. In this work, we analyzed the stress response of the spinal cord to tensile loading and obtained the mechanical properties of the cord both in vitro and in vivo. Physiological measurements showed that the spinal cord is pre-stressed to a strain of 10%, and during sinusoidal swimming, there is a local strain of 5% concentrated evenly at the mid-body and caudal sections. We found that the mechanical properties are homogeneous along the body and independent of the meninges. The mechanical behavior of the spinal cord can be characterized by a non-linear viscoelastic model, described by a modulus of 20 KPa for strains up to 15% and a modulus of 0.5 MPa for strains above 15%, in agreement with experimental data. However, this model does not offer a full understanding of the behavior of the spinal cord fibers. Using polymer physics we developed a model that relates the stress response as a function of the number of fibers.

  17. Progression of pre-eclampsia to eclampsia under spinal anaesthesia

    Directory of Open Access Journals (Sweden)

    Longinus N Ebirim

    2012-01-01

    Full Text Available Eclampsia remains a problem in the developing countries despite improvements in antenatal care and emergency obstetric facilities. It is an important cause of maternal morbidity and mortality in Nigeria. A 26-year-old primipara, residing in an urban city in Nigeria with antenatal care facilities, booked for antenatal care at 36 weeks of gestation and was then diagnosed with severe pre-eclampsia. She initially refused therapy and was later booked for an emergency cesarean section. She had eclamptic fits during cesarean section under spinal anesthesia, and the seizure was aborted with intravenous diazepam. The postoperative period was uneventful. Progression of pre-eclampsia to eclampsia during cesarean section under spinal anesthesia is rare, but it can occur. Early booking for antenatal care to enable an early diagnosis and treatment are necessary to prevent the progression of pre-eclampsia to eclampsia. There is need to educate the populace on the importance of ante natal care so as to improve its utilization.

  18. Before Anesthesia: The Patient's Active Role Makes a Difference

    Science.gov (United States)

    ... anesthesia, a candidate must have a four-year bachelor of science degree in nursing or other appropriate ... can—and should—take an active role in these preparations by communicating and cooperating with your anesthesia ...

  19. Discrimination of auditory stimuli during isoflurane anesthesia.

    Science.gov (United States)

    Rojas, Manuel J; Navas, Jinna A; Greene, Stephen A; Rector, David M

    2008-10-01

    Deep isoflurane anesthesia initiates a burst suppression pattern in which high-amplitude bursts are preceded by periods of nearly silent electroencephalogram. The burst suppression ratio (BSR) is the percentage of suppression (silent electroencephalogram) during the burst suppression pattern and is one parameter used to assess anesthesia depth. We investigated cortical burst activity in rats in response to different auditory stimuli presented during the burst suppression state. We noted a rapid appearance of bursts and a significant decrease in the BSR during stimulation. The BSR changes were distinctive for the different stimuli applied, and the BSR decreased significantly more when stimulated with a voice familiar to the rat as compared with an unfamiliar voice. These results show that the cortex can show differential sensory responses during deep isoflurane anesthesia.

  20. 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。

  1. PERIPHERAL BLOCK ANESTHESIA OF UPPER EXTREMITY AND ITS COMPLICATIONS

    OpenAIRE

    Tapar, Hakan; SÜREN, Mustafa; Kaya, Ziya; Arıcı, Semih; Karaman, Serkan; Kahveci, Mürsel

    2012-01-01

    Successful peripheral blocks and selection of appropriate technique according to surgery is possible with a good knowledge of anatomy. Regional peripheral block anesthesia of upper extremity which applied by single injection to plexus brachialis is the most recommended method of anesthesia in daily surgical procedures. The most important advantages of peripheral nerve blocks which are type of regional anesthesia according to general anesthesia and central blocks are less effect to...

  2. Inguinal hernioraphy under local anesthesia in the elderly patients

    OpenAIRE

    2012-01-01

    Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years) and theyounger. Anesthesia methods, additional anesthesia r...

  3. Implementation of an Anesthesia Information Management System (AIMS)

    OpenAIRE

    Douglas, James R.; Ritter, Melody J.

    2011-01-01

    During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care–related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applicati...

  4. Anesthesia care for the professional singer.

    Science.gov (United States)

    Meacham, Ryan K; Schindler, Joshua

    2015-06-01

    The professional singer comes to the day of surgery with a measure of anxiety about the effects of anesthesia or surgery on his or her voice. A detailed informed consent should be obtained to discuss and document risks, as well as set realistic expectations for recovery. The smallest endotracheal tube possible should be used to intubate in the least traumatic way. Movement of the tube should be minimized, both during anesthesia, as well as in emergence. Postoperative care may be coordinated with an otolaryngologist and speech language pathologist as the singer plans a return to performance.

  5. Congenital spinal malformations; Kongenitale spinale Malformationen

    Energy Technology Data Exchange (ETDEWEB)

    Ertl-Wagner, B.B.; Reiser, M.F. [Klinikum Grosshadern, Ludwig-Maximilians-Univ. Muenchen (Germany). Inst. fuer Klinische Radiologie

    2001-12-01

    Congenital spinal malformations form a complex and heterogeneous group of disorders whose pathogenesis is best explained embryologically. Radiologically, it is important to formulate a diagnosis when the disorder first becomes symptomatic. However, it is also crucial to detect complications of the disorder or of the respective therapeutic interventions in the further course of the disease such as hydromyelia or re-tethering after repair of a meningomyelocele. Moreover, once a congenital spinal malformation is diagnosed, associated malformations should be sought after. A possible syndromal classification such as in OEIS- or VACTERL-syndromes should also be considered. (orig.) [German] Kongenitale spinale Malformationen stellen eine komplexe Gruppe an Stoerungen dar, deren Genese sich am einfachsten aus der Embryologie heraus erklaeren laesst. Bei der klinisch-radiologischen Begutachtung ist zunaechst ihre korrekte Klassifikation im Rahmen der Erstdiagnose wichtig. Im weiteren Verlauf ist es jedoch zudem entscheidend, moegliche Komplikationen wie beispielsweise eine Hydromyelie oder ein Wiederanheften des Myelons nach Operation einer Spina bifida aperta zu erkennen. Zudem sollte bei der Diagnosestellung einer kongenitalen spinalen Malformation immer auch auf assoziierte Fehlbildungen, wie z.B. die Diastematomyelie oder das intraspinale Lipom bei der Spina bifida aperta, sowie auf eine moegliche syndromale Einordnung wie beispielsweise beim OEIS-oder VACTERL-Syndrom geachtet werden. (orig.)

  6. Nurse Anesthetists' Perceptions Regarding Utilization of Anesthesia Support Personnel

    Science.gov (United States)

    Ford, Mary Bryant

    2010-01-01

    Anesthesia support personnel (ASP) provide direct support to health care providers administering anesthesia (Certified Registered Nurse Anesthetists [CRNAs] and anesthesiologists). Because these anesthesia providers are caring for a patient whom they cannot legally or ethically leave unattended, ASP are employed to bring them extra supplies or…

  7. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger;

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to inve...

  8. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to...

  9. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  10. Spinal canal stenosis; Spinalkanalstenose

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Boutchakova, M. [Klinikum Bremen-Mitte/Bremen-Ost, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Bremen (Germany)

    2014-11-15

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. (orig.) [German] Die Spinalkanalstenose ist eine umschriebene, knoechern-ligamentaer bedingte Einengung des Spinalkanals, die zur Kompression der Nervenwurzeln oder des Duralsacks fuehren kann. Die lumbale Spinalkanalstenose manifestiert sich klinisch als Komplex aus Rueckenschmerzen sowie sensiblen und motorischen neurologischen Ausfaellen, die in der Regel belastungsabhaengig sind (Claudicatio spinalis). Die bildgebende Diagnostik mittels Magnetresonanztomographie, Computertomographie und Myelographie spielt eine entscheidende Rolle bei der optimalen patientenbezogenen Therapieentscheidung. (orig.)

  11. Awareness during general anesthesia: An Indian viewpoint

    Directory of Open Access Journals (Sweden)

    Reshma P Ambulkar

    2016-01-01

    Conclusion: Awareness under anesthesia is a distressing complication with a potential for long-term psychological consequences, and every effort should be undertaken to prevent it. It is reassuring though that our data in Indian cancer patients at high risk for intra-operative awareness suggests that it is an uncommon occurrence.

  12. [Clinical utility of thoracoscopy under local anesthesia].

    Science.gov (United States)

    Ishii, Yoshiki

    2007-07-01

    Thoracoscopy has been recently established as an indispensable technique for diagnosis and treatment of respiratory diseases. Although, thoracoscopy is usually applied under general anesthesia by a surgeon, it can also be applied by a chest physician under local anesthesia if the target is limited to pleural diseases. The main objective of medical thoracoscopy under local anesthesia is to establish a diagnosis of pleural effusions by means of observation and biopsy in the thoracic cavity. Our main target diseases are the pleuritis carcinomatosa, malignant mesothelioma and tuberculous pleuritis. These 3 diseases are the diseases with which medical thoracoscopy is most useful because they can be reliably diagnosed by biopsies and because early diagnosis and early treatment are essential. In case of the pneumothorax, treatment with bulla looping or cauterization may be possible, but we do not treat pneumothorax with medical thoracoscopy because it is impossible to approach and find air leaks of lesions located in or near blind spots such as the apex or mediastinal part In case of acute emphysema, it is important to release adhesions and perform effective drainage using thoracoscopy as soon as possible since deposition of fibrin tends to form quickly compartments that make drainage difficult. Scince medical thoracoscopy under local anesthesia is rapid, easy, safe, and well-tolerated procedure with an excellent diagnostic yield, it is recommended as a diagnostic procedure for cases with pleural diseases.

  13. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  14. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...

  15. The Biochemical Impact of Surgery and Anesthesia

    NARCIS (Netherlands)

    J.W. Hol (Jaap Willem)

    2014-01-01

    markdownabstract__Abstract__ General anesthesia has been considered by some medical historians as one of the most important contributions to modern medicine second to perhaps the concept of antiseptic medicine and hygiene. The first historical mention of a deep unnatural sleep so that surgery can t

  16. Outpatient varicocelectomy performed under local anesthesia

    Institute of Scientific and Technical Information of China (English)

    Geng-Long Hsu; Pei-Ying Ling; Cheng-Hsing Hsieh; Chii-Jye Wang; Cheng-Wen Chen; Hsien-Sheng Wen; Hsiu-Mei Huang; E. Ferdinand Einhorn; Guo-Fang Tseng

    2005-01-01

    Aim: To report a series of varicocelectomy performed under pure local anesthesia. Methods: From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale (VAS)was used to assess whether the pain level was acceptable. Results: The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % (567/575) of men could go back to work by the end of the first post-operative week and only 8 (1.4 %) men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of (18.5 ± 11.3) mm that was regarded as tolerable. Conclusion: This study has shown varicocelectomy under local anesthesia to be possible,simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

  17. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  18. [Obstetric and gynecologic anesthesia reported in the "Revista Española de Obstetricia y Ginecología" (1916-1936)].

    Science.gov (United States)

    Llorente, A; Giménez, M C; Figueira, A; Montero, G

    1994-01-01

    This study follows the evolution of anesthesia in gynecology and obstetrics in Spain between 1916 and 1936. Research included revising all articles and references concerning anesthesiology appearing in the Revista Española de Obstetricia y Ginecologia over the 20 years during which that journal was published. Eighty-three articles were found: 18 (21.6%) original research reports, 37 (44.6%) reviews of the Spanish professional literature and 28 (33.7%) summaries and descriptions of meetings of scientific organizations. Spanish references constituted 39.8% with the remaining 60.2% coming from European and Hispano-American sources. Twenty-four (34.9%) were related to spinal anesthesia, 15 (18%) covered various methods for analgesia during childbirth and 14 (16.8%) were on barbiturates. The remaining articles referred to rectally administered anesthesia, local anesthesia, inhalatory anesthesia and pain in gynecology. In conclusion, our review reveals the strong international contacts in Spanish gynecology during this period, as well as the interest of gynecologists and obstetricians in various anesthetic techniques and the rapid incorporation of new methods into their therapeutic arsenal.

  19. A Wavelet Transform Based Method to Determine Depth of Anesthesia to Prevent Awareness during General Anesthesia

    Directory of Open Access Journals (Sweden)

    Seyed Mortaza Mousavi

    2014-01-01

    Full Text Available Awareness during general anesthesia for its serious psychological effects on patients and some juristically problems for anesthetists has been an important challenge during past decades. Monitoring depth of anesthesia is a fundamental solution to this problem. The induction of anesthesia alters frequency and mean of amplitudes of the electroencephalogram (EEG, and its phase couplings. We analyzed EEG changes for phase coupling between delta and alpha subbands using a new algorithm for depth of general anesthesia measurement based on complex wavelet transform (CWT in patients anesthetized by Propofol. Entropy and histogram of modulated signals were calculated by taking bispectral index (BIS values as reference. Entropies corresponding to different BIS intervals using Mann-Whitney U test showed that they had different continuous distributions. The results demonstrated that there is a phase coupling between 3 and 4 Hz in delta and 8-9 Hz in alpha subbands and these changes are shown better at the channel T7 of EEG. Moreover, when BIS values increase, the entropy value of modulated signal also increases and vice versa. In addition, measuring phase coupling between delta and alpha subbands of EEG signals through continuous CWT analysis reveals the depth of anesthesia level. As a result, awareness during anesthesia can be prevented.

  20. Olfactory bulb encoding during learning under anesthesia

    Science.gov (United States)

    Nicol, Alister U.; Sanchez-Andrade, Gabriela; Collado, Paloma; Segonds-Pichon, Anne; Kendrick, Keith M.

    2014-01-01

    Neural plasticity changes within the olfactory bulb are important for olfactory learning, although how neural encoding changes support new associations with specific odors and whether they can be investigated under anesthesia, remain unclear. Using the social transmission of food preference olfactory learning paradigm in mice in conjunction with in vivo microdialysis sampling we have shown firstly that a learned preference for a scented food odor smelled on the breath of a demonstrator animal occurs under isofluorane anesthesia. Furthermore, subsequent exposure to this cued odor under anesthesia promotes the same pattern of increased release of glutamate and gamma-aminobutyric acid (GABA) in the olfactory bulb as previously found in conscious animals following olfactory learning, and evoked GABA release was positively correlated with the amount of scented food eaten. In a second experiment, multiarray (24 electrodes) electrophysiological recordings were made from olfactory bulb mitral cells under isofluorane anesthesia before, during and after a novel scented food odor was paired with carbon disulfide. Results showed significant increases in overall firing frequency to the cued-odor during and after learning and decreases in response to an uncued odor. Analysis of patterns of changes in individual neurons revealed that a substantial proportion (>50%) of them significantly changed their response profiles during and after learning with most of those previously inhibited becoming excited. A large number of cells exhibiting no response to the odors prior to learning were either excited or inhibited afterwards. With the uncued odor many previously responsive cells became unresponsive or inhibited. Learning associated changes only occurred in the posterior part of the olfactory bulb. Thus olfactory learning under anesthesia promotes extensive, but spatially distinct, changes in mitral cell networks to both cued and uncued odors as well as in evoked glutamate and GABA

  1. Intraoperative patient information handover between anesthesia providers

    Science.gov (United States)

    Choromanski, Dominik; Frederick, Joel; McKelvey, George Michael; Wang, Hong

    2014-01-01

    Abstract Currently, no reported studies have evaluated intraoperative handover among anesthesia providers. Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and, in many instances, significant intraoperative events are disregarded. An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide (120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs) and a smaller survey selection of CRNAs (10 institutions about 300 CRNAs in the metropolitan area of Detroit, MI, USA) to collect information on handover practices. The response rate to this survey (n = 216) was comprised of approximately 5% (n = 71) of the resident population in US anesthesia programs, 5% (n = 87) of MDAs , and 20% (n = 58) of the CRNAs. Out of all respondents (n = 212), 49.1 % had no hand-over protocol at their institution and 88% of respondents who did have institutional handover protocols believed them insufficient for effective patient handover. In addiiton, 84.8% of all responders reported situations where there was insufficient information received during a patient handover. Only 7% of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs. In contrast, 60% reported rarely having complications, 31% reported sometimes having complications, and 3% reported frequent complications. In conclusion, handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room. Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety. PMID:25332710

  2. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  3. Spinal cord swelling and candidiasis

    Energy Technology Data Exchange (ETDEWEB)

    Ho, K.; Gronseth, G.; Aldrich, M.; Williams, A.

    1982-11-01

    Fusiform swelling of the spinal cord was noted myelographically in a patient with Hodgkin's disease. Autopsy revealed that the swelling was caused by Candida infection of the spinal cord. It is suggested that fungal infection be included in the differential diagnosis of spinal cord swelling in the immunosuppressed cancer patient.

  4. Spinal actinomycosis: A rare disease

    Directory of Open Access Journals (Sweden)

    Dua Rakesh

    2010-01-01

    Full Text Available Actinomycosis is an indolent, slowly progressive infection caused by Actinomyces species. Of human actinomycosis, the spinal form is rare and actinomycosis-related spinal neurological deficit is uncommon. We report two cases with cervical and dorsal actinomycosis and one of them with spinal neurological deficit.

  5. Intramedullary spinal melanocytoma

    Directory of Open Access Journals (Sweden)

    Meic H. Schmidt

    2010-06-01

    Full Text Available Meningeal melanocytoma is a benign lesion arising from leptomeningeal melanocytes that at times can mimic its malignant counterpart, melanoma. Lesions of the spine usually occur in extramedullary locations and present with spinal cord compression symptoms. Because most reported spinal cases occur in the thoracic region, these symptoms usually include lower extremity weakness or numbness. The authors present a case of primary intrame­dullary spinal meningeal melanocytoma presenting with bilateral lower extremity symptoms in which the patient had no known supratentorial primary lesions. Gross total surgical resection allowed for full recovery, but early recurrence of tumor was detected on close follow-up monitoring, allowing for elective local radiation without loss of neurological function. Case reports of such tumors discuss different treatment strategies, but just as important is the close follow-up monitoring in these patients even after gross total surgical resection, since these tumors can recur.

  6. [Spinal cord infarction].

    Science.gov (United States)

    Naumann, N; Shariat, K; Ulmer, S; Stippich, C; Ahlhelm, F J

    2012-05-01

    Infarction of the spinal cord can cause a variety of symptoms and neurological deficits because of the complex vascular supply of the myelon. The most common leading symptom is distal paresis ranging from paraparesis to tetraplegia caused by arterial ischemia or infarction of the myelon. Venous infarction, however, cannot always be distinguished from arterial infarction based on the symptoms alone.Modern imaging techniques, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) assist in preoperative planning of aortic operations to reliably identify not only the most important vascular structure supplying the spinal cord, the artery of Adamkiewicz, but also other pathologies such as tumors or infectious disorders. In contrast to CT, MRI can reliably depict infarction of the spinal cord.

  7. Role of intraseptal anesthesia for pain-free dental treatment

    Directory of Open Access Journals (Sweden)

    G Gazal

    2016-01-01

    Full Text Available Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003, and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine, and intraosseous injection (2% lidocaine are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  8. Practice characteristics among dental anesthesia providers in the United States.

    Science.gov (United States)

    Boynes, Sean G; Moore, Paul A; Tan, Peter M; Zovko, Jayme

    2010-01-01

    General descriptions or "snapshots" of sedation/general anesthesia practices during dental care are very limited in reviewed literature. The objective of this study was to determine commonalities in dental sedation/anesthesia practices, as well as to accumulate subjective information pertaining to sedation/anesthesia care within the dental profession. This questionnaire-based survey was completed by participating anesthesia providers in the United States. A standardized questionnaire was sent via facsimile, or was delivered by mail, to 1500 anesthesia providers from a randomized list using an online database. Data from the returned questionnaires were entered onto an Excel spreadsheet and were imported into a JMP Statistical Discovery Software program for analyses. Quantitative evaluations were confined to summation of variables, an estimation of means, and a valid percent for identified variables. A total of 717 questionnaires were entered for data analysis (N=717). Data from this study demonstrate the wide variation that exists in sedation/anesthesia care and those providing its administration during dental treatment in the United States. The demographics of this randomized population show anesthesia providers involved in all disciplines of the dental profession, as well as significant variation in the types of modalities used for sedation/anesthesia care. Data from this study reveal wide variation in sedation/anesthesia care during dental treatment. These distinctions include representation of sedation/anesthesia providers across all disciplines of the dental profession, as well as variations in the techniques used for sedation/anesthesia care.

  9. Maladaptive spinal plasticity opposes spinal learning and recovery in spinal cord injury

    Directory of Open Access Journals (Sweden)

    Adam R Ferguson

    2012-10-01

    Full Text Available Synaptic plasticity within the spinal cord has great potential to facilitate recovery of function after spinal cord injury (SCI. Spinal plasticity can be induced in an activity-dependent manner even without input from the brain after complete SCI. The mechanistic basis for these effects is provided by research demonstrating that spinal synapses have many of the same plasticity mechanisms that are known to underlie learning and memory in the brain. In addition, the lumbar spinal cord can sustain several forms of learning and memory, including limb-position training. However, not all spinal plasticity promotes recovery of function. Central sensitization of nociceptive (pain pathways in the spinal cord may emerge with certain patterns of activity, demonstrating that plasticity within the spinal cord may contribute to maladaptive pain states. In this review we discuss interactions between adaptive and maladaptive forms of activity-dependent plasticity in the spinal cord. The literature demonstrates that activity-dependent plasticity within the spinal cord must be carefully tuned to promote adaptive spinal training. Stimulation that is delivered in a limb position-dependent manner or on a fixed interval can induce adaptive plasticity that promotes future spinal cord learning and reduces nociceptive hyper-reactivity. On the other hand, stimulation that is delivered in an unsynchronized fashion, such as randomized electrical stimulation or peripheral skin injuries, can generate maladaptive spinal plasticity that undermines future spinal cord learning, reduces recovery of locomotor function, and promotes nociceptive hyper-reactivity after spinal cord injury. We review these basic phenomena, discuss the cellular and molecular mechanisms, and discuss implications of these findings for improved rehabilitative therapies after spinal cord injury.

  10. Anesthesia information management systems: past, present, and future of anesthesia records.

    Science.gov (United States)

    Kadry, Bassam; Feaster, William W; Macario, Alex; Ehrenfeld, Jesse M

    2012-01-01

    Documenting a patient's anesthetic in the medical record is quite different from summarizing an office visit, writing a surgical procedure note, or recording other clinical encounters. Some of the biggest differences are the frequent sampling of physiologic data, volume of data, and diversity of data collected. The goal of the anesthesia record is to accurately and comprehensively capture a patient's anesthetic experience in a succinct format. Having ready access to physiologic trends is essential to allowing anesthesiologists to make proper diagnoses and treatment decisions. Although the value provided by anesthesia information management systems and their functions may be different than other electronic health records, the real benefits of an anesthesia information management system depend on having it fully integrated with the other health information technologies. An anesthesia information management system is built around the electronic anesthesia record and incorporates anesthesia-relevant data pulled from disparate systems such as laboratory, billing, imaging, communication, pharmacy, and scheduling. The ability of an anesthesia information management system to collect data automatically enables anesthesiologists to reliably create an accurate record at all times, regardless of other concurrent demands. These systems also have the potential to convert large volumes of data into actionable information for outcomes research and quality-improvement initiatives. Developing a system to validate the data is crucial in conducting outcomes research using large datasets. Technology innovations outside of healthcare, such as multitouch interfaces, near-instant software response times, powerful but simple search capabilities, and intuitive designs, have raised the bar for users' expectations of health information technology.

  11. Spinal Cord Stimulation

    DEFF Research Database (Denmark)

    Meier, Kaare

    2014-01-01

    pain after failed back surgery syndrome (FBSS)(4), pain due to peripheral nerve injury, stump pain(5), peripheral vascular disease(6) and diabetic neuropathy(7,8); whereas phantom pain(9), postherpetic neuralgia(10), chronic visceral pain(11), and pain after partial spinal cord injury(12) remain more...

  12. Management of autonomic hyperreflexia during cesarean section in a woman with spinal cord injury: a case report

    Institute of Scientific and Technical Information of China (English)

    李胜平; 唐小丽; 柏朝益; 韩仕碧

    2002-01-01

    @@ Labor is rarely encountered among women with spinal cord injury. Even the report by Goller and Paeslack dealt with 175 cases from 42 centers in 24 countries.1 Management and control methods of this rare condition have not been defined. Autonomic hyperreflexia (AH) is the most serious complication of labor among women with paraplegia and should be carefully controlled. We found epidural anesthesia can safely control AH during labor and delivery.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. Anesthesia for a Patient with Myotonic Dystrophy

    Directory of Open Access Journals (Sweden)

    Dilek Kalaycı

    2016-09-01

    Full Text Available Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature.

  17. Robust Adaptive Control of Hypnosis During Anesthesia

    Science.gov (United States)

    2007-11-02

    1 of 4 ROBUST ADAPTIVE CONTROL OF HYPNOSIS DURING ANESTHESIA Pascal Grieder1, Andrea Gentilini1, Manfred Morari1, Thomas W. Schnider2 1ETH Zentrum...A closed-loop controller for hypnosis was designed and validated on humans at our laboratory. The controller aims at regulat- ing the Bispectral Index...BIS) - a surro- gate measure of hypnosis derived from the electroencephalogram of the patient - with the volatile anesthetic isoflurane administered

  18. Anesthesia for Patients with Traumatic Brain Injuries.

    Science.gov (United States)

    Bhattacharya, Bishwajit; Maung, Adrian A

    2016-12-01

    Traumatic brain injury (TBI) represents a wide spectrum of disease and disease severity. Because the primary brain injury occurs before the patient enters the health care system, medical interventions seek principally to prevent secondary injury. Anesthesia teams that provide care for patients with TBI both in and out of the operating room should be aware of the specific therapies and needs of this unique and complex patient population.

  19. The effects of cigarette smoking on anesthesia.

    OpenAIRE

    Rodrigo, C.

    2000-01-01

    Cigarette smoke contains over 4000 substances, some of which are harmful to the smoker. Some constituents cause cardiovascular problems, increasing the blood pressure, heart rate, and the systemic vascular resistance. Some cause respiratory problems, interfering with oxygen uptake, transport, and delivery. Further, some interfere with respiratory function both during and after anesthesia. Some also interfere with drug metabolism. Various effects on muscle relaxants have been reported. Risk of...

  20. The National Anesthesia Clinical Outcomes Registry.

    Science.gov (United States)

    Liau, Adrian; Havidich, Jeana E; Onega, Tracy; Dutton, Richard P

    2015-12-01

    The Anesthesia Quality Institute (AQI) was chartered in 2008 by the American Society of Anesthesiologists to develop the National Anesthesia Clinical Outcomes Registry (NACOR). In this Technical Communication, we will describe how data enter NACOR, how they are authenticated, and how they are analyzed and reported. NACOR accepts case-level administrative, clinical, and quality capture data from voluntarily participating anesthesia practices and health care facilities in the United States. All data are transmitted to the AQI in summary electronic files generated by billing, quality capture, and electronic health care record software, typically on a monthly basis. All data elements are mapped to fields in the NACOR schema in accordance with a publicly available data dictionary. Incoming data are loaded into NACOR by AQI technologists and are subject to both manual and automated review to identify systematically missing elements, miscoding, and inadvertent corruption. Data are deidentified in compliance with Health Insurance Portability and Accountability Act regulations. The database server of AQI, which houses the NACOR database, is protected by 2 firewalls within the American Society of Anesthesiologists' network infrastructure; this system has not been breached. The NACOR Participant User File, a deidentified case-level dataset of information from NACOR, is available to researchers at participating institutions. NACOR architecture and the nature of the Participant User File include both strengths and weaknesses.

  1. 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.

  2. Analysis of anesthesia practice and needs in Louisiana.

    Science.gov (United States)

    de Lanzac, K S; Miller, M K; Eyrich, J E

    2001-07-01

    The Louisiana State University Health Sciences Center Department of Anesthesiology performed an analysis of anesthesia practice and needs within the State of Louisiana. The State of Louisiana currently has approximately 300 practicing anesthesiologists (physicians), 700 certified registered nurse anesthetists (CRNAs), and does not currently utilize anesthesiologist assistants (AAs). Approximately 500,000 anesthesia encounters occur annually in Louisiana. Although there is a recognized critical shortage of anesthesiologists nationally, this document will focus mainly on the issue of mid-level providers of anesthesia services. The overwhelming majority of surgical and obstetric procedures is performed using the anesthesia care team approach both nationally and in the State of Louisiana. Within the anesthesia care team model, the practice of certified registered nurse anesthetists and anesthesiologist assistants are interchangeable, and both would meet the need for mid-level anesthesia providers in the State of Louisiana.

  3. Randomized study of phentolamine mesylate for reversal of local anesthesia.

    Science.gov (United States)

    Laviola, M; McGavin, S K; Freer, G A; Plancich, G; Woodbury, S C; Marinkovich, S; Morrison, R; Reader, A; Rutherford, R B; Yagiela, J A

    2008-07-01

    Local anesthetic solutions frequently contain vasoconstrictors to increase the depth and/or duration of anesthesia. Generally, the duration of soft-tissue anesthesia exceeds that of pulpal anesthesia. Negative consequences of soft-tissue anesthesia include accidental lip and tongue biting as well as difficulty in eating, drinking, speaking, and smiling. A double-blind, randomized, multicenter, Phase 2 study tested the hypothesis that local injection of the vasodilator phentolamine mesylate would shorten the duration of soft-tissue anesthesia following routine dental procedures. Participants (122) received one or two cartridges of local anesthetic/vasoconstrictor prior to dental treatment. Immediately after treatment, 1.8 mL of study drug (containing 0.4 mg phentolamine mesylate or placebo) was injected per cartridge of local anesthetic used. The phentolamine was well-tolerated and reduced the median duration of soft-tissue anesthesia in the lip from 155 to 70 min (p < 0.0001).

  4. Differential diagnoses of spinal tumors; Differenzialdiagnose spinaler Tumoren

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-12-15

    A wide variety of degenerative, inflammatory and vascular diseases can resemble the clinical presentation and imaging findings of spinal tumors. This article provides an overview of the most frequent diseases which are important to recognize for diagnostic imaging of the spine. (orig.) [German] Eine Vielzahl degenerativer, entzuendlicher und vaskulaerer Erkrankungen kann das klinische Bild und radiologische Befunde spinaler Tumoren imitieren. Dieser Artikel dient der Uebersicht ueber die haeufigsten dieser Erkrankungen, deren Kenntnis wichtig fuer die spinale Bildgebung ist. (orig.)

  5. The heart rate variability when conducting anesthesia

    Directory of Open Access Journals (Sweden)

    Khmel'nitskiy I.V.

    2016-03-01

    Full Text Available The study was performed on the base of 10 years of using different methods of analysis of heart rate variability as an indicator of direct and reverse connection of the sympatho-adrenal system in the preoperative diagnosis and anesthetic monitoring. The possibility of predicting the depth of anaesthesia was analyzed, for depending on significant amounts of external and internal conditions, the level of anesthesia changes significantly. In this regard the influence of drugs and technological means of influencing the condition of all life-supporting systems, and the autonomic nervous system in particular, before, during and after anesthesia is of great practical interest. The balance of the pharmacological protection of the vegetative balance in the surgical aggression is studied, as well as the use of heart rate variability as a non-specific method in relation to nosological forms of pathology, both under internal and external influences. A review of a number of sources confirms that heart rate is virtually the only high-speed method to present the sympatho-vagal regulation, the most accessible somatic parameter for estimation of the cardiovascular system functioning in anesthesiology. The heart rate variability serves as an indicator of functional condition of autonomous (vegetative nervous system. It is proposed to perform the continuous monitoring of the autonomic indices of the heart rhythm, which allows to register sympaho-vagal imbalance. Dynamic monitoring, timely interpretation of heart rate variability are constantly in the spotlight, but the approach and methodology of the domestic and foreign authors distinctly differ on the following points: heart rythmography as a visual method of assessing information about the dynamics of slow-wave processes, spectral analysis of the heart sinus rhythm as the best method of analysis of large and small wave activity, tests of functional diagnostics for subsequent measurement of the autonomic nervous

  6. [Initial experiences with propofol (Disoprivan) for anesthesia induction in pediatric anesthesia].

    Science.gov (United States)

    Motsch, J; Must, W; Hutschenreuter, K

    1988-09-01

    Propofol is a new intravenous anesthetic agent that provides smooth and rapid induction of anesthesia. A short elimination half-life guarantees rapid recovery. Since it has been reformulated as an emulsion in soya bean oil, anaphylactoid reactions are unlikely to occur. As compared to adults, there is very little experience with propofol in pediatric anesthesia. The aim of this study was to evaluate propofol as an induction agent in children with respect to cardiovascular and respiratory effects and to investigate the incidence of other side-effects. METHOD. In 25 ASA I children aged 3-12 years (6.4 +/- 2.7 SD) anesthesia was induced with a single dose of propofol, after standard premedication with atropine 0.01 mg/kg and Thalamonal 0.04 ml/kg. Anesthesia was maintained with halothane, nitrous oxide, and oxygen. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation (SaO2) were measured before and each minute for 6 min after propofol administration. The incidence of side-effects during induction of anesthesia as well as during recovery and the postoperative period were recorded. RESULTS. Propofol 2.5 mg/kg produced rapid and smooth induction of anesthesia. Mean arterial pressure decreased after 1 min by 14.3% with a maximum of 16.8% after 3 min. HR was influenced differently by propofol; children with initially high HR had a decrease in HR, whereas in children with a low initial rate, HR increased transiently. After 1 min, no further changes occurred. Although no apnea was observed, respiration was shallow and depressed, as indicated by a decrease in SaO2. Two children complained of pain and 4 of discomfort at the site of the injection; 1 of these developed transient phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Nonoperating room anesthesia for the gastrointestinal endoscopy suite.

    Science.gov (United States)

    Tetzlaff, John E; Vargo, John J; Maurer, Walter

    2014-06-01

    Anesthesia services are increasingly being requested for gastrointestinal (GI) endoscopy procedures. The preparation of the patients is different from the traditional operating room practice. The responsibility to optimize comorbid conditions is also unclear. The anesthetic techniques are unique to the procedures, as are the likely events that require intervention by the anesthesia team. The postprocedure care is also unique. The future needs for anesthesia services in GI endoscopy suite are likely to expand with further developments of the technology.

  8. [Spinal opiates in obstetrics. Theoretical aspects and criteria for practical use].

    Science.gov (United States)

    Miranda, A

    1995-11-01

    Spinal opiates were introduced for use in obstetrics during the 1980's. The possibility of achieving analgesic effects with small doses, without motor and/or vegetative involvement, initially aroused a great deal of enthusiasm. After extensive experience using these drugs, however, it seems they only partially live up to these great expectations. Savings on dose seem to be attained only with morphine and the efficacy of spinal opiates used as the only agents against pain during childbirth is limited. Intradural administration is often accompanied by vegetative involvement, and the reduction in motor blockade generally does not have substantial effect on the progression of labor. On the other hand, it is important to underline the advantages of combining opiates with local anesthesia: both doses are reduced, quality of analgesia is greater, as is maternal satisfaction, and fetal/neonatal repercussions are scarce. Finally, in certain cases, opiates may constitute a valid alternative for local anesthesia, especially if delivery is intradural. The use of spinal opiates is certainly an important qualitative advance, though not a definitive one, in obstetrics.

  9. Unforgettable Ups and Downs of Acupuncture Anesthesia in China.

    Science.gov (United States)

    Jin, Lei; Wu, Jin-Song; Chen, Gong-Bai; Zhou, Liang-Fu

    2017-02-15

    Acupuncture Anesthesia originated from the pain relief and pain prevention theory in acupuncture and moxibustion. This technique is a new exploration of anesthesiology and an original achievement of China, representing a landmark combination of Traditional Chinese Medicine (TCM) and Western medicine. Acupuncture Anesthesia was initiated in 1958, and, reflecting the historical background of China after the 1960s, the use of this technique widely spread throughout the country. Reaching other countries after 1971, Acupuncture Anesthesia made a significant impact, drawing attention from medical academia worldwide. Thus, Acupuncture Anesthesia has made a special contribution to the medical science of modern China.

  10. Classifying depth of anesthesia using EEG features, a comparison.

    Science.gov (United States)

    Esmaeili, Vahid; Shamsollahi, Mohammad Bagher; Arefian, Noor Mohammad; Assareh, Amin

    2007-01-01

    Various EEG features have been used in depth of anesthesia (DOA) studies. The objective of this study was to find the excellent features or combination of them than can discriminate between different anesthesia states. Conducting a clinical study on 22 patients we could define 4 distinct anesthetic states: awake, moderate, general anesthesia, and isoelectric. We examined features that have been used in earlier studies using single-channel EEG signal processing method. The maximum accuracy (99.02%) achieved using approximate entropy as the feature. Some other features could well discriminate a particular state of anesthesia. We could completely classify the patterns by means of 3 features and Bayesian classifier.

  11. [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.

  12. Local anesthesia: A feasible option for pediatric frontalis sling surgery.

    Science.gov (United States)

    William, Jerald; Abbott, Joseph; Kipioti, Athina; Reuser, Tristan

    2011-01-01

    The purpose of this study was to demonstrate the suitability of local anesthesia in the pediatric age group for oculoplastic procedures. The authors present a case of frontalis sling surgery performed under local anesthesia in a 15-year-old boy with bilateral congenital ptosis. No significant technical difficulties were encountered during the procedure. Optimal intraoperative eyelid placement was facilitated by the patient's comfort and cooperation. For some selected children, local anesthesia is a good alternative to general anesthesia to obtain the best outcome.

  13. Imaging of Spinal Metastatic Disease

    Directory of Open Access Journals (Sweden)

    Lubdha M. Shah

    2011-01-01

    Full Text Available Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver. Approximately 60–70% of patients with systemic cancer will have spinal metastasis. Materials/Methods. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease. Conclusions. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease.

  14. A COMPARATIVE STUDY OF RECOVERY TIME AFTER GENERAL ANESTHESIA AND SUBARCHNOID BLOCK FOR INGUINAL HERNIORRAPHY IN PACU

    Directory of Open Access Journals (Sweden)

    Dipalisingh

    2014-06-01

    Full Text Available BACKGROUND: Inguinal herniorraphy is commonly performed on an outpatient basis under nerve blocks, local, spinal or general anesthesia (GA. We have selected inguinal herniorraphy under general anesthesia and spinal anesthesia (SA. OBJECTIVE: To compare the recovery time, postoperative pain and patient satisfaction in the Post Anesthetic Care Unit (PACU. METHODS: A prospective, single blinded, controlled study involved total 60 patients belonging to American Society of Anesthesiologists (ASA I/II scheduled for elective repair of unilateral inguinal hernia. Randomization was done using computer generated random numbers. GA group received intravenous (IV propofol (2mg/kg, butorphanol (40μg/kg and skeletal muscle relaxation was achieved with vecuronium bromide (0.1 mg/kg. Patient was maintained with nitrous oxide and oxygen (66:33 and sevoflurane. SA group received 2ml of 0.5% of hyperbaric bupivacaine intrathecal in lateral decubitus position with 0.04mg/kg midazolam injection IV for sedation. Modified Aldrete scoring system, Visual Analogue Scale (VAS and modified Bromage score were employed to assess recovery time. When pain score was more than 5, rescue analgesia was given with IV injection ketorolac 30mg. All data were analyzed statistically. RESULTS: Patients in GA group (136.23 ±17.82 minutes showed a statistically significant (p< 0.05 recovery time to get shifted from PACU compared with patients in the SA group (176.00 ± 11.92 minutes. But patients in the SA group had significantly less VAS score pain (1.30±1.76 vs. 3.23±2.88, less number of patient received rescue analgesia (16.7% vs. 50% and satisfaction was higher than GA group. CONCLUSIONS: We conclude that GA group resulted in faster recovery time from PACU but SA group had less post-operative pain and better satisfied

  15. Spinal brucellosis: a review

    Energy Technology Data Exchange (ETDEWEB)

    Chelli Bouaziz, Mouna; Ladeb, Mohamed Fethi; Chakroun, Mohamed; Chaabane, Skander [Institut M T Kassab d' orthopedie, Department of Radiology, Ksar Said (Tunisia)

    2008-09-15

    Brucellosis is a zoonosis of worldwide distribution, relatively frequent in Mediterranean countries and in the Middle East. It is a systemic infection, caused by facultative intra-cellular bacteria of the genus Brucella, that can involve many organs and tissues. The spine is the most common site of musculoskeletal involvement, followed by the sacroiliac joints. The aim of this study was to assess the clinical, biological and imaging features of spinal brucellosis. (orig.)

  16. 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.

  17. 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.

  18. Two spinal arachnoid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Puijlaert, J.B.C.M.; Vielvoye, G.J.; Dulken, H. van

    1985-05-01

    Two cases of spinal arachnoid cysts are reported. One is extradurally located, the other intradurally. The first is only documented with myelography, the second also by subsequent CT scanning. Some clinical and diagnostic aspects of the lesion are discussed. The aim of this report is to add two new cases to the literature and to emphasize the role of high-resolution CT scanning in the diagnosis of these lesions.

  19. [Anesthesia for laparoscopy in sterile patients].

    Science.gov (United States)

    Schönrath, B; Borgwardt, D; Langanke, D; Alexander, H; Baier, D; Haake, K W

    1990-01-01

    During 5 years 382 laparoscopies were carried through in female patients with sterility in different kinds of anaesthesia (Intubation anaesthesia, spinal anaesthesia, and i.v. anaesthesia). We found the most advantageous results in the cases of i.v. anaesthesia with Ketamin and Diazepam.

  20. Pain following spinal cord injury

    OpenAIRE

    2004-01-01

    The aims of this thesis were to assess and characterise nociceptive and neuropathic pain, the use of pharmacological and non-pharmacological pain treatment, and the influence of pain on the quality of sleep in a population following spinal cord injury (SCI). This thesis is divided into five separate studies: I. Pain in a Swedish spinal cord injury population. II. Gender related differences in pain in spinal cord injured individuals. III. Use of analgesic drugs in indi...

  1. [Information analysis of spinal ganglia].

    Science.gov (United States)

    Lobko, P I; Kovaleva, D V; Kovalchuk, I E; Pivchenko, P G; Rudenok, V V; Davydova, L A

    2000-01-01

    Information parameters (entropia and redundancy) of cervical and thoracic spinal ganglia of albino rat foetuses, mature animals (cat and dog) and human subjects were analysed. Information characteristics of spinal ganglia were shown to be level-specified and to depend on their functional peculiarities. Information parameters of thoracic spinal ganglia of man and different animals are specie specified and may be used in assessment of morphological structures as information systems.

  2. Spinal sensory circuits in motion

    OpenAIRE

    2016-01-01

    International audience; The role of sensory feedback in shaping locomotion has been long debated. Recent advances in genetics and behavior analysis revealed the importance of proprioceptive pathways in spinal circuits. The mechanisms underlying peripheral mechanosensation enabled to unravel the networks that feedback to spinal circuits in order to modulate locomotion. Sensory inputs to the vertebrate spinal cord were long thought to originate from the periphery. Recent studies challenge this ...

  3. Spinal dysraphism: MR imaging rationale.

    Science.gov (United States)

    Rossi, A; Cama, A; Piatelli, G; Ravegnani, M; Biancheri, R; Tortori-Donati, P

    2004-01-01

    Spinal cord development occurs through the three consecutive periods of gastrulation (weeks 2-3), primary neurulation (weeks 3-4), and secondary neurulation (weeks 5-6). Spinal cord malformations derive from defects in these early embryonic stages, and are collectively called spinal dysraphisms. Spinal dysraphisms may be categorized clinically into open and closed, based on whether the abnormal nervous tissue is exposed to the environment or covered by skin. Open spinal dysraphisms include myelomeningocele and other rare abnormalities such as myelocele, hemimyelomeningocele, and hemimyelocele, and are always associated with a Chiari II malformation. Closed spinal dysraphisms are further divided into two subsets based on whether a subcutaneous mass is present in the low back. Closed spinal dysraphisms with mass comprise lipomyelocele, lipomyelomeningocele, meningocele, and myelocystocele. Closed spinal dysraphisms without mass comprise simple dysraphic states (tight filum terminale, filar and intradural lipomas, persistent terminal ventricle, and dermal sinuses) and complex dysraphic states. The latter category involves abnormal notochordal development, either in the form of failed midline integration (ranging from complete dorsal enteric fistula to neurenteric cysts and diastematomyelia) or of segmental agenesis (caudal agenesis and spinal segmental dysgenesis). Magnetic resonance imaging is the imaging modality of choice for evaluation of this complex group of disorders.

  4. 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

  5. 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.

  6. Comparison of Total Intravenous Anesthesia (TIVA with Inhalation Anesthesia in Pediatric Bronchoscopy

    Directory of Open Access Journals (Sweden)

    Majid Razavi

    2013-12-01

    Full Text Available Background: Because of airway stimulations during the bronchoscopy and lack of direct access to the airway, preferred method of anesthesia for rigid bronchoscopy is already controversial. In this study we compared inhalation anesthesia with total intravenous anesthesia (TIVA for rigid bronchoscopy. Method and Materials: 30 patients aged 2-6 years were chosen divided on two same groups. Anesthesia in group I maintained with halothane and in group II maintained with remifentanil and propofol. Oxygenation, heart rate, respiratory rate, coughing, bucking, laryngospasm, bronchospasm were evaluated during and after surgery. Also Operation success and surgeon’s satisfaction were recorded as well.Results: Demographic findings were the same in both groups. Oxygenation and heart rate were more stable in group II (P=0.047 and P=0.026 respectively but there was no significant difference in respiratory rate between two groups (P=1. Success rate was also similar in both groups but surgeon’s satisfaction was significantly higher in TIVA (P=0.003. There was not any significant different between complications in two groups. Conclusion: We suggest TIVA for rigid bronchoscopy because of better oxygenation, more homodynamic stability, surgeon’s satisfaction, lack of air pollution and less interference with surgeon’s visual field.

  7. [Anesthesia for geriatric patients : Part 2: anesthetics, patient age and anesthesia management].

    Science.gov (United States)

    Herminghaus, A; Löser, S; Wilhelm, W

    2012-04-01

    Part 2 of this review on geriatric anesthesia primarily describes the multiple influences of age on the pharmacokinetics and pharmacodynamics of different anesthetic agents and their impact on clinical practice. In the elderly the demand for opioids is reduced by almost 50% and with total intravenous anesthesia the dosages of propofol and remifentanil as well as recovery times are more determined by patient age than by body weight. As a result depth of anesthesia monitoring is recommended for geriatric patients to individually adjust the dosing to patients needs. With muscle relaxants both delayed onset of action and prolonged duration of drug effects must be considered with increasing age and as this may lead to respiratory complications, neuromuscular monitoring is highly recommended. The following measures appear to be beneficial for geriatric patients: thorough preoperative assessment, extended hemodynamic monitoring, use of short-acting anesthetics in individually adjusted doses best tailored by depth of anesthesia monitoring, intraoperative normotension, normothermia and normocapnia, complete neuromuscular recovery at the end of the procedure and well-planned postoperative pain management in order to reduce or avoid the use of opioids.

  8. Assessment of different anesthesia depth under total intravenous anesthesia on postoperative cognitive function in laparoscopic patients

    Directory of Open Access Journals (Sweden)

    Delin Zhang

    2016-01-01

    Full Text Available Background: This study aimed to compare the effects of different depths of sedation during total intravenous anesthesia (TIVA with remifentanil and propofol given by target-controlled infusion (TCI on postoperative cognitive function in young and middle-aged patients undergoing gynecological laparoscopic surgery. Materials and Methods: A total of 150 American Society of Anesthesiologists physical Status I/II patients scheduled for gynecological laparoscopic operation were randomly divided into three groups. Anesthesia was maintained with intravenous infusion of TCI propofol and remifentanil, intermittent injected intravenously with rocuronium. The infusion concentration of propofol and remifentanil was adjusted to maintain bispectral index (BIS at 30 24 sores on the day before anesthesia and the day after surgery in all three groups. However, the first group had the significantly higher MMSE scores than the other two groups after surgery (P < 0.05. Compared with that before anesthesia, TMT completion time was shorter on the day after surgery in the first group, while prolonged in the third group (P < 0.05. The first group had the significantly lower TMT completion time than the other two groups (P < 0.05. Conclusion: The depth of sedation, 30 < BIS value ≤ 40, under TIVA with remifentanil and propofol given by TCI had the minimal influence on postoperative cognitive function.

  9. 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.

  10. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...... on the use of premedication, choice of anesthetics, and management of postoperative pain. This review reflects on both general considerations concerning geriatric patients but also on the specific features of perioperatively used drugs and anesthetics that might have an impact on patients with Alzheimer...

  11. Anesthesia for the child with cancer.

    Science.gov (United States)

    Latham, Gregory J

    2014-03-01

    Children with cancer undergo a host of surgeries and procedures that require anesthesia during the various phases of the disease. A safe anesthetic plan includes consideration of the direct effects of tumor, toxic effects of chemotherapy and radiation therapy, the specifics of the surgical procedure, drug-drug interactions with chemotherapy agents, pain syndromes, and psychological status of the child. This article provides a comprehensive overview of the anesthetic management of the child with cancer, focuses on a systems-based approach to the impact from both tumor and its treatment in children, and presents a discussion of the relevant anesthetic considerations.

  12. Oxidative Stress and Anesthesia in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Peivandi Yazdi A

    2014-04-01

    Full Text Available Free radical and peroxide production lead to intracellular damage. On the other hand, free radicals are used by the human immune system to defend against pathogens. The aging process could be limited by oxidative stress in the short term. Chronic diseases like diabetes mellitus (DM are full-stress conditions in which remarkable metabolic functional destructions might happen. There is strong evidence regarding antioxidant impairment in diabetes. Performing a particular method for anesthesia in diabetic patients might prevent or modify excessive free radical formation and oxidative stress. It seems that prescribing antioxidant drugs could promote wound healing in diabetics.  

  13. Anatomy of an anesthesia information management system.

    Science.gov (United States)

    Shah, Nirav J; Tremper, Kevin K; Kheterpal, Sachin

    2011-09-01

    Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records.

  14. SURVEILLANCE OF BACTERIAL CONTAMINATION OF ANESTHESIA MACHINE AND PERIPHERAL INTRAVENOUS CANNULA DURING GENERAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Ch. Srinivas

    2015-01-01

    Full Text Available BACKGROUND: Given the expanding role of the anesthesiologist as the “total perioperative physician,” the increasing number of invasive procedures performed by anesthesiologists, and the increase in the prevalence of emerging diseases, stringent attention to infection control practices is paramount. AIM : To find out the bacterial contamination of anesthesia machine and internal lumen of the injection port of peri pheral intravenous cannula, and evaluation of its risk factors during general anesthesia procedures. MATERIALS AND METHODS: 50 general anaesthesia procedures were selected randomly after the approval of ethics committee and informed consent from the patien t. Samples were taken for bacterial culture on 2 sites in anesthesia machine (Adjustable pressure limiting valve {APL} and agent concentration dial of inhaled anesthetics{AD} and internal lumen of the injection port of peripheral intravenous cannula befor e starting and after completion of procedures. Bacteria and colony count were identified according to standard laboratory methods . RESULTS : Adjustable pressure limiting valve area was contaminated with bacteria in 12% (6/50 before starting procedure and 34% (17/50 after completion of procedures. Agent concentration dial of inhaled anesthetic site was contaminated with bacteria in 10% (5/50 before starting procedure and 28% (14/50 after completion of procedures. Bacterial contamination occurred in the i nternal lumen of the injection port of peripheral intravenous cannula in 16% (8/50 during general anesthesia. Isolated bacteria in anesthesia machine and peripheral intra venous cannula sites are STAPHYLO COCCI, STREPTOCOCCI, MICRO COCCI, ENTERO COCCI, E. COLI, and PSEUDOMONAS . CONCLUSION: Bacterial contamination is significantly associated with procedure order in a day (bacterial contamination rate is increased from first procedure to fifth procedure in a day. It is significantly associated with surgical s pecialty highest in

  15. Optimization of a pain model: effects of body temperature and anesthesia on bladder nociception in mice.

    Science.gov (United States)

    Sadler, Katelyn E; Stratton, Jarred M; DeBerry, Jennifer J; Kolber, Benedict J

    2013-01-01

    Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating urological condition that is resistant to treatment and poorly understood. To determine novel molecular treatment targets and to elucidate the contribution of the nervous system to IC/BPS, many rodent bladder pain models have been developed. In this study we evaluated the effects of anesthesia induction and temperature variation in a mouse model of bladder pain known as urinary bladder distension (UBD). In this model compressed air is used to distend the bladder to distinct pressures while electrodes record the reflexive visceromotor response (VMR) from the overlying abdominal muscle. Two isoflurane induction models are commonly used before UBD: a short method lasting approximately 30 minutes and a long method lasting approximately 90 minutes. Animals were anesthetized with one of the methods then put through three sets of graded bladder distensions. Distensions performed following the short anesthesia protocol were significantly different from one another despite identical testing parameters; this same effect was not observed when the long anesthesia protocol was used. In order to determine the effect of temperature on VMRs, animals were put through three graded distension sets at 37.5 (normal mouse body temperature), 35.5, and 33.5°C. Distensions performed at 33.5 and 35.5°C were significantly lower than those performed at 37.5°C. Additionally, Western blot analysis revealed significantly smaller increases in spinal levels of phosphorylated extracellular-signal regulated kinase 2 (pERK2) following bladder distension in animals whose body temperature was maintained at 33.5°C as opposed to 37.5°C. These results highlight the significance of the dynamic effects of anesthesia on pain-like changes and the importance of close monitoring of temperature while performing UBD. For successful interpretation of VMRs and translation to human disease, body temperature should be maintained at 37.5

  16. Influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients' intra-operative serum indexes

    Institute of Scientific and Technical Information of China (English)

    Sheng-Yong Liang

    2015-01-01

    Objective:To analyze the influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients’ intra-operative serum indexes.Methods: 162 patients who received EMR from September 2013 to September 2014 in our hospital were enrolled and randomly divided into the observation group, including 81 cases, who received local mucosal anesthesia combined with non tracheal intubation general anesthesia, and the control group, including 81 cases, who received local mucosal anesthesia combined with routine tracheal intubation general anesthesia. Then inflammation index, stress index and immune index, etc were compared.Results:1) after general anesthesia, serum cytokine levels of IL-23, IL-32, PCT,β-EP and TNF-α, etc of the observation group were all significantly lower than those of the control group(P<0.05); 2) after general anesthesia, serum cytokine levels of COR, ET, TH and Ins, etc of the observation group were significantly lower than those of the control group(P<0.05); 3) after general anesthesia, serum levels of sICAM 1, CD11b, CD18 and CD20 of the observation group were lower than those of the control group; CD56 level was higher than that of the control group(P<0.05).Conclusion:Local mucosal anesthesia combined with non tracheal intubation general anesthesia provides sufficient anesthetic depth for EMR patients, and at the same time, can effectively reduce intra-operative systemic inflammatory response and stress response and contribute to the protection of body's immune function.

  17. Comparison of Hyperbaric Levobupivacaine with Hyperbaric Bupivacaine in Unilateral Inguinal Hernia Operations Performed Under Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Orhan Gozaydin

    2014-02-01

    Conclusions: Hyperbaric levobupivacaine was found to have similar effects to hyperbaric bupivakain for anesthetic effects, hemodynamic parameters, postoperative analgesic necessity time, and the first 24-hour side effects and complications. Levobupivacaine, having a lesser cardiovascular and central nervous system, was suggested as an alternative to bupivacaine. [Arch Clin Exp Surg 2014; 3(1.000: 1-9

  18. Local anesthesia for endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Cina, CS; Tielliu, IFJ; Zeebregts, CJ; Prins, TR; Eindhoven, GB; Span, MM; Kapma, MR; van den Dungen, JJAM

    2005-01-01

    Objectives: This study reports the results of a prospective continuous cohort of patients treated for endovascular aneurysm repair (EVAR) with a unified anesthetic strategy based on the use of local anesthesia (LA) in all patients, while reserving regional (RA) or general anesthesia (GA) only for th

  19. [Correction of the mental status during ketamine anesthesia].

    Science.gov (United States)

    Vorob'ev, A A; Shpilenia, L S; Zobin, M L

    1987-03-01

    Possibilities of pharmacological correction of the patient's mental state while performing Ketamin anesthesia were studied. The optimal results were obtained by the complex of Seduxen prior to and Pyracetam after anesthesia. It considerably reduced the frequency and degree of hallucinative--illusional disturbances and simultaneously markedly accelerated the restoration of the disturbed consciousness.

  20. General anesthesia suppresses normal heart rate variability in humans

    Science.gov (United States)

    Matchett, Gerald; Wood, Philip

    2014-06-01

    The human heart normally exhibits robust beat-to-beat heart rate variability (HRV). The loss of this variability is associated with pathology, including disease states such as congestive heart failure (CHF). The effect of general anesthesia on intrinsic HRV is unknown. In this prospective, observational study we enrolled 100 human subjects having elective major surgical procedures under general anesthesia. We recorded continuous heart rate data via continuous electrocardiogram before, during, and after anesthesia, and we assessed HRV of the R-R intervals. We assessed HRV using several common metrics including Detrended Fluctuation Analysis (DFA), Multifractal Analysis, and Multiscale Entropy Analysis. Each of these analyses was done in each of the four clinical phases for each study subject over the course of 24 h: Before anesthesia, during anesthesia, early recovery, and late recovery. On average, we observed a loss of variability on the aforementioned metrics that appeared to correspond to the state of general anesthesia. Following the conclusion of anesthesia, most study subjects appeared to regain their normal HRV, although this did not occur immediately. The resumption of normal HRV was especially delayed on DFA. Qualitatively, the reduction in HRV under anesthesia appears similar to the reduction in HRV observed in CHF. These observations will need to be validated in future studies, and the broader clinical implications of these observations, if any, are unknown.

  1. [New method of conduction anesthesia in the maxilla].

    Science.gov (United States)

    Efimov, Iu V; Tel'ianova, Iu V; Efimova, E Iu

    2014-01-01

    There was the research aimed at improving the effeciency of intraosseous anesthesia in the maxilla by blocking the infraorbital nerve conduction along its entire length. In the experimental part of the needle puncture defined place and character of the spreading of contrast medium into the upper jaw. In the clinical part of the study shows the advantages of the proposed method of intraosseous anesthesia.

  2. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    NARCIS (Netherlands)

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.

    2014-01-01

    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study Des

  3. Anesthesia methods used by anesthetic specialists for circumcision cases

    Science.gov (United States)

    Altaş, Cafer; Küçükosman, Gamze; Yurtlu, Bülent S.; Okyay, Rahşan D.; Aydın, Bengü G.; Pişkin, Özcan; Çimencan, Murat; Ayoğlu, Hilal; Hancı, Volkan; Özkoçak-Turan, Işıl

    2017-01-01

    Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision. PMID:28042634

  4. Biomarkers in spinal cord injury.

    NARCIS (Netherlands)

    Pouw, M.H.; Hosman, A.J.F.; Middendorp, J.J. van; Verbeek, M.M.; Vos, P.E.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Literature review. OBJECTIVES: In traumatic spinal cord injury (SCI), much effort has been put into the evaluation of SCI severity and the prediction of recovery potential. An accurate prediction of the initial damage of the spinal cord that differentiates between the severities of SCI

  5. Anesthesia Maintenance During Mini-Invasive Cardiac Valve Surgery

    Directory of Open Access Journals (Sweden)

    L. A. Krichevsky

    2013-01-01

    Full Text Available Based on own experience and published data the authors analyze the features and specific components of anesthesia maintenance during mini-invasive cardiac valve surgery. The following clinically relevant aspects of anesthesia and perioperative intensive care were identified: preoperative patient selection and surgical and anesthesia risk prediction; one-lung ventilation; peripheral connection of circulation and specific features of its performance; control of oxygen delivery in the bed of aortic arch branches; and echocardiographic monitoring. The main risks and probable complications due to these interventions, such as cerebral hypoxia, respiratory failure, pulmonary hypertension, etc., are described. The mechanisms of their development and the modes of prevention and treatment are shown. Key words: anesthesia in cardiac surgery, mini-invasive cardiac surgery, one-lung ventilation, anesthesia during cardiac valve surgery.

  6. Nonlinear analysis of anesthesia dynamics by Fractal Scaling Exponent.

    Science.gov (United States)

    Gifani, P; Rabiee, H R; Hashemi, M R; Taslimi, P; Ghanbari, M

    2006-01-01

    The depth of anesthesia estimation has been one of the most research interests in the field of EEG signal processing in recent decades. In this paper we present a new methodology to quantify the depth of anesthesia by quantifying the dynamic fluctuation of the EEG signal. Extraction of useful information about the nonlinear dynamic of the brain during anesthesia has been proposed with the optimum Fractal Scaling Exponent. This optimum solution is based on the best box sizes in the Detrended Fluctuation Analysis (DFA) algorithm which have meaningful changes at different depth of anesthesia. The Fractal Scaling Exponent (FSE) Index as a new criterion has been proposed. The experimental results confirm that our new Index can clearly discriminate between aware to moderate and deep anesthesia levels. Moreover, it significantly reduces the computational complexity and results in a faster reaction to the transients in patients' consciousness levels in relations with the other algorithms.

  7. 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.

  8. Hypnosis and dental anesthesia in children: a prospective controlled study.

    Science.gov (United States)

    Huet, Adeline; Lucas-Polomeni, Marie-Madeleine; Robert, Jean-Claude; Sixou, Jean-Louis; Wodey, Eric

    2011-01-01

    The authors of this prospective study initially hypothesized that hypnosis would lower the anxiety and pain associated with dental anesthesia. Thirty children aged 5 to 12 were randomly assigned to 2 groups receiving hypnosis (H) or not (NH) at the time of anesthesia. Anxiety was assessed at inclusion in the study, initial consultation, installation in the dentist's chair, and at the time of anesthesia using the modified Yale preoperative anxiety scale (mYPAS). Following anesthesia, a visual analogue scale (VAS) and a modified objective pain score (mOPS) were used to assess the pain experienced. The median mYPAS and mOPS scores were significantly lower in the H group than in the NH group. Significantly more children in the H group had no or mild pain. This study suggests that hypnosis may be effective in reducing anxiety and pain in children receiving dental anesthesia.

  9. 27-Gauge Vitrectomy for Symptomatic Vitreous Floaters with Topical Anesthesia

    Science.gov (United States)

    Lin, Zhong; Moonasar, Nived; Wu, Rong Han; Seemongal-Dass, Robin R.

    2017-01-01

    Purpose Traditionally acceptable methods o