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Sample records for continuous thoracic epidural

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

    DEFF Research Database (Denmark)

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

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  3. Continuous chloroprocaine infusion for thoracic and caudal epidurals as a postoperative analgesia modality in neonates, infants, and children.

    Science.gov (United States)

    Veneziano, Giorgio; Iliev, Peter; Tripi, Jennifer; Martin, David; Aldrink, Jennifer; Bhalla, Tarun; Tobias, Joseph

    2016-01-01

    Neonates and infants have decreased metabolic capacity for amide local anesthetics and increased risk of local anesthetic toxicity compared to the general population. Chloroprocaine is an ester local anesthetic that has an extremely short plasma half-life in infants as well as adults. Existing reports support the safety and efficacy of continuous chloroprocaine epidural infusions in neonates and young infants during the intraoperative period. Despite this, continuous chloroprocaine epidural infusion may be an under-utilized method of postoperative analgesia for this patient population. In particular, it may improve pain control in neonates and infants with incisions stretching many dermatomes or those with hepatic impairment. We retrospectively reviewed our experience over 4 years with continuous chloroprocaine epidural infusions in neonates, infants, and children with a focus on the postoperative management of pain. Twenty-one pediatric patients received continuous 2-chloroprocaine epidural infusions for postoperative pain management from January 2010 to April 2014 for thoracic, abdominal, and limb procedures. The epidural infusion consisted of 1.5% chloroprocaine or 1.5% chloroprocaine with fentanyl. Tabulating the morphine and hydromorphone used for rescue analgesia, the median (interquartile range) opioid consumption (mg·kg(-1) ·day(-1) of intravenous morphine equivalents) for the first, second, and third 24-h postoperative periods were 0.02 (0-0.48), 0.30 (0-0.44), and 0.14 (0-0.29), respectively. Examining the total fentanyl usage, the median (interquartile range) fentanyl consumption (μg·kg(-1) ·day(-1)) for first, second, and third 24-h postoperative periods were 3.89 (0.41-7.24), 0 (0.00-4.06), and 0 (0.00-0.51), respectively. The median N-PASS score assessed every 6 h from 0 to 72 h postoperatively was 0, 1, 2, 0, 0, 1, 0, 0, 0, 0, 1, 0, and 0, respectively. The median FLACC score assessed every 6 h from 0 to 72 h postoperatively was 0, 0, 2, 0, 0, 0

  4. A Comparison of the Effectiveness of a Continuous Lumbar Epidural Infusion of Preservative Free Morphine with a Continuous Thoracic Epidural Infusion of 0.0625% Bupivacaine Plus Fentanyl in Providing Post-Thoracotomy Analgesia

    National Research Council Canada - National Science Library

    Williams, James

    1998-01-01

    ... to the thoracic epidural approach using Bupivacaine 0.0625% with Fentanyl. Data were collected on 20 subjects who presented for a thoracotomy and had consented to an epidural for their post-thoracotomy analgesia...

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

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

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

  6. Thoracic epidural anaesthesia for major abdominal surgeries ...

    African Journals Online (AJOL)

    The pulse rate, blood pressure and oxygen saturation were monitored throughout the procedure and recorded. Data were obtained from the ... In a previous study, Consani et al.3 documented the feasibility of thoracic epidural ... thoracostomy and mastectomy in high-risk patients.2,6 Since TEA places less demand on drugs, ...

  7. Is urinary drainage necessary during continuous epidural analgesia after colonic resection?

    DEFF Research Database (Denmark)

    Basse, L; Werner, M; Kehlet, H

    2000-01-01

    BACKGROUND AND OBJECTIVES: Postoperative urinary retention may occur in between 10% and 60% of patients after major surgery. Continuous lumbar epidural analgesia, in contrast to thoracic epidural analgesia, may inhibit urinary bladder function. Postoperative urinary drainage has been common...... that routine bladder catheterization beyond postoperative day 1 may not be necessary in patients with ongoing continuous low-dose thoracic epidural analgesia....

  8. Thoracic epidural analgesia in donor hepatectomy: An analysis.

    Science.gov (United States)

    Koul, Archna; Pant, Deepanjali; Rudravaram, Swetha; Sood, Jayashree

    2018-02-01

    The purpose of this study is to analyze whether supplementation of general anesthesia (GA) with thoracic epidural analgesia (TEA) for right lobe donor hepatectomy is a safe modality of pain relief in terms of changes in postoperative coagulation profile, incidence of epidural catheter-related complications, and timing of removal of epidural catheter. Retrospective analysis of the record of 104 patients who received TEA for right lobe donor hepatectomy was done. Platelet count, international normalized ratio, alanine aminotransferase, and aspartate aminotransferase were recorded postoperatively until the removal of the epidural catheter. The day of removal of the epidural catheter and visual analogue scale (VAS) scores were also recorded. Any complication encountered was documented. Intraoperatively, central venous pressure (CVP), hemodynamic variables, and volume of intravenous fluids infused were also noted. Statistical analysis was performed by using SPSS statistical package, version 17.0 (SPSS Inc. Chicago, IL). Continuous variables were presented as mean ± standard deviation. A total of 90% of patients had mean VAS scores between 1 and 4 in the postoperative period between days 1 and 5. None of the patients had a VAS score above 5. Although changes in coagulation status were encountered in all patients in the postoperative period, these changes were transient and did not persist beyond postoperative day (POD) 5. There was no delay in removal of the epidural catheter, and the majority of patients had the catheter removed by POD 4. There was no incidence of epidural hematoma. Aside from good intraoperative and postoperative analgesia, TEA in combination with balanced GA and fluid restriction enabled maintenance of low CVP and prevention of hepatic congestion. In conclusion, vigilant use of TEA appears to be safe during donor hepatectomy. Living liver donors should not be denied efficient analgesia for the fear of complications. Liver Transplantation 24 214

  9. Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine

    DEFF Research Database (Denmark)

    Møiniche, S; Hjortsø, N C; Blemmer, T

    1993-01-01

    lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group...... and during mobilisation was superior compared to systemic morphine and NSAID. There were no significant differences between groups in haemodynamic responses (BP and heart rate) during rest, orthostatic stress and after walking assessed before, 24 and 48 h after operation except for a clinically unimportant...... position....

  10. Continuous positive airway pressure breathing increases cranial spread of sensory blockade after cervicothoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Eerd, M.J. van; Seventer, R. van; Gielen, M.J.M.; Giele, J.L.P.; Scheffer, G.J.

    2007-01-01

    BACKGROUND: Continuous positive airway pressure (CPAP) increases the caudad spread of sensory blockade after low-thoracic epidural injection of lidocaine. We hypothesized that CPAP would increase cephalad spread of blockade after cervicothoracic epidural injection. METHODS: Twenty patients with an

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

    Directory of Open Access Journals (Sweden)

    Ahmed M Hasanin

    2017-01-01

    Conclusion: Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

  12. Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS. The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI showed an image of a mass compressing the medulla.

  13. Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy

    DEFF Research Database (Denmark)

    Bigler, D; Dirkes, W; Hansen, R

    1989-01-01

    Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml...... by forced vital capacity, forced expiratory volume and peak expiratory flow rate decreased about 50% postoperatively in both groups. In conclusion, the continuous paravertebral bupivacaine infusion used here was insufficient as the only analgesic after cholecystectomy. In contrast, epidural blockade...... with combined bupivacaine and low dose morphine produced total pain relief in six of ten patients....

  14. Thoracic epidural steroid injection for rib fracture pain.

    Science.gov (United States)

    Rauchwerger, Jacob J; Candido, Kenneth D; Deer, Timothy R; Frogel, Jonathan K; Iadevaio, Robert; Kirschen, Neil B

    2013-06-01

    Treatment for rib fracture pain can be broadly divided into pharmacologic approaches with oral and/or parenteral medication and interventional approaches utilizing neuraxial analgesia or peripheral nerve blocks to provide pain relief. Both approaches attempt to control nociceptive and neuropathic pain secondary to osseous injury and nerve insult, respectively. Success of treatment is ultimately measured by the ability of the selected modality to decrease pain, chest splinting, and to prevent sequelae of injury, such as pneumonia. Typically, opioids and NSAIDs are the drugs of first choice for acute pain because of ease of administration, immediate onset of action, and rapid titration to effect. In contrast, neuropathic pain medications have a slower onset of action and are more difficult to titrate to therapeutic effect. Interventional approaches include interpleural catheters, intercostal nerve blocks, paravertebral nerve blocks, and thoracic and lumbar epidural catheters. Each intervention has its own inherent advantages, disadvantages, and success rates. Rib fracture pain management practice is founded on the thoracic surgical and anesthesiology literature. Articles addressing rib fracture pain are relatively scarce in the pain medicine literature. As life expectancy increases, and as healthcare system modifications are implemented, pain medicine physicians may be consulted to treat increasing number of patients suffering rib fracture pain and may need to resort to novel therapeutic measures because of financial constraints imposed by those changes. Here we present the first published case series of thoracic epidural steroid injections used for management of rib fracture pain. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

  15. Thoracic epidural analgesia for breast oncological procedures: A better alternative to general anesthesia

    Directory of Open Access Journals (Sweden)

    Parli Raghavan Ravi

    2017-01-01

    Full Text Available Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA and General Anaesthesia (GA for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55% in the TEA group had nausea/vomiting, while 11 out of 19 (57.8% of the GA group had similar symptoms (P < 0.001. The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6% while all patients in the GA group required more than 3 days of hospitalization (P < 0.001. Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home.

  16. Measurements of Epidural Space Depth Using Preexisting CT Scans Correlate with Loss of Resistance Depth during Thoracic Epidural Catheter Placement

    Directory of Open Access Journals (Sweden)

    Nathaniel H. Greene

    2015-01-01

    Full Text Available Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of the most challenging procedures in the repertoire of an anesthesiologist. Most patients presenting for a procedure that would benefit from a thoracic epidural catheter have already had high resolution imaging that may be useful to assist placement of a catheter. Methods. This retrospective study used data from 168 patients to examine the association and predictive power of epidural-skin distance (ESD on computed tomography (CT to determine loss of resistance depth acquired during epidural placement. Additionally, the ability of anesthesiologists to measure this distance was compared to a radiologist, who specializes in spine imaging. Results. There was a strong association between CT measurement and loss of resistance depth (P35 changed this relationship (P=0.007. The ability of anesthesiologists to make CT measurements was similar to a gold standard radiologist (all individual ICCs>0.9. Conclusions. Overall, this study supports the examination of a recent CT scan to aid in the placement of a thoracic epidural catheter. Making use of these scans may lead to faster epidural placements, fewer accidental dural punctures, and better epidural blockade.

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

    Directory of Open Access Journals (Sweden)

    Ali Alagoz

    2016-02-01

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

  18. Effects of combined general anesthesia and thoracic epidural ...

    African Journals Online (AJOL)

    2015-11-02

    Nov 2, 2015 ... Key words: Bupivacaine, combined-general-epidural anesthesia, inflammatory cytokines, laparoscopic cholecystectomy, ..... spinal-epidural anaesthesia for caesarean section. Left lateral ... laparoscopic segmental colectomy.

  19. Epidural Hematoma and Abscess Related to Thoracic Epidural Analgesia: A Single-Center Study of 2,907 Patients Who Underwent Lung Surgery.

    Science.gov (United States)

    Kupersztych-Hagege, Elisa; Dubuisson, Etienne; Szekely, Barbara; Michel-Cherqui, Mireille; François Dreyfus, Jean; Fischler, Marc; Le Guen, Morgan

    2017-04-01

    To report the major complications (epidural hematoma and abscess) of postoperative thoracic epidural analgesia in patients who underwent lung surgery. Prospective, monocentric study. A university hospital. All lung surgical patients who received postoperative thoracic epidural analgesia between November 2007 and November 2015. Thoracic epidural analgesia for patients who underwent lung surgery. During the study period, data for 2,907 patients were recorded. The following 3 major complications were encountered: 1 case of epidural hematoma (0.34 case/1,000; 95% confidence interval 0.061-1.946), for which surgery was performed, and 2 cases of epidural abscesses (0.68 case/1,000; 95% confidence interval 0.189-2.505), which were treated medically. The risk range of serious complications was moderate; only the patient who experienced an epidural hematoma also experienced permanent sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Comparison thoracic epidural and intercostal block to improve ventilation parameters and reduce pain in patients with multiple rib fractures.

    Science.gov (United States)

    Hashemzadeh, Shahryar; Hashemzadeh, Khosrov; Hosseinzadeh, Hamzeh; Aligholipour Maleki, Raheleh; Golzari, Samad E J; Golzari, Samad

    2011-01-01

    Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may require such high dose that they produce respiratory depression, especially in elderly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or intercostal block with 0.25% bupivacaine. The patients were assessed through ICU and hospital stay length, ventilation function tests. Pain score among the patients was measured with verbal rating scale, before and after administration of the analgesia. We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P pain at rest and pain caused by coughing and deep breathing in group A compared group B... ICU and hospital stay markedly reduced in Group A. thoracic epidural analgesia is superior to intercostals block regarding pain relief of rib fractures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  1. Primary thoracic epidural lymphoma: A rare cause of spinal cord ...

    African Journals Online (AJOL)

    Spinal epidural lymphoma is a rare entity that is not often considered in the differential diagnosis of an epidural mass in a previously healthy individual. Pfatients with Primary Spinal Epidural Lymphomas (PSELs) have negative diagnostic work up for systemic lymphoma and unlike disseminated lymphoma, they achieve ...

  2. Thoracic Epidural Teratoma: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jennifer L. Quon

    2014-01-01

    Full Text Available Purpose Spinal teratomas comprise a rare subset of spinal cord tumors, and here, we describe an even rarer childhood thoracic extradural-intracanalicular teratoma. The clinical presentation, management, and pathophysiology of these tumors are reviewed to promote recognition and guide treatment of these lesions. Methods We report the case of a 21-month-old boy who presented with marked spasticity, as well as failure to ambulate and meet motor milestones. Additionally, we provide a literature review of spinal teratomas, including their clinical presentation, work-up, pathophysiology, and underlying genetics. Results An MRI of the spine revealed a large dorsal epidural tumor extending from T3 to T10 with heterogeneous contrast enhancement and severe spinal cord compression. The tumor was resected revealing a cystic mass with tissue resembling hair, muscle, as well as cartilage; pathology confirmed the diagnosis of teratoma. Gross total resection was achieved, and the child eventually gained ambulatory function. Conclusions Given that spinal teratomas are rare entities that can present with significant neurologic compromise, they must remain on clinicians’ differentials. Unfortunately, the exact origin of these tumors remains inconclusive and requires further investigation.

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

    DEFF Research Database (Denmark)

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

    1988-01-01

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

  4. The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.

    Science.gov (United States)

    Harris, David J; Hilliard, Paul E; Jewell, Elizabeth S; Brummett, Chad M

    2015-01-01

    Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified. Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.

  5. Thoracic epidural analgesia reduces myocardial injury in ischemic patients undergoing major abdominal cancer surgery

    Directory of Open Access Journals (Sweden)

    Mohamad MF

    2017-04-01

    Full Text Available Mohamad Farouk Mohamad,1 Montaser A Mohammad,1 Diab F Hetta,1 Eman Hasan Ahmed,2 Ahmed A Obiedallah,3 Alaa Ali M Elzohry1 1Department of Anesthesia, ICU and Pain Relief, 2Department of Clinical Pathology, South Egypt Cancer Institute, 3Department of Internal Medicine, Faculty of Medicine, Assiut University, Arab Republic of Egypt Background and objectives: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery.Patients and methods: One hundred and twenty patients (American Society of Anesthesiologists grade II and III of either sex were scheduled for elective upper gastrointestinal cancer surgeries. Patients were allocated randomly into two groups (60 patients each to receive, besides general anesthesia: continuous intra and postoperative intravenous (IV infusion with fentanyl for 72 h postoperatively (patient controlled intravenous analgesia [PCIA] group or continuous intra and postoperative epidural infusion with bupivacaine 0.125% and fentanyl (PCEA group for 72 h postoperatively. Perioperative hemodynamics were recorded. Postoperative pain was assessed over 72 h using visual analog scale (VAS. All patients were screened for occurrence of myocardial injury (MI by electrocardiography, echocardiography, and cardiac troponin I serum level. Other postoperative complications as arrhythmia, deep venous thrombosis (DVT, pulmonary embolism, pneumonia, and death were recorded.Results: There was a significant reduction in overall adverse cardiac events (myocardial injury, arrhythmias, angina, heart failure and nonfatal cardiac arrest in PCEA group in comparison to PCIA group. Also, there was a significant reduction in dynamic VAS pain score in group PCEA in comparison

  6. Case Report Thoracic epidural for modified radical mastectomy in a ...

    African Journals Online (AJOL)

    patient, measuring peripheral capillary oxygen saturation and noninvasive BP. ... epidural depth was 5 cm, and 4 cm of the epidural catheter was left in situ in the ... mL/hour, and intravenous paracetamol at 600 mg 8-hourly for 48 hours to ...

  7. Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

    Directory of Open Access Journals (Sweden)

    Raheleh Aligholipour Maleki

    2011-08-01

    Full Text Available Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowing inspiration and coughing without of the risk of respiratory depression. Methods: sixty adult patients who with multiple rib fractures were enrolled in this study. They were divided into Group A or thoracic epidural with bupivacaine 0.125 % +1mg/5ml morphine and group B or inter-costal block with %0.25 bupivacaine. The patients were assessed through ICU and hos-pital stay length, ventilation function tests. Pain score among the patients was meas-ured with verbal rating scale, before and after administration of the analgesia. Results: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd days after epidural analgesia compared with the intercostal block (P < 0.004. Changes in the visual Analogue Scale were associated with marked improvement re-garding pain at rest and pain caused by coughing and deep breathing in group A com-pared group B... ICU and hospital stay markedly reduced in Group A. Conclusion: tho-racic epidural analgesia is superior to intercostals block regarding pain relief of rib frac-tures. Patients who received epidural analgesia had significantly lower pain scores at all studied times.

  8. Estimation of the depth of the thoracic epidural space in children using magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Wani TM

    2017-03-01

    Full Text Available Tariq M Wani,1,2 Mahmood Rafiq,1 Arif Nazir,1 Hatem A Azzam,1 Usama Al Zuraigi,1 Joseph D Tobias2 1Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia; 2Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA Background: The estimation of the distance from the skin to the thoracic epidural space or skin to epidural depth (SED may increase the success rate and decrease the incidence of complications during placement of a thoracic epidural catheter. Magnetic resonance imaging (MRI is the most comprehensive imaging modality of the spine, allowing for the accurate determination of tissue spaces and distances. The present study uses MRI-derived measurements to measure the SED and define the ratio between the straight and inclined SEDs at two thoracic levels (T6–7 and T9–10 in children.Methods: The T2-weighed sagittal MRI images of 109 children, ranging in age from 1 month to 8 years, undergoing radiological evaluation unrelated to spine pathology were assessed. The SEDs (inclined and straight were determined, and a comparison between the SEDs at two thoracic levels (T6–7 and T9–10 was made. Univariate and multivariate linear regression models were used to assess the relationship of the inclined thoracic T6–7 and T9–10 SED measurements with age, height, and weight.Results: Body weight demonstrated a stronger association with the SED than did the age or height with R2 values of 0.6 for T6–7 and 0.5 for T9–10. The formulae describing the relationship between the weight and the inclined SED were T6–7 inclined (mm = 7 + 0.9 × kg and T9–10 inclined (mm = 7 + 0.8 × kg.Conclusion: The depth of the pediatric thoracic epidural space shows a stronger correlation with weight than with age or height. Based on the MRI data, the predictive weight-based formulas can serve as guide to clinicians for placement of thoracic epidural catheters. Keywords: thoracic epidural space

  9. Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, cortisol and glucose during cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Kehlet, H

    1992-01-01

    The effect of thoracic (T7-8) epidural etidocaine 1.5%, 9 ml, and continuous per- and postoperative epidural infusion of etidocaine 1.5%, 4 ml/h, on early (less than 500 ms) somatosensory evoked potentials (SEPs), and cortisol and glucose in plasma during cholecystectomy, was examined in ten...... stimulation at the L1, T10 or T6 dermatomal level (P greater than 0.09). SEPs were abolished in only two patients at T6, and no patient had SEPs abolished at T10 or L1. The plasma concentrations of cortisol and glucose were significantly increased 20 min after surgical incision and remained increased...... throughout the study. No correlation was found between the block-induced decrease in the peak-to-peak amplitude at T6 or T10 and increase in plasma cortisol, except for a negative correlation at T10 and the initial increase in cortisol (Rs = 0.72, P = 0.03). In conclusion, thoracic epidural administration...

  10. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

    International Nuclear Information System (INIS)

    Avrahami, E.; Tadmor, R.; Feibel, M.; Itzhak, Y.; Tel Aviv Univ.; Ram, Z.; Tel Aviv Univ.

    1989-01-01

    Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography. (orig.)

  11. Echocardiographic evaluation of global left ventricular function during high thoracic epidural anesthesia.

    Science.gov (United States)

    Niimi, Y; Ichinose, F; Saegusa, H; Nakata, Y; Morita, S

    1997-03-01

    To assess the effects of high thoracic epidural anesthesia on left ventricular (LV) diastolic filling and systolic function in patients without heart disease. Prospective study. University hospital. 24 ASA physical status I and II patients scheduled for elective noncardiac surgery. Patients received high thoracic (HTE; n = 12) or low thoracic (LTE; n = 12) epidural anesthesia. Left ventricular diastolic filling was noninvasively determined by precordial echocardiography using a pulsed Doppler technique and with a newly developed acoustic quantification (AQ) method that automatically detects endocardial borders and measures cavity area. All measurements were performed in awake premedicated patients. In the HTE group, the extent of sensory blockade of T1-T5, at the least, was induced with 2% lidocaine 5 ml. During HTE, systolic blood pressure (119 +/- 16 vs. 108 +/- 14 mmHg, p LTE group, no significant differences were noted in all systolic and diastolic indices obtained by pulsed Doppler and AQ method. High thoracic epidural anesthesia causes a decrease in CO without changing LV ejection and diastolic filling performance in healthy subjects.

  12. Relevance of Postoperative Magnetic Resonance Images in Evaluating Epidural Hematoma After Thoracic Fixation Surgery.

    Science.gov (United States)

    Shin, Hong Kyung; Choi, Il; Roh, Sung Woo; Rhim, Seung Chul; Jeon, Sang Ryong

    2017-11-01

    It is difficult to evaluate the significant findings of epidural hematoma in magnetic resonance images (MRIs) obtained immediately after thoracic posterior screw fixation (PSF). Prospectively, immediate postoperative MRI was performed in 10 patients who underwent thoracic PSF from April to December 2013. Additionally, we retrospectively analyzed the MRIs from 3 patients before hematoma evacuation out of 260 patients who underwent thoracic PSF from January 2000 to March 2013. The MRI findings of 9 out of the 10 patients, consecutively collected after thoracic PSF, showed neurologic recovery with a well-preserved cerebrospinal fluid (CSF) space and no prominent hemorrhage. Even though there were metal artifacts at the level of the pedicle screws, the preserved CSF space was observed. In contrast, the MRI of 1 patient with poor neurologic outcome demonstrated a typical hematoma and slight spinal cord compression and reduced CSF space. In the retrospective analysis of the 3 patients who showed definite motor weakness in the lower extremities after their first thoracic fusion surgery and underwent hematoma evacuation, the magnetic resonance images before hematoma evacuation also revealed hematoma compressing the spinal cord and diminished CSF space. This study shows that epidural hematomas can be detected on MRI performed immediately after thoracic fixation surgery, despite metal artifacts and findings such as hematoma causing spinal cord compression. Loss of CSF space should be considered to be associated with neurologic deficit. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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    Ali Alagoz

    2016-01-01

    Full Text Available Background and objectives: In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients. Methods: After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second–third year (Group I and fourth year (Group II according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization. Results: Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05. Change of needle insertion level was statistically higher in Group II (p = 0.008, whereas paresthesia was significantly higher in Group I (p = 0.007. Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents’ experience (p  0,05. A alteração do nível de inserção da agulha foi estatisticamente maior no Grupo II (p = 0,008, enquanto que a parestesia foi significativamente maior no Grupo I (p = 0,007. As taxas de cefaléia durante e após punção dural foram maiores no Grupo I. Um índice de massa corporal (IMC maior e o nível do local de inserção foram fatores significativos para o fracasso do CET e para as taxas de complicações no pós-operatório, mas independentes da experiência dos residentes (p < 0,001, 0,005. Conclusão: O IMC e o nível do local

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

    DEFF Research Database (Denmark)

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

    1988-01-01

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

  15. Improved Outcomes Associated with the Liberal Use of Thoracic Epidural Analgesia in Patients with Rib Fractures.

    Science.gov (United States)

    Jensen, Courtney D; Stark, Jamie T; Jacobson, Lewis L; Powers, Jan M; Joseph, Michael F; Kinsella-Shaw, Jeffrey M; Denegar, Craig R

    2017-09-01

    Each year, more than 150,000 patients with rib fractures are admitted to US trauma centers; as many as 10% die. Effective pain control is critical to survival. One way to manage pain is thoracic epidural analgesia. If this treatment reduces mortality, more frequent use may be indicated. We analyzed the patient registry of a level II trauma center. All patients admitted with one or more rib fractures (N = 1,347) were considered. Patients who were not candidates for epidural analgesia (N = 382) were eliminated. Mortality was assessed with binary logistic regressions. Across the total population, mortality was 6.7%; incidence of pneumonia was 11.1%; mechanical ventilation was required in 23.8% of patients, for an average duration of 10.0 days; average stay in the hospital was 7.7 nights; and 49.7% of patients were admitted to the ICU for an average of 7.2 nights. Epidural analgesia was administered to 18.4% of patients. After matching samples for candidacy, patients who received epidurals were 3.7 years older, fractured 2.6 more ribs, had higher injury severity scores, and were more likely to present with bilateral fractures, flail segments, pulmonary contusions, hemothoraces, and pneumothoraces. Despite greater injury severity, mortality among these patients was lower (0.5%) than those who received alternative care (1.9%). Controlling for age, injury severity, and use of mechanical ventilation, epidural analgesia predicted a 97% reduction in mortality. Thoracic epidural analgesia associates with reduced mortality in rib fracture patients. Better care of this population is likely to be facilitated by more frequent reliance on this treatment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  16. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  17. Thoracic epidural anesthesia and interscalene block for a pneumonectomized patient posted for modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Mridul Dua

    2017-01-01

    Full Text Available Thoracic epidural anesthesia with ipsilateral brachial plexus block is emerging as an alternative to general anesthesia for oncologic breast surgery.1. A 31 year old, pneumonectomised female with a past history of MDR TB was diagnosed with infiltrating ductal carcinoma in left breast 2 months ago and was posted for MRM. She also had moderate Pulmonary Arterial Hypertension. Thoracic epidural anesthesia was induced with 12 ml of 0.5% Ropivacaine at T6-T7 level. Interscalene block was given with 10 ml 0.5% Ropivacaine using peripheral nerve locator. Patient was comfortable throughout the procedure and remained vitally stable. Post-operative analgesia was given with 10 ml of 0.2% ropivacaine and patient was discharged the following week. Thoracic epidural anesthesia provides the advantage of superior intra and post-operative analgesia without the adverse effects of general anesthesia like postoperative nausea, vomiting, respiratory depression and sedation.2 Coupled with interscalene block for axillary lymph node dissection, it can be successfully used as an alternative to GA for MRM.

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

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    Amir S Madjid

    2008-06-01

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

  19. Thoracic epidural analgesia in a child with multiple traumatic rib fractures.

    Science.gov (United States)

    Keech, Brian M

    2015-12-01

    The morbidity and mortality associated with blunt thoracic trauma are significant and can be multisystem in nature. Of these, pulmonary complications, including ventilatory impairment secondary to pain, have been recognized to be the most consequential. Although several analgesic strategies have emerged, thoracic epidural analgesia (TEA) has arguably demonstrated superior efficacy and is used frequently in adults. Unfortunately, TEA is rarely used in children after blunt thoracic trauma, but may be of considerable benefit. This low rate of use likely reflects one or more of several factors potentially encountered when considering the use of TEA in pediatric chest wall trauma. Among them are (1) uncertainty regarding safety and efficacy; (2) the technical challenges of pediatric thoracic epidural placement, including technique and equipment concerns; and (3) drug selection, dosing, and toxicity. The following case review describes the successful application of TEA in a 4-year-old boy after multiple traumatic rib fractures and associated pneumothorax and pulmonary contusion. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine

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    Terrien BD

    2017-01-01

    Full Text Available Brian D Terrien,1 David Espinoza,2 Charles C Stehman,3 Gabriel A Rodriguez,1 Nicholas C Connolly1 1Department of Anesthesiology, Naval Medical Center San Diego, 2Surface Warfare Medical Institute, San Diego, 3Department of Anesthesiology, Robert E. Bush Naval Hospital, Twenty Nine Palms, CA, USA Abstract: A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP block with liposome bupivacaine (Exparel intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels. Keywords: liposome bupivacaine (bupivacaine liposome injectable suspension, plasma bupivacaine levels, transversus abdominis plane (TAP nerve block, thoracic epidural

  1. The effect of pre-emptive intravenous Dexketoprofen + thoracal epidural analgesia on the chronic post-thoracotomy pain.

    Science.gov (United States)

    Comez, Mehmet; Celik, Mine; Dostbil, Aysenur; Aksoy, Mehmet; Ahiskalioglu, Ali; Erdem, Ali Fuat; Aydin, Yener; İnce, İlker

    2015-01-01

    Post thoracotomy chronic pain is a severe problem that affects the majority of patients and decreases the quality of life. The purpose of this study is to evaluate the long-term effects of thoracal epidural levobupivacaine and intravenous dexketoprofen analgesia formed pre-emptively on the wound site pain after major thoracotomy operations. This randomised, prospective and double-blind study was performed with 60 patients undergoing thoracic surgery. Patients were divided into three groups; Control Group (Group C), Pre-emptive Epidural Group (Group PE) and Pre-emptive Dexketoprofen + Epidural Group (Group PED). Patients in the Group C did not receive epidural analgesics and i.v. dexketoprofen before and during the operation. 10-15 ml 0.125% levobupivacaine was given to cases in Group PE pre-emptively through epidural catheter before the anesthesia induction. The cases in Group PED were given 10-15 ml 0.125% epidural levobupivacaine and 50 mg dexketoprofen with i.v. infusion pre-emptively. The VAS score was found to be lower in Group PED during postoperative 24 and 48 hours and before the discharge (P0.05). A statistically significant decrease was determined in the VAS score in Group PED during the sixth month, compared to the other groups (Pdexketoprofen and thoracal epidural analgesia reduce the chronic post-thoracotomy pain.

  2. Counterbalancing clinical supervision and independent practice: case studies in learning thoracic epidural catheter insertion.

    Science.gov (United States)

    Johnson, T

    2010-12-01

    Thoracic epidural catheter placement is an example of a demanding and high-risk clinical skill that junior anaesthetists need to learn by experience and under the supervision of consultants. This learning is known to present challenges that require further study. Ten consultant and 10 trainee anaesthetists in a teaching hospital were interviewed about teaching and learning this skill in the operating theatre, and a phenomenological analysis of their experience was performed. Trainee participation was limited by time pressure, lack of familiarity with consultants, and consultants' own need for clinical experience. There was a particular tension between safe and effective consultant practice and permitting trainees' independence. Three distinct stages of participation and assistance were identified from reports of ideal practice: early (part-task or basic procedure, consultant always present giving instruction and feedback), middle (independent practice with straightforward cases without further instruction), and late (skill extension and transfer). Learning assistance provided by consultants varied, but it was often not matched to the trainees' stages of learning. Negotiation of participation and assistance was recognized as being useful, but it did not happen routinely. There are many obstacles to trainees' participation in thoracic epidural catheter insertion, and learning assistance is not matched to need. A more explicit understanding of stages of learning is required to benefit the learning of this and other advanced clinical skills.

  3. [Comparison of clinical effectiveness of thoracic epidural and intravenous patient-controlled analgesia for the treatment of rib fractures pain in intensive care unit].

    Science.gov (United States)

    Topçu, Ismet; Ekici, Zeynep; Sakarya, Melek

    2007-07-01

    The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma. Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1+/-1.6 and 9.2+/-1.7) and the number of rib fractures (4+/-1.1 and 6.8+/-2.7) were higher in thoracic epidural analgesia group (pPain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (prib fractures who require intensive care.

  4. Comparison of Postoperative Analgesic Effects of Thoracic Epidural Morphine and Fentanyl

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    Gönül Sağıroğlu

    2011-11-01

    Full Text Available Objective: In our study, we aimed to compare epidural morphine and fentanyl analgesia and the side effects in post-thoracotomy pain management. Material and Methods: Forty patients, planned for elective thoracotomy were included. Bupivacain- morphine was administered through an epidural catheter to the patients in Group-M while bupivacain-fentanyl was given in Group-F. Pain assessment was carried out with the Visual Analogue Scale (VAS and VAS-I and VAS-II were assessed in 0, 4, 16 and 24th hour in the postoperative unit. Adverse effects were recorded after the 24th hour. Statistical analyses were performed by using Two-sample independent-t test, Mann Whitney-U test, Wilcoxon-signed ranks test and Pearson chi-squared tests. Results: Although, the VAS-I and VAS-II scores were lower in Group-M than Group-F, the difference was not significant statistically (p>0.05. When other hours were compared with initial states, beginning from the 4th hour, in both groups there was a statistically significant drop in VAS-I and VAS-II scores at all times (p<0.001. Comparing the complications between the groups, in Group-M nausea-vomiting (p<0.015 and bradycardia (p<0.012 were found significantly more frequently than in Group-F. Conclusion: We concluded that, in pain management after thoracic surgery, either morphine or fentanyl may be chosen in thoracal epidural analgesia but, especially in the early postoperative hours, close follow-up is necessary due to the risk of bradycardia development.

  5. Temporary quadriplegia following continuous thoracic paravertebral block.

    Science.gov (United States)

    Calenda, Emile; Baste, Jean Marc; Danielou, Eric; Michelin, Paul

    2012-05-01

    A case of temporary quadriplegia following a continuous thoracic paravertebral block in an adult patient scheduled for video-assisted thoracoscopy is presented. An 18-gauge Tuohy needle was inserted under direct vision by the surgeon but the tip of the catheter was not localized. Postoperatively, the patient developed temporary quadriplegia 90 minutes after the start of a continuous infusion of ropivacaine 0.2%. Imaging studies showed that the catheter was localized in the intrathecal space. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Primary epidural malignant hemangiopericytoma of thoracic spinal column causing cord compression: case report

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    Mohammad Mohammadianpanah

    Full Text Available CONTEXT: Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. Primary malignant hemangiopericytoma of the spinal column is extremely rare. CASE REPORT: We report on a case of primary epidural malignant hemangiopericytoma of the thoracic spinal column that invaded vertebral bone and caused spinal cord compression in a 21-year-old man. The patient presented with progressive back pain over a four-month period that progressed to paraparesis, bilateral leg paresthesia and urinary incontinence. The surgical intervention involved laminectomy and subtotal resection of the tumor, with posterior vertebral fixation. Postoperative involved-field radiotherapy was administered. A marked neurological improvement was subsequently observed. We describe the clinical, radiological, and histological features of this tumor and review the literature.

  7. Primary epidural malignant hemangiopericytoma of thoracic spinal column causing cord compression: case report.

    Science.gov (United States)

    Mohammadianpanah, Mohammad; Torabinejad, Simin; Bagheri, Mohammad Hadi; Omidvari, Shapour; Mosalaei, Ahmad; Ahmadloo, Niloofar

    2004-09-02

    Hemangiopericytoma is an uncommon mesenchymal neoplasm that rarely affects the spinal canal. Primary malignant hemangiopericytoma of the spinal column is extremely rare. We report on a case of primary epidural malignant hemangiopericytoma of the thoracic spinal column that invaded vertebral bone and caused spinal cord compression in a 21-year-old man. The patient presented with progressive back pain over a four-month period that progressed to paraparesis, bilateral leg paresthesia and urinary incontinence. The surgical intervention involved laminectomy and subtotal resection of the tumor, with posterior vertebral fixation. Postoperative involved-field radiotherapy was administered. A marked neurological improvement was subsequently observed. We describe the clinical, radiological, and histological features of this tumor and review the literature.

  8. Comparison of ultrasound imaging in transverse median and parasagittal oblique planes for thoracic epidurals: A pilot study.

    Science.gov (United States)

    Khemka, Rakhi; Rastogi, Sonal; Desai, Neha; Chakraborty, Arunangshu; Sinha, Subir

    2016-06-01

    The use of ultrasound (US) scanning to assess the depth of epidural space to prevent neurological complications is established in current practice. In this study, we hypothesised that pre-puncture US scanning for estimating the depth of epidural space for thoracic epidurals is comparable between transverse median (TM) and paramedian sagittal oblique (PSO) planes. We performed pre-puncture US scanning in 32 patients, posted for open abdominal surgeries. The imaging was done to detect the depth of epidural space from skin (ultrasound depth [UD]) and needle insertion point, in parasagittal oblique plane in PSO group and transverse median plane in TM group. Subsequently, epidural space was localised through the predetermined insertion point by 'loss of resistance' technique and needle depth (ND) to the epidural space was marked. Correlation between the UD and actual ND was calculated and concordance correlation coefficient (CCC) was used to determine the degree of agreement between UD and ND in both the planes. The primary outcome, i.e., the comparison between UD and ND, done using Pearson correlation coefficient, was 0.99 in both PSO and TM groups, and the CCC was 0.93 (95% confidence interval [95% CI]: 0.81-0.97) and 0.90 (95% CI: 0.74-0.96) in PSO and TM groups respectively, which shows a strong positive association between UD and ND in both groups. The use of pre-puncture US scanning in both PSO and TM planes for estimating the depth of epidural space at the level of mid- and lower-thoracic spine is comparable.

  9. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

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    Tsuyoki Minato

    2016-01-01

    Full Text Available We present a rare case of spinal epidural hematoma (SEH after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

  10. Continuous Thoracic Sympathetic Ganglion Block in Complex Regional Pain Syndrome Patients with Spinal Cord Stimulation Implantation

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    EungDon Kim

    2016-01-01

    Full Text Available The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS. However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS. In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia. We administered continuous thoracic sympathetic block using catheter in CRPS patients who underwent SCS implantations and achieved desirable outcomes. We believe a continuous sympathetic block is a considerable option before performing neurolysis or radiofrequency rhizotomy and even after SCS implantation.

  11. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

    Directory of Open Access Journals (Sweden)

    Joana Nunes

    Full Text Available Abstract Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB compared to continuous epidural infusion (CEI leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 µg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2 µg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus; B - Ropivacaine 0.1% plus Sufentanil 0.2 µg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37. The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83. We found a higher caesarean delivery rate in group A (56.7%; p = 0.02. No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.

  12. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia.

    Science.gov (United States)

    Nunes, Joana; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, Isabel

    2016-01-01

    There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. Perioperative epidural or intravenous ketamine does not improve the effectiveness of thoracic epidural analgesia for acute and chronic pain after thoracotomy.

    Science.gov (United States)

    Tena, Beatriz; Gomar, Carmen; Rios, Jose

    2014-06-01

    Persistent postsurgical pain (PPP) after thoracotomy effect 50% to 80%. Nerve damage and central sensitization involving NDMDAr activation may play an important role. This study evaluates the efficacy of adding intravenous (IV) or epidural ketamine to thoracic epidural analgesia (TEA) after thoracotomy. Double-blind randomized study on patients undergoing thoracotomy allocated to one of the following: group Kiv (IV racemic ketamine 0.5 mg/kg preincisional +0.25 mg/kg/h for 48 h), group Kep (epidural racemic ketamine 0.5 mg/kg preincisional +0.25 mg/kg/h for 48 h), or group S (saline). Postoperative analgesia was ensured by TEA with ropivacaine and fentanyl. Pain visual analog scales (VAS), Neuropathic Pain Symptom Inventory, Catastrophizing Scale, and Quantitative Sensory Testing, measuring both the peri-incisional and distant hyperalgesia area, were conducted preoperatively and postoperatively until 6 months. Plasma ketamine levels and stability of the analgesic solutions were analyzed. A total of 104 patients were included. PPP incidence was 20% at 6 months. Pain scores on coughing were significantly lower in Kiv and Kep than in S at 24 and 72 hours, but there were no differences afterwards. There were no significant differences in pain at rest, Neuropathic Pain Symptom Inventory, and Catastrophizing Scale, or in the area of mechanical allodynia at any time. Adverse effects were mild. Plasma ketamine levels did not differ significantly between groups. Analgesic solutions were stable. Adding epidural or IV racemic ketamine to TEA after thoracotomy did not lead to any reduction in PPP or allodynia. Epidural administration produced similar plasma ketamine levels to the IV route.

  14. Thoracic Epidural Anesthesia Can Be Effective for the Short-Term Management of Ventricular Tachycardia Storm.

    Science.gov (United States)

    Do, Duc H; Bradfield, Jason; Ajijola, Olujimi A; Vaseghi, Marmar; Le, John; Rahman, Siamak; Mahajan, Aman; Nogami, Akihiko; Boyle, Noel G; Shivkumar, Kalyanam

    2017-10-27

    Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (TEA), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (VT) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with TEA in the management of VT storm to determine its optimal therapeutic use. Data for 11 patients in whom TEA was instituted for VT storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant VT in 7 (64%), with polymorphic VT in 3 (27%) and monomorphic VT in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to TEA; 4 of the complete responders had incessant VT. All 4 patients with a documented response to deep sedation demonstrated a complete response to TEA. More than half of the patients with VT storm in our series responded to TEA. TEA may be effective and should be considered as a therapeutic option in patients with VT storm, especially incessant VT, who are refractory to initial management. Improvement in VT burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating VT and predict a positive response to TEA. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  15. Posterior paramedian subrhomboidal analgesia versus thoracic epidural analgesia for pain control in patients with multiple rib fractures.

    Science.gov (United States)

    Shelley, Casey L; Berry, Stepheny; Howard, James; De Ruyter, Martin; Thepthepha, Melissa; Nazir, Niaman; McDonald, Tracy; Dalton, Annemarie; Moncure, Michael

    2016-09-01

    Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA). This prospective study included 30 patients with three or more acute rib fractures admitted to a Level I trauma center. Thoracic epidural analgesia or PoPS catheters were placed, and local anesthesia was infused. Data were collected including patients' pain level, adjunct morphine equivalent use, adverse events, length of stay, lung volumes, and discharge disposition. Nonparametric tests were used and two-sided p Pain rating was lower in the PoPS group (2.5 vs. 5; p = 0.03) after initial placement. Overall, there was no other statistically significant difference in pain control or use of oral morphine adjuncts between the groups. Hypotension occurred in eight patients, 75% with TEA and only 25% with PoPS. No difference was found in adverse events, length of stay, lung volumes, or discharge disposition. In patients with rib fractures, PoPS analgesia may provide pain control equivalent to TEA while being less invasive and more readily placed by a variety of hospital staff. This pilot study is limited by its small sample size, and therefore additional studies are needed to prove equivalence of PoPS compared to TEA. Therapeutic study, level IV.

  16. A prospective, randomized, blinded-endpoint, controlled study – continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

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    Joana Nunes

    2016-09-01

    Full Text Available Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB compared to continuous epidural infusion (CEI leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 μg, parturient were randomly assigned to one of three regimens: A – Ropivacaine 0.15% plus Sufentanil 0.2 μg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus; B – Ropivacaine 0.1% plus Sufentanil 0.2 μg/mL as programmed intermittent epidural bolus and C – Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37. The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83. We found a higher caesarean delivery rate in group A (56.7%; p = 0.02. No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes. Resumo: Justificativa: Há evidências de que a administração de um bolus epidural intermitente programado (BEIP comparada à infusão epidural contínua (IEC resulta em maior eficácia da analgesia e da satisfação materna, com redução das intervenções anestésicas. Métodos: Neste estudo, 166

  17. Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review

    Directory of Open Access Journals (Sweden)

    Britt T

    2015-10-01

    Full Text Available Todd Britt, Ryan Sturm, Rick Ricardi, Virginia Labond Department of Emergency Medicine, Genesys Regional Medical Center, Grand Blanc, MI, USA Background: Thoracic trauma accounts for 10%–15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB may offer superior pain control with fewer side effects. This study's objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals. Methods: A hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures. All subjects were admitted and were treated with either an epidural or a subcutaneously placed catheter for continuous intercostal nerve blockade. Our primary outcome was a composite of either pneumonia or respiratory failure. Secondary outcomes included total hospital days, total ICU days, and days on the ventilator. Results: 12.5% (N=8 of the CINB group developed pneumonia or had respiratory failure compared to 16.3% (N=7 in the epidural group. No statistical difference (P=0.58 in the incidence of pneumonia or vent dependent respiratory failure was observed. There was a significant reduction (P=0.05 in hospital days from 9.72 (SD 9.98 in the epidural compared to 6.98 (SD 4.67 in the CINB group. The rest of our secondary outcomes showed no significant difference. Conclusion: This study did not show a difference in the rate of pneumonia or ventilator-dependent respiratory failure in the CINB vs epidural groups. It was not sufficiently powered. Our data supports a reduction in hospital days when CINB is used vs epidural. CINB may have advantages over epidurals such as fewer complications, fewer contraindications, and a shorter time to placement. Further studies are needed to confirm these statements

  18. Pharmacokinetics and analgesic effect of ropivacaine during continuous epidural infusion for postoperative pain relief

    DEFF Research Database (Denmark)

    Erichsen, C J; Sjövall, J; Kehlet, H

    1996-01-01

    BACKGROUND: The pharmacokinetics and clinical efficacy of ropivacaine (2.5 mg/ml) during a 24-h continuous epidural infusion for postoperative pain relief in 20 patients scheduled for abdominal hysterectomy were characterized using an open-label, increasing-dose design. METHODS: Through an epidural...... catheter inserted at T10-T12, a test dose of 7.5 mg ropivacaine was given 3 min before a bolus dose of 42.5 mg and immediately followed by a 24-h continuous epidural infusion with either 10 or 20 mg/h. Peripheral venous plasma samples were collected up to 48 h after infusion, and urinary excretion...... plasma concentrations of ropivacaine increased markedly and consistently during the 24-h epidural infusion, in contrast to stable unbound concentrations. Both total and unbound plasma concentrations at the end of infusion were proportional to the total dose, although only the latter was proportional...

  19. Comparison Thoracic Epidural and Intercostal Block to Improve Ventilation Parameters and Reduce Pain in Patients with Multiple Rib Fractures

    OpenAIRE

    Raheleh Aligholipour Maleki; Hamzeh Hosseinzadeh; Shahryar Hashemzadeh; Khosrov Hashemzadeh

    2011-01-01

    Introduction: Chest wall blunt trauma causes multiple rib fractures and will often be associated with significant pain and may compromise ventilator mechanics. Analgesia has great roll in rib fracture therapies, opioid are useful, but when used as sole agent may re-quire such high dose that they produce respiratory depression, especially in el-derly .the best analgesia for a severe chest wall injury is a continuous epidural infusion of local anesthetic. This provides complete analgesia allowi...

  20. Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review.

    Science.gov (United States)

    Britt, Todd; Sturm, Ryan; Ricardi, Rick; Labond, Virginia

    2015-01-01

    Thoracic trauma accounts for 10%-15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB) may offer superior pain control with fewer side effects. This study's objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals. A hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures. All subjects were admitted and were treated with either an epidural or a subcutaneously placed catheter for continuous intercostal nerve blockade. Our primary outcome was a composite of either pneumonia or respiratory failure. Secondary outcomes included total hospital days, total ICU days, and days on the ventilator. 12.5% (N=8) of the CINB group developed pneumonia or had respiratory failure compared to 16.3% (N=7) in the epidural group. No statistical difference (P=0.58) in the incidence of pneumonia or vent dependent respiratory failure was observed. There was a significant reduction (P=0.05) in hospital days from 9.72 (SD 9.98) in the epidural compared to 6.98 (SD 4.67) in the CINB group. The rest of our secondary outcomes showed no significant difference. This study did not show a difference in the rate of pneumonia or ventilator-dependent respiratory failure in the CINB vs epidural groups. It was not sufficiently powered. Our data supports a reduction in hospital days when CINB is used vs epidural. CINB may have advantages over epidurals such as fewer complications, fewer contraindications, and a shorter time to placement. Further studies are needed to confirm these statements.

  1. Bupivacaine constant continuous surgical wound infusion versus continuous epidural infusion for post cesarean section pain, randomized placebo-controlled study

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    Hossam A. ELShamaa

    2016-10-01

    Conclusion: The current study demonstrated that bupivacaine administered by continuous epidural infusion provided a significantly lower pain scores with mobilization, and hence better analgesia for post cesarean section pain in the first postoperative day compared to continuous bupivacaine wound infusion through fenestrated catheter using the constant flow PainFusor system.

  2. Thoracic combined spinal-epidural anesthesia for laparoscopic cholecystectomy in an obese patient with asthma and multiple drug allergies: a case report

    OpenAIRE

    Daszkiewicz Andrzej; Copik Maja; Misiolek Hanna

    2016-01-01

    Drug allergies, asthma, and obesity are more common in modern societies, and patients with these problems are often a challenge for anesthetists. Different techniques of regional anesthesia can be beneficial particularly for this group of patients. We present a patient who suffered from all of the above-mentioned conditions and successfully underwent laparoscopic cholecystectomy under thoracic combined spinal-epidural anesthesia. It is still not a popular practice, and we would like to show a...

  3. Thoracic combined spinal-epidural anesthesia for laparoscopic cholecystectomy in an obese patient with asthma and multiple drug allergies: a case report

    Directory of Open Access Journals (Sweden)

    Daszkiewicz Andrzej

    2016-12-01

    Full Text Available Drug allergies, asthma, and obesity are more common in modern societies, and patients with these problems are often a challenge for anesthetists. Different techniques of regional anesthesia can be beneficial particularly for this group of patients. We present a patient who suffered from all of the above-mentioned conditions and successfully underwent laparoscopic cholecystectomy under thoracic combined spinal-epidural anesthesia. It is still not a popular practice, and we would like to show another indication for using it.

  4. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine

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

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Suryaprakash, Sharadaprasad; Chakravarthy, Murali; Gautam, Mamatha; Gandhi, Anurag; Jawali, Vivek; Patil, Thimmannagowda; Jayaprakash, Krishnamoorthy; Pandey, Saurabh; Muniraju, Geetha

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Suryaprakash Sharadaprasad

    2011-01-01

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

  9. Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia.

    Science.gov (United States)

    Ayad, Sabry; Babazade, Rovnat; Elsharkawy, Hesham; Nadar, Vinayak; Lokhande, Chetan; Makarova, Natalya; Khanna, Rashi; Sessler, Daniel I; Turan, Alparslan

    2016-01-01

    Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (pconsumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and continuous epidural analgesia were similar in terms of pain and opioid consumption, and not worse in pain compared with IV PCA

  10. Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement

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    Ban CH Tsui

    2006-01-01

    Full Text Available Continuous epidural blockade remains the cornerstone of pediatric regional anesthesia. However, the risk of catastrophic trauma to the spinal cord when inserting direct thoracic and high lumbar epidural needles in anesthetized or heavily sedated pediatric patients is a concern. To reduce this risk, research has focused on low lumbar or caudal blocks (ie, avoiding the spinal cord and threading catheters from distal puncture sites in a cephalad direction. However, with conventional epidural techniques, including loss-of-resistance for localization of the needle, optimal catheter tip placement is difficult to assess because considerable distances are required during threading. Novel approaches include electrical epidural stimulation for physiological confirmation and segmental localization of epidural catheters, and ultrasound guidance for assessing related neuroanatomy and real-time observation of the needle puncture and, potentially, catheter advancement. The present article provides a brief and focused review of these two advances, and outlines recent clinical experiences relevant to pediatric epidural anesthesia.

  11. Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients

    Science.gov (United States)

    Kim, Jong-Hak; Lee, Jun Seop

    2013-01-01

    Background Continuous epidural anesthesia is useful for endoscopic urologic surgery, as mostly performed in the elderly patients. In such a case, it is necessary to obtain successful sacral anesthesia, and the insertion of epidural catheter in the caudad direction may be needed. However, continuous epidural catherization has been related to paresthesias. This study aimed to evaluate the effects of the direction of the catheter insertion on the incidence of paresthesias in the elderly patients. Methods Two hundred elderly patients scheduled for endoscopic urologic surgery were enrolled. The epidural catheter was inserted at L2-3, L3-4, and L4-5 using the Tuohy needle. In Group I (n = 100), the Tuohy needle with the bevel directed the cephalad during the catheter insertion. In Group II (n = 100), it directed the caudad. During the catheter insertion, an anesthesiologist evaluated the presence of paresthesias and the ease or difficulty during the catheter insertion. Results In Group I (n = 97), 15.5% of the patients had paresthesias versus 18.4% in Group II (n = 98), and there was no significant difference between the two groups. In paresthesia depending on the insertion site and the ease or difficulty during the catheter insertion, there were no significant differences between the two groups. Conclusions Our results concluded that the direction of epidural catheter insertion did not significantly influence the incidence of paresthesias in the elderly patients. PMID:23741568

  12. Comparison of the effects of continuous intrapleural vs epidural administration of 0.5% bupivacaine on pain, metabolic response and pulmonary function following cholecystectomy

    DEFF Research Database (Denmark)

    Scott, N B; Mogensen, T; Bigler, D

    1989-01-01

    Twenty patients undergoing elective cholecystectomy were prospectively randomised to receive either intrapleural (bolus 20 ml followed by 10 ml/h) or thoracic epidural (bolus 9 ml followed by 5 ml/h) bupivacaine 0.5% for 8 h postoperatively to assess the effect of these two techniques on pain...

  13. STUDY OF ULTRASOUND-GUIDED CONTINUOUS FEMORAL NERVE BLOCKADE WITH EPIDURAL ANALGESIA FOR PAIN RELIEF AFTER TOTAL KNEE REPLACEMENT

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    Srinivas Rapolu

    2016-11-01

    Full Text Available BACKGROUND Total knee replacement causes moderate-to-severe pain requiring effective analgesia. With use of ultrasound guidance, we may prove a more suitable approach compared with the epidural technique. Aim of this study is the comparison between Continuous Epidural Analgesia (CEA and Continuous Femoral Block (CFB techniques in Total Knee Replacement surgeries. MATERIALS AND METHODS This study was conducted on 60 adult male and female patients undergoing total knee replacement surgery for a period of 2 years. Patients were divided into 2 groups. Group - 1: Continuous epidural analgesia patients, Group - 2: Continuous femoral blockage patients. All patients were assessed clinically preoperatively and investigated to rule out any systemic disease. RESULTS The mean age of patient in Group - 1 was 66.54 ± 4.98 and in Group - 2 was 66.98 ± 5.02 years. P value was > 0.05, which was not significant. No significant differences in gender is observed between the groups. VAS scores were significantly high (P < 0.05 in the femoral group at 6 h, after which there was a declining trend and scores were essentially similar from 24 h. The use of rescue analgesic was also higher in the femoral group. Analysis of side-effects showed that all the five common sideeffects were twice as common in the epidural group than in the femoral study group. Only one patient in the femoral group had urinary retention when compared with four in the epidural group. The differences were not statistically significant. Muscle power at 48 h, time getting out of the bed and time stay in hospital (days are significant in comparison in 2 groups, range of movement is insignificant in groups. Patient satisfaction score was measured on a scale of 1 - 10. Patients in the Femoral group were slightly more satisfied with a mean ± SD score of 8.1 ± 1.2 when compared with the epidural group 7.3 ± 1.01. CONCLUSION Continuous femoral blockade using US guidance provides equivalent analgesia

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

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    Wei-Ren Chuang

    2010-01-01

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

  15. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m 2 for off pump coronary artery bypass surgery

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    Sharma Munish

    2010-01-01

    Full Text Available Perioperative Thoracic epidural analgesia (TEA is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB. We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index> 30 kg/m 2 for elective OPCAB were randomized into two groups (n=30 each. Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO 2 /FiO 2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB.

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

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    V. A. Sobokar

    2015-06-01

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

  17. Urinary retention in unilateral total knee arthroplasty: comparison between continuous epidural analgesia and single-shot femoral nerve block

    International Nuclear Information System (INIS)

    Khan, A.A.; Khan, R.I.

    2018-01-01

    To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing toatal knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block. Study Design: Randomized controlled study. Place and Duration of Study:Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015. Methodology:Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken at 24 hours postoperatively. Data was analyzed to compare the frequency of urinary retention between the two groups. Results:The average age of the patients was 59.58 +-5.85 years. There were 28 (46.7%) male and 32 (53.3%) female patients. Frequency of urinary retention was significantly high in Group E than Group F (46.7% vs. 6.7%; p=0.0005). Conclusion: Single-shot femoral nerve block offers a more favorable profile in terms of postoperative urinary retention when compared to continuous epidural analgesia. (author)

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Comparison of efficacy of continuous epidural block and pulsed radiofrequency to the dorsal root ganglion for management of pain persisting beyond the acute phase of herpes zoster.

    Directory of Open Access Journals (Sweden)

    Eung Don Kim

    Full Text Available There is little evidence regarding the effectiveness of intervention methods in the treatment of zoster-related pain (ZAP after the acute phase of zoster. Generally, if ZAP remains after more than 180 days from its onset, the likelihood of pain reduction is very low; this condition is considered as a "well established" post-herpetic neuralgia (PHN. Although the clinical efficacy of intrathecal steroid injection and spinal cord stimulation (SCS for ZAP management has been reported, these interventions are not widely used due to inherent disadvantages. Continuous epidural block is widely used in clinical practice, and the effectiveness of pulsed radiofrequency (PRF to the dorsal root ganglion (DRG in the treatment of ZAP already has been reported.The purpose of this study was to compare the clinical efficacy of continuous epidural block and DRG PRF beyond acute phase of zoster, bur before PHN was well established (from 30 days to180 days after zoster onset.Retrospective comparative study.A total of 42 medical records were analyzed. Patients were divided into two groups according to the type of procedure utilized: continuous epidural block (continuous epidural group and DRG PRF (PRF group. The clinical efficacy of the procedure was evaluated using a numeric rating scale (NRS and the medication dose before and 1 to 6 months after the procedure.There was a significant decrease in the NRS value with time in both groups. However, this decrease was more significant in the PRF group than in the continuous epidural group. The medication doses decreased significantly in the PRF group over time, but not in the continuous epidural group. The rate of clinically meaningful PHN (NRS≥3 was also lower in the PRF group than in the continuous epidural group.This study revealed that DRG PRF was more effective than a continuous epidural block in treating ZAP after the acute phase of zoster. A neuromodulation method such as DRG PRF may be a useful option for

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

    DEFF Research Database (Denmark)

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

    1988-01-01

    The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bupivacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five......-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given....... If sensory analgesia decreased more than five segments from the initial level or if the pain score reached 2 (moderate pain), the patient was removed from the study. Initial levels of sensory analgesia after loading doses of 21.8 +/- 0.5 and 19.3 +/- 0.8 ml bupivacaine 0.5% were similar (T3.8 +/- 0.3 and T3...

  1. Epidural block

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000484.htm Epidural block - pregnancy To use the sharing features on this page, please enable JavaScript. An epidural block is a numbing medicine given by injection (shot) ...

  2. Continuous versus patient-controlled epidural analgesia for labour analgesia and their effects on maternal motor function and ambulation.

    Science.gov (United States)

    Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert

    2014-01-01

    The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.

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

    Directory of Open Access Journals (Sweden)

    Sérgio D. Belzarena

    2008-12-01

    utiliza a menudo para procedimientos estéticos de la mama y existen pocos relatos de su uso en mastectomías con exploración axilar. El presente estudio comparó la técnica con anestesia general en operaciones oncológicas de la mama. MÉTODO: Cuarenta pacientes que se dividieron en dos grupos. En el grupo epidural (n = 20 se hizo una epidural torácica con bupivacaína y fentanil asociados a la sedación con midazolam. El otro grupo (n = 20, recibió anestesia general convencional con propofol, atracurio y fentanil y mantenimiento con O2 e isoflurano. En el intraoperatorio y durante la operación, se verificó la necesidad de complementación de la anestesia o de la sedación y variables hemodinámicas. En el postoperatorio fue registrado el tiempo para el alta de la sala de recuperación postanestésica y hospitalaria, la intensidad del dolor y el consumo de analgésicos, efectos adversos y la satisfacción con la técnica anestésica. RESULTADOS: Los grupos fueron similares y no hubo diferencia en la duración de la operación. Se hizo necesario complementar la sedación en un 100% de las pacientes que recibieron anestesia epidural y en un 15% fue complementada la analgesia con infiltración de anestésico local en la axila. Hubo una mayor incidencia de hipertensión arterial en el grupo de la anestesia general y de hipotensión entre las que recibieron epidural. Ocurrió prurito en un 55% de las pacientes con anestesia epidural. Náusea (30% y vómito (45%, fueron más frecuentes entre las que recibieron anestesia general. La analgesia postoperatoria tuvo una mejor calidad y el consumo de analgésicos fue menor en el grupo de la anestesia epidural. El período de internación también fue menor. CONCLUSIONES: La técnica epidural tiene algunas ventajas con relación a la anestesia general y puede ser considerada una opción para la anestesia en mastectomías oncológicas con vaciado axilar.BACKGROUND AND OBJECTIVES: Thoracic epidural block is frequently used for

  4. Continuous bilateral thoracic paravertebral blockade for analgesia after cardiac surgery: a randomised, controlled trial.

    Science.gov (United States)

    Lockwood, Geoff G; Cabreros, Leilani; Banach, Dorota; Punjabi, Prakash P

    2017-10-01

    Continuous bilateral thoracic paravertebral blockade has been used for analgesia after cardiac surgery, but its efficacy has never been formally tested. Fifty adult patients were enrolled in a double-blind, randomised, controlled study of continuous bilateral thoracic paravertebral infusion of 0.5% lidocaine (1 mg.kg -1 .hr -1 ) for analgesia after coronary surgery. Control patients received a subcutaneous infusion of lidocaine at the same rate through catheters inserted at the same locations as the study group. The primary outcome was morphine consumption at 48 hours using patient-controlled analgesia (PCA). Secondary outcomes included pain, respiratory function, nausea and vomiting. Serum lidocaine concentrations were measured on the first two post-operative days. There was no difference in morphine consumption or in any other outcome measure between the groups. Serum lidocaine concentrations increased during the study, with a maximum of 5.9 mg.l -1 . There were no adverse events as a consequence of the study. Bilateral paravertebral infusion of lidocaine confers no advantage over systemic lidocaine infusion after cardiac surgery. ISRCTN13424423 ( https://www.isrctn.com ).

  5. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  6. Improvement of thoracic aortic vasoreactivity by continuous and intermittent exercise in high-fat diet-induced obese rats.

    Science.gov (United States)

    Liu, Hongpeng; Yang, Zhen; Hu, Jian; Luo, Yan; Zhu, Lingqin; Yang, Huifang; Li, Guanghua

    2015-07-01

    The aim of the present study was to explore the effects of continuous and intermittent exercise on the thoracic aortic vasoreactivity and free radical metabolism in rats fed with a high-fat diet (HD). Sprague-Dawley (SD) rats were randomly divided into four groups (n=8, each group): Conventional diet (CD), HD, HD with continuous exercise (HCE) and HD with intermittent exercise (HIE). HCE rats swam once/day for 90 min; HIE rats performed swimming exercises 3 times/day, 30 min each time with an interval of 4 h. In these two groups, the exercise was conducted 5 days a week for 8 weeks. Rats in the CD and HD groups were fed without swimming training. At the end of the exercise, all the rats were sacrificed and the blood, thoracic aorta and myocardium were collected immediately. The thoracic aortic vasoreactivity, the plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), superoxide dismutase (SOD), malondialdehyde (MDA) and vascular endothelial nitric oxide synthase (eNOS) gene expression were measured. Compared to the control group, in the HD group the enhanced contractile response of the thoracic aortic rings to noradrenaline (NA) was observed (Pimprove the activity of the thoracic aorta in obese rats, which may be associated with enhanced antioxidant enzyme activity and reduced free radical generating. Additionally, intermittent exercise is better than the continuous exercise in improving the thoracic aorta vasoreactivity.

  7. Epidural extramedullary haemopoiesis in thalassaemia

    International Nuclear Information System (INIS)

    Boyacigil, S.; Ali, A.; Ardic, S.; Yuksel, E.

    2002-01-01

    lntrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31-year-old-man with a known diagnosis of β-thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone-marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow-up MRI was performed for evaluation efficacy of the treatment. Copyright (2002) Blackwell Science Pty Ltd

  8. Continous wound infusion versus epidural postoperative analgesia after liver resection in carcinoma patients

    OpenAIRE

    ŠTEFANČIĆ, LJILJA; BROZOVIĆ, GORDANA; ŠTURM, DEANA; MALDINI, BRANKA; ŠAKIĆ ZDRAVČEVIĆ, KATA

    2013-01-01

    Background: Continuous wound infiltration (CWI) and epidural thoracic analgesia (ETA) are analgesic techniques commonly used in the multimodal management of postoperative pain after open abdominal surgery. The aim of this study was to evaluate the effectiveness in pain reduce and postoperative recovery of these techniques in patients scheduled for liver resection. Methods: The retrospective study included 29 patients, with liver resection performed due to metastases of colon carc...

  9. [TRANSPORT OF OXYGEN DURING GEOMETRICAL RECONSTRUCTION OF THE LEFT VENTRICLE IN CONJUNCTION WITH CORONARY ARTERY BYPASS GRAFTING AND USING OF HIGH THORACIC EPIDURAL ANESTHESIA AS A MAJOR COMPONENT OF GENERAL ANAESTHESIA].

    Science.gov (United States)

    Zatevahina, M V; Farzutdinov, A F; Rahimov, A A; Makrushin, I M; Kvachantiradze, G Y

    2015-01-01

    The purpose of the study is to examine the perioperative dynamics of strategic blood oxygen transport indicators: delivery (DO2), consumption (VO2), the coefficient of oxygen uptake (CUO2) and their composition, as well as the dynamics of blood lactate indicators in patients with ischaemic heart disease (IHD) who underwent surgery under cardiopulmonary bypass with high thoracic epidural anaesthesia (HTEA) as the main component of anesthesia. Research was conducted in 30 patients with a critical degree of operational risk, during the correction of post-infarction heart aneurysmn using the V. Dor method in combination with coronary artery bypass grafting. The strategic blood oxygen transport indicators (delivery, consumption and the oxygen uptake coefficient) showed a statistically significant decrease compared to the physiological norm and to the initial data at two points of the research: the intubation of the trachea and during cardiopulmonary bypass. The system components of oxygen were influenced at problematic stages by the dynamics of SvO2 (increase), AVD (decrease), hemodilution withe fall of the HIb- in the process of JR in the persence of superficial hypothermia. The maintenance of optimal CA in the context of HTEA, combined with a balanced volemic load and a minimized cardiotonic support ensured the stabilisation of strategic blood oxygen transport indicators aithe postperfusion stage and during the immediate postoperative period The article is dedicated to the study of strategic blood oxygen transport indicators and their components during the operation of geometric reconstruc-tion of the left ventricle combined with coronary artery-bypass using cardiopulmonary bypass and with high thoracic epidural anesthesia as the main component of general anaesthesia. The analysis has covered the stagewise delivery dynamics, consumption and the oxygen uptake coefficient at II stages of the operation and of the immediate postoperative period. The study has ident (fled

  10. Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Jonathan B. Koea

    2009-01-01

    Full Text Available Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, =.06, less postoperative IV fluids (median 1200 mL versus 4300 mL, =.03 than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, =.05 and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, =.02. Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.

  11. Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report.

    Science.gov (United States)

    Turgut, Abdulkadir; Katar, Selahattin; Sak, Muhammet Erdal; Turgut, Fethiye Gülden; Sahin, Alparslan; Başaranoğlu, Serdar; Yalınkaya, Ahmet

    2013-01-01

    Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.

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

    Directory of Open Access Journals (Sweden)

    Djalma Sperhacke

    2004-08-01

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

  13. Case report: ultrasound-guided continuous thoracic paravertebral block for outpatient acute pain management of multilevel unilateral rib fractures.

    Science.gov (United States)

    Murata, Hiroaki; Salviz, Emine Aysu; Chen, Stephanie; Vandepitte, Catherine; Hadzic, Admir

    2013-01-01

    A 61-year-old man with multiple unilateral rib fractures (T3-T8) gained the ability to breathe deeply and to ambulate after ultrasound-guided continuous thoracic paravertebral block and was discharged home after being observed for 15 hours after the block. The ultrasound guidance was helpful in determining the site of rib fractures and the optimal level for catheter placement. This report also discusses the management of analgesia using continuous paravertebral block in an outpatient with trauma.

  14. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    International Nuclear Information System (INIS)

    Aydingoez, Ue.; Oto, A.; Cila, A.

    1997-01-01

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.)

  15. Pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: combined intrathecal morphine and continuous epidural versus PCA.

    Science.gov (United States)

    Ravish, Matthew; Muldowney, Bridget; Becker, Aimee; Hetzel, Scott; McCarthy, James J; Nemeth, Blaise A; Noonan, Kenneth J

    2012-12-01

    A retrospective case-comparison study. Compare efficacy and safety of combined intrathecal morphine (ITM) and epidural analgesia (EPI) to that of conventional intravenous patient-controlled analgesia (IV-PCA) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Pain control after PSF in AIS has been managed traditionally with IV-PCA. More recently studies have shown improvement in pain control with the use of continuous EPI or intraoperative ITM. No studies to our knowledge have compared the use of both ITM and EPI analgesia to that of IV-PCA. An Institutional Review Board-approved retrospective case-comparison study was performed from 1989 to 2009 of all patients undergoing PSF for AIS. Patients received either IV-PCA or ITM/EPI. Daily pain scores were recorded along with total opioid and benzodiazepine use. Adverse events were recorded for all the patients. A total of 146 patients were initially included in the study; 95 patients received ITM/EPI and 51 received IV-PCA as a historical control. Eight patients from the ITM/EPI group were excluded from the pain comparison portion of the study. There were no statistical differences in age, sex, weight, or hospital stay between the 2 groups. The ITM/EPI group had, on average, 1 additional level of fusion (P = 0.001). Daily average pain scores were lower in the ITM/EPI group on all hospital days, and statistically lower in days 1 and 3 to 5. Total opioid requirement was significantly lower in the ITM/EPI patients, although oral opioid use was higher among this group. Total benzodiazepine use was lower among the IV-PCA group. A total of 15.7% of the IV-PCA patients had bladder hypotonia, compared with 1.1% of the ITM/EPI group (P = 0.002). The rate of illeus was 15.7% in the IV-PCA patients and 5.7% in the ITM/EPI (P = 0.071). Respiratory depression was reported in 4 ITM/EPI patients, 0 in our PCA group. Technical catheter malfunction was reported in 8.5% of the EPI group. The use of ITM

  16. [Relationship of motor deficits and imaging features in metastatic epidural spinal cord compression].

    Science.gov (United States)

    Liu, Shu-Bin; Liu, Yao-Sheng; Li, Ding-Feng; Fan, Hai-Tao; Huai, Jian-Ye; Guo, Jun; Wang, Lei; Liu, Cheng; Zhang, Ping; Cui, Qiu; Jiang, Wei-Hao; Cao, Yun-Cen; Jiang, Ning; Sui, Jia-Hong; Zhang, Bin; Zhou, Jiu

    2010-06-15

    To explore the relationship of motor deficits of the lower extremities with the imaging features of malignant spinal cord compression (MESCCs). From July 2006 through December 2008, 56 successive MESCC patients were treated at our department. All were evaluated by magnetic resonance imaging and computed tomography and were scored according to motor deficits Frankel grading on admission. Imaging assessment factors of main involved vertebrae were level of vertebral metastatic location, epidural space involvement, vertebral body involvement, lamina involvement, posterior protrusion of posterior wall, pedicle involvement, continuity of main involved vertebrae, fracture of anterior column, fracture of posterior wall, location in upper thoracic spine and/or cervicothoracic junction. Occurrence was the same between paralytic state of MESCCs and epidural space involvement of imaging features. Multiple regression equation showed that paralytic state had a linear regression relationship with imaging factors of lamina involvement (X1), posterior protrusion of posterior wall (X2), location in upper thoracic spine and/or cervicothoracic junction (X7) of main involved vertebrae. The optimal regression equation of paralytic state (Y) and imaging feature (X) was Y = -0.009 +0.639X, + 0.149X, +0.282X. Lamina involvement of main involved vertebrae has a greatest influence upon paralytic state of MESCC patients. Imaging factors of lamina involvement, posterior protrusion of posterior wall, location in upper thoracic spine and/or cervicothoracic junction of main involved vertebrae can predict the paralytic state of MESCC patients. MESCC with lamina involvement is more easily encroached on epidural space.

  17. Risk factors for reinsertion of urinary catheter after early removal in thoracic surgical patients.

    Science.gov (United States)

    Young, John; Geraci, Travis; Milman, Steven; Maslow, Andrew; Jones, Richard N; Ng, Thomas

    2018-03-08

    To reduce the incidence of urinary tract infection, Surgical Care Improvement Project 9 mandates the removal of urinary catheters within 48 hours postoperatively. In patients with thoracic epidural anesthesia, we sought to determine the rate of catheter reinsertion, the complications of reinsertion, and the factors associated with reinsertion. We conducted a prospective observational study of consecutive patients undergoing major pulmonary or esophageal resection with thoracic epidural analgesia over a 2-year period. As per Surgical Care Improvement Project 9, all urinary catheters were removed within 48 hours postoperatively. Excluded were patients with chronic indwelling catheter, patients with urostomy, and patients requiring continued strict urine output monitoring. Multivariable logistic regression analysis was used to identify independent risk factors for urinary catheter reinsertion. Thirteen patients met exclusion criteria. Of the 275 patients evaluated, 60 (21.8%) required reinsertion of urinary catheter. There was no difference in the urinary tract infection rate between patients requiring reinsertion (1/60 [1.7%]) versus patients not requiring reinsertion (1/215 [0.5%], P = .389). Urethral trauma during reinsertion was seen in 1 of 60 patients (1.7%). After reinsertion, discharge with urinary catheter was required in 4 of 60 patients (6.7%). Multivariable logistic regression analysis found esophagectomy, lower body mass index, and benign prostatic hypertrophy to be independent risk factors associated with catheter reinsertion after early removal in the presence of thoracic epidural analgesia. When applying Surgical Care Improvement Project 9 to patients undergoing thoracic procedures with thoracic epidural analgesia, consideration to delayed removal of urinary catheter may be warranted in patients with multiple risk factors for reinsertion. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  18. Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia.

    Science.gov (United States)

    Franklin, Andrew D; Hughes, Elisabeth M

    2016-06-01

    Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate.

  19. Paraplegia following epidural analgesia: A potentially avoidable cause?

    Directory of Open Access Journals (Sweden)

    Jeson R Doctor

    2014-01-01

    Full Text Available Neurological deficit is an uncommon but catastrophic complication of epidural anesthesia. Epidural hematomas and abscesses are the most common causes of such neurological deficit. We report the case of a patient with renal cell carcinoma with lumbar vertebral metastasis who developed paraplegia after receiving thoracic epidural anesthesia for a nephrectomy. Subsequently, on histo-pathological examination of the laminectomy specimen, the patient was found to have previously undiagnosed thoracic vertebral metastases which led to a thoracic epidural hematoma. In addition, delayed reporting of symptoms of neurological deficit by the patient may have impacted his outcome. Careful pre-operative investigation, consideration to using alternative modalities of analgesia, detailed patient counseling and stringent monitoring of patients receiving central neuraxial blockade is essential to prevent such complications.

  20. Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.

    Science.gov (United States)

    Ross, Emma L; Reiter, Pamela D; Murphy, Michael E; Bielsky, Alan R

    2015-09-01

    To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours. A retrospective cohort review of the electronic medical record over a 14-month period. The level IV neonatal intensive care unit of a 414-bed free-standing children's hospital. Eighteen infants (mean age, 1.7 ± 1.8 months [0.03-6.3]; mean weight, 3.8 ± 1.3 kg [1.56-6.9]; n = 10 [55%] males) received 1% chloroprocaine for epidural analgesia postoperatively for up to 96-hour duration and met criteria for inclusion. Dosing requirements, placement of epidural catheter, supplementary analgesic therapy, respiratory support, vital signs, and incidence of adverse events associated with local anesthetics were collected. Epidural catheter placement was caudal (n = 8), lumbar (n = 6), or thoracic (n = 4). Mean operative time was 2.48 ± 1 hour (1-5). Initial chloroprocaine dose was 1.3 ± 0.5 mL/h (0.4-2.5) (3.5 ± 1 mg/kg per hour [1.4-5]) with a maximum dose of 1.5 ± 0.6 mL/h (0.4-3) (4.2 ± 1.1 mg/kg per hour [2.2-6.1]). Duration of epidural analgesia was 48.3 ± 21.5 hours (10-96). Duration of epidural infusion did not influence dosing requirement, suggesting the absence of drug tachyphylaxis. All patients received intermittent doses of opioid and nonopioid pain medications while receiving chloroprocaine. Two mechanically ventilated patients required continuous infusion of opioids. No adverse events were directly attributed to chloroprocaine use. Epidural 1% chloroprocaine, in doses of 0.4-3 mL/h (1.5-6.1 mg/kg per hour), was well tolerated in both mechanically ventilated and spontaneously breathing infants for up to 96 hours with no identified adverse effects or tachyphylaxis. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.

    Science.gov (United States)

    Niraj, G; Kelkar, A; Hart, E; Horst, C; Malik, D; Yeow, C; Singh, B; Chaudhri, S

    2014-04-01

    Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non-inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty-one patients completed the study. The transversus group received four-quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0-3.0 [0-5.5]) and the epidural group 2.5 (1.0-5.0 [0-6.0]). The one-sided 97.5% CI was a 0.0 (∞-1.0) difference in means, establishing non-inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non-inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  2. Acute presentation of solitary spinal epidural cavernous angioma in a child

    International Nuclear Information System (INIS)

    Khalatbari, M.R.; Moharamzad, Y.; Hamidi, M.

    2013-01-01

    Solitary spinal epidural cavernous angiomas are rare lesions, especially in paediatric age group. They are infrequently considered in the differential diagnosis of spinal epidural masses in children. We report a case of solitary epidural cavernous angioma of the thoracic spine in a child presenting with acute onset of back pain and myelopathy. Magnetic resonance imaging of the thoracic spine demonstrated a posterior epidural mass at T6-T8 levels with compression of the spinal cord. Using microsurgical technique and bipolar coagulation, total excision of the lesion was achieved. Histopathological examination confirmed the diagnosis of cavernous angioma. At the five-year follow-up, there was no recurrence of the tumour. (author)

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    receiving hydroxyethyl starch. RESULTS: Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic effects...... constant was 56 ml/min. CONCLUSIONS: Thoracic epidural anesthesia per se does not lead to changes in blood volumes despite a reduction in blood pressure. When fluid is infused, there is a dilution, and the fluid initially seems to be located centrally. Because administration of hydroxyethyl starch......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 when...

  4. Postoperative pain and gastro-intestinal recovery after colonic resection with epidural analgesia and multimodal rehabilitation

    DEFF Research Database (Denmark)

    Werner, M U; Gaarn-Larsen, L; Basse, L

    2005-01-01

    The aim of the study was to evaluate initial postoperative pain intensity and the association with recovery of gastrointestinal function and length of stay (LOS) in a multimodal programme with epidural analgesia, early oral nutrition and mobilisation with a 48 h planned hospital stay. One hundred...... of change in the surgical procedures (2), surgical morbidity (6), medical factors (4) and psychosocial or other factors (5) all independent of pain. Pain data were incomplete in two patients and therefore excluded. In the remaining 91 patients, median time to defaecation and LOS were 24 and 48 h......, respectively. Gastrointestinal recovery and LOS did not differ between patients with high (3-6) versus low (0-2) dynamic pain scores (P > 0.4 and P > 0.1, respectively). It is concluded that a multimodal rehabilitation program including continuous thoracic epidural analgesia leads to early recovery...

  5. Incidence of lower thoracic ligamentum flavum midline gaps

    NARCIS (Netherlands)

    Lirk, P.; Colvin, J.; Steger, B.; Colvin, H.-P.; Keller, C.; Rieder, J.; Kolbitsch, C.; Moriggl, B.

    2005-01-01

    Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar

  6. Epidural lipomatosis

    International Nuclear Information System (INIS)

    Quint, D.J.; Boulos, R.S.; Sanders, W.P.; Patel, S.C.; Mehta, B.A.; Tiel, R.L.; Washington, J.M.

    1987-01-01

    Central deposition of fat is a well-known clinical feature of long-term elevated corticosteroid levels. Rarely described is increased extadural fat within the spinal canal causing compression of the spinal cord and neurologic deficits. Together with 12 previously reported cases, the authors present six additional cases of epidural lipomatosis, review presenting signs and symptoms, and demonstrate the myelographic, CT, and MR findings in this condition. Previously undescribed examples of (1) normal myelography with diagnostic postmyelogram CT, (2) MR imaging of this condition, and (3) cases not associated with exogenous steroid use or morbid obesity are presented. The importance of considering this entity in the appropriate clinical setting is stressed. In particular, if clinical suspicion is high, even in the setting of a normal myelogram, CT or MR imaging should be considered

  7. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Aydingoez, Ue.; Oto, A.; Cila, A. [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

    1997-12-01

    Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.) With 3 figs., 6 refs.

  8. Orthogonal polarization spectral imaging of the microcirculation during acute hypervolemic hemodilution and epidural lidocaine injection

    NARCIS (Netherlands)

    van den Oever, Huub L. A.; Dzoljic, Misa; Ince, Can; Hollmann, Markus W.; Mokken, Fleur C.

    2006-01-01

    We used Orthogonal Polarization Spectral Imaging to examine the microcirculation of the vaginal mucosa in nine anesthetized patients during two consecutive anesthetic interventions: hypervolemic hemodilution using hydroxyethyl starch followed by thoracic epidural lidocaine. Images taken before and

  9. Comparison of intraoperative behavioral and hormonal responses to noxious stimuli between mares sedated with caudal epidural detomidine hydrochloride or a continuous intravenous infusion of detomidine hydrochloride for standing laparoscopic ovariectomy.

    Science.gov (United States)

    Virgin, Joanna; Hendrickson, Dean; Wallis, Ty; Rao, Sangeeta

    2010-08-01

    To compare the presence or absence of pain, pain-related behavioral responses, and hormonal responses to noxious stimuli during standing laparoscopic ovariectomy in mares sedated with continuous intravenous (IV) detomidine infusion and caudal epidural detomidine. A double blind prospective study. Mares (n=12) Mares were divided into 2 treatment groups; 6 were sedated using continuous IV detomidine infusion and 6 were sedated with caudal epidural detomidine. All mares received IV xylazine (0.33 mg/kg) and butorphanol tartrate (5 mg) premedication before detomidine administration. Venous blood samples were taken to assess serum cortisol levels in each mare at 4 time points: a baseline cortisol measurement after the mares' arrival to the clinic, 10 minutes before surgery, at the removal of the 2nd ovary, and 10 minutes postsurgery. Two surgeons performed bilateral ovariectomy and at 8 time points involving surgical manipulations, noted the presence or absence of pain (yes/no) and scored the patient's response on a 10 cm visual analogue scale (VAS) for pain assessment with 0 indicating no pain responses and 10 cm indicating pain so severe that the mare required additional sedation or analgesia to complete the procedure. Each mare was also assigned a VAS score by each surgeon for the overall satisfaction of analgesia during the entire procedure. Serum cortisol levels between the 2 detomidine administration groups differed significantly at the baseline (precortisol) measurement but not at the 3 remaining time points. Seven of the procedures within the surgeries did not differ significantly in VAS scores between the 2 groups. The initial grasp of the left ovary (the 1st ovary) in the continuous infusion group had a significantly higher (P=.05) median VAS score compared with the caudal epidural group. Mares sedated with a continuous IV infusion of detomidine have similar hormonal and behavioral responses to painful stimuli during standing laparoscopic ovariectomy as mares

  10. Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women.

    Science.gov (United States)

    Al-Aamri, I; Derzi, S H; Moore, A; Elgueta, M F; Moustafa, M; Schricker, T; Tran, D Q

    2017-07-01

    Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance). Sterile extension tubing, connected to a pressure transducer, was attached to the needle. An investigator determined the presence or absence of a pulsatile waveform, synchronised with the heart rate, on a monitor screen that was not in the view of the anaesthetist or the parturient. A bolus of 4 ml lidocaine 2% with adrenaline 5 μg.ml -1 was administered, and the epidural block was assessed after 15 min. Three women displayed no sensory block at 15 min. The results showed: epidural block present, epidural waveform present 93; epidural block absent, epidural waveform absent 2; epidural block present, epidural waveform absent 4; epidural block absent, epidural waveform present 1. Compared with the use of a local anaesthetic bolus to ascertain the epidural space, the sensitivity, specificity, positive and negative predictive values of waveform analysis were 95.9%, 66.7%, 98.9% and 33.3%, respectively. Epidural waveform analysis provides a simple adjunct to loss-of-resistance for confirming needle placement during performance of obstetric epidurals, however, further studies are required before its routine implementation in clinical practice. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  11. Pregnancy-related spinal epidural capillary-cavernous haemangioma: magnetic resonance imaging and differential diagnosis

    International Nuclear Information System (INIS)

    Hakan, T.; Berkman, M.Z.; Demir, M.K.; Aker, F.V.

    2007-01-01

    Full text: Epidural haemangiomas are very rare tumours of the spine. Only a few case reports have been published and most of them were cavernous or capillary. To the best of our knowledge, we report the first case of a histologically confirmed epidural capillary-cavernous haemangioma of the thoracic spine presented in the MRI

  12. The comparison of different medication project of continuous epidural analgesia for the patient after lumbar vertebra operation%腰椎手术病人连续硬膜外镇痛的不同用药方案比较

    Institute of Scientific and Technical Information of China (English)

    王成才; 袁红兵; 王新华

    2002-01-01

    Objective Comparing different medication project of continuous epidural analgesia for the patient after lumbar vertebra operation, to decrease the complications and promote analgesia effects. Methods 150 cases with ASAⅠ~Ⅱ grade, lumbar intervertebral disc extirpation and /or vertebral canal decompression, were divided into 5 groups. A group: 0.0625% bupivacaine; B group: 0.125% bupivacaine; C group: 0.0625% bupivacaine and 1 mg morphine; D group: 0.125% bupivacaine and 1 mg morphine; E group: no analgesia. Record the occurrence of RR,MAP,HR,VAS score and side effects. Results The analgesia effects of all groups were satisfying, but the occurrence of urine retention increased in B,C,D group, and the occurrence of nausea and vomit increased obviously in C,D group. Conclusions The continuous epidural analgesia with simple 0.0625% for patients after lumbar vertebral operation is best.

  13. Solitary Spinal Epidural Metastasis from Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Taisei Sako

    2016-01-01

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

  14. Ultrasound Pulsed-Wave Doppler Detects an Intrathecal Location of an Epidural Catheter Tip: A Case Report.

    Science.gov (United States)

    Elsharkawy, Hesham; Saasouh, Wael; Patel, Bimal; Babazade, Rovnat

    2018-04-01

    Currently, no gold standard method exists for localization of an epidural catheter after placement. The technique described in this report uses pulsed-wave Doppler (PWD) ultrasound to identify intrathecal location of an epidural catheter. A thoracic epidural catheter was inserted after multiple trials with inconclusive aspiration and test dose. Ultrasound PWD confirmed no flow in the epidural space and positive flow in the intrathecal space. A fluid aspirate was positive for glucose, reconfirming intrathecal placement. PWD is a potential tool that can be used to locate the tip of an epidural catheter.

  15. Labor epidural analgesia: Past, present and future

    Directory of Open Access Journals (Sweden)

    Reena

    2014-01-01

    Full Text Available One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

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

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2005-06-01

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

  17. MRI features of spinal epidural angiolipomas

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-10-15

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

  18. Thoracic CT

    Science.gov (United States)

    ... through a vein (IV) in your hand or forearm. It may be given through the rectum using ... CT scan Vertebra, thoracic (mid back) Normal lung anatomy Thoracic organs References Gotway MB, Panse PM, Gruden ...

  19. Safety and efficacy of prolonged epidural analgesia after oncologic colorectal surgery

    Directory of Open Access Journals (Sweden)

    R. V. Garyaev

    2012-01-01

    Full Text Available This study demonstrates effective thoracic epidural analgesia by ropivacain 0.2 %, phentanyl 2 mkg/ml, adrenaline 2 mkg/ml in single-use infusion pumps in 124 patients, who underwent surgery for colorectal cancer. Safe, effective and controllable analgesia was observed during surgery and postoperative period. Prolonged analgesia facilitates early rehabilitation and improves gastrointestinal peristaltic activity.  Prolonged epidural analgesia is the recommended method of analgesia in this group of patients.

  20. 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.

  1. The effects of epidural bupivacaine on ischemia/reperfusion-induced liver injury.

    Science.gov (United States)

    Sarikus, Z; Bedirli, N; Yilmaz, G; Bagriacik, U; Bozkirli, F

    2016-01-01

    Several animal studies showed beneficial effects of thoracic epidural anesthesia (TEA) in hippocampal, mesenteric and myocardial IR injury (2-4). In this study, we investigated the effects of epidural bupivacaine on hepatic ischemia reperfusion injury in a rat model. Eighteen rats were randomly divided into three groups each containing 6 animals. The rats in Group C had sham laparotomy. The rats in the Group S were subjected to liver IR through laparotomy and 20 mcg/kg/h 0.9% NaCl was administered to these rats via an epidural catheter. The rats in the Group B were subjected to liver IR and were given 20 mcg/kg/h bupivacaine via an epidural catheter. Liver tissue was harvested for MDA analysis, apoptosis and histopathological examination after 60 minutes of ischemia followed by 360 minutes of reperfusion. Blood samples were also collected for TNF-α, IL-1β, AST and ALT analysis. The AST and ALT levels were higher in ischemia and reperfusion group, which received only normal saline via the thoracic epidural catheter, compared to the sham group. In the ischemia reperfusion group, which received bupivacaine via the epidural catheter, IL-1 levels were significantly higher than in the other groups. TNF-α levels were higher in the Groups S and B compared to the sham group. Bupivacaine administration induced apoptosis in all animals. These results showed that thoracic epidural bupivacaine was not a suitable agent for preventing inflammatory response and lipid peroxidation in experimental hepatic IR injury in rats. Moreover, epidural bupivacaine triggered apoptosis in hepatocytes. Further research is needed as there are no studies in literature investigate the effects of epidural bupivacaine on hepatic ischemia reperfusion injury (Tab. 3, Fig. 3, Ref. 34).

  2. Proximal thoracic aorta dimensions after continuous-flow left ventricular assist device implantation: Longitudinal changes and relation to aortic valve insufficiency.

    Science.gov (United States)

    Fine, Nowell M; Park, Soon J; Stulak, John M; Topilsky, Yan; Daly, Richard C; Joyce, Lyle D; Pereira, Naveen L; Schirger, John A; Edwards, Brooks S; Lin, Grace; Kushwaha, Sudhir S

    2016-04-01

    In this study we examined the impact of continuous-flow left ventricular assist device (CF-LVAD) support on proximal thoracic aorta dimensions. Aortic root and ascending aorta diameter were measured from serial echocardiograms before and after CF-LVAD implantation in patients with ≥6 months of support, and correlated with the development of >mild aortic valve insufficiency (AI). Of 162 patients included, mean age was 58 ± 11 years and 128 (79%) were male. Seventy-nine (63%) were destination therapy patients. Mean aortic root and ascending aorta diameters at baseline, 1 month, 6 months, 12 months and long-term follow-up (mean 2.0 ± 1.4 years) were 3.5 ± 0.4, 3.5 ± 0.3, 3.9 ± 0.3, 3.9 ± 0.2 and 4.0 ± 0.3, and 3.3 ± 0.2, 3.3 ± 0.3, 3.6 ± 0.2, 3.6 ± 0.3 and 3.6 ± 0.3 cm, respectively. Only change in aortic root diameter from 1-month to 6-month follow-up reached statistical significance (p = 0.03). Nine (6%) patients had accelerated proximal thoracic aorta expansion (>0.5 cm/year), occurring predominantly in the first 6 months after implantation. These patients were older and more likely to have hypertension and baseline proximal thoracic aorta dilation. Forty-five (28%) patients developed >mild AI at long-term follow-up, including 7 of 9 (78%) of those with accelerated proximal thoracic aorta expansion. All 7 had aortic valves that remained closed throughout the cardiac cycle, and this, along with duration of CF-LVAD support and increase in aortic root diameter, were significantly associated with developing >mild AI. CF-LVAD patients have small increases in proximal thoracic aorta dimensions that predominantly occur within the first 6 months after implantation and then stabilize. Increasing aortic root diameter was associated with AI development. Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  3. Efeitos cardiorrespiratórios e analgésicos da cetamina por via epidural, por infusão intravenosa contínua ou pela associação de ambas, em cães submetidos à osteossíntese de fêmur Cardiorespiratory and analgesic effects of ketamine via epidural route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis

    Directory of Open Access Journals (Sweden)

    Adriano Bonfim Carregaro

    2010-07-01

    route, intravenous continuous infusion or association of both, in dogs submitted to femoral osteosynthesis. Twenty-five healthy bitches were randomly assigned to four groups: CEP (2mg kg-1 of ketamine associated with lidocaine 2% via epidural route, CIV (lidocaine 2% via epidural route and 1mg kg-1 of ketamine IV, followed by IV continuous infusion of 100µg kg min-1 of ketamine, CIVEP (epidural anesthesia identical to CEP and ketamine infusion as in CIV and CON (epidural anesthesia with lidocaine 2%. HR, RR, SAP, MAP, DAP and T°C, sensitive blockade time and post operative analgesia measured with visual analog scale were evaluated. There was an increase in HR in CIV and decrease of this parameter in CEP. Arterial pressures kept within physiological values and differences in RR and T°C were not observed. The anesthetic blockade time was augmented in the groups which received epidural ketamine, differing significantly in relation to the control. The time for rescue analgesia did not differ between the groups. It can be concluded the administration of ketamine via epidural route, intravenous continuous infusion or the association of both promoted cardiorespiratory stability during the operative period; however, it was not able to extend the duration of post operative analgesia in dogs submitted to femoral osteosynthesis.

  4. Imaging of human vertebral surface using ultrasound RF data received at each element of probe for thoracic anesthesia

    Science.gov (United States)

    Takahashi, Kazuki; Taki, Hirofumi; Onishi, Eiko; Yamauchi, Masanori; Kanai, Hiroshi

    2017-07-01

    Epidural anesthesia is a common technique for perioperative analgesia and chronic pain treatment. Since ultrasonography is insufficient for depicting the human vertebral surface, most examiners apply epidural puncture by body surface landmarks on the back such as the spinous process and scapulae without any imaging, including ultrasonography. The puncture route to the epidural space at thoracic vertebrae is much narrower than that at lumber vertebrae, and therefore, epidural anesthesia at thoracic vertebrae is difficult, especially for a beginner. Herein, a novel imaging method is proposed based on a bi-static imaging technique by making use of the transmit beam width and direction. In an in vivo experimental study on human thoracic vertebrae, the proposed method succeeded in depicting the vertebral surface clearly as compared with conventional B-mode imaging and the conventional envelope method. This indicates the potential of the proposed method in visualizing the vertebral surface for the proper and safe execution of epidural anesthesia.

  5. An epidural catheter removal after recent percutaneous coronary intervention and coronary artery stenting: Epidural catheter and antiaggregation therapy

    Directory of Open Access Journals (Sweden)

    Joksić Nikola

    2016-01-01

    Full Text Available Introduction: Anticoagulation and antiplatelet therapy in the presence of the epidural catheter is still controversial. It is well known that dual antiplatelet therapy is indicated for 12 months after the placement of drug-eluting stents (DES. Removal of an epidural catheter during that period is related to an increased risk of stent occlusion in case of discontinuation of platelet function inhibitors or, on the other hand, increased risk of epidural hematoma associated with neurological deficit if suppressed platelet function is still present. Case Report: Here we present a case of a 63-year-old man who was admitted to Institute for Cardiovascular Diseases Dedinje for elective aortic surgery. Before the induction, an epidural catheter was inserted at the Th10-Th11 epidural space. Uneventful surgery was performed under the combined epidural and general anesthesia. On the 2nd postoperative day, the patient sustained a ST depression myocardial infarction treated with percutaneous coronary intervention with DES placement, while epidural catheter was still in place. Dual antiplatelet therapy with 600mg of clopidogrel, 100 mg of acetilsalicylic acid (ASA and low molecular weight heparin (LMWH were started during the procedure. The next day, clopidogrel (75 mg and ASA (100 mg were continued as well as LMWH. The decision to remove the epidural catheter was made on the 9th postoperative day, after platelet aggregation assays were performed. Six hours after catheter removal the patient again received clopidogrel, ASA and LMWH. There were no signs of epidural hematoma. Conclusion: This case shows that point-of-care testing with platelet aggregation assays may be useful in increasing the margin of safety for epidural catheter removal during dual antiplatelet therapy.

  6. Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

    DEFF Research Database (Denmark)

    Callesen, T; Schouenborg, Lars Øland; Nielsen, D

    1999-01-01

    Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1...... or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P ... for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine....

  7. SEGMENTAL EPIDURAL ANAESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Sachidanand

    2015-09-01

    Full Text Available BACKGROUND: Epidural anaesthesia is suitable as a sole agent for lower abdominal surgery and surgery on lower limbs. It has some definite advantages over spinal anaesthesia like avoidance of post spinal headache, minimal chances of meningitis, and minimal chances of nausea and vomiting in postoperative period. But administration of conventional dosage of local epidural anaesthetics (15ml and above for surgical anaesthesia frequently results in multiple hemodynamic changes, including decreases in chronotropism, inotro pism, dromotropism, systemic vascular resistance, cardiac output, and myocardial oxygen consumption. The segmental epidural block denotes the use of a small volume enough to block only the segments involved in the field of surgery. AIM: To study the effect iveness of segmental epidural anaesthesia for inguinal hernia repair. DESIGN: R andomized control study. METHODS: 100 pts belonging to ASA PS I & II posted for inguinal hernia repair given 5ml of 0.5% bupivacaine through epidural route at L1 - L2 level and a fter conforming the adequacy and level of analgesia, the surgery was commenced. If the patient complained of pain during needle prick, then injected local anaesthetic (0.5% Bupivacaine with an incremental dosage of 1ml at a time, till the complete onset o f analgesia Pulse Rate and Blood Pressure were recorded at an interval of 1 minute for first 5 minutes and then every 5 minutes till the end of the surgery. Oxygen saturation and ECG monitoring was done continuously. Onset of analgesia, level of analgesia ( P re & post operatively, duration of analgesia, total dosage of local anaesthetic used were recorded. Complications like bradycardia, hypotension, respiratory depression, shivering, nausea and vomiting, sweating and inadvertent dural puncture were recorde d. RESULTS: 53% of patients had excellent quality of analgesia and relaxation. 34% patients had good quality analgesia and relaxation, mild discomfort while handling sac

  8. Hematoma epidural subagudo Subacute epidural hematoma

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    Yvei González Orlandi

    2011-03-01

    Full Text Available Se presenta el caso de un paciente con hematoma epidural subagudo, temporoparietal derecho, secundario a una agresión física. En el cuadro clínico, a las 24 h, predominó la cefalea de intensidad moderada, con somnolencia y agitación psicomotora ligera. Las radiografías simples de cráneo no mostraron alteraciones. Los síntomas se mantuvieron a pesar del tratamiento médico, por lo que se realizó una tomografía axial simple de cráneo que mostró la presencia de un hematoma epidural subagudo temporoparietal derecho, con desplazamiento de estructuras de la línea media. Se realizó una craneotomía temporoparietal derecha para la evacuación del hematoma posterior. El paciente evolucionó satisfactoriamente y se recuperó por completo, tanto clínica como imaginológicamente.This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging.

  9. Thermographic skin temperature measurement compared with cold sensation in predicting the efficacy and distribution of epidural anesthesia.

    Science.gov (United States)

    Bruins, Arnoud A; Kistemaker, Kay R J; Boom, Annemieke; Klaessens, John H G M; Verdaasdonk, Rudolf M; Boer, Christa

    2018-04-01

    Due to the high rates of epidural failure (3-32%), novel techniques are required to objectively assess the successfulness of an epidural block. In this study we therefore investigated whether thermographic temperature measurements have a higher predictive value for a successful epidural block when compared to the cold sensation test as gold standard. Epidural anesthesia was induced in 61 patients undergoing elective abdominal, thoracic or orthopedic surgery. A thermographic picture was recorded at 5, 10 and 15 min following epidural anesthesia induction. After 15 min a cold sensation test was performed. Epidural anesthesia is associated with a decrease in skin temperature. Thermography predicts a successful epidural block with a sensitivity of 54% and a PPV of 92% and a specificity of 67% and a NPV of 17%. The cold sensation test shows a higher sensitivity and PPV than thermography (97 and 93%), but a lower specificity and NPV than thermography (25 and 50%). Thermographic temperature measurements can be used as an additional and objective method for the assessment of the effectiveness of an epidural block next to the cold sensation test, but have a low sensitivity and negative predictive value. The local decrease in temperature as observed in our study during epidural anesthesia is mainly attributed to a core-to-peripheral redistribution of body heat and vasodilation.

  10. Efeitos da analgesia peridural e do bloqueio contínuo do plexo lombar sobre a reabilitação funcional após artroplastia total do quadril Efectos de la analgesia epidural y del bloqueo continuo del plexo lumbar sobre la rehabilitación funcional después de la artroplastia total de cadera Effects of epidural analgesia and continuous lumbar plexus block on functional rehabilitation after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2009-10-01

    in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA of the lumbar plexus on functional rehabilitation of patients undergoing THA. METHODS: Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5% ropivacaine (Epidural or continuous lumbar plexus block with 0.5% ropivacaine (Lumbar. In the recovery room, PCA with infusion of 0.2% ropivacaine (Lumbar or 0.2% ropivacaine + fentanyl 3 µg.mL-1 (Epidural was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump was compared between both groups. Different postoperative rehabilitation parameters were analyzed. RESULTS: Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. CONCLUSIONS: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.

  11. Comparison of epidural butorphanol versus epidural morphine in postoperative pain relief.

    Science.gov (United States)

    Parikh, Geeta P; Veena, Shah R; Vora, Kalpana; Parikh, Beena; Joshi, Anish

    2014-02-01

    Epidural route is preferable for postoperative pain relief in thoraco-abdominal and lower limb surgeries. We aimed to compare epidural butorphanol versus morphine for postoperative analgesia up to 24 hours in open nephrectomy surgery. 80 ASA physical status I and II adult patients were selected for this randomized double blind prospective study. A standard balanced general anesthesia technique was applied for all patients. Epidural catheter was placed in lower thoracic inter-vertebral space before the start of surgery. Injection butorphanol 0.04 mg/kg in group B (n = 40) or morphine 0.06 mg/kg in group M (n = 40) was given in a double blind manner after completion of surgery and before extubation through the epidural catheter. Patients were observed for pain relief by Visual Analogue Scale (VAS) for the next 24 hours. Dose was repeated when VAS was > 4. The onset and peak effect of pain relief, duration of analgesia of 1st dose, frequency of drug administration and side effects if any were observed. The average onset of analgesia was 26.5 +/- 7.61 minutes with butorphanol and 62.5 +/- 13.4 minutes with morphine group which was statistically significant (p < 0.05). The mean peak effect of pain relief following 1st dose was 173 +/- 51.25 minutes with butorphanol and 251 +/- 52.32 minutes with morphine group. The duration of pain relief after 1st dose was statistically significant and was 339.13 +/- 79.57 minutes in group B and 709.75 +/- 72.12 minutes in group M which was gradually increased on repeated dosing in group B while it was almost same in Group M. Number of doses required in 24 hours was significantly higher (p < 0.05) in butorphanol group than morphine group. Somnolence was the main side effect in group B while pruritus was the main side effect with group M. Epidural butorphanol appears to provide safer and faster postoperative analgesia without much untoward effects but its analgesic action is short so more repeated doses are required than morphine via

  12. Thoracic Trauma.

    Science.gov (United States)

    Dennis, Bradley M; Bellister, Seth A; Guillamondegui, Oscar D

    2017-10-01

    Management of chest trauma is integral to patient outcomes owing to the vital structures held within the thoracic cavity. Understanding traumatic chest injuries and appropriate management plays a pivotal role in the overall well-being of both blunt and penetrating trauma patients. Whether the injury includes rib fractures, associated pulmonary injuries, or tracheobronchial tree injuries, every facet of management may impact the short- and long-term outcomes, including mortality. This article elucidates the workup and management of the thoracic cage, pulmonary and tracheobronchial injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    Kushner, M.J.; Luken, M.G. III

    1983-01-01

    CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

  14. MR, CT, and myelographic features of epidural lipomatosis

    International Nuclear Information System (INIS)

    Quint, D.J.; Boulos, R.S.; Patel, S.C.; Sanders, W.P.; Tiel, R.L.; Washington, J.M.

    1987-01-01

    Central deposition of fat is a well-known clinical feature of chronically elevated corticosteroid levels. Rarely described is increased extradural fat causing compression of the spinal cord and neurologic deficits. Twelve previously reported and five new cases of epidural lipomatosis are presented. Representative examples of the common myelographic and CT findings in this disorder are shown. In addition, previously undescribed examples of epidural lipomatosis demonstrating (1) the MR findings, (2) no associated myelographic block, (3) lipomatosis in both the thoracic and lumbar regions, and (4) a case in a nonobese patient without known steroid use are presented. The importance of considering this entity in the appropriate clinical setting (chronic exogenous steroid use) even with a normal myelogram is stressed

  15. Effect of epidural blockade and oxygen therapy on changes in subcutaneous oxygen tension after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Pedersen, U; Erichsen, C J

    1994-01-01

    The effect of oxygen therapy (37% by face mask) and epidural local anesthetic blockade (9 ml 0.5% bupivacaine at Th9-11 level) on wound oxygenation was evaluated in eight otherwise healthy patients undergoing elective colorectal resection. The patients were monitored continuously for subcutaneous...... without epidural blockade and 15 (10-20) min with blockade (P surgery....

  16. Epidural Analgesia after Rib Fractures.

    Science.gov (United States)

    Zaw, Andrea A; Murry, Jason; Hoang, David; Chen, Kevin; Louy, Charles; Bloom, Matthew B; Melo, Nicolas; Alban, Rodrigo F; Margulies, Daniel R; Ley, Eric J

    2015-10-01

    Pain associated with rib fractures impairs respiratory function and increases pulmonary morbidity. The purpose of this study was to determine how epidural catheters alter mortality and complications in trauma patients. We performed a retrospective study involving adult blunt trauma patients with moderate-to-severe injuries from January 1, 2004 to December 31, 2013. During the 10-year period, 526 patients met the inclusion criteria; 43/526 (8%) patients had a catheter placed. Mean age of patients with epidural catheter (CATH) was higher compared with patients without epidural catheter (NOCATH) (54 vs 48 years, P = 0.021), Injury Severity Score was similar (26 CATH vs 27 NOCATH, P = 0.84), and CATH had higher mean rib fractures (7.4 vs 4.1, P ribs fractured. The epidural cohort had longer hospital LOS and decreased mortality. In contrast to other studies, DVT rates were increased in patients who received epidural catheters.

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

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    A GHAFOURI

    2001-09-01

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

  18. Subacute epidural hematoma

    International Nuclear Information System (INIS)

    Gonzalez Orlandi, Ivey; Elizondo Barrier, Luis; Junco Martin, Reinel

    2011-01-01

    This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging. (author)

  19. Spinal cord ischemia following thoracotomy without epidural anesthesia.

    Science.gov (United States)

    Raz, Aeyal; Avramovich, Aharon; Saraf-Lavi, Efrat; Saute, Milton; Eidelman, Leonid A

    2006-06-01

    Paraplegia is an uncommon yet devastating complication following thoracotomy, usually caused by compression or ischemia of the spinal cord. Ischemia without compression may be a result of global ischemia, vascular injury and other causes. Epidural anesthesia has been implicated as a major cause. This report highlights the fact that perioperative cord ischemia and paraplegia may be unrelated to epidural intervention. A 71-yr-old woman was admitted for a left upper lobectomy for resection of a non-small cell carcinoma of the lung. The patient refused epidural catheter placement and underwent a left T5-6 thoracotomy under general anesthesia. During surgery, she was hemodynamically stable and good oxygen saturation was maintained. Several hours following surgery the patient complained of loss of sensation in her legs. Neurological examination disclosed a complete motor and sensory block at the T5-6 level. Magnetic resonance imaging (MRI) revealed spinal cord ischemia. The patient received iv steroid treatment, but remained paraplegic. Five months following the surgery there was only partial improvement in her motor symptoms. A follow-up MRI study was consistent with a diagnosis of spinal cord ischemia. In this case of paraplegia following thoracic surgery for lung resection, epidural anesthesia/analgesia was not used. The MRI demonstrated evidence of spinal cord ischemia, and no evidence of cord compression. This case highlights that etiologies other than epidural intervention, such as injury to the spinal segmental arteries during thoracotomy, should be considered as potential causes of cord ischemia and resultant paraplegia in this surgical population.

  20. Epidural anesthesia as a cause of acquired spinal subarachnoid cysts

    International Nuclear Information System (INIS)

    Sklar, E.M.L.; Quencer, R.M.; Green, B.A.; Post, M.J.D.; Montalvo, B.M.

    1988-01-01

    Six patients with acquired spinal subarachnoid cysts secondary to epidural anesthesia were evaluated with MR imaging (seven patients) and intraoperative US (three patients). The cysts were located in the lower cervical and thoracic spine. Adhesions and irregularity of the cord surface were frequently noted. Associated intramedullary lesions, including intramedullary cysts and myelomalacia, were seen in two of the patients. Arachnoiditis was unsuspected clinically in three patients, and MR imaging proved to be the diagnostic examination that first suggested the cause of the patients symptoms. The underlying mechanism for the formation of these cysts is a chemically induced arachnoiditis

  1. Effects of combined general anesthesia and thoracic epidural ...

    African Journals Online (AJOL)

    Background: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro‑immuno‑endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, ...

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

    Science.gov (United States)

    Eldawlatly, Abdelazeem; Turkistani, Ahmed; Shelley, Ben; El-Tahan, Mohamed; Macfie, Alistair; Kinsella, John

    2012-01-01

    Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, Panesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice. PMID:23162388

  3. MR enhancement of epidural fibrosis by Gd-DTPA: Biodistribution and mechanism

    International Nuclear Information System (INIS)

    Ross, J.S.; Delamater, R.; Van Dyke, C.W.; Masaryk, T.J.; Hueftle, M.G.; Bohlman, H.; Modic, M.T.

    1987-01-01

    Epidural lumbar fibrosis was induced in eight beagle dogs at the L-6 level. Vascular injection with india ink showed abundant vessels in the scar. This agreed with light microscopy in eight patients with epidural fibrosis, which enhanced with Gd-DTPA from a clinical trial. Electron microscopy of epidural scar in humans and dogs demonstrated a continuous endothelium with scattered tight junctions. Biodistirbution was determined in four dogs with rapid MR scanning following intravenous (IV) bolus of 0.1 mmol/kg of Gd-DTPA and radioassay of tissue samples following Gd-153-DTPA IV injection. Maximum percent enhancement (70% humans, 100% dogs) occurred at 3-6 minutes in epidural fibrosis with a slow decline in enhancement over the next hour. These findings suggest that Gd-DTPA enhancement of epidural fibrosis is via an extracellular distribution within vascularized scar tissue

  4. The evolution of thoracic anesthesia.

    Science.gov (United States)

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.

  5. Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia: A Feasible Economical Alternative

    OpenAIRE

    Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa

    2017-01-01

    Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml?1 mixed with 0.5 ml of fentanyl 50 ?g ml?1. Other drugs we...

  6. Acute spinal epidural hematoma: MR imaging study

    International Nuclear Information System (INIS)

    Xu Wenjian; Xu Aide

    2003-01-01

    Objective: To study the pathogenesis of acute spinal epidural hematomas (ASEHs), MRI features, and its value on diagnosis and differential diagnosis. Methods: Fifteen patients with ASEHs (8 males, 7 females, mean age 37.8 years) were reviewed. Seven of the patients were secondary to spinal injuries (5 spinal trauma, 1 post-spinal operation, and 1 post-lumbar puncture) and 8 were spontaneous. Eleven patients were confirmed by operation. MRI was performed in all patients in sagittal SE T 1 WI and SE or FSE T 2 WI, 12 in axial FSE T 2 WI, 8 in axial SE T 1 WI, and 4 in contrast-enhanced SE T 1 WI. Results: Fifteen ASEHs involved 18 spinal segments, 6 of the segments (6/18) in cervical spine, 9 segments (9/18) in thoracic spine, and 3 segments (3/18) in lumbar spine. The hematomas located at pre-epidural space in 7 segments (7/18) and at posterolateral epidural space in 11 segments (11/18). The craniocaudal extent of the hematomas varied from 1 to 13 vertebral levels (average 4.87 vertebral level). There were low signal intensity lines between hematomas and spinal cord in all of the cases on T 1 WI. The low signal intensity line between hematoma and subarachnoid space was demonstrated in 8 cases (8/12) and 4 cases (4/15) on axial T 2 WI and sagittal T 2 WI, respectively. The figure of hematomas was biconvex on axial imaging in all of the cases, and long lentiform on sagittal imaging in 13 cases (13/15). The hematomas showed variable signal intensity. On T 1 WI, 5 showed isointensity to cord, 6 with hyperintensity, and 4 with inhomogeneous iso-hyperintensity. On T 2 WI, 5 showed hypointensity, 10 with inhomogeneous hypo-hyperintensity. There was no special MR manifestation after contrast administration. Conclusion: ASEHs is a rare disorder, and MRI features are characteristic for the diagnosis and differential diagnosis

  7. Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Pei-Ching Hung

    2007-10-01

    Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

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

    Science.gov (United States)

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

    2010-06-01

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

  9. Unintentional Infusion of Phenylephrine into the Epidural Space.

    Science.gov (United States)

    Townley, Kress R; Lane, Jason; Packer, Robyn; Gupta, Rajnish K

    2016-03-01

    We describe a patient who received an unintentionally prolonged epidural infusion of phenylephrine. The patient experienced no major morbidity. However, this case highlights the continuing problem of wrong-route drug administration and the urgent need to adopt route-specific connections.

  10. Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses

    Directory of Open Access Journals (Sweden)

    Kwang Ho Cho

    2016-01-01

    Full Text Available Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect.

  11. Thoracic Cavernoma with Intraosseous and Extradural Component Mimicking Metastasis: Case Presentation

    Directory of Open Access Journals (Sweden)

    Kocaman Umit

    2016-09-01

    Full Text Available Spinal epidural cavernomas are quite rare lesions and only 5% of all cavernomas are located in the spine. The lesions are most commonly localized in the thoracic region. The differential diagnosis includes neurogenic tumors, lymphoma, schwannoma, meningioma, multiple myeloma, Ewing's sarcoma and metastasis. A 40- year-old male patient presented with paraplegia and MR images revealed an epidural soft tissue constricting the right posterolateral of the cord at the T6 level. Pathology showed cavernous hemangioma. A literature search revealed no other case that so closely mimicked metastasis by invading all components of the thoracic vertebra and also expanding to the epidural distance. We therefore present the case emphasizing these features.

  12. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Science.gov (United States)

    Nie, Hong-Fei; Liu, Kai-Xuan

    2013-01-01

    Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. PMID:24455232

  13. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  14. 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

  15. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

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

  16. Multivertebral and epidural involvement of the multiple myeloma, as confirmed by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Okuda, Yasuhiro; Tamaki, Norihiko; Hosoda, Koukichi; Ehara, Kazumasa; Matsumoto, Satoshi

    1987-08-01

    A case is reported of a multiple myeloma exhibiting symptoms of paraparesis as an initial manifestation following tetraparesis, but with no particular common symptoms of multiple myeloma. Laboratory findings, however, strongly suggested multiple myeloma, and this was confirmed by a biopsy. Radiological investigations could not show all the features of this tumor invasion, but revealed only the osteosclerotic and destructive changes in the cervical and thoracic spine, plus a complete block at the C2 level. Magnetic resonance imaging, however, disclosed entire lesions. There existed multiple vertebral involvements and an epidural invasion of the tumor, continuing to an extraspinal mass. Multiple myeloma is a disorder with varied manifestations; it is rarely present as a primary neuropathological entity. Among these manifestations, initial neurological manifestations in the form of peripheral neuropathy have been reported most commonly. Unusual clinical presentations such as in our case may result in an erroneous and delayed diagnosis unless an early and correct identification of the lesion is made. Magnetic resonance imaging is thought to be the most useful technique to detect such a multiple lesion in the spinal canal with no invasive manipulation.

  17. Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    for improved mobilization and oral nutrition, and preservation of body composition and muscle function. Studies integrating continuous epidural local anaesthetics with enforced early nutrition and mobilization uniformly suggest an improved recovery, decreased hospital stay and convalescence. CONCLUSIONS......: Epidural local anaesthetics should be included in a multi-modal rehabilitation programme after major surgical procedures in order to facilitate oral nutrition, improve recovery and reduce morbidity....

  18. Traumatic posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    Ikeda, Yukio; Nakazawa, Shozo; Yamakawa, Kazuomi; Kobayashi, Shiro; Tsuji, Yukihide

    1981-01-01

    In this paper three acute cases and two subacute cases are reported. CT findings in acute cases show two different types. ''Type I'' shows crescent or lenticular high density area which is not enhanced after contrast infusion. ''Type II'' shows lenticular low density area with membranous high density region in its medial side after contrast infusion. In subacute cases plain CT scan shows lenticular iso or low density area with membranous high density region in its medial side. Forty five cases of posterior fossa epidural hematoma in the review of literature of this country are discussed. Disturbances of the consciousness are the most predominant symptoms in acute cases, while in subacute cases cerebellar signs, vomiting, headache and choked disc are noted. Angiographical examinations may not always be valuable in collecting the direct information of the existence of the epidural hematoma. Liquor cavity in the posterior fossa which is thought to serve as a buffer action of hematoma is about 20 ml, so we discuss about the volume of hematoma, especially of 20 ml, associated with clinical course and prognosis. Volume of epidural hematoma is one of the most important factors affecting clinical course and prognosis. In summary of these our experiences, we again emphasize the value of CT scan as the rapid, noninvasive, accurate radiological examination in the diagnosis of traumatic posterior fossa epidural hematoma. (author)

  19. Acute epidural hematoma in children

    International Nuclear Information System (INIS)

    Kusunose, Mutsuo; Nishijima, Michiharu; Fukuda, Osamu; Saito, Tetsugen; Takaku, Akira; Horie, Yukio.

    1992-01-01

    The clinical features and sequential changes of CT findings in children with acute epidural hematoma were correlated with the patient's age. Of the 373 children admitted for head injury during the past 8 years, 61 had an acute traumatic intra-cranial hematoma, and 38 of these had acute epidural hematoma. None of the patients with acute epidural hematoma was under 2 years of age, 15 were 2-6 years old, and 23 were 7-15 years old. In the pre-school group, the numbers of boys and girls were approximately equal, but in the older group boys outnumbered girls. Epidural hematoma was most often parietal (12 patients). Nine patients had posterior fossa hematomas; 30 (78.9%) had skull fractures, and the incidence was not related to the patient's age. In 28 of the 38 patients, CT scans were examined repeatedly for 24 hours. In 15 of them (53.6%), the size of the hematoma increased. In school-aged children, the hematoma tended to be larger than in pre-school children. In four patients with pneumocephalus, the hematoma increased in size. Eleven of the 13, whose hematomas did not increase in size, had skull fractures. (author)

  20. Radiologic evaluation of spinal epidural mass

    International Nuclear Information System (INIS)

    Lee, Ho Kyu; Lee, Moon Kyu; Chang, Kee Hyun

    1987-01-01

    It is often difficult to differentiate each pathologic entity among various spinal epidural masses on the radiologic basis. We retrospectively analysed radiologic findings of 67 cases of pathologically proven spinal epidural mass to find out any specific findings of each epidural mass. The results are as follows : 1. Of 67 cases, metastasis (16 cases), epidural abscess (15 cases), neurogenic tumor (16 cases) and meningioma (8 cases) are most common. The others consist of epidural angioma (3 cases), vertebral hemangioma (2 cases), chondrosarcoma (2 cases), fibrosarcoma (1 case), eosinophilic granuloma (1 case), lymphoma (1 case), lipoma (1 case) and lymphoid hyperplasia (1 case). 2. Destruction of the adjacent bone was commonly associated with the epidural mass in metastasis (75%) and epidural abscess (67%). It was also noted in 2 cases of chondrosarcoma, 1 fibrosarcoma and 1 eosinophilic granuloma. 3. Pressure erosion of adjacent bone was demonstrated in neurogenic tumor (75%) and meningioma (25%). 4. Narrowing of intervertebral space was seen in only 27% of epidural abscess. 5. The paraspinal tumor was associated in 67% of metastasis, 80% of epidural abscess, 75% of neurogenic tumor, 33% of meningioma. It was also seen in 2 cases of chondrosarcoma, 1 fibrosarcoma and 1 eosinophilic granuloma. 6. The intradural tumor was associated in 50% of neurogenic tumor and 67% of meningioma. 7. On axial CT image, most of the epidural mass shows eccentric location with displacing dural sac to the opposite side. The diseases that occasionally show encircling location are metastasis, epidural abscess, vertebral hemangioma, chondrosarcoma, eosinophilic granuloma, and lymphoma. Neurogenic tumor only shows multicentric location. 8. The disease extent more than height of one vertebral body was seen in 80% of epidural abscess, 58% of neurogenic tumor, 100% of epidural angioma. It was also seen in 2 cases of chondrosarcoma, 1 fibrosarcoma, 1 eosinophilic granuloma, 1 lymphoma, 1

  1. Asphyxiating thoracic dysplasia

    International Nuclear Information System (INIS)

    Franzcr, J.; Kozlowski, K.

    2008-01-01

    Asphyxiating Thoracic Dysplasia is the most frequent form of Small Thorax - Short Rib Syndromes. Asphyxiating Thoracic Dysplasia in two patients with different clinical course is reported. Radiographic examination is the only method to diagnose Asphyxiating Thoracic Dysplasia with certainty. The correct diagnosis is important for prognostication and genetic counseling. It also excludes the necessity of further, often expensive investigations. (author)

  2. Cervical Epidural Anaesthesia for Radical Mastectomy and Chronic Regional Pain Syndrome of Upper Limb - A Case Report

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2009-01-01

    Full Text Available A 47-yrs-female patient presented with carcinoma right breast, swelling and allodynia of right upper limb. radical mastectomy with axillary clearance and skin grafting was done under cervical epidural anaesthesia through 18G epidural catheter placed at C6/C7 level. Postoperative analgesia and rehabilitation of affected right upper limb was managed by continuous epidural infusion of 0.125% bupivacaine and 2.5 µg/ml -1 clonidine solution through epidu-ral catheter for 5 days and physiotherapy. This case report highlights the usefulness of cervical epidural analgesia in managing a complex situation of carcinoma breast with associated periarthitis of shoulder joint and chronic regional pain syndrome (CRPS of right upper limb.

  3. Epidural Analgesia in the Postoperative Period

    National Research Council Canada - National Science Library

    Mathsen, Curtis

    2001-01-01

    .... This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period...

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

    Directory of Open Access Journals (Sweden)

    Basile Júnior Roberto

    1999-01-01

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

  5. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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    Pritam Yadav

    2018-01-01

    Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

  6. [The Effectiveness of Epidural Droperidol for Prophylaxis of Postoperative Nausea and Vomiting: A Comparative Study of Droperidol and Adrenaline].

    Science.gov (United States)

    Toyonaga, Shinya; Shinozuka, Norihiro; Dobashi, Tamae; Iiyori, Nao; Sudo, Tomoko

    2016-05-01

    Intravenous droperidol has strong evidence for antiemetic efficacy in high risk patients for prevention of postoperative nausea and vomiting (PONV). However it is not clear whether continuous epidural administration of doroperidol prevent PONV. It has been reported that epidural adrenaline decreases PONV; therefore we prospectively compared the effectiveness of epidural droperidol and adrenaline for prophylaxis of PONV. Eighty-six patients were scheduled for abdominal gynecological surgery under general-epidural anesthesia in the study. Patients were randomly assigned to droperidol group or adrenaline group. We investigated the incidences of PONV, the frequency of using the antiemetics. There was no statistical difference between the groups. The incidences of PONV were 27.9% (doropeidol group) and 58.1% (adrenaline group), respectively (P = 0.0046). The frequency of the anti-emetics use were 18.6% and 41.9%, respectively (P = 0.0189). There was one patient who needed cancellation of continuous epidural administration for vomiting in adrenaline group, but no patient in doropeidol group. The results suggest that epidural droperidol effectively decreases PONV in high risk patients. However epidural adrenaline might be ineffective.

  7. Spinal epidural empyema in two dogs

    International Nuclear Information System (INIS)

    Dewey, C.W.; Kortz, G.D.; Bailey, C.S.

    1998-01-01

    Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever

  8. Thoracic myelopathy with alkaptonuria.

    Science.gov (United States)

    Akeda, Koji; Kasai, Yuichi; Kawakita, Eiji; Matsumura, Yoshihiro; Kono, Toshibumi; Murata, Tetsuya; Uchida, Atsumasa

    2008-01-15

    A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented. To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy. Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported. The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented. Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery. We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.

  9. Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

    Directory of Open Access Journals (Sweden)

    Leonardo Teixeira Domingues Duarte

    2004-06-01

    ,1%, 92,8% y 93,3% de la población estudiada. CONCLUSIONES: La analgesia peridural continua es efectiva y segura. Las complicaciones ocurridas no fueron consideradas graves. Todavía, no se puede dispensar rigurosa vigilancia a fin de obtenerse analgesia satisfactoria y diminuir las complicaciones.BACKGROUND AND OBJECTIVES: Epidural analgesia with local anesthetics and opioids has a reputation of high efficacy with low incidence of side effects. This study aimed at determining incidence, type and severity of postoperative complications related to epidural analgesia and catheter insertion. METHODS: Participated in this retrospective study 469 patients submitted to postoperative epidural analgesia in the period 10/18/99 to 10/18/01. Epidural analgesia was induced with 0.1% bupivacaine and fentanyl (1 to 5 µg.mL-1, at a 3 mL.h-1 rate. Infusion rate was adjusted according to patients' pain complaint. The following variables were evaluated: epidural infusion duration; incidence of side-effects and complications related to demographics, type of surgery and epidural catheter position; and quality of analgesia by means of a pain visual analog scale and a patients' satisfaction index. RESULTS: Epidural catheters remained in place 2.2 days in average, varying from 6 to 10 days. Global rate of technique-related complications was 46.3%, most of them minor complications without clinical repercussion. From these, 13.9% were directly related to the epidural catheter (disconnection, externalization, low back pain, inflammation and local infection. Other common complications were vomiting and urinary retention. Postoperative analgesia was effective in 97.2% of the patients which referred satisfaction with the technique. Patients without pain or slight pain during the first, second and third postoperative day represented 80.1%, 92.8% and 93.3%, respectively, of the studied population. CONCLUSIONS: Continuous epidural analgesia is effective and safe. Complications were not severe. However

  10. Anestesthesiological approach to pediatric patient for lobectomy due to lung abscess: Lung separation and epidural analgesia (lung separation and epidural analgesia

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    Vranić Lana

    2017-01-01

    Full Text Available Introduction: Acute lymphoblastic leukemia is the most common malignancy in childhood. Main characteristics of the disease are fast proliferation of lymphoblastic cells in bone marrow, destruction of other cells, causing insufficiency in the bone marow and infiltration of the liver, spleen and the lymphatic nodes. Pulmonary abscess and necrotizing pneumonia are rarely found in pediatric population and usually represent a significant problem for treatment. These conditions often require some surgical treatment modalities. The main goal of anesthesiological approach is to provide good and safe perioperative conditions and adequate analgesia. Case report: During treatment of acute leukemia in a 15-year-old boy, complication inform absenting pneumonia left side lung was developed. After four months antibiotic and antifungal therapy wide broad,(nije jasno decision of consilium was to perform left inferior lobectomy. Antibiotic prophylaxis with Ceftazidime 50 mg/kg BM. We performed a combination of general anesthesia and thoracic epidural anesthesia. Intubation with Robertshaw double lume tube. Ultrasound guided central venous catheter in left jugular veine and arterial line in right radial arteria. Anesthesia depth was controlled with entropy method. Epidural catheter was intoduded on level Thl0-Th 11. Conclusion: One ventilation with double lumen tube prevents spillage of infection sputum into the healthy lung. Epidural analgesia in this clinical situation held numerous benefits especially as a way to reduce postoperative respiratory complications caused by acute pain.

  11. Evaluation of electrical nerve stimulation for epidural catheter positioning in the dog.

    Science.gov (United States)

    Garcia-Pereira, Fernando L; Sanders, Robert; Shih, Andre C; Sonea, Ioana M; Hauptman, Joseph G

    2013-09-01

    To evaluate the accuracy of epidural catheter placement at different levels of the spinal cord guided solely by electrical nerve stimulation and resultant segmental muscle contraction. Prospective, experiment. Six male and two female Beagles, age (1 ± 0.17 years) and weight (12.9 ± 1.1 kg). Animals were anesthetized with propofol and maintained with isoflurane. An insulated epidural needle was used to reach the lumbosacral epidural space. A Tsui epidural catheter was inserted and connected to a nerve stimulator (1.0 mA, 0.1 ms, 2 Hz) to assess positioning of the tip at specific spinal cord segments. The catheter was advanced to three different levels of the spinal cord: lumbar (L2-L5), thoracic (T5-T10) and cervical (C4-C6). Subcutaneous needles were previously placed at these spinal levels and the catheter was advanced to match the needle location, guided only by corresponding muscle contractions. Catheter position was verified by fluoroscopy. If catheter tip and needle were at the same vertebral body a score of zero was assigned. When catheter tip was cranial or caudal to the needle, positive or negative numbers, respectively, corresponding to the number of vertebrae between them, were assigned. The mean and standard deviation of the number of vertebrae between catheter tip and needle were calculated to assess accuracy. Results are given as mean ± SD. The catheter position in relation to the needle was within 0.3 ± 2.0 vertebral bodies. Positive predictive values (PPV) were 57%, 83% and 71% for lumbar, thoracic and cervical regions respectively. Overall PPV was 70%. No significant difference in PPV among regions was found. Placement of an epidural catheter at specific spinal levels using electrical nerve stimulation was feasible without radiographic assistance in dogs. Two vertebral bodies difference from the target site may be clinically acceptable when performing segmental epidural regional anesthesia. © 2013 Association of Veterinary

  12. Thoracic spine pain

    Directory of Open Access Journals (Sweden)

    Aleksey Ivanovich Isaikin

    2013-01-01

    Full Text Available Thoracic spine pain, or thoracalgia, is one of the common reasons for seeking for medical advice. The epidemiology and semiotics of pain in the thoracic spine unlike in those in the cervical and lumbar spine have not been inadequately studied. The causes of thoracic spine pain are varied: diseases of the cardiovascular, gastrointestinal, pulmonary, and renal systems, injuries to the musculoskeletal structures of the cervical and thoracic portions, which require a thorough differential diagnosis. Facet, costotransverse, and costovertebral joint injuries and myofascial syndrome are the most common causes of musculoskeletal (nonspecific pain in the thoracic spine. True radicular pain is rarely encountered. Traditionally, treatment for thoracalgia includes a combination of non-drug and drug therapies. The cyclooxygenase 2 inhibitor meloxicam (movalis may be the drug of choice in the treatment of musculoskeletal pain.

  13. An epidural neuroblastoma causing spinal cord compression in a 67-year-old woman

    Directory of Open Access Journals (Sweden)

    Ethan Taub

    2010-04-01

    Full Text Available We report a case of disseminated neuroblastoma (NB causing epidural spinal cord compression in a 67-year-old woman. Because NB is primarily a tumor of infancy and childhood, less is known about its clinical course and optimal treatment in adults. This patient was treated with a thoracic laminectomy and tumor resection; polychemotherapy with one cycle of vindesine, cisplatin, and etoposide; one cycle of vincristine, dacarbazine, ifosfamide, and doxorubicin; and radiotherapy to the spine. She remained able to walk but died 8.5 months later of diffuse systemic tumor progression.

  14. Spinal epidural hemangioma related to pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, G.S.; Millett, P.J. [Dept. of Orthopaedics, Hospital for Special Surgery, New York, NY (United States); DiCarlo, E.F. [Dept. of Pathology, Hospital for Special Surgery, New York, NY (United States); Mintz, D.N. [Dept. of Radiology, Hospital for Special Surgery, New York, NY (United States); Dept. of Radiology, New York Presbyterian Hospital, NY (United States); Gamache, F.W. [Department of Surgery, Hospital for Special Surgery, New York, NY (United States); Dept. of Surgery, New York Presbyterian Hospital, NY (United States); Rawlins, B.A. [Dept. of Orthopaedics, Hospital for Special Surgery, New York, NY (United States); Weill Medical College of Cornell Univ., New York (United States)

    2001-05-01

    We report the case of a 39-year-old woman with adolescent idiopathic scoliosis presenting with myelopathy secondary to a spinal epidural hemangioma. MRI showed an epidural soft tissue mass within the spinal canal between T5 and T9 with severe spinal cord compression. Symptoms had a temporal relationship to her pregnancy. Surgical removal of the epidural hemangioma rapidly relieved her symptoms and neurologic deficits. Follow-up examination 2 years later demonstrated normal motor and sensory function, without any neurologic sequelae or progression of deformity. (orig.)

  15. Spinal epidural hematomas examined on MRI

    International Nuclear Information System (INIS)

    Rejnowski, G.; Poniatowska, R.; Kozlowski, P.

    1995-01-01

    Spinal epidural hematomas are rare pathology, caused by trauma or spontaneous. In clinical examination acute spinal cord compression is observed. MRI designations appear entirely particular. In sagittal projection, biconvex mass in the dorsal, or sometimes ventral part of the spinal canal is clearly visible. This is well delineated by the thecal sac from the cord and cauda equina. MRI investigations in 3 patients revealed corresponding with spinal bone injuries and cord edema epidural hematomas. Differential diagnosis must contain subdural hematoma and epidural neoplasms or abscess. (author)

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

    Directory of Open Access Journals (Sweden)

    Gisela Di Stilio

    2006-08-01

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

  17. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

    Directory of Open Access Journals (Sweden)

    Sukhen Samanta

    2016-01-01

    Full Text Available Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001 regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

  18. Epidural venous stasis in spinal stenosis

    International Nuclear Information System (INIS)

    Kaiser, M.C.; Capesius, P.; Poos, D.; Gratia, G.; Roilgen, A.; Sandt, G.

    1984-01-01

    Computed tomography permits reliable demonstration of the spinal canal and its contents. Measurements of the sagittal diameter of the bony canal do not take into consideration size, shape and state of intraspinal soft tissue structures, i.e. the thecal sac and its own contents, epidural fat and blood circulation pattern. Three particularly illustrative cases were selected in which obvious epidural venous engorgement was visualized in association with spinal stenosis. The authors think that epidural venous stasis occuring in segmental spinal stenosis is a CT sign of clinically significant narrowing of the neural canal. Accurate recognition of the type of lumbar stenosis together with epidural blood flow alterations permits a better understanding of the existing lesions. Thus, a more precise and specific surgical approach is possible. (orig.)

  19. Thoracic and abdominopelvic actinomycosis

    African Journals Online (AJOL)

    thoracic disease.1,2,4 The chronic progressive suppurative infection ... venous Penicillin G for 4 - 6 weeks being the treatment of ... pathology was demonstrated in the liver. (Figs 7a and b ). .... ulceration (may resemble Crohn's disease).3. 2.

  20. Society of Thoracic Surgeons

    Science.gov (United States)

    ... Apply for Membership Membership Directory Pay Your Dues Industry Mailing List License & eBlast Communications Programs Advertise on ... Hotel Discount Copyright © 2017 The Society of Thoracic Surgeons. ...

  1. Epidural Catheter Breakage In-Situ

    Directory of Open Access Journals (Sweden)

    Geetanjali S Verma

    2014-09-01

    Full Text Available A 45yr old woman diagnosed with dysfunctional uterine bleeding and incisional hernia was planned for total abdominal hysterectomy with bilateral salpingo-oophorectomy and mesh repair under combined spinal and epidural anaesthesia. Using VYGON® epidural catheter with its recommended introducer, the catheter was inserted but it snapped off at 11cm mark while positioning the catheter. After radiological confirmation, the neurosurgeon removed the catheter under general anaesthesia, which was followed by the scheduled surgery.

  2. Epidural Hematoma Following Cervical Spine Surgery.

    Science.gov (United States)

    Schroeder, Gregory D; Hilibrand, Alan S; Arnold, Paul M; Fish, David E; Wang, Jeffrey C; Gum, Jeffrey L; Smith, Zachary A; Hsu, Wellington K; Gokaslan, Ziya L; Isaacs, Robert E; Kanter, Adam S; Mroz, Thomas E; Nassr, Ahmad; Sasso, Rick C; Fehlings, Michael G; Buser, Zorica; Bydon, Mohamad; Cha, Peter I; Chatterjee, Dhananjay; Gee, Erica L; Lord, Elizabeth L; Mayer, Erik N; McBride, Owen J; Nguyen, Emily C; Roe, Allison K; Tortolani, P Justin; Stroh, D Alex; Yanez, Marisa Y; Riew, K Daniel

    2017-04-01

    A multicentered retrospective case series. To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment ( P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements.

  3. Spontaneous intracranial epidural hematoma during rivaroxaban treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jeronimo Buzetti; Jung, Gustavo Simiano; Silva Junior, Luis Fernando; Ramina, Ricardo, E-mail: leonardoruschel@yahoo.com.br [Instituto de Neurologia de Curitiba (INC), Curitiba, PR (Brazil)

    2016-11-15

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto®. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban. (author)

  4. Specially trained registered nurses can safely manage epidural analgesia infusion in laboring patients.

    Science.gov (United States)

    Charles, Lenore A; Korejwa, Elise; Kent, Donna Curtis; Raniero, Debbie

    2015-06-01

    To discover evidence for defining the registered nurse's (RN's) role in the management of epidural analgesia in the labor and delivery setting. The Labor Epidural Nurse Safety (LENS) study consisted of two parts. The first part was a 10-year retrospective review of the outcomes of 2,568 laboring women for whom epidural catheters had been placed and verified by an anesthesiologist or certified registered nurse anesthetist, then continuous epidural infusion initiated, and basal rate or patient-controlled epidural analgesia (PCEA) dose increased, if needed, within specified parameters by specially trained labor and delivery RNs. The second part compared the outcomes of the neonates born to the 2,568 women in the first part of the study with neonates born to mothers who received PCEA with a continuous infusion initiated and managed exclusively by anesthesiologists and/or certified registered nurse anesthetists at two control sites. Maternal outcomes were quantified by incidences of clinically significant hypotension and sentinel events, such as respiratory distress, cardio/respiratory distress, loss of consciousness, and seizures. Evidence of neonatal outcomes was collected by comparing Apgar scores. No sentinel events occurred, and there was no increase in maternal hypotensive events in the RN-managed group. There were no statistically significant differences in Apgar scores between the experimental and control groups. Specially trained RNs can safely initiate continuous infusions and increase the basal rate of epidural analgesia infusions or PCEA doses administered to laboring women, after insertion and confirmation of correct catheter placement by a qualified anesthesia provider, without adversely affecting maternal and fetal/neonatal outcomes. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  5. Reliability analysis of the epidural spinal cord compression scale.

    Science.gov (United States)

    Bilsky, Mark H; Laufer, Ilya; Fourney, Daryl R; Groff, Michael; Schmidt, Meic H; Varga, Peter Paul; Vrionis, Frank D; Yamada, Yoshiya; Gerszten, Peter C; Kuklo, Timothy R

    2010-09-01

    The evolution of imaging techniques, along with highly effective radiation options has changed the way metastatic epidural tumors are treated. While high-grade epidural spinal cord compression (ESCC) frequently serves as an indication for surgical decompression, no consensus exists in the literature about the precise definition of this term. The advancement of the treatment paradigms in patients with metastatic tumors for the spine requires a clear grading scheme of ESCC. The degree of ESCC often serves as a major determinant in the decision to operate or irradiate. The purpose of this study was to determine the reliability and validity of a 6-point, MR imaging-based grading system for ESCC. To determine the reliability of the grading scale, a survey was distributed to 7 spine surgeons who participate in the Spine Oncology Study Group. The MR images of 25 cervical or thoracic spinal tumors were distributed consisting of 1 sagittal image and 3 axial images at the identical level including T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images. The survey was administered 3 times at 2-week intervals. The inter- and intrarater reliability was assessed. The inter- and intrarater reliability ranged from good to excellent when surgeons were asked to rate the degree of spinal cord compression using T2-weighted axial images. The T2-weighted images were superior indicators of ESCC compared with T1-weighted images with and without Gd. The ESCC scale provides a valid and reliable instrument that may be used to describe the degree of ESCC based on T2-weighted MR images. This scale accounts for recent advances in the treatment of spinal metastases and may be used to provide an ESCC classification scheme for multicenter clinical trial and outcome studies.

  6. Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

    Science.gov (United States)

    Xu, Zhendong; Su, Jing; Liu, Zhiqiang

    2014-01-01

    Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (Panalgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation. PMID:25386749

  7. Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection

    International Nuclear Information System (INIS)

    Tok, Chung Hong; Kaur, Shaleen; Gangi, Afshin

    2011-01-01

    Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202–211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202–211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

  8. Parotitis after epidural anesthesia in plastic surgery: report of three cases.

    Science.gov (United States)

    Rosique, Marina Junqueira Ferreira; Rosique, Rodrigo Gouvea; Costa, Ilson Rosique; Lara, Brunno Rosique; Figueiredo, Jozé Luiz Ferrari; Ribeiro, Davidson Gomes Barbosa

    2013-08-01

    Acute swelling of the parotid glands after general anesthesia has become known as anesthesia mumps. Its cause is unknown. Only one case of postsurgical parotitis without general anesthesia is reported. This report describes three cases in this setting after plastic surgery. A 37-year-old women underwent breast surgery and abdominoplasty with a dual thoracic/lumbar epidural block (bupivacaine 0.5 %). The operative time totaled almost 6 h. Subsequently, 4 h after surgery, the patient experienced painless bilateral parotid swelling without palpable crepitus. The edema resolved completely within 12 h under clinical observation and parenteral hydration. A 45-year-old patient received subglandular breast implants and body contouring with liposuction, all with the patient under a dual thoracic/lumbar epidural block with 0.5 % marcaine. The total surgical time was 5 h. Subsequently, 3 h after surgery, the patient experienced a similar clinical presentation. The problem resolved completely in 36 h with clinical observation and parenteral hydration. CASE 3: A 30-year-old patient received a subglandular breast implant and underwent liposuction of the outer thighs using a dual thoracic/lumbar epidural block with lidocaine 1 %. The duration of surgery was 1 h. Subsequently, 5 h postoperatively, the patient experienced a similar clinical presentation. Dexamethasone and parenteral hydration were administered. The problem resolved completely in 48 h without sequelae. The occurrence of parotitis in patients undergoing surgery under epidural anesthesia is a novel situation, which increases the range of possible etiologies for this little known condition. Dehydration leading to transient parotid secretion obstruction may play a significant role. Further reports of parotitis occurring in the regional anesthesia setting are expected to help elucidate its pathophysiology. This journal requires that authors assign a level of evidence to each article. For a full description of

  9. The epidural expansion in the waist canal - less obvious findings

    International Nuclear Information System (INIS)

    Nekula, J.; Bucil, J.; Burval, S.

    1998-01-01

    The authors demonstrated 55 less obvious epidural expansion in the waist canal. These expansions are discussed. The detection of the epidural mass at myeloma multiples has a principal significance for the indication of the radiotherapy or surgical intervention

  10. Newborns from deliveries with epidural anaesthesia

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    Avramović Lidija

    2010-01-01

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

  11. Imaging of thoracic trauma

    International Nuclear Information System (INIS)

    Uffmann, M.; Herold, C.J.; Fuchs, M.

    1998-01-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [de

  12. Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas

    Science.gov (United States)

    Cheng, L.T.E.; Lim, W.E.H.

    2005-01-01

    Summary A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiomas and gastrointestinal haemangiomas has not been reported. PMID:20584496

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

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    2003-04-01

    slower in the Sufentanil group as compared to the Propofol group during 100 minutes after beginning of surgery. Time for extubation and referral to post-anesthetic recovery unit (PACU was significantly shorter for the Propofol group, however sedation intensity and duration were longer in this group as compared to Sufentanil group. Recovery scores were similar for both groups. Three hours after PACU admission all patients were meeting criteria to be transferred to the ward. Transient arterial hypotension was observed in 2 Sufentanil group patients. CONCLUSIONS: Continuous thoracic epidural anesthesia with 0.2% ropivacaine (1.5 mg.kg-1 associated to propofol infusion provides effective and safe anesthesia for upper pediatric abdominal surgeries. Propofol infusion rate and sedation duration were decreased with the association of sufentanil.

  14. Neonatal respiratory depression associated with epidural analgesia

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    Alberto Gálvez Toro

    2013-06-01

    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  15. Registered nurses' and midwives' knowledge of epidural analgesia.

    Science.gov (United States)

    Bird, Annette; Wallis, Marianne; Chaboyer, Wendy

    2009-01-01

    Despite epidural analgesia increasingly being utilized in hospitals, very little research-based evidence is available about registered nurses' (RNs) and midwives' knowledge of this technique. To describe the current epidural knowledge levels of RNs and midwives in a multi-site setting. RNs and midwives at four, regional teaching facilities completed an epidural knowledge test. The instrument included demographic items and five knowledge subscales relating to epidural analgesia: spinal cord anatomy and physiology; epidural pharmacology; complications of epidural analgesia; assessment of sensory and motor blockade and the general management of patients with epidural analgesia. A total of 408 (99.7% response) RNs and midwives completed the test. Respondents demonstrated good knowledge of sensory and motor blockade assessment and the general management of epidural analgesia subscales with correct responses to 75 and 77% of the questions in these subscales, respectively. Fair knowledge relating to the spinal cord anatomy and physiology subscale was demonstrated with 69% of the questions answered correctly. The knowledge subscales relating to epidural pharmacology (57% correct responses) and the complications of epidural analgesia (56% correct responses) were problematic for the sample. The research results provide generalizable information about what RNs and midwives know about epidural analgesia. These results are an important guide in the development of new and existing dedicated epidural education programs. The results also provide some direction for further research into this important topic.

  16. Epidural steroid injection for lumbosacral radiculopathy

    International Nuclear Information System (INIS)

    Sung, Mi Sook

    2006-01-01

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

  17. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-06-15

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

  18. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    Directory of Open Access Journals (Sweden)

    David Ruiz Picazo

    2016-01-01

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

  19. Sciatica caused by lumbar epidural gas.

    Science.gov (United States)

    Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; gazzaz, Miloudi; Boucetta, Mohammed

    2014-01-01

    Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence.

  20. Delayed epidural hematoma after mild head injury

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    Radulović Danilo

    2005-01-01

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

  1. Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

    Science.gov (United States)

    Johnson, Philip; Ammar, Hussam

    2013-04-11

    Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.

  2. Rapidly Progressive Spontaneous Spinal Epidural Abscess

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    Abdurrahman Aycan

    2016-01-01

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

  3. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study.

    Science.gov (United States)

    Patel, N P; El-Wahab, N; Fernando, R; Wilson, S; Robson, S C; Columb, M O; Lyons, G R

    2014-05-01

    We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h(-1) before and 9.9 (6.1) h(-1) after analgesia, epidural group 11.0 (7.3) h(-1) before and 8.4 (5.9) h(-1) after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  4. Effect of epidural tramadol and lignocaine on physiological and behavioural changes in goats subjected to castration with a high tension band.

    Science.gov (United States)

    Ajadi, R A; Owanikin, A O; Martins, M M; Gazal, O S

    2012-11-01

    To compare the effect of a single epidural injection of either lignocaine or tramadol on behavioural changes, anaesthetic indices, leucocyte parameters, erythrocyte sedimentation rates and concentration of cortisol in plasma in goats subjected to castration by high tension band. Ten male goats weighing 14.4 (SD 0.7) kg were randomly allocated to anaesthesia with epidural injections of tramadol (3 mg/kg), or lignocaine (4 mg/kg). Following anaesthesia, a rubber ring was applied and tensioned to the scrotal neck of each goat. Behavioural changes were noted as they occurred, and the onset of drug action (time between epidural injection and loss of pedal reflex) and duration of antinociception (time interval between disappearance and reappearance of pedal withdrawal reflex) were determined. Hearts rates, respiratory rates and rectal temperatures were determined every 15 minutes for a 90-minute period, while blood was obtained for determination of white cell counts, erythrocyte sedimentation rates and concentrations of cortisol. Anaesthetic indices were compared using Student's t-test, while physiological parameters were compared using an ANOVA for repeated measurements. Goats treated with epidural tramadol were not recumbent and continued rumination while goats treated with epidural lignocaine were recumbent and did not continue rumination. The onset of analgesia was longer (p=0.01) in goats treated with epidural tramadol (5.0 minutes; SD 1.2) than goats treated with epidural lignocaine (3.0 minutes; SD 1.1), while duration of analgesia was shorter (p=0.003) in goats treated with epidural tramadol (47.2 minutes; SD 13.1) than goats treated with epidural lignocaine (89.8 minutes; SD 23.1). There was no significant difference in heart rates, respiratory rates and erythrocyte sedimentation rates, while the concentration of cortisol in plasma differed (pcattle and where the ability of the animal to maintain standing is desired.

  5. Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.

    Science.gov (United States)

    Lai, Yi-Chen; Chia, Yuan-Yi; Lien, Wei-Hung

    2017-03-01

    Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.

  6. Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Zhang Wangping

    2017-01-01

    Full Text Available Background. Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. Methods. One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0.25, 0.5, 0.75, and 1 μg/ml of dexmedetomidine plus 0.1% ropivacaine, resp.. The onset of epidural anesthesia and stages of labor were studied, and pain was assessed using a visual analogue scale (VAS. Hemodynamic parameters and fetal heart rate were monitored. Apgar scores and umbilical artery pH were recorded. The side effects, if any, were recorded also. Results. The addition of 0.25, 0.5, and 0.75 μg/ml of dexmedetomidine to 0.1% ropivacaine provided safe and effective analgesia, but 1 μg/ml of dexmedetomidine resulted in increasing incidence of motor block. The hemodynamic parameters were similar between groups (P>0.05. Side effects in Group D were significantly higher than those in the other three groups (P<0.05. Conclusions. When dexmedetomidine is combined with 0.1% ropivacaine, the optimal concentration of dexmedetomidine is 0.5 μg/ml for epidural labor analgesia (this trial is registered with ChiCTR-OPC-16008548.

  7. Efficacy and safety of combined spinal: Epidural versus epidural technique for labor analgesia in parturients with rheumatic valvular heart disease

    Directory of Open Access Journals (Sweden)

    Babita Ghai

    2013-01-01

    Full Text Available Background: Hemodynamic changes induced by labor pain and apprehension in addition to physiological changes may pose risk to parturients with rheumatic heart disease (RHD. Therefore, it is important to provide adequate pain relief during labor in these patients. We planned this study to compare the efficacy and safety of epidural (E versus combined spinal - epidural (CSE for labor analgesia in parturients with rheumatic valvular heart disease. Methods: Twenty-five parturients with RHD included in this study were randomized to one of the two groups - E group (n = 12, received 6 mL of 0.0625% bupivacaine with 25 μg fentanyl or CSE group (n = 13, received 25 μg of fentanyl with 1.25 mg bupivacaine diluted to 1 mL in subarachnoid space. Afterward, a continuous infusion of 0.1% bupivacaine with 2 μg/mL fentanyl was started at 6-8 mL/h. Primary outcome, analgesic efficacy, was assessed by visual analog scale (VAS for pain. VAS ≤ 3 was considered as effective analgesia. Rescue analgesia in the form of epidural bolus was given if VAS > 3. Results: Demographic characteristics of the patients were comparable. Mitral stenosis was the predominant valvular lesion. The VAS at which the parturients received analgesia was comparable. The mean time to achieve effective analgesia was significantly faster in CSE group (4.46 ± 0.87 min compared with group E (15.09 ± 5.7 min (P < 0.001. Significantly lower median pain scores were recorded until the initial 15 min in CSE group. Afterward, median VAS for pain was comparable between the groups. VAS for pain was significantly low at all time intervals than baseline in both the groups. Maternal satisfaction and incidence of cesarean rate and complication were comparable between the groups. Conclusion: Both epidural and CSE are equally effective and safe for labor analgesia in parturients with rheumatic valvular heart disease. However, CSE technique provides a faster onset of analgesia.

  8. Vasovagal Syncope during Epidural Catheterization before ...

    African Journals Online (AJOL)

    The risk factors can be patient related (young, athletics, hypertensive, history of syncope, inferior myocardial infarction and others), anaesthesia related (light anaesthesia, spinal, epidural anaesthesia, airway manipulation, hypercapnia, hypoxia and others) and surgical related (strabismus, anal dilatation, abdominal and ...

  9. Spontaneous extracranial decompression of epidural hematoma

    International Nuclear Information System (INIS)

    Neely, John C.; Jones, Blaise V.; Crone, Kerry R.

    2008-01-01

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

  10. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-03-15

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

  11. EPIDURAL ANAESTHESIA FOR SURGERY IN ADVANCED CANCER

    African Journals Online (AJOL)

    Femi Olaleye

    adverse effects of either agent, e.g. hypotension and respiratory depression, which could have been easily precipitated during the course of surgery. Postoperative analgesia with epidural block is usually provided in the ICU or a high dependency unit (HDU), especially in developing countries with limited facilities. This is to ...

  12. pethidine study Epidural and intramuscular a pharmacokinetic

    African Journals Online (AJOL)

    1983-02-05

    Feb 5, 1983 ... study would indicate to what extent absorption and transport via the blood influenced the actions of epidural pethidine. Department of ... gas chromatograph using a 1,1 metre glass column of 2% Car- bowax 20M + 3% KOH on ...

  13. MRI features of epidural extramedullary hematopoiesis

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-07-01

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

  14. MRI features of epidural extramedullary hematopoiesis

    International Nuclear Information System (INIS)

    Alorainy, Ibrahim A.; Al-Asmi, Abdullah R.; Carpio, Raquel del

    2000-01-01

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

  15. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

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

  16. Epidural analgesia, neonatal care and breastfeeding.

    Science.gov (United States)

    Zuppa, Antonio Alberto; Alighieri, Giovanni; Riccardi, Riccardo; Cavani, Maria; Iafisco, Alma; Cota, Francesco; Romagnoli, Costantino

    2014-11-29

    The objective of our study is to evaluate the correlation between epidural analgesia during labor, start of breastfeeding and type of maternal-neonatal care.Two different assistance models were considered: Partial and Full Rooming-in.In this cohort study, 2480 healthy infants were enrolled, 1519 in the Partial Rooming-in group and 1321 in the Full Rooming-in group; 1223 were born to women subjected to epidural analgesia in labor.In case of Partial Rooming-in the rate of exclusive or prevailing breastfeeding is significant more frequent in newborns born to mothers who didn't receive analgesia. Instead, in case of Full Rooming-in the rate of exclusive or prevailing breastfeeding is almost the same and there's no correlation between the use or not of epidural analgesia.The good start of lactation and the success of breastfeeding seems to be guaranteed by the type of care offered to the couple mother-infant, that reverses any possible adverse effects of the use of epidural analgesia in labor.

  17. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    to the labouring woman’s relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance. Conclusion: After initiation of epidural...

  18. Carcinoma of the thoracic esophagus

    International Nuclear Information System (INIS)

    Herskovic, A.M.; Leichman, L.; Lattin, P.B.

    1987-01-01

    The authors analyzed all cases of thoracic esophagel carcinoma seen from 1980 to 1984 inclusive, plus an additional 22 cases from a pilot study at Wayne State University. Most patients received preoperative combination radiation and chemotherapy. Eighty-nine patients completed treatment (5-fluorouracil, cisplatin, and radiation therapy) as in both the RTOG and SWOG national studies. Of these 89, 39 refused or were not offered planned surgery. Four patients are still alive and well. Fifty patients underwent esophagectomy; 12 patients were free of tumor at esophagectomy, and four of these are alive and well. One patient with a tumor in the resected esophagus alone is still alive. Twenty-two patients were enrolled in the pilot study in which surgery was reserved for salvage, the initial radiation volume was increased, the tumor dose was increased to 5,000 rad give continuously, and chemotherapy was increased to four courses

  19. Managment of thoracic empyema.

    Science.gov (United States)

    Sherman, M M; Subramanian, V; Berger, R L

    1977-04-01

    Over a ten year period, 102 patients with thoracic empyemata were treated at Boston City Hospital. Only three patients died from the pleural infection while twenty-six succumbed to the associated diseases. Priniciples of management include: (1) thoracentesis; (2) antibiotics; (3) closed-tube thoracostomy; (4) sinogram; (5) open drainage; (6) empyemectomy and decortication in selected patients; and (7) bronchoscopy and barium swallow when the etiology is uncertain.

  20. Thoracic textilomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Dianne Melo; Zanetti, Glaucia; Araujo Neto, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Silva, Jorge Luiz Pereira e; Guimaraes, Marcos Duarte; Escuissato, Dante Luiz; Souza Junior, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Hospital Universitario Antonio Pedro (HUAP/UFF), Niteroi, RJ (Brazil)

    2014-09-15

    Objective: the aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: this was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: the majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: it is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. (author)

  1. The effect of 0.5% ropivacaine on epidural blood flow

    DEFF Research Database (Denmark)

    Dahl, J B; Simonsen, L; Mogensen, T

    1990-01-01

    Twenty patients scheduled for elective abdominal surgery received epidural analgesia with 20 ml 0.5% ropivacaine or 0.5% bupivacaine. Epidural blood flow was measured by an epidural 133Xe clearance technique on the day before surgery (no local anaesthetic) and again 1 h before surgery, 30 min after...... injection of the local anaesthetic during continuous infusion (8 ml/h). Median initial blood flow was 5.0 ml/min and 6.0 ml/min per 100 g tissue in patients receiving ropivacaine and bupivacaine, respectively. After epidural bupivacaine, blood flow increased in 8 of 10 patients to 6.9 ml/min per 100 g...... tissue (P less than 0.05) in contrast to a decrease in 9 of 10 patients to 3.3 ml/min per 100 g tissue after ropivacaine (P less than 0.05), (P less than 0.01 between groups). The median level of sensory analgesia was T3.5 and T4.5 in the ropivacaine and bupivacaine group, respectively (P greater than 0...

  2. Periarticular infiltration for pain relief after total hip arthroplasty: a comparison with epidural and PCA analgesia.

    Science.gov (United States)

    Pandazi, Ageliki; Kanellopoulos, Ilias; Kalimeris, Konstantinos; Batistaki, Chrysanthi; Nikolakopoulos, Nikolaos; Matsota, Paraskevi; Babis, George C; Kostopanagiotou, Georgia

    2013-11-01

    Epidural and intravenous patient-controlled analgesia (PCA) are established methods for pain relief after total hip arthroplasty (THA). Periarticular infiltration is an alternative method that is gaining ground due to its simplicity and safety. Our study aims to assess the efficacy of periarticular infiltration in pain relief after THA. Sixty-three patients undergoing THA under spinal anaesthesia were randomly assigned to receive postoperative analgesia with continuous epidural infusion with ropivacaine (epidural group), intraoperative periarticular infiltration with ropivacaine, clonidine, morphine, epinephrine and corticosteroids (infiltration group) or PCA with morphine (PCA group). PCA morphine provided rescue analgesia in all groups. We recorded morphine consumption, visual analog scale (VAS) scores at rest and movement, blood loss from wound drainage, mean arterial pressure (MAP) and adverse effects at 1, 6, 12, 24 h postoperatively. Morphine consumption at all time points, VAS scores at rest, 6, 12 and 24 h and at movement, 6 and 12 h postoperatively were lower in infiltration group compared to PCA group (p PCA group (p PCA with morphine after THA, providing better pain relief and lower opioid consumption postoperatively. Infiltration seems to be equally effective to epidural analgesia without having the potential side effects of the latter.

  3. Magnetic resonance maging of epidural and subdural spinal hematomas; Magnetresonanztomographie bei epiduralen und subduralen spinalen Haematomen

    Energy Technology Data Exchange (ETDEWEB)

    Felber, S. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Langmaier, J. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Judmaier, W. [Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Dessl, A. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Ortler, M. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Birbamer, G. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz; Piepgras, U. [Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie

    1994-11-01

    Epidural und subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MR) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD- and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n=2), thoracic spine (n=6) and lumbar spine (n=2). They were epidural in five patients and subdural in four. Blinded reading correctly indentified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas (<24 h) in three patients appeared isointense or slightly hyperintense on T1-weighted images and had mixed signal intensity on T2- and T2*-weighted images. Acute hematomas (1-3 days) in four patients were also isointense on T1-weighted images but were more hypointense on T2- and T2*-weighted images. Chronic heamatomas in two patients (7 days and 14 days) were hyperintense on all sequences. Differentiation between epi- and subdural hematomas required transverse T2*-weighted gradient echo sequences. Our results underline that MRI at 1 and 1.5 T is capable of identifying epidural and subdural spinal hematoma in the acute and peracute stage. MRI is superior to CT and myelography for the delineation of the craniocaudal extension in epidural and subdural spinal hematomas and should be the primary preoperative diagnostic method. (orig.) [Deutsch] Epidurale und subdurale spinale Haematome sind neurochirurgische Notfaelle, deren Diagnose bisher vorwiegend mittels Myelographie und Computertomographie gestellt

  4. Gd-DTPA-enhanced MR in thoracic disc herniations

    International Nuclear Information System (INIS)

    Parizel, P.M.; Rodesch, G.; Baleriaux, D.; Segebarth, C.; Zegers de Beyl, D.; Haens, J. d'; Noterman, J.

    1989-01-01

    The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins. (orig.)

  5. Laparoscopic Cholecystectomy under Segmental Thoracic Spinal Anesthesia: A Feasible Economical Alternative.

    Science.gov (United States)

    Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa

    2017-01-01

    Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml -1 mixed with 0.5 ml of fentanyl 50 μg ml -1 . Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward. The thoracic spinal anesthetia was performed easily in the patient. Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously. There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.

  6. Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease

    International Nuclear Information System (INIS)

    Morales, J. P.; Taylor, P. R.; Bell, R. E.; Chan, Y. C.; Sabharwal, T.; Carrell, T. W. G.; Reidy, J. F.

    2007-01-01

    Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis

  7. November 2017 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

    Full Text Available No abstract available. Article truncated after 150 words. The November 2017 Arizona Thoracic Society meeting was held on Wednesday, November 15, 2017 at the HonorHealth Rehabilitation Hospital beginning at 6:30 PM. This was a dinner meeting with a lecture followed by case presentations. There were 15 in attendance representing the pulmonary, critical care, sleep, allergy, infectious disease and radiology communities. At the beginning of the meeting several issues were discussed: 1. CME offered by the Southwest Journal of Pulmonary and Critical Care Medicine (SWJPCC is currently offered to only the Southwest state thoracic societies and the Mayo Clinic. After discussion it was felt that this restriction of access was no longer appropriate and CME credits should be available to all. 2. Efforts continue to obtain CME for the Arizona Thoracic Society meetings. Our Chapter Representative, Dr. Gerry Schwartzberg, is approaching this with the American Thoracic Society. Locally, HonorHealth sent out a survey on CME needs. Members were encouraged …

  8. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  9. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

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

    1993-01-01

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

  10. Laparoscopic cholecystectomy under epidural anesthesia: a clinical feasibility study.

    Science.gov (United States)

    Lee, Ji Hyun; Huh, Jin; Kim, Duk Kyung; Gil, Jea Ryoung; Min, Sung Won; Han, Sun Sook

    2010-12-01

    Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

  11. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Ziade, M.; Zufferey, P.; So, A.K.L.

    2007-01-01

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  12. Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature

    Science.gov (United States)

    Maugeri, Rosario; Anderson, David Greg; Graziano, Francesca; Meccio, Flavia; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

    2015-01-01

    Patient: Male, 30 Final Diagnosis: Acute epidural hematoma Symptoms: — Medication: — Clinical Procedure: Observation Specialty: Neurosurgery Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxial hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT findings) but also may depend on the judgement of the treating neurosurgeon. Case Report: A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed severe headache, no motor or sensory disturbances, and no clinical signs of intracranial hypertension. A CT scan documented a significant left fronto-parietal epidural hematoma, which was considered suitable for surgical evacuation. The patient refused surgery. Following CT scan revealed a minimal increase in the size of the hematoma and of midline shift. The neurologic examination maintained stable and the patient continued to refuse the surgical treatment. Next follow up CT scans demonstrated a progressive resorption of hematoma. Conclusions: We report an unusual case of a remarkable epidural hematoma managed conservatively with a favorable clinical outcome. This case report is intended to rather add to the growing knowledge regarding the best management for this serious and acute pathology. PMID:26567227

  13. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    International Nuclear Information System (INIS)

    Lee, K.-W.; McLeary, M.S.; Zuppan, C.W.; Won, D.J.

    2000-01-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  14. Epidural analgesia in patients with traumatic rib fractures

    DEFF Research Database (Denmark)

    Duch, P; Møller, M H

    2015-01-01

    BACKGROUND: Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials...... (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration...

  15. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

  16. Pharmacokinetics and clinical efficacy of long-term epidural ropivacaine infusion in children

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Ilett, K F; Lim, S I

    2000-01-01

    The clinical efficacy and pharmacokinetics of long-term epidural ropivacaine infusion were investigated in 18 postoperative children aged between 0.3 and 7.3 yr. A lumbar or thoracic epidural catheter was inserted after the anaesthetic induction. Sixty minutes following a bolus dose of ropivacaine...... 1 mg kg-1, 0.2% ropivacaine was infused at a fixed rate of 0.4 mg kg-1 h-1 for a mean of 61.3 h (range 36-96 h). Clinical evaluation comprised hourly recording of pain, sedation, motor block, nausea/vomiting, pruritus-scores, SpO2, pulse and respiratory rates, and recording of non-invasive arterial......) and free (10-56 micrograms litre-1) ropivacaine concentrations were within the range reported to be 'safe' in previous studies in adults. Mean (95% CI) volume of distribution was 3.1 litre kg-1 (2.1-4.2 litre kg-1), total clearance was 8.5 ml kg-1 min-1 (5.8-11.1 ml kg-1 min-1), free clearance was 220 ml...

  17. Thoracic organ transplantation.

    Science.gov (United States)

    Pierson, Richard N; Barr, Mark L; McCullough, Keith P; Egan, Thomas; Garrity, Edward; Jessup, Mariell; Murray, Susan

    2004-01-01

    This article presents an overview of factors associated with thoracic transplantation outcomes over the past decade and provides valuable information regarding the heart, lung, and heart-lung waiting lists and thoracic organ transplant recipients. Waiting list and post-transplant information is used to assess the importance of patient demographics, risk factors, and primary cardiopulmonary disease on outcomes. The time that the typical listed patient has been waiting for a heart, lung, or heart-lung transplant has markedly increased over the past decade, while the number of transplants performed has declined slightly and survival after transplant has plateaued. Waiting list mortality, however, appears to be declining for each organ and for most diseases and high-severity subgroups, perhaps in response to recent changes in organ allocation algorithms. Based on perceived inequity in organ access and in response to a mandate from Health Resources and Services Administration, the lung transplant community is developing a lung allocation system designed to minimize deaths on the waiting list while maximizing the benefit of transplant by incorporating post-transplant survival and quality of life into the algorithm. Areas where improved data collection could inform evolving organ allocation and candidate selection policies are emphasized.

  18. Thoracic damage control surgery.

    Science.gov (United States)

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  19. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

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

  20. Lumbar vertebral haemangioma causing pathological fracture, epidural haemorrhage, and cord compression: a case report and review of literature.

    Science.gov (United States)

    Vinay, S; Khan, S K; Braybrooke, J R

    2011-01-01

    Vertebral haemangiomas are recognized to be one of the commonest benign tumours of the vertebral column, occurring mostly in the thoracic spine. The vast majority of these are asymptomatic. Infrequently, these can turn symptomatic and cause neurological deficit (cord compression) through any of four reported mechanisms: (1) epidural extension; (2) expansion of the involved vertebra(e) causing spinal canal stenosis; (3) spontaneous epidural haemorrhage; (4) pathological burst fracture. Thoracic haemangiomas have been reported to be more likely to produce cord compression than lumbar haemangiomas. A forty-nine year old male with acute onset spinal cord compression from a pathological fracture in a first lumbar vertebral haemangioma. An MRI delineated the haemangioma and extent of bleeding that caused the cord compression. These were confirmed during surgery and the haematoma was evacuated. The spine was instrumented from T12 to L2, and a cement vertebroplasty was performed intra-operatively. Written consent for publication was obtained from the patient. The junctional location of the first lumbar vertebra, and the structural weakness from normal bone being replaced by the haemangioma, probably caused it to fracture under axial loading. This pathological fracture caused bleeding from the vascularized bone, resulting in cord compression.

  1. A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain

    Directory of Open Access Journals (Sweden)

    Resham Bahadur Rana

    2010-04-01

    Full Text Available Background: Despite advances in the knowledge of pathophysiology of pain and its management, patients continue to suffer from pain in many terminal stage cancer. Tramadol hydrochloride is a weak opioid with analgesic properties, and can be tried for cancer pain management. Objectives: This study was performed to find out the efficacy of the analgesic property of Tramadol through epidural route in cancer patients as an combination with low dose(.125% Bupivacaine and to compare with Fentanyl, a μ opioid agonist. Methods: 50 Cancer patients with or without previous pain management were randomly allocated to one of the two study regime- Group-A (tramadol 50 mg and Group-B (Fentanyl 50 mgm in combination with .125% Bupivacaine. Drugs were administered epidurally 6 hourly, 8 hourly and 12 hourly respectively for the 1st, 2nd and 3rd day. Low dose bupivacaine was added to both groups to enhance quality. Pain scores, blood pressure, respiratory rate, heart rate, side effects and patients' satisfaction score was recorded 6 hourly for 72 hrs. The data yielded from this study were compiled and analyzed by unpaired and paired ‘t' test with 95% confidence limit. A value of P< 0.05 was considered to be significant. ÷ square test was done for some of the data. Results: Pain scores were significantly decreased in both the groups but were not significantly different. The incidence of side effects including nausea and vomiting was found in both the groups and was not significantly different between the two groups. Conclusion: The use of epidural Tramadol in selected cancer pain patients (especially pain in lower abdomen and lower back may be very useful and is comparable to opioid in certain situations. Key words: Metastatic cancer pain; Epidural tramadol. DOI: 10.3329/bsmmuj.v2i2.4760 BSMMU J 2009; 2(2: 66-72

  2. The epidural needle guidance with an intelligent and automatic identification system for epidural anesthesia

    Science.gov (United States)

    Kao, Meng-Chun; Ting, Chien-Kun; Kuo, Wen-Chuan

    2018-02-01

    Incorrect placement of the needle causes medical complications in the epidural block, such as dural puncture or spinal cord injury. This study proposes a system which combines an optical coherence tomography (OCT) imaging probe with an automatic identification (AI) system to objectively identify the position of the epidural needle tip. The automatic identification system uses three features as image parameters to distinguish the different tissue by three classifiers. Finally, we found that the support vector machine (SVM) classifier has highest accuracy, specificity, and sensitivity, which reached to 95%, 98%, and 92%, respectively.

  3. Thoracic spine x-ray

    Science.gov (United States)

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most ...

  4. The European educational platform on thoracic surgery.

    Science.gov (United States)

    Massard, Gilbert; Rocco, Gaetano; Venuta, Federico

    2014-05-01

    As the largest scientific organisation world-wide exclusively dedicated to general thoracic surgery (GTS), the European Society of Thoracic Surgeons (ESTS) recognized that one of its priorities is education. The educational platform designed ESTS addresses not only trainees, but also confirmed thoracic surgeons. The two main aims are (I) to prepare trainees to graduation and to the certification by the European Board of Thoracic Surgery and (II) to offer opportunities for continuous medical education in the perspective of life-long learning and continuous professional development to certified thoracic surgeons. It is likely that recertification will become an obligation during the coming decade. At its inception, the platform differentiated two different events. A 6-day course emphasizing on theoretic knowledge was created in Antalya in 2007. The same year, a 2-day school oriented to practical issues with hands-on in the animal lab was launched in Antalya. These two teaching tracks need further development. In the knowledge track, we intend to organize highly specialized 2-day courses to deepen insight into theoretical questions. The skill track will be implemented by specialized courses for high technology such as tracheal surgery, ECMO, robotics or chest wall reconstruction. In order to promote tomorrows' leadership, we created an academic competence track giving an insight into medical communication, methodology and management. We also had to respond to an increasing demand from the Russian speaking countries, where colleagues may face problems to attend western meetings, and where the language bareer may be a major impediment. We initiated a Russian school with three events yearly in 2012. Contemporary teaching must be completed with an e-learning platform, which is currently under development. The school activities are organized by the educational committee, which is headed by the ESTS Director of Education, assisted by coordinators of the teaching tracks and

  5. Effect of epidural analgesia on labor and its outcomes

    International Nuclear Information System (INIS)

    Fawad, A.; Naz, H.; Nelofar, T.; Abbasi, A.U.N.

    2015-01-01

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia. (author)

  6. EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES.

    Science.gov (United States)

    Anwar, Sadia; Anwar, Muhannad Waseem; Ahmad, Sajjad

    2015-01-01

    Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of. 50 each as per convenience. Patients of any gravidity at term from 37-41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.

  7. Paravertebral block catheter breakage by electrocautery during thoracic surgery.

    Science.gov (United States)

    Saeki, Noboru; Sugimoto, Yuki; Mori, Yoko; Kato, Takahiro; Miyoshi, Hirotsugu; Nakamura, Ryuji; Koga, Tomomichi

    2017-06-01

    Advantages of thoracic paravertebral analgesia (TPA) include placement of the catheter closer to the surgical field; however, the catheter can become damaged during the operation. We experienced a case of intraoperative TPA catheter breakage that prompted us to perform an experiment to investigate possible causes. A 50-year-old male underwent a thoracoscopic lower lobectomy under general anesthesia with TPA via an intercostal approach. Following surgery, it was discovered that the catheter had become occluded, as well as cut and fused, so we reopened the incision and removed the residual catheter. From that experience, we performed an experiment to examine electrocautery-induced damage in normal (Portex™, Smith's Medical), radiopaque (Perifix SoftTip™, BBraun), and reinforced (Perifix FX™, BBraun) epidural catheters (n = 8 each). Chicken meat was penetrated by each catheter and then cut by electrocautery. In the normal group, breakage occurred in 8 and occlusion in 6 of the catheters, and in the radiopaque group breakage occurred in 8 and occlusion in 7. In contrast, breakage occurred in only 3 and occlusion in none in the reinforced group, with the 5 without breakage remaining connected only by the spring coil. Furthermore, in 7 of the reinforced catheters, electric arc-induced thermal damage was observed at the tip of the catheter. A TPA catheter for thoracic surgery should be inserted via the median approach, or it should be inserted after surgery to avoid catheter damage during surgery.

  8. Involvement of the thoracic duct in liver cirrhosis patients with ascites. Using MR lymphography

    International Nuclear Information System (INIS)

    Kuboyama, Shin-ichi; Ishii, Kunihide; Koga, Hiroyuki

    2003-01-01

    To elucidate whether the morphological changes of the thoracic duct are observed in patients with liver cirrhosis and ascites, the thoracic duct was examined at magnetic resonance (MR) lymphography without contrast agent. In 7 healthy volunteers, the thoracic duct was clearly visualized as an intermittent or continuous straight line along the thoracic aorta (its mean diameter was 3.9 mm). In 20 liver cirrhosis without ascites, its mean diameter was 3.6 mm. In 6 liver cirrhosis with refractory ascites, the thoracic duct was visualized as straight or slightly tortuous and slender line (its mean diameter was 2.5 mm). On the other hand, 7 cases with ascites which respond well to the administration of diuretics showed tortuous and dilated thoracic duct (its mean diameter was 4.3 mm). In cases with refractory ascites, mean diameter of the thoracic duct was significantly reduced, compared with the cases without ascites and with ascites that respond well to the administration of diuretics. Thus, it was found that the morphological differences of the thoracic duct depend on the response to the diuretics in liver cirrhosis patients with ascites. To elucidate whether the morphological changes of the thoracic duct are observed in patients with liver cirrhosis and ascites, the thoracic duct was examined at magnetic resonance lymphography without contrast agent. In cases with refractory ascites, mean diameter of the thoracic duct was significantly reduced, compared with the cases without ascites and with ascites that respond well to the administration of diuretics. (author)

  9. Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study.

    Science.gov (United States)

    Lim, Grace; Krohner, Robert G; Metro, David G; Rosario, Bedda L; Jeong, Jong-Hyeon; Sakai, Tetsuro

    2016-05-01

    similarly and significantly (P = 0.032) for both groups after the first attempt (estimated mean time [SE]: group MI, 16.0 [1.04] minutes to 13.7 [1.04] minutes to 13.3 [1.04] minutes; group LF: 15.8 [1.04] minutes to 13.4 [1.04] minutes to 13.1 [1.04] minutes). MI is not different from LF simulation training for epidural anesthesia skill acquisition. Education in epidural anesthesia with structured didactics and continual MI training may suffice to prepare novice learners before an attempt on human subjects.

  10. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

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

    1993-01-01

    the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  11. Sciatica caused by a dilated epidural vein: MR findings

    International Nuclear Information System (INIS)

    Demaerel, P.; Petre, C.; Wilms, G.; Plets, C.

    1999-01-01

    We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.)

  12. Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

    OpenAIRE

    Vien, Christine; Marovic, Paul; Ingram, Brendan

    2016-01-01

    Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

  13. The spontaneous spinal epidural hematoma : a study of the etiology

    NARCIS (Netherlands)

    Groen, R J; Ponssen, H

    From the literature 199 cases of spontaneous spinal epidural hematoma (SSEH) are analyzed. With these data and the vascular anatomical characteristics of the spinal epidural space, the theories on the etiology of the SSEH are discussed. There seems to be no relationship between the SSEH and arterial

  14. Vertex epidural haematoma manifesting with bilateral upper limb ...

    African Journals Online (AJOL)

    Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and ...

  15. Epidural versus In postoperatIve intramuscular pain relief pethidine

    African Journals Online (AJOL)

    Epidural versus. •. •. In postoperatIve ... would be left entirely up to them and they would receive analge- sia whenever they .... Fusion right knee. Epidural. 15 ..... reaches the brain but that its action persists in the spinal cord. The onset of ...

  16. Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory function.

    Science.gov (United States)

    Huang, Chih-Hung

    2007-12-01

    Cervical epidural anesthesia has been used widely for surgery of upper limbs. Although cervical epidural anesthesia with local anesthetic of 2% lidocaine (plain) has demonstrated the safety in respiratory function in spite of unavoidable phrenic and intercostal palsies to certain extent, the replacement of local anesthetics with 2% lidocaine plus epinephrine has not been investigated yet. I conducted this study to look into the effect of 2% lidocaine plus epinephrine on respiratory function. I collected data from 50 patients with mean age of 24 +/- 3 yrs, mean weight of 65 +/- 10 kg, ASA status: I-II without preoperative pulmonary dysfunction undergoing orthropedic open-reduction with internal fixation because of fractures of upper limbs. Cervical epidural space (C7-T1) was approached by hanging-drop method, using a 17G Tuohy needle. A catheter was inserted craniad to a distance of 12 cm. Pulmonary function measurement and arterial blood gas data were obstained before, 20 min, 50 min and 105 min after injection of 12 mL 2% lidocaine with 1:200,000 epinephrine. The anesthesia levels were between C3-T3 and obtained 15 +/- 2 min after injection. Mean arterial blood gas analysis showed mild respiratory acidosis at 20 min (PaCO2: 48 +/- 3 mmHg) and 50 min (PaCO2: 44 +/- 2 mmHg). The measured values of inspiratory vital capacity (IVC), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF) when compaired with control values, were decreased about 18.0% and 12.1% of the control values at 20 min and 50 min respectively. The ratios of FEV1/VC, FEV1/FVC were still within normal limits (> 80%). The results were significantly compatible with the criteria of mild restrictive type of pulmonary function. Cervical epidural anesthesia with 2% lidocaine plus epinephrine could reduce lung volumes and capacities, resulting from partially paralytic intercostal muscles and diaphragm innervated respectively by thoracic

  17. Free epidural fat-grafting after lumbar laminectomy using MRI

    International Nuclear Information System (INIS)

    Ohtsubo, Yoshimasa; Fujita, Masaaki; Motokawa, Satoru; Nakamura, Satoshi; Narabayashi, Yoko

    1994-01-01

    Free epidural fat-grafting was performed to prevent adhesion between scar tissue of the epidural space and dura and nerve root after lumbar laminectomy. The results were evaluated using MRI. Fifteen cases were operated upon with an average follow-up period of 7.5 months. MRI was recorded and the findings were classified into four types as follow: I, equally high signal case; II, slight fibrosis case; III, severe fibrosis case; IV, high signal disappeared case. The results showed 3 cases of type I, 7 cases of type II, 3 cases of type III, and 2 cases of type IV. According to MRI findings, free epidural fat is supposed to be still viable and alive, although slightly fibroses but the dural side remains a high signal area. Free epidural fat-grafting was useful for preventing adhesion around the epidural space. There was high relationship to age and sex with regard to viability of the free fat graft. (author)

  18. Epidural analgesia during labor vs no analgesia: A comparative study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  19. Intravenous remifentanil versus epidural ropivacaine with sufentanil for labour analgesia: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Rong Lin

    Full Text Available Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0 ∼ 180 min (P < 0.0001, and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P < 0.0001 and a higher sedation score (P < 0.0001 within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.007 and pain relief score (2.9 ± 0.3 vs. 2.8 ± 0.4, P < 0.0001 compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P < 0.0001 was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative

  20. October 2012 Arizona thoracic society notes

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2012-10-01

    Full Text Available No abstract available. Article truncated at 150 words. A dinner meeting was held on 10/24/2012 at Scottsdale Shea beginning at 6:30 PM. There were 23 in attendance representing the pulmonary, critical care, sleep, infectious disease, pathology, and radiology communities. An announcement was made that the Colorado Thoracic Society has accepted an invitation to partner with the Arizona and New Mexico Thoracic Societies in the Southwest Journal of Pulmonary and Critical Care Medicine. Discussions continue to be held regarding a combined Arizona Thoracic Society meeting with Tucson either in Casa Grande or electronically. Six cases were presented: Dr. Tim Kuberski, chief of Infectious Disease at Maricopa Medical Center, presented a 48 year old female who had been ill for 2 weeks. A CT of the chest revealed a left lower lobe nodule and a CT of the abdomen showed hydronephrosis and a pelvic mass. Carcinoembryonic antigen (CEA was elevated. All turned out to be coccidioidomycosis on biopsy. CEA decreased …

  1. Robotics in general thoracic surgery procedures.

    Science.gov (United States)

    Latif, M Jawad; Park, Bernard J

    2017-01-01

    The use of robotic technology in general thoracic surgical practice continues to expand across various institutions and at this point many major common thoracic surgical procedures have been successfully performed by general thoracic surgeons using the robotic technology. These procedures include lung resections, excision of mediastinal masses, esophagectomy and reconstruction for malignant and benign esophageal pathologies. The success of robotic technology can be attributed to highly magnified 3-D visualization, dexterity afforded by 7 degrees of freedom that allow difficult dissections in narrow fields and the ease of reproducibility once the initial set up and instruments become familiar to the surgeon. As the application of robotic technology trickle downs from major academic centers to community hospitals, it becomes imperative that its role, limitations, learning curve and financial impact are understood by the novice robotic surgeon. In this article, we share our experience as it relates to the setup, common pitfalls and long term results for more commonly performed robotic assisted lung and thymic resections using the 4 arm da Vinci Xi robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to help guide those who are interested in adopting this technology.

  2. High-frequency epidural stimulation across the respiratory cycle evokes phrenic short-term potentiation after incomplete cervical spinal cord injury.

    Science.gov (United States)

    Gonzalez-Rothi, Elisa J; Streeter, Kristi A; Hanna, Marie H; Stamas, Anna C; Reier, Paul J; Baekey, David M; Fuller, David D

    2017-10-01

    C2 spinal hemilesion (C2Hx) paralyzes the ipsilateral diaphragm, but recovery is possible through activation of "crossed spinal" synaptic inputs to ipsilateral phrenic motoneurons. We tested the hypothesis that high-frequency epidural stimulation (HF-ES) would potentiate ipsilateral phrenic output after subacute and chronic C2Hx. HF-ES (300 Hz) was applied to the ventrolateral C4 or T2 spinal cord ipsilateral to C2Hx in anesthetized and mechanically ventilated adult rats. Stimulus duration was 60 s, and currents ranged from 100 to 1,000 µA. Bilateral phrenic nerve activity and ipsilateral hypoglossal (XII) nerve activity were recorded before and after HF-ES. Higher T2 stimulus currents potentiated ipsilateral phasic inspiratory activity at both 2 and 12 wk post-C2Hx, whereas higher stimulus currents delivered at C4 potentiated ipsilateral phasic phrenic activity only at 12 wk ( P = 0.028). Meanwhile, tonic output in the ipsilateral phrenic nerve reached 500% of baseline values at the high currents with no difference between 2 and 12 wk. HF-ES did not trigger inspiratory burst-frequency changes. Similar responses occurred following T2 HF-ES. Increases in contralateral phrenic and XII nerve output were induced by C4 and T2 HF-ES at higher currents, but the relative magnitude of these changes was small compared with the ipsilateral phrenic response. We conclude that following incomplete cervical spinal cord injury, HF-ES of the ventrolateral midcervical or thoracic spinal cord can potentiate efferent phrenic motor output with little impact on inspiratory burst frequency. However, the substantial increases in tonic output indicate that the uninterrupted 60-s stimulation paradigm used is unlikely to be useful for respiratory muscle activation after spinal injury. NEW & NOTEWORTHY Previous studies reported that high-frequency epidural stimulation (HF-ES) activates the diaphragm following acute spinal transection. This study examined HF-ES and phrenic motor output

  3. Spontaneous Spinal Epidural Hematoma; a Case Report

    Directory of Open Access Journals (Sweden)

    Maryam Motamedi

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma (SSHE is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain.

  4. Collateral pathways in lumbar epidural venography

    International Nuclear Information System (INIS)

    Thijssen, H.O.M.; Ike, B.W.; Chevrot, A.; Bijlsma, R.

    1982-01-01

    Opacification of collateral pathways other than the central channels is very rare in lumbar epidural venography. Two cases of opacification of the inferior mesenteric vein following extravasation of contrast medium at the tip of the lateral sacral vein catheter are reported. One case is presented in which filling of normal parametrial venous plexuses and the left ovarian vein occurred as a consequence of incompetent or absent valves in the internal iliac vein. The literature containing comparable collateral flow patterns in disease is reviewed. The significance of the phlebographic features in our cases is discussed. (orig.)

  5. Epidural Labor Analgesia and Maternal Fever.

    Science.gov (United States)

    Sharpe, Emily E; Arendt, Katherine W

    2017-06-01

    Women receiving an epidural for labor analgesia are at increased risk for intrapartum fever. This relationship has been supported by observational, before and after, and randomized controlled trials. The etiology is not well understood but is likely a result of noninfectious inflammation as studies have found women with fever have higher levels of inflammatory markers. Maternal pyrexia may change obstetric management and women are more likely to receive antibiotics or undergo cesarean delivery. Maternal pyrexia is associated with adverse neonatal outcomes. With these consequences, understanding and preventing maternal fever is imperative.

  6. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    Science.gov (United States)

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  7. Rapid Spontaneous Resolution of Acute Epidural Hematoma: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Fatih Aydemir

    2016-06-01

    Full Text Available Background: Epidural hematomas (EDH are pathologies in which the early diagnosis and treatment are important. Resolution under 24 hours is very rare. Case Report: An 11-month-old male patient was brought to the emergency department with head trauma from falling out of bed onto his back. There were no neurological deficits, except for the patient being somnolent. Computed tomography (CT of the patient revealed subgaleal edema in the right parietal region, linear fracture and image consistent with EDH with a thickness of about 9 mm underneath fracture. A control CT was performed after 3 hours as somnolence continued in follow-up of the patient. Hematoma in the epidural region was observed to completely resolve and edema in the subgaleal region was observed to gain hemorrhagic characteristics. Conclusion: In total, 15 cases have been reported, including our case, in the literature with resolution less than 24 hours. Our case has the fourth fastest resolution ever reported in the English literature. We think that the most important factor in the rapid spontaneous resolution is the presence of a connection between the epidural and epicranial space, either through a fracture or cranial sutures.

  8. Epidural ropivacaine hydrochloride during labour: protein binding, placental transfer and neonatal outcome.

    LENUS (Irish Health Repository)

    Porter, J M

    2012-02-03

    This study was undertaken: (i) to quantify the effects of labour and epidural analgesia on plasma alpha1-acid glycoprotein concentration, (ii) to examine the effects of changes in plasma alpha1-acid glycoprotein concentration on plasma protein binding and placental transfer of ropivacaine, and (iii) to examine the association between umbilical venous ropivacaine concentration and neurobehavioural function in the neonate. Multiparous patients undergoing induction of labour received a continuous epidural infusion of 0.1% ropivacaine following an epidural bolus. A significant association was demonstrated between maternal plasma alpha1-acid glycoprotein concentration and 1\\/free fraction of ropivacaine 60 min after starting ropivacaine administration (r(2) = 0.77) but not at delivery. No significant correlation was demonstrable between maternal unbound ropivacaine concentration and either neonatal (cord) ropivacaine concentration or UV\\/MV (a measure of placental transfer). Thirty minutes after delivery, 9\\/10 neonates had neurological and adaptive capacity scores < 35, whereas only three infants had scores < 35 at 2 h. All scores exceeded 35 16 h after delivery. No association between mean (SD) umbilical venous ropivacaine concentration [0.09 (0.08) mg x l(-1)] and neurological and adaptive capacity scores was demonstrated.

  9. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

    Energy Technology Data Exchange (ETDEWEB)

    Simao, Marcelo Novelino, E-mail: marcelo_simao@hotmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil); Helms, Clyde A. [Radiology, Musculoskeletal Section, Duke University Medical Center, Durham, NC (United States); Richardson, William J. [Orthopedic Surgery, Spine Surgery Section, Duke University Medical Center, Durham, NC (United States)

    2012-07-15

    Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

  10. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

    International Nuclear Information System (INIS)

    Simao, Marcelo Novelino; Helms, Clyde A.; Richardson, William J.

    2012-01-01

    Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

  11. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Isoyama-Shirakawa, Yuko; Abe, Madoka; Nakamura, Katsumasa

    2015-01-01

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  12. Antenatal education for childbirth-epidural analgesia.

    Science.gov (United States)

    Cutajar, Lisa; Cyna, Allan M

    2018-05-07

    The language structures used by antenatal educators have not been previously researched in the context of antenatal childbirth classes. Epidural analgesia for labour is a common, and a frequently asked about, component of antenatal education for parents in hospitals providing maternity care. We aimed to identify the way information is described and presented by childbirth educators to assess content and determine which language structures such as metaphor, suggestion, information and storytelling are utilized. This observational study of antenatal education was conducted at a single tertiary referral center for maternity care in Western Sydney, Australia. All three childbirth educators agreed to be video recorded whilst providing information to parents during antenatal classes. Audio data was subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. For the purposes of the current study, data concerning a single topic was used for the analysis-'epidural analgesia for labour'. Language structures used were highly variable between educators, as was the content and time taken for the information being provided. Our findings represent a first attempt to identify baseline information used in the clinical setting of antenatal education in order to categories communication structures used. This study has identified areas for further improvements and consistency in the way educators provide information to parents and has important implications for future midwifery practice, education and research. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Intracranial epidural hemorrhage during lumbar spinal surgery.

    Science.gov (United States)

    Imajo, Yasuaki; Kanchiku, Tsukasa; Suzuki, Hidenori; Yoshida, Yuichiro; Nishida, Norihiro; Goto, Hisaharu; Suzuki, Michiyasu; Taguchi, Toshihiko

    2016-01-01

    The authors report a case of intracranial epidural hemorrhage (ICEH) during spinal surgery. We could not find ICEH, though we recorded transcranial electrical stimulation motor evoked potentials (TcMEPs). A 35-year-old man was referred for left anterior thigh pain and low back pain that hindered sleep. Sagittal T2-weighted magnetic resonance imaging revealed an intradural tumor at L3-L4 vertebral level. We performed osteoplastic laminectomy and en bloc tumor resection. TcMEPs were intraoperatively recorded at the bilateral abductor digiti minimi (ADM), quadriceps, tibialis anterior and abductor hallucis. When we closed a surgical incision, we were able to record normal TcMEPs in all muscles. The patient did not fully wake up from the anesthesia. He had right-sided unilateral positive ankle clonus 15 min after surgery in spite of bilateral negative of ankle clonus preoperatively. Emergent brain computed tomography scans revealed left epidural hemorrhage. The hematoma was evacuated immediately via a partial craniotomy. There was no restriction of the patient's daily activities 22 months postoperatively. We should pay attention to clinical signs such as headache and neurological findgings such as DTR and ankle clonus for patients with durotomy and cerebrospinal fluid (CSF) leakage. Spine surgeons should know that it was difficult to detect ICEH by monitoring with TcMEPs.

  14. Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

    Directory of Open Access Journals (Sweden)

    Ozlem Bilir

    2014-01-01

    Full Text Available Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

  15. Computerized tomography findings of acute traumatic epidural hematoma

    International Nuclear Information System (INIS)

    Kobayashi, Shiro; Nakazawa, Shozo; Yokota, Hiroyuki; Yajima, Kouzo; Yano, Masami; Otsuka, Toshibumi

    1984-01-01

    During four year period from April, 1977 to March, 1981, 53 cases with acute traumatic epidural hematoma had been encountered out of 430 acute head injured patients examined by computerized tomography (CT) within 24 hours after incurring the trauma. Besides the initial CT, the authors performed contrast enhanced CT (41 cases) and serial CT scanning (31 cases). There were 49 cases of epidural hematoma existing in the supratentorial region, Two cases infratentorial region and 2 cases in the both regions. Two cases of vertex epidural hematoma had been encountered, one of them required vertical scan technique. In 22 (41%) of the 53 patients, the initial CT showed evidence of other cerebral lesions. The most frequent lesion was pneumocephalus (11 cases), 3 cases of them existed in the epidural hematoma. There were also intracerebral hematoma (6 cases), subdural hematoma (4 cases), cerebral contusion (2 cases), intraventricular hemorrhage (2 cases) and 2 cases of them demonstrated ''diffuse traumatic cerebral injury''. During contrast enhanced CT, 11 cases out of 41 cases indicated several enhancement pattern. There were total enhancement of epidural hematoma (2 cases), partial enhancement of hematoma (2 cases) and enhancement of internal margin of hematoma (2 cases). Serial CT scans was performed in 36 out of the 53 patients. Common findings on the serial CT scans were decreased density collection in the subdural space such as subdural effusions or chronic subdural hematomas (8 cases) and enlargement of small epidural hematomas (3 cases). After evacuation of epidural hematoma, there were some cases showing the so-called ''delayed traumatic intracerebral hematoma'' (4 cases), appearance of other epidural hematoma (1 case) and development of small cerebral infarction in the basal ganglia. There was one case indicating appearance of a new epidural hematoma contra lateral to the side of evacuation of subdural hematoma. (J.P.N.)

  16. Sonographic evaluation of epidural and intrathecal injections in cats.

    Science.gov (United States)

    Otero, Pablo E; Verdier, Natali; Zaccagnini, Andrea S; Fuensalida, Santiago E; Sclocco, Matias; Portela, Diego A; Waxman, Samanta

    2016-11-01

    To describe the ultrasonographic anatomy of the caudal lumbar spine in cats and to detect ultrasound (US) signs associated with epidural or intrathecal injection. Prospective, clinical study. Twenty-six client-owned cats. Transverse (position 1) and parasagittal (position 2) two-dimensional US scanning was performed over the caudal lumbar spine in all cats. Midline distances between the identified structures were measured. Cats assigned to epidural injection (group E, n = 16) were administered a bupivacaine-morphine combination confirmed by electrical stimulation. Cats assigned to intrathecal injection (group I, n = 10) were administered a morphine-iohexol combination injected at the lumbosacral level and confirmed by lateral radiography. The total volume injected (0.3 mL kg -1 ) was divided into two equal aliquots that were injected without needle repositioning, with the US probe in positions 1 and 2, respectively. The presence or absence of a burst of color [color flow Doppler test (CFDT)], dural sac collapse and epidural space enlargement were registered during and after both injections. US scanning allowed measurement of the distances between the highly visible structures inside the spinal canal. CFDT was positive for all animals in group E. In group I, intrathecal injection was confirmed in only two animals, for which the CFDT was negative; seven cats inadvertently and simultaneously were administered an epidural injection and showed a positive CFDT during the second aliquot injection, and the remaining animal was administered epidural anesthesia and was excluded from the CFDT data analysis. Dural sac collapse and epidural space enlargement were present in all animals in which an epidural injection was confirmed. US examination allowed an anatomical description of the caudal lumbar spine and real-time confirmation of epidural injection by observation of a positive CFDT, dural sac collapse and epidural space enlargement. © 2016 Association of Veterinary

  17. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block

    NARCIS (Netherlands)

    Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.

    Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral

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

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from...... and two months later. The midwives were interviewed two hours after the birth. Method of analysis: The “Idealtype-” method, the “importance-” method and the “process-” method described by Bo Eneroth. Results: Two ideal-types were discovered: the worried and the unworried mother. Important and common...

  19. Fever following an Epidural Blood Patch in a Child

    Directory of Open Access Journals (Sweden)

    Agnes I. Hunyady

    2012-01-01

    Full Text Available There is increasing evidence that children suffer from the consequences of spontaneous or iatrogenic intracranial hypotension. Pediatric epidural blood patch is gaining popularity because of its ability to alter cerebrospinal fluid dynamics and to alleviate headaches attributed to low cerebrospinal fluid pressure. There is, however, still not enough data to document the safety profile of an epidural blood patch. Here we describe a case of a fever in a child temporally related to the administration of an epidural blood patch. This case depicts the dilemmas in making the diagnosis and instituting treatment for complications of this procedure in the pediatric population.

  20. Onset response of bupivacaine 0.5% which has been added with sodium bicarbonate on epidural block

    Directory of Open Access Journals (Sweden)

    Marwoto Marwoto

    2005-03-01

    Full Text Available There are many advantages in using epidural anesthesia technique. However, there are also some constraints, such as the relatively long onset, particularly in the case of bupivacaine. Whereas the need of a rapid onset of anesthesia technique for emergency cares is increasing lately. The objective of this study was to find a method to hasten the onset of bupivacaine. This is a cross sectional randomized double blind controlled clinical trial performed on 40 patients who would undergo lower abdomen and extremity surgery with epidural block. We evaluated the onset of action of bupivacaine which has been added with sodium bicarbonate. Consecutive sampling method was applied to get the sample. The criteria of sample are ASA I – II patient, aged of 20-60 years old, 50-60 kg of weight, 150-170 cm of height. Patients were allocated randomly into two groups. The treatment group would get epidural block using mixture of 20 cc of bupivacaine 0,5 % + 0.5 cc of sodium bicarbonate 1.4 %, whereas the control group received 20 cc bupivacaine 0.5 % + 0.5 cc aqua bides. Time to reach sensoric block at the level of thoracal 10 dermatome using the pinprick method and time to reach motoric blockade using the bromage scale was recorded. The result of this study showed a significant shortening of the onset of sensory blockade (p<0.05 in the treatment group (10.2±1.4 minutes compared with the control group (19.5±1.3 minutes. The onset of motor blockade had also a significant shortening (p<0.05 in the treatment group(13.3±1.6 minutes compared with the control group (23.0±1.2 minutes. It was concluded that the addition of sodium bicarbonate can hasten the onset of bupivacaine on epidural block. (Med J Indones 2005; 14: 7-10Keywords : onset response, bupivacaine 0.5%, sodium bicarbonate, epidural block

  1. Analgesia after total hip replacement: epidural versus psoas ...

    African Journals Online (AJOL)

    tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

  2. Expectant fathers' experience during labor with or without epidural analgesia.

    Science.gov (United States)

    Capogna, G; Camorcia, M; Stirparo, S

    2007-04-01

    For men the worst aspect of childbirth is witnessing their partner in pain. The aim of this study was to investigate fathers' attitudes towards labor and delivery with and without epidural analgesia. The study was performed using a questionnaire that included yes/no, multiple choice or 6-point ordinal scale answers. Expectant fathers whose partners were nullipara between 36 and 38 weeks of gestation were recruited and the questionnaires were administered on the day after the birth. To investigate paternal anxiety during labor, the State part of the State-Trait Anxiety Inventory was used. The questionnaire was completed by 243 fathers. Sixty percent (145) of the parturients received epidural analgesia and 40% (98) did not. Paternal characteristics were comparable. Fathers whose partners did not receive epidural analgesia felt their presence as troublesome and unnecessary (Pinvolvement (Pfathers whose partners did not or did receive epidural analgesia (Pinvolvement, participation and satisfaction with the experience of childbirth.

  3. Lower Back Tattoo: OK to Have an Epidural?

    Science.gov (United States)

    ... and delivery, postpartum care Could a lower back tattoo keep me from having an epidural during labor? ... Yvonne Butler Tobah, M.D. A lower back tattoo won't necessarily prevent you from having an ...

  4. Epidural haematoma: pathophysiological significance of extravasation and arteriovenous shunting

    International Nuclear Information System (INIS)

    Habash, A.H.; Sortland, O.; Zwetnow, N.N.

    1982-01-01

    35 patients with epidural bleeding operated on at Rikshospitalet, Oslo, during the period 1965 - 1980 had preoperative angiography with visualization of the external carotid artery. Twenty-one patients had extravasation of contrast medium from meningeal arteries. Seventeen of the 21 had also shunting of contrast medium from meningeal arteries to meningeal or diploic veins, while 20 of the 21 also had bled from a ruptured meningeal artery at operation. It was further found that of 20 patients who deteriorated after trauma 18 had an epidural arteriovenous shunt or extravasation. Conversely, of 15 patients who improved after trauma 12 had no evidence of a shunt. The strong correlation between the clinical course and the occurrence of extravasation supports previous experimental and clinical data, indicating the epidural arteriovenous shunt to be a major factor in the pathophysiology and the outcome of epidural bleeding. (author)

  5. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  6. The Role at Rehabilitation in Treatment of Thoracic Outlet Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Hosseinian

    2003-01-01

    Full Text Available Objective: Thoracic outlet syndrome is a complex disorder caused by neurovascular irritation in the region of the thoracic outlet. The syndrome have been said to be mainly due to anomalous structures in the thoracic outlet, treatment for thoracic outlet syndrome varies among different institutions, and there has not been any standard program. In general conservative and surgical treatment can be do if necessary. Materials & Methods: The rehabilitation program consists of exercise and physiotherapy and brace designed to hold the posture in which thoracic outlet is enlarged. Exercise program was designed simple enough to be performed in the daily living or during work after minimal training and isometric exercises of Serratus anterior, Levator Scapulae and Erector Spinae muscles to be performed in one posture: flexion and elevation of scapular girdle and correction position of upper-thoracic spine. During 7 years, 131 cases of (T.O.S. were evaluated that 26 cases (20% have operated and 84 cases (64% have treated with conservative treatment and 21 cases (16% have been candidate for surgery but they didn't accepted. Results: All of the cases have treated with conservative treatment for four months. 84 cases responded well and no further treatment was needed. 47 cases were not satisfied with. The outcome of their treatment, that 26 cases have operated and 21 cases have not accepted the operation and continued the conservative treatment, they have had pain and slightly disability. 23 cases of operated group responded well and they have resumed to work, one case has had neuropraxia for about one year. Conclusion: Most cases of thoracic outlet syndrome (T.O.S. can be treated conservatively. Surgically treatment is indicated only in cases severe enough to make them disable to work. It is better all the patients undergo conservative treatment for at least four months then will decided for surgical treatment.

  7. Sciatica caused by a dilated epidural vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, P.; Petre, C.; Wilms, G. [Dept. of Radiology, Catholic University of Leuven (Belgium); Plets, C. [Dept. of Neurosurgery, Catholic University of Leuven (Belgium)

    1999-02-01

    We report the MR imaging findings in a 41-year-old woman presenting with sudden low back pain and sciatica. At surgery a dilated epidural vein was found compressing the nerve root. The MR findings may suggest the diagnosis. Magnetic resonance imaging of a dilated epidural vein or varix causing sciatica has not been reported until now. (orig.) (orig.) With 1 fig., 4 refs.

  8. Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Christine Vien

    2016-01-01

    Full Text Available Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

  9. Epidural versus intravenous steroids application following percutaneous endoscopic lumbar discectomy.

    Science.gov (United States)

    Hu, Annan; Gu, Xin; Guan, Xiaofei; Fan, Guoxin; He, Shisheng

    2018-05-01

    Retrospectively study.The purpose of this study was to compare the effects of intraoperative epidural steroids and single dose intravenous steroids following a percutaneous endoscopic lumbar discectomy (PELD).Inflammatory irritation of dorsal root ganglia or sensory nerve roots may cause postoperative pain. Epidural steroids have been applied after a lumbar discectomy for more than 20 years. Epidural steroid application after a PELD is easier to perform and safer because the operations are under observation of the scope.We retrospectively reviewed the medical records of patients with lumbar intervertebral disc herniation who had undergone transforaminal PELD at our department. There are 60 patients in epidural steroid group, intravenous steroid group, and control group, respectively. Visual analog scores (VAS) and the Oswestry Disability Index (ODI) were collected. Successful pain control is defined as 50% or more reduction in back and leg pain (VAS scores).VAS scores (back and leg) and ODI showed a significant decrease in all groups when comparing pre- and postoperatively. Epidural steroid group had a significant improvement in successful pain control compared with the control group at 2 weeks of follow-up. VAS scores (leg) in the epidural steroid group showed a significant decrease compared with the intravenous steroids group at 1, 3, and 7 days after the surgery, but this difference had no statistical significance at 1, 6, and 12 months of follow-up. All groups did not show a significant difference in ODI at 1, 6, and 12 months follow-up.Epidural application of steroid has a better effect on controlling the postoperative pain of PELD in the short term. The epidural application of steroid did not show a tendency to cause infection.

  10. A randomised controlled trial using the Epidrum for labour epidurals.

    LENUS (Irish Health Repository)

    Deighan, M

    2015-03-01

    The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9\\/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3\\/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

  11. Inadvertent injection of succinylcholine as an epidural test dose

    Directory of Open Access Journals (Sweden)

    Chryssa Pourzitaki

    Full Text Available Abstract Background and objectives: Epidural action of neuromuscular blocking agents could be explained under the light of their physicochemical characteristics and epidural space properties. In the literature there are few cases of accidental neuromuscular agent's epidural administration, manifesting mainly with neuromuscular blockade institution or fasciculations. Case report: We report a case of accidental succinylcholine administration as an epidural test dose, in a female patient undergoing scheduled laparotomy, under combined general and epidural anesthesia. Approximately 2 min after the succinylcholine injection the patient complained for shortness of breath, while mild fasciculations appeared in her trunk and face, managed by immediate general anesthesia institution. With the exception of a relatively longer duration of neuromuscular blockade compared with intravenous administration, no neurological or cardiovascular sequelae or other symptoms of local or systemic toxicity were observed. Conclusions: Oral administration of diazepam seems to lessen the adverse effects from accidental epidural administration of succinylcholine. The meticulous and discriminative labeling of syringes, as well as keeping persistent cautions during all anesthesia procedures remains of crucial importance.

  12. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  13. The Efficacy of Programmed Intermittent Epidural Bolus for Postoperative Analgesia after Open Gynecological Surgery: A Randomized Double-Blinded Study

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    Shiho Satomi

    2018-01-01

    Full Text Available Background. It is well known that the programmed intermittent epidural bolus (PIEB technique effectively provides epidural anesthesia in labor. This randomized double-blind trial compared the postoperative analgesic efficacy of PIEB with that of continuous epidural infusion (CEI in patients undergoing gynecological surgery under combined general-epidural anesthesia. Methods. Patients undergoing open gynecological surgery under combined general-epidural anesthesia were randomized at a 1 : 1 ratio to receive PIEB or CEI. In the PIEB group, the pump delivered 4 mL ropivacaine 0.2% plus fentanyl 2 μg/mL every hour. In the CEI group, the pump delivered the same solution at a rate of 4 mL/h. In both groups, additional 4 mL boluses of ropivacaine 0.2% plus fentanyl 2 μg/mL were provided, when necessary, by patient-controlled epidural analgesia after surgery. The primary outcome was the total ropivacaine dose 40 hours after surgery. The secondary outcomes were the number of PCEA boluses and postoperative pain (evaluated on an 11-point numerical rating scale 3, 24, and 48 hours after surgery. Results. In total, 57 patients were randomized (n=28 and 29 in the PIEB and CEI groups, resp.. The two groups differ significantly in terms of the total ropivacaine dose 40 hours after surgery (mean (standard deviation: 155.38 (4.55 versus 159.73 (7.87 mL, P=0.016. Compared to the CEI group, the PIEB group had significantly lower numerical rating scale scores 3 hours (median [lower–upper quartiles]: 0 [0–0.5] versus 3 [0–5.5], P=0.002, 24 hours (1 [0–2] versus 3 [1–4], P=0.003, and 48 hours (1 [0–2] versus 2 [2–3.5], P=0.002 after surgery. Conclusion. PIEB was better than CEI in terms of providing postoperative analgesia after open gynecological surgery under combined general-epidural anesthesia.

  14. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient; Linfoma epidural primario sin afectacion vertebral en un paciente VIH positivo

    Energy Technology Data Exchange (ETDEWEB)

    Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A. [Hospital General Universitari Vall d`Hebron. Barcelona. (Spain)

    1999-05-01

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin`s lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs.

  15. Thoracic complications of rheumatoid disease

    International Nuclear Information System (INIS)

    Massey, H.; Darby, M.; Edey, A.

    2013-01-01

    Rheumatoid arthritis is a relatively common multisystem disease associated with significant mortality and morbidity. Thoracic disease, both pleural and pulmonary, is a frequent extra-articular manifestation of rheumatoid arthritis and responsible for approximately 20% of rheumatoid-associated mortality. Rheumatoid disease and its associated therapies can affect all compartments of the lung inciting a range of stereotyped pathological responses and it is not infrequent for multiple disease entities to co-exist. In some instances, development of pulmonary complications may precede typical rheumatological presentation of the disease and be the first indication of an underlying connective tissue disease. The spectrum of thoracic disease related to rheumatoid arthritis is reviewed

  16. Thoracic outlet syndrome: Case report

    International Nuclear Information System (INIS)

    Marquez, Juan Camilo; Acosta, Mauricio Fernando; Uribe Jorge Ricardo

    2009-01-01

    We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurysm. It is of our interest due to its low incidence and the small number of cases reported that have been diagnosed by arteriography. The thoracic outlet is the path through which vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.

  17. Thoracic chordoma: CT and MR findings

    International Nuclear Information System (INIS)

    Cha, Yoo Mi; Hwang, Hee Young; Kim, Sang Joon; Chung, Hyo Sun; Han, Heon

    1993-01-01

    Chordoma arising from the notochordal remnants is a rare primary bone tumor in the cervicosacral region and is even more unusual in the thoracic region. The authors experienced a case of thoracic chordoma and reports its CT and MR findings

  18. Patient Controlled Epidural Analgesia during Labour: Effect of Addition of Background Infusion on Quality of Analgesia & Maternal Satisfaction

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2009-01-01

    Full Text Available Patient controlled epidural analgesia (PCEA is a well established technique for pain relief during labor. But the inclusion of continuous background infusion to PCEA is controversial. The aim of this study was to assess whether the use of continuous infusion along with PCEA was beneficial for laboring women with regards to quality of analgesia, maternal satisfaction and neonatal outcome in comparison to PCEA alone. Fifty five parturients received epidural bolus of 10ml solution containing 0.125% bupivacaine +2 ìg.ml-1 of fentanyl. For maintenance of analgesia the patients of Group PCEA self administered 8 ml bolus with lockout interval of 20 minutes of above solution on demand with no basal infusion. While the patients of Group PCEA + CI received continuous epidural infusion at the rate of 10 ml.hr-1 along with self administered boluses of 3 ml with lockout interval of 10 minutes of similar epidural solution. Patients of both groups were given rescue boluses by the anaesthetists for distressing pain. Verbal analogue pain scores, incidence of distressing pain, need of supplementary/rescue boluses, dose of bupivacaine consumed, maternal satisfaction and neonatal Apgar scores were recorded. No significant difference was observed between mean VAS pain scores during labor, maternal satisfaction, mode of delivery or neonatal Apgar scores. But more patients (n=8 required rescue boluses in PCEA group for distressing pain. The total volume consumed of bupivacaine and opioid was slightly more in PCEA + CI group. In both the techniques the highest sensory level, degree of motor block were comparable& prolongation of labor was not seen. It was concluded that both the techniques provided equivalent labor analgesia, maternal satisfaction and neonatal Apgar scores. PCEA along with continuous infusion at the rate of 10 ml/ hr resulted in lesser incidence of distressing pain and need for rescue analgesic. Although this group consumed higher dose of bupivacaine

  19. Measuring and improving the quality of postoperative epidural analgesia for major abdominal surgery using statistical process control charts.

    Science.gov (United States)

    Duncan, Fiona; Haigh, Carol

    2013-10-01

    To explore and improve the quality of continuous epidural analgesia for pain relief using Statistical Process Control tools. Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief. Process control and quality improvement Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain. The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions. Statistical Process Control is a useful tool for measuring and improving the quality of pain management. The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that

  20. Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial

    NARCIS (Netherlands)

    Mungroop, Timothy H.; van Samkar, Ganapathy; Geerts, Bart F.; van Dieren, Susan; Besselink, Marc G.; Veelo, Denise P.; Lirk, Philipp

    2017-01-01

    Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine

  1. Chondrosarcoma of a thoracic vertebra

    International Nuclear Information System (INIS)

    Abdelwahab, I.F.; Casden, A.M.; Klein, M.J.; Spollman, A.

    1991-01-01

    Central chondrosarcoma is an uncommon primary malignancy of the axial skeleton which usually affects the posterior elements or the posterior part of a vertebral body. The authors present an unusual case of chondrosarcoma involving the anterior part of a thoracic vertebra with massive extravertebral extension into the posterior mediastinum. The roles of computed tomography and magnetic resonance imaging in identifying this pathology are emphasized

  2. Nanotechnology applications in thoracic surgery.

    Science.gov (United States)

    Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-07-01

    Nanotechnology is an emerging, rapidly evolving field with the potential to significantly impact care across the full spectrum of cancer therapy. Of note, several recent nanotechnological advances show particular promise to improve outcomes for thoracic surgical patients. A variety of nanotechnologies are described that offer possible solutions to existing challenges encountered in the detection, diagnosis and treatment of lung cancer. Nanotechnology-based imaging platforms have the ability to improve the surgical care of patients with thoracic malignancies through technological advances in intraoperative tumour localization, lymph node mapping and accuracy of tumour resection. Moreover, nanotechnology is poised to revolutionize adjuvant lung cancer therapy. Common chemotherapeutic drugs, such as paclitaxel, docetaxel and doxorubicin, are being formulated using various nanotechnologies to improve drug delivery, whereas nanoparticle (NP)-based imaging technologies can monitor the tumour microenvironment and facilitate molecularly targeted lung cancer therapy. Although early nanotechnology-based delivery systems show promise, the next frontier in lung cancer therapy is the development of 'theranostic' multifunctional NPs capable of integrating diagnosis, drug monitoring, tumour targeting and controlled drug release into various unifying platforms. This article provides an overview of key existing and emerging nanotechnology platforms that may find clinical application in thoracic surgery in the near future. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Thoracic periaortal fibrosis and Ormond's disease

    International Nuclear Information System (INIS)

    Kacl, G.M.; Bino, M.; Salomon, F.; Risti, B.; Marincek, B.

    1995-01-01

    Two cases of thoracic periaortal fibrosis as a manifestation of retroperitoneal fibrosis (Ormond's disease) are shown on CT and MRI. Thoracic periaortal fibrosis can result in an inflammatory aneurysmo with chronic dissection. Manifestation of thoracic periaortal fibrosis may typically occur intermittently over decades. (orig.) [de

  4. Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

    NARCIS (Netherlands)

    Groen, R J; van Alphen, H A

    OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was

  5. Thoracic trauma in newborn foals

    International Nuclear Information System (INIS)

    Jean, D.; Laverty, S.; Halley, J.; Hannigan, D.; Leveille, R.

    1999-01-01

    In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoraciccage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA, Fifty-five foals (20.1%) had TCA (9 RF), One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There weremore primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%), Thisstudy demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma

  6. Spontaneous spinal epidural hematoma diagnosed by CT scan

    International Nuclear Information System (INIS)

    Abumiya, Takeo; Isu, Toyohiko; Iwasaki, Yoshinobu; Akino, Minoru; Abe, Hiroshi

    1985-01-01

    A case of spinal epidural hematoma diagnosed by CT scan is reported. A 58-year-old man was admitted on June 18, 1984. He had had a sudden onset of severe low-back pain 7 days before admission and had developed paraparesis and numbness of the lower limbs 4 day before admission. Physical examination revealed weakness in the lower limbs, with the reflexes there decreased. The Babinski reflex and the Chaddock reflex were, however, present on both sides. Sensory disturbances were noted below L 2 . Urinary incontinence was present, too. Metrizamide myelography revealed an epidural mass which was located from the power part of T 11 to the upper part of L 2 . A CT scan revealed a biconvex, relatively high-density mass in the posterior spinal canal. On the day of admission, a laminectomy was performed from T 11 to L 1 , and the epidural hematoma was evacuated. The postoperative course was uneventful. Spinal epidural hematoma is uncommon. A CT scan can be used for an early diagnosis of this lesion. According to the review of the CT findings in 15 reported cases, including our case, CT reveals a smoothly marginated biconvex homogeneous density mass. The density of the hematoma decreases with the time. An acute type (within 3 days) is high-density, while a chronic type has a relatively high or isodensity. The acute type is easily differentiated from other epidural masses, such as a herniated disc, an epidural abscess, and an epidural tumor. On the other hand, the diagnosis of the chronic type is not always easy. (author)

  7. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  8. 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

  9. Acute cervical epidural hematoma: case report Hematoma epidural cervical agudo: relato de caso

    Directory of Open Access Journals (Sweden)

    GUILHERME BORGES

    2000-09-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.Paciente de 74 anos acordou à noite sentindo fortes dores na região da nuca acompanhadas de ansiedade e desconforto torácico e respiratório. A internação emergencial em clinica cardiológica não demonstrou problemas cardíacos. Com a progressão do quadro neurológico traduzida por quadriplegia severa foi realizada uma punção lombar para afastar hipótese de meningite, sendo retirados cerca de 20 ml de liquor. Trinta minutos imediatamente após a punção lombar foi observada completa remissão do déficit neurológico. Transferido para um hospital geral a tomografia computadorizada demonstrou extenso hematoma epidural espinal em nivel C4/C5 com extensão a C7/Th1, bem como hemangioma do sexto corpo vertebral (C6. A ressonância magnética demonstrou as mesmas lesões. Observando

  10. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    Energy Technology Data Exchange (ETDEWEB)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C. [Department of Radiology, University of Pisa, Via Roma 67, I-56 100 Pisa (Italy); Pifferi, M.; Baldini, G. [Department of Pediatrics, University of Pisa, Pisa (Italy)

    1997-12-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.) With 2 figs., 9 refs.

  11. Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

    International Nuclear Information System (INIS)

    Caramella, D.; Bulleri, A.; Battolla, L.; Bartolozzi, C.; Pifferi, M.; Baldini, G.

    1997-01-01

    CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema. (orig.)

  12. Spinal Epidural Haemangioma Associated with Extensive Gastrointestinal Haemangiomas: A Case Report

    OpenAIRE

    Cheng, L.T.E.; Lim, W.E.H.

    2005-01-01

    A case of spinal epidural cavernous haemangioma associated with gastrointestinal haemangiomas is discussed. The patient was a young Chinese female presenting with chronic lower back pain. She had a history of extensive gastric and small bowel haemangiomas. Lumbar spine MRI showed a heterogeneously enhancing epidural mass infiltrating the paravertebral muscles. Open biopsy confirmed an epidural cavernous haemangioma. To our knowledge, an association between spinal epidural cavernous haemangiom...

  13. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  14. EPIDURAL LABOUR ANALGESIA IN IZOLA GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sabina Verem

    2018-02-01

    Full Text Available Background. The study presents the experience with epidural analgesia (EPA for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 % EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005, longer labour length (278 vs 222 min; p < 0.0005, higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001 and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001. The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7, lowest during the transition stage (VAS 1.5 and some higher during the second phase (VAS 2.7. Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental

  15. Effects of intravenously administered yohimbine on antinociceptive, cardiorespiratory, and postural changes induced by epidural administration of detomidine hydrochloride solution to healthy mares.

    Science.gov (United States)

    Skarda, R T; Muir, W W

    1999-10-01

    To determine effects of i.v. administered yohimbine on perineal analgesia, cardiovascular and respiratory activity, and head and pelvic limb position in healthy mares following epidural administration of detomidine hydrochloride solution. 8 healthy mares. Each mare received detomidine hydrochloride (0.06 mg/kg of body weight), administered in the caudal epidural space, followed 61 minutes later by yohimbine (0.05 mg/kg; test) or sterile saline (0.9% NaCl) solution (control), administered i.v., in a randomized, crossover study design with > or = 2 weeks between treatments. Analgesia was determined by lack of sensory perception to electrical stimulation of perineal dermatomes and needle-prick stimulation of coccygeal to 15th thoracic dermatomes. Arterial pH, PaCO2, PaO2, heart and respiratory rates, rectal temperature, arterial blood pressure, and cardiac output were determined, and mares were observed for sweating and urination. Mean scores obtained for test and control groups were compared. Intravenously administered yohimbine significantly reduced mean scores of detomidine-induced perineal analgesia, head ptosis, changes in pelvic limb position, and sweating and diuresis; antagonized detomidine-induced decreases in heart rate and cardiac output; but did not affect detomidine-induced decrease in respiratory rate. Most effects of epidurally administered detomidine, except bradypnea, were antagonized by yohimbine, suggesting that detomidine may influence respiratory rate by mechanisms other than stimulation of alpha2-adrenoceptors, or that yohimbine induces respiratory depressant effects. Yohimbine may be an effective alpha2-adrenoceptor antagonist for all but respiratory depression following epidural administration of detomidine to mares.

  16. Patient controlled remifentanil and epidural analgesia during labour : satisfaction, costs and safety

    NARCIS (Netherlands)

    Freeman, Liv

    2016-01-01

    Epidural analgesia provided superior analgesia to remifentanil PCA. Women randomised to epidural analgesia with a request for pain relief are more satisfied with their analgesia than women randomised to remifentanil PCA. Costs of epidural analgesia and remifentanil PCA are not significantly

  17. Epidural anaesthesia with levobupivacaine and ropivacaine : effects of age on the pharmacokinetics, neural blockade and haemodynamics

    NARCIS (Netherlands)

    Simon, Mischa J.G.

    2006-01-01

    Epidural neural blockade results from processes after the administration of a local anaesthetic in the epidural space until the uptake in neural tissue. The pharmacokinetics, neural blockade and haemodynamics after epidural anaesthesia may be influenced by several factors, with age as the most

  18. Extending labor epidural analgesia using lidocaine plus either dexmedetomidine or epinephrine for emergency cesarean section

    Directory of Open Access Journals (Sweden)

    Riham Hasanein

    2016-07-01

    Conclusion: Epidural dexmedetomidine is comparable to epinephrine as an adjuvant to epidural lidocaine in fastening the onset of surgical anesthesia and resulted in better intraoperative analgesia and in longer duration of sensory and motor block in the settings of converting labor epidural analgesia for emergency CS.

  19. Epidural fat image in lumbar magnetic resonance image

    International Nuclear Information System (INIS)

    Nishijima, Yuichiro; Yamasaki, Yasuo; Higashida, Norihiko; Okada, Masato

    1993-01-01

    To examine epidural fat images, lumbar magnetic resonance (MR) images were retrospectively reviewed in a total of 103 patients with surgically proven lumbar disc herniation (DH, n=57) and lumbar canal stenosis (LCS, n=46). Epidural fat images consisted of middorsal epidural fat (MDF), paramedian ventral fat (PVF) and intervertebral foraminal fat (IFF) ones. In the group of DH, the thickness of MDF image did not correlate with that of subcutaneous fat, suggesting that epidural fat was not affected by body fat. From the pathophysiological point of view, decrease and disappearance of MDF images correlated with compression of the epidural canal. Decrease and disappearance of PVF images lead to suspicious compression of the traversing root. In addition, asymmetrical PVF images were useful for the bilateral diagnosis of herniation. Abnormal findings of IFF images were suggestive of compression of the exiting nerve root at the intervertebral foramen. This was also seen frequently at the non-responsible level in patients over the age of 50. Degenerative and sequentrated spondylolistheses in the group of LCS were more frequently associated with a higher incidence of abnormal findings of IFF images, suggesting the presence of existing nerve root compression. (N.K.)

  20. Nontraumatic spinal epidural hematomas. MR features

    International Nuclear Information System (INIS)

    Loevblad, K.O.; Baumgartner, R.W.; Zambaz, B.D.; Remonda, L.; Ozdoba, C.; Schroth, G.

    1997-01-01

    Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images. Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas. (orig.)

  1. Computational modeling of epidural cortical stimulation

    Science.gov (United States)

    Wongsarnpigoon, Amorn; Grill, Warren M.

    2008-12-01

    Epidural cortical stimulation (ECS) is a developing therapy to treat neurological disorders. However, it is not clear how the cortical anatomy or the polarity and position of the electrode affects current flow and neural activation in the cortex. We developed a 3D computational model simulating ECS over the precentral gyrus. With the electrode placed directly above the gyrus, about half of the stimulus current flowed through the crown of the gyrus while current density was low along the banks deep in the sulci. Beneath the electrode, neurons oriented perpendicular to the cortical surface were depolarized by anodic stimulation, and neurons oriented parallel to the boundary were depolarized by cathodic stimulation. Activation was localized to the crown of the gyrus, and neurons on the banks deep in the sulci were not polarized. During regulated voltage stimulation, the magnitude of the activating function was inversely proportional to the thickness of the CSF and dura. During regulated current stimulation, the activating function was not sensitive to the thickness of the dura but was slightly more sensitive than during regulated voltage stimulation to the thickness of the CSF. Varying the width of the gyrus and the position of the electrode altered the distribution of the activating function due to changes in the orientation of the neurons beneath the electrode. Bipolar stimulation, although often used in clinical practice, reduced spatial selectivity as well as selectivity for neuron orientation.

  2. Epidural block and neostigmine cause anastomosis leak

    Directory of Open Access Journals (Sweden)

    Ataro G

    2016-05-01

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

  3. Anesthetic management of descending thoracic aortobifemoral bypass for aortoiliac occlusive disease: Our experience

    Directory of Open Access Journals (Sweden)

    Anjum Saiyed

    2014-01-01

    Full Text Available Background: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients. Methods :0 Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 μg/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O 2 + N 2 O (30:70. Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line. Results: In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well. Conclusion: The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to

  4. Ultrasonographyin diagnosis of thoracic diseases

    OpenAIRE

    Stević Ruža; Jaković Radoslav; Mašulović Dragan; Nagorni-Obradović Ljudmila; Mujović Nataša; Jovanović Dragana

    2010-01-01

    Introduction. Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. Pleural lesions. Ultrasonography is very useful in diagnosing pleural effusion and disting...

  5. [History of rachianesthesia and epidural anesthesia in Spain].

    Science.gov (United States)

    Gonzalo Rodríguez, Victoria; Rivero Martínez, Ma Dolores; Pérez Albacete, Mariano; López López, Ana I; Maluff Torres, Alejandro

    2007-10-01

    To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V Sagarra Lascurain, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia.

  6. Extraskeletal ewing sarcoma of cervical epidural region: cases report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ki Jun; Jung, Hyun Seouk; Lee, Jae Hee; Sohn, Kyung Myung; Lee, Sung Yong [Our Lady of Mercy Hospital, Inchon (Korea, Republic of)

    2003-01-01

    Extraskeletal ewing sarcoma is a rare malignant tumor found in children and young adults. It commonly occurs in deep soft tissue of the trunk, especially in the paravertebral region and extremities. We report two cases of extraskeletal ewing sarcoma occurring as a cervical epidural tumor in elderly patients. The MRI and CT findings showed that paravertebral epidural tumors had invaded the spinal canal through the intervertebral foramen. At T1-weighted MR imaging, the masses were isointense to muscle, and at T2* and T2-weighted images were hyperintense, and heterogeneous contrast enhancement was observed. Extraskeletal ewing sarcoma, though quite rare, should be borne in mind in the differential diagnosis of paraspinal epidural tumors.

  7. MRI spectrum of findings in lumbosacral epidural lipomatosis

    International Nuclear Information System (INIS)

    Borre, Daniel G.; Borre, Guillermo E.; Palmieri, Gladys N.; Aude, Flavio A.; Lassalle, Eduardo

    2004-01-01

    Lumbosacral epidural lipomatosis (LEL) has been defined as a disease produced by excessive fat deposition within the spinal canal. In the pre MRI-era, this entity has been commonly overlooked. While a mild (or moderate) epidural fat hypertrophy is basically asymptomatic, severe LEL represents the symptomatic end-stage of this disease, conducing in many cases to surgical fat debulking. Since LEL may be concurrent with other substantial spinal abnormalities (e.g. disk herniation) MRI exams may increase our awareness of this condition to avoid its underestimation. MRI enables a reliable LEL characterization and may show its eventual reversibility in obese or corticosteroid receiving patients. This pictorial essay illustrates the usefulness of MRI to demonstrate the ongoing process of epidural fat accumulation in mild, moderate and severe LEL. The different morphologic patterns of the thecal sac produced by advanced LEL are analyzed. LEL and concurrent spinal disorders with superimposed neurological symptoms and signs are illustrated. (author)

  8. Extraskeletal ewing sarcoma of cervical epidural region: cases report

    International Nuclear Information System (INIS)

    Kim, Ki Jun; Jung, Hyun Seouk; Lee, Jae Hee; Sohn, Kyung Myung; Lee, Sung Yong

    2003-01-01

    Extraskeletal ewing sarcoma is a rare malignant tumor found in children and young adults. It commonly occurs in deep soft tissue of the trunk, especially in the paravertebral region and extremities. We report two cases of extraskeletal ewing sarcoma occurring as a cervical epidural tumor in elderly patients. The MRI and CT findings showed that paravertebral epidural tumors had invaded the spinal canal through the intervertebral foramen. At T1-weighted MR imaging, the masses were isointense to muscle, and at T2* and T2-weighted images were hyperintense, and heterogeneous contrast enhancement was observed. Extraskeletal ewing sarcoma, though quite rare, should be borne in mind in the differential diagnosis of paraspinal epidural tumors

  9. Primary epidural lymphoma without vertebral involvement in a HIV-positive patient

    International Nuclear Information System (INIS)

    Perez, M. O.; Grive, E.; Quiroga, S.; Rovira, A.

    1999-01-01

    Epidural involvement is rarely associated with lymphoma, it being more typical of non-Hodgkin's lymphoma in advanced stages of the disease. The invasion of the epidural space is usually caused by the extension of a paravertebral mass or by the affected vertebrae. However, the epidural space alone can be involved. We present a case of epidural lymphoma in a patient who presented with clinical evidence of spinal cord compression. Magnetic resonance disclosed the existence of an epidural mass compressing and displacing the spinal cord without involving the adjacent vertebra or the associated paravertebral mass. (Author) 9 refs

  10. Thoracic aortic aneurysms and dissections: endovascular treatment.

    Science.gov (United States)

    Baril, Donald T; Cho, Jae S; Chaer, Rabih A; Makaroun, Michel S

    2010-01-01

    The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.

  11. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

    2001-07-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  12. Epidural postoperative analgesia with tramadol after abdominal hysterectomy

    OpenAIRE

    González-Pérez, E.; González-Cabrera, N.; Nieto-Monteagudo, C. G.; Águila, D. P. C.; Santiago, A.; Rodríguez-Santos, C.

    2006-01-01

    Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular ca...

  13. Spontaneous Rapid Resolution of Acute Epidural Hematoma in Childhood

    Directory of Open Access Journals (Sweden)

    Ismail Gülşen

    2013-01-01

    Full Text Available Acute epidural hematoma is a critical emergency all around the world, and its aggressive diagnosis and treatment are of vital importance. Emergent surgical evacuation of the hematoma is known as standard management; however, conservative procedures are also used for small ones. Spontaneous rapid resolution of these hematomas has also been reported in eight pediatric cases. Various theories have been proposed to explain the underlying pathophysiology of this resolution. Herein, we are reporting a new pediatric case with spontaneously resolving acute epidural hematoma 12 hours after admission to the emergency room.

  14. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    International Nuclear Information System (INIS)

    Zizka, J.; Elias, P.; Michl, A.; Harrer, J.; Cesak, T.; Herman, A.

    2001-01-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  15. Sickle cell disease with orbital infarction and epidural hematoma

    International Nuclear Information System (INIS)

    Naran, A.D.; Fontana, L.

    2001-01-01

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  16. Epidural analgesia during labor among immigrant women in Sweden.

    Science.gov (United States)

    Ekéus, Cecilia; Cnattingius, Sven; Hjern, Anders

    2010-01-01

    To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Population-based register study. Nationwide study in Sweden. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Register study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers. Use of EDA during vaginal delivery. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women. EDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.

  17. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain.

    Science.gov (United States)

    Diwan, Sudhir; Manchikanti, Laxmaiah; Benyamin, Ramsin M; Bryce, David A; Geffert, Stephanie; Hameed, Haroon; Sharma, Manohar Lal; Abdi, Salahadin; Falco, Frank J E

    2012-01-01

    , psychological status, return to work, and reduction in opioid intake. For this systematic review, 34 studies were identified. Of these, 24 studies were excluded and a total of 9 randomized trials, with 2 duplicate studies, met inclusion criteria for methodological quality assessment. For cervical disc herniation, the evidence is good for cervical epidural with local anesthetic and steroids; whereas, it was fair with local anesthetic only. For axial or discogenic pain, the evidence is fair for local anesthetic, with or without steroids. For spinal stenosis, the evidence is fair for local anesthetic, with or without steroids. For postsurgery syndrome, the evidence is fair for local anesthetic, with or without steroids. The limitations of this systematic review continue to be the paucity of literature. The evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids, fair with local anesthetic only; whereas, it is fair for local anesthetics with or without steroids, for axial or discogenic pain, pain of central spinal stenosis, and pain of post surgery syndrome.

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

    Directory of Open Access Journals (Sweden)

    Shubhra Goel

    2011-01-01

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

  19. External validation of the Society of Thoracic Surgeons General Thoracic Surgery Database.

    Science.gov (United States)

    Magee, Mitchell J; Wright, Cameron D; McDonald, Donna; Fernandez, Felix G; Kozower, Benjamin D

    2013-11-01

    The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) reports outstanding results for lung and esophageal cancer resection. However, a major weakness of the GTSD has been the lack of validation of this voluntary registry. The purpose of this study was to perform an external, independent audit to assess the accuracy of the data collection process and the quality of the database. An independent firm was contracted to audit 5% of sites randomly selected from the GTDB in 2011. Audits were performed remotely to maximize the number of audits performed and reduce cost. Auditors compared lobectomy cases submitted to the GTSD with the hospital operative logs to evaluate completeness of the data. In addition, 20 lobectomy records from each site were audited in detail. Agreement rates were calculated for 32 individual data elements, 7 data categories pertaining to patient status or care delivery, and an overall agreement rate for each site. Six process variables were also evaluated to assess best practice for data collection and submission. Ten sites were audited from the 222 participants. Comparison of the 559 submitted lobectomy cases with operative logs from each site identified 28 omissions, a 94.6% agreement rate (discrepancies/site range, 2 to 27). Importantly, cases not submitted had no mortality or major morbidity, indicating a lack of purposeful omission. The aggregate agreement rates for all categories were greater than 90%. The overall data accuracy was 94.9%. External audits of the GTSD validate the accuracy and completeness of the data. Careful examination of unreported cases demonstrated no purposeful omission or gaming. Although these preliminary results are quite good, it is imperative that the audit process is refined and continues to expand along with the GTSD to insure reliability of the database. The audit results are currently being incorporated into educational and quality improvement processes to add further value. Copyright

  20. Benchmarking in Thoracic Surgery. Third Edition.

    Science.gov (United States)

    Freixinet Gilart, Jorge; Varela Simó, Gonzalo; Rodríguez Suárez, Pedro; Embún Flor, Raúl; Rivas de Andrés, Juan José; de la Torre Bravos, Mercedes; Molins López-Rodó, Laureano; Pac Ferrer, Joaquín; Izquierdo Elena, José Miguel; Baschwitz, Benno; López de Castro, Pedro E; Fibla Alfara, Juan José; Hernando Trancho, Florentino; Carvajal Carrasco, Ángel; Canalís Arrayás, Emili; Salvatierra Velázquez, Ángel; Canela Cardona, Mercedes; Torres Lanzas, Juan; Moreno Mata, Nicolás

    2016-04-01

    Benchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. To analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. Study data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. General parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. As in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  1. Central neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine.

    Science.gov (United States)

    Caranza, R; Jeyapalan, I; Buggy, D J

    1999-04-01

    In a prospective, randomized, double-blind study in 55 women undergoing elective caesarean section under spinal anaesthesia, we compared epidural diamorphine 3 mg (2 distinct boluses, group ED) with single-dose intrathecal morphine 0.2 mg (group SM), in terms of analgesic efficacy, patient satisfaction and side-effects at 2, 3, 4, 8, 12, 16, 24 and 28 h postoperatively. There were no significant differences between groups in pain (assessed by 100 mm visual analogue scale), incidence of pruritus, sedation or respiratory depression measured by continuous pulse oximetry. However, time to first request for supplementary oral analgesia was longer in SM than in ED (mean +/- SD: 22.3+/-12.0 h vs. 13.8+/-6.5 h, P=0.04). The incidence of nausea or vomiting was significantly higher in SM than ED (73% vs. 41%, P=0.01). In ED, the mean +/- SD time to requirement of the second bolus was 6.7+/-3.2 h. There was a high level of satisfaction in both groups. We conclude that two boluses of epidural diamorphine 3 mg and single-dose intrathecal morphine 0.2 mg provide satisfactory analgesia after caesarean section, but spinal morphine was associated with both delayed requirement for supplementary analgesia and a higher incidence of nausea and vomiting.

  2. [Acute epidural hematoma of the posterior fossa caused by forehead impact].

    Science.gov (United States)

    Abe, S; Furukawa, K; Endo, S; Hoshi, S; Kanaya, H

    1988-03-01

    A rare case of acute epidural hematoma of the posterior fossa caused by forehead impact is reported. This 36-year-old man fell from a truck and hit his face. He was conscious and was brought to our center 30 minutes after the injury. On admission, a contused wound of the right forehead was noticed. He was restless and had severe pain in the neck and upper extremities. Skull X-ray showed a linear fracture of the frontal bone and computed tomography (CT) scan was normal. He continued to be restless and sudden respiratory arrest and pupillary dilation occurred 10 hours after the admission. A CT scan revealed a lenticular high density area in the left posterior fossa which extended to the supratentorial region. The 4th ventricle was compressed and displaced to the right and also the quadrigeminal and ambient cisterns were not visualized at all. Immediate surgery disclosed a 30 g epidural hematoma of the left posterior fossa and the supratentorium and the clot was completely evacuated. The source of bleeding could not be identified. Opening of the dura revealed contusion in the occipital lobe. He died on the 17th postoperative day. The possible mechanism in the production of the posterior fossa hematoma in this case is discussed.

  3. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  4. Cervical spondylodiscitis with spinal epidural abscess caused by Aggregatibacter aphrophilus.

    Science.gov (United States)

    Pasqualini, Leonella; Mencacci, Antonella; Scarponi, Anna Maria; Leli, Christian; Fabbriciani, Gianluigi; Callarelli, Laura; Schillaci, Giuseppe; Bistoni, Francesco; Mannarino, Elmo

    2008-05-01

    Spondylodiscitis caused by Aggregatibacter aphrophilus, formerly known as Haemophilus paraphrophilus, is an unusual condition and can be very difficult to diagnose. We report a case of cervical spondylodiscitis complicated by spinal epidural abscess in a 63-year-old woman, without underlying predisposing conditions. The source of infection was identified as a periodontal infection. The patient was successfully treated with systemic antibiotics.

  5. Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

    Directory of Open Access Journals (Sweden)

    Mehmet Tiryaki

    2014-01-01

    Full Text Available Aim. Spontaneous cervical epidural hematoma (SCEH is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

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

    Directory of Open Access Journals (Sweden)

    Weijun Wang

    2016-01-01

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

  7. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others

    2000-01-01

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  8. Vertebral metastases: characteristic MRI findings due to epidural carcinomatous inflitration

    International Nuclear Information System (INIS)

    Hutzelmann, A.; Palmie, S.; Freund, M.

    1997-01-01

    Purpose: In cases of lumbar vertebral metastasis associated with anterior epidural carcinomatous infiltration, we have observed that infiltrations tend to respect the midline. This study led to the systematic recognition of these phenomena in vertebral metastases. Materials and Methods: 11 Patients with 17 vertebral metastases and adjacent anterior epidural infiltration were reviewed retrospectively. All cases were studied by MRI. The routinely used imaging technique included spin echo (SE) T 1 and T 2 weighted sequences in the sagittal plane native and T 1 -SE without and with Gd-DTPA in the axial planes. The radiological findings of these phenomena and the anatomy were studied. Results: We observed these phenomena to be uni- or bilateral in 88.3% of all cases with intraspinal anterior epidural carcinomatous infiltration, especially in that part of the vertebral body where the basal vertebral venous plexus was located. Conclusion: We conclude that vertebral metastases respect the midline. We interpret this fact as being due the anatomy of the vertebral body and especially its stabilization by the posterior longitudinal ligament. These findings may be helpful in the differential diagnosis of vertebral body metastases with epidural infiltration in contrast to intraspinal processes which proceed with the destruction of the vertebral body. (orig.) [de

  9. Post- operative analgesic effect of epidural bupivacaine alone and ...

    African Journals Online (AJOL)

    The study was conducted from December, 2013 to May, 2014 on 12 healthy bitches presented to the University of Gondar Teaching Veterinary Clinic for ovariohysterectomy to compare the epidural analgesic efficacy of bupivacaine alone and bupivacaine with tramadol to relieve postoperative pain and asses changes on ...

  10. Ethamsylate in vaginal surgery under lumbar epidural anaesthesia.

    OpenAIRE

    Smith, G. B.; Eltringham, R. J.; Nightingale, J. J.

    1983-01-01

    Sixty patients scheduled for vaginal surgery under lumbar epidural block were randomly allocated into two groups, one of which received ethamsylate intravenously prior to induction of anaesthesia. Ethamsylate did not reduce the blood loss at operation in these patients. The possible factors underlying this observation are discussed.

  11. Ethamsylate in vaginal surgery under lumbar epidural anaesthesia.

    Science.gov (United States)

    Smith, G B; Eltringham, R J; Nightingale, J J

    1983-03-01

    Sixty patients scheduled for vaginal surgery under lumbar epidural block were randomly allocated into two groups, one of which received ethamsylate intravenously prior to induction of anaesthesia. Ethamsylate did not reduce the blood loss at operation in these patients. The possible factors underlying this observation are discussed.

  12. Graded epidural anaesthesia for Caesarean section in a parturient ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the. Creative Commons License ... CASE REPORT. Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study. Anjum Naza*, Sugata Dasguptab, Bijoy Kumar Bandyopadhyayb and Hasibul Hasan Shirazeec. aDepartment of ...

  13. Maternal epidural use and neonatal sepsis evaluation in afebrile mothers.

    Science.gov (United States)

    Goetzl, L; Cohen, A; Frigoletto, F; Ringer, S A; Lang, J M; Lieberman, E

    2001-11-01

    Epidural use has been associated with a higher rate of neonatal sepsis evaluation. Epidural-related fever explains some of the increase but not the excess of neonatal sepsis evaluations in afebrile women We studied 1109 women who had singleton term pregnancies and who presented in spontaneous labor and were afebrile during labor (24 hours or sustained fetal heart rate of >160 beats per minute. Minor criteria included a maternal temperature of 99.6 degrees F to 100.4 degrees F, rupture of membranes for 12 to 24 hours, maternal admission white blood cell count of >15 000 cells/mL(3), or an Apgar score of 24 hours (6.2% vs 3.4%), low-grade fever of 99.6 degrees F to 100.4 degrees F (24.3% vs 5.2%), and rupture of membranes for 12 to 24 hours (21.4% vs 5.2%) than women without epidural. Epidural analgesia is associated with increased rates of major and minor criteria for neonatal sepsis evaluations in afebrile women.

  14. Surgical management of Stenson's duct injury using epidural catheter

    African Journals Online (AJOL)

    2012-07-05

    Jul 5, 2012 ... Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of ... to diagnose and manage the parotid duct injuries using an “epidural catheter” which is often used for inducing spinal anesthesia. .... Water-soluble contrast media have a definite advantage.

  15. Chronic spinal epidural hematoma in hemophilia A in a child

    International Nuclear Information System (INIS)

    Stanley, P.; McComb, J.G.; University of Southern California, Los Angeles

    1983-01-01

    A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery. (orig.)

  16. Chronic spinal epidural hematoma in hemophilia A in a child

    Energy Technology Data Exchange (ETDEWEB)

    Stanley, P.; McComb, J.G.

    1983-06-01

    A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery.

  17. Intracranial epidural hematoma in a newborn with DIC secondary to ...

    African Journals Online (AJOL)

    Epidural hematoma in newborns is rare, it occurs more frequently in infants born from nulliparous mothers with delivery difficulties. Intracranial hemorrhage in infants is usually secondary to vascular malformations, anticoagulation, inherited or acquired coagulopathy. Hematological disorders are infrequently associated with ...

  18. Ultrasound as a Screening Tool for Performing Caudal Epidural Injections

    International Nuclear Information System (INIS)

    Nikooseresht, Mahshid; Hashemi, Masoud; Mohajerani, Seyed Amir; Shahandeh, Farideh; Agah, Mahvash

    2014-01-01

    The caudal approach to the epidural space has been used for decades to treat low back pain caused by lumbosacral root compression. The use of fluoroscopy during epidural steroid injection is the preferred method for placing the needle more accurately in the sacral hiatus, but it carries the risk of radiation hazard. The aim of the study was to assess the anatomical structure of the sacral hiatus and the feasibility of caudal epidural injections under ultrasound guidance. Two hundred and forty patients (male = 100, female = 140) with low back pain and sciatica who were candidates for caudal epidural injection were enrolled into this study. Ultrasound images of the sacral hiatus and bilateral cornua were obtained by a real-time linear array ultrasound transducer. The distance between bilateral cornua and the anterior and posterior wall of the sacrum were measured at the base (sacral hiatus). Under the guide of ultrasonography, we defined the injection successful if turbulence of medication fluid was observed in the sacral canal, but correct placement of the needle and injectant was confirmed on fluoroscopic view as the gold standard technique. The epidurogram showed that the injection was successful in 230 of the 240 patients (95.8%). In eight patients, the injection was not in the correct place in the sacral canal. The sacral hiatus could not be identified by ultrasound images in only two patients who had a closed sacral hiatus identified by fluoroscopy. The mean distance of the sacral hiatus was 4.7 ± 1.7 mm and the mean distance between bilateral cornua was 18.0 ± 2.8 mm. The mean duration of the procedure was 10.8 ± 6.8 minutes. No major complication was observed in the next month. In conclusion, ultrasound could be used as a safe, fast and reliable modality to observe the anatomic variation of the sacral hiatus and to perform caudal epidural injections

  19. Thoracic organ transplantation: laboratory methods.

    Science.gov (United States)

    Patel, Jignesh K; Kobashigawa, Jon A

    2013-01-01

    Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.

  20. Imaging of thoracic aortic dissection

    International Nuclear Information System (INIS)

    Vu, F.H.; Young, N.; Soo, Y.S.

    1994-01-01

    Acute thoracic aortic dissection has a high mortality rate if untreated, so the diagnosis must be rapidly made. Multiple imaging techniques are often used. This retrospective study from 1988 to 1993 assesses the usefulness in diagnosis of chest X-rays, computed tomography (CT) scanning, aortography, magnetic resonance imaging (MRI), trans-thoracic (TTE) and trans-oesophageal (TOE) echocardiography. Forty-two patients with a final clinical diagnosis of dissection were studied. The diagnosis was confirmed in 16 (13 at surgery and three at autopsy). Three died with dissection given as the only cause of death. Chest X-ray abnormalities were seen in all 19 patients with surgery or death from dissection, with a widened mediastinum and/or dilated aorta being present in 17. In the group of 16 patients with surgery or autopsy proof, CT scans found dissections in 9 out of 12 patients studied and correctly classified the type in only five. Aortography was preformed in five, with accurate depiction of dissection and type in all. TTE found dissections in three of eight patients imaged by this method. MRI and TOE were preformed each on two patients, with accurate depiction of dissection and type in each. Because of the relatively low sensitivity of CT scanning in defining aortic dissections Westmead Hospital is currently assessing the use of TOE as the prime imaging modality prior to surgical intervention. 17 refs., 4 tabs., 4 figs

  1. Retrospective study of the association between epidural analgesia during labour and complications for the newborn.

    Science.gov (United States)

    Herrera-Gómez, A; García-Martínez, O; Ramos-Torrecillas, J; De Luna-Bertos, E; Ruiz, C; Ocaña-Peinado, F M

    2015-06-01

    our objective was to determine the association between epidural analgesia and different variables. the effect on newborns of epidural analgesia administered to the mother during labour remains under debate. this association was retrospectively investigated in a cohort of 2399 children born in a Spanish public hospital. Only full-term (>37 weeks of gestation) deliveries were included. Other exclusion criteria were: induced delivery (medical or obstetric indication), elective caesarean section, or the presence of an important pregnancy risk factors (hypertension, diabetes, severe disease, toxaemia, retarded intrauterine growth, chronologically prolonged pregnancy, prolonged membrane rupture (>24 hours), oligoamnios, or polyhydramnios). The Mann-Whitney U test and Fisher׳s exact test were applied to determine the relationship between variables. Apgar index values at one minute and five minutes were slightly but significantly lower in neonates whose mothers had received epidural analgesia. Neonatal intensive care unit admission was significantly more frequent in the epidural versus non-epidural group. Resuscitation was significantly more frequent in the epidural versus non-epidural group. Early breast feeding onset was more frequent in the non-epidural group. The adverse effect of epidural analgesia on early lactation remained significant after adjusting for NICU admission and the need for resuscitation in a logistic regression analysis. Epidural analgesia may have adverse effects on newborns, although the risks are low, and further research is required to elucidate the causal nature of this relationship. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. [CSE vs. augmented epidural anesthesia for cesarean section. Spinal and epidural anesthesia with bupivacaine 0.5% "isobar" require augmentation].

    Science.gov (United States)

    Halter, F; Niesel, H C; Gladrow, W; Kaiser, H

    1998-09-01

    Incomplete anaesthesia is a major clinical problem both in single spinal and in single epidural anaesthesia. The clinical efficacy of epidural anaesthesia with augmentation (aEA) and combined epidural and spinal anesthesia (CSE) for cesarean section was investigated in a prospective randomized study on 45 patients. Anaesthesia extending up to Th5 was aimed for. Depending on the patient's height, epidural anaesthesia was administered with a dose of 18-22 ml 0.5% bupivacaine and spinal anaesthesia with a dose of 11-15 mg 0.5% bupivacaine. Augmentation was carried out in all cases in epidural anaesthesia, initially with 7.5 ml 1% Lidocaine with epinephrine 1:400,000, raised by 1.5 ml per missing segment. The epidural reinjection in CSE was carried out as necessary with 9.5-15 ml 1% lidocaine with epinephrine, depending on the height and difference from the segment Th5. The extension of anaesthesia achieved in epidural anaesthesia after an initial dose of 101.8 mg bupivacaine and augmenting dose of 99 mg lidocaine reached the segment Th5. The primary spinal anaesthesia dose up to 15 mg corresponding to height led to a segmental extension to a maximum of Th3 under CSE. Augmentation was necessary in 13 patients; in 5 cases because of inadequate extent of anaesthesia and 8 cases because of pain resulting from premature reversion. The augmenting dose required was 13.9 ml. Readiness for operation was attained after 19.8 min (aEA) and after 10.5 min (CSE). No patient required analgesics before delivery. The additional analgesic requirement during operation was 63.6% (aEA) and 39.1% (CSE). Taking into account pain in the area of surgery, the requirement of analgesics was 50% (aEA) vs. 17.4% (CSE). Antiemetics were required in 18.2 (aEA) and in 65.2% (CSE). The systolic blood pressure fell by 17.7% (aEA) and in 30.3% (CSE). The minimum systolic pressure was observed after 13.4 min in aEA, and after 9.5 min in CSE. The APGAR score and the umbilical pH did not show any

  3. Evolution of thoracic surgery in Canada.

    Science.gov (United States)

    Deslauriers, Jean; Pearson, F Griffith; Nelems, Bill

    2015-01-01

    Canada's contributions toward the 21st century's practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another. To describe the numerous and important achievements of Canadian thoracic surgeons in the areas of surgery for pulmonary tuberculosis, thoracic oncology, airway surgery and lung transplantation. Information was collected through reading of the numerous publications written by Canadian thoracic surgeons over the past 100 years, interviews with interested people from all thoracic surgery divisions across Canada and review of pertinent material form the archives of several Canadian hospitals and universities. Many of the developments occurred by chance. It was the early and specific focus on thoracic surgery, to the exclusion of cardiac and general surgery, that distinguishes the Canadian experience, a model that is now emerging everywhere. From lung transplantation in chimera twin calves to ex vivo organ preservation, from the removal of airways to tissue regeneration, and from intensive care research to complex science, Canadians have excelled in their commitment to research. Over the years, the influence of Canadian thoracic surgery on international practice has been significant. Canada spearheaded the development of thoracic surgery over the past 100 years to a greater degree than any other country. From research to education, from national infrastructures to the regionalization of local practices, it happened in Canada.

  4. Advancements in robotic-assisted thoracic surgery.

    Science.gov (United States)

    Steenwyk, Brad; Lyerly, Ralph

    2012-12-01

    Advancements in robotic-assisted thoracic surgery present potential advantages for patients as well as new challenges for the anesthesia and surgery teams. This article describes the major aspects of the surgical approach for the most commonly performed robotic-assisted thoracic surgical procedures as well as the pertinent preoperative, intraoperative, and postoperative anesthetic concerns. Copyright © 2012. Published by Elsevier Inc.

  5. Thoracic duct lymphography by subcutaneous contrast agent ...

    African Journals Online (AJOL)

    A second lymphography revealed a collateral thoracic duct that was not detected during the first lymphography. The collateral duct was ligated and chylothorax was resolved after the second surgery. The lymphography applied in this study was minimally-invasive and easily provided images of the thoracic duct in a dog with ...

  6. Visualization of the thoracic duct by lymphoscintigraphy

    International Nuclear Information System (INIS)

    Baulieu, F.; Baulieu, J.L.; Itti, R.; Tours Univ., 37

    1987-01-01

    Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly usefull when radiological lymphography is contraindicated. (orig.)

  7. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  8. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  9. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  10. Tensile strength decreases and perfusion pressure of 3-holed polyamide epidural catheters increases in long-term epidural infusion.

    Science.gov (United States)

    Kim, Pascal; Meyer, Urs; Schüpfer, Guido; Rukwied, Roman; Konrad, Christoph; Gerber, Helmut

    2011-01-01

    Epidural analgesia is an established method for pain management. The failure rate is 8% to 12% due to technical difficulties (catheter dislocation and/or disconnection; partial or total catheter occlusion) and management. The mechanical properties of the catheters, like tensile strength and flow rate, may also be affected by the analgesic solution and/or the tissue environment. We investigated the tensile strength and perfusion pressure of new (n=20), perioperatively (n=30), and postoperatively (n=73) used epidural catheters (20-gauge, polyamide, closed tip, 3 side holes; Perifix [B. Braun]). To prevent dislocation, epidural catheters were taped (n=5) or fixed by suture (n=68) to the skin. After removal, mechanical properties were assessed by a tensile-testing machine (INSTRON 4500), and perfusion pressure was measured at flow rates of 10, 20, and 40 mL/h. All catheters demonstrated a 2-step force transmission. Initially, a minimal increase of length could be observed at 15 N followed by an elongation of several cm at additional forces (7 N). Breakage occurred in the control group at 23.5±1.5 N compared with 22.4±1.6 N in perioperative and 22.4±1.7 N in postoperative catheters (Ptensile strength, whereas perfusion pressure at clinically used flow rates (10 mL/h) increased significantly from 19±1.3 to 44±72 mm Hg during long-term (≥7 days) epidural analgesia (Ptensile strength or perfusion pressure. Epidural catheter use significantly increases the perfusion pressure and decreases the tensile strength. Copyright © 2011 by American Society of Regional Anesthesia and Pain Medicine

  11. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax.

    Science.gov (United States)

    Galvez, Carlos; Bolufer, Sergio; Navarro-Martinez, Jose; Lirio, Francisco; Corcoles, Juan Manuel; Rodriguez-Paniagua, Jose Manuel

    2015-05-01

    Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation.

  12. Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice.

    Science.gov (United States)

    Umari, Marzia; Falini, Stefano; Segat, Matteo; Zuliani, Michele; Crisman, Marco; Comuzzi, Lucia; Pagos, Francesco; Lovadina, Stefano; Lucangelo, Umberto

    2018-03-01

    In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation. Deep neuromuscular blockade should be pursued and carefully monitored, and an appropriate reversal administered before extubation. Management of one-lung ventilation (OLV) needs to be optimized to prevent not only intraoperative hypoxemia but also postoperative acute lung injury (ALI): protective ventilation strategies are therefore to be implemented. Locoregional techniques should be favored over intravenous analgesia: the thoracic epidural, the paravertebral block (PVB), the intercostal nerve block (ICNB), and the serratus anterior plane block (SAPB) are thoroughly reviewed and the most common dosages are reported. Fluid therapy needs to be administered critically, to avoid both overload and cardiovascular compromisation. All these practices are analyzed singularly with the aid of the most recent evidences aimed at the best patient care. Finally, a few notes on some of the latest trends in research are presented, such as non-intubated video-assisted thoracoscopic surgery (VATS) and intravenous lidocaine.

  13. Radiologic findings of thoracic trauma

    Directory of Open Access Journals (Sweden)

    Akgul Ozmen C

    2017-08-01

    Full Text Available Cihan Akgul Ozmen,1 Serdar Onat,2 Delal Aycicek3 1Department of Radiology, 2Department of Chest Surgery, Dicle University School of Medicine, Diyarbakir, 3Radiology Unit, Siirt State Hospital, Siirt, Turkey Introduction: Chest trauma may be blunt or penetrating and the chest is the third most common trauma region. It is a significant cause of mortality. Multidetector computed tomography (MDCT has been an increasingly used method to evaluate chest trauma because of its high success in detecting tissue and organ injuries. Herein, we aimed to present MDCT findings in patients with blunt and penetrating chest trauma admitted to our department. Methods: A total of 240 patients admitted to the emergency department of our hospital between April 2012 and July 2013 with a diagnosis of chest trauma who underwent MDCT evaluations were included. Most of the patients were male (83.3% and victims of a blunt chest trauma. The images were analyzed with respect to the presence of fractures of bony structures, hemothorax, pneumothorax, mediastinal organ injury, and pulmonary and vascular injuries. Results: MDCT images of the 240 patients yielded a prevalence of 41.7% rib fractures, 11.2% scapular fractures, and 7.5% clavicle fractures. The prevalence of thoracic vertebral fracture was 13.8% and that of sternal fracture was 3.8%. The prevalence of hemothorax, pneumothorax, pneumomediastinum, and subcutaneous emphysema was 34.6%, 62.1%, 9.6%, and 35.4%, respectively. The prevalence of rib, clavicle, and thoracic vertebral fractures and pulmonary contusion was higher in the blunt trauma group, whereas the prevalence of hemothorax, subcutaneous emphysema, diaphragmatic injury, and other vascular lacerations was significantly higher in the penetrating trauma group than in the blunt trauma group (p<0.05. Conclusion: MDCT images may yield a high prevalence of fracture of bony structures, soft tissue lacerations, and vascular lesions, which should be well understood by

  14. Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

    Science.gov (United States)

    Shrestha, Bikash; Devgan, Amit; Sharma, Mukti

    2014-12-10

    Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

  15. Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during Labor: A Randomized, Double-blind, Controlled Study.

    Science.gov (United States)

    Booth, Jessica L; Ross, Vernon H; Nelson, Kenneth E; Harris, Lynnette; Eisenach, James C; Pan, Peter H

    2017-07-01

    The addition of opioids to epidural local anesthetic reduces local anesthetic consumption by 20% but at the expense of side effects and time spent for regulatory compliance paperwork. Epidural neostigmine also reduces local anesthetic use. The authors hypothesized that epidural bupivacaine with neostigmine would decrease total hourly bupivacaine use compared with epidural bupivacaine with fentanyl for patient-controlled epidural analgesia. A total of 215 American Society of Anesthesiologists physical status II, laboring parturients requesting labor epidural analgesia consented to the study and were randomized to receive 0.125% bupivacaine with the addition of either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml). The primary outcome was total hourly local anesthetic consumption, defined as total patient-controlled epidural analgesia use and top-ups (expressed as milliliters of 0.125% bupivacaine) divided by the infusion duration. A priori analysis determined a group size of 35 was needed to have 80% power at α = 0.05 to detect a 20% difference in the primary outcome. Of 215 subjects consented, 151 patients were evaluable. Demographics, maternal and fetal outcomes, and labor characteristics were similar among groups. Total hourly local anesthetic consumption did not differ among groups (P = 0.55). The total median hourly bupivacaine consumption in the fentanyl group was 16.0 ml/h compared with 15.3, 14.6, and 16.2 ml/h in the 2, 4, and 8 μg/ml neostigmine groups, respectively (P = 0.55). The data do not support any difference in bupivacaine requirements for labor patient-controlled epidural analgesia whether patients receive epidural bupivacaine with 2 to 8 μg/ml neostigmine or epidural bupivacaine with 2 μg/ml fentanyl.

  16. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

    Blichfeldt-Eckhardt, Morten R; Andersen, Claus; Ørding, Helle

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

  17. Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial.

    Science.gov (United States)

    Mungroop, Timothy H; van Samkar, Ganapathy; Geerts, Bart F; van Dieren, Susan; Besselink, Marc G; Veelo, Denise P; Lirk, Philipp

    2017-01-01

    Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32). In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. Netherlands Trial Register NTR4948.

  18. Early versus late initiation of epidural analgesia for labour.

    Science.gov (United States)

    Sng, Ban Leong; Leong, Wan Ling; Zeng, Yanzhi; Siddiqui, Fahad Javaid; Assam, Pryseley N; Lim, Yvonne; Chan, Edwin S Y; Sia, Alex T

    2014-10-09

    Pain during childbirth is arguably the most severe pain some women may experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour. Many women have concerns regarding its safety. Furthermore, epidural services and anaesthetic support may not be available consistently across all centres. Observational data suggest that early initiation of epidural may be associated with an increased risk of caesarean section, but the same findings were not seen in recent randomised controlled trials. More recent guidelines suggest that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labour. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. There is no systematically reviewed evidence on the maternal and foetal outcomes and safety of this practice. This systematic review aimed to summarise the effectiveness and safety of early initiation versus late initiation of epidural analgesia in women. We considered the obstetric and fetal outcomes relevant to women and side effects of the treatments, including risk of caesarean section, instrumental birth and time to birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 February 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 1), MEDLINE (January 1966 to February 2014), Embase (January 1980 to February 2014) and reference lists of retrieved studies. We included all randomised controlled trials involving women undergoing epidural labour analgesia that compared early initiation versus late initiation of epidural labour analgesia. Two review authors independently assessed trials for inclusion, extracted the data and assessed the trial quality. Data were checked for accuracy. We included nine studies with a total of 15,752 women.The overall risk of bias of

  19. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail: kariyas@hirakata.kmu.ac.jp; Nakatani, Miyuki, E-mail: nakatanm@hirakata.kmu.ac.jp; Yoshida, Rie, E-mail: yagir@hirakata.kmu.ac.jp; Ueno, Yutaka, E-mail: uenoyut@hirakata.kmu.ac.jp; Komemushi, Atsushi, E-mail: komemush@takii.kmu.ac.jp; Tanigawa, Noboru, E-mail: tanigano@hirakata.kmu.ac.jp [Kansai Medical University, Department of Radiology (Japan)

    2017-01-15

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  20. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    International Nuclear Information System (INIS)

    Kariya, Shuji; Nakatani, Miyuki; Yoshida, Rie; Ueno, Yutaka; Komemushi, Atsushi; Tanigawa, Noboru

    2017-01-01

    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

  1. Effect of Epidural Block under General Anesthesia on Pulse Transit Time

    International Nuclear Information System (INIS)

    Choi, Byeong Cheol; Kim, Seong Min; Jung, Dong Keun; Kim, Gi Ryon; Lee, He Jeong; Jeon, Gye Rock

    2005-01-01

    Epidural block under general anesthesia has been widely used to control postoperative pain. In this anesthetic state many hemodynamic parameters are changed. Moreover pulse transit time is influenced by this memodynamic change. PPT change in the finger and the toe due to relaxation of arterial wall muscle after general anesthesia and epidural block under general anesthesia. This study, in the both general anesthesia and epidural block under general anesthesia, ΔPTT of the toe and of the finger are measured. In addition, ΔPTT(toe-finger) of the epidural block under general anesthesia and of the general anesthesia were compared

  2. Histopathological Alterations after Single Epidural Injection of Ropivacaine, Methylprednizolone Acetate, or Contrast Material in Swine

    International Nuclear Information System (INIS)

    Kitsou, Maria-Chrysanthi; Kostopanagiotou, Georgia; Kalimeris, Konstantinos; Vlachodimitropoulos, Demetrios; Soultanis, Konstantinos; Batistaki, Chrysanthi; Kelekis, Alexis

    2011-01-01

    Purpose: The consequences from the injection of different types of drugs in the epidural space remains unknown. Increasing evidence suggests that localized inflammation, fibrosis, and arachnoiditis can complicate sequential epidural blockades, or even epidural contrast injection. We investigate the in vivo effect of epidural injections in the epidural space in an animal model. Materials and Methods: A group of ten male adult pigs, five punctures to each at distinct vertebral interspaces under general anesthesia, were examined, testing different drugs, used regularly in the epidural space (iopamidol, methylprednisolone acetate, ropivacaine). Each site was marked with a percutaneous hook wire marker. Histological analysis of the epidural space, the meninges, and the underlying spinal cord of the punctured sites along with staining for caspase-3 followed 20 days later. Results: The epidural space did not manifest adhesions or any other pathology, and the outer surface of the dura was not impaired in any specimen. The group that had the contrast media injection showed a higher inflammation response compared to the other groups (P = 0.001). Positive staining for caspase-3 was limited to <5% of neurons with all substances used. Conclusion: No proof of arachnoiditis and/or fibrosis was noted in the epidural space with the use of the above-described drugs. A higher inflammation rate was noted with the use of contrast media.

  3. Lower thoracic degenerative spondylithesis with concomitant lumbar spondylosis.

    Science.gov (United States)

    Hsieh, Po-Chuan; Lee, Shih-Tseng; Chen, Jyi-Feng

    2014-03-01

    Degenerative spondylolisthesis of the spine is less common in the lower thoracic region than in the lumbar and cervical regions. However, lower thoracic degenerative spondylolisthesis may develop secondary to intervertebral disc degeneration. Most of our patients are found to have concomitant lumbar spondylosis. By retrospective review of our cases, current diagnosis and treatments for this rare disease were discussed. We present a series of 5 patients who experienced low back pain, progressive numbness, weakness and even paraparesis. Initially, all of them were diagnosed with lumbar spondylosis at other clinics, and 1 patient had even received prior decompressive lumbar surgery. However, their symptoms continued to progress, even after conservative treatments or lumbar surgeries. These patients also showed wide-based gait, increased deep tendon reflex (DTR), and urinary difficulty. All these clinical presentations could not be explained solely by lumbar spondylosis. Thoracolumbar spinal magnetic resonance imaging (MRI), neurophysiologic studies such as motor evoked potential (MEP) or somatosensory evoked potential (SSEP), and dynamic thoracolumbar lateral radiography were performed, and a final diagnosis of lower thoracic degenerative spondylolisthesis was made. Bilateral facet effusions, shown by hyperintense signals in T2 MRI sequence, were observed in all patients. Neurophysiologic studies revealed conduction defect of either MEP or SSEP. One patient refused surgical management because of personal reasons. However, with the use of thoracolumbar orthosis, his symptoms/signs stabilized, although partial lower leg myelopathy was present. The other patients received surgical decompression in association with fixation/fusion procedures performed for managing the thoracolumbar lesions. Three patients became symptom-free, whereas in 1 patient, paralysis set in before the operation; this patient was able to walk with assistance 6 months after surgical decompression

  4. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  5. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    primary effect parameter was total headache burden defined as area under the curve (AUC: intensity × duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency (days per month), duration in hours (total hours/month) and also medication days (days on medication...... of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...

  6. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... primary effect parameter was total headache burden defined as area under the curve (AUC: intensity × duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency (days per month), duration in hours (total hours/month) and also medication days (days on medication...

  7. Reduced hospital stay and narcotic consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty: a randomized clinical trial of an intraarticular technique versus epidural infusion in 80 patients

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Pfeiffer-Jensen, Mogens; Haraldsted, Viggo

    2007-01-01

    infusion. METHODS: 80 patients undergoing elective THA under spinal block were randomly assigned to receive either (1) continuous epidural infusion (group E) or (2) infiltration around the hip joint with a mixture of 100 mL ropivacaine 2 mg/mL, 1 mL ketorolac 30 mg/mL, and 1 mL epinephrine 0.5 mg...

  8. Emergency Anaesthetic Management of Extensive Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H C Chandola

    2007-01-01

    Full Text Available High speed vehicles, drug abuse, alcohol and easy availability of handguns are the main reasons of increasing number of trauma especially thoracic trauma. Anaesthesiologist plays an important role in the management of extensive thoracic trauma. Thoracic trauma, penetrating or blunt, may cause damage to organs suspended in thorax viz. pleura, lungs, heart, great vessels, trachea and oesophagus. It may lead to pneumothorax, cardiac tamponade or life threatening haemorrhage. With aggressive care and management of these factors, majority of patients can survive and return to normal life.

  9. Spontaneous Spinal Epidural Hematoma as a Potentially Important Stroke Mimic

    Directory of Open Access Journals (Sweden)

    Tetsu Akimoto

    2014-01-01

    Full Text Available Hemiparesis develops in response to a wide range of neurological disorders, such as stroke, neoplasms and several inflammatory processes. Occasionally, it may also occur due to a lesion located in the high cervical spinal cord. In this concise review, we describe the features of spontaneous spinal epidural hematoma, which should be included in the large list of stroke mimics. Various concerns regarding the diagnostic and therapeutic conundrums relating to the condition are also discussed.

  10. Epidural anaesthesia for caesarean section in pituitary dwarfism.

    Science.gov (United States)

    Li, Hongbo; Li, Ruihua; Lang, Bao

    2017-04-01

    We describe the anaesthetic management for caesarean section in a 32-year-old patient with pituitary dwarfism. In addition to supportive treatment, we offered a postoperative epidural analgesia pump. The patient recovered well without any complications. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  11. [Experience with combined spinal and epidural anesthesia at cesarean section].

    Science.gov (United States)

    Levinzon, A S; Taran, O I; Pura, K R; Mishchenko, G S; Mamaeva, N V

    2006-01-01

    The paper analyzes some experience gained in using various modes of regional anesthesia as an anesthetic appliance at cesarean sections and comparatively characterizes various types of central segmental blocks. The results of 213 cases of cesarean section performed under spinal or combined spinal and epidural anesthesia (CSEA) were generalized by the following parameters: block onset, maternal and fetal action, the quality of anesthesia and postoperative analgesia, which leads to the conclusion that CSEA is the method of choice.

  12. Radiographic appearance of a post-epidural headache.

    LENUS (Irish Health Repository)

    Weekes, G

    2012-02-01

    We report the case of a 35-year-old lady who presented with a 6-day history of a postural headache following an uncomplicated epidural catheter insertion. Meningitis was initially suspected and a neurology review was obtained. CT and MRI brain revealed features suggestive of meningitis. However these radiological features are also consistent with post dural puncture headache (PDPH). This case highlights the under reported and possible misleading radiographical features of PDPH.

  13. Combined spinal epidural labour analgesia: Complications and their management

    OpenAIRE

    YILMAZ, Nurullah; KOCAMANOGLU, Ismail Serhat; ABANOZ, Hakan

    2016-01-01

    Combined spinal-epidural analgesia (CSEA) is an effective and increasingly popular analgesia method used in vaginal delivery. CSEA provides rapid and excellent analgesia, allows mobilization, reduces drug consumption significantly and generally causes negligible maternal and fetal /neonatal adverse effects /complications not requiring treatment. The resulting adverse effects /complications are often associated with technical and /or agent/agents used and cause maternal and fetal /neonatal or,...

  14. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    OpenAIRE

    Varaprasad

    2015-01-01

    BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of seda...

  15. Preincisional and postoperative epidural morphine, ropivacaine, ketamine, and naloxone treatment for postoperative pain management in upper abdominal surgery.

    Science.gov (United States)

    Lai, Hou-Chuan; Hsieh, Chung-Bao; Wong, Chih-Shung; Yeh, Chun-Chang; Wu, Zhi-Fu

    2016-09-01

    Previous studies have shown that preincisional epidural morphine, bupivacaine, and ketamine combined with epidural anesthesia (EA) and general anesthesia (GA) provided pre-emptive analgesia for upper abdominal surgery. Recent studies reported that ultralow-dose naloxone enhanced the antinociceptive effect of morphine in rats. This study investigated the benefits of preincisional and postoperative epidural morphine + ropivacaine + ketamine + naloxone (M + R + K + N) treatment for achieving postoperative pain relief in upper abdominal surgery. Eighty American Society of Anesthesiology I-II patients scheduled for major upper abdominal surgery were allocated to four groups in a randomized, single-blinded study. All patients received combined GA and EA with a continuous epidural infusion of 2% lidocaine (6-8 mL/h) 30 minutes after pain regimen. After GA induction, in Group I, an epidural pain control regimen (total 10 mL) was administered using 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg; M + R); in Group II, 1% lidocaine 8 (mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg; M + R + K); in Group III, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + naloxone (2 μg; M + R + N); and in Group IV, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg) + naloxone (2 μg; M + R + K + N), respectively. All patients received patient-controlled epidural analgesia (PCEA) with different pain regimens to control subsequent postoperative pain for 3 days following surgery. During the 3-day period following surgery, PCEA consumption (mL), numerical rating scale (NRS) score while cough/moving, and analgesic-related adverse effects were recorded. Total PCEA consumption for the 3-day observation period was 161.5±17.8 mL, 103.2±21.7 mL, 152.4±25.6 mL, and 74.1±16.9 mL for Groups I, II, III, and IV, respectively. (p pain management than preincisional

  16. Ligamentum flavum hematomas of the cervical and thoracic spine.

    Science.gov (United States)

    Wild, Florian; Tuettenberg, Jochen; Grau, Armin; Weis, Joachim; Krauss, Joachim K

    2014-01-01

    To report extremely rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Only six cases of thoracic ligamentum flavum hematomas and three cases of cervical ligamentum flavum hematomas have been reported so far. Two patients presented with tetraparesis and one patient presented with radicular pain and paresthesias in the T3 dermatome. MRI was performed in two patients, which showed a posterior intraspinal mass, continuous with the ligamentum flavum. The mass was moderately hypointense on T2-weighted images and hyperintense on T1-weighted images with no contrast enhancement. The third patient underwent cervical myelography because of a cardiac pacemaker. The myelography showed an intraspinal posterior mass with compression of the dural sac at C3/C4. All patients underwent a hemilaminectomy to resect the ligamentum flavum hematoma and recovered completely afterwords, and did not experience a recurrence during follow-up of at least 2 years. This case series shows rare cases of ligamentum flavum hematomas in the cervical and thoracic spine. Surgery achieved complete recovery of the preoperative symptoms in all patients within days. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    Directory of Open Access Journals (Sweden)

    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  18. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Directory of Open Access Journals (Sweden)

    Emine Rabia Koç

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking

  19. From assistance towards restoration with epidural brain-computer interfacing.

    Science.gov (United States)

    Gharabaghi, Alireza; Naros, Georgios; Walter, Armin; Grimm, Florian; Schuermeyer, Marc; Roth, Alexander; Bogdan, Martin; Rosenstiel, Wolfgang; Birbaumer, Niels

    2014-01-01

    Today's implanted brain-computer interfaces make direct contact with the brain or even penetrate the tissue, bearing additional risks with regard to safety and stability. What is more, these approaches aim to control prosthetic devices as assistive tools and do not yet strive to become rehabilitative tools for restoring lost motor function. We introduced a less invasive, implantable interface by applying epidural electrocorticography in a chronic stroke survivor with a persistent motor deficit. He was trained to modulate his natural motor-related oscillatory brain activity by receiving online feedback. Epidural recordings of field potentials in the beta-frequency band projecting onto the anatomical hand knob proved most successful in discriminating between the attempt to move the paralyzed hand and to rest. These spectral features allowed for fast and reliable control of the feedback device in an online closed-loop paradigm. Only seven training sessions were required to significantly improve maximum wrist extension. For patients suffering from severe motor deficits, epidural implants may decode and train the brain activity generated during attempts to move with high spatial resolution, thus facilitating specific and high-intensity practice even in the absence of motor control. This would thus transform them from pure assistive devices to restorative tools in the context of reinforcement learning and neurorehabilitation.

  20. [Benefits of epidural analgesia in major neonatal surgery].

    Science.gov (United States)

    Gómez-Chacón, J; Encarnación, J; Couselo, M; Mangas, L; Domenech, A; Gutiérrez, C; García Sala, C

    2012-07-01

    The aim of this paper is to describe and evaluate the benefits of epidural anesthesia in major surgery neonatal. We have performed a matched case-control (2:1) study of patients undergoing neonatal major surgery (NMSs) who received intra-and postoperative epidural anesthesia (EA) and controls with conventional general anesthesia. The matching criteria were age, weight and baseline pathology. EA was administered by caudal puncture and epidural catheter placed with ultrasound support. Levobupivacaine was selected as anesthetic drug. The time to extubation, intestinal transit time, type of analgesia and complications were studied. This study is based on 11 cases (2 esophageal atresia, 2 diaphragmatic hernias, 1 necrotizing enterocolitis, 3 intestinal atresia, 2 anorectal malformation and 1 bladder exstrophy) and 22 controls. We observed statistically significant differences in time to extubation (95% CI OR 12 1.99 to 72.35; Chi2 p = 0.004, Mann U Whytney p = 0.013) and intestinal transit time (Mann Whitney U p analgesia. Therefore we believe that the intra-and postoperative EA helps improve postoperative management in neonates and should be preferred in centers where this technique is available.

  1. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less.

    Science.gov (United States)

    Moore, Albert R; Shan, William Li Pi; Hatzakorzian, Roupen

    2013-01-01

    Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to determine the characteristics associated with early epidural analgesia initiation. Information about women delivering at 37 weeks or greater gestation with epidural analgesia, who were not scheduled for cesarean delivery, was extracted from the McGill Obstetric and Neonatal Database. Patients were grouped into those who received epidural analgesia at a cervical dilation of ≤3 cm and >3 cm. Univariable and multivariable logistic regression was used to determine the maternal, neonatal, and labor characteristics that increased the risk of inclusion in the early epidural group. Of the 13,119 patients analyzed, multivariable regression demonstrated odds ratios (OR) of 2.568, 5.915 and 10.410 for oxytocin augmentation, induction, and dinoprostone induction of labor (P analgesia (OR 0.780, P analgesia (P neonatal weight (OR 0.943, P analgesia. Labor augmentation and induction, nulliparity, rupture of membranes spontaneously and before labor starts, increasing maternal weight, and decreasing neonatal weight are associated with early epidural analgesia. Many of these variables are also associated with cesarean delivery.

  2. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients : A Report from the Multicenter Perioperative Outcomes Group

    NARCIS (Netherlands)

    Lee, Linden O.; Bateman, Brian T.; Kheterpal, Sachin; Klumpner, Thomas T.; Housey, Michelle; Aziz, Michael F.; Hand, Karen W.; MacEachern, Mark; Goodier, Christopher G.; Bernstein, Jeffrey; Bauer, Melissa E.; Lirk, Philip; Wilczak, Janet; Soto, Roy; Tom, Simon; Cuff, Germaine; Biggs, Daniel A.; Coffman, Traci; Saager, Leif; Levy, Warren J.; Godbold, Michael; Pace, Nathan L.; Wethington, Kevin L.; Paganelli, William C.; Durieux, Marcel E.; Domino, Karen B.; Nair, Bala; Ehrenfeld, Jesse M.; Wanderer, Jonathan P.; Schonberger, Robert B.; Berris, Joshua; Lins, Steven; Coles, Peter; Cummings, Kenneth C.; Maheshwari, Kamal; Berman, Mitchell F.; Wedeven, Christopher; LaGorio, John; Fleishut, Peter M.; Ellis, Terri A.; Molina, Susan; Carl, Curtis; Kadry, Bassam; van Klei, Wilton A A; Pasma, Wietze; Jameson, Leslie C.; Helsten, Daniel L.; Avidan, Michael S.

    BACKGROUND:: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large

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

    OpenAIRE

    Mehta N; Gupta S; Sharma A; Dar MR

    2015-01-01

    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 anest...

  4. A comparison of intrathecal dexmedetomidine verses intrathecal fentanyl with epidural bupivacaine for combined spinal epidural labor analgesia

    OpenAIRE

    P K Dilesh; S Eapen; S Kiran; Vivek Chopra

    2014-01-01

    Context: Combined spinal epidural (CSE) analgesia technique is effective for labor analgesia and various concentrations of bupivacaine and lipophilic opioids like fentanyl have been studied. Dexmedetomidine is a highly selective alpha 2 adrenoreceptor agonist with analgesic properties and has been used intrathecally with bupivacaine for prolonged postoperative analgesia. Recent reviews have shown that it is highly lipophilic and does not cross placenta significantly. Aim: The aim of this s...

  5. Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine.

    Science.gov (United States)

    Yamazaki, Y; Mimura, M; Hazama, K; Namiki, A

    2000-04-25

    An epidural injection of saline was reported to extend spinal anesthesia because of a volume effect. The aim of this study was to evaluate the influence of the baricity of spinal local anesthetics upon the extension of spinal anesthesia by epidural injection of saline. Forty patients undergoing elective lower-limb surgery were randomly allocated to four groups of 10 patients each. Group A received no epidural injection after the spinal administration of hyperbaric tetracaine (dissolved in 10% glucose). Group B received an epidural injection of 8 ml of physiological saline 20 min after spinal hyperbaric tetracaine. Group C received no epidural injection after spinal isobaric tetracaine (dissolved in physiological saline). Group D received an epidural injection of 8 ml of saline 20 min after spinal isobaric tetracaine. The level of analgesia was examined by the pinprick method at 5-min intervals. The levels of analgesia 20 min after spinal anesthesia were significantly higher in hyperbaric groups than in isobaric groups [T5 (T2-L2) vs. T7 (T3-12)]. After epidural injection of saline, the levels of analgesia in groups B and D were significantly higher than in groups A and C. The segmental increases after epidural saline injection were 2 (0-3) in group B and 2 (1-7) in group D. Sensation in the sacral area remained 20 min after spinal block in one patient in group D; however, it disappeared after epidural saline injection. In this study, 8 ml of epidural saline extended spinal analgesia. However, there was no difference between the augmenting effect in isobaric and hyperbaric spinal anesthesia. We conclude that the reinforcement of spinal anesthesia by epidural injection of saline is not affected by the baricity of the spinal anesthetic solution used.

  6. Catamenial pneumothorax caused by thoracic endometriosis

    Directory of Open Access Journals (Sweden)

    Paolo Maniglio, MD

    2018-02-01

    Conclusion: The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.

  7. EPIDURAL ANALGESIA DURING LABOR Analgesia epidural para el trabajo de parto

    Directory of Open Access Journals (Sweden)

    Juan Carlos Zafra Pedone

    2008-12-01

    Full Text Available Introduction: The labor pain affect to all pregnant woman and it has biochemical and physiological changes that affect to mother and fetus and interact with your normal evolution. Currently there are analgesic techniques to less effectively labor pain, to provide a high satisfaction level and supply clinical and laboratory beneficial outcomes. In own context these techniques are very low used. Objective: To describe the use of epidural analgesic procedures in a pregnancy woman group during labor at the Universitarian Hospital San Jose – Popayan, Colombia. Materials and methods: Case series design. We recollected information of patients from Obstetric service during two months of 2006. The patient’s information was recollected from medical history with an instrument that content variables related with the analgesic technique and labor. The analyses were performed using descriptive statistics Results: 41 pregnant woman with a mean age of 23,4 were included. 65,9% were nulliparous and 85,4% were term pregnancy. At the moment of dural puncture the dilation and EVA pain scale mode was 6 and 8 respectively. The latency mean was 14,1 minutes. 95,1% were require a booster applied in a mean of 80 minutes and 61% were required a second booster applied in a mean of 49 min after that. The way of termination of pregnancy was vaginal predominantly. Conclusions: The results of this study are congruent to reporting in the world literature. These conclusions support the effectiveness of epidural analgesia and its favorable benefit/risk relation to the control of labor pain. Introducción: El dolor asociado con el trabajo de parto afecta a todas las pacientes e involucra alteraciones que afectan a la madre y al feto e interactúan interfiriendo con su evolución normal. Actualmente disponemos de alternativas analgésicas peridurales que han demostrado controlar en forma efectiva el dolor, proporcionar un alto grado de satisfacción de las pacientes y proveer

  8. Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor.

    Science.gov (United States)

    Mattei, Tobias A; Higgins, Michael; Joseph, Flynn; Mendel, Ehud

    2013-03-01

    Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma. The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2-3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion. Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in

  9. Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve.

    Science.gov (United States)

    Sudo, Hideki; Abe, Yuichiro; Abumi, Kuniyoshi; Iwasaki, Norimasa; Ito, Manabu

    2016-02-01

    There is limited consensus on the optimal surgical strategy for double thoracic adolescent idiopathic scoliosis (AIS). Recent studies have reported that pedicle screw constructs to maximize scoliosis correction cause further thoracic spine lordosis. The objective of this study was to apply a new surgical technique for double thoracic AIS with rigid proximal thoracic (PT) curves and assess its clinical outcomes. Twenty one consecutive patients with Lenke 2 AIS and a rigid PT curve (Cobb angle ≥30º on side-bending radiographs, flexibility ≤30 %) treated with the simultaneous double-rod rotation technique (SDRRT) were included. In this technique, a temporary rod is placed at the concave side of the PT curve. Then, distraction force is applied to correct the PT curve, which reforms a sigmoid double thoracic curve into an approximate single thoracic curve. As a result, the PT curve is typically converted from an apex left to an apex right curve before applying the correction rod for PT and main thoracic curve. All patients were followed for at least 2 years (average 2.7 years). The average main thoracic and PT Cobb angle correction rate at the final follow-up was 74.7 and 58.0 %, respectively. The average preoperative T5-T12 thoracic kyphosis was 9.3°, which improved significantly to 19.0° (p corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.

  10. Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient.

    Science.gov (United States)

    Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S

    2016-05-23

    Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

  11. A History of Thoracic Aortic Surgery.

    Science.gov (United States)

    McFadden, Paul Michael; Wiggins, Luke M; Boys, Joshua A

    2017-08-01

    Ancient historical texts describe the presence of aortic pathology conditions, although the surgical treatment of thoracic aortic disease remained insurmountable until the 19th century. Surgical treatment of thoracic aortic disease then progressed along with advances in surgical technique, conduit production, cardiopulmonary bypass, and endovascular technology. Despite radical advances in aortic surgery, principles established by surgical pioneers of the 19th century hold firm to this day. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Thoracic trauma: analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Maíra Benito Scapolan

    2010-09-01

    Full Text Available Objective: To analyze thoracic trauma assisted by the EmergencyService of Hospital da Irmandade da Santa Casa de Misericórdia deSão Paulo. Methods: One hundred patients with thoracic trauma wereassisted throughout six months in 2006. Data from their records werecollected and a protocol of thoracic trauma was fulfilled. The RevisedTrauma Score was used to evaluate gravity of injury and to calculatethe survival index. Results: Prevalence of trauma injury in male from20 to 29 years old was observed. Out of all patients, 44 had blunttrauma and 56 penetrating trauma (78.6% presented stab woundsand 21.4% gun shots. Up to the settings of injuries, 23% were in thethoracoabdominal transition, 7% in the precordium and 70% in theremainder thoracic area. In those with the thoracoabdominal transitioninjury, 22.7% were hemodynamically unstable and 77.3% stable.Thoracoabdominal injury patients presented 40.9% of diaphragmwound and all were stable. Of those with precordium wound, 37.5%presented cardiac injury. In cardiac onset, 66.7% presented stableand 33.3% unstable. Thoracic drainage was the most accomplishedsurgical procedure (71%. Conclusions: The thoracic trauma patientis most prevalently young male with stab wound penetrating injury,without associated injuries, hemodynamically stable, presentinghemothorax, with high probability of survival.

  13. MRI of thoracic outlet syndrome in children

    Energy Technology Data Exchange (ETDEWEB)

    Chavhan, Govind B.; Batmanabane, Vaishnavi [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); Muthusami, Prakash [The Hospital for Sick Children and University of Toronto, Department of Diagnostic Imaging, Toronto, ON (Canada); The Hospital for Sick Children, Division of Image Guided Therapy, Department of Diagnostic Imaging, Toronto, ON (Canada); Towbin, Alexander J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology and Medical Imaging, Cincinnati, OH (United States); Borschel, Gregory H. [The Hospital for Sick Children and University of Toronto, Division of Plastic Surgery, Department of Pediatric Surgery, Toronto, ON (Canada)

    2017-09-15

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  14. MRI of thoracic outlet syndrome in children

    International Nuclear Information System (INIS)

    Chavhan, Govind B.; Batmanabane, Vaishnavi; Muthusami, Prakash; Towbin, Alexander J.; Borschel, Gregory H.

    2017-01-01

    Thoracic outlet syndrome is caused by compression of the neurovascular bundle as it passes from the upper thorax to the axilla. The neurovascular bundle can be compressed by bony structures such as the first rib, cervical ribs or bone tubercles, or from soft-tissue abnormalities like a fibrous band, muscle hypertrophy or space-occupying lesion. Thoracic outlet syndrome commonly affects young adults but can be seen in the pediatric age group, especially in older children. Diagnosis is based on a holistic approach encompassing clinical features, physical examination findings including those triggered by various maneuvers, electromyography, nerve conduction studies and imaging. Imaging is performed to confirm the diagnosis, exclude mimics and classify thoracic outlet syndrome into neurogenic, arterial, venous or mixed causes. MRI and MR angiography are useful in this process. A complete MRI examination for suspected thoracic outlet syndrome should include the assessment of anatomy and any abnormalities using routine sequences, vessel assessment with the arms in adduction by MR angiography and assessment of dynamic compression of vessels with abduction of the arms. The purpose of this paper is to describe the anatomy of the thoracic outlet, causes of thoracic outlet syndrome, the MR imaging techniques used in its diagnosis and the principles of image interpretation. (orig.)

  15. Initial thoracic involvement in lymphoma. CT assessment

    International Nuclear Information System (INIS)

    Bustos, A.; Corredoira, J.; Ferreiros, J.; Cabeza, B.; Jorquera, M.; Pedrosa, I.; Martinez, R.; Fernandez, C.

    2002-01-01

    To analyze the initial thoracic involvement by CT in a consecutive series of patients with lymphoma. A retrospective analysis was made of thoracic CT studies made at the time of diagnosis of 259 patients with lymphoma. Mediastinal pulmonary, pleural, pericardial and chest wall involvement was assessed by CT. Of 259 patients (129 men y 130 women), 56 had Hodgkin's disease (HD) and 203 had non-Hodgkin lymphoma (NHL). Forty-two percent (42.5%, 110/259) of the patients had chest involvement on CT: 33 of 56 patients with HD (58.9%) and 77 of 203 patients with NHL (37.9%). All the patients with thoracic HD) and 71.4% of patients with thoracic NHL, had mediastinal lymph node involvement. of the patients with thoracic involvement 12.1% (4/33) of the patient with HD and 23.3% (18/77) of the patients with NHL had pulmonary involvement. Thoracic involvement on CT was more frequent in HD. Mediastinal lymph node involvement was the most common finding fundamentally in HD. Pulmonary disease always occurred in the presence of mediastinal lymph node involvement in HD but could occur as an isolated finding in NHL. (Author) 24 refs

  16. Successful linking of the Society of Thoracic Surgeons Database to Social Security data to examine the accuracy of Society of Thoracic Surgeons mortality data.

    Science.gov (United States)

    Jacobs, Jeffrey P; O'Brien, Sean M; Shahian, David M; Edwards, Fred H; Badhwar, Vinay; Dokholyan, Rachel S; Sanchez, Juan A; Morales, David L; Prager, Richard L; Wright, Cameron D; Puskas, John D; Gammie, James S; Haan, Constance K; George, Kristopher M; Sheng, Shubin; Peterson, Eric D; Shewan, Cynthia M; Han, Jane M; Bongiorno, Phillip A; Yohe, Courtney; Williams, William G; Mayer, John E; Grover, Frederick L

    2013-04-01

    data describing "mortality within 30 days of surgery" in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The Society of Thoracic Surgeons and Social Security Death Master File link reveals that capture of 30-day deaths occurring before discharge is highly accurate, and that these in-hospital deaths represent the majority (79% [13,014/16,565]) of all 30-day deaths. Capture of the remaining 30-day deaths occurring after discharge is less complete and needs improvement. Efforts continue to encourage Society of Thoracic Surgeons Database participants to submit Social Security numbers to the Database, thereby enhancing accurate determination of 30-day life status. The Society of Thoracic Surgeons and Social Security Death Master File linkage can facilitate ongoing refinement of mortality reporting. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  17. Single-stage epidural catheter lavage with posterior spondylodesis in lumbar pyogenic spondylodiscitis with multilevel epidural abscess formation.

    Science.gov (United States)

    Tschoeke, Sven K; Kayser, Ralph; Gulow, Jens; Hoeh, Nicolas von der; Salis-Soglio, Georg von; Heyde, Christoph

    2014-11-01

    Despite significant advances in the conservative management of pyogenic spondylodiscitis, consecutive instability, deformity, and/or neurologic compromise demands a prompt surgical intervention. However, in rare cases involving additional multilevel epidural abscess formation, the appropriate surgical strategy remains controversial. In this retrospective cohort analyses, we evaluated the efficacy of a single-stage posterior approach with the addition of a one-time multilevel epidural lavage via the surgically exposed interlaminar fenestration of the infected segment. From January 2009 through December 2010, 73 patients presenting pyogenic spondylodiscitis with instability of the lumbar spine were admitted. In all cases, the surgical strategy included a radical resection of the affected intervertebral disc and stabilization by intervertebral fusion using a titanium cage with autologous bone grafting in a level-dependent posterior approach with additional pedicle screw-and-rod instrumentation. In cases where multilevel abscess formation was evident, the standard surgical procedure was complemented by drainage and irrigation of the abscess from posterior by carefully advancing a soft infant feeding tube via the surgically exposed epidural space under fluoroscopic guidance. All patients received complementary oral antibiotic therapy for 12 weeks and were followed-up for a minimum of 12 months postoperatively. Ten patients (three male and seven female patients; mean age: 64.9 ± 10.9 years) presented with an additional lumbar epidural abscess extending beyond three levels proximal or distal to the infected disc. In all 10 patients the laboratory-chemical inflammatory parameters (leukocyte count, C-reactive protein) remained within the physiologic range after completing antibiotic therapy throughout the 1-year follow-up period. The plain radiographs and magnetic resonance imaging demonstrated solid fusion and the complete remission of the initial abscess formation after

  18. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  19. Audit of epidural anaesthesia services at a district hospital in Nigeria ...

    African Journals Online (AJOL)

    Background: Epidural anaesthesia and analgesia is considered the 'gold standard' analgesic technique for major surgery. However, its practice is limited in most hospitals in Nigeria. The objective of this review was to determine the rate of administration of epidural anaesthesia and to review the challenges affecting its ...

  20. Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam [Hanyang University Medical Center, Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Dong Woo [Dept. of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2015-07-15

    Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces.

  1. Spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces: A case report

    International Nuclear Information System (INIS)

    Yim, Bong Guk; Lee, Young Jun; Lee, Ji Young; Park, Chan Kum; Paik, Seung Sam; Park, Dong Woo

    2015-01-01

    Spinal capillary hemangiomas in the epidural space are extremely rare; however, a preoperative radiological diagnosis is very important because of the risk of massive intraoperative hemorrhage. We report a case of a spinal capillary hemangioma involving the lumbar epidural and paraspinal spaces

  2. Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kristensen, Billy Bjarne

    2005-01-01

    Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist...... on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery....

  3. Descending volleys generated by efficacious epidural motor cortex stimulation in patients with chronic neuropathic pain

    NARCIS (Netherlands)

    Lefaucheur, Jean-Pascal; Holsheimer, J.; Goujon, Colette; Keravel, Yves; Nguyen, Jean-Paul

    Epidural motor cortex stimulation (EMCS) is a therapeutic option for chronic, drug-resistant neuropathic pain, but its mechanisms of action remain poorly understood. In two patients with refractory hand pain successfully treated by EMCS, the presence of implanted epidural cervical electrodes for

  4. Penggunaan Anestesi Lokal dan Adjuvan pada Analgesi Epidural di Wilayah Jawa Barat Tahun 2015

    Directory of Open Access Journals (Sweden)

    Dedi Fitri Yadi

    2017-08-01

    Local Anesthetic and Adjuvan Used for Epidural Analgesia in West Java in 2015 Optimal analgesia epidural technique should promote effective pain relief with minor adverse event and major pastient satisfactory. Up till now, there was no data about local anesthetic and adjuvan agent used for epidural analgesia by anesthesiologist in Indonesia, especially in West Java. The purpose of this study to find data regarding local anesthetic and adjuvan agent used for epidural analgesia by anesthesiologist in Indonesia, especially in West Java in 2015. This research was conducted from August to September 2016 in the Department of Anesthesiology and Intensive Therapy Dr. Hasan Sadikin Hospital in Bandung. This is a descriptive study with cross sectional approach using questionairre. Questionairre was sent to 120 anesthesiologist through mail and 30 questionairre was given to anesthesiologists worked at Dr. Hasan Sadikin General Hospital Bandung. Response was obtained 47.3%. This study shows that there were 73.2% anesthesiologist performed epidural analgesia in 2015. The most  local anesthetic used in epidural blockade was bupivacaine, amounted 94.23% and the most concentration is 0.125%, amounted 82%. The most used adjuvant was fentanyl, 96.9%. In Conclusion, most of the anesthesiologist used epidural as an analgesia so bupivacaine and fentanyl used most frequent Key words: Epidural analgesia, local anesthetic, adjuvan

  5. Labour epidural analgesia audit in a tertiary state hospital in South ...

    African Journals Online (AJOL)

    complications of this study, relied on the number of epidural records containing ... and not the epidurals that were performed exclusively for. Caesarean ... Primigravida (Obstetrician request). 21. 14 ... (anaesthesiologists and nursing staff) are available, the ASA ... blockade, bupivacaine was cheaper and these advantages.

  6. Spontaneous spinal epidural hematoma presenting with quadriplegia after sit-ups exercise.

    Science.gov (United States)

    Chen, Chun-Lin; Lu, Ching-Hsiang; Chen, Nan-Fu

    2009-11-01

    Spontaneous spinal epidural hematoma (SSEH) represents 0.3% to 0.9% of spinal epidural space-occupying lesions, and most surgeons advocate aggressive and early surgical intervention. In this article, we describe a patient with SSEH with sudden quadriplegia after sit-ups exercise.

  7. A new technique for long time catheterization of sacral epidural canal in rabbits.

    Science.gov (United States)

    Erkin, Yüksel; Aydın, Zeynep; Taşdöğen, Aydın; Karcı, Ayşe

    2013-01-01

    In this study we aimed to develop a simple and practical technique for chronic sacral epidural catheterization of rabbits. We included ten rabbits weighing 2-2.5 kg in the study. After anesthesia and analgesia, we placed an epidural catheter by a 2 cm longitudinal skin incision in the tail above the sacral hiatus region. We confirmed localization by giving 1% lidocaine (leveling sensory loss and motor function loss of the lower extremity). The catheter was carried forward through a subcutaneous tunnel and fixed at the neck. Chronic caudal epidural catheter placement was succesful in all rabbits. The catheters stayed in place effectively for ten days. We encountered no catheter complications during this period. The localization of the catheter was reconfirmed by 1% lidocaine on the last day. After animals killing, we performed a laminectomy and verified localization of the catheter in the epidural space. Various methods for catheterization of the epidural space in animal models exist in the literature. Epidural catheterization of rabbits can be accomplished by atlanto-occipital, lumbar or caudal routes by amputation of the tail. Intrathecal and epidural catheterization techniques defined in the literature necessitate surgical skill and knowledge of surgical procedures like laminectomy and tail amputation. Our technique does not require substantial surgical skill, anatomical integrity is preserved and malposition of the catheter is not encountered. In conclusion, we suggest that our simple and easily applicable new epidural catheterization technique can be used as a model in experimental animal studies.

  8. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome.

    Science.gov (United States)

    Hasegawa, Junichi; Farina, Antonio; Turchi, Giovanni; Hasegawa, Yuko; Zanello, Margherita; Baroncini, Simonetta

    2013-02-01

    We aimed to clarify whether the short-term adverse neonatal outcomes associated with epidural analgesia are due to the epidural analgesia itself or to the instrumental delivery. A retrospective case-control study was conducted to evaluate the relationship between epidural analgesia, labor length, and perinatal outcomes. A total of 350 pregnant women at term who delivered under epidural analgesia (cases) were compared with 1400 patients without epidural analgesia (controls). Vacuum extraction (6.5 vs. 2.9 %) and cesarean section (19.9 vs. 11.1 %) were more frequently performed in the cases than controls (p neonatal variables stratified by mode of delivery were not different in cases and controls, except for a slightly lower umbilical arterial pH in spontaneous delivery for the cases group. However, the Apgar scores and umbilical arterial pH were significantly lower in the neonates delivered by vacuum extraction compared with those in the neonates delivered by spontaneous delivery or cesarean section, regardless of whether epidural analgesia was performed. A multivariable analysis showed that vacuum extraction much more consistently affected the arterial pH than the analgesia itself (the β coefficients were -0.036 for epidural analgesia vs. -0.050 for vacuum extraction). Epidural analgesia was associated with slowly progressing labor, thus resulting in an increased rate of instrumental delivery. This instrumental delivery appears to adversely affect the neonatal outcomes more strongly than the analgesia itself.

  9. Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?

    Science.gov (United States)

    Rossen, Janne; Klungsøyr, Kari; Albrechtsen, Susanne; Løkkegård, Ellen; Rasmussen, Steen; Bergholt, Thomas; Skjeldestad, Finn E

    2018-03-07

    Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet

    International Nuclear Information System (INIS)

    Borstlap, A.C.W.; Rooij, W.J.J. van; Sluzewski, M.; Leyten, A.C.M.; Beute, G.

    1995-01-01

    We present three obese patients with symptomatic lumbar epidural lipomatosis. All three were treated with a calorie-controlled diet and considerable weight reduction was achieved. MRI demonstrated a reduction in the epidural fat and relief of thecal sac compression in all three; two also improved clinically. (orig.). With 3 figs., 1 tab

  11. Outcome analysis of two different injection solutions for epidural injection in radicular lumbar backache syndromes

    International Nuclear Information System (INIS)

    Saqib, M.; Mukhtar, M.; Bhatti, S.N; Afridi, E.A.K.; Khan, R.

    2017-01-01

    Background: Backache is a significant source of disability and suffering in our society. The treatment modalities need continued enhancement in order to achieve the desired goals of lowering morbidity and financial losses while improving the response of the patient. Methods: This prospective comparative study was conducted at the department of Orthopaedics and Spine Surgery, Khyber Teaching Hospital Peshawar from July 2013 to June 2015. Two interventional groups were designated; Group 1 was comprised of 54 patients who were injected with epidural bupivacaine plus methylprednisolone while Group 2 included 55 patients who were injected with bupivacaine only. Outcome was assessed using the visual analogue scale and Oswestry disability index (ODI). Results: Fifty-five female and 54 male patients with mean age 49.37 years+-10.46 SD, Mean symptoms duration was 15.01 months+-9.32 SD. Common presenting symptoms were backache (77.1 percent), lower limbs pain (66.1 percent), dermatomal paresthesias (54.1 percent) and neurogenic claudication in 57.8 percent patients. The mean visual analogue score (VAS) after injection was 3.18+-1.29 while mean ODI after injection was 23.615. There was a statistically significant reduction in VAS scores (2-sided p=0.003, OR =4.03, 95 percent CI: 1.535-10.60) following the injection. Conclusion: An epidural spinal injection is a viable option for achieving relief of pain and improves functioning in individuals with radicular backache. However, further research is advised in order to clarify the role of ESI for long-term relief. (author)

  12. Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Rosenberg, J

    1994-01-01

    BACKGROUND AND OBJECTIVES. A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids......) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third...... postoperative day and the patient discharged from the hospital 80 hours after surgery. CONCLUSIONS. The technique of combined neural and humoral mediator block should be evaluated in other high-risk patients undergoing major surgical procedures, where minimal invasive techniques are not possible....

  13. Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient

    Science.gov (United States)

    Raasck, Kyle; Khoury, Jason; Aoude, Ahmed; Abduljabbar, Fahad; Jarzem, Peter

    2017-01-01

    Abstract Rationale: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord, and leading to acute neurological deficits. The disease's cloudy etiology and rarity contribute to dangerously suboptimal therapeutic principles. These neural deficits can be permanent, even fatal, if the SSEH is not treated in a timely and appropriate manner. Standard therapy is decompressive laminectomy, though nonsurgical management is a viable course of action for patients who meet a criterion that is continuously being refined. Patient concerns: A 76-year-old woman on warfarin for a past pulmonary embolism presented to the emergency room with jaundice, myalgia, hematuria, neck pain, and an International Normalized Ratio (INR) of 14. Upon admission, she rapidly developed quadriplegia and respiratory distress that necessitated intubation. Diagnoses: T2-weighted magnetic resonance imaging (MRI) revealed an epidural space-occupying hyperintensity from C2 to S5 consistent with a spinal epidural hematoma. An incidental finding of dilated intrahepatic and common bile ducts prompted an endoscopic retrograde cholangiopancreatography, which demonstrated choledocholithiasis. Interventions: The patient's INR was normalized with Vitamin K and Beriplex. Upon transfer to the surgical spine team for assessment of a possible intervention, the patient began to demonstrate recovery of neural functions. The ensuing sustained motor improvement motivated the team's preference for close neurologic monitoring and continued medical therapy over surgery. Thirteen hours after the onset of her symptoms, the patient was extubated. A sphincterotomy was later performed, removing 81 common bile duct stones. Outcomes: MRI demonstrated complete resorption of the SSEH and the patient maintained full neurological function at final follow-up. Lessons: Nonsurgical management of SSEH should be considered in the context of early and sustained recovery

  14. Spontaneous cervical epidural hematoma: a case report and review of the literature; Hematoma epidural cervical espontaneo: a proposito de un caso y revision de la bibligrafia

    Energy Technology Data Exchange (ETDEWEB)

    Aparici, F.; Mas, F.; Solera, M. C.; Moro, G. [Hospital Universitario La Fe. Valencia (Spain)

    2002-07-01

    We present the case of a 78-year-old woman with a spontaneous spinal epidural hematoma that presented with sudden interscapular pain accompanied by left hemiparesis and a significant improvement 15 minutes later. Initially diagnosed as angina, the persistence of pain in dorsal cervical spine suggested the need to perform magnetic resonance imaging (MRI). The images demonstrated a lesion in the epidural spinal canal at level C3-D2 that presented a heterogeneous signal intensity, with hyperintense areas in T1-weighted sequences and hypointense areas in gradient-echo sequences, with no sign of compression myelopathy. A diagnosis of epidural hematoma was established and, given the favorable clinical course, conservative treatment was indicated. The second MRI study showed the complete resorption of the epidural hematoma. (Author) 12 refs.

  15. Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace

    NARCIS (Netherlands)

    Everaert, Nele; Coppens, Marc; Vlerick, Peter; Braems, Geert; Wouters, Patrick; de Hert, Stefan

    2015-01-01

    Objective: We retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased

  16. Emergency thoracic surgery in elderly patients

    Science.gov (United States)

    Limmer, Stefan; Unger, Lena; Czymek, Ralf; Kujath, Peter; Hoffmann, Martin

    2011-01-01

    Objectives Emergency thoracic surgery in the elderly represents an extreme situation for both the surgeon and patient. The lack of an adequate patient history as well as the inability to optimize any co-morbidities, which are the result of the emergent situation, are the cause of increased morbidity and mortality. We evaluated the outcome and prognostic factors for this selected group of patients. Design Retrospective chart review. Setting Academic tertiary care referral center. Participants Emergency patients treated at the Department of Thoracic Surgery, University Hospital of Luebeck, Germany. Main outcome measures Co-morbidities, mortality, risk factors and hospital length of stay. Results A total of 124 thoracic procedures were performed on 114 patients. There were 79 men and 36 women (average age 72.5 ±6.4 years, range 65–94). The overall operative mortality was 25.4%. The most frequent indication was thoracic/mediastinal infection, followed by peri- or postoperative thoracic complications. Risk factors for hospital mortality were a high ASA score, pre-existing diabetes mellitus and renal insufficiency. Conclusions Our study documents a perioperative mortality rate of 25% in patients over 65 who required emergency thoracic surgery. The main indication for a surgical intervention was sepsis with a thoracic/mediastinal focus. Co-morbidities and the resulting perioperative complications were found to have a significant effect on both inpatient length of stay and outcome. Long-term systemic co-morbidities such as diabetes mellitus are difficult to equalize with respect to certain organ dysfunctions and significantly increase mortality. PMID:21369531

  17. Predicting early epidurals: association of maternal, labor, and neonatal characteristics with epidural analgesia initiation at a cervical dilation of 3 cm or less

    OpenAIRE

    Moore, Albert; Li Pi Shan,William; Hatzakorzian,Roupen

    2013-01-01

    Albert R Moore, William Li Pi Shan, Roupen Hatzakorzian Department of Anaesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada Background: Retrospective studies have associated early epidural analgesia with cesarean delivery, but prospective studies do not demonstrate a causal relationship. This suggests that there are other variables associated with early epidural analgesia that increase the risk of cesarean delivery. This study was undertaken to deter...

  18. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A

    2012-02-01

    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  19. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    Science.gov (United States)

    Fanning, Rebecca A; Briggs, Liam P; Carey, Michael F

    2009-03-01

    The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  20. Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

    Science.gov (United States)

    Wyshak, Grace; Ringer, Steven A.; Johnson, Lise C.; Rivkin, Michael J.; Lieberman, Ellice

    2012-01-01

    OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS: We studied all low-risk nulliparous women with singleton pregnancies ≥37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (≤99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature >100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (≤99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1- and 5-min Apgar scores 101°F had a two- to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS: The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied. PMID:22291120

  1. Thoracic CT in the ED: a study of thoracic computed tomography utilisation.

    LENUS (Irish Health Repository)

    Williams, E

    2010-02-01

    The aim of this retrospective study was to investigate the use of thoracic Computed Tomography (CT) in the Emergency Department of a Dublin Academic Teaching Hospital over a six month period. Data was retrieved using the hospital\\'s computerised information system. There were 202 referrals in total for thoracic CT from the Emergency Department during this time period. The most common indication for thoracic CT referral was for the investigation of pulmonary embolism with 127 (63%) referrals. There were 40 (25%) referrals for suspected malignancy and lung disease, whilst 8 (4%) of the referrals were for investigation of thoracic aortic dissection, 8 (4%) for infection, and 6 (3%) were for investigation of thoracic injury. Only 8 (4%) of all referrals were for investigation of injury as a result of chest trauma.

  2. COMBINED SPINAL EPIDURAL ANALGESIA IN LABOUR: COMPARISON OF BUPIVACAINE 1.25 MG WITH FENTANYL AND ROPIVACAINE 2.5 MG WITH FENTANYL INTRATHECAL

    Directory of Open Access Journals (Sweden)

    Prakash T. S. N

    2016-10-01

    , 105 and 120 mins., i.e. (every 5 mins. for 15 mins. and then every 15 mins. for 2 hrs. until the next request for analgesia. After positioning the patient in supine position, onset of analgesia and dermatome level were checked by loss of sensation to pinprick, time of onset and degree of motor blockade was checked by Bromage classification. VAS pain scores for all patients immediately before and after 15 mins. of the procedure at the next request for analgesia. Vitals were recorded and study was terminated. Continuation of epidural analgesia was done with 0.125% bupivacaine + 2 µg fentanyl in 10 mL. Monitoring - mother’s vital parameters, progress of labour, efficacy of analgesia and foetal welfare were watched in coordination with attending obstetrician. Pulse, NIBP, SpO2, respiratory rate were recorded before and after the start of procedure and every 5 mins. for first 15 mins. and then every 15 mins. for 2 hrs. If bradycardia occurred at any time (<60 bts./mins., Inj. Glycopyrrolate 0.2 mg was given. If hypotension occurred, then it was treated appropriately with IV fluids and vasopressor. If pruritus occurred, it was treated with pheniramine. Sensory blockade assessed by pinprick and motor blockade was assessed by Bromage scale. Statistical Analysis- In the present study, results are given as mean±standard deviation and range values for continuous data. Students test was used to compare the two groups, categorical data are expressed as number and percentages and difference between the groups was compared by chi-square test. A p value of 0.05 or less was set for statistical significance.RESULTS Maternal hypotension of 15% was noted in both groups, which was statistically significant. Onset of sensory analgesia in seconds showed a standard deviation of 38.12 with a mean difference of 47 seconds between the two groups was found to be statistically highly significant with a p value of <0.001. Maximal dermatomal level of sensory block achieved also showed

  3. Thoracic surgical resident education: a costly endeavor.

    Science.gov (United States)

    Calhoon, John H; Baisden, Clint; Holler, Ben; Hicks, George L; Bove, Ed L; Wright, Cameron D; Merrill, Walter H; Fullerton, Dave A

    2014-12-01

    We sought to define an accurate measure of thoracic surgical education costs. Program directors from six distinct and differently sized and geographically located thoracic surgical training programs used a common template to provide estimates of resident educational costs. These data were reviewed, clarifying questions or discrepancies when noted and using best estimates when exact data were unavailable. Subsequently, a composite of previously published cost-estimation products was used to capture accurate cost data. Data were then compiled and averaged to provide an accurate picture of all costs associated with thoracic surgical education. Before formal accounting was performed, the estimated average for all programs was approximately $250,000 per year per resident. However, when formal evaluations by the six programs were performed, the annual cost of resident education ranged from $330,000 to $667,000 per year per resident. The average cost of $483,000 per year was almost double the initial estimates. Variability was noted by region and size of program. Faculty teaching costs varied from $208,000 to $346,000 per year. Simulation costs ranged from $0 to $80,000 per year. Resident savings to program ranged from $0 to $135,000 per year and averaged $37,000 per year per resident. Thoracic surgical education costs are considerably higher than initial estimates from program directors and probably represent an unappreciated source of financial burden for cardiothoracic surgical educational programs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Thoracic CT findings at hypovolemic shock

    International Nuclear Information System (INIS)

    Rotondo, A.; Angelelli, G.; Catalano, O.; Grassi, R.; Scialpi, M.

    1998-01-01

    Purpose: To describe and discuss the thoracic CT features of hypovolemic shock. Material and Methods: From a group of 18 patients with signs of hypovolemia on contrast-enhanced abdominal CT, 11 were selected for our study as having also undergone a complete chest examination. Pulse rate, blood pressure, trauma score value, Glasgow coma scale value, surgical result, and final outcome were retrospectively evaluated. The CT features analyzed were: decreased cardiac volume, reduced caliber of the thoracic aorta, aortic branches and caval venous system, increased enhancement of the aorta, and increased enhancement of the pulmonary collapses/contusions. Results: All 11 subjects presented severe injuries and hemodynamic instability; 7 were stable enough to undergo surgery; only 1 of the 11 survived. Two patients showed none of the features of thoracic hypovolemia. All the other patients presented at least two signs: reduced caliber of the thoracic aorta in 7 cases; decreased volume of the cardiac chambers and increased aortic enhancement in 6; decreased caliber of the aortic vessels in 4; decreased caliber of the caval veins in 3; and increased enhancement of the pulmonary collapses/contusions in 3. Conclusions: In patients with hypovolemia, CT may show several thoracic findings in addition to abdominal ones. Knowledge of these features is important for distinguishing them from traumatic injuries. (orig.)

  5. Endovascular treatment of thoracic aorta aneurysm and dissection

    International Nuclear Information System (INIS)

    Petrov, I.; Stankov, Z.; Stefanov, St.; Stoyanov, Hr.

    2015-01-01

    Full text: The aim is to give up to date information about modern endovascular treatment of aortic pathology Dissection and aneurysms of the aorta are life threatening condition requiring in most of the cases prompt surgical or endovascular treatment because of the poor natural evolution. Purpose: to assess the immediate and 1-year outcome of endovascular treatment in broad spectrum of acute and subacute aortic syndrome during the last 3 years (November 2012 - August 2015) in City Clinic (Sofia, Bulgaria). We performed endovascular treatment of 47 patients (43 men, 4 women) at average age 54 y. with dissection (24) and aneurysms (23) of the aortic arch and thoracic aorta (in 5 emergent treatment was performed for aortic rupture). All patients were treated with minimal surgical femoral approach. In 4 (9%) of them initial carotid to carotid bypass was performed in order to provide a sufficient landing zone for the endograft implantation.the last 9 patients (19%) were treated without general anesthesia with either deep sedation or epidural anesthesia. Results: In all patients successful endograft implantation was achieved. Additional stent-graft or open cell stent was implanted in 4 cases in order to centralize the flow in the compressed true lumen. In 5 cases additional vascular plug or large coil was delivered in the left subclavian arteryostium in order to interrupt retrograde aneurysm or false lumen filling. Complications: 30 days mortality-2.2%, neurologic disorders (4.4%). one year survival- 45 (90.5%). 3 and 6 mo control CT scan showed no migration of the graft in 100%, full false lumen isolation in 19 out of 24 dissections (80%) and aneurysm free of expansion in 20 out of 23 (86%), patent carotid bay-pass graft in 4 of 4 (100%). This one center study showed excellent immediate and 1 year clinical and device results from endovascular repair of potentially fatal disease. Endovascular treatment is a method of choice for broad spectrum of aortic pathology

  6. Intra-arterial papaverine and leg vascular resistance during in situ bypass surgery with high or low epidural anaesthesia

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T V

    1993-01-01

    In situ saphenous vein arterial bypass flow was studied in 16 patients with respect to level of epidural anaesthesia. Arterial pressure and electromagnetic flow were used to evaluate arterial tone by intra-arterial (i.a.) papaverine. Eight patients had a low epidural block (... patients were operated during high epidural anaesthesia (> Th. 10). Flow increased and arterial pressure decreased after i.a. papaverine in all patients. When compared with patients operated during high epidural anaesthesia, flow increase and decrease in vascular resistance took place in patients operated...... during low epidural anaesthesia (P i.a. papaverine was not significantly different in patients operated in low epidural and general anaesthesia (n = 8). In eight patients with insulin-dependent diabetes mellitus who had low epidural anaesthesia, the increase...

  7. Identification of vehicle components associated with severe thoracic injury in motor vehicle crashes: a CIREN and NASS analysis.

    Science.gov (United States)

    Nirula, R; Pintar, F A

    2008-01-01

    Thoracic trauma secondary to motor vehicle crashes (MVC) continues to be a major cause of morbidity and mortality. Specific vehicle features may increase the risk of severe thoracic injury when striking the occupant. We sought to determine which vehicle contact points were associated with an increased risk of severe thoracic injury in MVC to focus subsequent design modifications necessary to reduce thoracic injury. The National Automotive Sampling System (NASS) databases from 1993 to 2001 and the Crash Injury Research and Engineering Network (CIREN) databases from 1996 to 2004 were analyzed separately using univariate and multivariate logistic regression stratified by restraint use and crash direction. The risk of driver thoracic injury, defined as an abbreviated injury scale (AIS) of score > or =3, was determined as it related to specific points of contact between the vehicle and the driver. The incidence of severe chest injury in NASS and CIREN were 5.5% and 33%, respectively. The steering wheel, door panel, armrest, and seat were identified as contact points associated with an increased risk of severe chest injury. The door panel and arm rest were consistently a frequent cause of severe injury in both the NASS and CIREN data. Several vehicle contact points, including the steering wheel, door panel, armrest and seat are associated with an increased risk of severe thoracic injury when striking the occupant. These elements need to be further investigated to determine which characteristics need to be manipulated in order to reduce thoracic trauma during a crash.

  8. Enhanced Recovery in Thoracic Surgery: A Review

    Directory of Open Access Journals (Sweden)

    Vesna D. Dinic

    2018-02-01

    Full Text Available The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.

  9. [YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia].

    Science.gov (United States)

    Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

    Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. A Case of Fatal Pulmonary Hypoplasia with Congenital Diaphragmatic Hernia, Thoracic Myelomeningocele, and Thoracic Dysplasia.

    Science.gov (United States)

    Ito, Ai; Fujinaga, Hideshi; Matsui, Sachiko; Tago, Kumiko; Iwasaki, Yuka; Fujino, Shuhei; Nagasawa, Junko; Amari, Shoichiro; Kaneshige, Masao; Wada, Yuka; Takahashi, Shigehiro; Tsukamoto, Keiko; Miyazaki, Osamu; Yoshioka, Takako; Ishiguro, Akira; Ito, Yushi

    2017-10-01

    Background  Congenital diaphragmatic hernia (CDH) is fatal in severe cases of pulmonary hypoplasia. We experienced a fatal case of pulmonary hypoplasia due to CDH, thoracic myelomeningocele (MMC), and thoracic dysplasia. This constellation of anomalies has not been previously reported. Case Report  A male infant with a prenatal diagnosis of thoracic MMC with severe hydrocephalus and scoliosis was born at 36 weeks of gestation. CDH was found after birth and the patient died of respiratory failure due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn at 30 hours of age despite neonatal intensive care. An autopsy revealed a left CDH without herniation of the liver or stomach into the thoracic cavity, severe hydrocephalus, Chiari malformation type II, MMC with spina bifida from Th4 to Th12, hemivertebrae, fused ribs, deformities of the thoracic cage and legs, short trunk, and agenesis of the left kidney. Conclusion  We speculate that two factors may be associated with the severe pulmonary hypoplasia: decreased thoracic space due to the herniation of visceral organs caused by CDH and thoracic dysplasia due to skeletal deformity and severe scoliosis.

  11. Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged.

    Science.gov (United States)

    Scull, T J; Hemmings, G T; Carli, F; Weeks, S K; Mazza, L; Zingg, H H

    1998-07-01

    To determine the effect of epidural analgesia on biochemical markers of stress, plasma oxytocin concentrations and frequency of uterine contractions during the first stage of labour. Nine nulliparous women, in spontaneous labour, with a singleton fetus and cervical dilatation < or = 5 cm were enrolled. Epidural bupivacaine 0.25% (range 10-14 ml) was administered and bilateral sensory blockade to ice (T8-L4) achieved. Blood samples were collected before the epidermal block and every 10 min for one hour after the block was achieved for the measurement of plasma beta-endorphin, cortical, glucose, lactate and oxytocin concentrations. No exogenous oxytocin was given. Intensity of pain was assessed at the time of the blood sampling using a 10 cm visual analogue scale (VAS). The frequency of uterine contractions was recorded for 60 min before and after the epidural block. There was a decrease in plasma beta-endorphin and cortisol concentrations after epidural block (P < 0.01). There were no changes in plasma glucose and lactate concentrations. The mean VAS for pain decreased 10 min after epidural block was achieved and remained < 2 throughout the study period (P < 0.001). Mean plasma oxytocin concentrations did not change. The frequency of uterine contractions before and after the epidural block was similar. The metabolic stress response to the pain of labour was attenuated by epidural analgesia. In contrast, plasma oxytocin concentration and frequency of uterine contractions were unaffected by the attenuation of metabolic stress response.

  12. Comparison of spring-loaded, loss of resistance and hanging drop techniques in lumbar epidural blocks.

    Science.gov (United States)

    Gülen, Güven; Akkaya, Taylan; Ozkan, Derya; Kaydul, Mehmet; Gözaydin, Orhan; Gümüş, Haluk

    2012-01-01

    The spring-loaded syringe is a loss of resistance syringe that provide a more objective sign that the epidural space has been entered compared with the traditional techniques. The aim of this study was to compare the time required to locate the epidural space and the backache incidence with the spring-loaded (SL), loss of resistance (LOR) and the hanging drop (HD) techniques for epidural blocks in patients undergoing transurethral resection procedure. Sixty patients undergoing transurethral resections were enrolled in the study. The patients were randomly assigned to one of three groups. Epidural block was performed in the first group with a spring-loaded syringe (n=20), in the second group with loss-of-resistance syringe (n=20), and in the third group with the hanging drop technique (n=20). The required time to locate the epidural space, the number of attempts, the incidence of dural puncture and the backache incidence were assessed during the procedure and for four weeks after the procedure in all patients. The required time to locate the epidural space was 29.1 ± 9.16 seconds in Group 1; 45.25 ± 19.58 seconds in Group 2, and 47.35 ± 11.42 seconds in Group 3 (p0.05). The use of SL syringe was found to have a shorter time period to locate the epidural space when compared with the LOR syringe and hanging drop technique.

  13. Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases

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    Kinya Nakanishi

    2011-01-01

    Full Text Available We report three cases of spontaneous spinal epidural hematoma (SSEH with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.

  14. Neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor.

    Science.gov (United States)

    Bell, Aleeca F; White-Traut, Rosemary; Medoff-Cooper, Barbara

    2010-01-01

    To explore relationships between maternal epidural analgesia and two measures of neurobehavioral organization in infants at the initial feeding 1 hour after birth. Prospective comparative design. Inner-city community hospital, Chicago, Illinois. Convenience sample of 52 low-risk, mainly Black and Latino, mother/infant dyads. Mothers self-selected to labor with epidural or no labor pain medication. Neonatal neurobehavioral organization was measured in term infants at the initial feeding 1 hour after birth. A nutritive sucking apparatus generated data on total number of sucks and sucking pressure. Video recordings of infants (before and after the initial feeding) were coded for behavioral states, with analysis on frequency of alertness. Total number of sucks and sucking pressure were not related to epidural exposure, although an epidural drug dosage effect on total number of sucks was evident when gender was a factor. Unmedicated girls demonstrated more sucks than girls in the high-dosage epidural group (p=.027). Overall, girls exhibited stronger sucking pressure than boys (p=.042). Frequency of alertness was not related to epidural exposure, although longer labor was related to greater alertness (p=.003), and Latino infants were more alert than Black infants (p=.002). Results suggest attenuated neonatal nutritive sucking organization in girls after exposure to high maternal epidural dosages. In comparison to boys, girls may have enhanced neurobehavioral organization at birth. Race/ethnicity and alertness may have spurious associations in which hidden factors drive the relationship.

  15. A RARE CASE OF THORACIC ACTINOMYCOSIS

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    Priyanka Das

    2017-10-01

    Full Text Available PRESENTATION OF CASE Actinomycetes are branching gram-positive anaerobic bacteria belonging to Actinomycetaceae family and are commensals in human oropharynx, gastrointestinal tract and female genitalia. Thoracic or pulmonary actinomycosis is an uncommon bacterial infection. The diagnosis of pulmonary or thoracic actinomycosis is often confounding because of its shared clinical features with malignant lung diseases and chronic suppurative lung diseases. However, chest physicians should be aware of actinomycosis being a differential diagnosis in persistent shadows in lung as early diagnosis leads to good prognosis. 1

  16. Failures and complications of thoracic drainage

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    Đorđević Ivana

    2006-01-01

    Full Text Available Background/Aim. Thoracic drainage is a surgical procedure for introducing a drain into the pleural space to drain its contents. Using this method, the pleura is discharged and set to the physiological state which enables the reexpansion of the lungs. The aim of the study was to prove that the use of modern principles and protocols of thoracic drainage significantly reduces the occurrence of failures and complications, rendering the treatment more efficient. Methods. The study included 967 patients treated by thoracic drainage within the period from January 1, 1989 to June 1, 2000. The studied patients were divided into 2 groups: group A of 463 patients treated in the period from January 1, 1989 to December 31, 1994 in whom 386 pleural drainage (83.36% were performed, and group B of 602 patients treated form January 1, 1995 to June 1, 2000 in whom 581 pleural drainage (96.51% were performed. The patients of the group A were drained using the classical standards of thoracic drainage by the general surgeons. The patients of the group B, however, were drained using the modern standards of thoracic drainage by the thoracic surgeons, and the general surgeons trained for this kind of the surgery. Results. The study showed that better results were achieved in the treatment of the patients from the group B. The total incidence of the failures and complications of thoracic drainage decreased from 36.52% (group A to 12.73% (group B. The mean length of hospitalization of the patients without complications in the group A was 19.5 days versus 10 days in the group B. The mean length of the treatment of the patients with failures and complications of the drainage in the group A was 33.5 days versus 17.5 days in the group B. Conclusion. The shorter length of hospitalization and the lower morbidity of the studied patients were considered to be the result of the correct treatment using modern principles of thoracic drainage, a suitable surgical technique, and a

  17. Thoracic pain in a collegiate runner.

    Science.gov (United States)

    Austin, G P; Benesky, W T

    2002-08-01

    This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the university track team.

  18. Idiopathic thoracic transdural intravertebral spinal cord herniation

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    Mazda K Turel

    2017-01-01

    Full Text Available Idiopathic spinal cord herniation is a rare and often missed cause of thoracic myelopathy. The clinical presentation and radiological appearance is inconsistent and commonly confused with a dorsal arachnoid cyst and often is a misdiagnosed entity. While ventral spinal cord herniation through a dural defect has been previously described, intravertebral herniation is a distinct entity and extremely rare. We present the case of a 70-year old man with idiopathic thoracic transdural intravertebral spinal cord herniation and discuss the clinico-radiological presentation, pathophysiology and operative management along with a review the literature of this unusual entity.

  19. Lungs, pleura, thoracal wall. 7. rev. ed.

    International Nuclear Information System (INIS)

    Stender, H.S.

    1988-01-01

    The book describes the anatomy of the lungs, as well as X-ray, computerized tomography, nuclear magnetic resonance, and nuclear-medical imaging techniques. Following a discussion of the general symptomatology of pulmonary diseases verifiable by X-ray, the individual diseases including inhalation damage from inorganic dusts and gases are dealt with. Traumatic thoracal conditions, the image of the thorax after operations, alterations of the thoracal wall, as well as pleural diseases are also discussed. (MG) With 1776 figs., 52 tabs [de

  20. Rare location of spondylitis tuberculosis;atlanto-axial, sacral and cervico-thoracic junction

    Science.gov (United States)

    Victorio; Nasution, M. D.; Ibrahim, S.; Dharmajaya, R.

    2018-03-01

    Three cases of rare location spondylitis tuberculosis are reported, each in atlantoaxial, cervico-thoracic junction,and sacral. The complaints were aweakness of motoric strength and local back pain. Patients’thoracal x-ray was normal, there was no complaint of acough, PCR forTB was early diagnostic and positive in all three cases, HIV negative, intraoperative tissue samplings were sent for histopathology examination and the results showed thespecific inflammatory process. Lesions were evaluated with computer tomography and/or MRI imaging.Preoperative TB regimens therapy were given for 2 weeks and continued for nine months. The surgical procedurewas done in all cases with excellent improvement of symptoms and motoric strength. In our institution,25 cases of total TB spondylitis were performed in 2 years, only 1 case eachwas found in atlanto-axial, cervico-thoracic and sacral.

  1. Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation

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    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD and ropivacaine + clonidine (RC, comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS version 10.0 for windows and value of P 0.05. Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia.

  2. Intraventricular Hemorrhage after Epidural Blood Patching: An Unusual Complication

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    Mohammad Sorour

    2014-01-01

    Full Text Available The authors present two cases of intraventricular hemorrhage (IVH believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT scan after undergoing an epidural blood patch (EBP. This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her overall symptoms. The second patient, a 29-year-old woman, was found to have nontraumatic IVH three days after undergoing an EBP. This was seen on CT scan of the head for workup of pressure-like headaches, nausea, vomiting, and absence seizures. Conservative management was followed in both instances. Serial CT scan of the head in our first patient displayed complete resolution of her IVH. The second patient did not have follow-up CT scans because her overall clinical picture had improved significantly. This highlights a potential sequel of EBP that may be observed on CT scan of the head. In the event that IVH is detected, signs and symptoms of hydrocephalus should be closely monitored with the consideration for a future workup if warranted by the clinical picture.

  3. Labor epidural analgesia is independent risk factor for neonatal pyrexia.

    Science.gov (United States)

    Agakidis, Charalampos; Agakidou, Eleni; Philip Thomas, Sumesh; Murthy, Prashanth; John Lloyd, David

    2011-09-01

    To explore whether epidural analgesia (EA) in labor is independent risk factor for neonatal pyrexia after controlling for intrapartum pyrexia. Retrospective observational study of 480 consecutive term singleton infants born to mothers who received EA in labor (EA group) and 480 term infants delivered to mothers who did not receive EA (NEA group). Mothers in the EA group had significantly higher incidence of intrapartum pyrexia [54/480 (11%) vs. 4/480 (0.8%), OR = 15.1, p neonatal pyrexia [68/480 (14.2%) vs. 15/480 (3.1%), OR = 5.1, p Neonates in the EA group had a median duration of pyrexia of 1 h (maximum 5 h) with a peak temperature within 1 h. Stepwise logistic regression analysis showed that maternal EA was independent risk factor for neonatal pyrexia (>37.5°C) after controlling for intrapartum pyrexia (>37.9°C) and other confounders (OR = 3.44, CI = 1.9-6.3, p neonates. It is unnecessary to investigate febrile offspring of mothers who have had epidurals unless pyrexia persists for longer than 5 h or other signs or risk factors for neonatal sepsis are present.

  4. Treatment of traumatic rupture of the thoracic aorta

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    Davidović Lazar

    2008-01-01

    Full Text Available INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74. RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25% patients died, while two (16.6% had paraplegia. Nine patients (75% were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years. CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases or external heparin-bonded shunts (five of our cases. Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.

  5. Posterior epidural disc fragment masquerading as spinal tumor: Review of the literature.

    Science.gov (United States)

    Park, Taejune; Lee, Ho Jun; Kim, Jae Seong; Nam, Kiyeun

    2018-03-09

    Posterior epidural lumbar disc fragment is infrequent because of anatomical barriers, and it is difficult to diagnose posterior epidural lumbar disc fragment because of its rare incidence and the ambiguity of radiologic evaluations. And it is difficult to differentiate it from other diseases such as spinal tumors. Differential diagnosis of posterior epidural lumbar disc fragment is clinically important because its diagnosis can affect treatment and prognosis. To investigate the incidence, anatomical concern, etiology, symptom, diagnostic tool, management and prognosis of posterior epidural lumbar disc fragment, we reviewed articles including case report. We performed a search of all clinical studies of posterior epidural lumbar disc fragment published to date. The following keywords were searched: Posterior epidural lumbar disc fragment, disc migration, posterior epidural disc, extradural migration, dorsal epidural migration, sequestrated disc, and disc fragment. We identified 40 patients of posterior epidural lumbar disc fragment from 28 studies. The most common presentation of posterior epidural lumbar disc fragment was sudden onset radiculopathy (70.0%), followed by cauda equina syndrome (27.5%). The most frequently used diagnostic modality was magnetic resonance imaging (MRI), conducted in 36 cases (90.0%), and followed by computed tomography in 14 cases (35.0%). After the imaging studies, the preoperative diagnoses were 45.0% masses, 20.0% lesions, and 12.5% tumors. Characteristic MRI findings in posterior epidural lumbar disc fragment are helpful for diagnosis; it typically displays low signals on T1-weighted images and high signals on T2-weighted images with respect to the parent disc. In addition, most of the disc fragments show peripheral rim enhancement on MRI with gadolinium administration. Electrodiagnostic testing is useful for verifying nerve damage. Surgical treatment was performed in all cases, and neurologic complications were observed in 12.5%. As

  6. Cervical spinal epidural abscess following acupuncture and wet-cupping therapy: A case report.

    Science.gov (United States)

    Yao, Yindan; Hong, Wenke; Chen, Huimin; Guan, Qiongfeng; Yu, Hu; Chang, Xianchao; Yu, Yaoping; Xu, Shanhu; Fan, Weinv

    2016-02-01

    Report of an uncommon complication of acupuncture and wet cupping. A 54-year-old man presented with neck pain and fever. Magnetic resonance imaging of the cervical spine revealed an epidural abscess at C4 to T2. The symptoms related to epidural abscess resolved partially after treatment with antibiotics. Acupuncture and wet-cupping therapy should be taken into consideration as a cause of spinal epidural abscesses in patients who present with neck pain and fever. Furthermore, acupuncture and wet-cupping practitioners should pay attention to hygienic measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Spinal epidural hematomas examined on MRI; Krwiaki nadtwardowkowe, wewnatrzkanalowe w badaniu metoda MR

    Energy Technology Data Exchange (ETDEWEB)

    Rejnowski, G.; Poniatowska, R.; Kozlowski, P. [Zaklad Neuroradiologii, Inst. Psychiatrii i Neurologii, Warsaw (Poland)

    1995-12-31

    Spinal epidural hematomas are rare pathology, caused by trauma or spontaneous. In clinical examination acute spinal cord compression is observed. MRI designations appear entirely particular. In sagittal projection, biconvex mass in the dorsal, or sometimes ventral part of the spinal canal is clearly visible. This is well delineated by the thecal sac from the cord and cauda equina. MRI investigations in 3 patients revealed corresponding with spinal bone injuries and cord edema epidural hematomas. Differential diagnosis must contain subdural hematoma and epidural neoplasms or abscess. (author) 8 refs, 3 figs

  8. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  9. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    Directory of Open Access Journals (Sweden)

    Joyce Leary

    2013-01-01

    Full Text Available Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues.

  10. Acute epidural hematoma manifesting with monoplegia in a child: Case report

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    Hakan Ak

    2013-06-01

    Full Text Available A seven year-old girl presented with left sided painlessmonoplegia at the lower extremity after falling from twometers height. Cranial computed tomography showedright sided fronto-parietal epidural hematoma. Urgentdecompressive craniotomy for the evacuation of the hematomawas performed. Patient discharged two weeksafter admission with minimal loss of muscle strength.Fronto-parietal epidural hematomas may also manifestwith monoplegia and early evacuation should be standardmanagement. J Clin Exp Invest 2013; 4 (2: 223-225Key words: Epidural hematoma, monoplegia, computedtomography

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

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    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.

  12. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  13. 罗哌卡因与布比卡因硬膜外自控镇痛的比较研究%Comparison of Ropivacaine and Bupivacaine for Postoperative Patient- controlled Epidural Analgesia

    Institute of Scientific and Technical Information of China (English)

    徐建設; 陳仲清; 廖志婕

    2002-01-01

    Objective To compare the characteristics of ropivacaine with bupivacaine for postoperative patient-controlled epidural analgesia(PCEA).Method Sixty epidural anesthesia patients (ASA Ⅰ~Ⅱ ) scheduled for low abdominalsurgery were divided into two groups randomly to receive 0.125% ropivacaine or0.125% bupivacaine for postoperative patient-controlled epidural analgesia respectively. A bolus doses of 5ml with 30min lockout and a continuous dose of 2ml/h weregiven within 48 hours after surgery. Analgesic efficacy was assessed using 100mm visual analog pain scores (VAS) ,and motorblock was assessed using Bromage score. Volume of the epidural infusion and number of patients requesting supplementaryanalgesics were recorded. Result There were no significant differences between groups in pain scores, volume of the epiduralinfusion and number of patients requesting supplementary analgesics (P > 0.05). But there was higher incidence of zeroBromage score at some time and mobilization recovered more quickly in ropivacaine group. Conclusion Comparing withbupivacaine,0. 125 % ropivacaine may produce equivalent anaglesia, less motor block and early recovery of mobilization forpostoperative (PCEA).

  14. Life-threatening neonatal epidural hematoma caused by precipitous vaginal delivery.

    Science.gov (United States)

    Josephsen, Justin B; Kemp, Joanna; Elbabaa, Samer K; Al-Hosni, Mohamad

    2015-01-30

    Neonatal in-hospital falls occur relatively frequently, although they are likely underreported. Significant intracranial head trauma from a fall or birth injury is not common in the immediate newborn period. Furthermore, intracranial bleeding requiring surgical intervention is exceedingly rare. We present an unusual case of an in-hospital fall in the delivery room requiring neurosurgical intervention. A term infant, appropriate for gestational age, delivered precipitously from a maternal standing position. The vertex neonate struck the linoleum floor after an approximate 80-cm fall, landing headfirst. The physical and neurological exams were initially normal, and skull films did not demonstrate an obvious fracture. The baby was closely observed, undergoing continuous cardiorespiratory monitoring. After the patient had an episode of apnea, a scalp hematoma was noted. A computed tomography (CT) scan revealed a left parietal fracture with an acute epidural hematoma, which required emergent craniotomy. The infant had an unremarkable post-operative course and had a normal neurodevelopmental assessment at 15 months of age. Close, continuous observation is recommended for infants following an in-hospital fall or after significant birth trauma. A high degree of suspicion for intracranial hemorrhage must be maintained. Fall prevention strategies should focus on careful baby handling by the convalescing mother.

  15. Evolution of Thoracic Surgery in Canada

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    Jean Deslauriers

    2015-01-01

    Full Text Available BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another.

  16. Thoracic endometriosis syndrome: Current concept in ...

    African Journals Online (AJOL)

    Background: Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective: To review the current concepts in the pathophysiology and ...

  17. Thoracic Ectopia Cordis in an Ethiopian Neonate

    African Journals Online (AJOL)

    GB

    2017-03-01

    Mar 1, 2017 ... Thoracic Ectopia Cordis in an Ethiopian Neonate. Henok Tadele*. 1 ... the chest wall. Initial treatment included covering the heart with sterile-saline soaked dressing, starting systemic antibiotics and supportive care. A staged ... of thoracoabdominal EC, anterior diaphragmatic hernia, lower sternal defect and ...

  18. April 2014 Arizona thoracic society notes

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    Robbins RA

    2014-04-01

    Full Text Available No abstract available. Article truncated at 150 words. The April 2014 Arizona Thoracic Society meeting was held on Wednesday, 4/23/2014 at Scottsdale Shea Hospital beginning at 6:30 PM. There were 15 in attendance representing the pulmonary, critical care, sleep, pathology and radiology communities. It was announced that there will be a wine tasting with the California, New Mexico and Colorado Thoracic Societies at the American Thoracic Society International Meeting. The tasting will be led by Peter Wagner and is scheduled for the Cobalt Room in the Hilton San Diego Bayfront on Tuesday, May 20, from 4-8 PM. Guideline development was again discussed. The consensus was to await publication of the IDSA Cocci Guidelines and respond appropriately. George Parides, Arizona Chapter Representative, gave a presentation on Hill Day. Representatives of the Arizona, New Mexico and Washington Thoracic Societies met with their Congressional delegations, including Rep. David Schweikert, to discuss the Cigar Bill, NIH funding, and the Medicare Sustainable Growth ...

  19. Thoracic trauma: presentation and management outcome

    International Nuclear Information System (INIS)

    Saaiq, M.; Shah, S. A.

    2008-01-01

    To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. out of 143 patients, 119 (83)% were males and 24 (17)% were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66)% patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. there were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions. (author)

  20. Thoracic and abdominopelvic actinomycosis | Spiegel | SA Journal ...

    African Journals Online (AJOL)

    intervention it is worthwhile including actinomycosis infection in the differential diagnosis. We present radiological findings for 4 patients presenting with different forms of thoracic and abdominopelvic actinomycosis infection, and a short review of the documented literature findings. South African Journal of Radiology Vol.

  1. Acquired intrathoracic kidney in thoracic kyphosis

    International Nuclear Information System (INIS)

    Murayama, Sadayuki; Kawashima, Akira; Ohuchida, Toshiyuki; Russell, W.J.

    1986-12-01

    Two cases of acquired intrathoracic kidney associated with thoracic kyphosis are reported, with emphasis on the radiographic manifestations. A search of the scientific literature disclosed that the acquired type of this abnormality is rare. The importance of recognizing this entity from a differential diagnostic standpoint is underscored. (author)

  2. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

    Directory of Open Access Journals (Sweden)

    Wagner Pasqualini

    2012-09-01

    Full Text Available A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente com leucemia.La ocurrencia de hematoma epidural, como complicación posquirúrgica, es relativamente baja. El reconocimiento de esa patología, en el diagnóstico diferencial en las paraplejías posquirúrgicas inmediatas y el tratamiento precoz por medio de intervención quirúrgica con la descompresión del canal, son factores que se relacionan directamente con la mejoría del cuadro neurológico. Este relato de caso es de un hematoma epidural en el posoperatorio inmediato, después de descompresión, por estenosis, del canal vertebral lumbar en paciente con leucemia.The occurrence of epidural hematoma as a postoperative complication is relatively low. The recognition of this condition in the differential diagnosis in the immediate postoperative paraplegia and the early surgical decompression are directly related with neurological improvement. We report a case of epidural hematoma in the early postoperative period of surgical decompression of the lumbar spinal canal, in a patient with leukemia.

  3. Unsuspected spondylolysis in patients with lumbar disc herniation on MRI: The usefulness of posterior epidural fat.

    Science.gov (United States)

    Akhaddar, A; Boucetta, M

    2012-12-01

    Lumbar disc herniation (LDH) at the level of non-displaced spondylolysis (isthmic spondylolisthesis) is an uncommon association rarely evaluated in the literature. In this study, authors examine whether the continuous posterior epidural fat between the dura mater and spinous process (continuous double-hump sign) at the level of LDH is a valuable tool to identify patients with non-displaced spondylolysis on MRI. Eighteen patients (group 1) presented at our department (2000-2010) with a LDH associated with an undiagnosed non-displaced spondylolysis on MRI. Spondylolysis was confirmed by direct visualization of the defect on CT-scan, dynamic radiography, MRI or at surgery. To validate this method, we made the same evaluation in 20 surgically treated patients (group 2) with a one-level LDH without spondylolysis. In all patients of group 1 spondylolysis was unsuspected on the MRI report. However, a positive "continuous double-hump sign" was seen in 16 patients. The spondylolysis was recognized on MRI in six cases, on CT-scan in nine cases and on dynamic radiography in one case. Two cases were diagnosed surgically. In group 2, only one patient had a positive "continuous double-hump sign". This new sign had a specificity of 95%, sensitivity of 88.88%, and accuracy of 92.10% for diagnosis of non-displaced spondylolysis. Non-displaced spondylolysis may be associated with adjacent LDH. Although uncommon, it is important for neurosurgeons to be aware of this association because of its implication on the therapeutical management. MRI is not always sufficient to recognize a non-displaced spondylolysis with certainty; however "continuous double-hump sign" may be used as a simple valuable diagnosis tool. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  4. Right thoracic curvature in the normal spine

    Directory of Open Access Journals (Sweden)

    Masuda Keigo

    2011-01-01

    Full Text Available Abstract Background Trunk asymmetry and vertebral rotation, at times observed in the normal spine, resemble the characteristics of adolescent idiopathic scoliosis (AIS. Right thoracic curvature has also been reported in the normal spine. If it is determined that the features of right thoracic side curvature in the normal spine are the same as those observed in AIS, these findings might provide a basis for elucidating the etiology of this condition. For this reason, we investigated right thoracic curvature in the normal spine. Methods For normal spinal measurements, 1,200 patients who underwent a posteroanterior chest radiographs were evaluated. These consisted of 400 children (ages 4-9, 400 adolescents (ages 10-19 and 400 adults (ages 20-29, with each group comprised of both genders. The exclusion criteria were obvious chest and spinal diseases. As side curvature is minimal in normal spines and the range at which curvature is measured is difficult to ascertain, first the typical curvature range in scoliosis patients was determined and then the Cobb angle in normal spines was measured using the same range as the scoliosis curve, from T5 to T12. Right thoracic curvature was given a positive value. The curve pattern was organized in each collective three groups: neutral (from -1 degree to 1 degree, right (> +1 degree, and left ( Results In child group, Cobb angle in left was 120, in neutral was 125 and in right was 155. In adolescent group, Cobb angle in left was 70, in neutral was 114 and in right was 216. In adult group, Cobb angle in left was 46, in neutral was 102 and in right was 252. The curvature pattern shifts to the right side in the adolescent group (p Conclusions Based on standing chest radiographic measurements, a right thoracic curvature was observed in normal spines after adolescence.

  5. CT morphometry of adult thoracic intervertebral discs.

    Science.gov (United States)

    Fletcher, Justin G R; Stringer, Mark D; Briggs, Christopher A; Davies, Tilman M; Woodley, Stephanie J

    2015-10-01

    Despite being commonly affected by degenerative disorders, there are few data on normal thoracic intervertebral disc dimensions. A morphometric analysis of adult thoracic intervertebral discs was, therefore, undertaken. Archival computed tomography scans of 128 recently deceased individuals (70 males, 58 females, 20-79 years) with no known spinal pathology were analysed to determine thoracic disc morphometry and variations with disc level, sex and age. Reliability was assessed by intraclass correlation coefficients (ICCs). Anterior and posterior intervertebral disc heights and axial dimensions were significantly greater in men (anterior disc height 4.0±1.4 vs 3.6±1.3 mm; posterior disc height 3.6±0.90 vs 3.4±0.93 mm; p<0.01). Disc heights and axial dimensions at T4-5 were similar or smaller than at T2-3, but thereafter increased caudally (mean anterior disc height T4-5 and T10-11, 2.7±0.7 and 5.4±1.2 mm, respectively, in men; 2.6±0.8 and 5.1±1.3 mm, respectively, in women; p<0.05). Except at T2-3, anterior disc height decreased with advancing age and anteroposterior and transverse disc dimensions increased; posterior and middle disc heights and indices of disc shape showed no consistent statistically significant changes. Most parameters showed substantial to almost perfect agreement for intra- and inter-rater reliability. Thoracic disc morphometry varies significantly and consistently with disc level, sex and age. This study provides unique reference data on adult thoracic intervertebral disc morphometry, which may be useful when interpreting pathological changes and for future biomechanical and functional studies.

  6. Labor induction just after external cephalic version with epidural analgesia at term.

    Science.gov (United States)

    Cuerva, Marcos J; Piñel, Carlos S; Caceres, Javier; Espinosa, Jose A

    2017-06-01

    To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV. ECV succeeded in 26 out of 40 (65%) patients. Among the 26 successful ECV, 6 delivered by cesarean (23.1%). 20 patients delivered vaginally (76.9%; 50% of all patients). Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient. Copyright © 2017. Published by Elsevier B.V.

  7. Labor induction just after external cephalic version with epidural analgesia at term

    Directory of Open Access Journals (Sweden)

    Marcos J. Cuerva

    2017-06-01

    Conclusion: Considering that a high number of cesarean deliveries can be avoided, induction of labor after ECV with epidural analgesia at term can be considered after being discussed in selected patient.

  8. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Multicentre randomised controlled equivalence trial. 15 hospitals in the Netherlands. Women with an intermediate to high obstetric risk with an

  9. Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia : a randomised equivalence trial

    NARCIS (Netherlands)

    Logtenberg, Slm; Oude Rengerink, K; Verhoeven, C J; Freeman, L M; van den Akker, Esa; Godfried, M B; van Beek, E; Borchert, Owhm; Schuitemaker, N; van Woerkens, Ecsm; Hostijn, I; Middeldorp, J M; van der Post, J A; Mol, B W

    OBJECTIVE: To distinguish satisfaction with pain relief using remifentanil patient-controlled analgesia (RPCA) compared with epidural analgesia (EA) in low-risk labouring women. DESIGN: Randomised controlled equivalence trial. SETTING: Eighteen midwifery practices and six hospitals in the

  10. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M; Bloemenkamp, Kitty W; Franssen, Maureen T; Papatsonis, Dimitri N; Hajenius, Petra J; Hollmann, Markus W; Woiski, Mallory D; Porath, Martina; van den Berg, Hans J; van Beek, Erik; Borchert, Odette W H M; Schuitemaker, Nico; Sikkema, J Marko; Kuipers, A H M; Logtenberg, Sabine L M; van der Salm, Paulien C M; Oude Rengerink, Katrien; Lopriore, Enrico; van den Akker-van Marle, M Elske; le Cessie, Saskia; van Lith, Jan M; Struys, Michel M; Mol, Ben Willem J; Dahan, Albert; Middeldorp, Johanna M; Oude Rengerink, K

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  11. Patient controlled analgesia with remifentanil versus epidural analgesia in labour : randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, Liv M.; Bloemenkamp, Kitty W.; Franssen, Maureen T.; Papatsonis, Dimitri N.; Hajenius, Petra J.; Hollmann, Markus W.; Woiski, Mallory D.; Porath, Martina; van den Berg, Hans J.; van Beek, Erik; Borchert, Odette W. H. M.; Schuitemaker, Nico; Sikkema, J. Marko; Kuipers, A. H. M.; Logtenberg, Sabine L. M.; van der Salm, Paulien C. M.; Rengerink, Katrien Oude; Lopriore, Enrico; van den Akker-van Marle, M. Elske; le Cessie, Saskia; van Lith, Jan M.; Struys, Michel M.; Mol, Ben Willem J.; Dahan, Albert; Middeldorp, Johanna M.

    2015-01-01

    Objective To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an

  12. Patient controlled analgesia with remifentanil versus epidural analgesia in labour: randomised multicentre equivalence trial

    NARCIS (Netherlands)

    Freeman, L.M.; Bloemenkamp, K.W.; Franssen, M.T.; Papatsonis, D.N.; Hajenius, P.J.; Hollmann, M.W.; Woiski, M.D.; Porath, M.; Berg, H.J. van den; Beek, E. van; Borchert, O.W.; Schuitemaker, N.; Sikkema, J.M.; Kuipers, A.H.; Logtenberg, S.L.; Salm, P.C. van der; Oude Rengerink, K.; Lopriore, E.; Akker-van Marle, M.E. van den; Cessie, S. le; Lith, J.M. van; Struys, M.M.; Mol, B.W.; Dahan, A; Middeldorp, J.M.

    2015-01-01

    OBJECTIVE: To determine women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. DESIGN: Multicentre randomised controlled equivalence trial. SETTING: 15 hospitals in the Netherlands. PARTICIPANTS: Women with an

  13. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  14. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen Vestergaard; Bak, Marie; Christensen, Birgitte Viebæk

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  15. Penggunaan Teknik Obat dan Permasalahan Blokade Epidural di Wilayah Jawa Barat pada Tahun 2015

    Directory of Open Access Journals (Sweden)

    Muhammad Ibnu

    2017-12-01

    Full Text Available Blokade epidural merupakan salah satu jenis anestesi regional yang memiliki rentang implikasi lebih luas dibanding dengan blokade spinal. Perbedaan teknik maupun rejimen obat untuk blokade epidural meningkat seiring dengan meningkatnya ketertarikan di bidang anestesi regional dikarenakan teknik anestesi regional memberikan efek analgesi yang efektif tanpa memengaruhi kesadaran pasien dan meningkatkan kenyamanan pasien. Tujuan penelitian ini mencari data mengenai penggunaan, teknik, rejimen obat, dan permasalahan yang dialami oleh dokter anestesi di Jawa Barat dalam melakukan blokade epidural. Penelitian ini dilakukan pada bulan Agustus hingga September 2016 di Departemen Anestesiologi dan Terapi Intensif Rumah Sakit Dr. Hasan Sadikin Bandung. Penelitian ini bersifat deskriptif dengan pengambilan data menggunakan kuesioner dan pendekatan cross sectional. Kuesioner dikirimkan kepada 120 dokter spesialis anestesi di Jawa Barat melalui jasa pos dan 30 kuesioner diberikan langsung kepada dokter spesialis anestesi yang bekerja di Rumah Sakit Dr. Hasan Sadikin Bandung. Angka respons yang didapatkan sebesar 47,3%. Hasil penelitian ini didapatkan dokter spesialis anestesi yang masih melakukan blokade epidural pada tahun 2015 sebesar 73,2%, teknik penusukan yang paling banyak dilakukan adalah pendekatan midline sebesar 73%, dan identifikasi rongga epidural paling banyak dengan pendekatan lost of resistance sebesar 80,7%. Obat anestesi lokal yang paling banyak digunakan untuk blokade epidural adalah bupivakain sebesar 95,9%. Adjuvan yang paling banyak digunakan adalah fentanil sebesar 92,3%. Permasalahan yang berkaitan dalam pelaksanaan tindakan blokade epidural pada tahun 2015 paling banyak adalah permasalahan staf di ruangan dalam membantu menangani pasien dengan epidural, yaitu sebesar 38,03%. Epidural Blockade Administration Technique and Issues in West Java in 2015 Epidural blockade is one of the regional anesthesia techniques with wider implication

  16. Spontaneous spinal epidural haematoma: a rare cause of quadriplegia in the post-partum period.

    Science.gov (United States)

    Bose, S; Ali, Z; Rath, G P; Prabhakar, H

    2007-12-01

    Spontaneous spinal epidural haematoma (SSEH) is a rare cause of neurological deficit in the pregnant and post-partum patients. However, SSEH with associated myelitis presenting as quadriplegia and respiratory paralysis in the post-partum period has never been reported. We report the development of acute onset quadriplegia progressing to respiratory arrest in a 24-yr-old woman 2 weeks after normal vaginal delivery. There was no history suggestive of any coagulopathy (inherited or acquired), eclampsia, pre-existing neurological deficit, or iatrogenic manipulations such as spinal/epidural injections. Magnetic resonance imaging revealed a posterior epidural haematoma extending from C4-C7 and areas of signal changes in spinal cord from cervicomedullary junction to D5 level (suggestive of demyelination). We highlight this rare cause of quadriplegia; focusing on the altered dynamics of the epidural vasculature in the peripartum period leading to SSEH.

  17. The effects of epidural analgesia on the course and outcome of labour.

    Science.gov (United States)

    Finster, M; Santos, A C

    1998-09-01

    The potential effects of epidural analgesia on the progress and outcome of labour have been the subject of lasting controversy. Retrospective reviews indicate that epidurals are associated with longer labours and/or an increase in the incidence of instrumental or operative delivery. Similar results were obtained in non-randomized prospective studies. None of them established a causal relationship, because without randomization the selection bias cannot be ruled out. Other factors, such as premature rupture of membranes and maternal socioeconomic status, may affect the outcome of labour. It was also reported that introduction of the on-demand epidural service did not increase the primary caesarean section rate. The few prospective randomized studies are contradictory and not very reliable owing to small patient populations and high cross-over rates. There is, however, unanimity among the authors regarding the superiority of pain relief provided by epidural blocks over systemically administered opioids.

  18. Diagnosis of epidural hematoma by brain scan and perfusion study: case report

    International Nuclear Information System (INIS)

    Buozas, D.J.; Barrett, I.R.; Mishkin, F.S.

    1976-01-01

    By using the arterial and venous phases of an anterior cerebral perfusion study, which showed downward displacement of the sagittal sinus, and the finding of a rim on the delayed scans, the specific diagnosis of epidural hematoma was established

  19. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    Directory of Open Access Journals (Sweden)

    Ignatius Ngene Esene

    2016-01-01

    Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis.

  20. Spontaneous cervical epidural hematoma: a case report and review of the literature

    International Nuclear Information System (INIS)

    Aparici, F.; Mas, F.; Solera, M. C.; Moro, G.

    2002-01-01

    We present the case of a 78-year-old woman with a spontaneous spinal epidural hematoma that presented with sudden interscapular pain accompanied by left hemiparesis and a significant improvement 15 minutes later. Initially diagnosed as angina, the persistence of pain in dorsal cervical spine suggested the need to perform magnetic resonance imaging (MRI). The images demonstrated a lesion in the epidural spinal canal at level C3-D2 that presented a heterogeneous signal intensity, with hyperintense areas in T1-weighted sequences and hypointense areas in gradient-echo sequences, with no sign of compression myelopathy. A diagnosis of epidural hematoma was established and, given the favorable clinical course, conservative treatment was indicated. The second MRI study showed the complete resorption of the epidural hematoma. (Author) 12 refs