Biomedical subjects

C M Viscomi

Publications and source records attributed to C M Viscomi.

23 records · Page 2Linked to original sources

PubMedDate not supplied

Anesthetic management of a parturient with an incompletely resected cerebral arteriovenous malformation.

BACKGROUND AND OBJECTIVES: The anesthetic, neurosurgical, and obstetric literature regarding management of parturients with intracranial arteriovenous malformations is relatively sparse. A case report is given of a parturient, with a recent subtotal resection of a cerebral arteriovenous malformation, who presented for delivery of a viable male fetus. METHODS: The patient was scheduled for an elective labor induction, with early epidural analgesia advocated as a strategy to minimize the cardiovascular changes of labor and prevent involuntary Valsalva maneuvers. An elective instrumental delivery was planned when the fetal head had descended appropriately. RESULTS: Epidural analgesia was initiated when the patient reached 3 cm cervical dilation and provided excellent labor analgesia. After a passive fetal descent during the second stage of labor, Luikart-Simpson forceps were used to facilitate this stage. The newborn Apgar score was 9 at both 1 and 5 minutes after delivery. Both the patient and the infant have done well. CONCLUSIONS: The available obstetric and neurosurgical literature does not offer firm recommendations for the optimal route of fetal delivery or the timing of neurosurgical resection of an arteriovenous malformation in the parturient. Anesthetic management is predicated on the principles of minimizing the cardiovascular changes of labor and preventing involuntary Valsalva maneuvers during the second stage of labor. Both of these goals are readily accomplished with epidural anesthesia.

Adult↗

PubMedDate not supplied

Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia.

BACKGROUND AND OBJECTIVES: Lipophilic opioids, especially fentanyl and sufentanil, are increasingly being administered intrathecally as adjuncts to spinal anesthesia. This review analyzes the efficacy of these opioids for subarachnoid anesthesia. METHODS: Medline search of the literature from 1980 to the present and a survey of recent meeting abstracts are reviewed. RESULTS: A significant number of citations regarding intrathecal lipophilic opioids as adjuncts to spinal anesthesia were found: 59 are cited in this review. Most clinical experience has been in obstetric surgery, but lipophilic spinal opioid administration is being used with greater frequency for other surgical procedures as well. The benefits include reduction of minimal alveolar concentration (MAC) when general anesthesia is combined with spinal anesthesia and enhancement of the quality of spinal anesthesia without prolongation of motor block. Intrathecal fentanyl and sufentanil allow clinicians to use smaller doses of spinal local anesthetic, yet still provide excellent anesthesia for surgical procedures. Furthermore, lipophilic opioid/local anesthetic combination permits more rapid motor recovery; short outpatient procedures are therefore more amenable to spinal anesthesia. Finally, the side-effect profiles of intrathecal lipophilic opioids are now well characterized and appear less troublesome than intrathecal morphine. CONCLUSIONS: The anesthesia-enhancing properties and side-effect profile of lipophilic opioids administered intrathecally suggest significant roles for these agents as adjuncts to spinal anesthesia for obstetric and outpatient procedures.

Adjuvants, Anesthesia↗

PubMedDate not supplied

Maternal fever, neonatal sepsis evaluation, and epidural labor analgesia.

BACKGROUND AND OBJECTIVES: Numerous studies have found an association between epidural analgesia for labor and maternal fever (temperature > or =38 degrees C). Maternal fever often results in treatment with maternal or neonatal antibiotics, neonatal sepsis evaluation, and increased costs. METHODS: Medline was used to identify literature regarding the association between epidural labor analgesia and maternal fever/neonatal sepsis. Studies examining thermoregulation during pregnancy and/or epidural analgesia were also reviewed. RESULTS: There appears to be a strong association between epidural labor analgesia and maternal fever. The link between epidural labor analgesia and neonatal sepsis evaluation is less clear. The incidence of confirmed neonatal sepsis does not increase with maternal epidural analgesia. Causes of the association between epidural labor analgesia and maternal fever include selection bias, altered thermoregulation, and increased shivering or decreased sweating with epidural analgesia. CONCLUSIONS: Maternal epidural labor analgesia is associated with maternal fever and possibly increased neonatal sepsis evaluation. There is no proof the relationship is causal.

Analgesia, Epidural↗

PubMedDate not supplied

Medial and lateral antebrachial cutaneous nerve blocks: an easily learned regional anesthetic for forearm arteriovenous fistula surgery.

BACKGROUND AND OBJECTIVES: Forearm arteriovenous fistula insertion is commonly performed to facilitate hemodialysis. This study was undertaken to assess the use of medial and lateral antebrachial cutaneous nerve blocks to provide anesthesia for this surgery. METHODS: Twelve patients with end-stage renal failure, presenting for insertion or revision of a forearm Gortex arteriovenous fistula, were anesthetized by local block of the medial and lateral antebrachial cutaneous nerves with a mepivacaine-bupivacaine mixture. RESULTS: Ten patients required no further local anesthetic for surgery. Two patients required minor local anesthetic supplementation in the proximal radial nerve distribution. CONCLUSIONS: Anesthesia for forearm arteriovenous fistula insertion can be provided by an easily performed regional anesthetic technique, which may have advantages over brachial plexus blocks and incisional field blocks.

Adult↗

PubMedDate not supplied

Analgesic efficacy and side effects of subarachnoid sufentanil-bupivacaine administered to women in advanced labor.

BACKGROUND AND OBJECTIVES: Previous studies of labor analgesia using subarachnoid sufentanil (alone or with adjuvants) have focused on women in the early first stage of labor. This study prospectively evaluated analgesia and side effects of subarachnoid sufentanil (10 micrograms) plus bupivacaine (2.5 mg) in parturients with cervical dilation of 7 cm or more. METHODS: In an open-label, nonrandomized trial, 32 parturients in the late first stage of labor, who had requested regional anesthesia, consented to subarachnoid injection of sufentanil (10 micrograms) and bupivacaine (2.5 mg). Patients rated their pain by a verbal pain score (0-10 scale) prior to regional anesthesia, 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score (0-3), mode of delivery, and need for supplemental analgesics were recorded. RESULTS: Lumbar puncture was successful in 30 women. Pain scores (mean +/- SD) were 8.7 +/- 1.0 prespinal and 0.7 +/- 1.5 5 minutes postinjection, and remained less than 5 for 130 minutes after the spinal injection. Of these 30 patients, 24 had unassisted vaginal delivery, 4 had instrumental vaginal delivery (3 vacuum, 1 low forceps), and 2 had cesarean delivery. Of the 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or lower. Blood pressure decreased after spinal analgesia (P < .05), and necessitated treatment in three patients. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted by 22 patients. CONCLUSION: In parturients with cervical dilation of 7 cm or more, subarachnoid sufentanil-bupivacaine produces rapid analgesia with an effective duration of approximately 130 minutes.

Adult↗