Small group teaching and the outcomes project.
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Anesthesiology↗
Biomedical subjects
Robert R Gaiser
Publications and source records attributed to Robert R Gaiser.
Advancing an epidural catheter 10 cm then retracting it 5 cm is no more effective than advancing it 5 cm.
STUDY OBJECTIVE: To determine whether threading an epidural catheter 10 cm then retracting it 5 cm affects its intravascular placement and paresthesias. DESIGN: Prospective randomized study. SETTING: Labor and Delivery Unit, University Medical Center. PATIENTS: Eighty parturients. INTERVENTIONS: All patients received epidural anesthesia. Patients were randomized to 1 of 2 groups: threading the epidural catheter 5 cm (5-cm group) or threading the epidural catheter 10 cm and retracting 5 cm (10-cm group). In the 10-cm group, the epidural catheter was threaded 10 cm and pulled back 5 cm. In the 5-cm group, the epidural catheter was threaded 5 cm. MEASUREMENTS AND MAIN RESULTS: Placement of the epidural catheter intravascularly, the presence of a paresthesia, and bilateral sensory levels were measured. There was no difference in the frequency of intravascular placement between 10- and 5-cm groups, 10.2% vs 7.5%, respectively. Although not statistically significant, there was a trend toward a higher frequency of paresthesia in the 10-cm group, 15.4% vs 7.5%, and a lower frequency of uneven sensory levels in the 10-cm group, 15% vs 2.6%. CONCLUSIONS: There is no clear clinical benefit or disadvantage to threading an epidural catheter 10 cm into the epidural space then withdrawing it 5 cm. Further study is warranted.
Adult↗
Labor epidurals and outcome.
The use of epidural analgesia for labor continues to increase dramatically. It has been suggested that epidural analgesia increases the risk of cesarean section, operative vaginal delivery, and prolonged labor. These issues have been extensively investigated. The use of epidural analgesia does not increase the risk of cesarean section. It may affect the incidence of forceps delivery, but it depends on the medications used. Epidural analgesia does prolong labor, although the clinical significance of this prolongation has not been shown.
Analgesia, Epidural↗
Epidural blood patch in a patient taking enoxaparin.
A 36-year-old, 204-kg parturient with a past medical history of Factor V Leiden requiring enoxaparin therapy developed a postdural puncture headache. With careful coordination of her enoxaparin dosing, an epidural blood patch was successfully performed. Performance of a blood patch in patients taking enoxaparin involves the withholding of the medication for a specific period.
Adult↗
Cystatin C as a cerebrospinal fluid biomarker for pain in humans.
Through a process of subtraction cloning and differential hybridization, we previously identified several new genes whose expression was induced by peripheral inflammation. One of these coded for cystatin C, a secreted cysteine protease inhibitor in the cystatin superfamily. We hypothesized that, concurrent with increased expression in dorsal horn, increased secretion would elevate the cystatin C content in cerebrospinal fluid (CSF) during active pain states. Alterations were assessed by immunoassay and by surface enhanced laser desorption ionization (SELDI) mass spectrometry with either reverse phase or immobilized anti-cystatin C antibody surfaces using CSF from ten age-matched obstetrical patients at term. Five control subjects were scheduled for an elective caesarian section and were not in pain. Another five subjects were in labor for 8.9+/-1h and were in severe pain as assessed with a visual analog scale and the McGill short form questionnaire. The level of cystatin C as measured by immunoassay in the non-pain patients was 2.77+/-0.75 microg/ml and in the pain patients 5.36+/-0.92 microg/ml (P<0.02). The elevation occurred without significant change in total CSF protein or beta-endorphin content. The cystatin C increase also was detectable by SELDI with either raw CSF or after antibody capture. These data are consistent with our previous animal study and the idea that persistent pain induces the synthesis and release of cystatin C in dorsal spinal cord, the surplus of which overflows into the CSF.
Adult↗
The epidural test dose in obstetric anesthesia: it is not obsolete.
Many anesthesiologists have called for the abandonment of the epidural test dose in the obstetric patient, citing its lack of sensitivity and specificity. A test dose of lidocaine 1.5% with epinephrine 1:200,000, in combination with aspiration, is highly effective in detecting incorrect placement of an epidural catheter. If the catheter is intrathecal, it requires approximately 2 minutes to obtain a sensory level. For the detection of an intravascular catheter, a positive test dose would result in a sudden increase in the maternal heart rate of 10 beats per minute within 1 minute after injection. It should not be administered during uterine contraction, as labor pain may trigger a tachycardic response. This test dose has been extensively studied and is safe both for both mother and fetus.
Analgesia, Epidural↗
Changes in the provision of anesthesia for the parturient undergoing cesarean section.
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Anesthesia, Obstetrical↗
Epidural blood patch in a patient with an arachnoid cyst.
Arachnoid cysts are relatively common occurrences, with the majority being asymptomatic. The safety of an epidural blood patch in a patient with an arachnoid cyst has not been reported. Our patient had a known thoracic arachnoid cyst and required epidural blood patch for a postdural puncture headache. Magnetic resonance imaging obtained following the epidural blood patch demonstrated no alterations of the cyst or spinal cord compression.
Adult↗
Ventricular tachycardia as an electrocardiography artifact during functional endoscopic sinus surgery.
BACKGROUND: Functional endoscopic sinus surgery is frequently performed during conscious sedation not provided by an anesthesiologist. Several monitors are used during conscious sedation, one of which is the electrocardiogram (EKG). Equipment used in the operating room may interfere with the EKG tracing. METHODS: A 30-year-old man underwent his fourth functional endoscopic sinus surgery during general anesthesia. For the procedure, a Xomed Straight Shot microdebrider was used. RESULTS: Because of stray electrical current, the use of the microdebrider caused the EKG waveform to resemble ventricular tachycardia. CONCLUSION: This case alerts the clinician to this possible occurrence to prevent inappropriate therapeutics from being initiated.
Adult↗