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T Standl

Publications and source records attributed to T Standl.

At least 73 records · Page 4Linked to original sources
PubMed1997

Comparison of continuous spinal with combined spinal-epidural anesthesia using plain bupivacaine 0.5% in trauma patients.

We investigated the efficacy and complications of microcatheter spinal anesthesia (CSA) in comparison to a combined spinal-epidural technique (CSE) using plain bupivacaine 0.5%. Sixty trauma patients randomly received either CSA using a 22-gauge Sprotte needle and a 28-gauge microcatheter or CSE after insertion of a 22-gauge epidural catheter through an 18-gauge Tuohy needle followed by dural puncture with a 25-gauge pencil-point needle inserted through the backeye of the Tuohy needle. An initial subarachnoid bolus of 2 mL of plain bupivacaine 0.5% was injected. If analgesia did not reach T12 within 20 min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5 mL in the CSA group or 16 mL in the CSE group. Mean arterial blood pressure, heart rate, and analgesic levels were recorded. On postoperative Day 4, patients were interviewed for postanesthetic complaints. Technical problems were more frequent in the CSE group than in the CSA group (47% vs 13%). Performance of anesthesia was faster (8 +/- 3 vs 15 +/- 8 min) and the total dose of bupivacaine lower (3.2 +/- 1.0 vs 9.7 +/- 5 mL) in patients who received CSA. The incidence of hypotension did not differ significantly. However, more patients in the CSE group were treated for bradycardia (4 vs 0). The number of patients suffering from postdural puncture headache was comparable in both groups, but there were more patients with lower back pain in the CSE group (8 vs 2). In conclusion, our data suggest that microcatheter CSA is not associated with an increased rate of complication in patients with lower limb fractures.

Adult↗
PubMed1997

Transfusion of autologous, hydroxyethyl starch-cryopreserved red blood cells.

UNLABELLED: In this prospective, randomized study, we investigated the safety and efficacy of the transfusion of hydroxyethyl starch (HES) cryopreserved red blood cells (RBC) compared with the transfusion of liquid-stored RBC in patients undergoing major orthopedic or urologic surgery. Thirty-six patients donated autologous blood 35 +/- 6 days before elective surgery. Only the first of 3.5 +/- 1.3 donated units of RBC was randomly assigned to be stored in the liquid state at 4 degrees C in phosphate/adenine/guanosine/glucose/saline-Mannitol or frozen below -130 degrees C by means of liquid nitrogen after the addition of HES (molecular weight 200,000 Dalton, degree of substitution 0.5, final concentration 11.5% wt/wt) as a cryoprotectant. After induction of anesthesia, patients donated 900 mL of autologous blood before they received one unit of liquid-stored RBC in Group 1. In Group 2, one unit of cryopreserved autologous RBC was transfused after removal of the cryoprotectant HES. In Group 3, patients received one unit of cryopreserved RBC without any manipulation after thawing. Patients in Groups 1 and 2 received additional 500 mL of 10% HES. Hemodynamic variables, arterial blood gases, plasma hemoglobin, and arterial lactate concentrations were measured after the induction of anesthesia, after hemodilution, and at 10-min intervals after transfusion of the respective RBC concentrate over a period of 40 min. Skeletal muscle tissue oxygen tension was measured in the quadriceps muscle using an automatically stepwise-driven oxygen partial pressure electrode. We found no differences among groups concerning demographics, arterial blood gas values, and lactate concentrations and observed no adverse reactions after transfusion of the conventionally stored or cryopreserved RBC. Hemodynamic variables did not differ among groups, with the exception of an increased mean arterial blood pressure after the transfusion of cryopreserved unwashed RBC. In all groups, the skeletal muscle tissue oxygen tension remained constant after hemodilution and increased after transfusion of either washed or unwashed cryopreserved RBC. Although the free plasma hemoglobin concentration remained constant after the transfusion of liquid-stored RBC (26 +/- 8 mg/dL), the plasma hemoglobin concentration increased twofold after the transfusion of cryopreserved washed RBC (60 +/- 12 mg/dL) and threefold after transfusion of cryopreserved unwashed RBC (98 +/- 20 mg/dL). The authors conclude that transfusion of one unit of RBC after cryopreservation with HES is safe and well tolerated by patients. Intravascular volume replacement and skeletal muscle oxygenation characteristics by erythrocytes did not differ between liquid-stored and cryopreserved RBC. IMPLICATIONS: This study examined whether a colloid should be used to store blood. Our data suggest that the transfusion of one unit of red blood cells after cryopreservation with hydroxyethyl starch is safe and well tolerated by patients. The effects of intravascular volume replacement and skeletal muscle oxygenation provided by red blood cells after liquid storage or cryopreservation were not different.

Adult↗
PubMed1997

Microcatheter CSA in a young woman with Fontan repair undergoing elective sterilization.

We present the case of a 28-yr-old woman with Fontan anastomosis undergoing elective sterilization. Because of concerns about laparoscopic surgery with capnoperitoneum and positive-pressure ventilation, a mini-laparotomy was performed in microcatheter spinal anaesthesia. Tiration of small doses of plain bupivacaine 0.5% supplemented with 5 microg sufentanil provided high cardiocirculatory and respiratory perioperative stability in this patient.

Adult↗
PubMed1996

Bovine haemoglobin is more potent than autologous red blood cells in restoring muscular tissue oxygenation after profound isovolaemic haemodilution in dogs.

PURPOSE: This study compares the effects of stored red cells, freshly donated blood and ultrapurified polymerized bovine haemoglobin (HBOC) on haemodynamic variables, oxygen transport capacity and muscular tissue oxygenation after acute and almost complete isovolaemic haemodilution in a canine model. METHODS: Following randomization to one of three groups, 24 anaesthetized Foxhounds underwent isovolaemic haemodilution with 6% hetastarch to haematocrit levels of 20%, 15% and 10% before they received isovolaemic stepwise augmentation of 1 g.dl-1 haemoglobin. In Group 1, animals were given autologous stored red cells which they had donated three weeks before. In Group 2, animals received freshly donated blood harvested during haemodilution. In Group 3, animals were infused with HBOC. Skeletal muscle tissue oxygen tension was measured with a polarographic 12 mu needle probe. RESULTS: In all groups, heart rate and cardiac index were increased with decreasing vascular resistance during haemodilution (P < 0.05). Haemodynamic variables showed a reversed trend during transfusion when compared to haemodilution but remained below baseline (P < 0.05). Arterial and venous oxygen content were changed in parallel to changes of haematocrit and haemoglobin concentrations but were lower in Group 3 than in Groups 1 and 2 (P < 0.05) during transfusion. In contrast, the oxygen extraction ratio was higher in Group 3 (59 +/- 8%, P < 0.01) at the end of transfusion than in Group 1 (37 +/- 13%) and 2 (32 +/- 5%). In Group 3, mean tissue oxygen tension increased from 16 +/- 5 mmHg after haemodilution to 56 +/- 11 mmHg after transfusion (P < 0.01) and was higher than in Group 1 (41 +/- 9, P < 0.01) and Group 2 (29 +/- 11, P < 0.01). While in Group 3 an augmentation of 0.7 g.dl-1 haemoglobin resulted in restoring baseline tissue oxygenation, higher doses of 2.7 g.dl-1 and 2.1 g.dl-1 were needed in Groups 1 and 2 to reach this level (P < 0.01). CONCLUSION: The results show a higher oxygenation potential of HBOC than with autologous stored red cells because of a more pronounced oxygen extraction.

Animals↗
PubMed1996

[Arthrogryposis multiplex congenita: special anesthesiological aspects].

Case report on a 2.5-year old girl suffering from arthrogryposis multiplex congenita (AMC) who was admitted for an extensive orthopaedic operation of equinovarus. The patient showed typical AMC-related problems such as skin and subcutaneous tissue abnormalities, lack of veins, contractural deformities of all four limbs and microgenia. Problems associated with anaesthesia in this patient were difficult intubation and venipuncture and a potential risk of developing malignant hyperthermia when using volatile anaesthetics. For preoperative blood chemistry sampling and intravenous induction of general anaesthesia, the patient received a central venous catheter under local and N2O/O2 anaesthesia on the day before surgery. Following intravenous induction of trigger-free anaesthesia using fentanyl, thiopental and vecuronium, the child was intubated and ventilated with 30% O2 in N2O the next day. A caudal catheter was inserted for intraoperative reduction of anaesthetics and postoperative pain relief. Intraoperatively, caudal anaesthesia was performed with 2 ml of 2% mepivacaine every 90 min. No inadvertent reactions were seen during a 7 h operation. In the recovery room, the patient received 4 ml of plain 0.25% bupivacaine per 4 h via the caudal catheter and had excellent analgesia during 24 postoperative hours. The following course was uneventful and the child was discharged from hospital two weeks later. AMC-related problems concerning the management of anaesthesia are discussed.

Anesthesia, Caudal↗
PubMed1996

[Acute effects of complete blood exchange with ultra-purified hemoglobin solution or hydroxyethyl starch on liver and kidney in the animal model].

OBJECTIVE: The present animal study investigates the influence of an acute and almost complete isovolaemic haemodilution with a new ultrapurified polymerized bovine haemoglobin (UPBH) on hepatic and renal function and histology in comparison to hydroxyethylstarch (HES). METHODS: Eighteen anaesthetized dogs underwent progressive isovolaemic haemodilution with either HES (group 1) or UPBH (group 2) to haematocrit target levels of 15, 10 and < 5%. Haemodynamics, arterial and mixed-venous blood gases and blood chemistry were determined at each measurepoint. With a haematocrit value < 5%, biopsies were taken from the liver and kidneys and prepared for light and electron microscopic analysis. One dog without haemodilution figured as control animal. Statistical analysis was performed using ANOVA, with p < 0.05 considered significant. RESULTS: In group 1, the cardiac output was increased in parallel to a decreasing vascular resistance, while in group 2 haemodynamic parameters remained unchanged. In group 1, avDO2 and final DO2 and VO2 were decreased. In contrast, avDO2 and oxygen extraction ratio were increased, while VO2 remained stable under decreasing DO2 in group 2. In both groups, coagulation values and blood chemistry showed dilution dependent changes. Colloid osmotic pressure and plasma viscosity were increased in both groups but COP was higher in group 1 compared to group 2. A lower urine output in comparison to group 1 and a maximal concentration of 0.27 g/dl of free haemoglobin in urine were seen in group 2. Liver biopsies showed no severe histological changes in both groups. Renal histology revealed severe alterations of proximal tubules after haemodilution with HES. In contrast, no histological indications for acute toxic or ischaemic lesions in the kidneys were seen after UPBH treatment. CONCLUSION: The high degree of purification and polymerization of bovine haemoglobin associated with adequate tissue oxygenation by increased oxygen extraction resulted in normal histological and functional findings after acute and almost complete blood exchange with UPBH. In contrast, HES-treated animals showed severe histological changes of renal tubuli caused by isovolaemic anaemia.

Animals↗
PubMed1996

[Does propofol have advantages over isoflurane for sufentanil supplemented anesthesia in children for strabismus surgery?].

OBJECTIVE: The present study investigates the effectivity and the incidence of side effects of sufentanil-supplemented propofol versus isoflurane anaesthesia in children undergoing elective strabismus surgery. METHODS: 130 children (aged 3-11; ASA I-II) were randomly allocated to one of four groups. In group 1 and 2, anaesthesia was induced with 2 mg/kg propofol and maintained with 15-20 mg/kg x h propofol and 30% O2 in air (group 1) or 10-15 mg/kg x h propofol in N2O (group 2). After induction with either 2 mg/kg propofol (group 3) or 5 mg/kg thiopentone (group 4), anaesthesia was maintained with 0.8-1.5 Vol% isoflurane and N2O in 30% O2 in these groups. All children were orally premedicated with midazolam and atropine and received a single dose of intravenous sufentanil (0.5 micrograms/kg) and atracurium (0.5 mg/kg) prior to intubation. Heart rate, mean arterial blood pressure and pulse oximetry were registered 5 min prior and after intubation as well as 10 min before and 5 min after extubation. The incidence of pain and involuntary movements during injection, oculocardiac reflex (OCR), laryngospasm and postoperative shivering were as well registered as the duration of the operation and the time of extubation. Episodes of nausea and vomiting were documented during 24 hours postoperatively. RESULTS: TIVA with Propofol resulted in a decreased heart rate (p = 0.002) and a higher frequency of OCR (p = 0.01) than thiopentone/isoflurane anaesthesia with a higher sensitivity of children younger than 6 years (p = 0.007) in all groups. There were no differences in extubation time between groups. The overall incidence of nausea (p = 0.002) and vomiting (p = 0.007) was lower in group 1 and 2 when compared to group 3 and 4. CONCLUSION: Propofol as an induction agent of balanced anaesthesia fails to show advantages over thiopentone. During total intravenous anaesthesia propofol increases the risk of bradycardia especially in younger children. However, a significantly lower incidence of postoperative nausea and vomiting after TIVA with propofol and sufentanil, irrespective of N2O administration, may be an advantage over isoflurane anaesthesia in paediatric patients after strabismus surgery.

Anesthesia, General↗
PubMed1996

Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery. Spinal versus general anaesthesia.

BACKGROUND: The present prospective study investigates the impact of a standardized technique of spinal and general anaesthesia on the incidence and consequences of postanaesthetic complaints dependent on age and sex of patients. METHODS: 433 orthopaedic patients underwent lower limb surgery in spinal (group 1) or general (group 2) anaesthesia. Spinal anaesthesia was performed with 0.5% hyperbaric bupivacaine using a 26-gauge Quincke needle. General anaesthesia was induced with i.v. injection of thiopentone, fentanyl and atracurium and maintained with 65% nitrous oxide and 1-1.5 Vol% isoflurane in oxygen. On postoperative day 4, patients were interviewed for onset and duration of postoperative complaints. RESULTS: The overall incidence of nausea/vomiting (P = 0.025) and sore throat (P = 0.0001) was higher in group 2. In addition, nausea/vomiting was higher in patients between 20 and 60 years in group 2 compared with group 1. While the incidence of urinary dysfunction was higher in men after spinal (P = 0.04), nausea/vomiting was more frequent in women after general anaesthesia (P = 0.008). Analgetic requirements (P = 0.013), time of postoperative surveillance (P = 0.042) and frequency of treatment of postoperative complaints (P = 0.0001) was higher in group 2. CONCLUSION: Spinal anaesthesia was associated with a lower incidence of postoperative complaints and treatments and a shorter surveillance compared to general anaesthesia. Specific complications related to spinal anaesthesia did not depend on age or sex and may allow for recommendation of this technique even in younger and female patients undergoing orthopaedic surgery.

Adolescent↗
PubMed1996

Propofol reduces emesis after sufentanil supplemented anaesthesia in paediatric squint surgery.

BACKGROUND: Squint surgery is associated with a high incidence of postoperative emesis. The purpose of this prospective study was to examine the influence of propofol and isoflurane anaesthesia on the incidence of postoperative nausea and vomiting in children. METHODS: Ninety children aged 3-10 years were randomly allocated to one of 3 groups. In all groups, children received 2 mg/kg propofol, 0.5 microgram/kg sufentanil and 0.5 mg/kg atracurium for induction of anaesthesia. In group 1, anaesthesia was maintained with 15-20 mg/kg.h propofol and children were ventilated with 30% O2 in air. In group 2, anaesthesia was maintained with 10-15 mg/kg.h propofol and 30% O2 in N2O. In group 3, anaesthesia was maintained with 1.0-1.5 Vol% isoflurane and 30% O2 in N2O. The time of extubation, awakening and postoperative surveillance, the incidence and numbers of episodes of postoperative nausea and vomiting were registered as well as requirements of antiemetics. Statistics were made using ANOVA and Chi-square test or Kruskal-Wallis test with P < 0.05 considered as significant. RESULTS: The overall incidence of nausea (P = 0.0001) and vomiting (P = 0.002) was higher in group 3 (70%;73%) than in group 1 (13%;23%) and 2 (20%;28%). Episodes of nausea (P = 0.0001) and vomiting (P = 0.0013) were more frequent in group 3 (74%;69%) than in group 1 (13%;15%) and 2 (13%;16%). Antiemetic requirements were higher and the time of postoperative sleep and surveillance was longer in group 3 than in group 1 and 2 (P = 0.04). CONCLUSION: Propofol-sufentanil anaesthesia results in less emesis and treatment during the early postoperative phase irrespective of N2O administration compared with propofol-induced isoflurane anaesthesia and may be recommended in children undergoing squint surgery.

Anesthesia, Intravenous↗
PubMed1995

A directional needle improves effectiveness and reduces complications of microcatheter continuous spinal anaesthesia.

The present prospective randomized study compares the impact of two different spinal needle designs--non-directional versus directional--on the effectiveness of continuous spinal anaesthesia provided via a microcatheter in orthopaedic patients. Using the midline approach, a 28-gauge spinal catheter was inserted either through a 22-gauge Quincke needle (non-directional, Group 1, n = 21) or a 22-gauge Sprotte needle (directional, Group 2, n = 21) under standardized conditions. The incidence of technical difficulties and postoperative complaints, onset time of analgesia at the level of T10 and dose requirement of plain bupivacaine 0.5% were recorded. Postoperatively, the subarachnoid position of the catheters was radiographically evaluated. There was a higher incidence of technical problems during catheter insertion in Group 1 compared with Group 2 (71% vs 19%, P < 0.05). Onset time of analgesia was shorter (P < 0.05) and anaesthetic dose requirement was lower in patients in Group 2 than in Group 1. While 40% of the catheters were found in a caudal position in Group 1, all catheters were in a cranial position or at the level of the puncture site in Group 2 (P < 0.05). There was no difference in the incidence of postoperative complaints between the groups. The faster onset of analgesia and lower dose requirement of local anaesthetics associated with a lower incidence of technical problems suggest that there is greater effectiveness and safety when microcatheters are inserted using directional needles rather than non-directional needles.

Adolescent↗
PubMed1995

[Propofol-alfentanil reduced cerebrovascular CO2 reactivity in comparison with isoflurane].

The present study compared the effects of propofol/alfentanil versus isoflurane anaesthesia on cerebral vascular reactivity to changes in carbon dioxide (CO2) using transcranial Doppler sonography (TCD). METHODS. Seventeen ASA class I patients undergoing minor elective surgery were studied following IRB approval and informed consent. In group 1 (n = 10), anaesthesia was induced with thiopental 4 mg/kg and alfentanil 15 micrograms/kg. Endotracheal intubation was facilitated by vecuronium 0.1 mg/kg. Anaesthesia was maintained with 1% end-tidal isoflurane and nitrous oxide (N2O) in oxygen O2 (6 l/min; FiO2 0.3). In group 2 (n = 7), anaesthesia was induced with propofol 2 mg/kg, alfentanil 15 micrograms/kg, and vecuronium 0.1 mg/kg for endotracheal intubation and maintained by infusion of propofol, alfentanil, and N2O-O2 (6 l/min; FiO2 0.3) according to the following protocol: propofol: 10, 8, and 6 mg/kg.h for 10 min each followed by 4 mg/kg.h; alfentanil: 55 micrograms/kg.h. Monitoring included measurement of mean arterial blood pressure (MAP, mm Hg), heart rate (HR), body temperature (T), end-tidal CO2 (PetCO2, mm Hg), isoflurane concentrations, and arterial O2 saturation (SaO2, %). Mean blood flow velocity (Vmean, cm/s) was measured in the middle cerebral artery using a bidirectional 2-MHz TCD system (TranspectT, Medasonics). Mechanical ventilation was adjusted to achieve PetCO2 levels of 40-50-40-30 and 40 mm Hg. Ten minutes of equilibration were allowed at each PetCO2 level. The CO2 reactivity index was calculated as delta Vmean/delta PetCO2 (cm/s.mm Hg). RESULTS. MAP, HR, T, and SaO2 were constant over time and were not different between groups. The CO2 reactivity index over the CO2 range of 30-50 mm Hg was higher in isoflurane (2.32 +/- 1.51 delta cm/s.mm Hg) compared to propofol/alfentanil patients (1.15 +/- 0.77 delta cm/s.mm Hg) (mean +/- SD, P < 0.05). CONCLUSIONS. The data show that although CO2 reactivity is maintained during both isoflurane and propofol/alfentanil anaesthesia, the cerebral vascular response to CO2 was lower in propofol/alfentanil compared to isoflurane patients. This is likely due to propofol/alfentanil-induced cerebral vasoconstriction. These data suggest that CO2 reactivity is a function of the pre-existing cerebral vascular tone induced by the anaesthetic.

Adult↗
PubMed1995

[The effect of puncture needle on the subarachnoid catheter position in continuous spinal ansthesia].

The subarachnoid position of the microcatheter has an impact on the outcome of continuous spinal anaesthesia (CSA). The present prospective, randomised study investigated the influence of two different spinal needles on the radiographically documented subarachnoid positions of microcatheters in CSA. In addition, the influence of the subarachnoid position of the microcatheter on onset time of analgesia, dose requirement of local anaesthetics, and level of analgesia was examined. METHODS. Forty orthopaedic patients received CSA using a 28-gauge spinal catheter inserted either through a non-directional 22-gauge Quincke needle (group 1) or a directional 22-gauge Sprotte needle (group 2). After initial injection of 2 ml to a maximum of 5 ml of supplemental doses of 0.5% plain bupivacaine, onset time of analgesia at the level of T 10, dose requirement of bupivacaine, and the achieved analgesic level were registered. After surgery, a dye-enhanced AP X-ray film of the lumbar spine was performed for radiological control of the subarachnoid catheter position. RESULTS. There was a higher number of cranial catheter positions in group 2 (60%) compared with group 1 (40%, P = 0.037). In contrast to group 1, with 35% caudally directed catheters, no catheter was seen in a caudal position in group 2. Onset time of analgesia (P = 0.0002) and anaesthetic dose requirement (P = 0.037) were lower in patients with cranially directed catheters compared to patients with the catheters situated at the level of the puncture site or in a caudal position. Maximal analgesic levels were higher in cranially directed catheters compared with other localisations (P = 0.022). CONCLUSIONS. Sprotte needles provide a higher number of cranially directed microcatheters, which are associated with faster onset of analgesia, lower dose requirement of local anaesthetics, and higher analgesic levels in CSA. The results suggest more effectiveness and probably more safety in microcatheter CSA using Sprotte needles for catheter insertion.

Aged↗
PubMed1995

Microcatheter continuous spinal anaesthesia in the post-operative period: a prospective study of its effectiveness and complications.

One hundred patients (aged 22-86 years, mean 62.5), undergoing lower limb orthopaedic surgery, received continuous spinal anaesthesia using a 28 s.w.g. catheter inserted through a 22 s.w.g. Quincke needle. Post-operative pain relief was provided by bolus injections of 1-2.5 mL 4 h-1 of plain 0.25% bupivacaine. The mean dose of bupivacaine required for sufficient pain relief in 93% of patients was 1.6 +/- 0.2 (1.3-1.9) mL 4 h-1. The highest dose was needed between 4 and 8 h post-operatively. No dependence of dose on age or type of operation was found. Technical problems with the microcatheter occurred in 12%. The most frequent complaint was post-operative backache (12%). Only one patient suffered from post-dural puncture headache on the day after surgery. There was no microbiological contamination of the catheter tips after removal. In the post-operative interview, 89% of the patients were completely satisfied with CSA; 91% would prefer this technique to general anaesthesia.

Adult↗
PubMed1995

[Peridural anesthesia in postoperative pain therapy].

This review gives a summary of historical developments of the technique of epidural anaesthesia as well as a synopsis of current knowledges in this method of regional anaesthesia. Besides of anatomical basics, the technique of epidural anaesthesia and its use in postoperative pain relief including indications, contraindications, advantages and complications are described. Beginning with commonly used and new local anaesthetics, the article further deals with opioids and alpha-2-agonists used for epidural anaesthesia in pain management. Different techniques of epidural drug application such as bolus injection or patient-controlled analgesia are discussed.

Analgesia, Epidural↗
PubMed1993

Radiological examination of the intrathecal position of microcatheters in continuous spinal anaesthesia.

There have been few studies of the intrathecal position of spinal catheters in continuous spinal anaesthesia. This prospective study was designed to examine radiologically the intrathecal position of 28-gauge spinal catheters. We studied the entry into the subarachnoid space and the intrathecal position of 68 spinal catheters. In 50%, the catheters passed in a cranial direction, in 34% the catheters remained at the level of the puncture site and in 16% the catheters were directed caudally. The intrathecal position of the catheters did not depend on the level of the lumbar puncture (P = 0.6246), but was dependent on the position of the patient during insertion of the catheter (P = 0.0093), and on the depth of insertion (P = 0.0099). Our study suggests that patients should be in a sitting position during insertion of a subarachnoid microcatheter and that the depth of insertion should not exceed 4 cm.

Adult↗
PubMed1993

Technical problems with 32-gauge microcatheters in continuous spinal anaesthesia.

Technical problems with microspinal catheters for continuous spinal anaesthesia (CSA) are not unknown. The present case report deals with two unusual technical complications in CSA with 32-gauge spinal catheters. The first case shows a catheter with extraordinary elongation due to breakage of the embedded stylet. The second case shows a tear in the extracorporeal part of the catheter with leakage of the local anaesthetic and consequently failed spinal anaesthesia.

Adult↗
PubMedDate not supplied

Continuous spinal analgesia. Comparison between patient-controlled and bolus administration of plain bupivacaine for postoperative pain relief.

BACKGROUND AND OBJECTIVES: Adequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement. METHODS: Forty-two patients (mean age, 69 +/- 11 years) were randomly allocated to one of two groups. Group. 1 patients received a constant subarachnoid infusion of 0.6 mg/h of bupivacaine by a patient-controlled device and were allowed to self-administer 0.6 mg every 30 minutes Group 2 patients received a nurse-administered bolus of 3.75 mg of plain bupivacaine on request. Pain was assessed by patients and nurses by a visual analog scale (VAS) every hour. The degree of motor block and the level of analgesia were documented every 4 hours. Hemodynamic and respiratory parameters were recorded hourly. Differences between groups were tested by analysis of variance for repeated measurement. RESULTS: Technical problems occurred in six patients were more frequent in group 1 but none in group 2. Patient-controlled analgesia resulted in lower pain scores than bolus application during 18 postoperative hours (VAS score 19 +/- 19 mm in group 1 and 39 +/- 30 mm in group 2; P < .01). Lower total doses of bupivacaine were required in group 1 (17.6 +/- 4 mg) than in group 2 (22.3 +/- 7 mg; P < .05). The groups did not differ with respect to the degree of motor block (Bromage score 3.5 +/- 0.5), the sensory level (L1-2 +/- 1), or hemodynamic or respiratory parameters. CONCLUSION: In spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.

Aged↗