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At least 451 records · Page 25Linked to original sources
PubMed2004

Spinal anesthesia for Cesarean section in a parturient with long QT syndrome.

PURPOSE: To report the first use of spinal anesthesia for Cesarean section (CS) in a parturient with a long QT syndrome (LQTS) and an automatic implantable cardiac defibrillator (AICD). Although both general and epidural anesthesia have been described for CS in patients with LQTS, there are no previous case reports on the use of spinal anesthesia. The clinical features, diagnosis, treatment and anesthetic management of LQTS are discussed. CLINICAL FEATURES: A 31-yr-old woman, gravida 2 para 1 known to have LQTS and an AICD, presented in labour at 35 weeks gestation, three weeks before her scheduled CS. Her previous delivery by CS under spinal anesthesia at our institution was uneventful. On this occasion, we elected to administer spinal anesthesia because she was asymptomatic (no arrhythmia or cardiac arrest) for the last few years, was hemodynamically stable, and had received uneventful spinal anesthesia before. CONCLUSION: Spinal anesthesia was used safely for CS in this parturient with LQTS.

Adult↗
PubMed2002

Transient restless legs syndrome after spinal anesthesia: a prospective study.

OBJECTIVE: To assess the incidence and time course of new-onset restless legs syndrome (RLS) after spinal anesthesia. METHODS: A total of 202 consecutive patients undergoing spinal anesthesia for various types of surgery were prospectively evaluated regarding the presence and severity of RLS symptoms 48 to 72 hours post surgery and after 1 week, 1 month, 3 months, and 6 months. A diagnosis of RLS was made according to the criteria of the International RLS Study Group (IRLSSG), and severity was assessed by the IRLSSG severity scale. RESULTS: Of 161 patients without any history of RLS, 8.7% developed first-onset RLS after spinal anesthesia. Symptoms were transient, with a mean duration of 33 +/- 30 days. Low mean corpuscular volume and mean corpuscular hemoglobin were associated with the occurrence of new-onset RLS after spinal anesthesia. CONCLUSIONS: Transient RLS can be induced by spinal anesthesia. The mechanisms by which spinal anesthesia can trigger RLS are unclear but may include deficits in spinal sensorimotor integration in susceptible individuals.

Adult↗
PubMed1997

Prevention of hypotension during spinal anesthesia: a comparison of intravascular administration of hetastarch versus lactated Ringer's solution.

This study was designed to compare the efficacy of 6% hetastarch to that of crystalloid administration in reducing the incidence and severity of hypotension during spinal anesthesia. Forty ASA grade I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 500 mL of hetastarch solution or 1000 mL of lactated Ringer's solution prior to spinal anesthesia. Spinal anesthesia was managed identically in both groups by anesthesiologists who were unaware of the type of fluid administered. The incidence of hypotension was 11 of 21 (52%) in the lactated Ringer's solution group and 3 of 19 (16%) in the hetastarch group. The difference in the incidence of hypotension was significant (P < 0.05). The requirement of 5-mg bolus doses of ephedrine to maintain systolic arterial blood pressure > 75% of baseline was significantly greater in the lactated Ringer's group than in the hetastarch group (15 vs 4, P < 0.05). We conclude that an intravenous infusion of 500 mL of 6% hetastarch solution is more effective than 1000 mL lactated Ringer's solution in attenuating spinal anesthesia induced hypotension in women undergoing postpartum tubal ligation.

Adult↗
PubMed2001

A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusion for outpatient knee arthroscopy.

UNLABELLED: Traditional methods of spinal anesthesia have proven problematic in the outpatient setting. Minidose lidocaine-fentanyl spinal anesthesia (SAB(MLF)) may be the adaptation necessary to reestablish spinal anesthesia in this venue. One hundred patients scheduled for outpatient knee arthroscopy were randomized to receive either local anesthesia plus a titrated IV propofol infusion (LA/PI) or SAB(MLF) using 20 mg lidocaine 0.5% + 20 microg fentanyl. Patients received midazolam 0.02-0.03 mg/kg IV and fentanyl 0.75-1.0 microg/kg IV upon arrival in the operating room before lumbar puncture or propofol infusion. The propofol infusion was begun at 50-75 microg. kg(-)(1). min(-)(1) and titrated to maintain patient comfort. Boluses (200-400 microg/kg) were given as needed. Local anesthesia included 30 mL lidocaine 1% with epinephrine 1:200,000 intraarticularly plus 10 mL at the portal sites. Three patients (6%) in the LA/PI group versus none in the SAB(MLF) group required general anesthesia. Airway support was required in 54% of the LA/PI patients and in none of the SAB(MLF) patients. Total operating room time (43 vs 45 min), time to home readiness (43 vs 45 min), actual discharge times (73.5 min in both groups), and the incidence of discharge >90 min (22% vs 24%) were the same for both LA/PI and SAB(MLF) groups. LA/PI and SAB(MLF) groups differed in terms of postoperative pruritus (8% vs 68%), pain (44% vs 20%), nausea (8% vs 22%), and ability to void before discharge (56% vs 32%). One patient in each group had mild difficulty initiating voiding at home, but neither required medical attention. In both groups, 90% of patients were either "satisfied" or "very satisfied" with their anesthetic. The two techniques provided comparable patient satisfaction and efficiencies both intraoperatively and in postoperative recovery and discharge. The efficiencies of these techniques were not dependent on special provisions of the physical plant or the practice model. IMPLICATIONS: Both local anesthesia supplemented by a titrated IV propofol infusion and minidose lidocaine-fentanyl spinal anesthesia for outpatient knee arthroscopy provide high patient satisfaction with equally rapid recovery and discharge.

Adolescent↗
PubMed2006

Needles used for spinal anesthesia.

Since the discovery of spinal anesthesia in 1885 by J Leonard Corning, spinal needles have been modified to simplify their use and minimize complications. Needle design variables, such as diameter, tip design and orifice location, have been altered to enable rapid flow of cerebral spinal fluid (CSF) and injected medications, yet simultaneously limit dural trauma and loss of CSF. CSF loss can result in a severe postdural puncture headache (PDPH). Blunt pencil-point tip needles have been observed to cause a lower incidence of PDPH than similar sized sharp, cutting tip needles. Smaller diameter needles are also associated with a lower incidence of PDPH. A recent alteration in spinal needles is not to the needle per se, but rather the microcatheters placed through them; currently used in Europe, such catheters are again being evaluated in the USA. Further advancements in spinal needles will most likely involve some of the design elements previously altered, as well as new features not yet recognized as important at this time.

Anesthesia, Spinal↗
PubMed2002

Does hearing loss after spinal anesthesia differ between young and elderly patients?

UNLABELLED: Fifty male patients scheduled for inguinal hernia repair with spinal anesthesia were included in this study. The patients were divided into two groups: 25 patients aged 30 yr or younger (Group Y) and 25 patients aged 60 yr or older (Group E). We performed subarachnoidal injection at the L3-4 interspace by using a 25-gauge Quincke needle with the patient in the sitting position, and 3 mL of 0.5% isobaric bupivacaine was administered. Patients were evaluated by pure tone audiometry (LdB [low frequencies], 125-500 Hz; SdB [speech frequencies], 500-2000 Hz; HdB [high frequencies], 2000-6000 Hz) on the day before and 2 days after spinal anesthesia. Low-frequency hearing loss observed in Group Y was significantly more common than in Group E (P < 0.01). There was no difference between the groups in speech and high frequencies. Mild hearing loss, defined as a hearing loss of 10-20 dB at two or more frequencies, was observed three times more frequently in Group Y than Group E (52% vs 16%; P = 0.014). We conclude that transient hearing loss was more common in young patients after spinal anesthesia, perhaps because the cerebrospinal fluid leakage after dural puncture is less in the elderly than in the young, a finding also associated with the infrequent incidence of postdural puncture headache in the elderly. IMPLICATIONS: Spinal anesthesia is one of the most frequently used regional anesthesia techniques in surgical interventions; however, rarely it may cause some transient or permanent neurological problems. One of these problems is headache, which is more frequent and severe in the young, and hearing loss, especially at low frequencies. Both the pain and the hearing loss are caused by leak of cerebrospinal fluid caused by the puncture in the membrane of the spinal cord during the procedure. We hypothesized that hearing loss might also be more frequent and severe in the young, and to test this hypothesis, we compared the hearing loss developing after spinal anesthesia between the young and the elderly. The implications of this study are as follows: First, spinal anesthesia must be performed carefully, especially in the young. Second, measures must be taken to avoid the leak of cerebrospinal fluid. This study reveals possible problems caused by spinal anesthesia in the young which can be easily overlooked.

Adult↗
PubMedDate not supplied

Atraucan: a new needle for spinal anesthesia.

BACKGROUND AND OBJECTIVES: Atraucan 26-gauge spinal needles have a tip designed to make a small linear cut (as opposed to a V-shaped cut) in the dura mater. The cut is shorter than the outside diameter of the needle and is dilated as the needle passes through the dura. The needle is used with a 20-gauge introducer. In vitro, it causes less leakage of cerebrospinal fluid than Quincke 26-gauge or Sprotte 24-gauge needles. This study was designed to test the ease of use and any damage caused to the needle tip during lumbar dural puncture. METHODS: This was a multicenter trial (six centers in five countries) involving 362 patients undergoing spinal anesthesia. A detailed questionnaire was filled in for every patient by the anesthesiologist. All the needles were returned to the factory and examined microscopically for damage. RESULTS: Lumbar dural puncture was successful in all but one patient. Spinal anesthesia was satisfactory for the planned surgery in 97%. Microscopy of the needle tips showed only a minor degree (0.01-0.19 mm) of bending in 14%, and none of the tips had a "hook." Postdural puncture headache (PDPH) occurred in nine patients (2.5%), all but one of whom (a 15-year-old male) were females under 55 years of age. CONCLUSIONS: The Atraucan needle is easy to use and has a high success rate in identifying the subarachnoid space. Lumbar dural puncture causes minimal damage to the tip. The incidence of PDPH is low, but a larger comparative study needs to be performed.

Adolescent↗
PubMedDate not supplied

Success rate of unilateral spinal anesthesia is dependent on injection flow.

BACKGROUND AND OBJECTIVES: The dependence of unilateral spinal anesthesia on injection flow is controversial. We hypothesized that it is possible to achieve strictly unilateral sympathetic block (as assessed by temperature measurements of the limbs) and unilateral sensory and motor block, respectively, during spinal anesthesia by a slow and steady injection of a hyperbaric local anesthetic solution. METHODS: Forty-four patients (American Society of Anesthesiologists [ASA] physical status I-III) undergoing surgery of one lower extremity were randomly assigned to one of two groups. Dependent on the patients' height, 1.4 to 1.7 mL hyperbaric bupivacaine 0.5% was injected manually with the patient in the lateral decubitus position, which was maintained for 30 minutes after injection. Injection flow was approximately 0.5 mL/min in group I ("air-buffered" injections performed by 4 mL air between the local anesthetic and the syringe's plunger, n = 25) and approximately 7.5 mL/min in group II ("conventional" injections, n = 19). Sympathetic block was defined as a temperature increase of more than 0.5 degrees C at the foot. Any reduction in the ability to move the hip, knee, or ankle as well as loss of temperature discrimination and/or pinprick even in one dermatome on the nondependent side was considered as a bilateral block. RESULTS: Before surgery, significant differences (P < .05) were observed for unilateral motor paralysis (92% in group I v 68.4% in group II), unilateral sensory block (48.0% v 10.5%), and unilateral sympathetic block (72% v 42.1%). Strictly unilateral spinal anesthesia was found to be significantly more frequent in group I (40% v 5.3%). Significant hemodynamic differences between the groups were not detected. CONCLUSIONS: For hyperbaric spinal anesthesia, the injection flow is an important factor in achieving unilateral sympathetic block. A slow injection proves useful to restrict spinal anesthesia to the side of surgery.

Adolescent↗
PubMedDate not supplied

Cardiovascular effects of 6% hetastarch and lactated Ringer's solution during spinal anesthesia.

BACKGROUND AND OBJECTIVES: The purpose of this prospective, randomized, double-blinded study was to compare the hemodynamic effects of 6% hetastarch with lactated Ringer's solution and to determine the main reasons for hemodynamic impairment following spinal anesthesia in elderly patients undergoing emergent hip surgery. METHODS: After receiving institutional approval and informed consent, we enrolled 24 ASA physical status III patients for this study. Hemodynamics were recorded with pulmonary artery and arterial catheters and an electrocardiogram. Following fluid administration with either 500 mL 6% hetastarch (group H) or 1500 mL lactated Ringer's solution (group R), spinal anesthesia was administered with 3.0 mL 0.5% bupivacaine (isobaric). Hemodynamic measurements were recorded prior to fluid administration, before spinal anesthesia, and 10, 20, and 30 minutes following spinal anesthesia and reported as relative changes relating to baseline. RESULTS: Although the hemodynamic measurements after spinal anesthesia remained stable in group H throughout the observation period, blood pressure, central venous pressure, pulmonary artery (PA) wedge pressure and systemic vascular resistance decreased significantly in group R (blood pressure: -7 +/- 10 vs - 14 +/- 8% 30 minutes after spinal anesthesia, P < .05 to group R; central venous pressure: 51 +/- 106 vs -26 +/- 27% 10 minutes, 63 +/- 89 vs -36 +/- 30% 20 minutes and 73 +/- 112 vs -33 +/- 29% 30 minutes after spinal anesthesia, P < .01 to group R; PA wedge pressure: 40 +/- 37 vs -5 +/- 40% 10 minutes, 40 +/- 35 vs -23 +/- 32% 20 minutes and 38 +/- 36 vs -23 +/- 32% 30 minutes after spinal anesthesia, P < .01 to group R; systemic vascular resistance: -10 +/- 16 vs -18 +/- 7% 20 minutes and -10 +/- 15 vs - 19 +/- 12% 30 minutes after spinal anesthesia, P < .05 to group R). CONCLUSIONS: Six percent hetastarch minimizes the hemodynamic responses during spinal anesthesia in elderly patients undergoing emergent hip surgery. In this study population, spinal anesthesia-induced hemodynamic impairment is caused by decreases in cardiac filling pressures and systemic vascular resistance.

Aged↗
PubMed2005

Clipping of the appendix induced cardiac arrest during appendectomy under spinal anesthesia.

Bradycardia is commonly seen in high spinal anesthesia, however, evolution of cardiac arrest from sudden onset of severe bradycardia is infrequent. Prompt recognization and resuscitative measures are of paramount importance because they may insure a complete recovery without sequela as an aftermath. We report herein a case of severe sinus bradycardia induced by clipping of the appendix during appendectomy under spinal anesthesia with the sensory block up to T5 dermatome. Prompt intravenous atropine failed to regain normal sinus rhythm, and cardiac arrest ensued. Cardiac massage, manual ventilation with oxygen and low-dose epinephrine successfully resuscitated the patient. The possible mechanisms and management of this complication are also discussed.

Anesthesia, Spinal↗
PubMed1985

Neurosecretory response of hypothalamic-hypophyseal axis to spinal anesthesia, minor gynecological surgery and irradiation.

The effect of spinal anesthesia, dilatation and curettage plus the first intracavitary radiotherapy or only that of intracavitary radiotherapy on growth hormone (HGH = the response of anterior pituitary) and arginine vasopressin (AVP = the response of posterior pituitary) levels was studied in 10 patients suffering from cervical or endometrial uterine cancer. Differing from earlier animal studies, irradiation had no effect on GH or AVP secretion, nor was there any change in the hormone levels following spinal anesthesia and dilatation and curettage. The neurosecretory response of hypothalamic-hypophyseal axis to spinal anesthesia and minor gynecological surgery appears to be minimal.

Adult↗