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At least 487 records · Page 27Linked to original sources
PubMed2006

The effects of spinal anesthesia on QT interval in preeclamptic patients.

In this study, we measured the effects of spinal anesthesia on the corrected QT (QTc) interval in women with severe preeclampsia. Twenty-five preeclamptic (preeclamptic group) and 25 healthy pregnant women with normal arterial blood pressure and QTc interval (control group) were enrolled in this prospective, case-controlled study. Arterial blood pressure, heart rate, and QTc interval values were obtained before (baseline value) and at 5, 10, 20, 30, 60, and 120 min after initiation of spinal anesthesia. Total ephedrine dose, time elapsed until sensory block, and Apgar scores were recorded. Prior to spinal anesthesia, QTc interval values were significantly higher in the preeclamptic group (452 +/- 17.5 ms) when compared with that in controls (376 +/- 21.4 ms). Although the QTc interval shortened during spinal anesthesia when compared with baseline value in the preeclamptic group (P < 0.05), it showed no significant change in the control group. In conclusion, the QTc interval may be prolonged in severe preeclamptic patients who have hypertension and hypocalcemia. Spinal anesthesia for cesarean delivery may normalize that prolonged QTc interval due to sympathetic blockade.

Adult↗
PubMed1990

Study of plasma neuropeptide Y (NPY) and catecholamines levels during spinal anesthesia.

Plasma levels of neuropeptide Y (NPY) and catecholamines were investigated during spinal anesthesia. Ten ASA physical status I-II patients were studied after obtaining institutional approval and informed contents. All patients were free from endocrine and metabolic disease underwent elective low risk operation. No premedication was given before operation. Spinal anesthesia was performed on lateral position from L3-4 interspace with 15 mg tetracaine without added epinephrine. The analgesic level was about at T6 dermatone. Blood samples were obtained from radial artery catheter, 15 minutes before spinal anesthesia and 5', 15', 30', 60', 120', during operative period and 30' after operation in postanesthesia recovery room. The results showed that there were significant elevation in plasma level of NPY during spinal anesthesia compared with the level before anesthesia. However, no statistically significant changes of plasma catecholamines were found.

Adolescent↗
PubMedDate not supplied

Use of hyperbaric bupivacaine with epinephrine for spinal anesthesia in infants.

Previous studies have established the efficacy of spinal anesthesia in infants with hyperbaric lidocaine, hyperbaric tetracaine and isobaric and hyperbaric bupivacaine. Use of the commercially available hyperbaric spinal anesthesia solution of 0.75% bupivacaine in 8.25% dextrose has not heretofore been documented in this patient population. We present a series of 12 cases in which this hyperbaric bupivacaine solution with epinephrine was used for spinal anesthesia in children younger than 8 months of age.

Anesthesia, Spinal↗
PubMed1992

Incidence of hypotension induced by spinal anesthesia with xylocaine for cesarean section and postpartum tubal ligation.

The incidence of hypotension induced by spinal anesthesia in 154 ASA class I or II patients having Cesarean section and postpartum bilateral tubal ligation was studied. Xylocaine (2%) 60-65 mg was used for spinal anesthesia. There was 41.0% of patients in Cesarean section group developed hypotension induced by spinal anesthesia, and 13.5% in tubal ligation group. We found no correlation between the time after delivery and the occurrence of hypotension induced by spinal anesthesia. In addition, 20.3% of the patients in tubal ligation group required intravenous narcotics because of inadequate sensory blockade during skin incision, but only 9.0% in Cesarean section needed the same supplement which was due to visceral pain during intra-abdominal manipulation. We conclude that spinal anesthesia with 2% xylocaine is safe and effective in both Cesarean section and postpartum tubal ligation although a significant difference of spinal hypotension existed.

Adult↗
PubMed1990

[Evaluation of the effectiveness of spinal anesthesia using lidocaine combined with morphine].

Spinal anesthesia with 2% solution of lidocaine++ in combination with 1-1.5 mg of morphine is more effective as compared with an analogous method of anesthesia without a narcotic analgetic: it considerably increased the quality of the above mentioned analgesia at the expense of an increased blockade of nociceptive reactions and longer duration of the surgical stage of anesthesia and also results in continuous postoperative analgesia.

Adult↗
PubMed1991

[Spinal anesthesia in ambulatory anesthesia of the infant].

Two hundred spinal anesthesias have been performed in infants for abdominal surgery, thirty of which for day surgery. Intrathecal injection of 0.5% bupivacaine solution is realised in good conditions, sometimes with narcosis complementation (ketamine or halothane). Motor block takes place without delay and lasts for an average of 95 +/- 25 minutes. There is no hemodynamic disturbance. This technic could be used in day surgery by reason of quick recovery.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Complications during spinal anesthesia: a prospective study.

Complications during spinal anesthesia were studied prospectively in 1881 patients. Twenty-six percent of the patients suffered from one or more complications. The most common complications were hypotension (16.4%) and bradycardia (8.9%). The risk for hypotension was found to be higher with increasing age of patients (p less than 0.005). Higher peak sensory level significantly increased the risk for hypotension (p less than 0.0001), bradycardia (p less than 0.0001) and nausea (p less than 0.0001). Female patients suffered significantly more hypotension (p less than 0.001), nausea (p less than 0.001) and vomiting (p less than 0.001) than males. Cementation of prosthesis and deflation of the leg tourniquet were other risk factors demonstrated in this study.

Adolescent↗
PubMed1990

[Does a cone-shaped cannula needle offer an advantage in spinal anesthesia?].

The so-called atraumatic spinal cannula of Sprotte is a modification of the Whitacre spinal needle. It consists of a conical tip with a lateral opening. This cannula (24 G) is said to cause a very low incidence of postspinal headache. In a prospective study, it was compared to a 25 G cannula with a Quincke tip. PATIENTS AND METHOD. The study was carried out on 500 patients who received spinal anesthesia for operations on the lower extremities. The cannulas were randomly assigned to the patients. Puncture characteristics and number of incomplete blocks were evaluated. Postoperatively patients were interviewed on days 1, 3, 5, and 7. Neither the subjects nor the investigator were aware of the type of cannula used. RESULTS. There were no differences with regard to age and sex; 80% of the patients ranged between 15 and 55 years, with a homogeneous spread. Performance of the block was superior with the Sprotte cannula and the incidence of incomplete blocks was lower (1.6% vs 7.8%, P = 0.0011). There was no significant difference with regard to postspinal headache (8.2% vs 7.8%). CONCLUSIONS. The atraumatic cannula had better puncture characteristics, but there was no statistically significant difference with regard to postspinal headaches.

Adolescent↗
PubMed1987

Effect of total spinal anesthesia on arterial and venous responses to dopamine and dobutamine.

To test whether acute denervation alters the vascular effects of dopamine and dobutamine, we anesthetized 16 greyhounds and placed them on total cardiopulmonary bypass (CPB). Eight dogs received total spinal anesthesia before drug testing; eight dogs were tested in the absence of total spinal anesthesia. During dopamine and dobutamine infusions, venous capacitance [determined by the volume of the CPB venous reservoir (VR)] and mean arterial pressure (MAP) were monitored. The CPB pump flows remained constant throughout our studies. Every dog received six increasing doses of both drugs. In the absence of total spinal anesthesia, both dopamine and dobutamine increased VR (decreased venous capacitance) in a dose-dependent manner. Dobutamine decreased MAP in a dose-related fashion but dopamine had no significant effect on MAP. After total spinal anesthesia, both dopamine and dobutamine produced greater dose-related increases in VR (i.e., decreases in venous capacitance) than in the absence of spinal anesthesia. Dopamine increased MAP but dobutamine had no significant effect. These data demonstrate how dopamine and dobutamine differ in their effects on the arterial circulation in the presence or absence of spinal anesthesia. The acute denervation of spinal anesthesia altered venous and arterial dose-response relationships of both drugs. Finally, our study demonstrates the effectiveness of dobutamine and, perhaps even more so, dopamine as possible alternatives to ephedrine for the pharmacologic correction of the noncardiac circulatory sequelae of spinal anesthesia.

Anesthesia, Spinal↗
PubMed1994

[Effects of solvent, baricity and dextrose concentration of 0.5% tetracaine solution on the efficacy of spinal anesthesia].

In 108 spinal anesthetic cases, 2.36 ml of each of five 0.5% tetracaine solutions, either with distilled water (DW), normal saline (NS) or different concentrations of dextrose (2.5%-2.5 G, 5%-5 G, 10%-10 G) was injected intrathecally at the L2/3 or L3/4 interspace. The specific gravity and osmotic pressure of these solutions and cerebrospinal fluid were measured. The cephalad spread of analgesia was greater with higher concentration of dextrose (5 G-Th7.4, 10 G-Th6.0), compared with DW, NS and 2.5 G (Th9.5-9.8). The variation of the maximum level of analgesia was large with DW and NS. The time to complete motor block of both legs were longer with DW and NS than with dextrose containing solutions. The hemodynamic changes after intrathecal injection were small with 2.5 G, DW and NS. Arterial hypotension requiring treatment occurred with 5 G and 10 G. The baricity of spinal anesthetic solution had an important effect on characteristics of the blockade.

Adult↗
PubMed1990

[Severe lightning pain during spinal anesthesia].

A 74-yr-old man was scheduled for the biopsy of prostatic tumor under spinal anesthesia. Preoperative serologic test for syphilis was highly positive. Spinal anesthesia was performed in the sitting position, and 2 ml of hyperbaric Neo-percamine S (a mixture of 0.24% dibucaine and 0.12% T-caine) was administered uneventfully with the onset of warm sensation on the perineal region. Ten minutes later, however, he began to complain of severe lightning sensation on the feet. After giving pentazocine intravenously, the short cystoscopic procedure was completed. As a cause of severe pain, an erroneous anesthetic solution or direct neuronal injury had been excluded because of rapid and complete recovery after anesthesia. Two weeks later, he was scheduled for TUR-P. He again complained of severe lightning pain after the successful spinal anesthesia with the same anesthetic solution. Because the pain was not relieved by analgesics, he was then anesthetized with enflurane and N2O in oxygen, and there were no neurological complications after anesthesia. Several cases of severe pain during spinal anesthesia have been reported in patients with tabes dorsalis. Although the patient lacks clear symptoms of neurosyphilis, positive serologic examination for syphilis without any other possible causes suggests altered sensitivity of the spinal cord to anesthetic solutions.

Aged↗
PubMed1997

[Evaluation of postoperative hypoxemia after spinal anesthesia with a pulse oximeter].

We investigated postoperative hypoxemia after spinal anesthesia in 24 adult patients by monitoring SPO2 with a pulse oximeter for 5 hours in the ward. The patients received spinal anesthesia with 0.5% hyperbaric tetracaine and sedated with midazolam during operation. Twelve patients inhaled 3 l.min-1 oxygen via a mask for initial 3 hours, and the other breathed room air all the time. In two of the patients breathing room air, SPO2 decreased to less than 94%. In patients inhaling oxygen, SPO2 was maintained above 98% but decreased significantly after stopping oxygen inhalation (below 94% in five patients). The postoperative SPO2 value correlated significantly with BMI (body mass index) and preanesthetic SPO2, but not with the dose of midazolam or supplemental pentazocine, and postoperative conscious states. In conclusion, there are some incidences of postoperative hypoxemia after spinal anesthesia irrespectively of the dose of midazolam used intraoperatively. Inhalation of 3 l.min-1 oxygen via a mask is sufficient to prevent such postoperative hypoxemia.

Adolescent↗
PubMed1995

[The influence of cyclo-oxygenase inhibitor and spinal anesthesia on the surgical stress responses during lower abdominal surgery].

In order to evaluate the influence of cyclooxygenase inhibitor and spinal anesthesia on the neuroendocrine responses to surgical stress, plasma levels of prostanoids (6-keto-PGF1 alpha, TXB2, and 11-DTX), stress hormones (ACTH, cortisol), and catecholamines (epinephrine, norepinephrine) were measured in 24 patients undergoing colo-rectal surgery. In group I patients (n = 8) who had received indomethacin preoperatively, the elevation of plasma levels of prostanoids were almost abolished, but plasma levels of stress hormones and catecholamines increased 30 min after skin incision and remained at high levels during the study. In group S (n = 8) patients who received general anesthesia combined with spinal anesthesia, the elevation of plasma levels of TXB2, and 11-DTX were attenuated, and plasma levels of cortisol and catecholamines showed no significant changes up to the postoperative period. In group C (control group) (n = 8) patients, plasma levels of prostanoids, stress hormones, and catecholamines increased significantly 30 min after skin incision, and remained at high levels during the study. These results suggest that 1) TXA2 production may be influenced by the activation of the sympathetic nervous system, 2) PGI2 production may be mainly influenced by the mechanical stimuli to the splanchnic organs during surgical procedure, 3) indomethacin pretreatment reduces inflammatory response but does not reduce endocrine and sympathetic response, and 4) spinal anesthesia attenuates both inflammatory response and sympathetic nerve activation, i.e. sympathetic nerve stimuli plays a predominant role in activating both prostanoids and stress hormone cascades during lower abdominal surgery.

Adrenocorticotropic Hormone↗
PubMed1955

Spinal anesthesia; a survey of neurologic complications.

The incidence of severe neurologic complications from spinal anesthesia in San Diego County in a series of 32,882 cases in a five-year period was 0.012 per cent. Morbidity of 1 in 10,000 cases compares favorably with morbidity associated with general anesthesia. Meticulous technique and abandonment of continuous spinal anesthesia can further reduce the incidence of complications. More emphasis should be placed on the elimination of preexisting neurologic disease as a contraindication to spinal anesthesia.

Anesthesia, General↗
PubMed2005

Endoscopic totally extraperitoneal inguinal hernioplasty under spinal anesthesia.

OBJECTIVES: Although endoscopic totally extraperitoneal inguinal hernioplasty (TEP) confers superior early outcomes compared to those of open repair, the requirement of general anesthesia has been held as an argument against the application of TEP by opponents of laparoscopic surgery. To date, the literature on TEP performed under spinal anesthesia remains scarce. The present study reports our early experience performing TEP under spinal anesthesia in selected patients who were medically unfit for general anesthesia. METHODS: Between March 2003 and March 2004, 6 male patients underwent attempted TEP under spinal anesthesia. Selection criteria for the procedure included reducibility of the inguinal hernia and concomitant medical conditions precluding general aesthesia, such as impaired lung function. Informed consent was obtained in all patients. RESULTS: All patients were conscious and able to communicate verbally during the operation. TEP was successfully completed in 4 patients, with a mean operative time of 33 minutes. All 4 patients were asymptomatic and experienced no pain throughout the procedure. Conversion to open repair was required in 2 patients because of uncooperative movement in one, and inadequate neural blockade by spinal anesthesia in the other. Intraoperative cardiorespiratory parameters were stable in all patients. Postoperative urinary retention occurred in 1 patient. The mean length of follow-up exceeded 3 months, and no seroma or recurrence was detected clinically. CONCLUSION: Successful performance of TEP under spinal anesthesia requires the combined efforts of an experienced anesthesiologist, a skilled surgeon, and a cooperative patient. Our initial experience of TEP under spinal anesthesia appeared promising. TEP under spinal anesthesia may have a role in selected patients who are medically unfit for general anesthesia but are otherwise suitable for TEP.

Adult↗
PubMed1998

Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid-diluted lidocaine 50 mg/ml or mepivacaine 40 mg/ml or bupivacaine 5 mg/ml.

BACKGROUND: Transient radicular irritation (TRI) is common after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml. The purpose of this study was to determine the incidence of TRI after spinal anesthesia with hyperbaric lidocaine 50 mg/ml diluted with cerebrospinal fluid (CSF) 1:1 and hyperbaric mepivacaine 40 mg/ml and hyperbaric bupivacaine 5 mg/ml. METHODS: Ninety ASA class I-IV patients undergoing mostly brief urological procedures under spinal anesthesia were randomly allocated to receive either hyperbaric lidocaine 50 mg/ml diluted with CSF 1:1 (Group L), hyperbaric mepivacaine 40 mg/ml (Group M) or hyperbaric bupivacaine 5 mg/ml (Group B). Characteristics of the patients and details of the surgical procedures and spinal anesthesias were similar in all groups except for the intensity of motor block. The patients were evaluated on the first postoperative day by an anesthesiologist who did not know which spinal anesthetic agent had been used. RESULTS: Six patients (20%) in group L, 11 patients (37%) in Group M and none (0%) in Group B experienced pain in the legs and/or back (TRI) after spinal anesthesia. CONCLUSION: TRI is frequent after spinal anesthesia induced with hyperbaric lidocaine 50 mg/ml diluted with CSF 1:1. The incidence of TRI after hyperbaric mepivacaine 40 mg/ml is of the same magnitude. TRI could not be observed after bupivacaine spinal anesthesia.

Adult↗
PubMed1991

Heart rate responses to body tilt during spinal anesthesia.

To evaluate whether low-pressure baroreceptors located in the right atrium could affect the heart rate (HR) during spinal anesthesia, the authors determined the effects of right atrial pressure changes associated with body tilt on HR in 40 unpremedicated patients. Ten-degree head-up body tilt produced significant increases in HR of 6 +/- 1 and 6 +/- 1 beats/min (mean +/- SE, P less than 0.01) and significant decreases in systolic arterial pressure of 2.8 +/- 0.9 and 6.6 +/- 1.7 mm Hg (P less than 0.01) during low (T-10 +/- 0.2, n = 20) and high (T-4 +/- 0.2, n = 20) analgesic levels of tetracaine spinal anesthesia, respectively. Ten-degree head-down body tilt caused significant decreases in HR without significant changes in systolic arterial pressure during spinal anesthesia. The reflex HR responses to body tilt were similar between low and high levels of spinal anesthesia and were preserved after administration of sedatives. The magnitudes of changes in right atrial pressure associated with body tilt were similar during spinal anesthesia and after sedation. These findings suggest that HR responses to head-up body tilt are mediated mainly by arterial baroreceptors even in the face of decreased venous return during low or high levels of spinal anesthesia and that light sedation does not impair this reflex HR response.

Adult↗