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PubMed1993

[Evaluation of skin temperature of patients under spinal anesthesia during cesarean section].

Temperature changes of the first finger and toe were evaluated in patients under spinal anesthesia. One hundred and thirty female patients who were to undergo cesarean section were selected for this study. During spinal anesthesia the changes in skin temperature were classified in three patterns. The first pattern showed a rise of the first finger and toe temperature just after intrathecal injection of 0.3% dibucaine (hand and foot type, n = 77). The second pattern showed only a rise of the first toe temperature (foot type, n = 55), and the third pattern showed no change in the first finger and toe temperature (unchanged type, n = 3). The results of cold description tests were T5 +/- 2 (mean +/- SD) in hand and foot type, T8 +/- 2 in foot type and L1 +/- 6 in unchanged type. The skin temperature pattern was affected by the position of the patient. When the patients were placed in a head down position, 38 cases of foot type showed a rise of the first finger temperature, and 1 case of unchanged type showed a rise of the first finger and toe temperature. In these cases the operative procedure was done under spinal anesthesia. The remaining 4 cases of foot type and 2 cases of unchanged type needed another anesthetic method. In cesarean section under spinal anesthesia, skin temperature pattern of hand and foot type seems desirable. Simultaneous monitoring of hand and foot (first fingertip temperature) seems to be useful to evaluate the height of spinal anesthesia.

Adult↗
PubMed1989

Effects of pH of cerebrospinal fluid and local anesthetic on the success rate of spinal anesthesia.

Forty-three ASA physical status I-II adult patients, receiving spinal anesthesia for lower abdominal or lower limb surgery, were allocated randomly to two groups. Group 1 patients (n = 21) were given heavy bupivacaine 12 mg and group 2 patients (n = 22) were given tetracaine 12 mg in 2.5 mL of 10% dextrose. Spinal anesthesia was performed in the lateral decubitus position the at L 3-4 interspace with a 25-G spinal needle. Radial artery blood samples were collected before and after spinal anesthesia fpr pH measurement using a NOVA Biomedical machine; CSF samples were collected before and after injection of local anesthetic, and local anesthetic was also collected at the same time, for pH measurement using a Radio pH meter. The time from injection to maximal cephalad spread of analgesia and level of spinal analgesia were measured by the pin-prick method. The result was regarded as a failure if pain sensation still existed at the level of the operation site after spinal anesthesia. There were 1 failure case in the bupivacaine group and 2 failures in tetracaine group. The pH of CSF and local anesthetic in these failures were compared with those in effective cases, and the results showed that there was no significant relationship between the pH value of CSF and the local anesthetic drug.

Adolescent↗
PubMed1993

Incremental dosing versus single-dose spinal anesthesia and hemodynamic stability.

We compared the hemodynamic stability after spinal anesthesia with two different dosing regimens in the elderly. Fifty patients, all older than 60 yr and scheduled for elective knee or hip surgery were assigned to two groups. After administration of 10 mL/kg of lactated Ringer's solution (RL) intravenously (i.v.) in the first group, we performed a continuous spinal anesthesia (CSA) by means of a 28-gauge catheter through which repetitive injections of 2.5-5 mg of plain bupivacaine 0.5% were given. In the other group, a single-dose spinal anesthesia (SS) with 20 mg of the same local anesthetic (LA) was carried out. Noninvasive mean arterial pressure (MAP), heart rate, and levels of analgesia were measured. To maintain MAP within 25% of initial value, the patients received additional i.v. fluids (RL) as first measure. When MAP could not be maintained despite hydration, incremental doses of ephedrine were given i.v. Six patients in the CSA group and 17 in the SS group developed a level of anesthesia higher than T6 (P < 0.01). In the SS group more fluid was needed (792 vs 388 ml) than in the CSA group (P < 0.01). Moreover, more patients of the SS group (11 vs 4) required ephedrine (P < 0.05). We conclude that CSA produces reliable and predictable analgesia for lower limb surgery with less need for correction of hemodynamic changes compared to SS.

Aged↗
PubMed1998

[Clinical study of AJ-007 (bupivacaine) in spinal anesthesia--investigation of clinical dosage of isobaric and hyperbaric formulations].

Spinal anesthesia with two types of 0.5% bupivacaine hydrochloride solution, isobaric AJ-007 I and hyperbalic AJ-007 H, was studied clinically in 106 surgical patients with collaboration of 7 university hospitals. The following results were obtained. 1) Successful analgesia with motor block on abdominal wall and legs could be induced by dosages of 2.0 ml, 3.0 ml and 4.0 ml of either of the two solutions. 2) With isobaric solutions, the duration of the block was prolonged dose dependently. Anesthetic levels tended to increase and onset times of the block tended to decrease, with increasing dosage. 3) Hyperbalic solutions tended to produce higher levels of the block more rapidly. However, the duration of the block seemed to be shorter than that achieved by isobaric solutions. 4) The incidence of hypotension and bradycardia was similar to that observed in ordinary clinical spinal anesthesia. In one young male, a high level (C 2) of anesthesia was achieved after administration of 4.0 ml of hyperbaric solution. This patient was managed uneventfully under general anesthesia during the surgery. These results indicate that these two solutions of 0.5% bupivacaine are useful for spinal anesthesia.

Adult↗
PubMed2003

Fluid administration prevents renal dysfunction during hypotension under spinal anesthesia in a rat model.

BACKGROUND: Severe hypotension deteriorates renal functions and renal hemodynamics especially renal cortical blood flow. Systemic hypotension following high level spinal anesthesia may impair renal functions in spite of the blockade of renal sympathetic nerves that may help prevent vasoconstriction. Fluid loading is clinically applied for preventing hypotension but the effects on the changes of renal functions have not been studied. This study was designed to investigate the effects of fluid loading on systemic hemodynamics, renal hemodynamics and functions especially the blood distribution to renal cortex. METHODS: A rat model was used in our study. Intravenous normal saline infusion was started in both control group (5 ml/kg/h, 8 rats) and fluid loading group (15 ml/kg/h, 8 rats) 30 min before spinal anesthesia. A high level (above T4) spinal anesthesia was conducted via a preset intrathecal catheter with 0.5% hyperbaric bupivacaine. Blood pressure, heart rate and renal cortical microvascular blood flow (CMBF) were measured via a laser Doppler probe firmly contacted on renal cortex and recorded continuously after spinal anesthesia. Renal functions including glomerular filtration rates (GFR, by inulin clearance), effective renal plasma flow (ERPF, by P-aminohippurate clearance), urine flow rate (UFR) and electrolytes excretion were measured every 30 min after spinal anesthesia. RESULTS: Severe hypotension was notable within 5-10 min after intrathecal anesthesia and recovered with 30 min in both groups but the difference was not significant between groups. In the control group, GFR and ERPF decreased significantly in the first 30 min by 51.9 +/- 19.8% and 44.3 +/- 13.7% respectively (P < 0.05) and recovered after 60 min. Also the deteriorations of UFR and CMBF were significantly longer (over 60 min). In fluid loading group, ERPF, UFR and CMBF could maintain throughout the experiment but only GFR was affected in the first 30 min. CONCLUSIONS: Fluid administration did not prevent hypotension following high level spinal anesthesia but might have beneficial effects on renal hemodynamics especially on the renal cortical circulation and urine flow rate.

Anesthesia, Spinal↗
PubMed1990

[The effect of barbotage on the sensory spread in spinal anesthesia using isobaric and hyperbaric 0.5% bupivacaine].

The effect of spinal anesthesia with barbotage versus without barbotage on the spread of analgesia was investigated. For comparison, hyper- and isobaric bupivacaine 0.5% with adrenaline 1:200,000 was used. MATERIAL AND METHODS. Barbotage was accomplished as follows: after lumbar puncture 0.5 ml CSF was aspirated into the local anesthetic solution, followed by reinjection of 1.0 ml of the solution. This process was repeated six times. Sixty patients who were scheduled for urological or lower limb surgery under spinal anesthesia were selected for this study. Patients were each arbitrarily assigned to one of four groups (isobaric and hyperbaric, without and with barbotage). RESULTS. There was no statistically significant difference in the maximum level of sensory analgesia. The mean maximum level of sensory analgesia reached T9 (group 1), T8 (group 2), T9 (group 3) and T8 (group 4). Time to highest dermatome was significantly shorter with barbotage (groups 1-4: 19.0 min, 13.0 min, 18.7 min, 12.3 min). Times for regression of analgesia to T12 (mean maximum duration) were 142 (+/- 54.9) min, 164 (+/- 29.7) min, 130 (+/- 40.4) min and 144 (+/- 36.2) min (groups 1-4). Motor block grade 3 (Bromage) was achieved in significantly shorter times with barbotage than without. The shortest onset time was recorded with isobaric bupivacaine. The onset time of a complete motor block was 12.5 (+/- 5.5) min in group 1, 6.1 (+/- 2.9) min in group 2, 15.8 (+/- 4.7) min in group 3, and 11.7 (+/- 5.1) min in group 4. CONCLUSIONS. The results showed no significant differences between the maximum segmental sensory levels or duration of anesthesia observed with isobaric and with hyperbaric bupivacaine (with and without barbotage). Sufficient analgesia was obtained with barbotage and without barbotage. Uncontrolled cephalad spread of spinal anesthesia was not observed. Barbotage has the advantage of shortening time for spread to highest dermatome and the time to onset of complete motor block.

Aged↗
PubMed1981

A chronic model for investigation of experimental spinal anesthesia in the dog.

A chronic model for investigation of spinal anesthesia in the dog is described. This model incorporates the use of a chronically implanted catheter in the lumbar subarachnoid space. An 18-gauge thin-walled Crawford needle is passes percutaneously into the subarachnoid space. An 18-gauge epidural catheter is then threaded through the needle into the subarachnoid space and the distal end attached to a special metal valve which is sutured under the skin. One-milliliter volumes of various local anesthetic solutions were injected intrathecally via the valve and catheter. Durations of the effects of the local anesthetics were evaluated. Duration which hind-limb paralysis persisted in the dog. The times to onset and durations of motor blockades were evaluated following the intrathecal injection of dibucaine, tetracaine, lidocaine, bupivacaine, chloroprocaine, and mepivacaine. Times to onset ranged from 1.1 to 2.3 min. Durations of motor blockade were longest for dibucaine and tetracaine, followed in order of decreasing duration by bupivacaine, lidocaine, chloroprocaine, and mepivacaine. The durations of subarachnoid conduction motor blockades in the dog are qualitatively similar to reported values for spinal anesthesia in man. Therefore, the technique described may provide a useful model to evaluate factors that may influence spinal anesthesia.

Anesthesia, Spinal↗
PubMed1985

Epinephrine does not prolong lidocaine spinal anesthesia in term parturients.

The effect of adding epinephrine to spinal anesthesia performed with lidocaine in young, healthy patients was determined in a prospective, controlled, randomized double-blind study. Patients were randomly assigned to one of two groups. One group received lidocaine in dextrose, and the other, lidocaine in dextrose plus epinephrine. Maximum segmental level, time to maximum level, and duration as determined by time to two-segment regression were determined for each of the two groups. There were no significant differences between the two groups in any of the observed parameters, most notably, duration. The present results substantiate those from a previous study in an older population that showed that epinephrine did not significantly prolong lidocaine spinal anesthesia. The present results do not, however, support the hypothesis based upon these earlier data that failure of epinephrine to prolong lidocaine spinal anesthesia is restricted to elderly patients.

Adolescent↗
PubMed2005

Transient neurologic symptoms after spinal anesthesia with lidocaine versus other local anesthetics: a systematic review of randomized, controlled trials.

Lidocaine has been used for spinal anesthesia since 1948, seemingly without causing concern. However, during the last 10 years, a number of reports have appeared implicating lidocaine as a possible cause of neurologic complications after spinal anesthesia. Follow-up of patients who received uncomplicated spinal anesthesia revealed that some of them developed pain in the lower extremities--transient neurologic symptoms (TNS). In this study, we sought to compare the frequency of 1) TNS and 2) neurologic complications after spinal anesthesia with lidocaine with that after other local anesthetics. Published trials were identified by computerized searches of The Cochrane Library, MEDLINE, LILAC, and EMBASE and by checking the reference lists of trials and review articles. The search identified 14 trials reporting 1347 patients, 117 of whom developed TNS. None of these patients showed signs of neurologic complications. The relative risk for developing TNS after spinal anesthesia with lidocaine was higher than with other local anesthetics (bupivacaine, prilocaine, procaine, and mepivacaine), i.e., 4.35 (95% confidence interval, 1.98-9.54). There was no evidence that this painful condition was associated with any neurologic pathology; in all patients, the symptoms disappeared spontaneously by the 10th postoperative day.

Adult↗
PubMedDate not supplied

Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience.

BACKGROUND AND OBJECTIVES: To evaluate the incidence and causes of complications associated with spinal anesthesia for cesarean delivery. METHODS: Prospective study, case series. SETTING: Tampere University Hospital, 284 patients scheduled for elective or nonelective cesarean delivery with spinal anesthesia. Complications occurring during spinal anesthesia with hyperbaric 0.5% bupivacaine during a 1-year period were analyzed. RESULTS: Hyperbaric 0.5% bupivacaine for cesarean delivery proved to be a reliable anesthetic with a failure rate of 2.8%. The most common complications were hypotension (42%) and nausea (14%). In 81% of patients, hypotensive periods occurred before delivery. Hypotension before delivery had no correlation with low Apgar scores or with low pH in the umbilical artery of the infant. Risk factors for hypotension were elective procedures and operations without prophylactic ephedrine infusion. Nausea occurred significantly more often if a lower interspace was used for administering the subarachnoid block. CONCLUSIONS: Spinal anesthesia proved to be a safe, reliable, and rapid method of anesthesia for cesarean delivery, but, in view of a high incidence of minor complications, careful patient monitoring during spinal anesthesia is necessary to make the outcome optimal for mother and fetus.

Anesthesia, Obstetrical↗
PubMedDate not supplied

Continuous spinal anesthesia: the Canadian perspective.

BACKGROUND AND OBJECTIVES: Until the arrival of microcatheters, continuous spinal anesthesia was mainly restricted to elderly and high-risk patients. The introduction of microcatheters enabled the technique to be used in a wider range of patients. This paper describes the experiences of anesthetists in Canada with these catheters, and the changes in their practice since their withdrawal. METHODS: Anesthetists (those known to have experience with continuous spinal anesthesia, or to be regional anesthesia enthusiasts) across Canada were surveyed by telephone or mail. RESULTS: Of a total of 36 respondents, 25 had tried continuous spinal anesthesia with microcatheters. The majority had experience of only a few cases but a few reported larger series of hundreds of cases, Numerous technical difficulties with catheter insertion occurred, and problems with catheter breakage and neurologic deficit were reported. Some of these problems were reported to the Health Protection Branch, and, as a result of these reports and problems experienced in the United States, microcatheters were recalled in Canada soon after the FDA safety alert in the United States. CONCLUSIONS: Various techniques are being used instead of continuous spinal anesthesia with microcatheters, and only a few anesthetists favored their return.

Anesthesia, Spinal↗
PubMed1994

Postanesthesia nursing care for ambulatory surgery patients post-spinal anesthesia.

There has been a renewed interest in spinal anesthesia in recent years. However, its use for ambulatory surgery patients has not been as well accepted as its use for inpatients because of the high incidence of postdural puncture headache (PDPH) and uncertain patient recovery time before hospital discharge. Recently, studies indicate that the incidence of PDPH can be lowered to an acceptable level by applying improved techniques such as the use of a 27-g spinal needle or a needle with a tip designed like a pencil point, such as a Whitacre (Becton-Dickinson, Rutherford, NJ) or Sprotte (Pajunk, Geisingen, Germany) needle. Also, by using xylocaine or bupivacaine, which are short- or intermediate-acting local anesthetics, rather than tetracaine, a long-acting anesthetic, patients can be safely discharged from the hospital within 4 to 6 hours from the induction of anesthesia. These improved techniques have allowed spinal anesthesia to be a valid, even desirable, option for selected patients undergoing ambulatory surgery. When considering spinal anesthesia for ambulatory surgery patients, it is important that the postanesthesia care staff be knowledgeable, because nursing care is one of the three integral parts of total patient care that makes ambulatory surgery successful. The other two components are surgery and anesthesia management. This presentation reviews the history, indications, benefits, and complications of spinal anesthesia and recommends nursing care for patients undergoing ambulatory surgery.

Adult↗
PubMed2000

Spinal anesthesia for preterm infants undergoing inguinal hernia repair.

HYPOTHESES: Use of spinal anesthesia is safe and effective in an outpatient population of preterm infants undergoing inguinal hernia repair (IHR) and eliminates routine postoperative hospital admission for apnea monitoring. METHODS: From October 1982 through October 1997, all preterm (gestational age [GA], < or =37 weeks), high-risk (preterm infants whose postconceptual age at surgery [PCAS] is <60 weeks) infants undergoing IHR with spinal anesthesia were studied prospectively. No exclusions were made for preexisting conditions. Elective IHRs and incarcerated hernias were both considered. A postoperative apnea rate was calculated and compared with published postoperative apnea rates in preterm infants after receiving general anesthesia. RESULTS: For 269 IHRs performed, 262 spinal anesthetic placements (97.3%) were successful in 259 infants; 246 placements were achieved on the first attempt and 16 on the second. The mean GA was 32 weeks (GA range, 24-37 weeks); mean PCAS, 43.7 weeks (PCAS range, 33.4-59.3 weeks); and mean birth weight, 1688 g (weight range, 540-3950 g). Two hundred six patients (78.6 %) did not require supplemental anesthesia; 56 (21.4%) did: 34 received intravenous anesthesia; 6, general; 12, local; and 4, other regional. One hundred fifty-three infants had a history of apnea. Thirteen episodes of apnea were noted in 13 infants (4.9%) following the 262 procedures; all 13 were inpatients undergoing concomitant therapy for apnea (mean GA, 28 weeks; PCAS, 42.9 weeks). Four of these infants received supplemental anesthesia. This apnea rate is significantly lower than the published rate (10%-30%) (P = .01). One hundred three infants underwent IHR on an outpatient basis, 39 of whom had a history of apnea. None of these developed apnea postoperatively. The mean birth weight of this group was 2091 g (weight range, 710-3693 g); mean GA, 33 weeks (GA range, 25-37 weeks); and mean PCAS, 44.3 weeks (PCAS range, 35.4-59.2 weeks). All 103 patients were discharged home the day of surgery. Average time from room entry to incision was 26.3 minutes, which is similar to anesthesia induction time for patients receiving general anesthesia. Average time from bandaging to leaving room was 1 minute, less than usual time for patients receiving general anesthesia. CONCLUSIONS: Spinal anesthesia is safe, effective, and eliminates the need for postoperative hospital admission in an outpatient population of preterm infants undergoing IHR. This results in considerable cost savings without compromising quality of care.

Anesthesia, Spinal↗
PubMed1989

[Chronic subdural hematoma following spinal anesthesia].

A chronic subdural hematoma was observed 4 weeks after spinal anesthesia. The 70-year-old patient complained of severe, long-lasting headache soon after lumbar puncture. The later symptoms of hemiparesis and aphasia were first misinterpreted as a cerebral vascular accident. After evacuation of the hematoma the patient recovered. Long-lasting, severe headaches after lumbar puncture may be caused by a chronic subdural hematoma, a very rare complication. Risk groups are elderly patients and alcoholics, but every age group can be affected, including parturient women who deliver under spinal anesthesia. The diagnostic procedure of choice is computerized tomography (CAT). The application of contrast medium might be necessary if the CAT scan appears suspicious for a hematoma with the same density as the brain tissue. Because this complication is so rare informing the patient before spinal anesthesia does not seem to be necessary. According to expert opinions, a connection between lumbar puncture and subdural hematoma should be possible. In elderly patients and alcoholics, a pre-existing subdural hematoma may be possibly present.

Aged↗
PubMed2002

[Influence of positioning on the quality of unilateral spinal anesthesia].

OBJECTIVE: Unilateral spinal anaesthesia ("hemi-spinal") is theoretically associated with the advantages of fewer cardiovascular effects and longer duration of action while offering high density motor block of the extremity affected. METHODS: In a prospective, randomised study 60 patients received 2 mls of 4 % hyperbaric mepivacaine intrathecally. Group I (n = 30) was returned into the supine position after 5 minutes in the lateral position, Group II (n = 30) was kept in the lateral position for 15 minutes. Spread and subsequently offset of sensory and motor block were assessed separately for each side at predetermined time intervals pre-, intra-, and postoperatively. RESULTS: Both groups were identical regarding their morphometric parameters. In Group I (5 minutes), the mean cephalad spread of sensory block of the initially dependent side was T6 after 15 mins and T4 after 25 mins. On the initially non-dependent side, the sensory block reached to T5 after 25 mins. In Group II (15 mins), the initial mean difference was equivalent to two segments (T7/T9). After 25 minutes there was no difference to the results in Group I. CONCLUSIONS: Unilateral spinal anaesthesia ("hemi-spinal") is an attractive concept, supposed to be associated with the above mentioned advantages and the additional benefit of a partially maintained sensation of one limb. The results demonstrated in this study seriously question this theoretical concept. The most likely reason for the lack of inter-lateral differences in sensory block is the high concentration of hyperbaric local anaesthetic in the cerebrospinal fluid on the dependent side, which, on turning the patient to the supine position, will transit to the previously non-dependent side subsequently leading to a significant block.

Anesthesia, Spinal↗