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PubMedDate not supplied

A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies.

BACKGROUND AND OBJECTIVES: Ambulatory surgery requires anesthesia methods that allow rapid recovery and safe discharge of the patient. Spinal anesthesia is easy and quick to perform, and the use of noncutting small gauge needles reduces the occurrence of postdural puncture headache. For minimal hemodynamic consequences and faster recovery and discharge it would be optimal to limit the spread of spinal anesthesia only to the area which is necessary for surgery. In this study, the possibility in achieving unilateral spinal anesthesia with 0.18% hypobaric bupivacaine was studied. METHODS: Spinal anesthesia with 3.4 mL of hypobaric 0.18% bupivacaine (6.12 mg), without any intravenous infusion or prophylactic vasopressors, was administered with 27-gauge Whitacre unidirectional needle to 70 ASA I and II patients undergoing knee arthroscopies. The patients were allocated randomly to be kept either 20 (group I) or 30 (group II) minutes in the lateral position operation side uppermost. Sensory and motor block (pinprick/modified Bromage scale) were compared between the operation and the contralateral side. RESULTS: The motor and sensory block between operation and contralateral sides were significantly different at all testing times in both groups (P < .001, Mann-Whitney U test). The motor block was completely unilateral in 14 patients (39%) in group I and in 22 patients (65%) in group II. The hemodynamics were stable in all 70 patients. CONCLUSIONS: Approximately three and a half milliliters hypobaric 0.18% bupivacaine (6.12 mg) provides a predominantly unilateral spinal block. Thirty minutes spent in the lateral position does not provide benefits over 20 minutes. The main advantages of our method are the hemodynamic stability and the patient satisfaction.

Adult↗

PubMed2002

Spinal anesthesia: exploring some common surgical myths.

OBJECTIVE: To evaluate and compare whether a difference exists between measurable factors such as heart rate, blood pressure, pulse, and anesthesia induction time in patients undergoing spinal versus general anesthesia. METHODS: A retrospective study of eighteen surgical cases on the leg from the knee and distally under spinal anesthesia were compared to identical or similar procedures performed with a patient under general anesthesia. Data for heart rate, blood pressure, oxygen saturation, and the time interval for anesthesia induction were studied. Heart rate and blood pressure values recorded from the intra-operative anesthesia record were compared with the recorded preoperative values obtained from the anesthesia record. Anesthesia induction time was obtained from the interval between the recorded time for beginning anesthesia and the surgery start time. RESULTS: Systolic blood pressure increased by an average of 12.3 mmHg in the general anesthesia (GA) group compared with a value of 12.9 for the spinal anesthesia (SA) group. Average intra-operative systolic pressure decreased by 10.9 mmHg in the GA group vs. a decrease of 7.7 for SA. Pulse rate for GA decreased by 3.7 bpm versus an increase of 3.2 in SA. Induction time for GA was 27.9 minutes compared to an average SA induction time of 29.8 minutes. CONCLUSIONS: The study found no significant differences in intra-operative patient vital signs when comparing patients under general anesthesia to those under spinal anesthesia. Additionally, although the literature states that spinal anesthesia takes longer if the patient is not prepared prior to the operating room being ready, this study found no significant delay in operation start times for general anesthesia versus spinal anesthesia.

Anesthesia, General↗

PubMed2002

Subdural hygroma: a rare complication of spinal anesthesia.

IMPLICATIONS: We describe a patient with frontal hygroma after spinal anesthesia--a rare complication. This condition should be considered in patients after spinal anesthesia with persisting orthostatic headache. Risk factors include ventriculo-peritoneal shunt or brain atrophy caused by old age.

Aged↗

PubMed2005

Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anesthesia for ambulatory knee arthroscopy.

BACKGROUND: We tested the hypothesis that selective spinal anesthesia for ambulatory knee arthroscopy can be accomplished with a small dose of bupivacaine at the L3/4 interspace with or without a head-down tilt of 5 degrees when the patients were in the lateral decubitus position. METHODS: In this double-blind study, 123 patients were randomly allocated to receive spinal anesthesia with 4 mg of hyperbaric bupivacaine inserted at either the L2/3 interspace, while the vertebral column was kept horizontal (L2/3 group), or the L3/4 level, with the vertebral column horizontal (L3/4H) or tilted 5 degrees head-down (L3/4T). At 7 min, an additional head down tilt was used in all groups if the sensory block was inadequate. RESULTS: In the L3/4T group the sensory block (Th8) reached a significantly higher level 30 min after spinal injection, compared with both the L2/3 (Th10) and L3/4H (Th11) groups. In the L3/4H group, 39% of the patients needed an additional tilt for 3 min at 7 min, compared with 10% (P=0.004) in the L3/4T group. Sacral block developed later and recovered faster (P<0.05) in the L3/4T group compared to the L3/4H group. Home-readiness was achieved equally fast in all groups. CONCLUSION: When producing selective spinal anesthesia, the posture of the vertebral column is a major determinant of both sensory and motor segments to be blocked. A 4-mg dose of hyperbaric bupivacaine at the L3/4 interspace with a 5 degrees head-down tilt of the vertebral column for 6 min is recommended for knee arthroscopy.

Adult↗

PubMed2003

Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl.

BACKGROUND AND OBJECTIVE: Addition of fentanyl to hyperbaric bupivacaine spinal anesthesia prolonged the duration of sensory block. This study seeks to test the hypothesis that adding fentanyl to small dose hypobaric spinal anesthesia will improve intraoperative patients and surgeon satisfaction without delay in recovery. METHODS: Patients (n = 80) subjected to minor cystoscopic surgery were randomly assigned to have spinal anesthesia with either 5 mg bupivacaine 0.1% or 5 mg bupivacaine 0.1% mixed with 20 micrograms fentanyl. The main outcome measures included intraoperative patient and endoscopist satisfaction, sedative/analgesic supplementation, postoperative side effects and time to ambulation. RESULTS: Patients in the bupivacaine group needed more analgesic supplementation. Analgesia was more adequate in the bupivacaine-fentanyl group. Pruritus was the main side effect in the bupivacaine fentanyl group. Ambulation and discharge of patients were nearly the same in both groups. CONCLUSIONS: Spinal anesthesia with small dose (5 mg) hypobaric (0.1%) bupivacaine mixed with fentanyl (20 micrograms) produced adequate anesthesia for short cystoscopic procedures with minimal side effects and without delay in ambulation.

Adult↗

PubMed1982

Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section.

Ephedrine sulfate was administered to 44 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Twenty patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the base line systolic blood pressure (mean dose of ephedrine 31.6 mg). Twenty-four patients (control group) received 20 mg of ephedrine as an intravenous bolus, and additional 10-mg increments, if necessary when systolic blood pressure decreased to 80% of the base line systolic blood pressure (mean dose of ephedrine 26.8 mg). In patients given the infusion, systolic blood pressure did not change significantly from the base line systolic blood pressure following spinal anesthesia (p greater than 0.1) and reactive hypertension did not occur. Nausea and/or vomiting occurred in nine women in the control group and one patient in the infusion group (p less than 0.01). Apgar scores, fetal blood gas tensions, and time for onset of respiration were comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.

Adult↗

PubMed1998

Oral clonidine premedication enhances the pressor response to ephedrine during spinal anesthesia.

UNLABELLED: Clonidine premedication enhances the pressor effects of ephedrine in awake and anesthetized patients. To test the hypothesis that clonidine augments the pressor response to ephedrine during spinal anesthesia, 48 ASA physical status I or II patients were randomly assigned to either the clonidine group (n = 23), receiving oral clonidine approximately 5 microg/kg 90 min before spinal anesthesia, or the control group (n = 25), receiving no clonidine. Spinal anesthesia was performed at either the L2-3 or the L3-4 interspace using 0.5% hyperbaric tetracaine solution 1.4-3.0 mL. Blood pressure (BP), heart rate, and the upper dermatomal level of analgesia were determined at 1-min intervals with the patient in the supine position after tetracaine injections. When systolic BP decreased to <80% of the prespinal value or <100 mm Hg, IV ephedrine 0.2 mg/kg was administered as a bolus. There were no differences in the duration until the first dose of ephedrine after tetracaine injections, and the upper level of analgesia between groups (control group 8.5+/-3.7 min, T5; clonidine group 7.7+/-2.7 min, T6). Although prespinal and preephedrine BP values were higher in the control group, the magnitude of increases in mean BP after ephedrine was significantly greater in the clonidine group (P < 0.05). We conclude that oral clonidine premedication augments the pressor response to IV ephedrine during spinal anesthesia. IMPLICATIONS: The pressor effect of ephedrine is enhanced in patients given oral clonidine premedication during spinal anesthesia.

Administration, Oral↗

PubMed2006

Heart rate variability predicts severe hypotension after spinal anesthesia.

BACKGROUND: Hypotension due to vasodilatation after spinal anesthesia (SA) may be harmful. Heart rate variability, an indirect measure of autonomic control, may predict hypotension. METHODS: One hundred patients were studied. Retrospectively, heart rate variability was analyzed in 30 patients, classified depending on the lowest systolic blood pressure (SBP) after SA. Seventy patients were studied prospectively, assigned to one of two groups by their low to high frequency ratio (LF/HF) before SA. Sensitivity and specificity of LF/HF for prediction of decrease of SBP greater 20% of baseline were tested. RESULTS: Retrospective analysis showed differences of LF/HF depending on the degree of hypotension after SA. Prospective analysis demonstrated significant differences of SBP after SA depending on baseline LF/HF (mean +/- SD): low LF/HF (1.3 +/- 0.7) = > SBP: 91 +/- 8% of baseline versus high LF/HF (5.5 +/- 2.4) = > SBP: 66 +/- 10% of baseline (P < 0.05). Baseline LF/HF as well as high frequency and proportional decrease of SBP after SA correlated significantly, in contrast to baseline hemodynamic parameters heart rate and SBP. A receiver operator curve characteristic analysis showed a sensitivity and specificity of LF/HF > 2.5 of 85% to predict SBP decrease of greater than 20% of baseline after SA. CONCLUSIONS: Heart rate variability analysis before SA may predict hypotension after SA with high sensitivity and specificity. LF/HF may be a tool to detect patients at high risk of hypotension due to SA. This indicates that the predictive value of LF/HF is superior to established predictors.

Aged↗

PubMed1998

Spinal anesthesia for cesarean section. 1963.

Safety in spinal anesthesia for cesarean section is achieved by strict adherence to the cardinal principles of proper evaluation and selection of patients, the use of prophylactic vasopressors, preanesthetic establishment of a reliable intravenous channel, small doses of the local anesthetic, close monitoring and maintenance of systolic blood pressure above 100 mm. Hg, and avoidance of ergot compounds in the presence of vasopressors.

Anesthesia, Obstetrical↗

PubMed1977

Spinal anesthesia with bupivacaine and tetracaine in sheep.

Spinal anesthesia was performed in sheep in order to compare hyperbaric solutions of 0.375 and 0.75% bupivacaine and tetracaine. There was no significant difference between the two compounds in the duration of sensory analgesia in the anal regions nor, at 0.75% in the time required for complete regression of the block. However, at 0.375% the duration of sensory analgesia and motor block in the hind limbs and the time required for complete regression were shorter with bupivacaine. In addition to exhibiting a higher incidence and a longer duration of motor block in the hind limbs, the sheep that received tetracaine were unable to stand on the hind limbs even after complete regression of block had occurred. Although further studies are required to establish the cause of this phenomenon, we suggest this may reflect a block of proprioceptor fibers.

Anesthesia, Spinal↗

PubMed1989

[The effect of midazolam on blood circulation and respiration during spinal anesthesia in urology].

Ten urological patients with spinal anesthesia were sedated with midazolam 0.03 mg/kg i.v. A similar group (n = 10) was given placebo instead of midazolam (2 ml 0.9% NaCl). Patients who received midazolam slept lightly but were rousable. During the operation 2 l/min oxygen was administered via a nasal cannula; pO2 and pCO2 remained within normal limits throughout the procedure. No cardiovascular side effects such as hypotension or other reaction such as vomiting, nausea, or confusion were observed after midazolam. At the end of the operation all patients were fully awake and cooperative.

Aged↗

PubMed1989

[Power spectral analysis of heart rate and peripheral blood flow variations during total spinal anesthesia].

We evaluated the effect of total spinal anesthesia (TSA) on the heart rate and peripheral blood flow variations to evaluate if TSA could influence these parameters as indicators of autonomic nervous function (ANF). Four patients with intractable pain were treated by TSA by administration of local anesthetics (lidocaine or mepivacaine) into the C7-Th1 vertebral interspace. Power spectrum of heart rate before TSA showed three peaks; low (LO-FR, 0.04-0.095 Hz), mid (MID-FR, 0.095-0.15Hz) and high frequency areas (HI-FR, 0.15-0.3Hz). Spectral peaks of LO-FR and MID-FR disappeared during TSA (P less than 0.001). HI-FR area decreased to 3.3% of the control level (P less than 0.001). Mean peripheral blood flow was changed to 59.9% of the control level (not significant). However, peripheral blood flow variations of LO-FR decreased to 11.3% of the control level (P less than 0.001) after TSA. Furthermore, the vagal discharge disappeared promptly after TSA in dog. These results suggest that TSA depresses the vagal activity as well as the sympathetic activity innervating the cardiovascular system and therefore, heart rate and peripheral blood flow variations are totally eliminated. Thus, we conclude that heart rate and peripheral blood flow variations can serve as valid markers of ANF activity.

Anesthesia, Spinal↗

PubMed2005

Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section.

BACKGROUND: Hypotension associated with spinal anesthesia for cesarean section is still a clinical problem. Colloid solutions seem preferable to crystalloid solutions for preloading. In most studies the overall rate of hypotension is reported. Few studies have, however, investigated the maternal and neonatal consequences of different levels of maternal hypotension. METHODS: In this randomized, double-blinded study 110 patients presenting for elective cesarean section received either 1000 ml acetated Ringer's solution or 1000 ml 3% dextran 60 solution immediately before spinal anesthesia. The effect on overall hypotension, clinically significant hypotension (hypotension associated with maternal discomfort defined as nausea, retching/vomiting, dizziness or chest symptoms) and severe hypotension (systolic arterial pressure <80 mmHg) was studied. RESULTS: Dextran reduced the incidence of overall hypotension from 85 to 66% (P=0.03), reduced the incidence of clinically significant hypotension from 60 to 30% (P=0.002) and reduced the incidence of severe hypotension from 23 to 3.6% (P=0.004) compared to Ringer's solution. There were neither differences in neonatal outcome between treatment groups nor between neonates grouped after severity of maternal hypotension. CONCLUSION: Clinically significant hypotension seems to be a more suitable outcome variable than overall hypotension. The protective effect of the colloid solution increased with increased severity of hypotension.

Adult↗

PubMed1997

Combined popliteal and posterior cutaneous nerve of the thigh blocks for short saphenous vein stripping in outpatients: an alternative to spinal anesthesia.

STUDY OBJECTIVE: To compare a combination of peripheral nerve blocks with spinal anesthesia in ambulatory patients undergoing short saphenous vein stripping. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 28 ASA physical status l and II ambulatory surgery patients undergoing short saphenous vein stripping. INTERVENTIONS: 14 patients received a popliteal block (sciatic nerve block at the popliteal fossa) using 30 ml of alkalinized 3% chloroprocaine and a posterior cutaneous nerve of the thigh block with 10 ml of 1% lidocaine. The 14 patients who were randomized to the spinal anesthesia group received 65 mg of 5% hyperbaric lidocaine. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in age and gender between the two groups (mean age 53 +/- 13 years, 8 men and 20 women). Patients in the peripheral nerve block group recovered significantly faster in phase 1 of the postanesthesia care unit (PACU) (67 +/- 10 min vs. 122 +/- 50 min, p < 0.01) and were discharged home sooner (222 +/- 53 min vs. 294 +/- 69 min, p < 0.01) than the patients in the spinal anesthesia group. CONCLUSIONS: The combination of popliteal and posterior cutaneous nerve of the thigh blocks provided adequate anesthesia and a faster recovery profile with a similar subjective acceptance of both anesthetic techniques in ambulatory patients undergoing short saphenous vein stripping in the prone position.

Ambulatory Surgical Procedures↗

PubMed2000

Reinforcement of spinal anesthesia by epidural injection of saline: a comparison of hyperbaric and isobaric tetracaine.

PURPOSE: An epidural injection of saline was reported to extend spinal anesthesia because of a volume effect. The aim of this study was to evaluate the influence of the baricity of spinal local anesthetics upon the extension of spinal anesthesia by epidural injection of saline. METHODS: Forty patients undergoing elective lower-limb surgery were randomly allocated to four groups of 10 patients each. Group A received no epidural injection after the spinal administration of hyperbaric tetracaine (dissolved in 10% glucose). Group B received an epidural injection of 8 ml of physiological saline 20 min after spinal hyperbaric tetracaine. Group C received no epidural injection after spinal isobaric tetracaine (dissolved in physiological saline). Group D received an epidural injection of 8 ml of saline 20 min after spinal isobaric tetracaine. The level of analgesia was examined by the pinprick method at 5-min intervals. RESULTS: The levels of analgesia 20 min after spinal anesthesia were significantly higher in hyperbaric groups than in isobaric groups [T5 (T2-L2) vs. T7 (T3-12)]. After epidural injection of saline, the levels of analgesia in groups B and D were significantly higher than in groups A and C. The segmental increases after epidural saline injection were 2 (0-3) in group B and 2 (1-7) in group D. Sensation in the sacral area remained 20 min after spinal block in one patient in group D; however, it disappeared after epidural saline injection. CONCLUSION: In this study, 8 ml of epidural saline extended spinal analgesia. However, there was no difference between the augmenting effect in isobaric and hyperbaric spinal anesthesia. We conclude that the reinforcement of spinal anesthesia by epidural injection of saline is not affected by the baricity of the spinal anesthetic solution used.

Clinical Trial↗

PubMed2000

[Factors influencing the level of spinal anesthesia: (I). Characteristics of anesthetic solutions].

The practitioner of spinal anesthesia needs to know the minimum block he or she can expect in order to guarantee the adequate anesthesia to perform a given operation. At the same time, the anesthesiologist needs to know the maximum extent of block, for which he or she must be prepared to avoid being caught unaware. The height of sensory block is determined by the cephalad distribution of the local anesthetic in the cerebrospinal fluid and uptake by neuronal tissue in sufficient amounts to produce the block. Out of many factors that have been considered to affect the distribution, this paper discusses characteristics of anesthetic solutions. It has been suggested that solutions that are marginally hyperbaric can safely produce relatively consistent blocks with an extent that is suitable for many operations performed under spinal anesthesia.

Anesthesia Recovery Period↗

PubMed1989

Time-courses of zones of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine.

The purposes of this study were twofold: to compare bupivacaine and tetracaine spinal anesthesia with regard to the zones of differential sensory blockade and to evaluate the time-courses of the widths of the zones of differential sensory blockade during spinal anesthesia. In 51 patients, the most rostral levels of sensory denervation to light touch, pinprick, and temperature discrimination were measured. There was no statistically significant difference in the height of sensory blockade in the 29 patients given bupivacaine and in the 22 patients given equipotent doses of tetracaine. The widths of the zones of differential blockade were also not statistically different between the two groups during onset, maintenance, and regression of anesthesia, except that the light touch-to-pinprick and light touch-to-temperature zones of differential blockade were greater with bupivacaine than with tetracaine 30 min after subarachnoid injection. The width of the zones of differential blockade also remained unchanged within each group during onset, maintenance, and regression of anesthesia. Changes in, and absolute levels of, blood pressure and heart rate were similar with both bupivacaine and tetracaine throughout. We conclude that zones of differential sensory blockade are essentially the same with tetracaine and bupivacaine, that the widths of the zones of differential sensory blockade remain constant during onset, maintenance, and offset of spinal anesthesia, and that bupivacaine and tetracaine are associated with similar changes in heart rate and blood pressure during spinal anesthesia.

Adult↗

PubMed1989

[Effect of increasing amounts of clonidine during hyperbaric tetracaine spinal anesthesia].

The effect of adding clonidine to hyperbaric tetracaine spinal anesthesia was investigated in 60 ASA class I-II patients scheduled for orthopedic and lower abdominal surgery. The subjects were randomly allocated into 4 groups. All patients received tetracaine 10 mg in 10% glucose solution 2 mL. Patients in group 1 received above medication and were the control group, patients in the other groups received tetracaine plus increasing dosages of clonidine: 15 microgram (Gr.2), 30 microgram (Gr.3), and 45 microgram (Gr.4). The segmental level of sensory loss was tested by the pinprick method using a 23 G needle. The three clonidine groups had significantly increased in the sensory regression time to L1 level (by 42, 47, 60% respectively), and also had significantly increased motor complete recovery time (by 48, 70, 74% respectively), but the incidence of hypotension and bradycardia was increased in the clonidine 0.045 mg group. It is concluded that addition of 15 or 30 microgram clonidine may be useful as a means of increasing the duration of hyperbaric tetracaine spinal anesthesia.

Adult↗