[Extradural spinal anesthesia].
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Anesthesia↗
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The immediate complications of spinal anesthesia.
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Anesthesia↗
[Extradural spinal anesthesia].
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Anesthesia↗
Bacterial meningitis following lumbar puncture and spinal anesthesia.
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Anesthesia↗
Low dose ketamine and midazolam as supplements for spinal anesthesia.
BACKGROUND: Low dose ketamine and midazolam together were used as supplements during spinal anesthesia to provide analgesia for insertion of spinal needle and intraoperative sedation. METHODS: Two regimens of drug combination (ketamine 0.5 mg/kg and midazolam 0.05 mg/kg in group I, n = 30; ketamine 0.5 mg/kg and midazolam 0.1 mg/kg in group II, n = 30) were administered intravenously before proceeding lumbar puncture. RESULTS: Systolic and diastolic arterial blood pressure, heart rate, and arterial oxygen saturation did not change significantly before and after the administration of drugs. Most patients in both groups showed good analgesic response to the lumbar puncture. The medications induced a brief unconsciousness (4.1 min in group I; 8.5 min in group II). The time from drug administration to recovery of mental orientation was 8.8 min in group I and 15.1 min in group II. The regimens also provided intraoperative sedation. Patients in group II appeared to be more depressed than group I in the first 30 min. None of the patients had significant respiratory disturbance, involuntary movement, or recall to spinal puncture. There were 7 patients in group I and 4 patients in group II who experienced dreaming. CONCLUSIONS: The use of low dose ketamine together with midazolam as supplement for spinal anesthesia is helpful in anesthetic practice.
Adolescent↗
Body mass and spread of spinal anesthesia with bupivacaine.
The effect of body mass on spinal anesthesia with isobaric 0.5% bupivacaine was examined in 90 patients. The first 50 patients received 3 ml isobaric 0.5% bupivacaine. Another 40 patients, selected at random to receive 3 ml of either hyperbaric or isobaric bupivacaine 0.5%, were then studied. Levels of pin-prick analgesia and motor block were tested during induction, surgery, and recovery. The effects of high spinal anesthesia on peak expiratory flow (PEF) and arterial blood gas tensions were also examined in the last 40 patients. With isobaric bupivacaine, persons with higher than normal BMI [body mass index = weight (kg) divided by height-squared (m2)], or persons who were shorter than normal had higher cephalad spread of anesthesia. With hyperbaric bupivacaine only shorter individuals developed higher levels of anesthesia. Because of considerable interindividual variability, however, these observations are of only limited clinical value in predicting the spread of bupivacaine spinal analgesia. The higher spread of analgesia was associated with a decrease in PEF, whereas, the blood gas tensions remained undisturbed.
Adult↗
Augmentation of venous return by adrenergic agonists during spinal anesthesia.
To test the effectiveness of adrenergic agonists in correcting the vascular sequelae of spinal anesthesia, we used venous reservoir volume (RV) and mean arterial pressure (MAP) as indices of the changes in venous capacitance and arterial resistance produced by adrenergic agonists in dogs anesthetized with pentobarbital and undergoing cardiopulmonary bypass (CPB). A CPB-based technique was chosen both to prevent drug and reflex effects on the heart from influencing the results and to provide a convenient means by which to monitor venous capacitance. Total spinal anesthesia significantly decreased both RV and MAP relative to steady-state CPB values. Return of these hemodynamic alterations to baseline was attempted using pure alpha- and beta-adrenergic agonists, and a mixed adrenergic agonist (phenylephrine, isoproterenol, and ephedrine, respectively). Isoproterenol increased RV, but further decreased MAP. Phenylephrine increased MAP but not RV. Ephedrine increased both MAP and RV. We conclude that a mixed adrenergic agonist such as ephedrine more ideally corrects the noncardiac circulatory sequelae of spinal anesthesia than does either a pure alpha- or beta-adrenergic agonist.
Adrenergic alpha-Agonists↗
[Meralgia paresthetica after spinal anesthesia].
A 27-year-old man underwent appendectomy under spinal anesthesia with 0.3% dibucaine 2.7 ml. The perioperative course was uneventful. The surgical procedure, however, lasted for 1.5 hours in the supine position. On the second postoperative day, a postspinal headache occurred and lasted for 18 days. On the seventh postoperative day the patient complained of numbness along the anterolateral aspect of the left thigh innervated by the lateral cutaneous nerve. There was no reflex or motor deficit indicative of the involvement of other nerves. The disorder was diagnosed as meralgia paresthetica caused by the surgical procedures. The numbness disappeared after the oral administration of mecobalamin in several days. In the treatment of a case like this, it is important to exclude neurological complications caused by spinal anesthesia.
Administration, Oral↗
Warming 0.5% bupivacaine to 37 degrees C increases duration of spinal anesthesia.
The effect of warming glucose-free 0.5% bupivacaine to 37 degrees C before injection for spinal anesthesia was studied in 20 patients having total knee replacement. Twenty additional patients having spinal anesthesia for the same procedure were given glucose-free 0.5% bupivacaine at room temperature (approximately 20 degrees C). Onset, maximum cephalad spread, quality of sensory anesthesia, and duration and degree of motor blockade were the same in both groups. However, the duration of sensory anesthesia was significantly prolonged in patients who received bupivacaine at 37 degrees C. The mechanism by which warming bupivacaine prolongs the duration of sensory spinal anesthesia is uncertain. However, a decrease in the dissociation constant (pKa) of bupivacaine owing to increasing the temperature to 37 degrees C may account for some of this effect.
Adult↗
Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.
A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.
Adult↗
Prolonged PR interval is a risk factor for bradycardia during spinal anesthesia.
BACKGROUND AND OBJECTIVES: Bradycardia occurs during 9%-13% of spinal anesthetics and may lead to cardiac arrest. Several risk factors for the development of bradycardia have been identified, but the risk conferred by presence of abnormalities detected on preoperative electrocardiogram (ECG) has not been examined. The authors undertook the study to correlate abnormal ECG findings with the incidence of bradycardia. METHODS: The data-base was previously collected from 952 patients undergoing spinal anesthesia. Patient records were reviewed and 537 had ECGs performed within 6 months of surgery. Intraoperative bradycardia was defined as a heart rate < 50 bpm (plus > 10% decrease from baseline). Abnormalities recorded from the ECG were prolonged PR interval (PR > 0.2 sec), atrial-ventricular conduction abnormalities, evidence of chamber hypertrophy, ischemia, and infarction. The findings were compared with incidence of bradycardia using contingency tables. Significant correlations were then evaluated with logistic regression. Significance was defined as P < .05. RESULTS: The incidence of bradycardia in this population was 12%. Patients with a prolonged PR interval had an increased incidence of bradycardia (25%, P = .01). Other ECG abnormalities did not correlate with increased incidence of bradycardia. Duration of PR interval did correlate significantly (P = .001) but poorly (r2 = 0.014) with baseline heart rate. However, logistic regression demonstrated that prolonged PR interval was a significant and independent predictor for bradycardia (odds ratio = 3.2, P = .01). CONCLUSIONS: Risk factors previously identified for the development of bradycardia during spinal anesthesia include: baseline heart rate < 60 bpm, ASA physical status 1 versus 3 or 4, use of beta-blocking drugs, sensory block height > or = T5, and age < 50. The results demonstrate that prolonged PR interval on the preoperative ECG is another significant and independent predictor for bradycardia.
Adult↗
[A new sedation technique with propofol during spinal anesthesia].
We compared our new sedation technique with propofol during spinal anesthesia (Group B, n = 50) with a previously described method by Mackenzie et al. (Group A, n = 20). In Group A, propofol was started at a rate of 6 mg.kg-1.h-1 for 10 minutes, followed by continuous infusion at a rate of 4 mg.kg-1.h-1 till the end of surgery. In Group B, propofol 0.4 mg.kg-1 was administered by a bolus injection at the beginning. One-hundred and fifty minutes after the first injection, propofol 0.2 mg.kg-1 was added. The third dose of 0.1 mg.kg-1 of propofol was given 150 seconds after the second dose, followed by continuous infusion at a rate of 4 mg.kg-1.h-1 till the end of surgery. When adequate sedation was not obtained in Group B, propofol 0.1 mg.kg-1 was added by bolus fashion occasionally. In Group A, it took 9 min. 29 sec. to complete adequate sedation assessed by Mackenzie and Grant's sedation score. On the other hand, in Group B, it was 7 min. 27 sec. (P < 0.05 compared with Group A). There was neither excitation nor movement during sedation in Group B, while 5 patients experienced such events in Group A. The blood concentrations of propofol in Group B was 0.946 +/- 0.076 microgram.ml-1 and 0.693 +/- 0.136 microgram.ml-1 at 5 minutes and 10 minutes after the beginning of propofol, respectively. These values were significantly lower than those reported by Kugimiya. Our newly developed method for sedation with propofol during spinal anesthesia would be safer and more effective than that previously described by Mackenzie et al.
Adolescent↗
Duration of spinal anesthesia in infants less than one year of age. Comparison of three hyperbaric techniques.
BACKGROUND AND OBJECTIVES: Although numerous reports of the use of spinal anesthesia have appeared in recent literature, little information is available on the duration of anesthesia provided by standard doses of the commonly used drugs: lidocaine with epinephrine, tetracaine, or tetracaine with epinephrine. The authors evaluated the duration of spinal anesthesia using standard doses of local anesthetics and an objective endpoint of motor recovery in infants less than 1 year of age. METHODS: After reviewing historic literature to select doses, the duration of hyperbaric spinal anesthesia in 100 infants from 1-month to 12-months of age undergoing surgery below the diaphragm was evaluated. Spinal anesthesia was induced, cutaneous level of anesthesia determined by the infant's response to tetanic stimulation with a peripheral nerve stimulator, and time from injection to flexion of hip in response to stimulus was recorded. RESULTS: Lidocaine 3 mg/kg with epinephrine lasted 56 +/- 2.5 minutes, while tetracaine 0.4 mg/kg lasted 86 +/- 4 minutes and tetracaine 0.4 mg/kg with epinephrine lasted 128 +/- 3 minutes. CONCLUSIONS: The three subarachnoid techniques produced varying levels of duration of motor block. The authors recommend lidocaine 3 mg/kg with epinephrine for very brief procedures, tetracaine 0.4 mg/kg for procedures with a potential duration of 1 hour or less, and tetracaine 0.4 mg/kg with epinephrine for procedures estimated to last 90 minutes in infants less than 1 year of age.
Anesthesia, Spinal↗
Continuous retrobulbar anesthesia for scleral buckling surgery using an ultra-fine spinal anesthesia catheter.
PURPOSE: To evaluate a novel retrobulbar catheter technique for intraoperative and postoperative analgesia in patients undergoing scleral buckling procedures. METHODS: This prospective noncomparative clinical interventional case-series study included 43 consecutive patients undergoing scleral buckling procedures as treatment of rhegmatogenous retinal detachments. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of local anesthetic were injected into the retrobulbar space. Through the same needle, a 28-gauge commercially available flexible spinal anesthesia catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed. The catheter was removed on the morning of the first postoperative day. When the patients started to feel pain during or after surgery, 2 mL of local anesthetic were re-injected through the catheter. RESULTS: During surgery, 12 (27.9%) patients received a pain-free re-injection through the retrobulbar catheter resulting in a marked reduction of pain. Two (4.7%) patients needed a second re-injection. In the postoperative period, 23 (53.5%) patients experienced pain of grade 3 or higher 5.4 +/- 6.7 hr after start of surgery and received a retrobulbar re-injection. Eleven (25.6%) patients asked for a second postoperative re-injection, and four (9.3%) patients received a third postoperative re-injection. Cardiopulmonary and central nervous adverse effects were not noticed. CONCLUSIONS: Use of an ultra-fine retrobulbar catheter for repeat intraoperative and postoperative injections of local anesthetics is a simple and effective method to achieve analgesia during and after scleral buckling procedures.
Aged↗
Spinal cord blood flow during spinal anesthesia in dogs: the effects of tetracaine, epinephrine, acute blood loss, and hypercapnia.
To examine the effects of subarachnoid tetracaine and epinephrine on spinal cord blood flow (SCBF), lumbar SCBF and cerebral blood flow (CBF) were measured simultaneously by the hydrogen clearance technique in dogs (n = 45) anesthetized with halothane. The lumbar subarachnoid administration of tetracaine, 5 mg dissolved in 1 ml of a 7.5% dextrose solution had no significant effect on either SCBF or CBF for 4 hr even though arterial blood pressure and heart rate decreased significantly. After subarachnoid epinephrine alone (100, 300, and 500 micrograms), SCBF varied widely but did not change significantly with any of the injections, nor did CBF. Responses of SCBF to hypercapnia and to acute blood loss during spinal anesthesia with tetracaine were also examined. Increased PaCO2 (from 35 to 57 mm Hg) increased both SCBF and CBF similarly before and after subarachnoid tetracaine; SCBF increased from 26.8 +/- 9.0 ml X 100 g-1 X min-1 (mean +/- SD) before to 34.2 +/- 13.6 ml X 100 g-1 X min-1 during hypercapnia during spinal anesthesia, which was almost identical to the increase (from 31.5 +/- 8.1 ml X 100 g-1 X min-1 to 39.9 +/- 6.0 ml X 100 g-1 X min-1) before spinal anesthesia. Whereas acute blood loss (approximately 20% of estimated blood volume) during spinal anesthesia with tetracaine caused a 23% reduction of SCBF (P less than 0.05), in the absence of tetracaine SCBF remained unchanged during hemorrhagic hypovolemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Anesthesia, Spinal↗
Uneventful spinal anesthesia for a patient with carcinoid syndrome managed with long-acting octreotide.
PURPOSE: To present a case of spinal anesthesia in a patient suffering from carcinoid syndrome undergoing an inguinal hernia repair. In the past, regional anesthesia was considered unacceptable in these patients because of the possibility of intraoperative hypotension, hypertension, or bronchospasm. Recently, however, the preoperative use of octreotide, the synthetic analogue of the naturally occurring hormone somastatin, has been found to prevent these complications. Nevertheless, it remains unclear whether the use of this drug in patients with carcinoid syndrome allows the possibility of regional anesthesia. CLINICAL FINDINGS: We report the uneventful use of spinal anesthesia in a patient suffering from carcinoid syndrome treated with long-acting octreotide. With careful attention to volume status of the patient and low volume of local anesthetics (10 mg hyperbaric bupivacaine 0.5%) supplemented with intrathecal narcotics (fentanyl 20 micro g), we were able to prevent any episodes of intraoperative hypotension in this patient. Octreotide was available in the operating theatre in case of an emergency. One of the original aspects of this case report is that the patient received long-acting octreotide (once a month administration) instead of the usual daily dose. In addition this is one of the few reports of spinal anesthesia administered to a patient with carcinoid syndrome. CONCLUSION: Preoperative octreotide may result in more favourable conditions for regional anesthesia in patients with carcinoid syndrome. However, further studies will be required to confirm the favourable outcome observed in this patient.
Aged↗
Sameridine is safe and effective for spinal anesthesia: a comparative dose-ranging study with lidocaine for inguinal hernia repair.
UNLABELLED: Sameridine is a new compound with local anesthetic and analgesic properties when injected intrathecally. We studied the anesthetic and analgesic efficacy of three doses of isobaric sameridine (15, 20, and 23 mg) compared with 100 mg of hyperbaric lidocaine for spinal anesthesia in 140 healthy male patients undergoing inguinal hernia repair. Patients received spinal anesthesia with 4 mL of the study drug injected at the L2-3 or L3-4 interspace in the lateral decubitus position. All three doses of sameridine provided spinal anesthesia similar to lidocaine, with a slightly longer time to reach peak block height. The failure rate was highest in the 15-mg sameridine group, and accrual was discontinued in that group after 35 patients. The duration of blockade was shorter with lidocaine, but the time to voiding and ambulation was similar in all groups. Patients receiving sameridine were less likely to request morphine for postoperative analgesia and were less likely to request any analgesia in the first 4 h after injection of the drug. Use of oral analgesics (hydrocodone and acetaminophen) was similar in all groups after the first 4 h of the 24-h observation. We conclude that, in the three doses studied, sameridine provided spinal anesthesia similar to lidocaine, but with residual analgesia after drug injection that reduced the need for systemic analgesics in the first 4 h postoperatively. IMPLICATIONS: In this clinical trial, we show the potential efficacy of a class of drugs that can produce both spinal anesthesia and postoperative analgesia when used for hernia repair.
Adolescent↗
The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection.
UNLABELLED: We sought to identify factors that are associated with hypotension after the induction of spinal anesthesia (SpA) by using an anesthesia information management system. Hypotension was defined as a decrease of mean arterial blood pressure of more than 30% within a 10-min interval, and relevance was defined as a therapeutic intervention with fluids or pressors within 20 min. From January 1, 1997, to August 5, 2000, data sets from 3315 patients receiving SpA were recorded on-line by using the automatic anesthesia record keeping system NarkoData. Hypotension meeting the predefined criteria occurred in 166 (5.4%) patients. Twenty-nine patient-, surgery-, and anesthesia-related variables were studied by using univariate analysis for a possible association with the occurrence of hypotension after SpA. Logistic regression with a forward stepwise algorithm was performed to identify independent variables (P < 0.05). The discriminative power of the logistic regression model was checked with a receiver operating characteristic curve. Calibration was tested with the Hosmer-Lemeshow goodness-of-fit test. The univariate analysis identified the following variables to be associated with hypotension after SpA: age, weight, height, body mass index, amount of plain bupivacaine 0.5% used for SpA, amount of colloid infusion before puncture, chronic alcohol consumption, ASA physical status, history of hypertension, urgency of surgery, surgical department, sensory block height of anesthesia, and frequency of puncture. In the multivariate analysis, independent factors for relevant hypotension after SpA consisted of three patient-related variables ("chronic alcohol consumption," odds ratio [OR] = 3.05; "history of hypertension," OR = 2.21; and the metric variable "body mass index," OR = 1.08) and two anesthesia-related variables ("sensory block height," OR = 2.32; and "urgency of surgery," OR = 2.84). The area of 0.68 (95% confidence interval, 0.63-0.72) below the receiver operating characteristic curve was significantly greater than 0.5 (P < 0.01). The goodness-of-fit test showed a good calibration of the model (H = 4.3, df = 7, P = 0.7; C = 7.3, df = 8, P = 0.51). This study contributes to the identification of patients with a high risk for hypotension after SpA induction, with the risk increasing two- or threefold with each additional risk factor. IMPLICATIONS: By using automated data collection, 5 (chronic alcohol consumption, history of hypertension, body mass index, sensory block height, and urgency of surgery) of 29 variables could be detected as having an association with hypotension after spinal anesthesia induction. The knowledge of these risk factors should be useful in increasing vigilance in those patients most at risk for hypotension, in allowing a more timely therapeutic intervention, or even in suggesting the use of alternative methods of spinal anesthesia, such as titrated continuous or small-dose spinal anesthesia.
Aged↗