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PubMedDate not supplied

The peripheral nerve stimulator: a monitor during continuous spinal anesthesia. Case report.

BACKGROUND AND OBJECTIVES: A continuous spinal anesthetic was planned and conducted for a medically compromised and demented 80-year-old man presenting for repair of an intratrochanteric hip fracture. METHODS: A peripheral nerve stimulator was successfully employed to monitor the height and to help time the redosing of the continuous spinal anesthetic. RESULTS: The use of a peripheral nerve stimulator allowed careful titration of our continuous spinal anesthetic to provide dense analgesia at the surgical site for 1 hour 5 minutes, using a total spinal dose of 27 mg lidocaine and 7.5 micrograms spinal fentanyl. CONCLUSION: A standard peripheral nerve stimulator is an effective monitor to help optimize management of continuous spinal anesthesia.

Aged↗

PubMed2002

A sudden death following tetracaine-induced spinal anesthesia.

A 56-year-old Japanese woman died after being given 10 mg of tetracaine to induce spinal anesthesia in preparation for orthopedic surgery. Autopsy findings and microscopic analysis revealed no external injuries or disease, and further toxicological examinations were carried out to determine the cause of death. For this we used gas chromatography-mass spectrometry. Tetracaine was not detected in most tissue samples, but the metabolite, p-butylaminobenzoic acid, was clearly detected in all samples. The concentration of the metabolite in the brain stem (234.7 ng/g) was higher than in the cerebrum (30.5 ng/g), cerebellum (36.7 ng/g), whole blood of the left heart (164.8 ng/ml) and whole blood of the left femoral vein (84.0 ng/ml). These distribution patterns were exactly same as rabbits sacrificed by high spinal anesthesia. Our findings suggest that tetracaine spread to the high regions of cerebrospinal nerves and acted directly on the central nervous system. Therefore, the cause of her death was high spinal anesthesia induced by tetracaine. This is apparently the first toxicologically proven case in which spinal anesthesia affected high brain centers.

Journal Article↗

PubMed1999

[Is spinal anesthesia for operations in the prone or jackknife position suitable?].

There is still controversy on the usefulness of spinal anesthesia for operations performed in the prone or jackknife position. There is about the risk of inadvertent increase of the sensomotory blockade with the patient in the prone position and the difficulty of managing consecutive cardiorespiratory complications or inducing general anesthesia in case of failures. This article reviews the current literature in terms of safety and effectiveness of spinal anesthesia for such operations. For lower-limb or perianal operations with limited extension and blood loss, performed in the prone position, spinal anesthesia seems to be a safe, effective and economic technique in patients without severe a cardiac history. Substantial knowledge about the onset time, fixation time, duration of sensomotory block and baricity of the applied local anesthetic is crucial in this setting. Obese patients are at risk for sudden extension of the block when turned into the prone position. Additional narcotics and sedatives should be avoided and continuous monitoring of hemodynamic and respiratory parameters, of the level of the blockade and vigilance of the patient is mandatory.

Anesthesia, Spinal↗

PubMed2004

Evidence that intravenous vasopressors can affect rostral spread of spinal anesthesia in pregnancy.

BACKGROUND: The authors have previously observed an apparent association between rostral spread of spinal anesthesia and choice of intravenous vasopressor given to maintain maternal systolic arterial pressure during cesarean delivery. This study tested the hypothesis that an intravenous infusion of phenylephrine can reduce rostral spread of spinal anesthesia in pregnancy, compared with ephedrine. METHODS: The study was randomized and double blind. It compared phenylephrine 100 microg/ml (phenylephrine group, n = 30), and ephedrine 3 mg/ml (ephedrine group, n = 30), given by infusion, to prevent maternal hypotension during combined spinal-epidural anesthesia for cesarean delivery. Two ml intrathecal plain levobupivacaine, 0.5%, combined with 0.4 ml intrathecal fentanyl, 50 microg/ml, and 10 ml epidural saline was given with the patient in the sitting position. The upper level of neural blockade to cold and light touch sensation was recorded at 10 and 20 min postspinal. Epidural space pressure was recorded at 5, 10, 15, and 20 min. RESULTS: At 20 min, the upper dermatome blocked to cold sensation was median T3 (interquartile range, T2-T4) for the phenylephrine group, compared with T1 (T1-T2) for the ephedrine group (P = 0.001). At 20 min, the upper dermatome blocked to light touch sensation was median T5 (T4-T8) for the phenylephrine group, compared with T3 (T2-T6) for the ephedrine group (P = 0.009). The mean epidural space pressure in the phenylephrine group was 16 (13-19) mmHg, compared with 16 (13-18) mmHg in the ephedrine group (P = 0.63). CONCLUSIONS: This study provides evidence that intravenous phenylephrine can decrease rostral spread of spinal anesthesia in pregnancy, compared with intravenous ephedrine. Further work is required to investigate possible mechanisms and to assess its clinical significance.

Adult↗

PubMed1995

[Patient's complaints preceding severe bradycardia and hypotension during spinal anesthesia].

We reported an episode of sudden bradycardia and hypotension during spinal anesthesia, in which the patient complained of nausea before the bradycardia and hypotension were recognized by the monitors, such as, intermittent measurement of arterial pressure, electrocardiography, pulse oxymetry and continuous arterial blood gas analysis. We emphasize the importance of strict vigilance during spinal anesthesia.

Aged↗

PubMed1987

[Headache following spinal anesthesia: also a problem of the local anesthetic used?].

In a prospective clinical study we followed 320 patients operated upon in spinal anesthesia. We were especially interested in headache patterns after spinal anesthesia and their causes, with particular reference to the local anesthetic used. Apart from the typical postspinal headache due to low cerebrospinal fluid (CSF) pressure, we found a nontypical pattern which was considerably more prevelant than the classical type. The typical postspinal headache correlated well with procedures (multiple perforations, thicker cannulae) that lower or prolong the reduction of CSF pressure and a history of migraine. The nontypical headache correlated with the use of lignocaine/articaine for spinal anesthesia, possibly due to metabolic and structural factors.

Adolescent↗

PubMedDate not supplied

Metoclopramide decreases emesis after spinal anesthesia supplemented with subarachnoid morphine.

BACKGROUND AND OBJECTIVES: The authors studied whether metoclopramide decreases the incidence of emesis after spinal anesthesia supplemented with subarachnoid morphine. METHODS: Patients underwent total hip arthroplasty under spinal anesthesia using tetracaine with norepinephrine and morphine 0.2 mg. Forty-eight patients were included in the study conducted with a paired design, using sequential analysis. Patients were allocated randomly and double-blinded to the treatment with metoclopramide or to the control group. In one group, metoclopramide 20 mg intramuscularly was given before and after surgery; patients in the control group were given equal volumes of saline. The presence of emesis for 5 hours postoperatively was recorded. RESULTS: In the postoperative period, emesis was noted in 58% of control patients but in only 17% of patients given metoclopramide (P < .05). CONCLUSIONS: The data suggest that metoclopramide is effective against postoperative emesis after spinal anesthesia supplemented with subarachnoid morphine.

Aged↗

PubMed1994

Influence of duration of lateral decubitus on the spread of hyperbaric tetracaine during spinal anesthesia: a prospective time-response study.

Searching for a differential spinal block between dependent and nondependent sides, we evaluated a prospective randomized time-response study of the influence of the duration of lateral decubitus on the spread of hyperbaric local anesthetic solution during spinal anesthesia in 60 patients undergoing lower limb surgery. In a lateral position with the operated side dependent, all patients received 12 mg of lyophilized tetracaine with 0.2 mg epinephrine in 2.5 mL 10% dextrose and were randomized into four groups according to the duration of lateral decubitus after spinal injection: Group 0, patients immediately turned supine after spinal injection; Group 6, 6 min in lateral decubitus then supine; Group 12, 12 min in lateral decubitus then supine; Group 18, 18 min in lateral decubitus then supine. There was no difference in maximum sensory level between both sides in the same group nor between the four groups. In all four groups a comparable number of patients had a Grade 4 motor block on the dependent as well as on the nondependent side. A positive correlation found between duration of lateral decubitus and duration of sensory block on the dependent side suggested a preferential spread of hyperbaric local anesthetics. This differential spread was confirmed by the positive correlation between the duration of lateral decubitus and the difference in duration between dependent and nondependent sides of both sensory and motor blocks. However, because of the minimal differences between groups, we believe there is no reason to routinely maintain patients in the lateral position after performing spinal anesthesia.

Adult↗

PubMed2002

[Anaphylactoid reaction to dibucaine during spinal anesthesia].

A 71-year-old man with a history of allergic rhinitis for 6 years received spinal anesthesia using 2 ml of 0.3% dibucaine for transurethral prostatectomy. Two months previously he had undergone prostate biopsy and cystoscopy under spinal anesthesia with isobaric bupivacaine uneventfully. Forty five minutes after injection of dibucaine he complained of itching in the periorbital area, and developed tremor and muscle rigidity followed by loss of consciousness. Soon after, his blood pressure decreased to 40 mmHg, and erythema appeared over his body. Symptoms were relieved by epinephrine, hydrocortisone and antihistamine agents, but ten minutes after the treatment he again developed hypotension and erythema. Continuous infusion of epinephrine was needed for complete relief of symptoms. An intradermal test with 0.3% dibucaine carried out 6 days after surgery demonstrated a 12 x 8 mm wheal with flare. Although anaphylactic reaction to an amide local anesthetic has been reported to be quite rare, this is the 7th case report of anaphylactic reaction to dibucaine used for spinal anesthesia in Japan.

Aged↗

PubMed2005

Is transcutaneous electrical stimulation a realistic surrogate for genuine surgical stimulation during spinal anesthesia for cesarean delivery?

Several studies have investigated differential block during spinal anesthesia using transcutaneous electrical stimulation (TES) applied to patient's skin. These TES stimuli are claimed to be a surrogate for surgical stimulation, but TES has never been shown to be a realistic surrogate for a surgical stimulus during regional anesthesia. We investigated whether patients could appreciate nonpainful TES at the same time as they were undergoing painless cesarean delivery surgery. We applied a nonpainful TES (10 mA, 50 Hz, 1-s duration) to the skin, at 5 different dermatomal levels, in 20 women undergoing elective cesarean delivery during spinal anesthesia. During surgery, all the women were totally pain free but we noted that the level of block to TES was variable: in 30% of women, TES could be felt at the T10 dermatome or more caudally. The first appreciation of touch was consistently at T6 or above. The fact that a nonpainful TES stimulus could be appreciated within the dermatomes directly involved in transmitting surgical stimuli, at a time when the patients were totally pain free, suggests that TES at the tested levels is of little value as a surrogate surgical stimulus.

Adult↗

PubMedDate not supplied

Does spinal anesthesia affect cerebral oxygenation during transurethral prostatectomy?

BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate (TURP) is associated with the unique complication of transurethral resection of prostate syndrome (TURS), which is attributed to the absorption of irrigating fluid. This study was initiated to investigate the effects of spinal anesthesia and TURP on cerebral oxygen balance. METHODS: Thirty patients scheduled for TURP were included. Jugular bulb oxygen saturation (SjbO2) was measured via retrograde cannulation of jugular venous bulb. Spinal anesthesia was initiated by 3 mL hyperbaric 0.5% bupivacaine injected at L3-L4 in the sitting position, producing a block to the T10 dermatome. Hemodynamic measurements and arterial and jugular bulb blood gasometry were performed before and after spinal anesthesia, throughout surgery, and during the postoperative period. RESULTS: A significant decrease of cerebral perfusion pressure after spinal anesthesia was accompanied by a significant decrease of SjbO2 below a preoperative value of 61% +/- 1. Eight patients developed yawning, irritability, restlessness, and nausea toward the end of surgery, and these were considered to be early signs of TURS. These patients demonstrated SjbO2 below 55% and 50% in 63% and 42% of respective data set points. CONCLUSION: The neurologic symptoms in patients undergoing TURP during spinal anesthesia might not only be caused by absorption of irrigating fluid but also by impairment of cerebral oxygenation.

Aged↗

PubMed2001

Selective spinal anesthesia for outpatient laparoscopy. V: pharmacoeconomic comparison vs general anesthesia.

PURPOSE: To compare the cost and effectiveness of small-dose spinal anesthesia (SP) with general anesthesia (GA) for outpatient laparoscopy. METHODS: A retrospective record analysis of 24 patients who received SP were compared with 28 patients who received GA in our Daycare centre. The costs of anesthesia and recovery were calculated, from an institutional perspective, using 1997 Canadian Dollar values. Effectiveness was measured in terms of time for anesthesia and recovery, and postoperative antiemetic and analgesic requirements. RESULTS: Both groups were well matched for age, weight, duration and type of surgery. The mean total cost for the SP group of $53.45 +/- 10.40 was no different from that for the GA group of $48.92 +/- 10.25 (95% CI -10.3, 1.2). Time to administer anesthesia was longer in the SP group with a mean time of 18 +/- 8 min compared with 10 +/- 3 min in the GA group (CI -11.3, -4.7). Recovery time in the PACU was longer in the SP group 123 +/- 51 min compared with 94 +/- 48 min (CI -56.6,-1.4). Postoperative antiemetic requirements were similar: 8% in SP group vs 14% in GA group, whereas analgesic requirements were less in the SP group with 25% receiving analgesia compared with 75% in the GA group (P < 0.05). CONCLUSION: The total cost of anesthesia and recovery using SP is similar to that for GA when used for outpatient laparoscopy. Spinal anesthesia was less effective than GA in time to administer anesthesia and in duration of recovery. Postoperative analgesic requirements were reduced using SP.

Adult↗

PubMed1990

[No effect of injection volume on sensory and motor blockade in isobaric spinal anesthesia].

The authors were interested to find whether the course of sensory and motor blockade in isobaric spinal anesthesia was determined by the dose or the volume of the anesthetic agent. In a randomized double-blind study in 60 patients, each underwent isobaric spinal anesthesia with 17.5 mg bupivacaine. In three groups of 20 patients, this dose was administered as 3.5 mg bupivacaine 0.5%, 7 ml bupivacaine 0.25% or 10 ml bupivacaine 0.175%. The development, spread and regression of sensory block (anesthesia, analgesia) and motor block (Bromage scale, rectus abdominis muscle test) were determined. The clinical data recorded in the three groups were comparable. The rate of development, the maximal spread or intensity, and the regression of sensory and motor blockade did not differ in the three groups. The only difference was that the complete regression was shorter following 10 ml bupivacaine 0.175% (P less than 0.05). It is therefore concluded that the dose, and not the volume, determines the course of sensory and motor blockade of isobaric spinal anesthesia.

Adult↗

PubMed2001

[The effect of obesity on spinal anesthesia for cesarean section].

To evaluate the effect of obesity on spinal anesthesia for cesarean section, we retrospectively studied 90 parturients who had undergone cesarean section, dividing the patients into 2 groups: obesity group (body mass index > 30, n = 41); control group (body mass index < 30, n = 49). Total surgical time and anesthetic time were longer in the obesity group than in the control group. The amount of ephedrine administered was also greater in the obesity group than in the control group. However, there were no significant differences in time for spinal tap and the incidence of hypotension between the two groups. Spinal anesthesia for cesarean section in obese patients may be an acceptable method.

Adult↗

PubMed1999

Spinal anesthesia for nonpulmonary surgery in a lung transplant recipient.

The anesthetic implications for patients requiring anesthesia for surgery after lung transplantation have not been thoroughly studied. The use of spinal anesthesia in patients undergoing lumbar laminectomy has been well described. This case demonstrates the use of spinal anesthesia for lumbar laminectomy in a patient who had previously undergone a bilateral lung transplantation. Spinal anesthesia was used to minimize the risk of respiratory complications such as aspiration, atelectasis, and pneumonia that may be associated with administration of a general anesthetic.

Anesthesia, Spinal↗

PubMed2001

The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review.

UNLABELLED: We evaluated in this qualitative systematic review the efficacy of increasing central blood volume on the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Randomized controlled trials investigating any method of increasing central blood volume before the initiation of obstetric spinal anesthesia were sought by using MEDLINE (1966-2000), Embase (January 1988-April 2000), and the Cochrane Library (Issue 1, 2000). Additional reports from retrieved and review articles, hand searching of non-MEDLINE journals, and abstracts of major anesthesia meetings (1994-1999) were located. The primary outcome was the incidence of hypotension. Secondary outcomes included: ephedrine use, Apgar scores, umbilical cord pH values, and maternal nausea and vomiting. Twenty-three articles met our inclusion criteria with the use of crystalloid preload, colloid preload, and mechanical methods of increasing central volume. Crystalloid preload was inconsistent in preventing hypotension, whereas colloid appeared to be effective in all but one study. Leg wrapping and thromboembolic stockings decreased the incidence of hypotension compared with leg elevation or control. Few differences in fetal outcomes or maternal nausea and vomiting were reported. Increasing central blood volume by using colloid and leg wrapping decreases but does not abolish the incidence of hypotension before spinal anesthesia for elective cesarean delivery. IMPLICATIONS: We performed a systematic review to determine whether fluid loading reduced the incidence of low blood pressure after spinal anesthesia for cesarean delivery. Although no technique totally eliminates the occurrence of hypotension, colloid administration (starch or gelatin containing fluids) and leg wrapping were the most effective.

Adult↗

PubMed1983

Meningitis--a complication of spinal anesthesia.

During a five-year period, 17 of 1429 patients admitted with meningitis had had recent spinal anesthesia in Cairo, Egypt. Ten of the 17 had positive cerebrospinal fluid cultures: 8 were Pseudomonas aeruginosa, 1 was Staphylococcus aureus, and 1 was Streptococcus mitis. These organisms were not cultured from patients who had not had spinal anesthesia. Two patients with negative cultures had lumbar spine x-ray changes consistent with tuberculosis. Antibiotic therapy was based upon the sensitivity of cultured organisms. Four of the 17 patients died. These data strongly suggest that meningitis in patients with recent spinal anesthesia is commonly due to unusual or nosocomial organisms. Aggressive, meticulous bacteriologic evaluation of these patients is essential.

Anesthesia, Spinal↗

PubMed2000

Spinal anesthesia for gastrostomy in an infant with nemaline myopathy.

IMPLICATIONS: We report a case of spinal anesthesia in an infant with nemaline myopathy. Spinal anesthesia was administered to preempt the potential problems of difficult tracheal intubation and prolonged mechanical ventilation secondary to muscle weakness after the use of IV anesthetics in this patient.

Anesthesia, Spinal↗