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PubMed1998

Advantages of spinal anesthesia in abdominal gynecologic surgery.

The advantages obtained in vaginal surgery and caesarean section using spinal anesthesia led us to test this anesthesia to verify feasibility, problems and advantages in abdominal surgery. Spinal anesthesia was performed in 60 patients between 21 and 87 years of age. Thirty-seven total abdominal hysterectomies with or without adnexectomy, 5 laparotomic miomectomies, 3 adnexectomies, 5 colposacropexies, 2 hysterectomies with lymphadenectomy, 7 Burch colposuspension with or without hysterectomy and 1 laparoscopy for sterilization were performed. No significant problems during surgery and the postoperative period were observed. Resumption of the different physiologic functions were more rapid, hospital stay shorter and compliance greater than with general anesthesia.

Adnexa Uteri↗

PubMed1992

[Pulmonary embolism was suspected during hip surgery under spinal anesthesia: a case report].

Most of the lower leg surgeries are done under spinal anesthesia. This 53 year old male had undergone a surgery for his left hip fracture previously and was scheduled for the removal of the screw. Spinal anesthesia was administered and sensory block was obtained up to T8. After the removal of the screw, he coughed weakly for several times. Suddenly ECG monitor showed severe bradycardia and hypotension was observed. He complained of chest pain, dyspnoea and went into shock. Immediately after giving atropine 0.5 mg iv, ephedrine 8 mg x 2 was necessary to raise his heart rate. About 3 minutes later he recovered from his shock state. ECG changes were transient and the bradyarrhythmia during his shock turned out to be AV dissociation. Arterial blood gas analysis showed decreased PaO2 and increased PaCo2. We suspected lung embolism. However, postoperative chest X-ray and pulmonary perfusion scans were within normal limits.

Anesthesia, Spinal↗

PubMed1998

Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients.

BACKGROUND: Recent evidence suggests that transient neurologic symptoms commonly follow lidocaine spinal anesthesia. However, information concerning factors that affect their occurrence is limited. Accordingly, to evaluate many potential risk factors, the authors undertook a prospective, multicenter, epidemiologic study. METHODS: On a voluntary basis, anesthetists at 15 participating centers forwarded a data sheet on patients who had spinal anesthesia to a research nurse blinded to the details of anesthesia and surgery. A subset was randomly selected for follow-up. The pressure [corrected] of transient neurologic symptoms, defined as leg or buttock pain, was the principal outcome variable. Logistic regression was used to control for potential confounders, and adjusted odds ratios and confidence intervals were used to estimate relative risk. RESULTS: During a 14-month period, 1,863 patients were studied, of whom 47% received lidocaine, 40% bupivacaine, and 13% tetracaine. Patients given lidocaine were at higher risk for symptoms compared with those receiving bupivacaine (relative risk, 5.1; 95% CI, 2.5 to 10.2) or tetracaine (relative risk, 3.2; 95% CI, 1.04 to 9.84). For patients who received lidocaine, the relative risk of transient neurologic symptoms was 2.6 (95% CI, 1.5 to 4.5) with the lithotomy position compared with other positions, 3.6 (95% CI, 1.9 to 6.8), for outpatients compared with inpatients, and 1.6 (95% CI, 1 to 2.5) for obese (body mass index >30) compared with nonobese patients. CONCLUSIONS: These results indicate that transient neurologic symptoms commonly follow lidocaine spinal anesthesia but are relatively uncommon with bupivacaine or tetracaine. The data identify lithotomy position and outpatient status as important risk factors in patients who receive lidocaine. Among other factors postulated to increase risk, obesity had an effect of borderline statistical significance, whereas age, sex, history of back pain, needle type, and lidocaine dose and concentration failed to affect risk.

Adult↗

PubMed1991

[Severe bradycardia and hypotension during spinal anesthesia: a report of five cases without morbidity].

We reported five cases of sudden onset of bradycardia and hypotension during spinal anesthesia in which measurable parameters of the patients were monitored continuously by inter-operating-room local area network system. In the first two cases, episodes of bradycardia and hypotension were caused by incomplete spinal blockade. In the third patient, severe bradycardia was preceded by gradual decrease of heart rate following high spinal blockade. In the last two cases of high spinal anesthesia, no remarkable change of the heart rate was observed before sudden onset of bradycardia and hypotension. All five patients were easily and adequately treated and they showed no signs of hypoxia. We would like to emphasize the importance of adequate and continuous monitoring during spinal anesthesia.

Adolescent↗

PubMed1996

[Removal of femoral interlocking nail-induced pulmonary embolism under spinal anesthesia--a case report].

Most of the lower limb surgeries are done under spinal anesthesia. This 21 year-old male had undergone open reduction with interlocking nail for his right femoral fracture and was scheduled for removal of interlocking nail. Spinal anesthesia was performed and a sensory block up to T8 level was achieved. During removing of the nail, the patient complained of chest pain, dyspnea and headache. Consequently, tachycardia and hypotension were observed. Then he coughed up pink frothy sputum. Ephedrine 5 mg was given to raise his blood pressure. About 3 min later, he recovered from the hypotension. Arterial blood gas analysis showed hypoxemia and hypercapnia. After endotracheal intubation, he was sent to surgical intensive care unit. In surgical intensive care unit, fat globules in urine, anemia and thrombocytopenia were noted. Chest roentgenogram showed patchy pulmonary infiltrates in the left lower lobe. A pulmonary artery catheter was inserted for pulmonary measurement, which read pulmonary artery pressure 45/28 mmHg, wedge pressure 14 mmHg, and cardiac output was 5-34 L/min. Supportive treatment which included steroid therapy, and O2 therapy with positive end-expiratory pressure was initiated under the impression of pulmonary embolism. The course in surgical ICU was uneventful and he left there three days later and was discharged on the fifth hospitalization day.

Adult↗

PubMed1999

Laparoscopic extraperitoneal inguinal hernia repair with spinal anesthesia and nitrous oxide insufflation.

BACKGROUND: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with nitrous oxide insufflation was investigated. METHODS: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures (24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications were collected prospectively. RESULTS: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time was 39 +/- 7 min for unilateral hernia and 65 +/- 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients (63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence. CONCLUSIONS: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia.

Aged↗

PubMed2006

Spinal anesthesia using single injection small-dose bupivacaine versus continuous catheter injection techniques for surgical repair of hip fracture in elderly patients.

Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia. We compared the hemodynamic effect of continuous spinal anesthesia (CSA) and small dose single injection spinal anesthesia (SA) regarding the incidence of hypotension. Seventy-four patients aged >75 yr undergoing surgical repair of hip fracture were randomized into 2 groups of 37 patients each. Group CSA received a continuous spinal anesthetic with a titration of 2.5 mg boluses every 15 min of isobaric bupivacaine, while group SA received a single injection spinal anesthetic with 7.5 mg of isobaric bupivacaine. The overall variations in noninvasive automated arterial blood pressure were not statistically significantly different in the 2 groups at baseline and after CSA or SA (not significant). In the SA group, 68% of patients experienced at least one episode of hypotension (decrease in systolic arterial blood pressure greater than 20% of baseline value) versus 31% of patients in the CSA group (P = 0.005). In the SA group, 51% of patients experienced at least one episode of severe hypotension (decrease in systolic arterial blood pressure more than 30% of baseline value) versus 8% of patients in the CSA group (P < 0.0001). In the CSA group, 4.5 +/- 2 mg of ephedrine was injected versus 11 +/- 2 mg in the SA group (P = 0.005). In the CSA group, 5 mg (2.5-10) of anesthetic solution was required versus 7.5 mg in the SA group (P < 0.0001). We conclude that, in elderly patients undergoing hip fracture repair, CSA provides fewer episodes of hypotension and severe hypotension compared with a single intrathecal injection of 7.5 mg bupivacaine.

Aged↗

PubMedDate not supplied

A prospective study on reproducibility of the spread of spinal anesthesia using plain 0.5% bupivacaine.

This prospective study was carried out to determine whether a spinal block with plain 0.5% bupivacaine spreads similarly when repeated in the same patient. During a 14-month period, 50 patients underwent from two to five spinal anesthesias using identical anesthetic technique, including the same premedication, the same volume of injected plain 0.5% bupivacaine, the same site of injection and the same position of the patient. Plain 0.5% bupivacaine was injected with the patient lying in the lateral horizontal position. Thereafter, the patients were turned to the supine horizontal position. Pinprick analgesia was recorded 60 minutes after the injection. Regression analysis showed that the reproducibility of the maximal analgesic segmental spread of the second anesthesia on the basis of the initial anesthesia was highly significant (p less than 0.0001). The blocking results of the patients who underwent from three to five anesthesias within the study period were in accordance with the spread of the first anesthesia. If a higher or lower spread of anesthesia is desirable, a modification or another local anesthetic for the spinal anesthesia may be preferred.

Adult↗

PubMed1989

[Accidental catheterization of the subdural space: a complication of continuous spinal anesthesia and continuous peridural anesthesia].

Two cases of subdural catheter placement following continuous spinal and continuous epidural anaesthesia are presented. In the first, despite an easy reflux of clear cerebrospinal fluid through the catheter, the injection of 4 ml bupivacaine 0.5 per cent with epinephrine 1:200,000 followed by 3 ml tetracaine 0.5 per cent showed a failure of spinal anesthesia. In the second, the administration through the catheter of 20 ml lidocaine 2.0 per cent CO2 plus epinephrine 1:200,000 and of ten ml bupivacaine 0.5 per cent lead to an insufficient, patchy and asymmetrical analgesia. The clinical signs observed in these two cases are compared with previous publications. The importance of an x-ray contrast study to confirm the diagnosis of subdural catheter insertion is stressed.

Adolescent↗

PubMed2006

Transcutaneous acupoint electrical stimulation with the ReliefBand for the prevention of nausea and vomiting during and after cesarean delivery under spinal anesthesia.

We randomized 94 patients undergoing cesarean delivery with spinal anesthesia to receive transcutaneous acupoint electrical stimulation using the ReliefBand at the P6 point (active group) or an active ReliefBand applied to the dorsum of the wrist (sham control group). The ReliefBand was applied 30-60 min preoperatively and left in place for 24 h. There was no statistically significant difference between the active and sham control groups in the incidence of intraoperative/postoperative nausea (30% versus 43%/23% versus 41%), vomiting (13% versus 9%/26 versus 37%), need for rescue antiemetics (23% versus 18%/34% versus 39%), or complete response (55% versus 57%/51% versus 34%). There was also no difference between the two groups in nausea scores, number of vomiting episodes, or patient satisfaction with postoperative nausea and vomiting management.

Acupuncture Points↗

PubMed1991

Practical points in understanding spinal anesthesia.

The purpose of this article is to discuss spinal anesthesia, including its indications and contraindications, techniques, type and measurement of blockade, and complications. Nursing implications will also be presented.

Anesthesia, Spinal↗

PubMed2003

Effects of adding epinephrine plus fentanyl to low-dose lidocaine for spinal anesthesia in outpatient knee arthroscopy.

BACKGROUND: This study investigated whether addition of 15 microg epinephrine plus 25 microg fentanyl to lidocaine spinal anesthesia for outpatient knee arthroscopy makes it possible to use a subanesthetic lidocaine dose. The aim was to assess the quality of anesthesia and the suitability of this protocol for outpatient knee arthroscopy. METHODS: Seventy-five outpatients scheduled for knee arthroscopy were randomly assigned to one of three spinal anesthetic protocols: Group L10F25 received 10 mg of lidocaine plus 25 micro g fentanyl; Group L10F25E15 received 10 mg of lidocaine plus 25 microg fentanyl plus 15 microg epinephrine; and Group L20F25 received 20 microg lidocaine plus 25 microg fentanyl. Tourniquet pain and surgical pain were assessed using a visual analog scale. If spinal anesthesia was inadequate despite supplementary intravenous analgesia and sedation, the patient was converted to general anesthesia. Recovery times and side-effects in the early postoperative period were recorded. RESULTS: The highest level of sensory block was above the T12 dermatome in all patients. Compared with the other groups, significantly more patients in Group L10F25 converted to general anesthesia. Group L10F25 had a significantly higher mean surgical pain score than the other groups. The mean tourniquet pain score was significantly higher in Group L20F25 than Group L10F25E15. Group L10F25E15 had a significantly shorter time to discharge than the other groups. Post-operative nausea and vomiting and drowsiness were more frequent in Group L10F25 than in the other groups. CONCLUSION: The combination of 10 mg lidocaine and 25 microg fentanyl plus 15 microg epinephrine provides adequate spinal anesthesia and has favorable recovery characteristics for outpatient knee arthroscopy.

Adult↗

PubMedDate not supplied

A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia.

BACKGROUND AND OBJECTIVES: The injection of small doses of local anesthetic solutions through pencil-point directional needles and maintaining the lateral decubitus position for 15 to 30 minutes after the injection have been suggested to facilitate the unilateral distribution of spinal anesthesia. We evaluated the effects of hypobaric and hyperbaric bupivacaine in attempting to achieve unilateral spinal anesthesia for patients undergoing lower limb orthopedic surgery. METHODS: Fifty patients were randomly allocated into 2 groups to receive either 1.5 mL hyperbaric bupivacaine 0.5% (7.5 mg; n = 25) or 4.2 mL hypobaric bupivacaine 0.18% (7.5 mg; n = 25). Drugs were administered at the L3-4 interspace with the patient in the lateral position. Patients remained in this position for 15 minutes before turning supine for the operation. Spinal block was assessed by pinprick and modified Bromage scale on both sides. RESULTS: Unilateral spinal block was observed in 20 patients in the hyperbaric group (80%) and in 19 patients in the hypobaric group (76%) while in the lateral position. However, 15 minutes after patients were turned supine, unilateral spinal anesthesia decreased to 68% of cases in the hyperbaric group and 24% of cases in the hypobaric group (P <.05). The motor block was more intense during the first 5 and 10 minutes (P <.05), but at the end of operation there was no difference between the groups. The hemodynamic changes were similar between the groups. CONCLUSION: As a result, unilateral spinal anesthesia with hyperbaric and hypobaric bupivacaine provided a rapid motor and sensory recovery and good hemodynamic stability, but more unilateral spinal block was achieved in patients in the hyperbaric group when compared with patients in the hypobaric group.

Adult↗

PubMed1994

Comparison of prophylactic angiotensin II versus ephedrine infusion for prevention of maternal hypotension during spinal anesthesia.

OBJECTIVE: Our purpose was to study the efficacy of ephedrine versus angiotensin II prophylactic infusions to counter maternal hypotension that occurs during spinal anesthesia at cesarean delivery. STUDY DESIGN: Healthy pregnant women undergoing elective repeat cesarean delivery at term with spinal anesthesia were randomized either to a control group (n = 10) or to one of two prophylactic infusion groups: angiotensin II (n = 10) or ephedrine (n = 10). Prophylactic infusions were titrated to a maternal diastolic blood pressure 0 to 10 mm Hg above baseline. Maternal and fetal blood samples for angiotensin II levels and acid-base status were obtained. Student's t test, chi 2, and analysis of variance were used. RESULTS: Mean arterial pressures were maintained after spinal anesthesia in the ephedrine and angiotensin II groups but decreased (p < 0.05) in the control group. Maternal angiotensin II levels rose with angiotensin II infusions but were unaltered in the other groups. Umbilical artery and vein angiotensin II levels were unaltered by angiotensin II infusions. Mean umbilical artery blood pH was lower (p < 0.05) in the ephedrine group than in the angiotensin II and control groups. CONCLUSIONS: In the healthy term fetus there is an advantage in using angiotensin II to maintain maternal blood pressure during regional anesthesia.

Adult↗

PubMed2003

A teaching tool in spinal anesthesia.

The purpose of the present study was to develop and evaluate a new model for teaching spinal anesthesia to nurse anesthesia students. The new teaching tool was evaluated to determine if the use of a spinal model allowing visual combined with the haptic sense was more effective than the traditional spinal model using primarily the haptic sense. Specifically, was there a difference in the number of successful passes, the amount of time taken for each spinal attempt, and the number of participants who reached 90% proficiency when comparing the use of both spinal models? Data analysis using a paired t test and Wilcoxon signed rank test revealed that the number of successes, amount of time needed to complete 1 needle pass, and point at which 90% proficiency was reached with the newly designed model were significantly greater than with the traditional model. The present study demonstrated that significant differences exist between participants who used both visual and haptic sense and participants who used primarily the haptic sense when performing spinal anesthesia. Findings of this study will be used to provide information that may be used to change the current curriculum for the training of nurse anesthesia students in spinal anesthetic procedures.

Anesthesia, Spinal↗

PubMed1977

Acid-base status in diabetic mothers and their infants following general or spinal anesthesia for cesarean section.

Acid-base status was studied in 30 diabetic mothers and their infants and in 30 healthy mothers and their babies after general or spinal anesthesia for cesarean section. A normal acid-base state was found for the diabetic subjects following general or spinal anesthesia. However, the infants of diabetic mothers given spinal anesthesia had an average pH of 7.20 and a base excess value of -5.67 mEq/l in umbilical-artery blood at delivery. These values were significantly lower than those observed in the infants of the other groups, where the average pH was between 7.28 and 7.30 and the base excess between -1.87 mEq/l and 1.00 mEq/l. These findings were significantly related to maternal diabetes and maternal hypotension.

Acid-Base Equilibrium↗

PubMed1990

A rabbit model for evaluation of spinal anesthesia: chronic cannulation of the subarachnoid space.

A rabbit model for evaluation of spinal anesthesia is presented. Chronic cannulation of the subarachnoid space was performed in 44 rabbits using the translumbar approach. An autopsy was performed 24 h after the operation on four of the animals. Intrathecal injections of methylene blue did not reveal any leakage from the spinal space. X-ray examination performed on the second and 30th days after the implantation indicated free spread of the injected solution in the subarachnoid space without any obstruction. Repeated injections of four identical doses of bupivacaine at 3-day intervals showed reproducible pharmacologic effects. Administration of different doses of the anesthetic produced a clear dose-response relationship. The relative activity of the anesthetic agents was found to be identical to that previously obtained in humans. No significant complications after the implantation have been recorded. We suggest the current model as an additional appropriate tool for the investigation of spinal anesthesia.

Anesthesia, Spinal↗

PubMed2004

Levobupivacaine spinal anesthesia in neonates: a dose range finding study.

BACKGROUND: Our aim was to determine the clinical efficacy of levobupivacaine for awake spinal anesthesia in ex-premature infants having lower abdominal surgery. The secondary aim was to determine the minimum local analgesic dose (MLAD) defined as the median effective local anesthetic dose for spinal anesthesia in neonates. METHODS: Fifty neonates < 55 weeks postconceptional age having lower abdominal surgery were enrolled. The dose of levobupivacaine was determined by up-down sequential allocation. The first infant received 1.25 mg x kg(-1) 0.5% levobupivacaine with subsequent doses determined by the response of the previous patient. Dose interval was 0.25 mg x kg(-1). RESULTS: There were no significant adverse effects attributable to levobupivacaine. Success rates for 1.25, 1, 0.75 and 0.5 mg x kg(-1) were 100, 83, 81 and 46%, respectively. Mean duration (95% confidence interval) of lower limb motor blockade was 81.7 min (75.8-87.6 min). Duration of anesthesia far exceeded surgical duration in all but one case. The up-down sequences were analyzed with the Dixon and Massey method. The motor block MLAD (95% confidence interval) was 0.48 mg x kg(-1) (0.42-0.54). Probit analysis was used to compare calculated ED50 and to calculate an ED95 by extrapolation of data into the clinical range. The ED(50) (95% C.I.) was 0.52 mg x kg(-1) (0.30-0.73). The calculated ED95 was 1.14 mg x kg(-1) (0.78-1.50). These values were confirmed by logit analysis. CONCLUSIONS: Levobupivacaine is an effective agent for spinal anesthesia in neonates at a recommended dose of 1 mg x kg(-1). It appears to be of equivalent potency to racemic bupivacaine for motor blockade in ex-premature infants requiring lower abdominal surgery.

Anesthesia, Spinal↗