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At least 829 records · Page 46Linked to original sources
PubMed1989

Spinal anesthesia and electroerection in dogs and monkeys.

We studied the penile erectile response to cavernous nerve electrostimulation in five monkeys and eight dogs before and during spinal anesthesia. Anesthesia was obtained by intradural injection (at L4-L5 level) of either xylocaine (two mg./kg. body weight) or tetracaine (0.2 mg./kg.). In monkeys, systolic blood pressure reduction (average 17.2%), slight elongation and tumescence of the penis, and increase of intracavernous pressure were noted after spinal anesthesia. Electrostimulation of the cavernous nerves resulted in longer erection and detumescence phases than obtained before anesthesia. In dogs, a similar blood pressure decrease (16.6% average) was noted after anesthesia. The response during anesthesia to electrostimulation of the erectile nerves was, however, variable. Changing the animal's position abolished the erectile response in three of four dogs while no change of erectile response due to anesthesia could be demonstrated in the remaining four dogs. We conclude that spinal anesthesia seems to enhance simian, but not canine, erectile response to electrostimulation of the erectile nerves, possibly via interference of the autonomic regulatory mechanism.

Anesthesia, Spinal↗
PubMed2003

[The effects of colloid preload on hemodynamics and plasma concentration of atrial natriuretic peptide during spinal anesthesia in elderly patients].

We evaluated the effects of moderate colloid preloading on hemodynamics and plasma concentration of atrial natriuretic peptide (ANP) during spinal anesthesia in elderly patients undergoing low extremity surgery. Twenty patients (aged 66-90 yr) were randomly divided into two groups. Control group (n = 10) received no prehydration, and hydration group (n = 10) received colloid (6% hydroxyethyl starch; HES) preloading of 8 ml.kg-1 before spinal anesthesia. Systolic blood pressure decreased significantly 10 and 30 min after spinal anesthesia in either group, and there was no difference between the groups in the incidence of hypotension. The concentration of ANP decreased significantly by 23% in control group, whereas it increased significantly by 86% in hydration group, suggesting that cardiac preload might increase with volume expansion effect of prehydration with HES. In conclusion, colloid preloading with moderate volume might prevent the decrease in cardiac preload with increasing ANP, whereas it did not prevent spinal-induced hypotension in elderly patients.

Aged↗
PubMedDate not supplied

Spinal anesthesia for postpartum tubal ligation after pregnancy complicated by preeclampsia or gestational hypertension.

BACKGROUND AND OBJECTIVES: The American College of Obstetricians & Gynecologists has opposed postpartum tubal ligation (PPTL) in patients whose pregnancies have been complicated by a medical condition, including hypertension. A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL in patients with hypertensive disorders of pregnancy. METHODS: After institutional review board approval and written informed consent, women scheduled for PPTL were enrolled. The hypertensive group (n = 25) consisted of women whose pregnancies were complicated by gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. For each hypertensive patient, a matched control was designated by selecting the next consenting normotensive patient scheduled for PPTL. After an intravenous bolus of lactated ringers solution 500 mL, spinal anesthesia was induced with hyperbaric lidocaine. Hemodynamic measurements were recorded every 2 minutes for 20 minutes after spinal injection. Ephedrine IV was administered for systolic blood pressure < or =90 mm Hg. RESULTS: The mean preoperative mean blood pressure (MAP) was 107+/-17 mm Hg in the hypertensive group and 85+/-11 mm Hg in the controls, P<.0001. The hypertensive group sustained a more profound percentage decrease in MAP than did their control counterparts during spinal anesthesia (29%+/-12% v. 15%+/-8%, P<.0001). However, the lowest intraoperative MAP was similar in both groups. Thirty-five percent of hypertensive patients and 24% of the controls received ephedrine IV. CONCLUSIONS: PPTL during spinal anesthesia in patients whose pregnancies have been complicated by hypertension had results comparable with patients with uncomplicated pregnancies; however, further studies are needed to ascertain its safety.

Adult↗
PubMed2004

Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery.

UNLABELLED: In a randomized, double-blinded, controlled trial, we investigated the prophylactic infusion of IV phenylephrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Immediately after intrathecal injection, phenylephrine was infused at 100 microg/min (n = 26) for 3 min. From that point until delivery, phenylephrine was infused at 100 microg/min whenever systolic arterial blood pressure (SAP), measured each minute, was less than baseline. A control group (n = 24) received IV bolus phenylephrine 100 microg after each measurement of SAP <80% of baseline. Phenylephrine infusion decreased the incidence (6 [23%] of 26 versus 21 [88%] of 24; P < 0.0001), frequency, and magnitude (median minimum SAP, 106 mm Hg; interquartile range, 95-111 mm Hg; versus median, 80 mm Hg; range, 73-93 mm Hg; P < 0.0001) of hypotension compared with control. Heart rate was significantly slower over time in the infusion group compared with the control group (P < 0.0001). Despite a large total dose of phenylephrine administered to the infusion group compared with the control group (median, 1260 microg; interquartile range, 1010-1640 microg; versus median, 450 microg; interquartile range, 300-750 microg; P < 0.0001), umbilical cord blood gases and Apgar scores were similar. One patient in each group had umbilical arterial pH <7.2. Prophylactic phenylephrine infusion is a simple, safe, and effective method of maintaining arterial blood pressure during spinal anesthesia for cesarean delivery. IMPLICATIONS: In patients receiving spinal anesthesia for elective cesarean delivery, a prophylactic infusion of phenylephrine 100 microg/min decreased the incidence, frequency, and magnitude of hypotension with equivalent neonatal outcome compared with a control group receiving IV bolus phenylephrine.

Acid-Base Equilibrium↗
PubMed2006

Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia.

PURPOSE: To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position. CLINICAL FEATURES: A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (-30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation. CONCLUSIONS: Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient.

Anesthesia, Spinal↗
PubMed2004

[Spinal anesthesia with isobaric 0.5% bupivacaine for lower limb surgery: effects of different volumes].

BACKGROUND: The effects of different volumes (2.4, 2.6, 2.8 and 3.0 ml) of isobaric 0.5% bupivacaine used for spinal anesthesia were compared in 206 patients scheduled for lower limb surgery. METHODS: The spinal anesthesia was performed with the patients in the lateral position and the isobaric 0.5% bupivacaine was injected intrathecally at the L3-4 interspace. RESULTS: The time to maximum cephalad spread of anesthesia (loss of cold sensation) varied between 25 and 40 min. A significant difference was found in cephalad spread between 2.4 ml group and 3.0 ml group (T11 vs T7), and between 2.6 ml group and 3.0 ml group (T11 vs T7). Severe hypotension did not occur during the study. CONCLUSIONS: Spinal anesthesia with 2.8 ml of isobaric 0.5% bupivacaine proved satisfactory for lower limb surgery.

Adult↗
PubMed1993

[Comparison between the effects of epidural and spinal anesthesia for selective cesarean section].

This study is proposed to compare the analgesic and side effects of different types of anesthesia used for Cesarean section (CS). Based on the use of CS inpatients, of whom 27 were without and 20 with previous CS experience, 47 cases were randomized into two groups: 21 epidural and 26 spinal anesthesia. Visual analogue scale was used to measure the pain score in seven stages (p1-p7): skin incision, peritoneum incision, abdominal wall retraction, delivering neonate, uterus exteriorization, checking bleeding and suturing skin, respectively. Significantly higher pain scores were found in epidural than spinal anesthesia during p1 to p4. However no significant differences were found during p5 to p7. This may be due to post-delivery intravenous injection of other analgesics and sedatives. No significant differences in hypotensive rate were found between epidural and spinal anesthesia (RR = 1.04, 95% C.I. = 0.93-1.17). There were also no significant differences in occurrence of tachycardia either according to definition (PR > or = 100 beats/min or 120% of baseline pulse rate) or clinical judgement (tachycardia resulted from hypotension). (According to definition:RR = 1.08, 95% C.I. = 0.91-1.27; clinical judgement:RR = 0.83, 95% C.I. = 0.35-1.95). If clinical judgement is used as the gold standard, sensitivity and specificity were 100% and 12.5% respectively. The rate of nausea and vomiting in the epidural group was only half of that of spinal group, but was not statistically significant (RR = 0.5, 95% C.I. = 0.18-1.36). Based on the above, no significantly better effects on blood pressure and pulse rate in epidural, rather than spinal, anesthesia were found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

Spinal anesthesia: bupivacaine compared with tetracaine.

A solution of 0.75% bupivacaine (Marcaine) in 8.25% dextrose was compared with a similar solution of tetracaine (Pontocaine), the drug most used for spinal anesthesia in the USA. The study employed a randomized double-blind method and a standardized technique for spinal anesthesia in 435 patients. For perineal and lower extremity surgery, 7.5 mg of the local anesthetic was injected, and for intra-abdominal gynecologic surgery, 12 mg was administered. With the 7.5-mg dose, in only one of 121 patients was anesthesia unsatisfactory when bupivacaine was used; anesthesia was unsatisfactory in 19 of 114 patients when tetracaine was used. With the 12-mg dose, 12 patients given bupivacaine and 14 given tetracaine had unsatisfactory analgesia. With both doses, the motor blockade lasted significantly longer with tetracaine. Epinephrine added to the local anesthetic solution significantly increased the duration of action of both drugs. It also prolonged the duration of postoperative analgesia of tetracaine significantly more than the duration of bupivacaine. Bupivacaine 0.75% in 8.25% dextrose is a safe, reliable local anesthetic solution for spinal anesthesia.

Analgesia↗