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PubMed2000

[The necessity and the efficacy of the second administration of midazolam for sedation during spinal anesthesia].

We investigated the necessity of the second additional administration of intravenous midazolam for sedation during spinal anesthesia and the adequate dose if necessary. Fifty patients with ages between 35 to 70 years for spinal anesthesia were administered midazolam 0.05 mg.kg-1 intravenously during surgery. Thirty-four patients opened their eyes spontaneously and to these patients midazolam 1 mg was administered every three minutes until patients closed their eyes. All 34 patients closed their eyes with 1 mg of midazolam. Patients opened their eyes again at 47 +/- 16 minutes (mean +/- SD) after the first dose (0.05 mg.kg-1) and at 24 +/- 14 minutes after the second dose (1 mg). The decreases in blood pressure, heart rate and percutaneous arterial oxygen saturation after the administration of midazolam were less after the second administration than those after the first one. The percent of patients with amnesia was larger in the patients with only first administration than those with the second dose. These results suggest that the additional dose of midazolam is not necessary after intravenous midazolam 0.05 mg.kg-1 until patients open their eyes and the additional 1 mg is useful even after patients have opened their eyes.

Adult↗
PubMed1998

[Spread of spinal anesthesia with 3 different hyperbaric solutions used in Japan].

We studied the spread of spinal anesthesia with 3 different hyperbaric solutions commercially available in Japan. Percamin-S [0.3% dibucaine in 5% hyperbaric saline] (P), Neo-Percamin.S [0.24% dibucaine with 0.12% T-caine in 9.5% glucose] (N) and 0.5% Tetcaine [tetracaine] in 10% glucose (T) were studied. Two ml of each solution was administered intrathecally using a 25 gauge Quincke needle. Patients (n = 90) were allocated to one of 9 groups receiving 2 ml of P, N or T at L 2-3, L 3-4 or L 4-5 interspace. Both N and T produced significantly higher spread of analgesia than P at any of L 3-4 and L 4-5 interspaces. P and N have the same specific gravity, even though significant differences were found in spread of segmental analgesia. Local anesthesic agents and solvent solutions themselves are considered to influence the spread of spinal anesthesia as the specific gravity of hyperbaric solution does.

Adult↗
PubMed1984

Hyperbaric bupivacaine for spinal anesthesia in cesarean section.

The efficacy and safety of 0.5% hyperbaric bupivacaine (Sensorcaine, Astra) was evaluated in 22 patients undergoing elective cesarean section under spinal anesthesia. The dose varied from 7.5 to 10 mg, (depending on the patient's height) which was significantly lower than previously reported. Patients were placed in head-down tilt immediately after subarachnoid injection. The mean spread of analgesia was to T3, which was reached in 10-15 min. Regression was complete in 258 +/- 16 min. Complete motor paralysis of lower extremities occurred in only two patients. Complete recovery of motor function in all patients was evident in less than 2.5 h. All infants were vigorous at birth and there were no serious maternal complications. The incidence of hypotension was 4.5%, the lowest reported as a consequence of spinal anesthesia in this group of patients. A technique involving the use of reduced doses of hyperbaric bupivacaine (0.5%) in conjunction with head-down tilt appears to be useful for spinal anesthesia for cesarean section.

Adult↗
PubMed1995

Comparison of 5% with dextrose, 1.5% with dextrose, and 1.5% dextrose-free lidocaine solutions for spinal anesthesia in human volunteers.

The use of lidocaine in concentrations less than 5% for spinal anesthesia may be advantageous but has not been carefully studied. Lidocaine 50 mg (1.5% with dextrose and 1.5% dextrose-free) was administered to eight volunteers in a randomized, double blind, cross-over fashion. All of these subjects had previously received 5% lidocaine with dextrose using the same experimental protocol. Sensory analgesia was assessed with pinprick, transcutaneous electrical stimulation (TES) equivalent to surgical incision, and duration of tolerance of pneumatic thigh tourniquet. Motor block was assessed with isometric force dynamometry. Peak dermatomal level was the highest and duration until regression of pinprick the longest with the 5% solution (P < 0.05). Duration of tolerance to TES was increased (33 +/- 10 min) with the 5% solution (P < 0.04). Duration of tolerance to tourniquet pain was increased (11 +/- 3 min) with the 5% solution (P < 0.02). Duration of motor block was increased (45 +/- 9 min) with the 5% and the 1.5% without dextrose solutions (P < 0.04). Time to void was increased (33 +/- 5 min) with the 5% solution (P < 0.03). In conclusion, the use of different solutions of lidocaine for spinal anesthesia results in significant differences in sensory and motor block and time until recovery of micturition.

Adult↗
PubMed1996

The effects of solution concentration and epinephrine on lateral distribution of hyperbaric tetracaine spinal anesthesia.

In a search of a differential spinal block between dependent and nondependent sides, we investigated whether the use of a larger concentration of hyperbaric tetracaine (T) and/or the omission of epinephrine (E) would provide differential spread in patients left for 15 min in the lateral decubitus position. Spinal anesthesia was performed in the lateral decubitus position with the operated side dependent in 60 patients scheduled for lower limb surgery. All patients remained lateral for 15 min after spinal injection before being turned supine. They received 12 mg of T in 10% dextrose and E 0.2 mg was added when predicted duration of surgery was more than 90 min. The concentration of T to be used for each patient was randomized. This resulted in four groups of 15 patients: T 0.5% + E (control group), T 1% + E, T 0.5%, and T 1%. A unilateral anesthesia was defined as the presence of an adequate sensory (L-1 or higher) and/or motor (3 degrees) blockade on the dependent side and the absence of one or both modalities on the nondependent side, or as a duration of sensory (regression to L-2) and motor (1 degrees of recovery) blockade 20% longer on the dependent compared to the nondependent side. None of the 60 patients showed unilateral sensory block. A comparable number of patients in all groups showed unilateral motor block: four in T 0.5% + E, two in T 1% + E, four in T 0.5%, and five in T 1%. Likewise, a comparable number of patients in all groups showed a prolonged duration of sensory and motor block, respectively: six and eight in T 0.5% + E, six and nine in T 1% + E, six and eight in T 0.5%, and seven and seven in T 1%. In conclusion, although a preferential distribution of hyperbaric T toward the dependent side in patients of all four groups was noticed, the use of a larger concentration of T, omission of E, or combination of these two factors did not provide a more marked differential spread when compared to the standard solution of T 0.5% + E.

Adrenergic Agonists↗
PubMedDate not supplied

Local anesthetic distribution in a spinal model: a possible mechanism of neurologic injury after continuous spinal anesthesia.

BACKGROUND AND OBJECTIVES: Cauda equina syndrome has been reported recently in patients receiving continuous spinal anesthesia using newly developed microcatheters (28 gauge). Failure of microcatheters to allow adequate mixing of local anesthetic was studied as a possible mechanism of the neurologic injury reported with these catheters. METHODS: A spinal canal model was developed and the distribution of hyperbaric lidocaine was measured after injection through catheters typically used for continuous spinal anesthesia (i.e., 20, 28, and 32 gauge). RESULTS: Lidocaine distribution was less uniform and lidocaine concentration and osmolarity in the dependent portions of the model were significantly higher after injection through microcatheters compared to the 20-gauge catheter. CONCLUSIONS: Dependent drug concentrations were greater than those reported in the literature, capable of producing permanent neurologic injury. Directing the catheter tip in the nondependent direction and injecting lidocaine rapidly or through catheters with multiple end holes improved mixing and decreased dependent drug concentration.

Anesthesia, Spinal↗
PubMedDate not supplied

Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block.

BACKGROUND AND OBJECTIVES: The clinical impact of patient positioning on motor block during unilateral spinal anesthesia was the focus of our study. It was assumed that a 45 degrees rotation toward the prone position would minimize blocking the ventral motor roots compared with using the conventional lateral decubitus position. METHODS: Spinal anesthesia with 3.4 mL of hypobaric 0.18% bupivacaine via a 27-gauge Whitacre needle was administered to 70 patients undergoing knee arthroscopy. The patients were kept either in a lateral decubitus position (group I) or rotated approximately 45 degrees toward the prone position (group II). No prophylactic vasopressors or infusions were used. The intensity of motor block (modified Bromage scale) was assessed for both the operative and the contralateral side. RESULTS: The patients in group I had a slightly more pronounced motor block, but statistical significance could be shown only 20 minutes following the block. There was no statistical difference between the groups in the need of additional analgesics during the operation. None of the patients needed general anesthesia. The hemodynamics were stable and none of the patients developed postspinal headache or backache. CONCLUSIONS: The position of the patient affects the spread of the spinal anesthesia when clearly hypobaric agents are used. However, this small modification in positioning of the patient did not lead to a clinically meaningful difference in the spread of the motor block.

Anesthesia, Spinal↗
PubMed2002

Total spinal anesthesia provides transient relief of intractable pain.

PURPOSE: Intentional total spinal anesthesia (TSA) has been used for intractable pain treatment. However, the long-term effect of pain-relief is controversial. We investigate the short- and long-term effects of pain-relief by TSA. METHODS: Twelve patients with intractable pain participated in a crossover study. All participants received two different treatments in random order at a 30-day interval: i.v. infusion with 300 mg of lidocaine (i.v.-Lido), and TSA with 20 mL of 1.5% lidocaine (TSA-Lido). Pain level at rest was scored with the visual analogue scale (VAS: 0-100), and blood pressure and heart rate were measured before and at two hours, 24 hr, seven days, and 30 days after treatment. Plasma lidocaine concentrations were measured at 0.5, one, and two hours. RESULTS: Heart rate and mean arterial pressure during or after TSA-Lido were similar to those before TSA-Lido. Plasma lidocaine concentrations were similar between the two treatments. No significant difference in any value occurred in the i.v.-Lido treatment. VAS were similar before both treatments (87 +/- 6 for TSA-Lido; 86 +/- 7 for i.v.-Lido). After TSA-Lido, VAS decreased significantly until day seven (two hours, 17 +/- 22, P < 0.01; 24 hr, 43 +/- 20, P < 0.01; seven days, 66 +/- 16, P < 0.01). However, VAS returned to the pre-block values 30 days after TSA-Lido. CONCLUSION: Intractable pain was decreased significantly for several days after TSA, but pain-relief was not sustained.

Adult↗
PubMed2001

Spinal anesthesia: a comparison of procaine and lidocaine.

PURPOSE: To compare spinal procaine to spinal lidocaine with regard to their main clinical characteristics and incidence of transient radicular irritation (TRI). METHODS: In this randomized, double-blind, prospective study, patients (two groups, n=30 each) received either 100 mg of lidocaine 5% in 7.5% glucose (Group L) or 100 mg of procaine 10% diluted with 1 ml cerebrospinal fluid (Group P). After spinal anesthesia, segmental level of sensory block was assessed by pinprick. Blood pressure and the height of the block were noted each minute for the first ten minutes, then every three minutes for the next 35 min and finally every five minutes until regression of the block to L4. Motor blockade was evaluated using the Bromage scale. To evaluate the presence of TRI, each patient was questioned 48 hr after surgery. RESULTS: Time to highest sensory level and to maximum number of segments blocked showed no difference between groups. Mean time for sensory regression to T10 and for regression of the motor block were shorter in Group P. Eighty minutes following injection, sensory levels were lower in Group P. Five patients had inadequate surgical anesthesia in Group P and only one in Group L. No patient in Group P had TRI (95% CI 10-12%) while eight (27%) in Group L did (95% CI 12-46%). CONCLUSIONS: Procaine 10% was associated with a clinical failure rate of 14.2%. This characteristic must be balanced against an absence of TRI, which occurs more frequently with the use of lidocaine 5%.

Adult↗
PubMed1986

Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia.

Alterations in the skin temperature of the trunk during spinal anesthesia, using either tetracaine, 6 mg, or lidocaine, 50 mg, were monitored at intervals by means of a General Electric Spectrotherm 2000 Thermographic Imager and recorded on Polaroid 107C photographic film. The upper level of sensory blockade was determined with each thermograph by recording the most cephalad dermatome at which analgesia to pinprick occurred. The upper limit of diminished sympathetic activity was assumed to be the most cephalad dermatome at which skin temperature elevation occurred. In all cases, the uppermost level of temperature elevation was cephalad to the upper limit of sensory blockade. Assuming that temperature elevation reflects diminished sympathetic activity, the mean sympathetic-sensory differential for lidocaine, 50 mg, was 6.00 (+/- SE 0.70) segments, and for tetracaine, 6 mg, was 6.70 (+/- SE 0.50) segments. Arrival of the temperature elevation "front" at the fourth thoracic dermatome and above was associated with decreases in mean arterial pressure.

Anesthesia, Spinal↗
PubMed1991

Cauda equina syndrome after continuous spinal anesthesia.

Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a single-injection technique. We postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.

Aged↗