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PubMed2004

Hearing impairment associated with spinal anesthesia.

OBJECTIVES: Hearing loss after spinal anesthesia has been reported to be related to the transmission of a reduced subarachnoid pressure to the inner ear via the cochlear aqueduct due to loss of spinal fluid. However, there are also some controversies related to this phenomenon, which require systematic investigation. MATERIAL AND METHODS: The effect of spinal needle diameter on hearing loss was investigated using audiometric tests in a prospective comparative study of 30 patients who were scheduled for surgery with spinal anesthesia. The bony structure of the cochlear and vestibular aqueducts was determined from temporal bone CT scans. RESULTS: Four out of 15 patients (26.67%) treated with a 22 G spinal needle demonstrated hearing loss the day after surgery, which recovered within 2-5 weeks. However, none of the patients treated with a 27 G spinal needle had statistically significant hearing loss in either ear at any frequency. Three out of four patients with hearing loss had an acute-onset balance problem. There was no difference between the two groups in terms of the widths of the vestibular and cochlear aqueducts. CONCLUSIONS: It has been shown audiometrically that the diameter of the spinal needle used to induce spinal anesthesia seems to have an effect on subsequent hearing loss. The patency of the bony canal determines the transmission of pressure changes to the inner ear. However, the individual risk of this complication is not predictable as there is no radiological abnormality of the canal.

Acoustic Impedance Tests↗

PubMed1988

Refractory bradycardia during retrograde pyelography and spinal anesthesia.

Bradycardia commonly occurs during spinal anesthesia as a result of vagally mediated slowing of sinoatrial (SA) node firing. Peritoneal traction or urinary bladder distension, for example, may serve as a stimulus for SA node inhibition, particularly when thoracic levels of spinal anesthesia interrupt function of the sympathetic limb of the autonomic nervous system. Although atropine dependably reverses such heart rate slowing, we recently encountered, during spinal anesthesia for cystoscopy and retrograde pyelography, bradycardia that was unexpected and refractory to treatment with atropine.

Aged↗

PubMed1995

Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery.

Lidocaine spinal anesthesia is a popular anesthetic for short procedures due to its brief duration. The addition of fentanyl may improve the quality and duration of lidocaine spinal anesthesia. Eight volunteers received plain lidocaine 5% in dextrose (50 mg) both with and without 20 micrograms of fentanyl in a randomized, double-blind, cross-over fashion. Sensory analgesia was assessed with pinprick, cold, touch, transcutaneous electrical stimulation equivalent to surgical incision, and duration of tolerance of pneumatic thigh tourniquet. Motor block was assessed with isometric force dynamometry. Regression of pinprick, touch, and cold was prolonged with fentanyl. Duration of tolerance of electrical stimulation at the umbilicus, hip, knee, and ankle was increased with fentanyl (181% increase from plain lidocaine on average; P < 0.01). Duration of tolerance of tourniquet-induced pain was increased by an average of 48% with addition of fentanyl (P = 0.02). Neither motor block nor time to void was prolonged with fentanyl. Pruritus occurred in all subjects receiving fentanyl but was treated easily and were well tolerated. We recommend the addition of 20 micrograms of fentanyl to lidocaine spinal anesthesia as a means to improve duration of sensory anesthesia without prolonging recovery of motor function or time to micturition.

Adult↗

PubMed2004

Minimal dosage of tetracaine supplemented with epinephrine for spinal anesthesia in anorectal surgery.

BACKGROUND: Spinal anesthesia has been widely used in clinical setting with relatively high incidences of hypotension and bradycardia. Lowering the dosage of local anesthetics is one of the methods to mitigate the side effects. This study was to evaluate the feasibility of lowering the dosage of tetracaine in spinal anesthesia for patients undergoing anorectal surgery. METHODS: Thirty patients scheduled for anorectal surgery were studied. Patients were randomly divided into experiment (n = 15, 3.0 mg of tetracaine) and control groups (n = 15, 6.0 mg of tetracaine). The extent of analgesia was assessed by loss-of-sensation to pinprick. Dermatomic level of the sensory block was evaluated and recorded every minute for 10 minutes. BP and HR were recorded at 3-min interval for the 10-min in the study period. Numeric data were statistically analyzed with Student's t-test. The categorical data were compared using the chi-square test. P-value less than 0.05 was considered statistically significant. RESULTS: Ten min after the injection, the mean peak level of sensory block reached T12 for experiment and T9 for control groups. A noticeable difference in frequency of hypotension between two groups was found though it was not statistically significant (P = 0.08). Incidences of moderate bradycardia and severe bradycardia were similar in both groups, being 13.3% and 6.7% respectively. CONCLUSIONS: This study confirmed that lowering the dosage of tetracaine to 3.0 mg could equally provide adequate spinal anesthesia for anorectal surgery. The reduced dosage has the tendency of reducing the rate of hypotension, but apparently it does not reduce the incidence of bradycardia.

Adult↗

PubMed1991

AANA Journal course. 15: new technologies in anesthesia: update for nurse anesthetists--continuous spinal anesthesia.

The production of microcatheters small enough to be threaded through 22- to 26-gauge spinal needles has focused renewed attention on the technique of continuous spinal anesthesia. This technique has a specific combination of advantages which cannot be duplicated by any other method of regional blockade. The most important of these advantages is that sensory blockade can be produced quickly and precisely with small doses of local anesthetic, that the duration of anesthesia can be extended indefinitely, and that recovery is rapid when short-acting local anesthetics are used. Inadequate anesthesia, failure to thread the catheter, catheter breakage, prolonged neurologic deficits (e.g., cauda equina syndrome), and postdural puncture headache are uncommon complications. This installment of the AANA Journal Course will explore the latest developments regarding this emerging regional technique.

Anesthesia, Spinal↗

PubMed2006

Cardiac arrest during spinal anesthesia: a report of two cases.

Spinal anesthesia is a widely practiced technique for both elective and emergency procedures. It is so recommended because of its efficacy and safety. Cardiac arrest during spinal anesthesia is considered as a "very rare", "unusual", and "unexpected" event. We report here two instances of cardiac arrest during spinal anesthesia in young healthy people. Discussions on the causes, management, and prevention of cardiac arrest following spinal anesthesia are also brought forward in the text.

Anesthesia, Spinal↗

PubMed1989

[A space-occupying hemorrhage following spinal anesthesia in the presence of an undiagnosed small spinal tumor (ependymoma)].

Space-occupying subarachnoid bleeding after atraumatic puncture of the spinal canal for spinal anesthesia in a patient with no coagulation disorders or anticoagulant therapy is described. The hematoma was caused by puncturing a previously undiagnosed small spinal ependymoma. A thorough and specific preoperative evaluation is of importance to minimize the risks associated with spinal anesthesia.

Anesthesia, Spinal↗

PubMed1996

Coronary perfusion pressure during cardiopulmonary resuscitation after spinal anesthesia in dogs.

Cardiac arrest during spinal anesthesia is a rare event, but when it does happen cardiopulmonary resuscitation (CPR) is often ineffectual. This study examines the effect of spinal anesthesia on coronary perfusion pressure (CPP) during CPR and the subsequent response of CPP to epinephrine administration. Twenty mongrel dogs were anesthetized, and randomly assigned to a spinal injection with either 0.5 mg/kg bupivacaine or with an equivalent volume of normal saline. Twenty minutes later, ventricular fibrillation was electrically induced and after 1 min CPR was started. CPP was measured every minute. After 4 min of CPR, epinephrine 0.01 mg/kg was given followed by 0.1, 0.2, and 0.4 mg/kg epinephrine intravenously (IV) at 6, 8, 10 min of CPR, respectively. The bupivacaine (n = 11) group had significantly less CPP than the sham spinal (n = 8) group, 12-13 mm Hg as compared to 27-34 mm Hg. Only 4/11 dogs (36%) in the bupivacaine group had CPP > or = 15 mm Hg during the first 4 min after arrest as compared to 8/8 (100%) in the sham spinal group. This increased to 7/11 dogs (64%) after 0.01 mg/kg epinephrine and to 9/11 after 0.1 mg/kg epinephrine. Total spinal anesthesia decreases CPP and thus the efficacy of CPR in dogs below the threshold previously established for predicting successful resuscitation. Epinephrine is effective in increasing CPP during CPR above the critical threshold. These data suggest that if cardiac arrest occurs during spinal anesthesia, epinephrine should be given in doses of 0.01-0.02 mg/kg IV initially and then increasing to 0.1 mg/kg IV. When this does not work, and ineffective CPR is suspected, alternative resuscitative measures should be considered.

Anesthesia, Spinal↗

PubMed1994

[Complications of pediatric spinal anesthesia].

We evaluated retrospectively the complications of pediatric spinal anesthesia in our center based on the histories of 50 spinal anesthesia cases (5-15 years of age, 0.56%) over the last 15 years. Five cases (10%) showed transient hypotension. In the prospective study of those under 5 years of age (35 children), there were no hypotensive cases, and the only critical complication was high spinal anesthesia; this case was complicated by giant hepatoblastoma. There was no obvious neurological damage in any of the patients who underwent spinal anesthesia. Because of low incidence of complications, pediatric spinal anesthesia is a useful method especially for patients with respiratory insufficiency. It is advisable to watch carefully for changes in blood pressure in senior infants, and to avoid spinal anesthesia in patients with giant abdominal tumors.

Adolescent↗

PubMedDate not supplied

Hearing loss after continuous or single-shot spinal anesthesia.

BACKGROUND AND OBJECTIVES: Hearing loss after spinal anesthesia is probably caused by cerebrospinal fluid (CSF) leakage. Spinal catheters may mechanically plug the hole in the dura and cause inflammatory swelling which should prevent cerebrospinal fluid leakage and hearing loss. An audiometric evaluation was therefore performed in patients who had spinal anesthesia by single-shot or catheter. METHODS: Twenty-one patients received single-shot spinal anesthesia and 19 patients continuous spinal anesthesia for orthopedic surgery of the lower limbs. Spinal catheters were removed 24 hours after the start of anesthesia. Audiometry was performed on the day before the operation and on the first, second, and third postoperative day and repeated on the fifth postoperative day, if necessary. RESULTS: The frequency of hearing impairment (threshold change > 10 dB) was 43% in the single-shot and 37% in the continuous spinal group. The deterioration lasted longer in the continuous spinal group (3 days vs. 1.4 days; P < .01). CONCLUSION: Although inflammatory swelling of the dura mater around the spinal catheter had been observed, use of such a catheter for 24 hours did not prevent hearing loss after its removal.

Adult↗

PubMed2000

[Pituitary necrosis after spinal anesthesia : a case report].

Spinal anesthesia was administered to a patient for the surgical reduction of an inguinal hernia. However, the procedure was complicated by corticotropic insufficiency secondary to the necrosis of a non-secretory hypophyseal adenoma. The clinical presentation is discussed here together with both medical and neurosurgical managements. Etiology and pathophysiological mechanisms of this complication are analyzed in accordance with the most recent of the literature.

Adenoma↗

PubMed1989

[Isobaric and hyperbaric bupivacaine 0.5% solution for spinal anesthesia].

The effects of spinal anesthesia with 0.5% isobaric and hyperbaric (8% glucose) bupivacaine were investigated in 45 patients who had lower limb or lower abdominal surgery. The patients were divided into 3 groups. Group 1 patients received 3 ml of 0.5% isobaric bupivacaine. The patients in group 2 and 3 received 3 or 2 ml of 0.5% hyperbaric bupivacaine (8% glucose). Blood pressure dropped in all groups. The decrease in blood pressure was so severe in group 2 that vasopressors were required in 70% of cases. The average segmental level of analgesia was T9 in group 1, C8 in group 2 and T4 in group 3. Complete motor blockade was obtained in all the patients. Time to complete motor blockade of the lower limbs was 12.6 min in group 1, 5.5 min in group 2 and 8.4 min in group 3. Duration of analgesia and motor blockade were 387.4 min and 303.7 min in group 1, 373.5 min and 300.0 min in group 2 and 318.9 min and 228.9 min in group 3. These results suggest that adequate surgical anaesthesia could be obtained with 3 ml of 0.5% isobaric bupivacaine and 2 ml of 0.5% hyperbaric bupivacaine.

Abdomen↗

PubMed1988

[Epinephrine in spinal anesthesia].

Isobaric bupivacaine for spinal anesthesia has frequently proved advantageous because of its long and safe analgesia, good motor blockade and low incidence of side-effects. Significant prolongation of analgesia is possible with an epinephrine concentration of as low as 1:200,000 added to bupivacain 0.5%, while optimal prolongation can be achieved by a concentration of 1:100,000. The addition of 1:50,000 epinephrine, however, does not induce any further enhancement. These results are contrary to those of Chambers and Scott, whose short durations of action were possibly due to relative overdosage of epinephrine with a paradoxical reduction of action. The latency period until complete blockade is achieved can be reduced by high epinephrine concentrations (beginning with 1:50,000), a fact which is possibly due to a direct, receptor-induced mechanism of epinephrine. The motor blockade of ankle and toe joints beginning from a concentration of 1:100,000 epinephrine is also prolonged significantly. With all epinephrine concentrations, the overall duration of analgesia could be prolonged significantly, in contrast to the overall duration of motor blockade. Only with free bupivacaine solution did motor and sensory function return at more or less the same time. The period between the beginning and the end of regression for both sensation and motor function was influenced only by the highest epinephrine concentration (1:50,000).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

[Ventilation under high spinal anesthesia--the effect of hypotension].

The ventilatory changes during the course of high spinal anesthesia and the effect of hypotension on ventilation during high spinal anesthesia were studied. Spinal anesthesia with hyperbaric tetracaine was applied to 30 patients scheduled for elective surgery. Patients breathed by mask for ten minutes at rest before and after receiving spinal anesthesia. Respiratory parameters were measured in supine position during (1) pre-anesthetic period under resting condition, (2) anesthetic period when analgesia with pin prick extended to T4 level and (3) anesthetic period when analgesia extended to T1 level. The patients were divided into two groups; those with and without hypotension. In hypotension group, tidal volume and minute ventilation decreased significantly for 30% compared with the control values after spinal anesthesia. PaO2 decreased and PaCO2 increased. In non-hypotension group, tidal volume and minute ventilation after spinal anesthesia increased for 10% compared with the control values. In conclusion, hyperventilation tended to occur in patients with high spinal anesthesia unless hypotension was severe enough. Once severe hypotension had occurred, obvious hypoventilation and respiratory irregularity were observed. Decrease of tidal volume and minute ventilation, hypoxia, hypercarbia and increase in VD/VT were significant during hypotension. The results suggest that during high spinal anesthesia severe hypotension causes hypoventilation and if not treated respiratory arrest ensues.

Adolescent↗

PubMed2006

[Laparoscopic treatment of ventral hernia under spinal anesthesia].

INTRODUCTION: Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair. PATIENTS AND METHOD: Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum. RESULTS: Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration. CONCLUSIONS: Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted.

Adult↗

PubMedDate not supplied

Complications of spinal anesthesia.

Serious neurological complications after spinal anesthesia are rare, but do occur. The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade. The diagnoses and management of these sequelae are discussed.

Anesthesia, Spinal↗

PubMed1994

[The level of analgesia and changes in heart rate during spinal anesthesia].

It is well known that high spinal anesthesia produces bradycardia. Studies are lacking, however, on the relation of changes in heart rate and the level of sympathetic blockade. Investigation was designed to elucidate the relationship between sympathetic blockade and heart rate during high spinal anesthesia. Subjects of the study were 70 rheumatoid arthritis patients who received spinal anesthesia with isobaric 0.5% bupivacaine. Cephalad spread of sympathetic blockade (loss of cold sensation to alcohol sponge) was determined at 30 minutes after injection of local anesthetics into the subarachnoid space. Heart rate was also measured before anesthesia and 30 minutes following spinal anesthesia. Heart rate was expressed by percent change. The results show that sympathetic blockade above T6 decreases heart rate more than 30%. In conclusion, sympathetic blockade above T6 by cold test produces 30% decrease in heart rate and this means that cardiac sympathetic denervation is almost complete at this level.

Adult↗

PubMed2003

Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study.

BACKGROUND: Spinal anesthesia has been successfully used to perform various laparoscopic procedures. However, laparoscopic cholecystectomy under spinal anesthesia has not been reported. Is this feasible? METHODS: Ten successive laparoscopic cholecystectomies were performed under spinal anesthesia. The surgical technique was modified using nitrous oxide insufflation, lower levels of intraabdominal pressure, modified trocar sites, and minimal surgical manipulation. We used spinal anesthesia by intrathecal hyperbaric 10-12 mg bupivacaine with 10 microg fentanyl to give an anesthetic level at T8-T6. RESULTS: The mean age was 39.3 years and there were four females. Only one patient was converted to general anesthesia due to intolerable shoulder pain. One patient vomited intraoperatively. Nine patients considered the procedure well tolerated under spinal anesthesia. The mean operative time was 47.4 min. Postoperatively, there were minimal pain and no vomiting. CONCLUSIONS: Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia and is well tolerated.

Adult↗