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At least 163 records · Page 9Linked to original sources

PubMed2004

Spinal anesthesia with bupivacaine decreases cerebral blood flow in former preterm infants.

UNLABELLED: Spinal anesthesia is commonly used in former preterm infants (FPI). In these patients, hypotension induced by spinal anesthesia may impair cerebral blood flow. We measured cerebral blood flow velocity (CBFV) by transcranial Doppler ultrasound to assess the effect of hypotension induced by spinal anesthesia on cerebral hemodynamics. Twelve FPI scheduled for inguinal hernia repair were operated under spinal anesthesia using 1 mg/kg isobaric 0.5% bupivacaine. Systolic, diastolic, and mean middle cerebral artery CBFV were measured at 5 min before and 5 min and 10 min after spinal anesthesia using a transcranial pulsed Doppler ultrasonography. Arterial blood pressure and heart rate were recorded simultaneously. Cerebral arteries resistance index (RI) was calculated as RI = (peak systolic CBFV - end-diastolic CBFV)/peak systolic CBFV. Diastolic CBFV decreased significantly from 30.0 +/- 11.1 cm/s to 20.1 +/- 8.4 cm/s at 5 min and to 20.1 +/- 7.0 cm/s at 10 min. RI increased significantly from 0.7 +/- 0.1 to 0.8 +/- 0.1 at 5 min and 10 min. Systolic, diastolic, and mean arterial blood pressures decreased significantly at the same time intervals. We suggest that in FPI, spinal anesthesia induces a decrease in cerebral blood flow related to changes in arterial blood pressure. Whether these changes have deleterious consequences remains to be determined. IMPLICATIONS: In former preterm infants having spinal anesthesia with bupivacaine, a decrease in cerebral blood flow velocity is displayed by middle cerebral artery transcranial Doppler examination.

Anesthesia, Spinal↗

PubMedDate not supplied

Transient radicular irritation after bupivacaine spinal anesthesia.

BACKGROUND AND OBJECTIVES: Transient radicular irritation (TRI) has been described to occur following spinal anesthesia with hyperbaric 5% lidocaine. The authors recently used only isobaric or hyperbaric 0.5% bupivacaine for spinal anesthesia. All patients who had spinal anesthesia for various kinds of surgery were interviewed after the operation to discover the possibility of TRI following bupivacaine spinal anesthesia. METHODS: The study included 226 patients. Isobaric 0.5% bupivacaine was given to 116 patients and hyperbaric 0.5% bupivacaine to 110. The local anesthetic was chosen according to the expected duration of surgery. All patients were interviewed by an anesthesiologist 24 hours after spinal anesthesia, and after 1 week the patients were asked to return a written questionnaire. If pain not associated with operation was noted, the patients were interviewed by phone. RESULTS: One 48-year-old woman reported TRI after spinal anesthesia (saddle block) with hyperbaric 0.5% bupivacaine in the 24-hour interview. Her spinal anesthetic was performed in a sitting position and the anal surgery in a lithotomy position. In the 1-week questionnaire (response rate 92%), none of the other patients fulfilled our criteria for TRI. CONCLUSIONS: In spite of one case of TRI, the authors consider bupivacaine to be safe for spinal anesthesia. The association of the sitting and lithotomy positions to the restricted distribution of hyperbaric solution and consequent TRI warrants further studies.

Adolescent↗

PubMed2005

Spinal anesthesia with an indwelling catheter reduces the stress response in pediatric open heart surgery.

BACKGROUND: Extreme stress and inflammatory responses to open heart surgery are associated with increased morbidity and mortality. Based on both animal and adult human data, it was hypothesized that spinal anesthesia would be more effective at attenuating these responses than conventional high dose intravenous opioid techniques in infants and young children undergoing open heart surgery. METHODS: A prospective randomized controlled clinical trial was performed in 60 children aged up to 24 months undergoing open heart surgery. Patients were randomly assigned to receive either high-dose intravenous opioid or high-dose intravenous opioid plus spinal anesthesia. Spinal anesthesia was administered via an indwelling intrathecal catheter. RESULTS: Spinal anesthesia significantly reduced the stress responses as measured by plasma norepinephrine and epinephrine concentrations (both P < 0.05). Spinal anesthesia reduced plasma lactate concentrations (P < 0.05), but increased fluid requirements during the first postoperative day (P < 0.05). There were no differences in other cardiovascular parameters. CONCLUSIONS: Continuous spinal anesthesia reduces stress responses in infants and young children undergoing cardiac surgery with cardiopulmonary bypass more effectively than high-dose intravenous opioids alone.

Anesthesia, General↗

PubMed1995

Spinal anesthesia for repair of meningomyelocele in neonates.

The use of spinal anesthesia for meningomyelocele repair in neonates has received minimal attention. Spinal anesthesia may lessen the stress response to surgery and decrease postoperative respiratory complications. We therefore examined the efficacy of spinal anesthesia in 14 neonates requiring repair of lumbar or sacral meningomyelocele. All neonates were positioned prone with a small chest roll. Hyperbaric 0.5% tetracaine with epinephrine was injected into the caudal end of the meningomyelocele sac. If necessary, supplemental tetracaine was administered directly into the intrathecal space by the surgeon during the operation. Blood pressure, heart rate, and oxyhemoglobin saturation were measured throughout surgery. Neonates were monitored with transthoracic impedance apnea monitors, electrocardiogram (ECG), and pulse oximetry for 36 h after surgery. Spinal anesthesia was successful in all cases. Seven patients received one supplemental tetracaine injection; one patient received two supplemental injections. Arterial blood pressure decreased an average of 5 mm Hg with the largest decrease being 10 mm Hg. Two postoperative respiratory events occurred in the first 8 h after surgery. Both neonates had received intraoperative midazolam for sedation. Neurologic function was assessed pre- and postoperatively. Twelve patients had no change in neurologic function after surgery, while two infants demonstrated improved function. We conclude that spinal anesthesia can be safely used for meningomyelocele repair.

Anesthesia, Spinal↗

PubMed1992

Respiratory interaction after spinal anesthesia and sedation with midazolam.

The combined use of midazolam and spinal anesthesia is common in clinical practice. Despite the known potential for each to alter ventilation, the effect of their interaction has not been examined. Nineteen healthy volunteers were studied to assess the impact of intravenous midazolam (0.05 or 0.075 mg/kg), spinal anesthesia (T3-T8; mean level, T6), and their combination on resting ventilation and ventilatory responses to progressive hyperoxic hypercapnia. Resting ventilatory pattern was altered significantly by each condition. Midazolam caused a 29% decrease in resting tidal volume and a 24% decrease in mean inspiratory flow rate, while respiratory frequency increased by 14% and minute ventilation remained unchanged. By contrast, spinal anesthesia alone caused a 32% increase in tidal volume, a 24% increase in mean inspiratory flow rate, and a 13% increase in minute ventilation accompanied by a 14% decrease in respiratory frequency. The combination of midazolam and spinal anesthesia caused a significant decrease in minute ventilation (19%), tidal volume (28%), and mean inspiratory flow rate (27%), all of which were significantly more than the predicted sum of the individual interventions. Midazolam and spinal anesthesia each produced a significant decrease in hypercapnic ventilatory response slope, whereas their combination provoked no net change in hypercapnic ventilatory response slope. Interpretation of the hypercapnic ventilatory response data was complicated by shifts in the position of the ventilatory response curve, particularly under the spinal anesthesia condition. It is concluded that intravenous midazolam depresses resting ventilation, spinal anesthesia stimulates resting ventilation, and their combination has a modest synergistic effect of depressing resting ventilation.

Adult↗

PubMed1993

Gamete intrafallopian transfer with spinal anesthesia.

OBJECTIVE: To investigate the feasibility of performing GIFT under spinal anesthesia administered through a thin (27-gauge) needle. DESIGN: Prospectively studied case series. SETTING: A tertiary care center staffed by a 260 physician multispecialty group. PATIENTS: Twenty-seven consecutive fertility patients underwent 28 laparoscopic GIFT procedures, electing to receive spinal anesthesia administered through a thin (27-gauge) needle. INTERVENTIONS: Laparoscopic GIFT and thin-needle spinal anesthesia. MAIN OUTCOME MEASURES: Assessment of anesthetic complications and reproductive outcome. RESULTS: Satisfactory anesthesia was obtained in 27 of the 28 cases (96%). One patient required additional general anesthesia because of failed spinal anesthesia. All patients were discharged from the hospital on the day of surgery and no postdural headache, persistent back pain, meningitis, or neurological deficit was reported on a 7-day follow-up. Of the 12 clinical pregnancies (43%), 9 ongoing/delivered pregnancies occurred (32%). Six patients had livebirths, and three patients have ongoing second or third trimester pregnancies; there were three spontaneous abortions. CONCLUSIONS: Spinal anesthesia administered through a 27-gauge needle is an attractive option for laparoscopic GIFT. The risk of serious morbidity because of an anesthetic-related complications may be reduced, and the oocytes are not exposed to the potentially deleterious effects of the drugs associated with general anesthesia.

Adult↗

PubMedDate not supplied

[Complications and side effects of spinal anesthesia].

Complication and side effects of spinal anesthesia have been studied in 2603 patients. The following complications of spinal anesthesia have been observed: transient and prolonged arterial hypotension; marked respiratory and circulatory depression; neurological consequences and early and late respiratory depression associated with intrathecal administration of narcotic analgesics. Side effects comprised vomiting, nausea, transitory urination disturbances, and itching. The dependence of the number of complications and side effects on the level of puncture, the patient's age and concentration of the anesthetic introduced into subarachnoidal space has been established.

Adolescent↗

PubMed2006

[Cerebellar hemorrhage after spinal anesthesia].

Cerebellar hemorrhage is a rare complication of spinal anesthesia. We report a case in a 51-year-old woman with a history of hypertension who underwent uterine dilatation and curettage with spinal anesthesia. During recovery she vomited and complained of headache. Postdural puncture headache was diagnosed. When there was no response to conventional treatment, computed tomography and magnetic resonance scans of the head were performed. The scans confirmed cerebellar hemorrhage due to rupture of a cavernous angioma. The patient recovered fully without surgical decompression. We review the pathogenesis of headache and cerebral hemorrhage after spinal anesthesia and propose differential diagnosis between spontaneous rupture related to hypertension and cerebrospinal fluid hypotension syndrome caused by trauma from lumbar spinal puncture. Patients with prolonged severe headache after spinal anesthesia require neurologic and radiologic monitoring to rule out the possibility of intracranial complications.

Anesthesia, Spinal↗

PubMed2003

Subdural hematoma as a late complication of spinal anesthesia.

Subdural hematoma is a rare complication of spinal anesthesia. This patient underwent bilateral inguinal herniorrhaphy under spinal anesthesia 40 days prior to admission. Two days after spinal anesthesia, the patient described a typical postdural puncture headache. Oral analgesics, fluid therapy, and lying flat were recommended. Because of prolonged headache, computed tomography scan was performed and demonstrated chronic subdural hematoma in the left fronto-temporo-parietal region. After surgical drainage, the patient fully recovered. Prolonged headache should be regarded as a warning sign of subdural hematoma.

Adult↗

PubMed2001

Spinal anesthesia in children: pro.

Spinal anaesthesia, first introduced in children at beginning of 20th century, offers adequate intraoperative anaesthetic conditions (analgesia and muscle relaxation). The technique is easy to perform even if lumbar puncture is more difficult when the children is smaller. It has not been observed haemodynamic modifications especially in patients under 5 year of age; duration of spinal anaesthesia is shorter if compared to adults and post dural puncture headache (PDPH) after spinal anaesthesia is as common in children as it is in adults, but was usually mild and very short lasting. PDPH has not been correlated with the type of spinal needle used. Hyperbaric solution of local anaesthetics like bupivacaine and tetracaine are preferable. The only adjuvant used for spinal anesthesia in children is morphine, which should be administered only in patients admitted to high dependency unit in the postoperative period. Spinal anaesthesia is indicated mainly in sub umbilical surgical procedures lasting no more than 90 minutes and particularly in the surgical treatment of former premature infants who present an higher risk with regional anaesthesia.

Anesthesia, Spinal↗

PubMed1991

Respiratory effects of spinal anesthesia: resting ventilation and single-breath CO2 response.

The effects of spinal anesthesia with bupivacaine or lidocaine on resting pulmonary ventilation and on the response to the single-breath carbon dioxide test were studied in 11 unpremedicated patients. Resting end-tidal PCO2 decreased from 34.8 +/- 4.5 (mean +/- SD) to 31.6 +/- 4.6 mm Hg after induction of spinal anesthesia (P = 0.002). The decrease in end-tidal PCO2 correlated negatively with patient age (r = -0.67, P = 0.02) and positively with spinal analgesic level (r = 0.58, P = 0.06). Breath-to-breath variability of ventilation increased during spinal anesthesia. Spinal anesthesia was not associated with statistically significant changes in tidal volume, respiratory rate, minute ventilation, mean inspiratory flow rate, inspiratory duty cycle duration, or the response to the single-breath CO2 test.

Adult↗

PubMed1995

[Urethrovesical morphology in continent women in spinal anesthesia].

OBJECTIVE: To assess the influence of spinal anesthesia on bladder neck position and a clinical stress test in continent women. METHODS: In a prospective investigation, 14 women underwent urodynamic, sonographic and clinical assessment during spinal anesthesia. Results were compared to those obtained immediately preoperatively in the same patient. RESULTS: During spinal anesthesia, the bladder neck was found to be located significantly lower and more posterior, and in 4/7 parous patients (0/7 nullipara) the clinical stress test was positive. CONCLUSION: These data provide additional evidence for the importance of neuromuscular function in the etiology of pelvic floor dysfunction and genuine stress incontinence.

Adult↗

PubMed1996

Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter.

Sixty elderly patients (> 70 yr old) undergoing surgery for hip fracture were prospectively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 30). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting dose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached. Onset of anesthesia, noninvasive hemodynamic variables and the need for ephedrine were studied for 4 h after induction of anesthesia. Spinal anesthesia was successful in all patients. Decreases in mean arterial pressure were significantly less frequent and less pronounced in the CSA group (19.9% +/- 1.6% of the baseline value) than in the SDSA group (40.2% +/- 1.9%, P < 0.0001). The mean dose of ephedrine was significantly less in the CSA group (1.8 +/- 0.7 mg, administered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications related to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric bupivacaine, is safe, efficient, and provides better hemodynamic stability than SDSA in elderly patients.

Aged↗

PubMed2003

Factors related to patient satisfaction regarding spinal anesthesia.

PURPOSE: Regional anesthesia has been shown to improve the clinically oriented outcome and many studies investigating the use of regional anesthesia have incorporated patient satisfaction measurements. This study was undertaken to find the factors related to patient satisfaction after spinal anesthesia which is the most frequent regional anesthesia conducted. METHOD: A prospective descriptive study of spinal anesthesia and post-operative survey of patients on the day after surgery was conducted by collecting pre-operative and intra-operative data on a constructed questionaire. Post-operative data including average pain score, satisfaction score of receiving spinal anesthesia, adverse effects and willingness to accept or refuse spinal anesthesia for a similar surgery again were asked by the performer of spinal anesthesia or trained anesthesia personnel. RESULTS: The average satisfaction score of receiving spinal anesthesia of 522 patients was 8.30 +/- 1.80 which was divided into 502 (96.2%) of satisfied patients (satisfaction score > or = 5) and 20 (3.8%) of dissatisfied patients (satisfaction score < 5). Factors associated with dissatisfaction were the increasing number of attempts of spinal block, p = 0.028, OR = 0.67 (0.48-0.96); pain during spinal block, p = 0.035, OR = 0.77 (0.60-0.98), inadequate analgesia, p = 0.005, OR = 0.07 (0.01-0.45) and post-operative urinary retention, p < 0.001, OR = 0.07 (0.02-0.28). Factors associated with refusal to have spinal anesthesia for similar surgery again were: female gender, p = 0.008, OR = 6.00 (1.61-22.37), low body weight, p = 0.009, OR = 0.95 (0.92-0.98), intra-operative vomiting, p = 0.01, OR = 5.02 (1.47-17.08) and low satisfaction score of spinal anesthesia, p < 0.001, OR = 0.04 (0.01-0.12). CONCLUSION: The patients receiving spinal anesthesia gave a high rate of patient satisfaction score of receiving spinal anesthesia. Ensuring quality of spinal anesthesia, improving clinical skill of anesthesiologists and prevention of side effects especially urinary retention would improve patient satisfaction.

Adult↗

PubMed2000

Spinal anesthesia in MELAS syndrome: a case with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes.

MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) is one of the classic mitochondrial encephalomyopathies with variable clinical presentation and multisystem involvement. Enhanced sensitivity to neuromuscular blockade or anesthetic agents and susceptibility to malignant hyperthermia in these patients have ever been reported, all of which complicate the management of general anesthesia. To avoid these appalling troubles in general anesthesia, we chose spinal anesthesia for a patient with MELAS syndrome receiving appendectomy. The patient obtained adequate anesthesia and good recovery without neurologic sequelae. Although there is little information about the application of regional anesthesia in MELAS patients, we demonstrate that it may be a satisfactory choice. However, it is suggested that regional anesthesia is performed only when neurological abnormalities of spinal cord or peripheral nerves are definitely ruled out.

Adult↗

PubMed2006

[Fentanyl shows different effects by administration routes on bispectral index during spinal anesthesia in patients undergoing cesarean section].

BACKGROUND: Spinal anesthesia using a local anesthetic with fentanyl has been reported to induce sedation. We previously reported that the bispectral index (BIS) value was significantly decreased by spinal anesthesia using only bupivacaine and fetanyl after cesarean delivery. In the present study, we studied the effect of different fentanyl administration routes on BIS values during spinal anesthesia for cesarean section. METHODS: Forty-six women scheduled for cesarean section were allocated into five-groups according to the route of fentanyl administration and amount of local anesthetic: intrathecal 0.5% isobaric bupivacaine 2.5 ml plus fentanyl 20 microg (n = 11), intrathecal 0.5% isobaric bupivacaine 2.5 ml plus intravenous fentanyl 100 microg (n = 12), intrathecal 0.5% isobaric bupivacaine 2.5 ml plus epidural fentanyl 100 microg (n = 8), intrathecal 0.5% isobaric bupivacaine 2.5 ml (n = 8), and intrathecal 0.5% isobaric bupivacaine 3.0 ml (n = 7). BIS values were recorded during anesthesia. RESULTS: BIS values in intrathecal fentanyl group were lower than those of other groups (P = 0.03). The cumulative duration of BIS values 80 and below 80 was longer in the intrathecal fentanyl group than those of other groups (P = 0.004). CONCLUSION: The BIS value was significantly decreased only by intrathecal fentanyl for cesarean section.

Adult↗

PubMedDate not supplied

Optimizing spinal anesthesia for ambulatory surgery.

BACKGROUND AND OBJECTIVES: Spinal anesthesia is used for ambulatory surgical procedures. We provide an overview of the use of local anesthetics, use of continuous techniques, and use of adjuncts for optimization of spinal anesthesia for ambulatory surgery. METHODS: Review of current literature and critical analysis of selected manuscripts. RESULTS: Small doses of lidocaine (approximately 40 mg) and bupivacaine (approximately 7.5 mg) are appropriate for ambulatory surgery. Increasing concentration of local anesthetic solution may result in increased duration of anesthesia and recovery. While use of hyperbaric solutions consistently produce more cephalad sensory block, use of isobaric solutions provide adequate sensory and motor block for lower extremity surgical procedures. The use of continuous techniques may provide valuable anesthetic titration, as small doses of spinal anesthetics may produce highly variable results. Epinephrine is not recommended as an adjunct due to prolongation of recovery time. In contrast, intrathecal fentanyl may prolong surgical anesthesia without prolonging recovery. CONCLUSIONS: Ambulatory spinal anesthesia may be optimized by selection of dose, concentration, and baricity of local anesthetic. Use of a continuous technique or an intrathecal adjunct may also be valuable means to optimize spinal anesthesia for ambulatory surgery.

Ambulatory Surgical Procedures↗

PubMed1996

A case of coronary artery spasm during spinal anesthesia.

We present a rare case of coronary artery spasm during spinal anesthesia in a patient who had neither complications nor prior history of coronary artery disease. Some factors are involved in the occurrence of perioperative coronary artery spasm. Many cases of coronary artery spasm during general anesthesia, or general plus epidural anesthesia, have been reported. Although spinal anesthesia by itself has not been reported to be a cause of coronary artery spasm, it is likely, in the current case, that the combination of the activated parasympathetic nerve system by the retraction of the peritoneum and spinal anesthesia might have caused the coronary artery spasm. Anesthesiologists need to be aware that coronary artery spasm may occur during spinal anesthesia, especially when the peritoneum is retracted.

Adult↗