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At least 19 recordsLinked to original sources
PubMed2004

Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy.

AIM: The aim of this study was to compare efficacy, efficiency and surgeon's satisfaction of total intravenous anesthesia with propofol and remifentanil with those of spinal or peripheral nerve blocks for outpatient knee arthroscopy. METHODS: One hundred and twenty patients undergoing elective outpatient knee arthroscopy were randomly allocated to receive total intravenous anesthesia with propofol and remifentanil (40), combined sciatic-femoral nerve block (40), or spinal anesthesia (40). Preparation times, surgeon's satisfaction, and discharge times with the 3 anesthesia techniques were measured. Anesthesia-related costs were also compared based on costs of drugs, disposable materials, and anesthesia and nurse staff. RESULTS: Preparation time was 13 min (8-22 min) with general anesthesia, 15 min (5-30 min) with spinal anesthesia and 15 min (5-25 min) with sciatic-femoral blocks (p=0.006). Surgeon's satisfaction was similar in the 3 groups, but 17 patients receiving peripheral nerve block (42%) and 12 receiving spinal anesthesia (30%) by-passed the postanesthesia care unit after surgery as compared with only 2 general anesthesia patients (5%) (p=0.01). Discharge from the postanesthesia care unit required 5 min (5-20 min) after peripheral block as compared with 15 min (5-25 min) with spinal and 15 min (5-80 min) with general anesthesia (p=0.005); however, stay in the Day-Surgery Unit was shorter after general anesthesia [170 (100-400) min] than peripheral [265 (110-485) min] or spinal blocks [230 (95-800) min] (p=0.026). Urinary retention was reported in 3 spinal patients only (8%) (p=0.03). CONCLUSION: Regional anesthesia techniques reduce the rate of admission and the duration of stay in the postanesthesia care unit as compared with general anesthesia. Peripheral rather than spinal nerve blocks should be preferred to minimise the risk for urinary retention.

Adult↗
PubMed1989

Rationale for spinal anesthesia.

Spinal anesthesia is probably the most widely used form of regional anesthesia today. A number of clinical studies suggest that spinal anesthesia may be superior to general or epidural anesthesia for certain patients and for certain surgical procedures. The endocrine-metabolic response to surgery appears to be blunted when spinal anesthesia is employed compared to the response during general anesthesia. Blood loss and thromboembolic complications are also reduced when spinal anesthesia is used, particularly for major lower limb orthopedic procedures. Although long-term survival is not affected by the anesthetic technique employed, short-term mortality may be decreased in elderly patients having major orthopedic surgery under spinal anesthesia. Compared to epidural blockade, spinal anesthesia provides a more rapid onset, a more predictable level of analgesia, and a more profound degree of surgical anesthesia. On the other hand, spinal anesthesia is associated with a greater degree of hypotension compared to epidural anesthesia. The results of these various investigations show that a scientific rationale exists for the continued use of spinal anesthesia.

Anesthesia, Epidural↗
PubMed2000

New developments in spinal anesthesia.

Spinal anesthesia can be used effectively and efficiently for a variety of cases in both the inpatient and the ambulatory surgery setting. Choice of agent, dose, distribution, use of adjuncts, and occasionally the use of continuous spinal anesthesia can tailor the spinal anesthetic to a specific type and duration of surgery. Although spinal anesthesia is extremely safe, adherence of new guidelines for patients receiving anticoagulant drugs, LMWH in particular, may minimize the risk of neurologic injury from spinal bleeding. At present, intrathecal adjuncts, such as neostigmine and clonidine used with local anesthetics, have shown limited usefulness, whereas lipophilic opioids, such as fentanyl, appear to increase duration and quality of spinal block without increasing the time to recovery. In the future, shorter-acting local anesthetics, possibly in conjunction with continuous catheter technologies, may reduce recovery times after spinal anesthesia without increasing risk. Spinal agents with long-acting analgesic properties that do not produce sensorimotor deficits may go beyond the immediate perioperative period and relieve postoperative pain. Currently there is controversy surrounding the use of spinal lidocaine and the occurrence of TNS, especially in the outpatient setting. The prudent use of small-dose bupivacaine and possibly procaine may reduce this risk, further supporting the use of spinal anesthesia for ambulatory as well as inpatient surgical procedures.

Adjuvants, Anesthesia↗
PubMed1996

Subcutaneous cysts: another cause of "failed" spinal anesthesia?

Spinal anesthesia continues to be one of the major techniques in the arsenal of the modern anesthesiologist. Inadequate anesthesia may follow a spinal anesthetic for a variety of reasons. We report a case in which entry of a spinal needle into a subcutaneous cyst mimicked the free flow of cerebrospinal fluid seen with dural puncture. This was confirmed by microscopic examination of the fluid, which was consistent with the contents of a subcutaneous cyst. This represents an unusual cause for failure of spinal anesthesia. Such a possibility should be borne in mind, especially when "clear fluid" return occurs through a spinal needle placed at a relatively superficial depth.

Adult↗
PubMed1952

The don'ts of spinal anesthesia.

Spinal anesthesia is an essentially safe procedure with no unavoidable complications, except headache and backache in a relatively small number of cases, if certain well defined contraindications are observed and if there is rigid adherence to a careful and rational technique of administration and of preparation of materials.

Anesthesia, Spinal↗
PubMed1992

[Rigidity abolished by intravenous dantrolene in a patient with Parkinson's disease under spinal anesthesia].

Spinal anesthesia was given to a patient with right femur fracture and Parkinson's disease (PD). Although sufficient analgesia was obtained up to L1 level after spinal anesthesia, the muscular rigidity remained. Furthermore, tremor of the upper extremities continued. After administering dantrolene sodium (DT) intravenously, these untoward features were abolished. These findings suggest that DT abolishes rigidity and tremor in PD, and is useful for the management of anesthesia for a patient with PD.

Aged↗
PubMed1998

[Intracranial subdural hematoma during spinal anesthesia].

Spinal anesthesia (SA) is frequently used in tropical zones. Intracranial subdural hematoma is an uncommon complication of SA. The purpose of this report was to describe a case of intracranial subdural hematoma observed during SA performed for cesarean section in a 22-year-old women in Senegal. After one month of persistent intense headache, diagnosis was confirmed by computerized tomography. The hematoma was successfully treated by drainage under general anesthesia. Intracranial subdural hematoma has been attributed to cerebrospinal fluid hypotension due to leakage through the dural puncture site. Diagnosis, which may be difficult in Africa, should be suspected in patients with persistent headaches after SA. Confirmation requires computerized tomography of the brain. Prevention of this complication depends on the use of fine beveled-tipped puncture needle which are rarely available in the African setting.

Adult↗
PubMedDate not supplied

Post-lumbar puncture headache as a complication of spinal anesthesia.

Spinal anesthesia is a frequently used technique for surgery of the lower extremities. A complication of this form of regional anesthesia is post-lumbar puncture headache. Rapid diagnosis and treatment are essential in preventing prolonged disability and neurologic sequelae. Two case reports are presented, followed by a review of the literature concerning etiology, diagnosis, and treatment of post-lumbar puncture headache.

Anesthesia, Spinal↗
PubMed1994

[Hemodynamic effects of genu-pectoral position during the surgery of lumbar disk herniation: spinal anesthesia versus general anesthesia].

Spinal anesthesia (SA) for lumbar disk surgery in the genu-pectoral position (GP) has been proposed as an alternative to general anesthesia (GA). This study compares the haemodynamic effects of GP in two groups of patients undergoing either SA (n = 43) or GA (n = 40). Mean arterial pressure (MAP) and heart rate (HR) were recorded before and after GP. MAP and HR were significantly lower in the GA group after GP. We conclude that SA during GP for lumbar disk surgery is haemodynamically well tolerated.

Adult↗
PubMed1988

Debate on use of spinal anesthesia in obstetrics: spinal anesthesia has definite indications in obstetrics.

Spinal anesthesia has the advantages of speed of onset, reliability and lack of toxicity over lumbar epidural block. Against this must be offset several disadvantages, but these can be largely eliminated by careful choice of equipment and meticulous attention to details of technique. Only experienced obstetric anesthetists should perform spinal anesthesia, especially for Caesarean section. Given these conditions, spinal block has a most important part to play in obstetric anesthesia.

Anesthesia, Obstetrical↗
PubMed1993

[Single-shot spinal anesthesia versus continuous spinal anesthesia using the CoSPAN catheter].

OBJECTIVE: We compared conventional single-shot spinal anaesthesia (SS) with continuous spinal anaesthesia (CS) in a randomised prospective study. PATIENTS AND METHODS: Sixty patients undergoing urological surgery received either SS (n = 30) using an atraumatic needle or CS (n = 30) using a CoSPAN catheter. Prior to performing the spinal anesthesia, patients were prehydrated with 250 ml of hydroxyethyl starch 10%. Spinal anaesthesia was performed with the patients in the sitting position at L3-4 interspace. In the CS group CSF was aspirated via the catheter to check its correct position, and initially 0.5 ml of hyperbaric 5% lidocaine were injected. 0.25 ml boli at 5 min intervals were repeated as often as necessary to reach the desired sensory blockade up to the T10 segment. In patients undergoing the single-shot technique 1.5 to 3.5 ml of hyperbaric 0.5% bupivacaine was injected. After performing the block, haemodynamic parameters were assessed for 20 minutes at 2 min intervals, before and thereafter at 5 min intervals. The required time for recovery of motor activity of the legs was assessed postoperatively. The patients were visited on the 1st, 3rd and 5th postoperative day and asked about possible headache. RESULTS: The CoSPAN spinal catheter was easy to handle. CSF could be aspirated via this catheter within 33.1 +/- 7.6 seconds. The desired maximum cephalad spread (T10) was exceeded by a mean of 0.63 +/- 1.3 segments in the CS group and by a mean of 1.4 +/- 2.6 segments in the SS group. In the SS group a mean volume of hyperbaric 0.5% bupivacaine of 2.59 +/- 0.4 ml was used. In the CS group a mean volume of 1.08 +/- 0.4 ml of hyperbaric 5% lidocaine was necessary. In the SS group, mean arterial blood pressure was found to have significantly decreased to lower than the initial value within the first 20 min after injection at each of the 10 determinations. Maximal decrease of mean arterial pressure to 89.3 +/- 7.7% was registered 14 min after injection. In the CS group, only the measurement 14 min after injection of the initial bolus revealed a significant decrease of the mean arterial blood pressure to 94.2% of the initial value. The mean interval elapsed before motor function of the legs returned after the end of surgery was 67.7 +/- 50 min in the SS group and 26.7 +/- 15.4 min in the CS group. None of the 60 patients complained about postspinal headache. DISCUSSION: Fractionated injection of the local anesthetic via a spinal catheter was more precise in achieving the desired maximum cephalad spread than SS. The CS group revealed a significantly more stable blood pressure than the SS group. The use of a short-acting local anesthetic for CS provided an earlier postoperative return of motor function of the legs. Postspinal headache appears not to be a clinically relevant problem when 28-gauge spinal catheters are used.

Aged↗
PubMed2001

Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair.

One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. The incidence of PONV (0%) v/s 19% and 21% was significantly reduced in patients treated with the PVB compared to patients receiving SA and GA respectively. The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.

Anesthesia, General↗
PubMed2003

[Postoperative delirium after general anesthesia vs. spinal anesthesia in geriatric patients].

BACKGROUND: Influence of the type of anesthesia on postoperative delirium was examined in geriatric patients with femoral neck fracture. METHODS: Forty patients aged 70 or more were randomly allocated to receive either general anesthesia (sevoflurane, nitrous oxide in oxygen, G group, n = 21) or spinal anesthesia (0.5% bupivacaine, S group, n = 19). G group received the oxygen therapy during the 12-hour postoperative period. Postoperative assessments included the rate of postoperative delirium during the 4-day postoperative period, oxygen saturation during the 18-hour postoperative period, the value of hemoglobin at 1 postoperative day and the number of analgesics requirements during the 4-day postoperative period. RESULTS: The rate of postoperative delirium was similar between the two groups during the 4-day postoperative period. However, that of S group tended to be higher during the 1-day postoperative period. Postoperative analgesic effect and the value of hemoglobin at 1 postoperative day were similar between the two groups. Oxygen saturation was similar between the two groups except 6 hours after the operation. CONCLUSIONS: The type of anesthesia, general or spinal, does not affect the postoperative delirium in geriatric patients with femoral neck fracture.

Aged↗
PubMedDate not supplied

Epidural and spinal anesthesia do not influence gastric emptying and small intestinal transit in volunteers.

The influence of thoracic epidural anesthesia, spinal anesthesia, and a painful stimulus on gastric emptying, orocecal transit time, and small intestinal transit were studied in nine healthy volunteers. Gastric emptying was measured by the acetaminophen absorption method. Orocecal transit time was determined by measuring end-expiratory hydrogen concentration. Small intestinal transit was calculated from measurements of the orocecal transit time and gastric emptying. Cold pain stress with intermittent immersion of the feet in ice-cold water was used as a painful stimulus. Each volunteer was investigated on four occasions: 1. during nociceptive stimulation of the feet (cold pain); 2. during low spinal anesthesia with block of the afferent nerves from the nociceptive stimulated area; 3. during thoracic epidural anesthesia (0.5% bupivacaine) with block of the efferent nerves to the stomach and small intestine but with intact afferents from the nociceptive stimulated area; 4. as a control study without pain and anesthesia. Without spinal anesthesia, immersion of the feet in cold water was very painful and caused a circulatory stress reaction with increased blood pressure. Cold pain stress in itself did not influence gastric emptying, orocecal transit time, or small intestinal transit. Neither did epidural or spinal anesthesia during cold pain stress influence these variables of gastrointestinal motility. Thus, low spinal anesthesia or thoracic epidural anesthesia in itself did not influence gastric emptying, orocecal transit, or small intestinal transit.

Adult↗
PubMed1993

[Prevention and treatment of hypotension during spinal anesthesia].

Spinal and epidural anaesthesias alter self-regulation of arterial pressure as they lead to a sympathetic blockade. The extent and the speed of appearance of this blockade conditions the magnitude of the decrease of arterial pressure. So, epidural or spinal anaesthesias may only be performed on hemodynamically stable patients for a non hemorrhagic surgery. The routine fluid preloading is illogical and poorly efficient. Correcting a deep arterial hypotension demands first of all the use of vasoconstricting agents the choice of which depends on the site of the anaesthesia and on the cardiovascular condition of the patient. The occurrence of bradycardia more often indicates a hypovolaemic state.

Anesthesia, Epidural↗