Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.920
Filtrar
1.
BMC Anesthesiol ; 22(1): 185, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710348

RESUMO

BACKGROUND: Epidural catheters are associated with certain risks such as accidental epidural catheter removal, including dislodgement and disconnection. Globally, neuraxial connector designs were revised in 2016 to provide new standardization aimed at decreasing the frequency of misconnections during the administration of medications. However, no studies have investigated accidental epidural catheter removal after the revised standardization. This study aimed to examine differences in dislodgement and disconnection rates associated with different catheter connector types, and to investigate the linear tensile strength required to induce disconnection. METHODS: This retrospective cohort study included adult patients who underwent elective surgery and received patient-controlled epidural analgesia. Patients were divided into groups according to the type of catheter connection used: old standard, new standard, and new standard with taping groups. Furthermore, we prepared 60 sets of epidural catheters and connectors comprising 20 sets for each of the old, new, and taping groups, and used a digital tension meter to measure the maximum tensile strength required to induce disconnection. RESULTS: This clinical study involved 360, 182, and 378 patients in the old, new, and taping groups, respectively. Dislodgement rates did not differ statistically among the three groups, while there was a significant difference in disconnection rates. Propensity score matching analysis for disconnection rates showed no difference between the old and new groups (2.8% vs. 4.5%, p = 0.574), while the new group had higher rates than the taping group (6.5% vs. 0%, p = 0.002). This laboratory study identified that a tensile strength of 12.41 N, 12.06 N, and 19.65 N was required for disconnection in the old, new, and taping groups, respectively, and revealed no significant difference between the new and old groups (p = 0.823), but indicated a significant difference between the new and taping groups (p < 0.001). CONCLUSIONS: This clinical study suggested that dislodgement rates did not change among the three groups. Both clinical and laboratory studies revealed that disconnection rates did not change between the old and new connectors. Moreover, as a strategy to prevent accidents, taping the connecting points of the catheter connectors led to an increase in the tensile strength required for disconnection.


Assuntos
Analgesia Epidural , Anestesia Epidural , Adulto , Cateterismo , Cateteres , Espaço Epidural , Humanos , Estudos Retrospectivos
2.
A A Pract ; 16(6): e01591, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35679142

RESUMO

Sensory innervation of the breast is complex, thereby making it difficult to perform any surgical procedure with a single regional anesthesia technique. Because of the involvement of pectoral muscles and extension of the incision into the axilla, a modified radical mastectomy makes it further challenging and requires multiple techniques. We have used a new combination of regional techniques in this case series and found that it provided complete surgical anesthesia with a smaller volume of local anesthetic.


Assuntos
Anestesia Epidural , Bloqueio do Plexo Braquial , Neoplasias da Mama , Bloqueio do Plexo Braquial/métodos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Mastectomia Radical Modificada/métodos
3.
Best Pract Res Clin Anaesthesiol ; 36(1): 3-15, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35659957

RESUMO

The ideal technique for labor analgesia would have a quick onset, predictable quality, and adjustable depth and duration. Moreover, it would be easy to perform and have minimal maternal and fetal side effects. A catheter-based neuraxial approach encompasses these desirable characteristics and includes the epidural, combined spinal epidural, dural puncture epidural, and intrathecal catheter techniques. In this review, we outline the unique technical considerations, analgesic characteristics, and side effect profiles for each technique that can ultimately impact the maternal-fetal dyad. The selection of neuraxial analgesia techniques should consider the patient and team's goals and expectations, the clinical context, and the institutional culture. Labor analgesic techniques that initiate with an intentional dural puncture component have a faster onset, greater bilateral and sacral spread, and lower rates of epidural catheter failure. Further elucidation of the mechanisms, benefits, and risks of each neuraxial initiation technique will continue to benefit patients and care providers.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestesia Epidural , Trabalho de Parto , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Analgésicos , Feminino , Humanos , Gravidez
4.
Medicine (Baltimore) ; 101(24): e29421, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35713450

RESUMO

RATIONALE: Patients with a single ventricle, who have not undergone surgery, reportedly have a lower survival rate. Furthermore, multiple pregnancies are rare among these females. We reported a case of anesthesia management of cesarean section in an uncorrected single-ventricular multi-pregnancy woman and review the anesthesia management of the published similar cases. PATIENT CONCERNS: An uncorrected single ventricular pregnant woman with a cardiac function of New York Heart Association class II, who had experienced one spontaneous abortion and three vaginal deliveries, was scheduled for cesarean section at 37+6 weeks of gestation. DIAGNOSES: : Echocardiography revealed a complex congenital heart disease in the mother: a single ventricle (the left ventricle is dominant), atrioventricular valve ectopic, double-inlet left ventricle, abnormal location of the great arteries, probably pulmonary stenosis, atrial septal defect, and left-to-right shunt. The fetus was in breech presentation with umbilical cord around the neck. INTERVENTIONS: Cesarean section was successfully performed under the combined spinal epidural anesthesia with careful monitoring. OUTCOMES: : Both mother and newborn recovered good and were discharged from the hospital 5 days after surgery without any adverse reactions. LESSONS: Single ventricular pregnant woman with a cardiac function of New York Heart Association class I-II could tolerate pregnancy and delivery well. Both general and regional anesthesia are applicable to cesarean section in these patients. The principle of anesthesia management is to maintain the appropriate balance between systemic vascular resistance and pulmonary vascular resistance, as well as to maintain preload and cardiac output.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Anestésicos , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez
5.
Niger J Clin Pract ; 25(6): 855-860, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35708428

RESUMO

Background: Systemic immune-inflammation index (SII) is increasingly valued for its simplicity and predictability. Anesthesia/analgesia technique may affect cancer survey. Aims: The primary aim of this study is to offer a comparative evaluation for the effect of different anesthesia/analgesia techniques employed in radical prostatectomy surgery on SII, a new inflammatory index. Patients and Methods: Eighty-one patients who underwent radical prostatectomy between January 1, 2012, and December 31, 2020, were included in the study. We recorded oncological demographic data of Group G (n = 45) and Group GE (n = 36), preoperative and postoperative (within the first 4 hrs and 24th hr) SII values, perioperative surgical bleeding, and amount of blood transfusion. Results: Despite the lack of significant difference in the SII values between the groups, both the peak SII level and the SII change in the postoperative period became higher in Group G than in Group GE. In addition, the amount of surgical bleeding and blood transfusion was observed to be significantly lower in Group GE (P < 0.001, P = 0.092, respectively). Conclusions: GE in radical prostatectomy surgery in terms of SII, the SII change in the postoperative period was more pronounced in Group G. However, a significant difference was noted in surgical bleeding in Group GE. We can conclude that comparing the SII values of different anesthesia techniques with prospective studies might thus create a difference in survival and metastasis at the micro-level.


Assuntos
Analgesia Epidural , Anestesia Epidural , Anestesia Geral , Perda Sanguínea Cirúrgica , Humanos , Inflamação , Masculino , Estudos Prospectivos , Prostatectomia/métodos , Estudos Retrospectivos
6.
Acta Biomed ; 93(S1): e2022205, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35612262

RESUMO

A 67-year-old lung transplant recipient with severe comorbidities was admitted for renal transplant. As anesthesia technique, combined spinal-epidural at the T11-T12 level was chosen, associated with intravenous sedation. Graft's function initially results altered, bringing to pulmonary fluid overload. Beginning from the postoperative day 5 there was a slow but constant gain-of-function of the graft, proven by an improvement of renal function indexes and by the resolution of the pulmonary edema. Conclusions: Whereas general anesthesia remains the gold standard anesthesia technique for kidney transplant, a locoregional anesthesia, could be a feasible and effective option in patients at high risk of respiratory complications. (www.actabiomedica.it).


Assuntos
Anestesia Epidural , Raquianestesia , Transplante de Rim , Idoso , Anestesia Epidural/métodos , Raquianestesia/métodos , Humanos , Transplante de Rim/métodos , Pulmão , Transplantados
7.
Sci Rep ; 12(1): 9057, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35641505

RESUMO

Epidural anesthesia requires injection of anesthetic into the epidural space in the spine. Accurate placement of the epidural needle is a major challenge. To address this, we developed a forward-view endoscopic optical coherence tomography (OCT) system for real-time imaging of the tissue in front of the needle tip during the puncture. We tested this OCT system in porcine backbones and developed a set of deep learning models to automatically process the imaging data for needle localization. A series of binary classification models were developed to recognize the five layers of the backbone, including fat, interspinous ligament, ligamentum flavum, epidural space, and spinal cord. The classification models provided an average classification accuracy of 96.65%. During puncture, it is important to maintain a safe distance between the needle tip and the dura mater. Regression models were developed to estimate that distance based on the OCT imaging data. Based on the Inception architecture, our models achieved a mean absolute percentage error of 3.05% ± 0.55%. Overall, our results validated the technical feasibility of using this novel imaging strategy to automatically recognize different tissue structures and measure the distances ahead of the needle tip during the epidural needle placement.


Assuntos
Anestesia Epidural , Aprendizado Profundo , Anestesia Epidural/métodos , Animais , Espaço Epidural/diagnóstico por imagem , Agulhas , Suínos , Tomografia de Coerência Óptica/métodos
8.
Comput Math Methods Med ; 2022: 4243244, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35637847

RESUMO

To analyze the investigation of the application effects of different doses of dexmedetomidine (Dex) with combined spinal and epidural anesthesia nursing on analgesia after transurethral resection of prostate (TURP) by intelligent algorithm-based magnetic resonance imaging (MRI), MRI imaging segmentation model of mask regions with convolutional neural network (Mask R-CNN) features was proposed in the research. Besides, the segmentation effects of Mask R-CNN, U-net, and V-net algorithms were compared and analyzed. Meanwhile, a total of 184 patients receiving TURP were selected as the research objects, and they were divided into A, B, C, and D groups based on random number table method, each group including 46 cases. Patients in each group were offered different doses of Dex, and visual analogue scale (VAS) and Ramsay scores of different follow-up visit time, use of other analgesics, the incidence of postoperative cystospasm, and nursing satisfaction of patients in four groups were compared. The results demonstrated that Dice similarity coefficient (DSC) value, specificity, and positive predictive value of Mask R-CNN algorithm were 0.623 ± 0.084, 98.61%, and 69.57%, respectively, all of which were higher than those of U-net and V-net algorithms. Pain VAS scores and the incidence of cystospasm at different time periods of groups B and C were both significantly lower than those of group D (P < 0.05). Ramsay scores of groups B and C at 8 hours, 12 hours, 24 hours, and 48 hours after the operation were all remarkably higher than those in group D (P < 0.05). Besides, nursing satisfaction of groups B and C was obviously superior to that in group D, and the difference demonstrated statistical meaning (P < 0.05). The differences revealed that Dex showed excellent analgesic and sedative effects and could effectively reduce the incidence of complications after TURP, including cystospasm and nausea. In addition, it helped improve nursing satisfaction and patient prognosis.


Assuntos
Anestesia Epidural , Dexmedetomidina , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Algoritmos , Anestesia Epidural/efeitos adversos , Humanos , Hiperplasia/etiologia , Imageamento por Ressonância Magnética/métodos , Masculino , Próstata/diagnóstico por imagem , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos
9.
A A Pract ; 16(5): e01588, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35605206

RESUMO

Anesthesia can be a challenge for patients with amyotrophic lateral sclerosis (ALS). This progressive neurological disease is associated with a high risk of aspiration and postoperative ventilatory failure. Our patient was a 72-year-old man with ALS, quadriplegia, bulbar symptoms, dysphagia, and dysarthria who underwent palliative exploratory laparotomy and loop ileostomy creation. He received a single-shot spinal anesthetic at L4-L5 and a thoracic T11-12 epidural. He tolerated the procedure well with no perioperative pulmonary complications or worsening of his ALS. To reduce the risks of general anesthesia, we chose a neuraxial approach.


Assuntos
Esclerose Amiotrófica Lateral , Anestesia Epidural , Raquianestesia , Idoso , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/cirurgia , Anestesia Geral , Humanos , Ileostomia , Masculino
10.
J Ayub Med Coll Abbottabad ; 34(2): 279-282, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35576286

RESUMO

BACKGROUND: Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019. METHODS: Eightytwo patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome.. RESULTS: Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G. CONCLUSIONS: Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.


Assuntos
Anestesia Epidural , Colecistectomia Laparoscópica , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Humanos , Dor Pós-Operatória
11.
BMC Vet Res ; 18(1): 200, 2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35624498

RESUMO

BACKGROUND: There is scant clinical research on neuraxial analgesia in dogs undergoing major surgery. With this study we compared the perioperative analgesic effects of thoracic epidural anaesthesia (TEA) and intrathecal morphine (ITM) in dogs scheduled for thoracic or cranial abdominal surgery. The dogs received methadone and dexmedetomidine, were anaesthetized with propofol maintained with sevoflurane, and randomly assigned to receive either TEA (ropivacaine 0.5% at 0.2 mg/kg and morphine 0.1 mg/kg administered at T12-T13) or ITM (morphine 30 µg/kg administered at L6-L7). Intraoperative rescue analgesia (iRA) was fentanyl 1 µg/kg administered if heart rate or mean arterial pressure increased by 30% above the pre-stimulation level. Glasgow Pain Composite Scale score (GPCS) dictated the use of postoperative rescue analgesia (pRA) with methadone 0.2 mg/kg. RESULTS: There was a statistically significant difference in iRA, median time to first fentanyl bolus, median fentanyl dose after surgical opening, and median GPCS score at 30 minutes (min), 1 ,2, 4, 6, and 8 hours (h) between the two groups (p<0.001; p<0.001; p<0.001; p<0.01; p<0.01; p<0.001; p<0.01; p=0.01; p=0.01, respectively). Fewer TEA than ITM group dogs required iRA during surgical opening and pRA: 5% (1/18) and 2/18 (11%), respectively, in the TEA and 83% (16/18) and 10/18 (55%), respectively, in the ITM group. Side effects were urinary retention in 3/18 (16%) TEA group dogs and 2/18 (11%) ITM group dogs and prolonged sedation in 2/18 (11%) in ITM group dogs. TEA and ITM were effective in managing perioperative pain in dogs undergoing thoracic or cranial abdominal surgery.


Assuntos
Anestesia Epidural , Doenças do Cão , Analgésicos Opioides , Anestesia Epidural/veterinária , Animais , Doenças do Cão/tratamento farmacológico , Doenças do Cão/cirurgia , Cães , Fentanila/uso terapêutico , Metadona/uso terapêutico , Morfina , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/veterinária
12.
Theriogenology ; 187: 1-8, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35500422

RESUMO

Regional centro-axial block is a recommended technique for uncomplicated caesarean section in human medicine. Since the application of regional anaesthesia as the only technique in veterinary medicine is impractical, the objective of the study was to assess and compare the epidural component of caesarean section (CS) on maternal and fetal outcomes. Bitches (n = 36) undergoing elective CS were enrolled in this study. Females were randomly assigned into two groups: Gr I (Isoflurane, n = 20) and Gr IE (Isoflurane plus Epidural, n = 16). Anaesthesia was induced with propofol, and maintained with isoflurane in oxygen. In the IE group, epidural anaesthesia was also performed using lidocaine. The maternal intraoperative parameters were compared at three time points: T1 - just before the skin incision, T2 - after the last puppy removal, and T3 - at the end of surgery. At least 100 mcl of mixed umbilical cord blood was collected for gas analysis. The modified Apgar scoring system (AS) was used to objectively score newborn health and vitality immediately after birth (0 min), 5 and 20 min after birth. Systolic, diastolic, and mean blood pressure were lower in the IE group at T1, T2, and T3 compared to I group (p < 0.05). In the combined anaesthesia group blood pressure remained stable but low at all time points. Throughout surgery, the IE group required a lower concentration of isoflurane (p < 0.05). The median values of the umbilical blood gas results were found to be similar (p > 0.05) in both investigated groups. The initial results of the Apgar score were comparable in the I and IE groups (p > 0.05). However, subsequent AS measurements revealed significant differences between both groups. Puppies from the IE group received better AS scores at 5 and 20 min compared to the I group (median AS 8 and 9 vs. 5 and 8, respectively). The results obtained demonstrated that epidural anaesthesia administration reduced the requirement for isoflurane in dams undergoing caesarean section and despite episodes of maternal hypotension did not affect the results of neonatal umbilical blood gas. Furthermore, newborns from the epidural anaesthesia group improved more quickly postnatally, developing a satisfactory condition in a shorter time.


Assuntos
Anestesia Epidural , Isoflurano , Anestesia Epidural/veterinária , Anestesia Geral/veterinária , Animais , Cesárea/métodos , Cesárea/veterinária , Cães , Feminino , Humanos , Saúde do Lactente , Isoflurano/farmacologia , Gravidez
13.
Ulus Travma Acil Cerrahi Derg ; 28(3): 382-389, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35485565

RESUMO

BACKGROUND: In open-heart surgeries, many organ functions, particularly the respiratory system, are affected by post-operative pain, and so is mortality. Following open-heart surgery, geriatric patients have a higher risk of organ dysfunction and mortality. We aimed to compare the short-term outcomes and mortality of thoracic epidural analgesia (TEA) and intravenous (IV) analgesia in geri-atric patients undergoing open heart surgery. METHODS: This study included patients over the age of 65 who had open-heart surgery between 2010 and 2020. The patients were divided into two groups: Those who received TEA (Group E) and those who received IV paracetamol or tramadol or dexmedetomi-dine (Group I). The patients' post-operative sedation and analgesia requirements, mechanical ventilation (MV) duration, blood glucose levels, liver and kidney function tests, complications, intensive care and hospital stay lengths, and mortality rates were all compared. RESULTS: The study included a total of 548 patients, with 408 in Group E and 140 in Group I. As a result of the comparisons be-tween the groups, sedation requirement, analgesia requirement, MV duration, post-extubation facial mask oxygen requirement, non-invasive MV need, re-intubation requirement, and blood glucose level were found to be lower in Group E than in Group I. Moreover, periods spent in intensive care and lengths of hospital stay were found to be lower in Group E than Group I. There was no difference found between the two groups in terms of hospital mortality. CONCLUSION: In elderly patients undergoing open-heart surgery, TEA reduced the length of time in intensive care and hospital stays by improving the respiratory status and blood glucose regulation by supplying analgesia and sedation.


Assuntos
Analgesia Epidural , Anestesia Epidural , Procedimentos Cirúrgicos Cardíacos , Idoso , Glicemia , Humanos , Dor Pós-Operatória/tratamento farmacológico
14.
Ann Med ; 54(1): 1112-1117, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35443838

RESUMO

OBJECTIVE: To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion. METHODS: Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women's and Children's Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered. RESULTS: A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037-1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031-1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23-1.93; p < .01). CONCLUSION: Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGESProlonged duration of epidural labour analgesia > 8 h is associated with conversion failure.If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestesia Epidural , Trabalho de Parto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/métodos , Anestesia Epidural/métodos , Cesárea , Criança , Feminino , Humanos , Gravidez
15.
Anaesthesia ; 77(7): 785-794, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35460068

RESUMO

Data on safety and success rates of ultrasound-guided caudal blockade, performed on sedated children with an uninstrumented airway, are scarce. We performed a retrospective observational study of validated data from April 2014 to December 2020 in a paediatric cohort where the initial plan for anaesthetic management was sedation and caudal epidural without general anaesthesia or airway instrumentation. We examined success rates of this approach and rates of block failure and block-related complications. In total, 2547 patients ≤ 15 years of chronological age met inclusion criteria. Among the 2547 cases, including 453 (17.8%) former preterm patients, caudal-plus-sedation success rate was 95.1%. The primary anaesthesia plan was abandoned for general anaesthesia in 124 cases. Pain-related block failure in 83 (3.2%) was the most common cause for conversion. Complications included 39 respiratory events and 9 accidental spinal anaesthetics. Higher odds of pain-related block failure were associated with higher body weight (adjusted OR 1.063, 95%CI 1.035-1.092, p < 0.001) as well as with mid-abdominal surgery (e.g. umbilical hernia repair) (adjusted OR 15.11, 95%CI 7.69-29.7, p < 0.001), whereas extreme (< 28 weeks) former prematurity, regardless of chronological age, was associated with higher odds (adjusted OR 3.62, 95%CI 1.38-9.5, p = 0.009) for respiratory problems. Ultrasound-guided caudal epidural, performed under sedation with an uninstrumented airway, is an effective technique in the daily clinical routine. Higher body weight and mid-abdominal surgical procedures are risk factors for pain-related block failure. Patients who, regardless of chronological age, had been born as extreme preterm babies are at the highest risk for respiratory events.


Assuntos
Anestesia Epidural , Peso Corporal , Criança , Humanos , Lactente , Recém-Nascido , Dor , Estudos Retrospectivos , Ultrassonografia de Intervenção
16.
J Anesth ; 36(3): 441-443, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35391581

RESUMO

A drop of saline placed within the hub of an epidural needle is sucked in when the needle is advanced and penetrates through a polyurethane foam cube. This phenomenon might be explained by the release of compressed air inside of the needle into the air. The positive pressure inside of the needle may be generated by advancing of the needle. To prove this hypothesis, the pressure inside of the needle was measured during needle advancement, and it increased gradually and then dropped to zero suddenly when the needle fully penetrated the polyurethane foam block. We can speculate that the same phenomenon occurs during hanging-drop method of epidural anesthesia, and this may occur regardless of whether epidural subatmospheric pressure exists or not.


Assuntos
Anestesia Epidural , Anestesia Epidural/métodos , Espaço Epidural , Agulhas , Poliuretanos , Seringas
17.
Int J Obstet Anesth ; 50: 103538, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35390734

RESUMO

BACKGROUND: The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). METHODS: We performed a monocentric retrospective study at the Angers University Hospital (France). All non-elective CSs performed under GA between January 2015 and December 2019 were included. The CSs were classified using a three-color coding system (green for non-urgent delivery, orange for urgent CS, and red for very urgent CS). The primary neonatal outcome was a composite of umbilical artery pH <7.10 or 5-min Apgar score <7. The crude and adjusted odds ratios (OR) for the risk of neonatal morbidity associated with secondary GA were estimated. RESULTS: We included 247 patients, of whom 101 (41.3%) had a secondary GA and 146 (58.7%) had primary GA. In the secondary GA group, 86.1% (87/101) had epidural anesthesia and 13.9% (14/101) had spinal anesthesia. Multivariate analysis showed no difference in neonatal morbidity between the two groups (adjusted odds ratio 1.18, 95% CI 0.56 to 2.51). CONCLUSIONS: Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.


Assuntos
Anestesia Epidural , Anestesia Obstétrica , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral , Anestesia Obstétrica/métodos , Índice de Apgar , Cesárea/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
18.
Vet Anaesth Analg ; 49(4): 417-422, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35400580

RESUMO

OBJECTIVE: To compare the antinociceptive effects of morphine administered via cervical epidural catheter to intravenously administered morphine using a thermal threshold (TT) testing model in healthy adult horses. STUDY DESIGN: Prospective, randomized, blinded experimental study. ANIMALS: A total of six university-owned adult horses. METHODS: Horses were instrumented with a cervical (C1-C2) epidural catheter and TT testing device with probes at withers and thoracic limb coronary bands. All horses underwent three TT testing cycles including cervical epidural morphine administration (treatment EpiM; 0.1 mg kg-1), systemic morphine administration (treatment SystM; 0.1 mg kg-1) and no morphine administration (treatment Control). Baseline TT was established prior to treatments, and TT was tested at 15, 30, 60, 90, 120, 150, 180, 240, 300, 360, 420, 480, 600 and 720 minutes following treatment. Horses underwent a 5 day washout period between treatments and the order of treatment was randomized. Differences between treatments were analyzed with repeated measures anova. RESULTS: Systemic and epidural morphine administration resulted in significantly higher TT values compared with baseline and control treatment. The duration of effect was significantly longer in treatment EpiM (10-12 hours) than in treatment SystM (1.5-2.0 hours). Horses in treatment EpiM had significantly higher TT values at time points 180-600 minutes (withers) and 300-600 minutes (coronary band) than horses in treatment SystM. CONCLUSIONS AND CLINICAL RELEVANCE: Cervical epidural administration of morphine provided antinociceptive effects as measured by increased TT for 10-12 hours compared with 1.5-2.0 hours for intravenously administered morphine. No complications or adverse effects were noticed following epidural placement of a C1-C2 catheter and administration of morphine. The use of a cervical epidural catheter can be considered for analgesia administration in treatment of thoracic limb and cervical pain in the horse.


Assuntos
Analgesia Epidural , Anestesia Epidural , Administração Intravenosa/veterinária , Analgesia Epidural/veterinária , Analgésicos , Analgésicos Opioides , Anestesia Epidural/veterinária , Animais , Cavalos , Humanos , Morfina , Estudos Prospectivos
19.
J Anesth ; 36(3): 335-340, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35243545

RESUMO

PURPOSE: To investigate the paths of thoracic epidural catheters in children, this retrospective study was performed. METHODS: We investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery. RESULTS: The median level for the catheter tip location was T3 (range C6-T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2-3 cm (1-1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6-T4)] than in those with curved or coiled paths after the initial 2-3 cm [median (range) T4 (T2-T7)] (p < 0.0001). CONCLUSIONS: Our findings indicate that the course of epidural catheters in children is unpredictable after the first 2-3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.


Assuntos
Anestesia Epidural , Tórax em Funil , Anestesia Epidural/métodos , Cateterismo/métodos , Cateteres , Criança , Tórax em Funil/cirurgia , Humanos , Estudos Retrospectivos
20.
Ann Ital Chir ; 92: 27-32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342098

RESUMO

AIM: Paraplegia is an infrequent although fearsome complication of anesthesia and surgical procedures, such as epidural anesthesia and thoracotomy. It may occur in both adults and children and a medullary lesion may be confirmed by magnetic resonance imaging, rather than computed tomography. The aim of this study is to describe the experience of two pediatric tertiary centers, contextualizing it with the other cases reported in literature. MATERIAL AND METHODS: We reported three pediatric cases of post-operative paraplegia in oncological patients, focusing on the potential causes and underling the possible strategies to prevent this complication. RESULTS: From our study, two principal features emerged: 1) Epidural anesthesia may expose children to a greater risk of spinal cord permanent damage due to the execution of the procedure under general anesthesia, which deprives the anesthesiologist of an important feedback about the position of the device; 2) In thoracotomy, the risk of paraplegia tends to increase along with the proximity to the costo-vertebral angle, especially if electrocautery or hemostatic materials are used. CONCLUSIONS: A prompt post-surgical neurological status routine assessment in pediatric patients undergoing epidural anesthesia or thoracotomy should be mandatory and, associated with the correct imaging study, may lead to the most appropriate therapeutic pathway and to a better prognosis. KEY WORDS: Anesthesia, Children, Epidural, Thoracotomy, Paraplegia.


Assuntos
Anestesia Epidural , Toracotomia , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Criança , Humanos , Imageamento por Ressonância Magnética , Paraplegia/etiologia , Paraplegia/prevenção & controle , Toracotomia/efeitos adversos , Toracotomia/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...