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1.
Medicine (Baltimore) ; 99(3): e18773, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011469

RESUMO

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.


Assuntos
Período de Recuperação da Anestesia , Anestesia Epidural/métodos , Anestesia Geral/métodos , Braço/irrigação sanguínea , Braço/cirurgia , Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica/terapia , Diálise Renal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
2.
Br J Anaesth ; 124(3): e108-e114, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959386

RESUMO

BACKGROUND: Norepinephrine infusion has been suggested as an effective method for preventing hypotension during spinal anaesthesia for Caesarean delivery. However, optimal dosing regimens for norepinephrine have not been well established. This study aimed to determine the dose-response characteristics of a weight-adjusted fixed-rate infusion of norepinephrine to prevent hypotension during neuraxial anaesthesia for Caesarean delivery. METHODS: In a double-blind, randomised controlled trial, 80 parturients having elective Caesarean delivery received a prophylactic norepinephrine infusion at 0.025 µg kg-1 min-1 (Group N1), 0.05 µg kg-1 min-1 (Group N2), 0.075 µg kg-1 min-1 (Group N3), or 0.10 µg kg-1 min-1 (Group N4), starting immediately after induction of combined spinal-epidural anaesthesia. The primary outcome was non-occurrence of hypotension, defined as a decrease in systolic arterial pressure ≥20% below baseline value or to ≤90 mm Hg, before delivery. Values for 50% effective dose (ED50) and ED90 were calculated using probit regression. RESULTS: The incidence of hypotension was 11/20 (55%), 6/20 (30%), 2/20 (10%), and 1/20 (5%) in Groups N1, N2, N3, and N4, respectively (P<0.0001). The ED50 and ED90 (95% confidence interval) of norepinephrine infusions for preventing hypotension were 0.029 (-0.002 to 0.043) and 0.080 (0.065-0.116) µg kg-1 min-1, respectively. The incidence of reactive hypertension increased with increasing norepinephrine dose (P=0.002). Other adverse effects were similar among groups. CONCLUSIONS: Under the conditions of this study, an infusion of norepinephrine 0.08 µg kg-1 min-1 was effective for preventing hypotension in 90% of patients. This information should provide a guide for initiating norepinephrine infusions. CLINICAL TRIAL REGISTRATION: ChiCTR1900022322 at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enindex.aspx).


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Hipotensão/prevenção & controle , Norepinefrina/administração & dosagem , Adulto , Pressão Sanguínea/efeitos dos fármacos , Cesárea , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Hipotensão/epidemiologia , Gravidez
3.
Medicine (Baltimore) ; 99(1): e18629, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895822

RESUMO

OBJECTIVES: To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making. METHODS: We searched PubMed, Embase, the Cochrane library, Web of Science, Medline, ScienceDirect, and the China National Knowledge Infrastructure from inception to June 2019 in order to identify randomized and nonrandomized controlled trials comparing EA and LA for PTED. Studies assessing at least 2 of the following indicators were eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), and complications. Two assessors evaluated the quality of the literature using the Cochrane Handbook or Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.3 software. RESULTS: Four randomized controlled trials and 4 retrospective cohort studies involving a total of 1000 patients were included. The LA and EA groups included 473 and 527 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative (P < .00001) and postoperative (P < .00001) lumbar VAS scores, intraoperative (P < .00001) and postoperative (P = .001) leg VAS scores, and anesthesia satisfaction rate (P < .00001), with EA being superior to LA in all aspects. There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative ODI, and complication rate. CONCLUSION: EA is as safe as LA and produces better anesthetic effects than does LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.


Assuntos
Anestesia Epidural , Anestesia Local , Discotomia Percutânea , Humanos
4.
Medicine (Baltimore) ; 99(4): e18986, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977915

RESUMO

RATIONALE: Anesthetic management of pregnant women with Fontan circulation remains challenging. There are few reports that describe the anesthetic management of cesarean section after Fontan surgery. Here, we present a case of successful epidural anesthesia in a woman with Fontan circulation who required emergency cesarean section. PATIENT CONCERNS: A 29-year-old woman at gestational week 28 was scheduled for emergency cesarean section because of fetal distress. Her past medical history was significant for congenital transposition of the great arteries that had been treated by Fontan surgery 26 years earlier. Her postoperative course had been uneventful and she had reached a near normal level of activity with no arrhythmias or thrombotic complications. On presentation, her oxygen saturation was approximately 84% and she had digital clubbing. Arterial blood gas analysis showed a PCO2 of 35 mmHg, PO2 of 55.5 mmHg, and hemoglobin of 16.3 g/dL. Her blood coagulation parameters were within normal limits except for a high fibrinogen concentration (4.55 g/L). DIAGNOSIS: The diagnosis was pregnancy requiring emergency cesarean section because of fetal distress. INTERVENTIONS: Before anesthesia, a radial artery line was established for continuous measurement of blood pressure. An air pressure pump was placed on the patient's lower limbs and a low-dose dobutamine infusion was started. Next, epidural anesthesia was successfully performed at L2-3. Five milliliters of 2% lidocaine followed by 10 mL of 0.75% ropivacaine were injected. Dobutamine was infused to maintain a target blood pressure of 100-120/60-70 mmHg. OUTCOMES: The procedure was uneventful with the patient maintaining a stable heart rate of 80 to 90 beats/min and an oxygen saturation of 90% to 94%. A male infant weighing 840 g was delivered. The Apgar score was 9 at 1 and 5 minutes. The patient was transferred to the intensive care unit for 20 hours of monitoring and discharged 9 days later. The neonate was discharged after 2 months of specialist neonatal treatment. LESSONS: Epidural anesthesia may be used in women with Fontan circulation undergoing emergency cesarean section. Knowledge of the physiology of the heart lesion and that of pregnancy are critical to the outcome.


Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Técnica de Fontan/efeitos adversos , Adulto , Cesárea/métodos , Feminino , Sofrimento Fetal , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/terapia
5.
Curr Opin Anaesthesiol ; 33(1): 64-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31833864

RESUMO

PURPOSE OF REVIEW: Regional anesthesia blocks may benefit patients undergoing cardiovascular surgery. This review coincides with the evolution of ultrasound-guided fascial plane blocks, societal concerns regarding opioid misuse and changing expectations regarding surgical recovery. RECENT FINDINGS: Paravertebral block and thoracic epidural analgesia have comparable postoperative analgesic profiles following thoracotomy; however, the former has a more favorable complication profile. Limited trials have compared these modalities in cardiac surgery. The mechanism of action of continuous paravertebral blockade may be systemic. Bilateral continuous paravertebral (and other continuous peripheral nerve blocks) should be used with caution in adult patients having cardiac surgery because of the risk of systemic local anesthetic toxicity and bleeding. Novel ultrasound-guided blocks: erector spinae, serratus anterior, pectoral, transversus thoracic muscle and pecto-intercostal fascial plane blocks potentially reduce postoperative opioid requirements; however, they require further investigation before their routine use can be recommended in adult cardiovascular surgical practice. The mechanism of action of erector spinae block is not fully elucidated. SUMMARY: Ultrasound-guided fascial plane blocks may reduce postoperative opioid requirements. Investigation into the safety and efficacy of bilateral continuous ultrasound-guided blockade for cardiac surgery is required. Trial protocols should be embedded into enhanced recovery after surgery programs. Patient-reported and long-term outcomes are recommended.


Assuntos
Anestesia por Condução , Anestesia Epidural , Procedimentos Cirúrgicos Cardiovasculares , Bloqueio Nervoso , Ultrassonografia de Intervenção , Adulto , Humanos , Bloqueio Nervoso/métodos , Dor Pós-Operatória , Toracotomia
6.
Thorac Surg Clin ; 30(1): 1-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761277

RESUMO

Nonintubated thoracic surgery (NITS) has a good safety record in experienced hands, but has pitfalls for beginners. The main aim of NITS is to keep the patient under spontaneous respiration, avoiding adverse effects, such as hypoxemia, hypercapnia, panic attacks, and finally conversion to general anesthesia. In this paper, the safety aspects of anesthesia for NITS is discussed based on data from the literature and personnel clinical experiences.


Assuntos
Anestesia Geral/métodos , Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Torácicos , Anestesia Epidural/métodos , Humanos , Monitorização Intraoperatória/métodos , Transtorno de Pânico/prevenção & controle , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Torácicos/psicologia
7.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Anaesthesia ; 74(12): 1626, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31681993
9.
Medicine (Baltimore) ; 98(40): e17366, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577735

RESUMO

This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated risk factors.This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ±â€Š4.8 hours (mean ±â€ŠSD) after morphine administration and the duration of pruritus was 14.0 ±â€Š8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (P < .001) and serotonin receptor antagonist (P < .05), were significantly correlated with incidence of EMIP.In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.Trial registration: ChiCTR-OPC-17012345.


Assuntos
Analgésicos Opioides/efeitos adversos , Anestesia Epidural/efeitos adversos , Cesárea/métodos , Morfina/efeitos adversos , Prurido/induzido quimicamente , Adulto , Analgésicos Opioides/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Grupos Étnicos , Feminino , Humanos , Incidência , Morfina/uso terapêutico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
10.
Medicine (Baltimore) ; 98(39): e17026, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574800

RESUMO

Continuous epidural block (CEB) is a popular clinical method for controlling postherpetic neuralgia (PHN). However, the long-term effects of CEB on PHN have not yet been established. This study aimed to confirm the clinical efficacy of epidural electrical stimulation catheters in CEB to manage PHN.Patients were classified into 2 groups: those with subacute PHN, between 30 and 180 days after the onset of the rash; and those with chronic PHN, over 180 days after the onset of the rash. On the basis of the type of catheter used, the patients were further divided into the following 2 groups: the esopocan group, in which the site of herpes zoster infection was confirmed using a contrast medium alone; and the epistim group, in which an additional method of electrical stimulation through a guide-wire in the catheter was used for detecting the site affected by herpes. Clinical efficacy was assessed with a numerical rating scale immediately 1, 3, and 6 months after the procedure. We also investigated whether additional interventional treatment was necessitated because of insufficient pain control during the 6-month follow-up.We examined 88 patients. In the subacute PHN period, the numerical rating scale score was significantly lower in the epistim group than in the esopocan group until 6 months. In the chronic PHN period, no significant differences in the numerical rating scale scores were observed between the 2 groups until 6 months. In the subacute PHN period, the adjusted odds ratio for other interventional procedures within 6 months in the esopocan group versus the epistim group was 2.59 (95% confidence interval [CI] 0.83-8.09, P = .10), and in the chronic PHN period, it was 1.31 (95% CI 0.11-5.46, P = .79).Epidural drug administration to specific segments using electrical stimulation catheters may be more useful in mitigating zoster-associated pain in subacute PHN.


Assuntos
Anestesia Epidural/métodos , Terapia por Estimulação Elétrica , Bloqueio Nervoso/métodos , Neuralgia Pós-Herpética/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento
11.
Am J Case Rep ; 20: 1356-1359, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31515465

RESUMO

BACKGROUND It is still challenging to remove an epidural catheter in a postoperative patient receiving urgent antiplatelet and anticoagulation therapy for acute coronary syndrome. CASE REPORT While under general anesthesia combined with thoracic epidural anesthesia, a 72-year-old male patient underwent right radical nephrectomy for renal cell carcinoma. On postoperative day 1 (POD1), the patient experienced bradycardia and a decrease in blood pressure, and he was diagnosed acute myocardial infarction. Intra-aortic balloon pumping (IABP) was induced for cardiogenic shock, and urgent thrombus aspiration and coronary balloon angioplasty were performed. On POD3, the surgeon removed the epidural catheter under both antiplatelet and anticoagulation therapy. At that time, the platelet count was 45×109/L and the activated partial thromboplastin time (APTT) was 72.2 seconds. Four hours after the epidural catheter was removed, the patient complained of bilateral fatigue in legs and developed a loss of sensation. Six hours after the epidural catheter was removed, he developed motor paralysis and became completely paralyzed in both limbs after 9 hours. At 19 hours after the epidural catheter was removed, emergency magnetic resonance imaging detected a spinal epidural hematoma at the level of Th9-11 with compression of the spinal cord. Emergency laminectomy was performed to decompress and remove the spinal epidural hematoma at 18 hours after the onset of sensorimotor symptoms. After surgery and rehabilitation, these symptoms had only slightly improved. CONCLUSIONS In patients with urgent antithrombotic therapy for urgent percutaneous coronary intervention (PCI) with an IABP for acute coronary syndrome, the epidural catheter should not be removed until the IABP and heparin are discontinued, and platelet counts have recovered.


Assuntos
Anestesia Epidural/efeitos adversos , Angioplastia Coronária com Balão , Anticoagulantes/efeitos adversos , Hematoma Epidural Espinal/etiologia , Balão Intra-Aórtico , Infarto do Miocárdio/terapia , Idoso , Anestesia Geral , Anticoagulantes/administração & dosagem , Bradicardia/etiologia , Bradicardia/terapia , Trombose Coronária/terapia , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/terapia , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Infarto do Miocárdio/etiologia , Paralisia/etiologia , Paralisia/terapia , Complicações Pós-Operatórias , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Trombectomia
12.
Vet Clin North Am Small Anim Pract ; 49(6): 1095-1108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31492542

RESUMO

Epidural and spinal anesthesia with a combination of local anesthetics and opioids (when available) is a commonly used technique in veterinary medicine and a safe one when practiced under strict guidelines. It is a valuable tool in the analgesic armamentarium and can greatly extend the ability to provide analgesia and reduce postoperative opioid requirements. As with all regional anesthetic techniques, clinical experience should be gained in order to practice it efficiently, and care should be taken to minimize the risks and complications associated with its use.


Assuntos
Anestesia Epidural/veterinária , Raquianestesia/veterinária , Manejo da Dor/veterinária , Animais de Estimação , Anestesia Epidural/métodos , Raquianestesia/métodos , Animais , Manejo da Dor/métodos
13.
S D Med ; 72(7): 310-312, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31461586

RESUMO

Intrathecal administration of digoxin occurs very rarely. Some case reports of inadvertently administering it when performing spinal/epidural anesthesia were described. We report for the first time a case of a chemical meningitis and status epilepticus caused by accidental epidural administration of digoxin. A 26-year-old female underwent epidural anesthesia for a planned cesarean section (CS). Post operatively the patient became lethargic, agitated and encephalopathic, she was intubated and transferred to our hospital intensive care unit (ICU). She had seizures on admission. Electroencephalogram (EEG) was performed and showed generalized slowing and status epilepticus with a focus noted in the right temporal region which resolved after antiepileptic medication administration. A lumbar puncture (LP) was performed; cerebro-spinal fluid (CSF) was suggestive for meningitis. However, there was no evidence for viral or bacterial infections. Within a day of admission, the referring hospital informed us that the patient received 250 mcg of digoxininadvertently-through epidural injection. The patient remained intubated for four days. She became more responsive and alert and was eventually extubated. After extubation, the patient was responsive and full neurological exam and brain imaging were normal. She was discharged from the hospital after seven days.


Assuntos
Anestesia Epidural , Digoxina/efeitos adversos , Meningite , Estado Epiléptico , Adulto , Anestesia Epidural/efeitos adversos , Cesárea , Digoxina/administração & dosagem , Feminino , Humanos , Meningite/induzido quimicamente , Gravidez , Estado Epiléptico/induzido quimicamente
14.
A A Pract ; 13(8): 299-302, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31274513

RESUMO

Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. One of the most feared sequelae of hyperthyroidism is thyroid storm, which has a mortality rate >10%. Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.


Assuntos
Doença de Graves , Período Pós-Parto , Complicações na Gravidez , Crise Tireóidea , Adulto , Anestesia Epidural , Feminino , Humanos , Trabalho de Parto Prematuro , Gravidez
15.
Vet Surg ; 48(7): 1330-1337, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31328291

RESUMO

OBJECTIVE: To compare perioperative opioid consumption and duration of hospitalization (DOH) in anesthetized dogs receiving opioid-based analgesia (OBA) vs those receiving bupivacaine epidural-based analgesia (EPID) during cystotomy. STUDY DESIGN: Retrospective cross-sectional study. ANIMALS: Fifty-six client-owned dogs undergoing cystotomy. METHODS: Clinical records of dogs undergoing cystotomy between January 2015 and December 2017 were reviewed. Demographic data, duration of anesthesia and surgery, anesthetic management, perioperative opioid consumption expressed in morphine equivalents (ME), perioperative use of adjuvant analgesics, time to first micturition, time to eat, time to ambulate, and DOH were recorded. Opioid consumption and DOH were compared with a Wilcoxon rank-sum test, followed by linear regression analysis as appropriate. Time to first micturition, time to eat, and time to walk unassisted were modeled with Cox-proportional hazard models. RESULTS: Dogs treated with EPID during surgery required 1.5 mg/kg ME less compared with those treated with OBA (P = .04) during surgery. Three of 19 dogs treated with EPID vs 15 of 37 dogs receiving OBA required intraoperative adjuvant analgesics (P = .06). Dogs treated with EPID regained motor function slower than dogs treated with OBA (P = .01); however, there was no difference in time to urinate, time to eat, or DOH between treatments. CONCLUSION: Perioperative lumbosacral epidural with bupivacaine reduced intraoperative opioid consumption in dogs anesthetized for cystotomy. CLINICAL SIGNIFICANCE: The use of epidural bupivacaine in dogs undergoing cystotomy may reduce intraoperative opioid requirements without affecting return of bladder function or DOH.


Assuntos
Analgesia Epidural/veterinária , Bupivacaína/uso terapêutico , Cistotomia/veterinária , Doenças do Cão/cirurgia , Morfina/uso terapêutico , Dor Pós-Operatória/veterinária , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestesia Epidural , Anestésicos Locais/administração & dosagem , Animais , Bupivacaína/administração & dosagem , Estudos Transversais , Cistotomia/efeitos adversos , Cães , Feminino , Hospitalização , Humanos , Masculino , Morfina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
16.
Med Sci Monit ; 25: 5272-5279, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31308355

RESUMO

BACKGROUND The objective of this study was to analyze the effects of general anesthesia in cesarean section on the umbilical cord blood gas values and intraoperative hemodynamics of parturient women. MATERIAL AND METHODS A total of 112 parturient women who received cesarean section were eventually randomized into 2 groups, GA (general anesthesia) group (n=56), and SE (combined spinal and epidural anesthesia) group (n=56). The umbilical cord blood gas values, postpartum Apgar score, intraoperative blood loss, mean arterial pressure, heart rate, total operative time, time intervals from anesthesia to delivery and from skin incision to delivery, the incidences of adverse reactions and neonatal asphyxia, and the postoperative patient satisfaction were compared between the 2 groups. RESULTS There were no significant differences between the 2 groups in total operative time, Apgar score, neonatal asphyxia rate, umbilical arterial and venous cord blood gas values, intraoperative blood loss, and time interval from skin incision to delivery (all P˃0.05). The GA group was significantly shorter in the time interval from anesthesia to delivery than the SE group (P˂0.05). The incidences of nausea, vomiting, and chills in the GA group were significantly lower than those in the SE group (all P˂0.05). The GA group was significantly higher in postoperative patient satisfaction than the SE group (P˂0.05). CONCLUSIONS General anesthesia has little impact on the umbilical cord blood gas values and Apgar score, and ensures better hemodynamic stability in cesarean section. Moreover, general anesthesia is characterized by rapid induction and is therefore valuable for use in clinical procedures.


Assuntos
Anestesia Epidural/métodos , Anestesia Geral/métodos , Sangue Fetal/fisiologia , Adulto , Raquianestesia/métodos , Índice de Apgar , Gasometria/métodos , Cesárea/métodos , China , Método Duplo-Cego , Feminino , Hemodinâmica/fisiologia , Humanos , Recém-Nascido , Gravidez
17.
Transplant Proc ; 51(9): 3074-3076, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31331719

RESUMO

Severe recessive dystrophic epidermolysis bullosa is a very rare inherited disease with excessive blisters forming starting at birth. Surgical intervention in this population creates a challenge: preventing formation of new lesions while managing previously scarred tissues. We present a case of a 27-year-old patient with end-stage renal disease caused by rapidly progressive IgA nephropathy. Living donor kidney transplantation was performed under local, spinal and epidural anesthesia. Living kidney transplantation in epidermolysis bullosa patients with end-stage renal disease should not be a contraindication for transplantation and should be considered as a viable and feasible option after careful preparation.


Assuntos
Epidermólise Bolhosa Distrófica/complicações , Transplante de Rim/métodos , Adulto , Anestesia Epidural , Glomerulonefrite por IGA/complicações , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Doadores Vivos , Masculino
18.
A A Pract ; 13(8): 316-318, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31343431

RESUMO

Anesthetic management of the adult patient with a Fontan circulation is complex and requires understanding of the specific physiology of the individual patient. Long-term survival in this cohort has increased to the point where patients are presenting for noncardiac surgery related to degenerative diseases of aging. We describe the perioperative management of a patient with a Fontan circulation undergoing total hip arthroplasty using combined spinal-epidural anesthesia and discuss the issues requiring special consideration for this surgical procedure in this group of patients.


Assuntos
Anestesia Epidural , Raquianestesia , Artroplastia de Quadril , Técnica de Fontan , Feminino , Humanos , Pessoa de Meia-Idade
19.
Pain Physician ; 22(4): E325-E332, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337174

RESUMO

BACKGROUND: Intracranial pressure (ICP) is affected after epidural saline solution or local anesthetic injection. Both ICP and epidural pressures have been shown to reach peak pressure just after epidural injection and begin decline thereafter. Measuring the optic nerve sheath diameter (ONSD) through ultrasonography is one of the noninvasive methods used for ICP assessment. OBJECTIVES: The purpose of this study was to investigate the effect of the speed of epidural saline injection on the ONSD under awake conditions. STUDY DESIGN: Prospective randomized trial. SETTING: An interventional pain management practice in South Korea. METHODS: This study included 40 patients receiving thoracic epidural catheterization for pain management after upper abdominal or thoracic surgery. Following successful epidural space confirmation, patients were randomized to receive epidural saline infusion with a speed of either 1 mL/second (slow speed, A group) or 3 mL/second (rapid speed, B group), respectively. For the measurement of ONSD, transorbital sonography was performed and ONSD was measured at 3 mm posterior to the optic nerve head. RESULTS: The A and B groups showed significant increases in ONSD according to time. Post hoc analysis of this result revealed that ONSD at T10 and T30 were significantly increased from baseline values (T0) (*P < 0.05 vs. T0; +P < 0.001 vs. T0). The mean values at any of the time points and degree of changes (T1-T0, T10-T0, and T30-T0) in ONSD between groups A and B did not show any significance. LIMITATIONS: We could not confirm the time of normalization of ONSD after the end of epidural injection of normal saline. CONCLUSIONS: Thoracic epidural injection of 10 mL of normal saline solution resulted in a significant increase of ONSD compared to baseline, however, the speed of injection did not affect the increase of ONSD. KEY WORDS: Epidural, saline, optic nerve, diameter. Trial registry number: Clinical trial registry information service (NCT03362255).


Assuntos
Anestesia Epidural/métodos , Injeções Epidurais/efeitos adversos , Pressão Intracraniana , Nervo Óptico/patologia , Solução Salina/administração & dosagem , Adulto , Idoso , Anestesia Epidural/efeitos adversos , Feminino , Humanos , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , República da Coreia , Solução Salina/efeitos adversos , Ultrassonografia
20.
Medicine (Baltimore) ; 98(30): e16610, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348308

RESUMO

The purpose of this study was to investigate the influences of varied anesthetic methods and depths on inflammatory cytokines and stress hormone levels in radical operation among colon cancer patients during perioperative period.A total of 120 patients were collected in the study and randomly divided into 4 groups, A: general anesthesia + Narcotrend D1, B: general anesthesia + Narcotrend D2, C: general anesthesia + epidural anesthesia + Narcotrend D1, D: general anesthesia + epidural anesthesia + Narcotrend D2. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, cortisol (Cor), adrenocorticotropic hormone (ACTH), and endothelin-1 (ET-1) were measured adopting commercial kits before anesthesia (T0), 4 hours after surgery (T1), 24 hours after surgery (T2), and 72 hours after surgery (T3).There was no significant difference in basic clinical characteristics among the groups. In comparison with group A, B and C, group D showed significantly lower levels of TNF-α, IL-6, IL-10, Cor, ACTH, and ET-1 at T1 and T2 (all, P < .05). Significantly higher levels of TNF-α, IL-6, IL-10, Cor, and ACTH were detected at T1 and T2 than those at T0 (all, P < .05), whereas, at T3, the levels of inflammatory cytokines and stress hormones were all decreased near to preoperation ones.General anesthesia combined with epidural anesthesia at Narcotrend D2 depth plays an important role in reducing immune and stress response in patients with colon cancer from surgery to 24 hours after surgery.


Assuntos
Anestesia Epidural/métodos , Anestesia Geral/métodos , Neoplasias do Colo/cirurgia , Citocinas/biossíntese , Mediadores da Inflamação/metabolismo , Hormônio Adrenocorticotrópico/biossíntese , Citocinas/sangue , Quimioterapia Combinada , Endotelina-1/biossíntese , Feminino , Humanos , Hidrocortisona/biossíntese , Mediadores da Inflamação/sangue , Interleucinas/biossíntese , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/biossíntese
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