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1.
Curr Opin Anaesthesiol ; 34(2): 199-203, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630772

RESUMO

PURPOSE OF REVIEW: Effective and sustained perioperative analgesia in thoracic surgery and pulmonary resection is beneficial to patients by reducing both postoperative pulmonary complications and the incidence of chronic pain. In this review, the indication of thoracic epidural anaesthesia in video- (VATS) and robotic-assisted (RATS) thoracoscopy shall be critically objectified and presented in a differentiated way. RECENT FINDINGS: Pain following VATS and RATS has a negative influence on lung function by inhibiting deep respiration, suppressing coughing and secretion and favours the development of atelectasis, pneumonia and other postoperative pulmonary complications.In addition, inadequate pain therapy after these procedures may lead to chronic pain. SUMMARY: Since clear evidence-based recommendations for optimal postoperative analgesia are still lacking in VATS and RATS, there can be no universal recommendation that fits all centres and patients. In this context, thoracic epidural analgesia is the most effective analgesia procedure for perioperative pain control in VATS and RATS-assisted surgery for patients with pulmonary risk factors.


Assuntos
Anestesia Epidural , Pulmão/cirurgia , Procedimentos Cirúrgicos Robóticos , Anestesia Epidural/efeitos adversos , Humanos , Dor Pós-Operatória/prevenção & controle , Pneumonectomia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Cirurgia Torácica Vídeoassistida
2.
Medicine (Baltimore) ; 100(3): e24374, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546075

RESUMO

RATIONALE: Vocal fold paralysis and cauda equina syndrome are very rare neurologic deficits. This report describes the case of a patient who simultaneously developed both after uneventful spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine. PATIENT CONCERNS: We report the case of a 45-year-old female, who underwent surgery for bilateral hallux valgus developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered. There was no pain or paresthesia during needle placement or drug injection. Surgery was performed uneventfully. DIAGNOSES: Right vocal fold paralysis was diagnosed with flexible laryngoscopy. INTERVENTIONS: Patient was started on the treatment with a surgery for bilateral hallux valgus, who developed cauda equina syndrome and unilateral vocal fold paralysis after uneventful spinal-epidural anesthesia was administered. OUTCOMES: Postoperatively, she had difficulty in urination and defecation. In addition, she developed unilateral vocal fold paralysis characterized by hoarseness, effortful voice production, and choking with liquids. Magnetic resonance imaging performed on the lumbosacral area and computed tomography of the neck, the chest, and the skull revealed entirely normal results. However, flexible laryngoscopy revealed a right vocal fold paralysis. Although cauda equina syndrome can occur due to neurotoxicity of local anesthetics, the exact etiology of vocal fold paralysis is uncertain. LESSONS: The case highlights that 2 rare and serious complications of spinal-epidural anesthesia can even occur in the same patient after uneventful surgery and block performance.


Assuntos
Anestesia Epidural/efeitos adversos , Síndrome da Cauda Equina/etiologia , Paralisia/etiologia , Prega Vocal/anormalidades , Anestesia Epidural/métodos , Raquianestesia/efeitos adversos , Raquianestesia/métodos , Síndrome da Cauda Equina/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Paralisia/fisiopatologia , Prega Vocal/fisiopatologia
4.
Medicine (Baltimore) ; 100(2): e23977, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466139

RESUMO

ABSTRACT: Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management.Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. Logistic regression was used to analyze the potential influencing factors.A total of 572 patients with laparoscopic surgery were included. The incidence of POCD was 11.89%. There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO2 during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13-0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery.For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.


Assuntos
Laparoscopia/efeitos adversos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Idoso , Analgesia Controlada pelo Paciente/efeitos adversos , Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , Comorbidade , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Oxigênio/sangue , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
9.
Ulus Travma Acil Cerrahi Derg ; 26(3): 445-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436967

RESUMO

BACKGROUND: This study aims to evaluate the effects of the anesthesia technique on the intraoperative blood loss in acetabular fracture patients undergoing the Modified Stoppa approach. METHODS: We retrospectively identified 63 patients who underwent a Modified Stoppa approach for acetabular fracture from January 2014 to July 2018. A total of 20 patients were excluded from this study for the following reasons: bilateral acetabular fractures (n=6), undergoing antiaggregant treatment (n=3), incomplete anesthesia records (n=3), emergency pelvic surgery due to hemodynamic instability (n=5), splenic rupture (n=2), and liver laceration (n=1). The patients were divided into two groups as follows: patients undergoing general anesthesia (GA) (n=22) and patients undergoing combined epidural-general anesthesia (CEGA) (n=21). The main outcome measurements studied were the intraoperative blood loss and the need for intraoperative and/or postoperative blood transfusions. RESULTS: No statistically significant differences were found between the groups concerning the age, gender, type of fracture, mechanism of injury, time from injury to surgery, Injury Severity Score, associated injuries, and comorbidities (p>0.05). The mean intraoperative blood losses were 717.27 ml (300-1.600 ml) in the GA group and 473.81 ml (150-1.020 ml) in the CEGA group (p<0.001). In the cases with only an isolated acetabular fracture, the intraoperative blood transfusion means were 2.43 units (1-5 units) in 14 patients in the GA group and 1.27 units (1-4 units) in 15 patients in the CEGA group (p<0.001). CONCLUSION: Less intraoperative bleeding was seen in those patients undergoing CEGA when compared to those undergoing GA. This is a significant advantage for acetabular surgery, which has a long learning curve and a high risk of bleeding.


Assuntos
Acetábulo , Anestesia Epidural/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Acetábulo/lesões , Acetábulo/cirurgia , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Humanos , Estudos Retrospectivos
11.
Anesth Analg ; 131(1): 273-279, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32058449

RESUMO

BACKGROUND: Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption; however, postdural puncture headache (PDPH) remains a significant risk associated with this technique. The literature specifically examining this complication in adolescents is scarce. Our primary objective was therefore (1) to estimate the incidence of PDPH with a 27G pencil-point needle in patients between the ages of 12 and 19 undergoing ambulatory lower extremity procedures and (2) to compare it to the incidence in adults aged 20-45 years. METHODS: After institutional review board (IRB) approval, patients aged 12-45 years undergoing ambulatory lower extremity surgery were approached. Patients undergoing the procedure under combined spinal-epidural (CSE) or spinal anesthesia with a 27G pencil-point needle were eligible for enrollment. Patients were consented before surgery and received a survey via e-mail on postoperative day (POD) 4 inquiring about the presence of a headache. Each headache was described by the participant and assessed for severity, time of onset, duration, location, and whether it was of a postural nature. All patients reporting a postural headache were contacted by a physician author to confirm a diagnosis of PDPH using the International Headache Society diagnostic criteria. RESULTS: A total of 656 patients were included in the analysis. Overall, 3.4% of patients developed PDPH. The percentage developing PDPH was 4.9% (3.0-7.8) among those aged 12-19 years and 1.8% (0.8-3.9) in the 20- to 45-year-old group. After adjusting for covariates, the age group between 12 and 19 years was associated with an almost 3-fold increase in the odds (2.8 [95% confidence interval {CI}, 1.1-7.3]) for the development of PDPH compared to that in the 20-45 age group. One patient in the adult group required an epidural blood patch. CONCLUSIONS: The overall incidence for the development of PDPH in ambulatory patients <45 years of age is low. However, the odds for developing PDPH is significantly higher in teenagers compared to those aged 20-45 years. This increase was not associated with an increase in the need for an epidural blood patch. Providers may incorporate these data in their consent process and have a higher index of suspicion for PDPH in teenagers who report headaches after neuraxial anesthesia.


Assuntos
Anestesia Epidural/efeitos adversos , Cefaleia Pós-Punção Dural/diagnóstico , Cefaleia Pós-Punção Dural/epidemiologia , Punção Espinal/efeitos adversos , Adolescente , Adulto , Anestesia Epidural/tendências , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Punção Espinal/tendências , Adulto Jovem
12.
Trials ; 21(1): 55, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915040

RESUMO

BACKGROUND: Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anaesthesia. It limits patients' general activity and increases the length of hospital stays and the use of care. It is particularly disabling during the postpartum period, when mothers have to take care of their child. Epidural blood patch is the standard treatment for PDPH. However, it is an invasive procedure that may result in rare but serious complications. Recent evidence has suggested that adrenocorticotropic hormone (ACTH) is effective in the management of PDPH. The aim of this study is to assess the efficacy and safety of tetracosactide (Synacthen®), a synthetic analogue of ACTH, for PDPH treatment in patients who receive neuraxial anaesthesia during labour. METHODS: This randomised, double-blind, placebo-controlled, parallel-arm trial, is performed in two French university hospitals. Eligible patients are those suffering from postpartum PDPH, who are randomised to receive either 1 mg of tetracosactide intravenously over 20 min or to 0.9% saline (placebo). The primary endpoint is the rate of epidural blood patch within a 15-day follow-up period. Headache duration, pain intensity, reduction of general activity, increase in length of hospital stay, adverse events, analgesic use (type and duration) and number of blood patches per patient in each group are recorded. DISCUSSION: We expect a decrease in the use of epidural blood patch in those receiving tetracosactide, thus indicating a decrease in PDPH symptoms in these patients. This will define the therapeutic success of tetracosactide and the possibility to use this treatment as a non-invasive alternative to blood patch for PDPH treatment. TRIAL REGISTRATION: Primary Registry ClinicalTrials.gov Protocol Registration and Results System Date of Registration 24 June 2016 Unique Protocol ID 69HCL15_0429 Secondary IDs EudraCT Number 2015-003357-17 ClinicalTrials.gov ID NCT02813655 ANSM 160214A-31 Protocol version V4 28/09/2018.


Assuntos
Cosintropina/administração & dosagem , Hormônios/administração & dosagem , Manejo da Dor/métodos , Cefaleia Pós-Punção Dural/terapia , Administração Intravenosa , Adulto , Analgésicos/uso terapêutico , Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Placa de Sangue Epidural/efeitos adversos , Placa de Sangue Epidural/estatística & dados numéricos , Ensaios Clínicos Fase II como Assunto , Cosintropina/efeitos adversos , Método Duplo-Cego , Feminino , Hormônios/efeitos adversos , Humanos , Tempo de Internação/estatística & dados numéricos , Medição da Dor , Cefaleia Pós-Punção Dural/diagnóstico , Cefaleia Pós-Punção Dural/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
13.
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
14.
Transplantation ; 104(9): 1959-1965, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31651791

RESUMO

BACKGROUND: Spinal cord ischemia (SCI) is a rare but devastating condition that can occur in the perioperative period resulting in paraplegia. Although diabetes mellitus is a risk factor for SCI in other types of major surgery, SCI is not widely recognized in transplantation. The aim of this study was to quantify the risk of SCI in pancreatic transplantation. METHODS: All UK pancreas transplant units were surveyed between 2017 and 2018. The risk of SCI in pancreas transplantation was estimated using the number of radiologically confirmed cases relative to the number of pancreatic transplants from UK registry data during the same time period. RESULTS: There have been 6 cases of SCI during pancreas transplantation since 2002. No aortic clamping occurred in any recipient. During or after surgery, all patients experienced episodes of hypotension (systolic blood pressure ≤ 90 mm Hg) before the onset of neurological symptoms. Epoprostenol, epidural anesthesia, and postoperative hemodialysis may have contributed to systemic hypotension. The mainstay of early treatment for SCI for all cases was blood pressure control. CONCLUSIONS: Based on these findings, there is approximately a 1:440 risk of SCI in pancreas transplantation. Hypotension appears to be a prominent risk factor. Strategies for mitigating the risk of SCI are discussed, drawing on evidence from thoraco-abdominal aortic aneurysm surgery. The risk of long-term neurological deficit should be discussed with prospective pancreas recipients given the potential impact on posttransplant quality of life.


Assuntos
Transplante de Pâncreas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Isquemia do Cordão Espinal/etiologia , Adulto , Anestesia Epidural/efeitos adversos , Feminino , Humanos , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose/etiologia
15.
Anesth Analg ; 130(2): 321-331, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498191

RESUMO

BACKGROUND: Epidural-related maternal fever (ERMF) is an adverse effect of epidural analgesia during labor and is associated with perinatal and neonatal morbidity. Local anesthetics have been proposed to trigger ERMF via sterile inflammation. Ropivacaine is currently the most frequently used epidural anesthetic and considered least toxic. This study investigates molecular effects of ropivacaine on human umbilical vein endothelial cells (HUVECs) as model system for endothelial cells and human placental trophoblasts (TBs), compares the effects to the putative anti-inflammatory lidocaine and investigates the partially alleviating impact of the anti-inflammatory corticosteroid dexamethasone. METHODS: HUVECs and TBs were exposed to ropivacaine (35 µM-7 mM) or lidocaine (21 mM) with or without dexamethasone (1 µM). AnnexinV/propidium iodide staining and lactate dehydrogenase release were used to analyze apoptosis and cytotoxicity. Proinflammatory interleukins-6 (IL-6) and IL-8 as well as prostaglandin E2 (PGE2) were measured by enzyme-linked immunosorbent assay (ELISA), while activation of signaling pathways was detected by Western blotting. Oxidative stress was visualized by live cell imaging and quantification of antioxidant proteins, intercellular adhesion molecule 1, vascular cell adhesion molecule 1, platelet endothelial cell adhesion molecule 1, cyclooxygenase 2, and mitochondrial deoxyribonucleic acid by real-time polymerase chain reaction. Dissipation of the mitochondrial membrane potential was assessed with cytofluorimetric analysis using the J-Aggregate (JC-1 staining [cytofluorimetric analysis using the J-Aggregate]). RESULTS: Ropivacaine exposure dose-dependently induced apoptosis and an increased release of IL-6, IL-8, and PGE2 from HUVECs and TBs. Furthermore, caspase-3, nuclear factor-κB, and p38 mitogen-activated protein kinase pathways were activated, while extracellular signal-regulated kinase 1/2 and protein kinase B (Akt) were dephosphorylated. Downregulation of antioxidative proteins induced oxidative stress and upregulation of ICAM1, VCAM1, and PECAM1 possibly facilitate leukocyte transmigration. Mitochondrial effects included increased release of the proinflammatory mitochondrial DNA damage-associated molecular patterns, but no significant dissipation of the mitochondrial membrane potential. Conversely, lidocaine exhibited repression of IL-6 and IL-8 release over all time points, and early downregulation of COX2 and cell adhesion molecules, which was followed by a late overshooting reaction. Dexamethasone reduced especially inflammatory effects, but as an inducer of mitophagy, had negative long-term effects on mitochondrial function. CONCLUSIONS: This study suggests that ropivacaine causes cellular injury and death in HUVECs and TBs via different signaling pathways. The detrimental effects induced by ropivacaine are only partially blunted by dexamethasone. This observation strengthens the importance of inflammation in ERMF.


Assuntos
Anestesia Epidural/efeitos adversos , Anestésicos Locais/efeitos adversos , Apoptose/efeitos dos fármacos , Febre/metabolismo , Mediadores da Inflamação/metabolismo , Ropivacaina/efeitos adversos , Anestésicos Locais/administração & dosagem , Apoptose/fisiologia , Células Cultivadas , Relação Dose-Resposta a Droga , Feminino , Febre/induzido quimicamente , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Gravidez , Ropivacaina/administração & dosagem , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia
16.
Anesth Analg ; 130(1): 187-193, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30829668

RESUMO

BACKGROUND: Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight. METHODS: Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal-epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis. RESULTS: Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups. CONCLUSIONS: Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Anestesia Obstétrica , Raquianestesia , Pressão Sanguínea/efeitos dos fármacos , Cesárea , Hipotensão/prevenção & controle , Parto , Fenilefrina/administração & dosagem , Vasoconstritores/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 1/efeitos adversos , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Peso Corporal , Cesárea/efeitos adversos , China , Relação Dose-Resposta a Droga , Método Duplo-Cego , Cálculos da Dosagem de Medicamento , Feminino , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Hipotensão/fisiopatologia , Infusões Intravenosas , Fenilefrina/efeitos adversos , Gravidez , Fatores de Tempo , Resultado do Tratamento , Vasoconstritores/efeitos adversos
17.
Best Pract Res Clin Anaesthesiol ; 33(4): 487-497, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791565

RESUMO

Regional anesthesia is responsible for approximately one-fifth of professional liability claims. The present investigation evaluated common and rare complications related to regional and neuraxial anesthesia, including postdural puncture headache, backache, transient neurological symptoms, inadvertent intrathecal injection, epidural hematoma and abscess, meningitis, arachnoiditis, postoperative urinary retention, local anesthetic systemic toxicity, and cardiac arrest. Regional anesthetic techniques are increasingly used in perioperative care of surgical patients for acute pain management and for chronic pain states. This manuscript also provides an overview and analysis of the existing literature and makes some recommendations in terms of strategies to prevent or minimize the potential patient injury, with a focus on those more commonly associated with patient injury and liability exposure. The role of ultrasound in preventing patient injury during regional anesthesia is also discussed.


Assuntos
Anestesia por Condução/métodos , Anestesia Epidural/métodos , Manejo da Dor/métodos , Complicações Pós-Operatórias/prevenção & controle , Anestesia por Condução/efeitos adversos , Anestesia Epidural/efeitos adversos , Humanos , Manejo da Dor/efeitos adversos , Cefaleia Pós-Punção Dural/induzido quimicamente , Cefaleia Pós-Punção Dural/etiologia , Cefaleia Pós-Punção Dural/prevenção & controle , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/etiologia
18.
Acta Med Okayama ; 73(6): 543-546, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31871339

RESUMO

We here report that a 71-year-old Japanese woman with a history of anaphylaxis induced by muscle relaxants had local anesthetic systemic toxicity (LAST) following an abdominal surgery under general anesthesia with combined spinal-epidural anesthesia without muscle relaxants. The total dosages of local anesthetics reached 0.67 mg/kg of ropivacaine and 11.5 mg/kg of lidocaine over 12.5 h to obtain sufficient muscle relaxation for surgery. Regional anesthesia is useful in cases in which muscle relaxants are to be avoided during a surgery. However, especially for a patient with risk factors and prolonged surgery, precautions should be taken to prevent LAST.


Assuntos
Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Emulsões Gordurosas Intravenosas/uso terapêutico , Lidocaína/efeitos adversos , Ropivacaina/efeitos adversos , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Emulsões Gordurosas Intravenosas/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Lidocaína/farmacologia , Ropivacaina/administração & dosagem , Ropivacaina/farmacologia
19.
Ortop Traumatol Rehabil ; 21(5): 379-388, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31774065

RESUMO

Traumatic injury to the spinal cord during spinal or epidural anesthesia is usually secondary to either direct needle penetration or intra-neural injection of local anesthetics. Two women were admitted to a rehabilitation department with paraparesis and hypoesthesia after delivery. One had undergone a lower segment cesarean section under spinal anesthesia and the other, a spontaneous delivery under epidural anesthesia. After discharge from the rehabilitation treatment, they both experienced some weakness in the lower limbs. The patho-physiological basis of this complication seems to be either direct damage to the spinal cord by intra-neural injection of local anesthetics, or local ischemia.


Assuntos
Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/métodos , Paraparesia/etiologia , Paraparesia/terapia , Adulto , Feminino , Humanos , Gravidez , Resultado do Tratamento
20.
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
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