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1.
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
2.
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
3.
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
4.
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
5.
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
6.
Br J Anaesth ; 123(3): 269-287, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351590

RESUMO

BACKGROUND: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. METHODS: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. RESULTS: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57-0.80/OR: 0.83, 95% CI: 0.60-1.15; pulmonary OR: 0.65, 95% CI: 0.52-0.80/OR: 0.69, 95% CI: 0.58-0.81; acute renal failure OR: 0.69, 95% CI: 0.59-0.81/OR: 0.73, 95% CI: 0.65-0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42-0.65/OR: 0.77, 95% CI: 0.64-0.93; infections OR: 0.73, 95% CI: 0.67-0.79/OR: 0.80, 95% CI: 0.76-0.85; and blood transfusion OR: 0.85, 95% CI: 0.82-0.89/OR: 0.84, 95% CI: 0.82-0.87. CONCLUSIONS: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. RECOMMENDATION: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. TRIAL REGISTRY NUMBER: PROSPERO CRD42018099935.


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Geral/efeitos adversos , Raquianestesia/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Anestesia Epidural/mortalidade , Anestesia Geral/mortalidade , Raquianestesia/mortalidade , Artroplastia de Quadril/mortalidade , Artroplastia do Joelho/mortalidade , Medicina Baseada em Evidências/métodos , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Pain Physician ; 22(3): 265-270, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31151334

RESUMO

BACKGROUND: Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. OBJECTIVES: To investigate whether there is a difference between blunt and sharp needles in intravascular injection rates during CTEB. STUDY DESIGN: Prospective, randomized, clinical trial. SETTING: A tertiary hospital in South Korea. METHODS: After institutional review board approval, 108 patients undergoing CTEB for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov. RESULTS: The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs. 56.67 ± 8.3 seconds, P < 0.001). LIMITATIONS: This was a single-center study. Additionally, the physicians could not be blinded to the type of needle used. CONCLUSIONS: In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. KEY WORDS: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.


Assuntos
Anestesia Epidural/instrumentação , Injeções Epidurais/instrumentação , Agulhas , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Manejo da Dor/métodos , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , República da Coreia
8.
BMC Anesthesiol ; 19(1): 54, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975081

RESUMO

BACKGROUND: Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurological impairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinical presentation of spinal epidural hematoma is even rarer and insidious. CASE PRESENTATION: We reported a case of a 44-year-old woman who underwent a caesarean section for a twin pregnancy during which a delayed dorsal spinal epidural hematoma occurred. Symptoms were reported 5 days after surgery and 72 h after removal of the epidural catheter. An MRI scan showed a dorsal epidural hematoma. The patient was moved to the Neurosurgical Department and underwent decompression surgery. CONCLUSION: The possibility of the delayed onset of a spinal epidural hematoma in a pregnant woman who undergoes epidural anaesthesia in labour must always be taken into consideration. In order to achieve the best clinical result, we stress the importance of a timely diagnosis and prompt surgical treatment.


Assuntos
Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Hematoma Epidural Espinal/diagnóstico por imagem , Transtornos Puerperais/diagnóstico por imagem , Adulto , Anestesia Epidural/tendências , Raquianestesia/tendências , Cesárea/efeitos adversos , Cesárea/tendências , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Hematoma Epidural Espinal/etiologia , Hematoma Epidural Espinal/cirurgia , Humanos , Período Pós-Parto/fisiologia , Gravidez , Transtornos Puerperais/etiologia , Transtornos Puerperais/cirurgia
10.
Medicine (Baltimore) ; 98(6): e14406, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732190

RESUMO

RATIONALE: We present a case of high spinal anesthesia after inadvertent injection of local anesthetics and corticosteroids into the subarachnoid space during attempted epidural injection. Cerebrospinal fluid (CSF) lavage is a suitable method for treatment. PATIENT CONCERNS: A 45-year-old woman presented with posterior thigh, leg, and ankle pain for >6 months and was treated with epidural injection. Five minutes after the third time of epidural injection, the patient complained loss of sensation and muscle strength in the lower extremities and abdominal area. DIAGNOSES: A high spinal anesthesia was confirmed by the patient loss of sensation and muscle strength in the lower extremities and abdominal area. INTERVENTIONS: CSF lavage was performed for treatment. OUTCOMES: After CSF lavage, the patient gradually returns to normal sensory and motor functions of lower limbs. On the fourth day, the patient sensed her physical function restoring gradually and was discharged uneventfully. At 4-month follow-up, the patient could have normal activities without obvious subsequent complications and any pain. LESSONS: We conclude that CSF lavage could be a helpful maneuver to clear lidocaine and betamethasone and avoid potential nerve damage caused by an unintentional intrathecal injection during an epidural injection for the treatment of chronic low back pain.


Assuntos
Anestesia Epidural/efeitos adversos , Dor Crônica/tratamento farmacológico , Injeções Epidurais/efeitos adversos , Dor Lombar/tratamento farmacológico , Irrigação Terapêutica/métodos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/líquido cefalorraquidiano , Anestesia Epidural/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Anestésicos Locais/líquido cefalorraquidiano , Feminino , Humanos , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Lidocaína/líquido cefalorraquidiano , Pessoa de Meia-Idade , Espaço Subaracnóideo
11.
Pain Pract ; 19(6): 586-593, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30791208

RESUMO

BACKGROUND: Pain management after surgery is crucial to decrease perioperative morbidity and mortality. Acute pain services (APS) are multidisciplinary teams that represent a modern strategy to address pain inside hospitals. The APS defines and applies pain treatment protocols specific for each surgery. To evaluate the performance of the APS at our institute, we performed a large retrospective cohort study focusing on complications of epidural analgesia and IV opiates. METHODS: Data from the 10 years of activity of the APS were collected. Pain was assessed using the VAS at rest (VASr) and during movement (VASm) at each daily visit; the presence of side effects and complications was also assessed. RESULTS: A total of 17,913 adult patients were followed by APS during the study period. Epidural analgesia was used in 7,776 cases (43%), while 9,239 (52%) patients used IV patient-controlled analgesia (PCA). A combination of the 2 was used in 87 patients (0.5%). A total of 456 perineural catheters (2.6%) were placed, while 442 patients(2.5%) used other analgesic techniques. We recorded 163 dural punctures during catheter placement, with no epidural hematoma, epidural abscess, or meningitis, and no permanent modification in sensitive or motor functions. CONCLUSIONS: In our large case series, APS was confirmed safe and effective in treating postoperative pain, using both epidural analgesia and IV PCA with morphine.


Assuntos
Analgesia Epidural/efeitos adversos , Analgésicos Opioides/efeitos adversos , Clínicas de Dor , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Adulto , Analgesia Epidural/métodos , Analgésicos Opioides/uso terapêutico , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Estudos Retrospectivos
12.
Curr Opin Anaesthesiol ; 32(3): 315-324, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30789839

RESUMO

PURPOSE OF REVIEW: Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. RECENT FINDINGS: Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/µl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache. SUMMARY: Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Administração Intranasal , Anestesia Epidural/instrumentação , Anestesia Epidural/métodos , Anestesia Obstétrica/instrumentação , Anestesia Obstétrica/métodos , Raquianestesia/instrumentação , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/terapia , Cateterismo , Cateteres/efeitos adversos , Feminino , Humanos , Incidência , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Gravidez , Gravidez de Alto Risco
13.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796074

RESUMO

Caudal epidural injections and facet joint injections using steroids and local anaesthetic are widely used methods of pain control in patients suffering from radicular leg pain. In the vast majority of cases this is low risk. We present an interesting case of a patient who suffered from symptomatic adrenal suppression following a caudal epidural injection, and thus wish to draw this rare but significant complication to the attention of orthopaedic practitioners.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Anestesia Caudal/efeitos adversos , Anestesia Epidural/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Hidrocortisona/uso terapêutico , Radiculopatia/tratamento farmacológico , Feminino , Humanos , Doença Iatrogênica , Injeções Intra-Articulares , Pessoa de Meia-Idade , Radiculopatia/fisiopatologia , Resultado do Tratamento , Articulação Zigapofisária
14.
Curr Opin Anaesthesiol ; 32(3): 268-270, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30747727

RESUMO

PURPOSE OF REVIEW: Low-dose combined spinal epidural (CSE) anesthesia is a common technique to anesthetize women for cesarean section. It is used to reduce the incidence of hypotension while providing excellent anesthetic conditions. RECENT FINDINGS: Low spinal doses produce effective anesthesia but of limited duration. Therefore, an epidural catheter (and thus CSE) is required to guarantee pain-free surgery. Recent work confirmed that lower spinal doses can reduce significantly hypotension. SUMMARY: Low-dose CSE is a valuable strategy to anesthetize pregnant women for cesarean section but requires attention and training.


Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Bupivacaína/administração & dosagem , Cesárea/efeitos adversos , Hipotensão/prevenção & controle , Anestesia Epidural/efeitos adversos , Anestesia Epidural/instrumentação , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/instrumentação , Anestésicos Locais , Bupivacaína/efeitos adversos , Cateteres , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipotensão/induzido quimicamente , Hipotensão/epidemiologia , Incidência , Gravidez , Fatores de Tempo
16.
Biosci Rep ; 39(2)2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30643009

RESUMO

Objective: Meperidine used to control shivering during perioperative period has associated side effects. The present study compared the safety of selective α2-adrenoreceptor agonist dexmedetomidine and meperidine for anti-shivering in primiparas after caesarean delivery under combined spinal-epidural anesthesia (CSEA).Methods: 100 primiparas scheduled for caesarean delivery were randomly allocated to dexmedetomidine group (Group D, n=50) and meperidine positive control group (Group M, n=50). Primiparas experienced shivering that continued to cord clamping were treated with dexmedetomidine (0.5 µg/kg) or meperidine (0.5 mg/kg) after cord clamping. The primary outcome measures were incidence of nausea, vomiting, and respiratory depression. Secondary outcome measures were shivering score, vital signs including blood pressure, heart rate and O2 saturation, tympanic temperature, and sedation score.Results: Dexmedetomidine provided similar anti-shivering effects as meperidine in patients after caesarean delivery under CSEA, evidenced as all shivering primiparas responded to either dexmedetomidine or meperidine treatment within 15 min. However, incidence of nausea and vomiting were significantly lower after dexmedetomidine treatment, accompanied with more stable blood pressure. Dexmedetomidine also provided well regulation of tympanic temperature and good sedation.Conclusion: Selective α2-adrenoreceptor agonist dexmedetomidine has a better safety profile compared with meperidine for anti-shivering in primiparas undergoing caesarean delivery. Dexmedetomidine could be a better choice for anti-shivering in patients requiring caesarean section. The mechanism of anti-shivering for dexmedetomidine may relate to well regulation of temperature and good sedation.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Raquianestesia/efeitos adversos , Cesárea , Dexmedetomidina/uso terapêutico , Tremor por Sensação de Frio/efeitos dos fármacos , Administração Intravenosa , Adulto , Anestesia Epidural/efeitos adversos , Regulação da Temperatura Corporal/efeitos dos fármacos , Dexmedetomidina/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Meperidina/administração & dosagem , Meperidina/uso terapêutico , Cuidados Pós-Operatórios , Gravidez , Resultado do Tratamento
17.
PLoS One ; 14(1): e0209825, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673740

RESUMO

BACKGROUND: Epidural catheters are state of the art for postoperative analgesic in abdominal surgery. Due to neurolysis it can lead to postoperative urinary tract retention (POUR), which leads to prolonged bladder catheterization, which has an increased risk for urinary tract infections (UTI). Our aim was to identify the current perioperative management of urinary catheters and, second, to identify the optimal time of suprapubic bladder catheter removal in regard to the removal of the epidural catheter. METHODS: We sent a questionnaire to 102 German hospitals and analyzed the 83 received answers to evaluate the current handling of bladder drainage and epidural catheters. Then, we conducted a retrospective study including 501 patients, who received an epidural and suprapubic catheter after abdominal surgery at the University Hospital Würzburg. We divided the patients into three groups according to the point in time of suprapubic bladder drainage removal in regard to the removal of the epidural catheter and analyzed the onset of a UTI. RESULTS: Our survey showed that in almost all hospitals (98.8%), patients received an epidural catheter and a bladder drainage after abdominal surgery. The point in time of urinary catheter removal was equally distributed between before, simultaneously and after the removal of the epidural catheter (respectively: ~28-29%). The retrospective study showed a catheter-associated UTI in 6.7%. Women were affected significantly more often than men (10,7% versus 2,5%, p<0.001). There was a non-significant trend to more UTIs when the suprapubic catheter was removed after the epidural catheter (before: 5.7%, after: 8.4%). CONCLUSION: The point in time of suprapubic bladder drainage removal in relation to the removal of the epidural catheter does not seem to correlate with the rate of UTIs. The current handling in Germany is inhomogeneous, so further studies to standardize treatment are recommended.


Assuntos
Cistostomia/métodos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/prevenção & controle , Adulto , Idoso , Anestesia Epidural/efeitos adversos , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo/efeitos adversos , Drenagem/efeitos adversos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Bexiga Urinária/cirurgia , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia , Infecções Urinárias/etiologia
19.
J Matern Fetal Neonatal Med ; 32(16): 2711-2715, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29526150

RESUMO

BACKGROUND: Hyponatremia during labor and delivery may result in severe maternal and neonatal sequelae. Our aim was to describe the direct effect of hyponatremia in labor on pregnancy outcome. METHODS: A case series of parturients diagnosed with hyponatremia during labor and their neonates. Clinical presentation, laboratory workup, and maternal and neonatal outcomes are presented. RESULTS: Four parturients and their corresponding six neonates were diagnosed with hyponatremia. Of these, two cases were caused by water intoxication and two were preeclampsia induced. While two were identified due to maternal or neonatal symptoms, two were diagnosed by routine laboratory testing. In all cases, low maternal sodium resulted in similarly low neonatal sodium. Neonatal symptoms included respiratory distress syndrome (RDS), lethargy, and jaundice. CONCLUSION: Psychogenic drinking during labor and preeclampsia may predispose to maternal hyponatremia, resulting in neonatal hyponatremia. Early recognition and treatment can prevent further maternal deterioration and adverse neonatal sequelae.


Assuntos
Hiponatremia/etiologia , Doenças do Recém-Nascido/etiologia , Pré-Eclâmpsia/fisiopatologia , Intoxicação por Água/complicações , Adulto , Anestesia Epidural/efeitos adversos , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/terapia , Trabalho de Parto/sangue , Trabalho de Parto/fisiologia , Masculino , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez
20.
Anesth Analg ; 129(1): 149-154, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29533260

RESUMO

BACKGROUND: Insufficient fixation of an epidural catheter may result in migration of the catheter and eventual catheter failure. However, the best fixation method remains to be established. Aron Alpha A (2-ethyl cyanoacrylate) adhesive is approved for clinical use and can be used for surgical adhesion to both skin and blood vessels. We hypothesized that the addition of Aron Alpha A adhesive to film dressing would result in consistent and dependable catheter fixation. METHODS: In this study, 58 women who were scheduled for cesarean delivery under spinal and epidural anesthesia were recruited. Patients were randomly assigned to a control or treatment group. In the control group, the catheter was fixed solely by film dressing. In the treatment group, a small amount of Aron Alpha A was applied at 2 sites along the catheter. The fixation area was then covered by film dressing. The catheter insertion length was recorded after fixation (T0), immediately postoperatively (T1), on postoperative day 1 (T2), and when the catheter was removed (T3). The change in insertion length from T0 to T3 between the 2 groups was the primary outcome measure. The incidence of catheter failure was also recorded. For all comparisons, P < .05 was considered statistically significant. RESULTS: Initially, 58 women were enrolled; however, 3 patients were excluded. From the remaining 55 patients, 27 and 28 were assigned to the control and treatment groups, respectively, and were evaluated. The change in insertion length from T0 to T3 was significantly more in the control group compared with the treatment group (-1.9 ± 2.2 vs 0 ± 0 cm, respectively; P < .001). In the control group, 11 catheters (41%) failed; in the treatment group, all catheters provided effective analgesia throughout the study (P < .001). CONCLUSIONS: Epidural catheter fixation using film dressing combined with 2-ethyl cyanoacrylate adhesive application at 2 sites along the catheter resulted in secure fixation in patients receiving postoperative epidural analgesia for cesarean delivery.


Assuntos
Anestesia Epidural/instrumentação , Anestesia Obstétrica/instrumentação , Bandagens , Cateteres de Demora , Cesárea , Cianoacrilatos/administração & dosagem , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Cianoacrilatos/efeitos adversos , Remoção de Dispositivo , Falha de Equipamento , Feminino , Humanos , Japão , Gravidez , Fatores de Tempo , Resultado do Tratamento
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