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1.
Medicine (Baltimore) ; 98(51): e18311, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860981

RESUMO

BACKGROUND: Studies have shown the efficacy of norepinephrine in the treatment of maternal hypotension during cesarean section by comparing it to treatment with phenylephrine. However, few studies have compared the efficacy of norepinephrine to ephedrine. METHODS: Ninety-seven women undergoing elective cesarean section were administered norepinephrine at 4 µg/minute (group N; n = 48) or ephedrine at 4 mg/minute (group E; n = 49) immediately postspinal anesthesia, with an on-off titration to maintain systolic blood pressure (SBP) at 80% to 120% of baseline. A rescue bolus of 8 µg norepinephrine was given whenever SBP reached the predefined lower limit. Our primary outcome was the incidence of tachycardia. Secondary outcomes included the incidence of bradycardia, hypertension, hypotension, severe hypotension, hypotensive episodes, number of rescue top-ups, hemodynamic performance error including median performance error (MDPE), and median absolute performance error (MDAPE). Neonatal Apgar scores and umbilical arterial (UA) blood gas data were also collected. RESULTS: Women in group N experienced fewer cases of tachycardia (4.2% vs 30.6%, P = .002, odds ratio: 0.11 [95% confidence interval, CI: 0.02-0.47]), a lower standardized heart rate (HR) (70.3 ±â€Š11 vs 75 ±â€Š11, P = .04, difference: 4.7 ±â€Š2.2 [95% CI: 0.24-9.1]), and a lower MDPE for HR (1.3 ±â€Š9.6 vs 8.4 ±â€Š13.5 bpm, P = .003, difference: 3.1 ±â€Š1.8 [95% CI: -0.6-6.7]). In addition, the lowest or the highest HR was lower in group N compared to group E (both P < .05). Meanwhile, the standardized SBP in group N was lower than that in group E (P = .04). For neonates, the UA blood gas showed a higher base excess (BE) and a lower lactate level in group N compared to E (both P < .001). Other hemodynamic variables, maternal, and neonatal outcomes were similar. CONCLUSION: Infusion of 4 µg/minute norepinephrine presented fewer cases of tachycardia, less fluctuation and a lower HR compared to baseline values, as well as a less stressed fetal status compared to ephedrine infusion at 4 mg/minute. In addition, norepinephrine infusion presented a lower standardized SBP compared to ephedrine.


Assuntos
Raquianestesia/métodos , Cesárea/efeitos adversos , Efedrina/uso terapêutico , Hipotensão/prevenção & controle , Norepinefrina/uso terapêutico , Adulto , Raquianestesia/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Cesárea/métodos , Método Duplo-Cego , Efedrina/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipotensão/etiologia , Infusões Intravenosas , Norepinefrina/administração & dosagem , Gravidez
2.
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
3.
Prog Urol ; 29(8-9): 402-407, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31266700

RESUMO

INTRODUCTION: Spinal anesthesia in outpatient urology is controversial (longer hospital stay, risk of urinary retention). The main goal was to evaluate outpatient spinal anesthesia and to compare 2 local anesthetics secondarily. MATERIAL: Monocentric retrospective study including all patients undergoing surgery in urological ambulatory surgery under spinal anesthesia between December 2011 and May 2015, split into two groups according to the local anesthetic used: bupivacaine (BP) and chloroprocaine (CP). Quantitative variables were compared by Student's t-test, qualitative variables by χ2 test. RESULTS: Seventy-one (95%) out of the 75 patients included have been discharged the same day. Discharge was impossible in these cases: patient alone at home (1), bladder clot (1), JJ intolerance (1), delayed micturition (1). The mean duration of the procedure was 27±19min, the SSPI's was 55±31min, the stay's was 360±91min. A total of 45 patients (60%) received BP and 30 (40%) received CP. The mean residence time in SSPI was significantly reduced in the CP group (47±24min vs. 61±34min, P=0.04). One patient experienced urination delay in the BP group with no significant difference. No significant difference for the other criteria studied despite the mean age, which is higher in the CP group (P=0.02). CONCLUSION: Spinal anesthesia is adapted to ambulatory urology, and does not increase the risk of urinary retention, especially with CP that would decrease the length of stay in SSPI compared to BP. LEVEL OF EVIDENCE: 4.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Procaína/análogos & derivados , Procedimentos Cirúrgicos Urológicos/métodos , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Raquianestesia/efeitos adversos , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procaína/administração & dosagem , Procaína/efeitos adversos , Estudos Retrospectivos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia
4.
Medicine (Baltimore) ; 98(27): e16334, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277184

RESUMO

BACKGROUND: Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients. METHODS: The subjects were 60 elderly patients in our hospital (aged 65-80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L3-4. They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L3-4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain). RESULTS: No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) (P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference (P > .05). CONCLUSION: Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia de Quadril , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Ropivacaina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Raquianestesia/instrumentação , Estudos de Viabilidade , Feminino , Hemiartroplastia , Humanos , Vértebras Lombares , Masculino , Agulhas
6.
Cardiol Young ; 29(6): 845-846, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159910

RESUMO

Correction of tetralogy of Fallot during infancy usually eliminates the risks associated with general anaesthesia. In rare cases of uncorrected defects persisting into adulthood, anaesthetic management during non-cardiac surgery may therefore be challenging. We describe the use of continuous spinal anaesthesia to successfully circumvent the operative risk of major abdominal surgery in an adult patient with uncorrected tetralogy of Fallot.


Assuntos
Raquianestesia/métodos , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Tetralogia de Fallot/complicações , Ecocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Gástricas/complicações , Tetralogia de Fallot/diagnóstico
7.
A A Pract ; 12(11): 393-395, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162165

RESUMO

Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. Ultrasound imaging improves accuracy of intervertebral level identification compared to clinical estimation. We present the case of a parturient with Currarino triad and a low conus medullaris undergoing cesarean delivery where preprocedural magnetic resonance imaging and ultrasound imaging allowed for successful combined spinal-epidural anesthesia to be performed. Despite these measures, however, the patient did develop a high spinal and temporary postoperative dizziness.


Assuntos
Canal Anal/anormalidades , Anestesia Epidural/métodos , Raquianestesia/métodos , Anormalidades do Sistema Digestório/complicações , Reto/anormalidades , Sacro/anormalidades , Siringomielia/complicações , Adulto , Cesárea , Feminino , Humanos , Imagem por Ressonância Magnética , Gravidez , Ultrassonografia
8.
Int J Surg ; 68: 35-39, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185312

RESUMO

BACKGROUND: Paravertebral block (PVB) as a sole anesthetic technique is difficult even in experienced hands. Hence, this study was undertaken to study the safety and efficacy of PVB and to compare with subarachnoid block (SAB) for inguinal hernia repair surgery (IHRS) in elderly male patients. MATERIALS AND METHODS: Sixty-five male patients aged 65 to 89 scheduled for IHRS were allocated randomly by computer-generated randomisation sequence into two groups. They underwent PVB (Group PVB: 33 patients were injected with 10 ml ropivacaine 0.5% at each level from T12 to L1) or SAB (Group SAB: 32 patients were injected with 15 mg ropivacaine 0.5% at L3-L4 level). Primary outcomes were hemodynamic changes and duration of postoperative analgesia. Secondary outcomes were dosage of remedial analgesics, time to perform the block, side effects and satisfaction of patients. RESULTS: The hemodynamics in the Group PVB were more stable than those in the Group SAB during surgery (P < 0.05). The duration of post-operative analgesia was significantly longer in the Group PVB (P < 0.001). The total dose of fentanyl was smaller in the Group PVB in the first 24 h (P < 0.001). The time to perform the block was significantly longer in the Group PVB (P < 0.001). There was a significant difference in the visual analogue scales (VAS) scores between the two groups at 4 h, 6 h, 8 h and 10 h (P < 0.05) but not at 2 h, 12 h and 24 h (P > 0.05). The VAS scores were lowest at 2 h for both the 2 groups, highest at 12 h for Group PVB and at 8 h for Group SAB respectively. The Group PVB had fewer adverse effects (P < 0.05) and higher satisfaction of patients (P < 0.05). CONCLUSION: Ultrasound-guided PVB can ensure the anesthetic effects of unilateral-opened IHRS in elderly male patients. It has a small impact on hemodynamics, a longer postoperative analgesia time and less complications.


Assuntos
Raquianestesia/métodos , Anestésicos/administração & dosagem , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Bloqueio Nervoso/métodos , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Analgésicos/uso terapêutico , Herniorrafia/efeitos adversos , Humanos , Injeções , Masculino , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Coluna Vertebral/inervação , Espaço Subaracnóideo , Resultado do Tratamento
10.
Actas urol. esp ; 43(5): 248-253, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181092

RESUMO

Introducción y objetivos: El objetivo del presente estudio ha sido comparar los procedimientos de CRIR realizados bajo anestesia general (AG) y anestesia espinal (AE) con respecto a las tasas de éxito y las tasas de complicaciones. Materiales y métodos: Se ha realizado una evaluación retrospectiva de los datos de los pacientes tratados con CRIR bajo AG y AE en 2 centros, entre octubre del 2014 y enero del 2018. Los grupos de AG y AE han sido evaluados con respecto a los parámetros: libre de cálculos, tasa de complicaciones, control del dolor postoperatorio y duración de la estancia en el hospital. Los cirujanos que participaron en el estudio examinaron las tasas de ausencia de cálculos de los procedimientos de CRIR bajo AE. Resultados: Un total de 1.361 pacientes fueron incluidos en el estudio. Se obtuvo una tasa libre de cálculos del 84,4% en toda la muestra, el 85,3% pertenecientes al grupo tratado con AE y el 83,5% al grupo de AG (p = 0,364). No se determinaron diferencias estadísticamente significativas entre los cirujanos que llevaron a cabo la CRIR bajo AE con respecto a las tasas de éxito y complicaciones y el tiempo quirúrgico (p = 0,676). El tiempo quirúrgico se determinó como 44,2 ± 14,2 min en el grupo de AE y 49,7 ± 19,1 min en el grupo de AG (p = 0,014). Conclusiones: La CRIR se puede llevar a cabo de forma segura, tanto con AE como con AG. Se observó que el éxito de la CRIR bajo AE era independiente del factor relacionado con el cirujano, por lo que esta puede considerarse una buena alternativa a la AG


Introduction and objectives: The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates. Materials and methods: A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2 centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study. Results: A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P = .364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P = .676). Operating time was determined as 44.2 ± 14.2 mins in the SA group and 49.7 ± 19.1 mins in the GA group (P = .014). Conclusions: The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cálculos Renais/cirurgia , Anestesia Geral/métodos , Raquianestesia/métodos , Cálculos Renais/complicações , Ureteroscopia/métodos , Estudos Retrospectivos
11.
Rev Bras Anestesiol ; 69(3): 311-314, 2019.
Artigo em Português | MEDLINE | ID: mdl-31080009

RESUMO

Reversible cerebral vasoconstriction syndrome is a cerebrovascular disorder leading to multifocal arterial constriction and dilation. Reversible cerebral vasoconstriction syndrome is possibly caused by transient deregulation of cerebral vascular tone. We report a rare case of a patient with chief complain of postpartum headache, was later diagnosed as a case of reversible cerebral vasoconstriction syndrome. A young full term primigravida with good uterine contraction admitted to labour room. Later she complained of leaking per vagina and on examination meconium stained liquor was noted. Caesarean delivery under spinal anesthesia was done and intra-operative period was uneventful. Both mother and baby were normal and shifted to postoperative ward and nursery respectively. In postoperative ward, mother complained of severe headache after one hour and later developed seizure. Midazolam was given intravenously and was intubated and transferred to critical care unit for further investigation and management. Non contrast computerized tomography scan of brain showed right occipital intracerebral as well as subarachnoid bleed. CT angiography showed right vertebral artery narrowing without any other vascular malformation. Patient was managed in critical care unit for 2 days and then extubated and shifted to high dependency ward after a day observation and discharged 3 days later after a full uneventful recovery.


Assuntos
Transtornos Cerebrovasculares/diagnóstico por imagem , Cefaleia/etiologia , Período Pós-Parto , Vasoconstrição , Adulto , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Angiografia por Tomografia Computadorizada/métodos , Feminino , Cefaleia/diagnóstico por imagem , Humanos , Gravidez , Síndrome
12.
N Z Vet J ; 67(5): 241-248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31081479

RESUMO

AIMS: To develop a technique for the injection of local anaesthetic into the spinal canal of broiler chickens by first determining the ideal location for needle placement based on anatomy and histology, and then using the developed technique to assess the onset and duration of action of three doses of lidocaine. METHODS: Two-month-old Ross broiler chickens (n = 30) were used in this study. Computed tomography imaging followed by anatomical examination of fresh cadavers (n = 6) were used to identify a suitable intervertebral space for injection of local anaesthetic, and landmarks to locate this space. Histological evaluation of the microanatomy of the caudal vertebral column in another six birds was used to examine the position of the spinal cord within the canal. Spinal anaesthesia was attempted using injection of lidocaine at 0.5 mg/kg (n = 6), 1 mg/kg (n = 6), and 2 mg/kg (n = 6) via the selected intervertebral space. Analgesia was tested by pinching the skin of the pericloacal area with thumb forceps to determine the onset and duration of analgesia. Respiratory rate, and cloacal temperature were measured at 0 minutes and every 10 minutes after injection until sensation returned. RESULTS: The space between synsacrum and first free coccygeal vertebra (synsacrococcygeal space) was selected as the most suitable site for spinal injection. In this region, the dura mater adhered to the internal wall of the spinal canal, and the subarachnoid space was large indicating that injection would be into the subarachnoid rather than the epidural space. The interval to onset of analgesia was similar for all doses of lidocaine (1.5 (SD 0.7), 2 (SD 1) and 1.3 (SD 0.5) minutes for 0.5, 1 and 2 mg/kg, respectively; p = 0.604). Duration of analgesia was longer following injection with 2 than 0.5 or 1 mg/kg lidocaine (21.3 (SD 2.5) vs. 4.5 (SD 3.5) vs. 11.3 (SD 2) minutes, respectively; p = 0.002). Mean cloacal temperature decreased between 0 and 20 minutes after injection with all doses of lidocaine (p = 0.021). CONCLUSIONS AND CLINICAL RELEVANCE: Spinal anaesthesia in chickens is feasible and is a practical, inexpensive and simple technique for regional anaesthesia of the pericloacal area.


Assuntos
Raquianestesia/veterinária , Anestésicos Locais/administração & dosagem , Galinhas , Lidocaína/administração & dosagem , Dor/veterinária , Análise de Variância , Raquianestesia/métodos , Animais , Feminino , Disco Intervertebral , Dor/tratamento farmacológico , Região Sacrococcígea/diagnóstico por imagem , Coluna Vertebral/anatomia & histologia , Coluna Vertebral/citologia , Coluna Vertebral/diagnóstico por imagem
13.
Anesth Analg ; 128(6): e100-e103, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094803

RESUMO

The effect of intravenous dexamethasone on the regression of sensory and motor block after isobaric bupivacaine spinal anesthesia is unknown. We conducted a prospective, double-blind, randomized controlled trial on 60 patients who received intravenously either placebo (group P) or 8-mg dexamethasone (group D) during the intrathecal injection of 12-mg isobaric bupivacaine 0.5%. Primary outcome was the time from bupivacaine injection to regression of 2 dermatomes in relation to the highest dermatome blocked by the spinal local anesthetic. Time to 2-dermatome regression was 85 minutes (74-96 minutes) in group P versus 87 minutes (76-98 minutes) in group D (P = .79).


Assuntos
Raquianestesia/métodos , Bupivacaína/administração & dosagem , Dexametasona/administração & dosagem , Infusões Intravenosas , Bloqueio Nervoso , Adulto , Idoso , Anestesia Local , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
14.
Med Arch ; 73(1): 44-48, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31097860

RESUMO

Introduction: The most common complications after spinal anesthesia for Cesarean section is hypotension. Administration of intravenous crystalloid or colloid fluid before the induction of anesthesia is a way to prevent it. Aim: The aim of this study was to compare the effects of preloading with ringer's solution and Voluven on hemodynamic changes in patients underwent elective Caesarean section under spinal anesthesia. Methods: This study was conducted on 70 pregnant women. They were randomly divided into two groups of 35. Group I received 10 ml/kg Ringer's solution (R group) and group II received 10 ml/kg Voluven (V group) over 15 min before spinal anesthesia. Mean SBP, DBP, MAP, HR, SPO2, mean Apgar of newborn at 1 and 5 minutes after birth, mean blood pH and analysis of umbilical venous blood gases of newborns, prevalence of nausea and vomiting, and the rate of shivering and its severity were recorded in the both groups. Results: Blood pH and analysis of blood gases and Apgar of newborn at 1 and 5 minutes after birth were similar in both groups. Shivering did not differ significantly between the two groups. Level of anesthesia and the incidence of nausea and vomiting in the R group were significantly higher than those in the V group (P=0.041 and P=0.029, respectively). Conclusion: The administration of both crystalloid and colloid fluids were effective in preventing the hypotension, although the use of Voluven was preferred to Ringer with respect to the level of the blockade and the incidence of nausea and vomiting.


Assuntos
Raquianestesia , Cesárea/métodos , Hemodinâmica/efeitos dos fármacos , Derivados de Hidroxietil Amido/uso terapêutico , Solução de Ringer/uso terapêutico , Adulto , Raquianestesia/efeitos adversos , Raquianestesia/métodos , Cesárea/efeitos adversos , Método Duplo-Cego , Feminino , Hemodinâmica/fisiologia , Humanos , Hipotensão/etiologia , Hipotensão/prevenção & controle , Gravidez
15.
Taiwan J Obstet Gynecol ; 58(3): 428-433, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31122537

RESUMO

OBJECTIVE: Spinal anesthesia induced hypotension (SAIH) is a common occurrence during spinal anesthesia for cesarean section resulting in perturbing effects on maternal and fetal outcomes. Previous studies conducted to attenuate SAIH focused on the timing of intravenous fluid infusion and demonstrated the superiority of coload strategy on traditional preload strategy but neither of them focused on the effect of the temperature of crystalloid infused on SAIH and fetal outcomes. The current study aimed to assess the effect of the temperature of the crystalloid infused with coload strategy on the incidence of SAIH and fetal outcomes. MATERIALS AND METHODS: Seventy-six parturients were enrolled into the study and data of 60 parturients were analyzed. Patients were randomly assigned to receive crystalloid coload at room temperature (Group RT, n = 30) or warmed at 37 °C (Group W, n = 30). The incidence of hypotension, cumulative hypotension episodes, heart rate, core body temperature, ephedrine dose, and fetal outcomes were recorded. RESULTS: There was no significant difference in the incidence of maternal hypotension, cumulative hypotension episodes, and ephedrine dose (p = 0,625, p = 0,871, p = 0,460 respectively). Umbilical arterial pH and fetal Apgar scores at first and fifth minutes were higher in Group W than in Group RT (p = 0.013, p = 0.006 and p = 0.045 respectively). One fetus in Group RT but none in Group W had umbilical arterial pH lower than seven. Fetal birth weight and rectal temperature measurements were comparable in both groups (p = 0.639 and p = 0.675 respectively). Demographic data, patient characteristics, and surgery data were comparable between groups. CONCLUSIONS: Isothermic crystalloid coload strategy results in higher umbilical pH values and Apgar scores in parturients scheduled for cesarean section under spinal anesthesia.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea/métodos , Soluções Cristaloides/administração & dosagem , Hipotensão/prevenção & controle , Adulto , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Temperatura Ambiente , Adulto Jovem
16.
Breast J ; 25(4): 631-637, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31087471

RESUMO

BACKGROUND: Postoperative pain remains a major challenge following immediate breast reconstruction with 40% of patients experiencing acute pain and up to 60% developing chronic pain. Paravertebral blocks (PVB's) have emerged as a promising adjunct to standard analgesic protocols. The aim of this study was to assess the utility of PVB's in immediate breast reconstruction following mastectomy. METHODS: A retrospective review of patients undergoing immediate breast reconstruction following mastectomy was performed. The primary outcome was postoperative pain measured by total oral morphine equivalent usage and self reported pain scores and secondary outcomes were length of stay in the PACU, complications, and OR delay. RESULTS: Of 298 patients undergoing immediate breast reconstruction, 112(38%) underwent standard analgesic protocols and 186(62%) underwent PVB in addition to the standard protocol. PVB's were associated with reductions in average postoperative pain scores (2.8 vs 3.3, P = 0.002), total opiate consumption (52 units vs 63 units, P = 0.038) and time spent in the PACU 92 vs 142 minutes, P = 0.0228) compared to patients who had general anesthesia alone. The overall complication rate was 3.7% (7/186 patients), all which were minor complications such as headache, bloody tap, vasovagal episode and temporary weakness. The use of PVBs delayed the OR start time on average by 15 minutes (34 vs 49 minutes). CONCLUSIONS: The present study offers one of the largest retrospective cohort studies to date evaluating the utility of PVB's in immediate breast reconstruction following mastectomy. We demonstrate that, PVB's in immediate breast reconstruction are associated with reductions in postoperative pain, narcotic usage and length of stay in PACU, but are associated with delays to the start time of the case. Anesthesiologists, plastic surgeons and hospital administrators must continue to work together to ensure this important and necessary service is administered in an efficient and cost effective manner.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Raquianestesia/métodos , Epinefrina/uso terapêutico , Feminino , Humanos , Tempo de Internação , Mamoplastia/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Ropivacaina/uso terapêutico
17.
Eur J Anaesthesiol ; 36(6): 442-448, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30985539

RESUMO

BACKGROUND: Peri-operative hypothermia and shivering are frequent events in patients during caesarean delivery under spinal anaesthesia. OBJECTIVE: We assessed the efficacy of combined pre-anaesthetic forced-air warming in combination with warmed intravenous fluid infusion for preventing hypothermia and shivering during caesarean delivery under spinal anaesthesia. DESIGN: A randomised controlled study. SETTING: A tertiary care teaching hospital from July 2017 to April 2018. PATIENTS: A total of 50 pregnant women, American Society of Anaesthesiologists physical status 2, aged 20 to 45 years, scheduled for caesarean delivery under spinal anaesthesia. INTERVENTION: Patients were enrolled and randomised into two groups: an active warming group (n = 25), which received combined pre-anaesthetic whole body forced-air warming for 15 min and prewarmed intravenous fluids, and a control group, which received no active warming or warmed fluids (C group; n = 25). Spinal anaesthesia was induced with 10 mg bupivacaine containing fentanyl (10 µg). MAIN OUTCOME MEASURES: Tympanic membrane temperature and shivering severity were measured at baseline and every 10 min during surgery, and then every 10 min for 1 h postoperatively. Neonatal outcomes (tympanic membrane temperature at birth, umbilical venous blood pH, Apgar score) were also recorded. RESULTS: The incidences of peri-operative hypothermia (0 vs. 48%, P < 0.001) and shivering (22 vs. 52%, P = 0.031) were significantly lower in the active warming than in the C group. The maximum temperature change was also significantly lower in the active warming than in the C group. Maternal thermal comfort scores were higher in the active warming than in the C group. Neonatal parameters were not significantly different between the groups. CONCLUSION: The combination of pre-anaesthetic forced-air warming and warmed intravenous fluid infusions appears to be effective for preventing hypothermia and shivering during caesarean delivery under spinal anaesthesia. TRIAL REGISTRATION: This trial was registered with Clinical Trials.gov (identifier: NCT03256786).


Assuntos
Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Hipotermia/prevenção & controle , Adulto , Ar , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Temperatura Corporal/efeitos dos fármacos , Temperatura Corporal/fisiologia , Estudos de Casos e Controles , Terapia Combinada/métodos , Feminino , Temperatura Alta/uso terapêutico , Humanos , Hipotermia/etiologia , Hipotermia/fisiopatologia , Infusões Intravenosas/métodos , Período Perioperatório , Gravidez , Estudos Prospectivos , Tremor por Sensação de Frio/efeitos dos fármacos , Tremor por Sensação de Frio/fisiologia , Resultado do Tratamento
18.
Med Sci Monit ; 25: 2859-2867, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30998665

RESUMO

BACKGROUND This study compared combined spinal-epidural anesthesia (CSEA) and single-shot spinal anesthesia (SSSA) by performing a meta-analysis. MATERIAL AND METHODS An electronic search of relevant studies was done through 2017. Primary endpoints included duration of surgery, and time for (1) sensory recovery to thoracic vertebra (T10), (2) maximal sensory, (3) motor blockade, and (4) motor recovery. Secondary endpoints were the adverse effects. RevMan 5.3 analytical software was used with odds ratios (OR) and 95% confidence intervals (CIs) as the analytic parameters. Standard deviation and mean were used to evaluate data by weighted mean differences (WMDs) with 95% CI. RESULTS A total of 370 patients were analyzed. A similar duration of surgery was observed with CSEA and SSSA (WMD: 0.24, 95%CI: -3.41-3.89; P=0.90). Time to maximal sensory blockade (WMD: 0.96, 95%CI: -2.91-4.83), time to maximal motor blockade (WMD: 0.25, 95%CI: -2.46-2.96), time for complete motor recovery (WMD: -6.28, 95%CI: -29.42-16.86), and time for sensory recovery to T10 vertebra (WMD: 0.42, 95%CI: -11.07-11.91) were not significantly different. Adverse effects such as hypotension (OR: 1.49, 95%CI: 0.27-8.31), pruritus (OR: 0.23, 95%CI: 0.03-2.18), nausea/vomiting (OR: 0.84, 95%CI: 0.12-5.99). and shivering (OR: 0.53, 95%CI: 0.11-2.56) were also similar with CSEA and SSSA. CONCLUSIONS CSEA was not associated with significantly different maximal duration of sensory/motor blockade, complete motor recovery, sensory regression to T10, or adverse drug events compared to SSSA. Hence, both should be considered effective in cesarean delivery.


Assuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Raquianestesia/métodos , Cesárea/métodos , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Espaço Epidural/efeitos dos fármacos , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
An. sist. sanit. Navar ; 42(1): 93-96, ene.-abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183053

RESUMO

La cirugía de pared abdominal alta puede requerir anestesia general pero en los pacientes con alto riesgo de vía aérea difícil y de complicaciones respiratorias es de elección la anestesia local o regional. La anestesia espinal usada habitualmente (isobara o hiperbara) puede comprometer la función respiratoria al bloquear la metámera T6 o superiores. La anestesia espinal hipobara (AEH) a dosis bajas (3,6 cc de bupivacaína hipobara al 0,1% y 0,2 cc de fentanilo al 0,005%) consigue una analgesia suficiente con mínimo bloqueo motor. Exponemos el caso de un paciente con una hernia supraumbilical de gran tamaño, con alto riesgo de vía aérea difícil y de complicaciones respiratorias, al que se le aplicó AEH. El paciente no refirió dolor ni disnea durante la intervención, por lo que la AEH a dosis bajas es una opción a tener en cuenta en la cirugía de pared abdominal alta, pese a no haber sido descrita para este uso


High abdominal wall surgery may require general anesthesia but, in patients with high risk of difficult airway and respiratory complications, local or regional anesthesia is the choice whenever possible. Spinal anesthesia usually used (both isobaric and hyperbaric) could compromise the respiratory function due to blockade of the T6 metamere or higher. Hypobaric spinal anesthesia (HSA) at low doses (3.6 cc of 0.1% hypobaric bupivacaine plus 0.2 cc of 0.005% fentanyl) achieves sufficient analgesia with minimal motor blockade. We present the case of a patient with a large supraumbilical hernia with high risk of difficult airway and respiratory complications, who went through HSA. The patient did not report pain or dyspnea during the surgical procedure thus, HSA at low doses is an option to be taken into account in high abdominal wall surgery despite not having been described for this use


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hérnia Ventral/cirurgia , Raquianestesia/métodos , Transtornos Respiratórios/complicações , Bupivacaína/administração & dosagem , Manuseio das Vias Aéreas/métodos , Complicações Intraoperatórias , Hérnia Umbilical/cirurgia , Obesidade Abdominal/complicações , Bloqueio Atrioventricular/cirurgia , Marca-Passo Artificial
20.
An Sist Sanit Navar ; 42(1): 93-96, 2019 Apr 25.
Artigo em Espanhol | MEDLINE | ID: mdl-30895966

RESUMO

High abdominal wall surgery may require general anesthesia but, in patients with high risk of difficult airway and respiratory complications, local or regional anesthesia is the choice whenever possible. Spinal anesthesia usually used (both isobaric and hyperbaric) could compromise the respiratory function due to blockade of the T6 metamere or higher. Hypobaric spinal anesthesia (HSA) at low doses (3.6 cc of 0.1% hypobaric bupivacaine plus 0.2 cc of 0.005% fentanyl) achieves sufficient analgesia with minimal motor blockade. We present the case of a patient with a large supraumbilical hernia with high risk of difficult airway and respiratory complications, who went through HSA. The patient did not report pain or dyspnea during the surgical procedure thus, HSA at low doses is an option to be taken into account in high abdominal wall surgery despite not having been described for this use.


Assuntos
Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Hérnia Ventral/cirurgia , Manuseio das Vias Aéreas/métodos , Fentanila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade
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