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spinal anaesthesia

Andrew Davidson, Justin Skowno
PURPOSE OF REVIEW: There has been a steady advance in neuromonitoring during anaesthesia. Inevitably much of the research is first done in adults and later in children. This review will focus on the recent paediatric publications (2017-2019) in two areas of neuromonitoring - measuring anaesthesia effect and cerebral perfusion and oxygenation. RECENT FINDINGS: For EEG-derived depth monitors, the main recent advances have been in better understanding their performance in infants...
March 18, 2019: Current Opinion in Anaesthesiology
D Sarotti, R Rabozzi, P Franci
The aim of this randomised, prospective clinical trial was to determine how the administration of a low dose of dexmedetomidine (DEX) by IV constant rate infusion, modified the duration of the nerve block in dogs undergoing spinal anaesthesia (SA) in a clinical setting. Forty-four dogs undergoing hind limb orthopaedic surgery in a day-surgery regime, maintained under anaesthesia with isoflurane plus SA, were randomly assigned to receive 1 μg/kg/h (IV) of DEX (group D) or not (group C). Spinal anaesthesia was performed with a hyperbaric solution of bupivacaine and morphine at the L5-6 interspace...
March 2, 2019: Research in Veterinary Science
Sampson Uzo Anya, Fidelis Anayo Onyekwulu, Elias Chukwujioke Onuora
Background: Obstetrical haemorrhage is a potentially preventable cause of maternal morbidity and mortality; and measurements of surgical blood loss (BL) are often inaccurate. Accurate BL estimation is paramount as it may substantially alter the timing of interventions to control haemorrhage. The study compares the assessment of intra-operative BL by visual estimation with BL calculated from haemoglobin estimation using the HemoCue®201+. Materials and Methods: A total of 60 pregnant patients at term undergoing elective caesarean section under spinal anaesthesia were enrolled into the study...
January 2019: Nigerian Postgraduate Medical Journal
Marion Wiegele, Peter Marhofer, Per-Arne Lönnqvist
Caudal epidural blockade in children is one of the most widely administered techniques of regional anaesthesia. Recent clinical studies have answered major pharmacodynamic and pharmacokinetic questions, thus providing the scientific background for safe and effective blocks in daily clinical practice and demonstrating that patient selection can be expanded to range from extreme preterm births up to 50 kg of body weight. This narrative review discusses the main findings in the current literature with regard to patient selection (sub-umbilical vs mid-abdominal indications, contraindications, low-risk patients with spinal anomalies); anatomical considerations (access problems, age and body positioning, palpation for needle insertion); technical considerations (verification of needle position by ultrasound vs landmarks vs 'whoosh' or 'swoosh' testing); training and equipment requirements (learning curve, needle types, risk of tissue spreading); complications and safety (paediatric regional anaesthesia, caudal blocks); local anaesthetics (bupivacaine vs ropivacaine, risk of toxicity in children, management of toxic events); adjuvant drugs (clonidine, dexmedetomidine, opioids, ketamine); volume dosing (dermatomal reach, cranial rebound); caudally accessed lumbar or thoracic anaesthesia (contamination risk, verifying catheter placement); and postoperative pain...
April 2019: British Journal of Anaesthesia
Frederick Sieber, Karin J Neufeld, Allan Gottschalk, George E Bigelow, Esther S Oh, Paul B Rosenberg, Simon C Mears, Kerry J Stewart, Jean-Pierre P Ouanes, Mahmood Jaberi, Erik A Hasenboehler, Nae-Yuh Wang
BACKGROUND: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function. METHODS: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0-2] or lighter (OAA/S 3-5) sedation, and were assessed for postoperative delirium...
April 2019: British Journal of Anaesthesia
J Oji-Zurmeyer, C M Ortner, K U Klein, M Gries, C Kühn, T Schroffenegger, G Putz, S Jochberger
BACKGROUND: The aim of this study was to describe the current obstetric anaesthetic practices in Austria by performing a comprehensive questionnaire survey. METHODS: A questionnaire was sent via email to key anaesthesiologists from obstetric anaesthesia departments of 81 hospitals registered at the Austrian Ministry of Health. RESULTS: Of 81 departments contacted, 65 (80%), covering 84% of annual births in Austria, responded to the 82-question survey...
February 15, 2019: International Journal of Obstetric Anesthesia
Joanne Guay, Santhanam Suresh, Sandra Kopp
BACKGROUND: The use of ultrasound guidance for regional anaesthesia has become popular over the past two decades. However, it is not recognized by all experts as an essential tool, perhaps because it is unclear whether ultrasound reduces the risk of severe neurological complications, and the cost of an ultrasound machine (USD 22,000) is substantially higher than the cost of other tools. This review was published in 2016 and updated in 2019. OBJECTIVES: To determine whether ultrasound guidance offers any clinical advantage when neuraxial and peripheral nerve blocks are performed in children in terms of decreasing failure rate or the rate of complications...
February 27, 2019: Cochrane Database of Systematic Reviews
Parthiban Velayutham, Verghese T Cherian, Vedantam Rajshekhar, Krothapalli S Babu
Background and Aims: Transcranial electrical stimulation (TES) elicited intraoperative motor evoked potentials (iMEPs), are suppressed by most anaesthetic agents. This prospective randomised study was carried out to compare the effects of Isoflurane and Propofol on iMEPs during surgery for spinal cord tumours. Methods: A total of 110 patients were randomly divided into two groups. In group P, anaesthesia was maintained with intravenous propofol (6.6 ± 1.5 mg/kg/hr) and in group I anaesthesia was maintained with isoflurane (0...
February 2019: Indian Journal of Anaesthesia
T M Cook, A Wilkes, P Bickford Smith, L Dorn, M Stacey, S M Kinsella, P Sharpe, P Phillips
To avoid potentially fatal wrong-route neuraxial drug errors, international standard ISO 80369-6 specifying a non-Luer neuraxial connector design was published in 2016. We describe usability studies used in development of the design. Thirty-eight doctors and 17 nurses performed simulated procedures on manikins, using devices fitted with Luer connectors or draft ISO 80369-6 'non-Luer' connectors. The procedures included spinal anaesthesia; intrathecal chemotherapy; lumbar puncture, cerebrospinal fluid collection and pressure measurement; epidural catheter placement with bolus injection and critical care use...
February 21, 2019: Anaesthesia
E Chao, H-L Sun, S-W Huang, J-H Liao, P-L Ma, H-C Chen
INTRODUCTION: During caesarean section, the use of a vasopressor is often required to achieve haemodynamic stability of the parturient. Metaraminol is a vasopressor used in this context in some countries. However, the differences between metaraminol and other vasopressors remain unclear. METHODS: A search of the PubMed, Cochrane Library, and Embase databases was performed to identify randomised controlled trials comparing the use of metaraminol with other vasopressors during spinal anaesthesia at caesarean section...
January 25, 2019: International Journal of Obstetric Anesthesia
M B Adegboye, I K Kolawole, B O Bolaji
Introduction: The duration of action of sub-arachnoid block is short, and one of the ways to overcome this is the use of oral clonidine. Methods: 108 patients of ASA I and II, aged 18 to 65 years undergoing lower abdominal surgeries under spinal anaesthesia were randomized into three groups.. Control group A (n=36) no oral clonidine pre-medication, Group B (n=36) and group C (n=36) received 100 µg and 200 µg of oral clonidine pre-medication respectively, 1hr before spinal anaesthesia...
December 2018: African Health Sciences
David W Hewson, Frank Worcester, James Sprinks, Murray D Smith, Heather Buchanan, Philip Breedon, Jonathan G Hardman, Nigel M Bedforth
BACKGROUND: The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation...
February 13, 2019: Trials
Mary Angela O'Neal
Neurologists are often consulted to see women postpartum who are having difficulties involving the lower extremities; weakness, numbness and pain. Many of these women have received labour analgesia. Often, there is limited understanding by the neurologist of how these procedures are performed, why a neuraxial technique is chosen and their potential complications. This case-based review will explain the differences in the neuraxial procedures: epidural, spinal and combined spinal epidural; their advantages and disadvantages, why one technique might be chosen over another, contraindications as well as procedural risks...
February 12, 2019: Practical Neurology
Vrushali C Ponde, Vinit V Bedekar, Ankit P Desai, Rishiraj Borhazowal
No abstract text is available yet for this article.
January 2019: Indian Journal of Anaesthesia
Pushpavathi Ture, Ashwini H Ramaswamy, Safiya I Shaikh, Jagadish B Alur, Ajay V Ture
Background and Aims: Bupivacaine is the most frequently used local anaesthetic for spinal anaesthesia, however, use of levobupivacaine in clinical practice has advanced recently. This study aimed to compare the anaesthetic potency and haemodynamic effects of intrathecal bupivacaine with buprenorphine versus levobupivacaine with buprenorphine in infraumbilical surgeries. Methods: This prospective randomised double blind study was conducted in seventy patients aged 18-65 years, American Society of Anesthesiologists grade I-II, scheduled for lower abdominal and lower limb surgery under spinal anaesthesia...
January 2019: Indian Journal of Anaesthesia
Neil Wickham, K Skaria Alexander, Anthony Fletcher, Ciaran O'Boyle
Introduction: Enzymatic debridement for mixed depth and full thickness burns is gaining recognition as an important technique available to the burns surgeon. Reductions in blood loss, the need for autologous skin grafting and the number of wounds requiring surgical excision are among the benefits of this evolving treatment modality. We present a case of successful treatment using enzymatic debridement of mixed depth flame burns in a young patient with systemic sclerosis (scleroderma)...
January 2019: Scars, Burns & Healing
Xianping Zhang, Qingyong Dong, Jun Fang
OBJECTIVE: To investigate the impacts of general and spinal anesthesia on short-term cognitive function and mental status in elderly patients undergoing orthopaedic surgery. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Anesthetics, the Central People's Hospital of Tengzhou City, Shandong Province, China, from December 2016 to December 2017. METHODOLOGY: A total of 80 elderly patients undergoing orthopaedic surgery were selected and randomly divided into the observation group and the control group, 40 cases in each group...
February 2019: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Sevim Cesur, Ahmet Murat Yayik, Figen Ozturk, Ali Ahiskalioglu
Pain control is an important administration of postoperative management in lumbar spinal surgery, and multimodal analgesia is most likely an important strategy in reducing postoperative spinal surgery. Erector spinae plane (ESP) block is a recently described regional anaesthesia technique that blocks the dorsal and ventral rami of the spinal nerves and the sympathetic nerve fibers. While the ESP block has been shown to provide effective postoperative analgesia after thoracic, breast, and abdominal surgery in case reports and randomised controlled studies, there are only a few case series that report that an ultrasonography (US)-guided bilateral ESP block provides effective postoperative analgesia in lumbar surgery...
November 16, 2018: Curēus
Kurtis D Carlock, Kyle R Hildebrandt, Sanjit R Konda, Kenneth A Egol
PURPOSE: The purpose of this study was to determine the effect of regional anaesthesia as compared to general anaesthesia on clinical, functional, and radiographic outcomes following long bone fracture nonunion repair. METHODS: 262 patients who underwent operative repair of a long bone fracture nonunion and had at least 12 months of post-operative follow up were included in this study. Functional outcomes were assessed prospectively using the Short Musculoskeletal Function Assessment (SMFA) and Visual Analog Scale (VAS) pain scores prior to nonunion repair and at routine intervals post-operatively...
January 14, 2019: Injury
Yoshiro Iida, Katuhiko Honda, Hideo Saitou, Yoshinori Munemoto, Hiromasa Tanaka
AIM: Rectal prolapse (RP) is usually associated with elderly women and is well recognized as having a detrimental effect on quality of life. A number of surgical procedures for RP are available, but morbidity and mortality are substantial. The Gant-Miwa-Thiersch procedure (GMT) has been frequently used for RP in Japan. However, as the GMT has a high recurrence rate it is not widely used elsewhere. The aim of this study was to evaluate a modified version of GMT (mGMT) in comparison with other procedures...
January 23, 2019: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
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