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Combined spinal epidural

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https://www.readbyqxmd.com/read/29782398/benefit-and-harm-of-adding-epinephrine-to-a-local-anesthetic-for-neuraxial-and-locoregional-anesthesia-a-meta-analysis-of-randomized-controlled-trials-with-trial-sequential-analyses
#1
Clément Tschopp, Martin R Tramèr, Alexis Schneider, Maroun Zaarour, Nadia Elia
BACKGROUND: This systematic review examines the benefit and harm of adding epinephrine to local anesthetics for epidural, intrathecal, or locoregional anesthesia. METHODS: We searched electronic databases to October 2017 for randomized trials comparing any local anesthetic regimen combined with epinephrine, with the same local anesthetic regimen without epinephrine, reporting on duration of analgesia, time to 2 segments regression, or any adverse effects. Trial quality was assessed using the Cochrane risk of bias tool and a random-effects model was used...
May 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29781504/epidural-versus-non-epidural-or-no-analgesia-for-pain-management-in-labour
#2
REVIEW
Millicent Anim-Somuah, Rebecca Md Smyth, Allan M Cyna, Anna Cuthbert
BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour...
May 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29773486/labor-analgesia-in-czech-republic-and-slovakia-a-2015-national-survey
#3
J Bláha, P Štourač, M Grochová, R Klozová, S Richterová, P Nosková, D Seidlová, V Zenkner, A Novotný, D Schwarz, J Ščamburová, M Kosinová, Ch Kufa, M Kirchnerová, J Macková, L Várošová, R Toboláková, J Cepák, J Firment
BACKGROUND: The purpose of this international survey was to describe the current practices and techniques of labor analgesia in the Czech Republic (CZE) and Slovakia (SVK). METHODS: All Czech and Slovak departments that provide obstetric anesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in detail all peripartum anesthetic procedures delivered by anesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE)...
April 7, 2018: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29770432/automated-mandatory-bolus-versus-basal-infusion-for-maintenance-of-epidural-analgesia-in-labour
#4
REVIEW
Ban Leong Sng, Yanzhi Zeng, Nurun Nisa A de Souza, Wan Ling Leong, Ting Ting Oh, Fahad Javaid Siddiqui, Pryseley N Assam, Nian-Lin R Han, Edwin Sy Chan, Alex T Sia
BACKGROUND: Childbirth may cause the most severe pain some women experience in their lifetime. Epidural analgesia is an effective form of pain relief during labour and is considered to be the reference standard. Traditionally epidural analgesia has been delivered as a continuous infusion via a catheter in the epidural space, with or without the ability for the patient to supplement the analgesia received by activating a programmable pump to deliver additional top-up doses, known as patient-controlled epidural analgesia (PCEA)...
May 17, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29770224/hybrid-surgery-radiosurgery-therapy-for-metastatic-epidural-spinal-cord-compression-a-prospective-evaluation-using-patient-reported-outcomes
#5
Ori Barzilai, Mary-Kate Amato, Lily McLaughlin, Anne S Reiner, Shahiba Q Ogilvie, Eric Lis, Yoshiya Yamada, Mark H Bilsky, Ilya Laufer
Background: Patient-reported outcomes (PRO) represent an important measure of cancer therapy effect. For patients with metastatic epidural spinal cord compression (MESCC), hybrid therapy using separation surgery and stereotactic radiosurgery preserves neurologic function and provides tumor control. There is currently a paucity of data reporting PRO after such combined modality therapy for MESCC. Delineation of hybrid surgery-radiosurgery therapy effect on PRO validates the hybrid approach as an effective therapy resulting in meaningful symptom relief...
May 2018: Neuro-oncology Practice
https://www.readbyqxmd.com/read/29768964/effects-of-combined-spinal-epidural-analgesia-on-first-stage-of-labor-a-cohort-study
#6
Silvia Poma, Luigia Scudeller, Chiara Verga, Giorgio Mirabile, Barbara Gardella, Federica Broglia, Maria Ciceri, Marinella Fuardo, Simona Pellicori, Maddalena Gerletti, Silvia Zizzi, Elena Masserini, Maria Paola Delmonte, Giorgio Antonio Iotti
BACKGROUND: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal-epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal-epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal-epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes...
May 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29752149/tourniquet-pressure-settings-based-on-limb-occlusion-pressure-determination-or-arterial-occlusion-pressure-estimation-in-total-knee-arthroplasty-a-prospective-randomized-double-blind-trial
#7
Bahattin Tuncali, Hakan Boya, Zeynep Kayhan, Sukru Arac
OBJECTIVE: The aim of this study was to compare the limb occlusion pressure (LOP) determination and arterial occlusion pressure (AOP) estimation methods for tourniquet pressure setting in adult patients undergoing knee arthroplasty under combined spinal-epidural anesthesia. METHODS: Ninety-three patients were randomized into two groups. Pneumatic tourniquet inflation pressures were adjusted based either on LOP determination or AOP estimation in Group 1 (46 patients, 38 female and 8 male; mean age: 67...
May 8, 2018: Acta Orthopaedica et Traumatologica Turcica
https://www.readbyqxmd.com/read/29732150/efficacy-of-prophylactic-epidural-ketamine-for-reducing-shivering-in-patients-undergoing-caesarean-section-with-combined-spinal-epidural-anesthesia
#8
Xing Xue, Ying Lv, Youhong Zhao, Yufang Leng, Yan Zhang
Intravenous ketamine is known to inhibit postoperative shivering; however, at present, there has been little research on whether this effect may be achieved with epidural application. The aim of the present study was to evaluate the efficacy and safety of epidural ketamine as a prophylactic agent to prevent shivering in patients undergoing caesarean section during combined spinal-epidural anesthesia. A prospective, randomized, double-blind study was performed. A total of 60 patients who were undergoing elective caesarean section under combined spinal-epidural anesthesia and had an American Society of Anesthesiologists physical status of I or II were recruited...
May 2018: Biomedical Reports
https://www.readbyqxmd.com/read/29709741/long-term-follow-up-of-patients-with-metastatic-epidural-spinal-cord-compression-mescc-from-solid-tumors-submitted-surgery-followed-by-radiation-therapy
#9
Federico Pessina, Pierina Navarria, Giulio Alberto Carta, Giuseppe Roberto D'Agostino, Elena Clerici, Marco Conti Nibali, Francesco Costa, Maurizio Fornari, Marta Scorsetti
OBJECTIVE: To evaluate the outcome of patients, with epidural spinal cord compression (MESCC) from different solid tumors, treated with a combined approach, surgery plus radiotherapy (RT), with a follow-up longer than 10 years. METHODS: Ninety-seven patients treated between 2002 and 2009 were included. Surgical treatment was performed in patients with good performance status, limited metastatic disease, life expectancy longer than 3 months and progressive neurologic deficit and/or intractable pain...
April 27, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29693946/a-case-of-sudden-shock-during-caesarean-section-in-whi-ch-amniotic-fluid-embolism-is-suspected
#10
Hiroo Shimono, Satoko Haraguchi, Yuko Minoda, Mari Beppu, Naomi Shinmura, Yuki Suzuki, Mikiko Higashi, Yuichi Kanmura
We report a case of sudden shock during caesarean section under combined spinal epidural anesthesia. The patient was a 29-year-old woman. During the operation vital signs had been almost stable until a female-baby was born. But after the delivery of the placenta, the patient developed an episode of coughing and dyspnea followed by unconsciousness and bradycardia. She was given adrenaline and intubated, appearing ventricular fibrillation on a EKG. Cardiopulmonary resuscitation was immediately started and sinus rhythm returned...
May 2017: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/29686567/usefulness-of-intrapartum-magnetic-resonance-imaging-for-a-parturient-with-neurofibromatosis-type-1-during-induction-of-labor-for-preeclampsia
#11
Jacqueline M Galvan, Michael P Hofkamp
A 22-year-old woman, G3P0 at 31 weeks, 1 day gestational age, was admitted to the labor and delivery unit for induction of labor (IOL) due to preeclampsia with severe features. Her medical history included neurofibromatosis type 1 (NF-1) and systemic lupus erythematosus with pericarditis and pericardial effusion. When labor analgesia was considered, the concern for an undiagnosed spinal neurofibroma and attendant sequelae was deliberated. After a multidisciplinary discussion, the IOL was halted during the cervical ripening phase to allow timely magnetic resonance imaging (MRI) of the spine...
January 2018: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/29661417/postoperative-delirium-in-total-knee-and-hip-arthroplasty-patients-a-study-of-perioperative-modifiable-risk-factors
#12
S M Weinstein, L Poultsides, L R Baaklini, E E Mörwald, C Cozowicz, J N Saleh, M B Arrington, J Poeran, N Zubizarreta, S G Memtsoudis
BACKGROUND: Postoperative delirium continues to pose major clinical difficulties. While unmodifiable factors (e.g. age and comorbidity burden) are commonly studied risk factors for delirium, the role of modifiable factors, such as anaesthesia type and commonly used perioperative medications, remains understudied. This study aims to evaluate the role of modifiable factors for delirium after hip and knee arthroplasties. METHODS: We performed a retrospective study of 41 766 patients who underwent hip or knee arthroplasties between 2005 and 2014 at a single institution...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29643618/a-randomized-clinical-trial-of-intrathecal-magnesium-sulfate-versus-midazolam-with-epidural-administration-of-0-75-ropivacaine-for-patients-with-preeclampsia-scheduled-for-elective-cesarean-section
#13
Sophia Paleti, P Krishna Prasad, B Sowbhagya Lakshmi
Background and Aims: Magnesium sulfate and midazolam have been used as adjuvants to local anesthetics via intrathecal and epidural routes to augment the quality of block and prolong postoperative analgesia. This study compares addition of intrathecal magnesium sulfate versus intrathecal midazolam to epidurally administered isobaric ropivacaine as a part of combined spinal epidural technique in pre-eclamptic parturients undergoing elective cesarean section. Material and Methods: After institutional ethics committee approval and written informed consent, 50 pre-eclamptic parturients were randomly allocated to one of the two groups of 25 each to either receive intrathecal magnesium sulfate (50 mg) or intrathecal midazolam (1 mg) in combination with epidural ropivacaine (0...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29628682/perioperative-pain-management-following-total-joint-arthroplasty-a-review-and-update-to-an-institutional-pain-protocol
#14
REVIEW
Kimberly L Stevenson, Alexander L Neuwirth, Neil Sheth
As the rate of total joint arthroplasty increases with the aging population of the United States, new focus on decreasing opioid use through the development of multimodal pain regimens (MPRs) is becoming an important area of research. MPRs use different agents and modes of delivery in order to synergistically address pain at many levels of the pain pathway. MPRs include a combination of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, opioids (short- and long-acting), spinal/epidural analgesia, regional nerve blocks, and local anesthetics...
January 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29628594/an-unusual-case-of-a-parturient-with-uncorrected-pentalogy-of-fallot-presenting-for-elective-cesarean-section-delivery-of-twins
#15
Ying Ci Ho, Sek Koon Boey, Abey Matthew Varughese Mathews, Hooi Geok See, Nian Chih Hwang
We present a 31-year-old primigravida with uncorrected pentalogy of Fallot, pregnant with monochorionic-diamniotic twins, undergoing elective lower segment cesarean section at 36 weeks gestation. Preoperative workup included a transthoracic echocardiogram which revealed a large ventricular septal defect of 1.8 cm with bidirectional shunting, a moderate size atrial septal defect of 1.8 cm with predominant left-to-right shunting, an overriding aorta, moderate right ventricular hypertrophy, and severe pulmonary valve stenosis...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628571/epidural-volume-extension-with-saline-in-combined-spinal-epidural-anesthesia-for-hip-surgeries-using-low-dose-of-intrathecal-hyperbaric-bupivacaine
#16
Rajiv Singh Bhandari, Rohan Bhatia, Sanjay Agrawal
Background and Aims: The aim of the study was to evaluate the effectiveness of epidural volume extension (EVE) technique in terms of sensory and motor block characteristics along with hemodynamic parameters as a part of combined spinal-epidural anesthesia (CSEA). Materials and Methods: A total of 60 patients undergoing hip surgeries were assigned to one of the two groups containing 30 patients each. Group I (the CSE-EVE group) patients were anesthetized using CSE with EVE and Group II (the CSE group) patients were anesthetized using CSE without EVE, using the same technique and low dose of intrathecal hyperbaric bupivacaine...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29620988/a-simple-guide-to-regional-anaesthesia
#17
E M Valsamis, S Wade, C Thornhill, C Carey, D Ricketts
Regional anaesthesia is widely used in modern anaesthetic practice for perioperative and postoperative analgesia. In the operating theatre, regional anaesthesia is used both on its own and in combination with other techniques (general anaesthesia and sedation). Regional anaesthesia is now a core skill set in anaesthetic training. This article provides a basic outline of regional anaesthesia for surgeons and other non-anaesthetic staff working with anaesthetists, reviewing preparation, consent, basic and specialist equipment, central neuraxial blocks (spinal, epidural and caudal), trunk blocks, upper limb blocks (interscalene, supraclavicular, infraclavicular and axillary) and lower limb blocks (femoral, fascia iliaca, sciatic, popliteal and ankle)...
April 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29590465/population-description-and-clinical-response-assessment-for-spinal-metastases-part-2-of-the-spine-response-assessment-in-neuro-oncology-spino-group-report
#18
Ilya Laufer, Simon S Lo, Eric L Chang, Jason Sheehan, Matthias Guckenberger, Moon-Jun Sohn, Samuel Ryu, Matthew Foote, Alexander Muacevic, Scott G Soltys, Samuel Chao, Sten Myrehaug, Peter C Gerszten, Eric Lis, Pejman Maralani, Mark Bilsky, Charles Fisher, Laurence Rhines, Jorrit-Jan Verlaan, David Schiff, Michael G Fehlings, Lijun Ma, Susan Chang, Wendy R Parelukar, Michael A Vogelbaum, Arjun Sahgal
Background: Approximately 40% of metastatic cancer patients will develop spinal metastases. The current report provides recommendations for standardization of metrics used for spinal oncology patient population description and outcome assessment beyond local control endpoints on behalf of the SPIne response assessment in Neuro-Oncology (SPINO) group. Methods: SPINO group survey was conducted in order to determine the preferences for utilization of clinician-based and patient-reported outcome measures for description of patients with spinal metastases...
March 24, 2018: Neuro-oncology
https://www.readbyqxmd.com/read/29587655/impedance-cardiography-as-tool-for-continuous-hemodynamic-monitoring-during-cesarean-section-randomized-prospective-double-blind-study
#19
Alessandro D'Ambrosio, Antonella Cotoia, Renata Beck, Potito Salatto, Lada Zibar, Gilda Cinnella
BACKGROUND: Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia. METHODS: Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups...
March 27, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29582422/the-effect-of-spinal-hyperbaric-bupivacaine-fentanyl-or-hyperbaric-bupivacaine-on-uterine-tone-and-fetal-heart-rate-in-labouring-women-a-randomised-controlled-study
#20
A Kuberan, K Jain, R Bagga, J K Makkar
The mechanism for fetal heart rate abnormalities following spinal opioids remains controversial. We evaluated uterine tone, using an intra-uterine pressure catheter, and fetal heart rate abnormalities in 30 women in spontaneous labour with cervical dilation of 3-5 cm having combined spinal-epidural analgesia. Women were randomly assigned to receive a spinal with 2.0 mg hyperbaric bupivacaine plus 15 μg fentanyl, or 2.5 mg hyperbaric bupivacaine. The primary outcome measure was an increase > 10 mmHg in baseline uterine tone in the 30-min period following spinal injection...
March 26, 2018: Anaesthesia
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