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epidural anaesthesia

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https://www.readbyqxmd.com/read/29661417/postoperative-delirium-in-total-knee-and-hip-arthroplasty-patients-a-study-of-perioperative-modifiable-risk-factors
#1
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/29620988/a-simple-guide-to-regional-anaesthesia
#2
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/29576110/haematoma-and-abscess-after-neuraxial-anaesthesia-a-review-of-647-cases
#3
REVIEW
E M E Bos, J Haumann, M de Quelerij, W P Vandertop, C J Kalkman, M W Hollmann, P Lirk
Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spinal haematomas and abscesses associated with central neuraxial blocks. Extracted data included patient characteristics, symptoms, treatment, and outcome. We analysed 409 reports, including 647 patients (387 patients with spinal haematoma and 260 patients with spinal abscess)...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29497531/blood-patch-for-the-treatment-of-post-dural-puncture-tinnitus
#4
Wei Jia, Fiqry Fadhlillah
Audiometric disturbances are recognised as potential complications after spinal or epidural anaesthesia; however, incidences of tinnitus occur less frequently. We report a case of a patient with severe bilateral tinnitus post-lumbar puncture who was treated with an epidural blood patch. A 40-year-old ASA I lady (a medically fit patient with no known medical problem) presented with ongoing bilateral severe tinnitus for 6 days after a lumbar puncture. Venous blood (18 mL) was injected into the epidural space using a 16G needle...
2018: SAGE open medical case reports
https://www.readbyqxmd.com/read/29491521/erector-spinae-plane-block-may-aid-weaning-from-mechanical-ventilation-in-patients-with-multiple-rib-fractures-case-report-of-two-cases
#5
Amar Nandhakumar, Amritha Nair, V Kiran Bharath, Sriraam Kalingarayar, Balaji P Ramaswamy, D Dhatchinamoorthi
Uncontrolled pain in patients with rib fracture leads to atelectasis and impaired cough which can progress to pneumonia and respiratory failure necessitating mechanical ventilation. Of the various pain modalities, regional anaesthesia (epidural and paravertebral) is better than systemic and oral analgesics. The erector spinae plane block (ESPB) is a new modality in the armamentarium for the management of pain in multiple rib fractures, which is simple to perform and without major complications. We report a case series where ESPB helped in weaning the patients from mechanical ventilation...
February 2018: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29486879/clinical-comparison-of-the-effects-of-isoflurane-or-propofol-anaesthesia-on-mean-arterial-blood-pressure-and-ventilation-in-dogs-undergoing-orthopaedic-surgery-receiving-epidural-anaesthesia
#6
R Bustamante, D Aguado, R Cediel, I A Gómez de Segura, S Canfrán
The aim of this study was to compare the effects on mean arterial pressure (MAP) and ventilation of propofol total IV anaesthesia (TIVA) and isoflurane as anaesthetic maintenance in healthy dogs undergoing orthopaedic surgery, with epidural anaesthesia. Dogs were premedicated IM with dexmedetomidine (4μg/kg) and methadone (0.3mg/kg), induced with IV propofol (0.65-5mg/kg) and randomly assigned to be maintained with isoflurane (group I) or propofol (group P). Isoflurane end-tidal concentration (EtISO) and propofol infusion rate were adjusted during the surgery to maintain a suitable anaesthetic depth...
March 2018: Veterinary Journal
https://www.readbyqxmd.com/read/29485637/influence-of-tramadol-on-anaesthetic-indices-and-physiological-parameters-of-epidural-lignocaine-in-west-african-dwarf-sheep-undergoing-laparo-ovariectomy
#7
R A Ajadi, O A Sobanke, A A Adeniyi, A A Adeusi, A Adebiyi, A K Akinloye
The influence of tramadol on the anaesthetic indices and physiological parameters of epidural injection of lignocaine was evaluated in West African Dwarf (WAD) sheep undergoing laparo-ovariectomy. Ten female sheep weighing (16.2 ± 1.3 kg) were randomly allocated into anaesthesia with epidural injection of lignocaine (4mg/kg) (LIG), or lignocaine (2mg/kg) and tramadol (2mg/kg) (LIG-TRA). Following anaesthesia, they were aseptically prepared and subjected to laparo-ovariectomy. Behavioural changes were noted as they occur, and onset of drug action (OAN) (time between epidural injection and loss of pedal reflex), duration of analgesia (DAN) (time between disappearance and reappearance of pedal reflex) were determined...
December 30, 2017: Nigerian Journal of Physiological Sciences: Official Publication of the Physiological Society of Nigeria
https://www.readbyqxmd.com/read/29479931/dexmedetomidine-as-an-adjunct-for-caudal-anaesthesia-and-analgesia-in-children-a-review
#8
Mehdi Trifa, Dmitry Tumin, Joseph D Tobias
BACKGROUND: The aim of this review was to evaluate the current evidence regarding the use of dexmedetomidine as an adjuvant to local anaesthetic agents (LAA) for caudal blockade anaesthesia and analgesia in children. METHODS: A literature search was performed of the Medline, Embase, and CINAHL databases using the keywords "dexmedetomidine" and "caudal". We included all studies that used caudal dexmedetomidine as an adjuvant to a LAA in children, excluding case reports, reviews, expert opinions, and animal studies...
February 22, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29477995/postoperative-epidural-abscess-after-spinal-anaesthesia-for-a-circumcision-necessitated-by-phimosis
#9
Sjaak Pouwels, Darryl M Coll, Alexander G J van Marle
A 70-year-old man was admitted to our hospital for a penile circumcision due to phimosis using continuous dose spinal anaesthesia. On postoperative day 10 he came to the emergency department with a superficial abscess localised at the injection site of the spinal catheter. He was treated with intravenous antibiotics for 10 days, and the superficial abscess was incised and drained. Ten days later, the patient was readmitted to the emergency department with complaints of back pain and fever. A repeat MRI scan of his lumbar sacral area was done and showed epidural abscesses without any compression of the medulla or the myelum...
February 23, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29464580/outcome-after-early-mobilization-following-hip-reconstruction-in-children-with-developmental-hip-dysplasia-and-luxation
#10
Katharina Susanne Gather, Eva von Stillfried, Sebastien Hagmann, Sebastian Müller, Thomas Dreher
BACKGROUND: Most orthopedic surgeons prefer spica cast immobilization in children for 4 to 12 weeks after surgical hip reconstruction in children with developmental hip dysplasia. This challenging treatment may be associated with complications. Studies are lacking that focus on early mobilization without casting for postoperative care after hip reconstruction. METHODS: Twenty-seven children (3.4±2.0 years), including 33 hips with developmental hip dysplasia (DDH) and dislocation of the hip (Tönnis grade 1 to 4), who underwent hip reconstruction (Dega acetabuloplasty, varisation-derotation osteotomy and facultative open reduction) were retrospectively included in this study...
February 20, 2018: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/29454333/comparative-study-of-ultrasound-guided-paravertebral-block-versus-intravenous-tramadol-for-postoperative-pain-control-in-percutaneous-nephrolithotomy
#11
Zehra Hatipoglu, Ersel Gulec, Mediha Turktan, Volkan Izol, Atilla Arıdogan, Yasemin Gunes, Dilek Ozcengiz
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for renal calculi, and nephrostomy tubes lead to postoperative pain after PCNL. Regional techniques (e.g., epidural analgesia and peripheral blocks) and opioids are applied for postoperative pain treatment. The aim of this study was to compare effectiveness of ultrasound-guided paravertebral block (PVB) and tramadol on postoperative pain in patients who underwent PCNL. METHOD: Fifty-three patients were included in this prospective randomized study...
February 17, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29447711/no-355-physiologic-basis-of-pain-in-labour-and-delivery-an-evidence-based-approach-to-its-management
#12
Julie Bonapace, Guy-Paul Gagné, Nils Chaillet, Raymonde Gagnon, Emmanuelle Hébert, Sarah Buckley
OBJECTIVE: To review the evidence relating to nonpharmacological approaches in the management of pain during labour and delivery. To formulate recommendations for the usage of nonpharmacological approaches to pain management. OPTIONS: Nonpharmacological methods available for pain management during labour and delivery exist. These should be included in the counselling and care of women. EVIDENCE: PubMed and Medline were searched for articles in French and English on subjects related to "breastfeeding," "pain," "epidural," "anaesthesia," "analgesia," "labour," "labor," and combined with "gate control theory," "alternative therapies," "massage," "position," "mobility," "TENS," "bathing," "DNIC," "acupuncture," "acupressure," "sterile water injection," "higher center," "control mind," "cognitive structuring," "holistic health," "complementary therapy(ies)," "breathing," "relaxation," "mental imagery," "visualization," "mind focusing," "hypnosis," "auto-hypnosis," "sophrology," "mind and body interventions," "music," "odors," "biofeedback," "Lamaze," "Bonapace," "prenatal training," "gymnastic," "chanting," "haptonomy," "environment," "transcutaneous electrical stimulus-stimulation," "antenatal education," "support," "continuous support," "psychosocial support," "psychosomatic medicine," "supportive care," "companion," "intrapartum care," "nurse," "midwife(ves)," "father," "doula," "caregiver," " hormones," "oxytocin," "endorphin," "prolactin," "catecholamine," "adrenaline," and "noradrenaline" from 1990 to December 2015...
February 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/29379383/comparison-of-single-shot-intrathecal-morphine-injection-and-continuous-epidural-bupivacaine-for-post-operative-analgaesia-after-elective-abdominal-hysterectomy
#13
Wan Mohd Nazaruddin Wan Hassan, Anafairos Md Nayan, Azmi Abu Hassan, Rhendra Hardy Mohamad Zaini
Background: Abdominal hysterectomy (AH) is painful. The aim of this study was to compare intrathecal morphine (ITM) and epidural bupivacaine (EB) for their analgaesia effectiveness after this surgery. Methods: Thirty-two patients undergoing elective AH were randomised into Group ITM (ITM 0.2 mg + 2.5 mL 0.5% bupivacaine) (n = 16) and Group EB (0.25% bupivacaine bolus + continuous infusion of 0.1% bupivacaine-fentanyl 2 μg/mL) (n = 16).The procedure was performed before induction, and all patients subsequently received standard general anaesthesia...
December 2017: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/29363103/effect-of-combined-epidural-anaesthesia-on-tumor-infiltrating-lymphocytes-in-lung-adenocarcinoma-a-prospective-exploratory-sub-analysis
#14
M-H Li, Z-Z Xu, S-M Huang, T Li, X-Y Li, D-X Wang
BACKGROUND: Regional anaesthesia may have advantages in preserving immune function. Tumor-infiltrating lymphocytes (TILs) are considered indicators of immune response in the tumor microenvironment and used as a prognostic marker in patients after cancer surgery. This study investigated the effects of combined epidural anaesthesia on the number of TILs in patients undergoing surgery for lung adenocarcinoma. METHODS: Patients undergoing radical resection for primary lung cancer were randomized to receive either combined epidural-general anaesthesia (Epi-GA) or general anaesthesia (GA) in an ongoing randomized controlled trial (ChiCTR-TRC-14004136)...
January 23, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29343042/harlequin-syndrome-as-a-rare-complication-after-epidural-anaesthesia-in-an-obstetric-patient
#15
Juan M Redondo, María Rivas, María L Martín, María D Torrado, María J Rodríguez
No abstract text is available yet for this article.
January 17, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29336785/the-erector-spinae-plane-block-in-4-cases-of-video-assisted-thoracic-surgery
#16
J C Luis-Navarro, M Seda-Guzmán, C Luis-Moreno, J L López-Romero
Multimodal anaesthesia, combining epidural catheter and general anaesthesia, is a common technique in thoracic surgery, however, epidural catheter placement is not always possible. Recently, erector spinae plane block has been described, which provides analgesia like that of the epidural block, although unilateral, and which has been used in various procedures at thoracic level. At present, there are no studies comparing the efficacy or safety of this block with those commonly used in thoracic surgery. However, its safety profile and contraindications seem different from those of the epidural catheter, since its placement is done under ultrasound view, the needle introduction is done in plane and the ultrasound target, the transverse process, is easily identifiable and is relatively remote from major neural or vascular structures and the pleura...
January 11, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29330854/combined-spinal-epidural-vs-spinal-anaesthesia-for-caesarean-section-meta-analysis-and-trial-sequential-analysis
#17
REVIEW
M Klimek, R Rossaint, M van de Velde, M Heesen
Combined spinal-epidural and single-shot spinal anaesthesia are both used for caesarean section. It has been claimed in individual trials that combined spinal-epidural is associated with higher sensory spread and greater cardiovascular stability. We set out to gather all available evidence. We performed: a systematic literature search to identify randomised controlled trials comparing combined spinal-epidural with spinal anaesthesia for caesarean section: conventional meta-analysis; trial-sequential analysis; and assessment of trial quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system...
January 13, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29326765/pneumocephalus-following-combined-spinal-epidural-anaesthesia-for-total-knee-arthroplasty-a-case-report
#18
Y W Chew, V K Suppan, S R Ashutosh, M M Tew, J H Jimmy-Tan
The authors describe a case of pneumocephalus following epidural anaesthesia for total knee arthroplasty. Multiple attempts in locating the epidural space for the anaesthesia and the use of loss of resistance to air (LORA) technique were identified as the source of air entry. Supportive management was given including high flow oxygenation therapy and spontaneous reabsorption of air was noted five days after surgery. The presence of pneumocephalus should be kept in mind if patient develops neurological complications postoperatively following epidural anaesthesia...
November 2017: Malaysian Orthopaedic Journal
https://www.readbyqxmd.com/read/29322504/a-randomised-controlled-trial-comparing-needle-movements-during-combined-spinal-epidural-anaesthesia-with-and-without-ultrasound-assistance
#19
A Chin, B Crooke, L Heywood, R Brijball, A M Pelecanos, W Abeypala
Ultrasound assistance for neuraxial techniques may improve technical performance; however, it is unclear which populations benefit most. Our study aimed to investigate the efficacy of neuraxial ultrasound in women having caesarean section with combined spinal-epidural anaesthesia, and to identify factors associated with improved technical performance. Two-hundred and eighteen women were randomly allocated to ultrasound-assisted or control groups. All the women had a pre-procedure ultrasound, but only women in the ultrasound group had this information conveyed to the anaesthetist...
April 2018: Anaesthesia
https://www.readbyqxmd.com/read/29313911/spinal-cord-injury-arising-in-anaesthesia-practice
#20
REVIEW
D W Hewson, N M Bedforth, J G Hardman
Spinal cord injury arising during anaesthetic practice is a rare event, but one that carries a significant burden in terms of morbidity and mortality. In this article, we will review the pathophysiology of spinal cord injury. We will then discuss injuries relating to patient position, spinal cord hypoperfusion and neuraxial techniques. The most serious causes of spinal cord injury - vertebral canal haematoma, spinal epidural abscess, meningitis and adhesive arachnoiditis - will be discussed in turn. For each condition, we draw attention to practical, evidence-based measures clinicians can undertake to reduce their incidence, or mitigate their severity...
January 2018: Anaesthesia
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