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continuous spinal anesthesia

Ze-Yu Zhao, Jian-Hui Gan, Jian-Bo Liu, Qing Cheng
Background: Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported to decreases heart rate in a dose-dependent manner. In the present study, we compared the bolus dose of midazolam and bolus loaded dexmedetomidine over 10 min to determine additional sedation methods. Methods: A total of 100 patients who were classified as American Society of Anesthesiologists physical status I-II undergoing spinal anesthesia were randomly divided into two groups...
December 2017: Saudi Journal of Biological Sciences
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
Yutaka Oda, Michie Fujita, Chika Motohisa, Shinichi Nakata, Motoko Shimada, Ryushi Komatsu
Background: Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. Case presentation: A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section...
2018: JA Clin Rep
Yogita Patil, Suyog Bagade, Nilesh Patil, Nalini Jadhav
Background and Aims: Desflurane and sevoflurane are inhalational anesthetics which provide stable intraoperative hemodynamics and rapid emergence from anesthesia. Dexmedetomidine is an α2-agonist with sedative and hypnotic effects. We compared recovery following anesthesia with a combination of a continuous intravenous infusion of dexmedetomidine and desflurane or sevoflurane in cases of spine surgeries because no such data are available from India. Material and Methods: It was a single-blind, prospective, randomized study...
October 2017: Journal of Anaesthesiology, Clinical Pharmacology
Alberto Manassero, Andrea Fanelli, Susanna Ugues, Cristian Bailo, Stefano Dalmasso
BACKGROUND: The purpose of this study was to determine whether oral prolonged- release oxycodone-naloxone combination (OXN) could provide equivalent analgesia and a side-effect profile similar to intravenous morphine patient-controlled analgesia (IVPCA) for the control of pain in the immediate postoperative period after total knee replacement (TKR). METHODS: All patients received a sciatic nerve block with 0.3% ropivacaine 15ml, femoral nerve block with 0.5% ropivacaine 20 ml, spinal anesthesia and postoperative continuous femoral nerve infusion (ropivacaine 0...
January 16, 2018: Minerva Anestesiologica
Denise A Lapa Pedreira, Gregório L Acacio, Rodrigo T Gonçalves, Renato Augusto M Sá, Reynaldo A Brandt, Ramen Chmait, Eftichia Kontopoulos, Ruben A Quintero
OBJECTIVE: We have previously described our percutaneous fetoscopic technique for the treatment of open spina bifida (OSB). However, approximately 20-30% of OSB defects are too large to allow primary skin closure. We hereby describe a modification of our standard technique using a bilaminar skin substitute to allow closure of such large spinal defects. The aim of this study was to report our clinical experience with the use of a bilaminar skin substitute and a percutaneous fetoscopic technique for the prenatal closure of large spina bifida defects...
January 4, 2018: Ultrasound in Obstetrics & Gynecology
Matthew R Patrick, Hari K Parvataneni, Donald S Bohannon, André P Boezaart
Objective: Total knee arthroplasty (TKA) is a commonly performed surgery in the United States, with demand for unilateral and simultaneous bilateral TKAs (BTKAs) expected to increase significantly over the coming decades. This study reports the authors' early experience in a consecutive series of simultaneous BTKAs performed under regional anesthesia and mild sedation. Methods: In this retrospective case series, the authors examined all simultaneous BTKAs performed over two years by a single surgeon...
November 28, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Shinju Obara, Tsuyoshi Imaizumi, Takahiro Hakozaki, Atsuyuki Hosono, Yuzo Iseki, Norie Sanbe, Masahiro Murakawa
PURPOSE: Little information is available on the predictive ability of previously published pharmacokinetic models of dexmedetomidine in patients under spinal anesthesia. We evaluated nine published pharmacokinetic models that were constructed in different study settings. METHODS: Sixteen patients received dexmedetomidine infusions after spinal anesthesia according to the manufacturer's recommended regimen (6 µg/kg/h over 10 min followed by 0.2-0.7 µg/kg/h) or target-controlled infusion (initial target of 1...
November 2, 2017: Journal of Anesthesia
Wangping Zhang, Hanbin Wu
BACKGROUND: Studies have reported that prophylactic continuous infusion of phenylephrine during spinal anesthesia for cesarean section can decrease the spread of local anesthetics. We investigated the ED50 of intrathecal hyperbaric ropivacaine in parturient women undergoing cesarean section under prophylactic infusion of phenylephrine. METHODS: Sixty parturient women were allocated into 2 groups in this prospective study. Group P received 0.5 mL kg h of phenylephrine (5 mg/50 mL) at the start of intrathecal injection, and Group C (control group) received the same volume of saline...
November 2017: Medicine (Baltimore)
Liam Bosch, Carla Boan, Miranda Falk, Greg R White, M Wade Shrader
STUDY DESIGN: Retrospective, chart review. OBJECTIVES: The objective of this study is to investigate the impact of using two surgeons for posterior spinal fusion (PSF) in patients with AIS with large-magnitude curves (greater than 70°). SUMMARY OF BACKGROUND DATA: Previous studies have shown that intraoperative risk factors can be reduced by having two surgeons operate simultaneously. METHODS: A retrospective chart review identified 47 patients between January 1, 2009, and December 31, 2014, who underwent a posterior spinal fusion (PSF) with AIS with large-magnitude curves (greater than 70°)...
November 2017: Spine Deformity
Amer Majeed, Iftikhar Ahmed, Ghadah Jamaan Alkahtani, Nasser Abdullah Altahtam
With rapid improvement in healthcare in Saudi Arabia, increasing number of women with surgically corrected kyphoscoliosis are likely to present for cesarean section (CS) or vaginal delivery requiring anesthesia or analgesia. Despite the surgical correction, these patients have poor cardiopulmonary reserves which increase the risks associated with general anesthesia. Whereas altered vertebral anatomy from previous surgery and the presence of metal work in spine make performing of regional anesthesia (RA) difficult and unpredictable, we report anesthetic management of such a patient who underwent CS using continuous spinal anesthesia technique...
October 2017: Saudi Journal of Anaesthesia
Jose Ramon Ortiz-Gómez, Francisco Javier Palacio-Abizanda, Francisco Morillas-Ramirez, Inocencia Fornet-Ruiz, Ana Lorenzo-Jiménez, Maria Lourdes Bermejo-Albares
BACKGROUND: Prophylactic administrations of ondansetron or phenylephrine have been reported to provide a protective effect against hypotension in women undergoing cesarean delivery under spinal anesthesia (SA). The main hypothesis is that ondansetron improves the hemodynamic response, especially combined with phenylephrine infusion. METHODS: This prospective, double-blind, randomized, placebo-controlled study included 265 healthy pregnant women scheduled for elective cesarean delivery under SA...
October 2017: Saudi Journal of Anaesthesia
Hong Zhang, Jian Gu, Yi Feng, Haiyan An
OBJECTIVE: The purpose of this study is to investigate the absorption dynamics of flurbiprofen axetil in cerebrospinal fluid. MATERIALS AND METHODS: We analyzed the concentrations of flurbiprofen in peripheral venous blood and cerebrospinal fluid (CSF) to explore the absorption dynamics of flurbiprofen axetil loaded in lipid microspheres in CSF. 72 adult patients who planned to undergo selective operations under spinal anesthesia or combined spinal-epidural anesthesia were intravenously injected with flurbiprofen axetil (1 mg/kg) and randomly divided into nine groups according to the sampling time after administration: 5 (T5), 10 (T10), 15 (T15), 20 (T20), 25 (T25), 30 (T30), 35 (T35), 40 (T40), and 45 minutes (T45)...
November 2017: International Journal of Clinical Pharmacology and Therapeutics
Suma Vishwanatha, Sandhya Kalappa
BACKGROUND: Peripheral neural blockade provides effective analgesia with potentially less side effects than an epidural blockade. The present study was undertaken to compare continuous femoral nerve blockade (CFNB) with continuous epidural analgesia (CEA) for postoperative pain control in knee surgeries. MATERIALS AND METHODS: The patients belonging to the American Society of Anesthesiologists Class I and II scheduled for various knee surgeries under spinal anesthesia were enrolled in this study...
July 2017: Anesthesia, Essays and Researches
Ivan Veličković, Borislava Pujic, Charles W Baysinger, Curtis L Baysinger
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used...
2017: Frontiers in Medicine
Seung Suk Seo, Ok Gul Kim, Jin Hyeok Seo, Do Hoon Kim, Youn Gu Kim, Beyoung Yun Park
BACKGROUND: This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. METHODS: Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0...
September 2017: Clinics in Orthopedic Surgery
Femke Streijger, Kitty So, Neda Manouchehri, Seth Tigchelaar, Jae H T Lee, Elena B Okon, Katelyn Shortt, So-Eun Kim, Kurt McInnes, Peter Cripton, Brian K Kwon
Traumatic spinal cord injury (SCI) triggers many perturbations within the injured cord, such as decreased perfusion, reduced tissue oxygenation, increased hydrostatic pressure, and disrupted bioenergetics. While much attention is directed to neuroprotective interventions that might alleviate these early pathophysiologic responses to traumatic injury, the temporo-spatial characteristics of these responses within the injured cord are not well documented. In this study, we utilized our Yucatan mini-pig model of traumatic SCI to characterize intraparenchymal hemodynamic and metabolic changes within the spinal cord for 1 week post-injury...
December 15, 2017: Journal of Neurotrauma
Zifeng Xu, Tao Xu, Puwen Zhao, Rui Ma, Mazhong Zhang, Jijian Zheng
BACKGROUND: Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia...
November 2017: Anesthesia and Analgesia
Vrushali C Ponde, Vinit V Bedekar, Ankit P Desai, Kiran A Puranik
BACKGROUND: Caudo-lumbar and caudo-thoracic epidural anesthesia is an established technique that carries a low risk of dural puncture or spinal cord trauma in infants. Traditionally catheter advancement is based on external measurements. However, malpositioning of catheters are known to occur. We hypothesized that caudal-epidural catheters inserted under real-time ultrasound guidance may be more accurate than the accuracy of the measurements traditionally used for their placement. METHODS: We studied 25 patients, aged 2 days to 5 months, posted for abdominal or thoracic surgery, receiving general anesthesia followed by caudo-epidural continuous block...
October 2017: Paediatric Anaesthesia
Hea-Jo Yoon, Sang-Hwan Do, Yeo Jin Yun
BACKGROUND: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS. METHODS: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h...
August 2017: Korean Journal of Anesthesiology
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