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jrgNeuraxial anesthesia

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By Jesse Guscott McMaster Family Practice Anesthesia program director. Medical educator, ER, Anesthesia Twitter:@GuscottJesse
B L Sng, N L R Han, W L Leong, R Sultana, F J Siddiqui, P N Assam, E S Chan, K H Tan, A T Sia
Both isobaric and hyperbaric bupivacaine have been used for spinal anaesthesia for elective caesarean section, but it is not clear if one is better than the other. The primary objective of this systematic review was to determine the effectiveness and safety of hyperbaric bupivacaine compared with isobaric bupivacaine administered during spinal anaesthesia for elective caesarean section. We included 10 studies with 614 subjects in the analysis. There was no evidence of differences either in the risk of conversion to general anaesthesia, with a relative risk (95%CI) of 0...
April 2018: Anaesthesia
M D Daley, S H Rolbin, E M Hew, B A Morningstar, J A Stewart
The experience of 18 patients with previous spinal surgery who requested epidural anesthesia for obstetric pain was reviewed. Three received epidural anesthetics in two separate pregnancies, producing a total of 21 attempts at epidural anesthesia. All were initiated during labor and three were later extended for Cesarean delivery. Continuous lumbar epidural anesthesia was successfully established in 20 of 21 attempts. Ten were performed easily on the first attempt. There were excessive local anesthetic requirements and/or a patchy block for the remaining 11 attempts...
November 1990: Regional Anesthesia
Anthony Chau, Carolina Bibbo, Chuan-Chin Huang, Kelly G Elterman, Eric C Cappiello, Julian N Robinson, Lawrence C Tsen
BACKGROUND: The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques...
February 2017: Anesthesia and Analgesia
Lisa M Einhorn, Ashraf S Habib
PURPOSE: The purpose of this retrospective cohort study was to investigate factors associated with failed and high spinal blocks in patients who received spinal anesthesia for Cesarean delivery following a labour epidural that was inadequate for surgical anesthesia. METHODS: We searched our perioperative database for women with a labour epidural who received spinal or combined spinal-epidural anesthesia for Cesarean delivery due to the inadequacy of the existing epidural...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Daniel M Pöpping, Nadia Elia, Hugo K Van Aken, Emmanuel Marret, Stephan A Schug, Peter Kranke, Manuel Wenk, Martin R Tramèr
OBJECTIVE: To quantify benefit and harm of epidural analgesia, compared with systemic opioid analgesia, in adults having surgery under general anesthesia. BACKGROUND: It remains controversial whether adding epidural analgesia to general anesthesia decreases postoperative morbidity and mortality. METHODS: We searched CENTRAL, EMBASE, PubMed, CINAHL, and BIOSIS till July 2012. We included randomized controlled trials comparing epidural analgesia (with local anesthetics, lasting for ≥ 24 hours postoperatively) with systemic analgesia in adults having surgery under general anesthesia, and reporting on mortality or any morbidity endpoint...
June 2014: Annals of Surgery
E B Rosero, G P Joshi
BACKGROUND: This study aimed to describe the incidence and risk factors of in-hospital spinal hematoma and abscess associated with epidural analgesia in adult obstetric and non-obstetric populations in the United States. METHODS: The Nationwide Inpatient Sample was analyzed to identify patients receiving epidural analgesia from 1998 to 2010. Primary outcomes were incidence of spinal hematoma and epidural abscess. Use of decompressive laminectomy was also investigated...
July 2016: Acta Anaesthesiologica Scandinavica
R F Brooker, J F Butterworth, D W Kitzman, J M Berman, H I Kashtan, A C McKinley
BACKGROUND: Despite many advantages, spinal anesthesia often is followed by undesirable decreases in blood pressure, for which the ideal treatment remains controversial. Because spinal anesthesia-induced sympathectomy and management with a pure alpha-adrenergic agonist can separately lead to bradycardia, the authors hypothesized that epinephrine, a mixed alpha- and beta-adrenergic agonist, would more effectively restore arterial blood pressure and cardiac output after spinal anesthesia than phenylephrine, a pure alpha-adrenergic agonist...
April 1997: Anesthesiology
Elske Sitsen, Erik Olofsen, Agnes Lesman, Albert Dahan, Jaap Vuyk
BACKGROUND: Neuraxial blockade reduces the dose requirements of sedative agents. It is unclear whether neuraxial blockade affects the pharmacokinetics and/or the pharmacodynamics of IV hypnotics. We therefore studied the influence of epidural blockade on the pharmacokinetics of propofol in patients scheduled for general surgery. METHODS: Twenty-eight patients were randomly divided into 4 groups, in a double-blind manner, to receive 0, 50, 100, or 150 mg epidural ropivacaine...
May 2016: Anesthesia and Analgesia
Thomas Volk, Christine Kubulus
PURPOSE OF REVIEW: As the increased use of new oral anticoagulants may put patients at particular risk of bleeding, experts suggested strategies to perform neuraxial anesthesia as well tolerated as possible. This review summarizes different approaches. RECENT FINDINGS: Data from licensing studies, drug pharmacology, registries, authorities and expert opinions are available and covered by the article. Spinal epidural hematoma formation associated with neuraxial blocks is rare...
October 2015: Current Opinion in Anaesthesiology
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