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Younger JD, Faryami A, Prasad M, Viar D, Menkara A, Tang A, Harris CA. Direct Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter: An Experimental Study. Anesth Analg 2023; 136:1198-1205. [PMID: 36730916 DOI: 10.1213/ane.0000000000006268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The programmable intermittent epidural bolus (PIEB) has been popularized as the optimal delivery technique for labor analgesia. Suggested advantages of this method are less local anesthetic consumption, improved maternal satisfaction, potentially shorter duration of labor, and decreased workload requirements for the anesthesia providers. However, a manual bolus is still routinely used for breakthrough pain when the PIEB is underperforming. METHODS We conducted a laboratory-based study to quantify the flow through a multiorifice epidural catheter using the PIEB setting on an epidural pump compared to the manual epidural bolus. Four syringe volumes, 3, 5, 10, and 20 mL, were selected for this experiment. The flow in a manual bolus was also studied with and without the presence of an epidural catheter filter. A generalized estimating equation analysis was done to compare data between the groups. RESULTS Regardless of the syringe size, there was a several-fold increase in flow when a manual bolus was used compared to a pump-administered dose, with the highest difference in the peak flow rate observed in 3-mL boluses with up to a 12-fold difference, while the difference was, at most, 7-fold in 5-mL and 10-mL boluses. Manual boluses without a filter achieve a mean peak flow rate higher than manual boluses with a filter. CONCLUSIONS Our study found that manual boluses produced a higher flow rate compared to the CADD-Solis epidural pump (Smiths Medical). This study also found that the placement of a particulate filter reduces the flow rates generated while bolusing. Bulk flow rate is directly correlated with induced pressure and solution spread. Because higher bolus pressure has been shown to provide a more efficient distribution of local anesthetic and more efficient pain relief, these results may have impactful clinical significance and will pave the way for future studies.
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Affiliation(s)
- Joshua D Younger
- From the Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, Michigan
| | - Ahmad Faryami
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Monica Prasad
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan
| | - Daniel Viar
- Department of Computer Science and Engineering, University of Toledo, Toledo, Ohio
| | - Adam Menkara
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Amy Tang
- Department of Public Health Science, Henry Ford Health, Detroit, Michigan
| | - Carolyn A Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
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Kanawati S, Nassour A. Inadvertent epidural injection of labetalol during labor. J Clin Anesth 2018; 48:39-40. [PMID: 29729552 DOI: 10.1016/j.jclinane.2018.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Saleh Kanawati
- Anesthesia Department, Makassed General Hospital, Beirut, Lebanon.
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Goudra BG, Singh PM, Jackson M, Sinha AC. Epidural chloroprocaine bolus in emergency cesarean section-lessons learned from a near mishap. J Anaesthesiol Clin Pharmacol 2016; 32:263-5. [PMID: 27275062 PMCID: PMC4874087 DOI: 10.4103/0970-9185.173362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Administration of a large bolus of epidural chloroprocaine to hasten the spread of anesthesia is an accepted practice during emergency cesarean section. Occasionally, this practice can result in a very high block that can compromise patient's safety. We describe a case of epidural chloroprocaine administration in a 4 point position resulting in a high dermatomal block requiring respiratory assistance. Events surrounding the case are discussed, with a view to warn the reader about the pitfalls of such a practice.
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Affiliation(s)
- Basavana G Goudra
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maisie Jackson
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ashish C Sinha
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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4
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Cheong SH, Park DS, Moon SH, Cho KR, Lee SE, Kim YH, Lim SH, Lee JH, Lee KM, Choe YK, Kim YJ, Shin CM. The Aspiration of Injected Air via an Epidural Catheter as an Indicator for Appropriate Placement of the Catheter in the Epidural Space. Korean J Pain 2009. [DOI: 10.3344/kjp.2009.22.2.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Soon Ho Cheong
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae Sik Park
- Department of Anesthesiology and Pain Medicine, Gupo Sungsim Hospital, Busan, Korea
| | - Sung Ho Moon
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Kwang Rae Cho
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Sang Eun Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Hwan Kim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Se Hun Lim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jeong Han Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Kun Moo Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Kyun Choe
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Jae Kim
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Chee Mahn Shin
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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5
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Abstract
Intravascular placement of an epidural catheter is recognised as a potentially fatal complication of epidural anaesthesia and analgesia. Up to 10% of epidural catheters may be inserted into an epidural vessel, the majority of which will be recognised; however, a proportion (1% of all epidural catheters inserted) may not be identified as lying intravascularly. Opinions differ on the optimal method for identifying intravascular catheters and no perfect method exists. Some debate the need for a test of correct location, as a lack of specificity may mean that a proportion of correctly located catheters are withdrawn and resited. This review outlines the incidence and risk factors associated with intravascular placement and aims to evaluate the detection methods that have been described, in an attempt to answer the question: “What is the optimal way of detecting intravascular placement of an epidural catheter?”
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Affiliation(s)
- D N Bell
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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6
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Kim YT, Kim SS, Ryu JK, Jung W. Intravascular Migration of an Epidural Catheter Despite using Several Testing Maneuvers. Korean J Anesthesiol 2007. [DOI: 10.4097/kjae.2007.53.4.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Young Taek Kim
- Department of Anesthesiology and Pain Medicine, Donkang Hospital, Ulsan, Korea
| | - Sin Sung Kim
- Department of Anesthesiology and Pain Medicine, Donkang Hospital, Ulsan, Korea
| | - Ji Keun Ryu
- Department of Anesthesiology and Pain Medicine, Donkang Hospital, Ulsan, Korea
| | - Wook Jung
- Department of Anesthesiology and Pain Medicine, Donkang Hospital, Ulsan, Korea
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Homi HM, Sulzer C, Lappas G, D'Amico T, Stafford-Smith M. Suitability of the Lumbar Test Dose for the Thoracic Epidural Space. J Cardiothorac Vasc Anesth 2006; 20:700-3. [PMID: 17023292 DOI: 10.1053/j.jvca.2006.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Indexed: 11/11/2022]
Affiliation(s)
- H Mayumi Homi
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
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8
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Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obstet Anesth 2005; 15:13-7. [PMID: 16256330 DOI: 10.1016/j.ijoa.2005.05.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 05/01/2005] [Accepted: 05/01/2005] [Indexed: 01/20/2023]
Abstract
Combined spinal-epidural anesthesia balancing low-dose intrathecal bupivacaine/fentanyl and low-dose epidural bupivacaine may be more useful than single-shot spinal anesthesia for cesarean delivery in reducing incidences of adverse effects such as hypotension and nausea and in shortening motor recovery. Combined spinal-epidural anesthesia (n=50) or spinal anesthesia (n=50) was randomly performed in 100 parturients. Intrathecal bupivacaine 6 mg added by fentanyl 20 mug followed after 5 min by 10 mL of 0.25% epidural bupivacaine were used for combined spinal-epidural and intrathecal bupivacaine 9 mg with fentanyl 20 mug for spinal anesthesia. The initial sensory block level was higher in the spinal group (P<0.001), although the maximum levels were the same (T3). Complete surgical anesthesia was achieved and no patient complained of intraoperative pain in either group. Patients in the spinal group had denser motor block in the extremities and a higher incidence of hypotension (P<0.05) and nausea and vomiting (P<0.05). Motor recovery was faster in the combined spinal-epidural group (P<0.001). We concluded that combined spinal-epidural anesthesia using low-dose local anesthetic-opioid spinal anesthesia and routine epidural supplementation before surgery had some potential advantages over single-shot spinal anesthesia in the lower incidences of adverse effects and quicker recovery.
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Affiliation(s)
- D-H Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Tsen LC. What’s new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature. Int J Obstet Anesth 2005; 14:126-46. [PMID: 15795148 DOI: 10.1016/j.ijoa.2004.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 12/24/2004] [Indexed: 10/25/2022]
Abstract
THE PREGNANT PATIENT: Age; maternal disease; prophylactic antibiotics; gastroesophageal reflux; obesity; starvation; genotyping; coagulopathy; infection; substance abuse; altered drug responses in pregnancy; physiological changes of pregnancy. THE FETUS: Fetal monitoring; intrauterine surgery. THE NEWBORN: Breastfeeding; maternal infection, fever, and neonatal sepsis evaluation. OBSTETRIC COMPLICATIONS: Embolic phenomena; hemorrhage; preeclampsia; preterm delivery. OBSTETRIC MANAGEMENT: External cephalic version and cervical cerclage; elective cesarean delivery; fetal malpresentation; vaginal birth after cesarean delivery; termination of pregnancy. OBSTETRIC ANESTHESIA: Analgesia for labor and delivery; anesthesia for cesarean delivery; anesthesia for short obstetric operations; complications of anesthesia. MISCELLANEOUS: Consent; ethics; history; labor support; websites/books/leaflets/journal announcements.
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Affiliation(s)
- L C Tsen
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston MA 02115, USA.
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Kuczkowski KM. Standard epidural test dose in obstetric anesthesia: it is not obsolete, but has a risk/benefit ratio. J Clin Anesth 2004; 16:477; author reply 477. [PMID: 15567659 DOI: 10.1016/j.jclinane.2004.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Gaiser RR. Reply. J Clin Anesth 2004. [DOI: 10.1016/j.jclinane.2004.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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