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Xiang J, Cao C, Chen J, Kong F, Nian S, Li Z, Li N. Efficacy and safety of ketamine as an adjuvant to regional anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2024; 94:111415. [PMID: 38394922 DOI: 10.1016/j.jclinane.2024.111415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/03/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
STUDY OBJECTIVE To identify whether adding ketamine to the local anesthetics (LA) in the regional anesthesia could prolong the duration of analgesia. DESIGN A Systematic review and meta-analysis of randomized controlled trials. SETTING The major dates were obtained in the operating room and the postoperative recovery ward. PATIENTS A total of 1011 patients at ASA physical status I and II were included in the analysis. Procedure performed including cesarean section, orthopedic, radical mastectomy, urological or lower abdominal surgery and intracavitary brachytherapy implants insertion. INTERVENTIONS After an extensive search of the electronic database, patients received regional anesthesia combined or not combined general anesthesia and with or without adding ketamine to LA were included in the analysis. The regional anesthesia includes spinal anesthesia, brachial plexus block, pectoral nerve block, transversus abdominis plane block and femoral and sciatic nerve block. MEASUREMENT The primary outcome was the duration of analgesia. Secondary outcomes were the duration and onset time of motor and sensory block as well as the ketamine-related adverse effect. Data are expressed in mean differences in continuous data and odds ratios (OR) for dichotomous data with 95% confidence intervals. The risk of bias of the included studies was evaluated using the revised Cochrane risk of bias tool for randomized trials. The quality of evidence for each outcome was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group system. MAIN RESULT Twenty randomized controlled trials were included in the analysis. When ketamine was used as an adjuvant to LA, the duration of analgesia could be prolonged(172.21 min, 95% CI, 118.20 to 226.22; P<0.00001, I2 = 98%), especially in the peripheral nerve block(366.96 min, 95% CI, 154.19 to 579.74; P = 0.0007, I2 = 98%). Secondary outcomes showed ketamine could prolong the duration of sensory block(29.12 min, 95% CI, 10.22 to 48.01; P = 0.003, I2 = 96%) but no effect on the motor block(6.94 min, 95% CI,-2.65 to 16.53;P = 0.16, I2 = 84%), the onset time of motor and sensory block (motor onset time, -1.17 min, 95% CI, -2.67 to 0.34; P = 0.13, I2 = 100%; sensory onset time, -0.33 min, 95% CI,-0.87 to 0.20; P = 0.23, I2 = 96%) as well as the ketamine-related adverse effect(OR, 1.97, 95% CI,0.93 to 4.17;P = 0.08, I2 = 57%). CONCLUSION This study indicates that ketamine could be an ideal adjuvant to local anesthetics regardless of the types of anesthesia. Overall, the quality of the evidence is low.
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Affiliation(s)
- Jiajia Xiang
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China; Kunming Medical University, Kunming, Yunnan, China
| | - Chunyan Cao
- Department of Obstetrics and Gynecology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China
| | - Jiayu Chen
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Sunqi Nian
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Zhigui Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
| | - Na Li
- Department of Anesthesiology, 920th Hospital of Joint Logistics Support Force, Kunming, Yunnan, China.
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Ehelepola NDB, Ranathunga RMDC, Abeysundara AB, Jayawardana HMRP, Nanayakkara PSK. Super-refractory status epilepticus, rhabdomyolysis, central hyperthermia and cardiomyopathy attributable to spinal anesthesia: a case report and review of literature. BMC Anesthesiol 2024; 24:132. [PMID: 38582882 PMCID: PMC10998312 DOI: 10.1186/s12871-024-02485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND There are only six past reports of super-refractory status epilepticus induced by spinal anesthesia. None of those patients have died. Only < 15 mg of bupivacaine was administered to all six of them and to our case. Pathophysiology ensuing such cases remains unclear. CASE PRESENTATION A 27 year old gravida 2, para 1, mother at 37 weeks of gestation came to the operating theater for an elective cesarean section. She had no significant medical history other than controlled hypothyroidism and one episode of food allergy. Her current pregnancy was uneventful. Her American Society of Anesthesiologists (ASA) grade was 2. She underwent spinal anesthesia and adequate anesthesia was achieved. After 5-7 min she developed a progressive myoclonus. After delivery of a healthy baby, she developed generalized tonic clonic seizures that continued despite the induction of general anesthesia. She had rhabdomyolysis, one brief cardiac arrest and resuscitation, followed by stress cardiomyopathy and central hyperthermia. She died on day four. There were no significant macroscopic or histopathological changes in her brain that explain her super refractory status epilepticus. Heavy bupivacaine samples of the same batch used for this patient were analyzed by two specialized laboratories. National Medicines Quality Assurance Laboratory of Sri Lanka reported that samples failed to confirm United States Pharmacopeia (USP) dextrose specifications and passed other tests. Subsequently, Therapeutic Goods Administration of Australia reported that the drug passed all standard USP quality tests applied to it. Nonetheless, they have detected an unidentified impurity in the medicine. CONCLUSIONS After reviewing relevant literature, we believe that direct neurotoxicity by bupivacaine is the most probable cause of super-refractory status epilepticus. Super-refractory status epilepticus would have led to her other complications and death. We discuss probable patient factors that would have made her susceptible to neurotoxicity. The impurity in the drug detected by one laboratory also would have contributed to her status epilepticus. We propose several possible mechanisms that would have led to status epilepticus and her death. We discuss the factors that shall guide investigators on future such cases. We suggest ways to minimize similar future incidents. This is an idiosyncratic reaction as well.
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Affiliation(s)
- N D B Ehelepola
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka.
| | | | - A B Abeysundara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - P S K Nanayakkara
- Teaching (General) Hospital - Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Yotsuya K, Sarukawa J, Yamazaki K, Yasuda T, Oishi T, Ushirozako H, Arima H, Matsuyama Y. Background factors for intra-operative hypotension during hip fracture repair surgery in the elderly under spinal anesthesia managed by orthopedic surgeons: A retrospective case-control study. Injury 2024; 55:111549. [PMID: 38621349 DOI: 10.1016/j.injury.2024.111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Spinal anesthesia is used for femoral trochanteric fracture surgery, but frequently induces hypotension and the causative factors remain unclear. We examined background factors for the use of an intraoperative vasopressor in elderly patients receiving spinal anesthesia for femoral trochanteric fracture surgery. METHODS We retrospectively analyzed 203 patients >75 years (mean age, 87.9 years) with femoral trochanteric fractures who underwent short nail fixation under orthopedically managed spinal anesthesia at our hospital between April 2020 and July 2023. Patients were divided into two groups: group A (intraoperative vasopressor) and group B (no vasopressor). The following data were compared: age, sex, height, weight, body mass index, antihypertensive medication, years of experience as a primary surgeon, bupivacaine dose, puncture level, anesthesia time, operation time, hemoglobin level and blood urea nitrogen/creatinine ratio on the day of surgery, brain natriuretic peptide level, left ventricular ejection fraction, and percentage of patients operated on the day of transport. RESULTS There were 65 patients in group A and 138 in group B. The average dose of bupivacaine was 11.7 mg. In a univariate analysis, group A was slightly younger (87.0 vs. 88.3 years), had a higher blood urea nitrogen/creatinine ratio (27.1 vs. 24.5), more frequently received β-blockers (14.1% vs. 5.8 %) and diuretic medications (21.9% vs. 11.6 %), and had a higher puncture level. A logistic regression analysis identified younger age (p = 0.02) and diuretic medication (p = 0.001) as independent risk factors in group A. Vasopressor use was more frequent at a higher puncture level in group A (57 % for L2/3, 33 % for L3/4, 15 % for L4/5, 0 % for L5/S). CONCLUSIONS Spinal anesthesia-induced hypotension is attributed to volume deficit or extensive sympathetic blockade and may be prevented by avoiding high puncture levels and increasing preoperative fluid supplementation in patients on diuretics. There is currently no consensus on anesthetic dosages.
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Affiliation(s)
- Kumiko Yotsuya
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu city, Shizuoka 431-3192, Japan; Department of Orthopedic Surgery, Iwata City Hospital, 512-3 Okubo, Iwata city, Shizuoka, 438-8550, Japan.
| | - Junichiro Sarukawa
- Department of Orthopedic Surgery, Iwata City Hospital, 512-3 Okubo, Iwata city, Shizuoka, 438-8550, Japan
| | - Kaoru Yamazaki
- Department of Orthopedic Surgery, Iwata City Hospital, 512-3 Okubo, Iwata city, Shizuoka, 438-8550, Japan
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, 512-3 Okubo, Iwata city, Shizuoka, 438-8550, Japan
| | - Takato Oishi
- Department of Orthopedic Surgery, Iwata City Hospital, 512-3 Okubo, Iwata city, Shizuoka, 438-8550, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Morimachi Public Hospital, 391-1 Kusagaya, Morimachi, Syuchi-gun, Shizuoka 437-0214, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu city, Shizuoka 431-3192, Japan
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Boyacı S, Onay M, Güleç MS. Optic nerve sheath diameter measurement for prediction of postdural puncture headache. J Clin Monit Comput 2024; 38:415-422. [PMID: 37555877 DOI: 10.1007/s10877-023-01067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Intracranial hypotension due to cerebrospinal fluid leak is mainly the causal factor for the pathophysiology of postdural puncture headache (PDPH). In this study, we aimed to evaluate the effectiveness of optic nerve sheath diameter (ONSD) measurement in predicting the development of PDPH in patients undergoing spinal anesthesia. METHODS According to the American Society of Anesthesiology (ASA) physical classification I-III, 83 patients aged 18-65 years scheduled for spinal anesthesia for elective surgery were included in the study. Demographic data (age, ASA, sex, smoking, migraine, and PDPH history) and operative data were recorded. Preoperative ONSD measurements were taken in the right and left eye, axial, and sagittal planes. The mean of four measurements was recorded before and 24 h after the spinal anesthesia. RESULTS A total of 83 patients (59 males and 24 females) were included in the study. In our study, the rate of PDPH development was determined as 22.9% (n = 19). There was a statistically significant difference in the preoperative and postoperative ONSD values between patients with and without PDPH development (p = 0.046). In the receiver operating characteristic analysis, the area under the curve was 0.843, and the cutoff value was 0.4. CONCLUSION The difference between the ONSD values measured before and after spinal anesthesia may be an important parameter for predicting the risk of PDPH development.
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Affiliation(s)
- Semih Boyacı
- Department of Anesthesiology and Reanimation, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Meryem Onay
- Department of Anesthesiology and Reanimation, Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
| | - Mehmet Sacit Güleç
- Department of Anesthesiology and Reanimation, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Haim S, Cohen B, Lustig A, Greenberger C, Aptekman B, Weiniger CF. Lower-body warming and postoperative temperature in cesarean delivery under spinal anesthesia: a randomized controlled trial. Int J Obstet Anesth 2024:103990. [PMID: 38614895 DOI: 10.1016/j.ijoa.2024.103990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/25/2024] [Accepted: 03/13/2024] [Indexed: 04/15/2024]
Affiliation(s)
- S Haim
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - B Cohen
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - A Lustig
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - C Greenberger
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - B Aptekman
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - C F Weiniger
- Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Rajjoub R, Ghaith AK, El-Hajj VG, Rios-Zermano J, De Biase G, Atallah E, Tfaily A, Saad H, Akinduro OO, Elmi-Terander A, Abode-Iyamah K. Comparative outcomes of awake spine surgery under spinal versus general anesthesia: a comprehensive systematic review and meta-analysis. Eur Spine J 2024; 33:985-1000. [PMID: 38110776 DOI: 10.1007/s00586-023-08071-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Awake surgery, under spinal anesthesia (SA), is an alternative to surgery under general anesthesia (GA), in neurological and spine surgery. In the literature, there seem to be some evidence supporting benefits associated with the use of this anesthetic modality, as compared to GA. Currently, there is a notable lack of updated and comprehensive review addressing the complications associated with both awake SA and GA in spine surgery. We hence aimed to perform a systematic review of the literature and meta-analysis on the topic. METHODS A systematic search was conducted to identify studies that assessed SA in spine surgery from database inception to April 14, 2023, in PubMed, Medline, Embase, and Cochrane databases. Outcomes of interest included estimated blood loss, length of hospital stay, operative time, and overall complications. Meta-analysis was conducted using random effects models. RESULTS In total, 38 studies that assessed 7820 patients were included. The majority of the operations that were treated with SA were single-level lumbar cases. Awake patients had significantly shorter lengths of hospital stay (Mean difference (MD): - 0.40 days; 95% CI - 0.64 to - 0.17) and operative time (MD: - 19.17 min; 95% CI - 29.68 to - 8.65) compared to patients under GA. The overall complication rate was significantly higher in patients under GA than SA (RR, 0.59 [95% CI 0.47-0.74]). Patients under GA had significantly higher rates of postoperative nausea/vomiting RR, 0.60 [95% CI 0.39-0.90]) and urinary retention (RR, 0.61 [95% CI 0.37-0.99]). CONCLUSIONS Patients undergoing awake spine surgery under SA had significantly shorter operations and hospital stays, and fewer rates of postoperative nausea and urinary retention as compared to GA. In summary, awake spine surgery offers a valid alternative to GA and added benefits in terms of postsurgical complications, while being associated with relatively low morbidity.
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Affiliation(s)
- Rami Rajjoub
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Victor Gabriel El-Hajj
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Ali Tfaily
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Kingsley Abode-Iyamah
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Karimi H, Patel J, Olmos M, Kanter M, Hernandez NS, Silver RE, Liu P, Riesenburger RI, Kryzanski J. Spinal Anesthesia Reduces Perioperative Polypharmacy and Opioid Burden in Patients Over 65 Who Undergo Transforaminal Lumbar Interbody Fusion. World Neurosurg 2024:S1878-8750(24)00340-1. [PMID: 38432509 DOI: 10.1016/j.wneu.2024.02.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce polypharmacy and opioid administration is warranted. We aim to compare the perioperative polypharmacy and dose of administered opioids in patients ≥65 years who undergo transforaminal lumbar interbody fusion (TLIF) under SA versus general anesthesia (GA). METHODS A retrospective analysis of 200 patients receiving a single-surgeon TLIF procedure at a single academic center (2014-2021) was performed. Patients underwent the procedure with SA (n = 120) or GA (n = 80). Demographic, procedural, and medication data were extracted from the medical record. Opioid consumption was quantified as morphine milligram equivalents (MME). Statistical analyses included χ2 or Student's t-test. RESULTS Patients receiving SA were administered 7.45 medications on average versus 12.7 for GA patients (P < 0.001). Average perioperative opioid consumption was 5.17 MME and 20.2 MME in SA and GA patients, respectively (P < 0.001). The number of patients receiving antiemetics and opioids remained comparable postoperatively, with a mean of 32.2 MME in the GA group versus 27.5 MME in the SA group (P = 0.14). Antiemetics were administered less often as a prophylactic in the SA group (32%) versus 86% in the GA group (P < 0.001). CONCLUSIONS SA reduces perioperative polypharmacy in patients ≥65 years undergoing TLIF procedures. Further research is necessary to determine if this reduction correlates to a decrease the incidence of postoperative cognitive dysfunction and delirium.
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Affiliation(s)
- Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
| | - Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas S Hernandez
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Rachel E Silver
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA; Energy Metabolism Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ron I Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Liu W, Bao S, Chen J, Li Y, Gu Y, Ye Q, Hai K. Bupivacaine-fentanyl isobaric spinal anesthesia reduces the risk of ICU admission in elderly patients undergoing lower limb orthopedic surgery. J Orthop Surg Res 2024; 19:160. [PMID: 38429736 PMCID: PMC10908117 DOI: 10.1186/s13018-024-04618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To evaluate if bupivacaine-fentanyl isobaric spinal anesthesia could reduce the risk of ICU admission compared with general anesthesia in elderly patients undergoing lower limb orthopedic surgery. METHODS This study comprised a retrospective review of all lower limb orthopedic surgeries performed at our hospital between January 2013 and December 2019. According to anesthesia methods, patients were divided into the spinal anesthesia group (n = 1,728) and the general anesthesia group (n = 188). The primary outcome evaluated was the occurrence of ICU admission. Secondary outcomes included hemodynamic changes, postoperative complications, and mortality. RESULTS Repeated measure analysis of variance indicated that the difference between the two groups in the systolic blood pressure (SBP) was not significant before anesthesia (T0), immediately after anesthesia (T1), and before leaving the operation room (T8) (P > 0.05), but significant (P < 0.01) from 5 min after anesthesia (T2) to after operation (T7). The proportions of ICU admission (6.4% vs. 23.8%, P < 0.01) and unplanned intubation (0.1% vs. 3.8%, P < 0.01) were significantly lower in the spinal anesthesia group compared with those in the general anesthesia group. Multivariate logistic regression revealed that after controlling for potential confounding factors, the odds of ICU admission for patients in the spinal anesthesia group was 0.240 times (95% CI 0.115-0.498; P < 0.01) than those in the general anesthesia group. CONCLUSIONS Bupivacaine-fentanyl isobaric spinal anesthesia significantly reduced the risk of ICU admission and unplanned intubation, and provided better intraoperative hemodynamics in elderly patients undergoing lower limb orthopedic surgery. TRIAL REGISTRATION This study has been registered in the Chinese Clinical Trial Registry (ChiCTR2000033411).
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Affiliation(s)
- Wenxun Liu
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, 301 Zhengyuan North Street, Yinchuan, 750001, China
| | - Shuzhen Bao
- Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, China
| | | | - Yan Li
- Ningxia Medical University, Yinchuan, China
| | - Yinghua Gu
- Ningxia Medical University, Yinchuan, China
| | - Qingshan Ye
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, 301 Zhengyuan North Street, Yinchuan, 750001, China
| | - Kerong Hai
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, 301 Zhengyuan North Street, Yinchuan, 750001, China.
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Amin S, Hasanin A, Mansour R, Mostafa M, Zakaria D, Arafa AS, Yassin A, Ziada H. Oral midodrine for prophylaxis against post- spinal anesthesia hypotension during hip arthroplasty in elderly population: a randomized controlled trial. BMC Anesthesiol 2024; 24:64. [PMID: 38355397 PMCID: PMC10865567 DOI: 10.1186/s12871-024-02442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND We aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty. METHODS This randomized controlled trial included elderly patients undergoing hip arthroplasty under spinal anesthesia. Ninety minutes before the procedure, patients were randomized to receive either 5-mg midodrine or placebo (metoclopramide). After spinal anesthesia, mean arterial pressure (MAP) and heart rate were monitored every 2 min for 20 min then every 5 min until the end of the procedure. Post-spinal hypotension (MAP < 80% baseline) was treated with 10 mg ephedrine. The primary outcome was intraoperative ephedrine consumption. Secondary outcomes were the incidence of post-spinal hypotension, bradycardia, and hypertension (MAP increased by > 20% of the baseline reading). RESULTS We analyzed 29 patients in the midodrine group and 27 in the control group. The intraoperative ephedrine consumption was lower in the midodrine group than in the control group (median [quartiles]: 10 [0, 30] mg versus 30 [20, 43] mg, respectively, P-value: 0.002); and the incidence of intraoperative hypotension was lower in the midodrine group than that in the control group. The incidence of hypertension and bradycardia were comparable between the two groups. CONCLUSION The use of 5 mg oral midodrine decreased the vasopressor requirements and incidence of hypotension after spinal anesthesia for hip surgery in elderly patients. CLINICAL TRIAL REGISTRATION This study was registered on September 22, 2022 at clinicaltrials.gov registry, NCT05548985, URL: https://classic. CLINICALTRIALS gov/ct2/show/NCT05548985 .
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Affiliation(s)
- Sarah Amin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rehab Mansour
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Zakaria
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amany S Arafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Yassin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hisham Ziada
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Heydinger G, Roth C, Kidwell R, Tobias JD, Veneziano G, Jayanthi VR, Whitaker EE, Thung AK. A Single Center's Experience With Spinal Anesthesia for Pediatric Patients Undergoing Surgical Procedures. J Pediatr Surg 2024:S0022-3468(24)00081-2. [PMID: 38418274 DOI: 10.1016/j.jpedsurg.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
PURPOSE To perform a single institution review of spinal instead of general anesthesia for pediatric patients undergoing surgical procedures. Spinal success rate, intraoperative complications, and postoperative outcomes including unplanned hospital admission and emergency department visits within seven days are reported. METHODS Retrospective chart review of pediatric patients who underwent spinal anesthesia for surgical procedures from 2016 until 2022. Data collected included patient demographics, procedure and anesthetic characteristics, intraoperative complications, unplanned admissions, and emergency department returns. RESULTS The study cohort included 1221 patients. Ninety-two percent of the patients tolerated their surgical procedure without requiring conversion to general anesthesia, and 78% of patients that had spinals placed successfully did not receive any sedation following lumbar puncture. The most common intraoperative event was systolic blood pressure below 60 mm Hg (14%), but no cases required administration of vasoactive agents, and no serious intraoperative adverse events were observed. Post-Anesthesia Care Unit Phase I was bypassed in 72% of cases with a median postoperative length of stay of 84 min. Forty-six patients returned to the emergency department following hospital discharge, but no returns were due to anesthetic concerns. CONCLUSIONS Spinal anesthesia is a viable and versatile option for a diversity of pediatric surgical procedures. We noted a low incidence of intraoperative and postoperative complications. There remain numerous potential advantages of spinal anesthesia over general anesthesia in young pediatric patients particularly in the ambulatory setting. LEVEL OF EVIDENCE IV. TYPE OF STUDY Retrospective cohort treatment study.
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Affiliation(s)
- Grant Heydinger
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Catherine Roth
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rachel Kidwell
- Heritage College of Osteopathic Medicine, Dublin Campus (Dublin) and Ohio University, Athens, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Giorgio Veneziano
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Venkata R Jayanthi
- Division of Pediatric Urology, Nationwide Children's Hospital and the Department of Urology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Emmett E Whitaker
- Department of Anesthesiology, University of Vermont Larner College of Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Arlyne K Thung
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
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11
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Borrelli MC, Sprowell AJ, Moldysz A, Idris M, Armstrong SL, Kowalczyk JJ, Li Y, Hess PE. A randomized controlled trial of spinal morphine with an enhanced recovery pathway and its effect on duration of analgesia after cesarean delivery. Anaesth Crit Care Pain Med 2024; 43:101309. [PMID: 37863195 DOI: 10.1016/j.accpm.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Intrathecal morphine is frequently administered after cesarean delivery to provide pain relief lasting up to 24 h. An enhanced recovery after cesarean pathways reduces the amount of postoperative opioids needed. The ideal dose of intrathecal morphine when combined with a pathway has not been determined. METHODS This was a non-inferiority trial in 72 healthy women undergoing a scheduled cesarean delivery. Women were randomized to receive either 50 mcg, 150 mcg, or 250 mcg of intrathecal morphine during spinal anesthesia, with a standardized postoperative enhanced recovery pathway. The time to request supplemental opioids was the primary outcome. Secondary outcomes included pain scores, side effects, and quality of recovery at 24 h. RESULTS The duration of analgesia with 50 mcg of morphine (median 24.5 h [IQR: 3.5-34.4]) was inferior to 150 mcg (29.4 h [24.5-72]), and both doses were inferior to 250 mcg (32 h [30.5-72]). Women who received 50 mcg morphine had higher pain scores than the other doses, received more supplemental opioids, and had lower quality recovery scores. The secondary outcomes between 150 mcg and 250 mcg were similar. Side effects were similar among all groups. 63% of women who received 250 mcg remained opioid-free at 72 h, compared to 150 mcg (52%) and 50 mcg (30%). CONCLUSIONS The duration of analgesia using intrathecal morphine with an enhanced recovery pathway was longer with 250 mcg than with lower doses, and side effects were similar. 50 mcg provided inferior pain relief over 24 h. More than half of our patients avoided additional opioids for up to 72 h with either 150 mcg or 250 mcg doses. REGISTRATION Clinical trial number NCT05069012.
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Affiliation(s)
- Maria C Borrelli
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Andrew J Sprowell
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Anna Moldysz
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Mohammed Idris
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Samantha L Armstrong
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - John J Kowalczyk
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Yunping Li
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
| | - Philip E Hess
- All authors performed the work at Beth Israel Deaconess Medical Center, Boston, MA USA.
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12
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Nabatame M, Takeuchi M, Takeda C, Kawakami K. Association between sedation during spinal anesthesia and mortality in older patients undergoing hip fracture surgery: A nationwide retrospective cohort study in Japan. J Clin Anesth 2024; 92:111322. [PMID: 37952283 DOI: 10.1016/j.jclinane.2023.111322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/13/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE Intraoperative sedation plays an important role in the management of regional anesthesia. Few studies have investigated the association of sedation during spinal anesthesia with postoperative mortality in older patients as a primary outcome. This study aimed to test the hypothesis that sedation during spinal anesthesia increases postoperative mortality in older patients undergoing hip fracture surgery. DESIGN Retrospective, cohort study. SETTING Acute and subacute care hospitals in Japan. PATIENTS Patients aged 65 years and older who received hip fracture surgery under spinal anesthesia between April 2014 and May 2022. EXPOSURE Sedation during spinal anesthesia. MEASUREMENTS Postoperative in-hospital all-cause mortality within 30 days. MAIN RESULTS In total, 25,554 eligible patients were identified. Propensity score matching created 4735 pairs, and baseline patient characteristics were acceptably balanced between the sedation and non-sedation groups. There was no significant difference in 30-day postoperative mortality between the two groups (hazard ratio [95% CIs]: 0.92 [0.59-1.44]). CONCLUSIONS There was no association between sedation during hip fracture surgery in older patients under spinal anesthesia and postoperative mortality. However, these results are limited to our population, and further prospective studies are needed to determine the safety of sedation.
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Affiliation(s)
- Maki Nabatame
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Chikashi Takeda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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13
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Wu YY, Fang Z, Liu KS, Li MD, Cheng XQ. Whole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia for cesarean section: A randomized, controlled trial. Heliyon 2024; 10:e23534. [PMID: 38173522 PMCID: PMC10761565 DOI: 10.1016/j.heliyon.2023.e23534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Background Dexmedetomidine is known to prolong the analgesic duration of spinal anesthesia, but it can be challenging to achieve further extension without opioids. Therefore, this study aimed to investigate a novel analgesic strategy using dexmedetomidine as an adjuvant to spinal-epidural anesthesia for elective cesarean surgery. Methods The study was a randomized, double-blind, controlled trial conducted at a single center. Sixty parturients who underwent elective cesarean were randomly assigned to either group C or group D. Group D received an intrathecal injection of 12.5 mg ropivacaine and 5 μg dexmedetomidine followed by continuous epidural patient-controlled analgesia (PCA) infusion with a total volume of 100 ml, containing 0.2 % ropivacaine and 0.5 μg/kg dexmedetomidine. Group C received an intrathecal injection of 12.5 mg ropivacaine with an equivalent saline placebo followed by a similar PCA infusion, containing 0.2 % ropivacaine and an equivalent saline placebo. Results The primary outcome was visual analog scale score on movement at 24 h after surgery. The results showed that the rest and motion pain scores in group D were significantly lower than those in group C at 6 h, 12 h, and 24 h after surgery (P < 0.05), with the differences at 24 h were 5.0 (5.0, 5.0)in group D versus 5.0 (5.0, 6.0) in group C (P = 0.04). Additionally, the time to the first PCA in group D was significantly longer than that in group C (P < 0.05), as well as the time of sensory and motor recovery. Conclusions Whole-course application of dexmedetomidine as an adjuvant to spinal-epidural anesthesia could effectively extend the analgesic duration of ropivacaine to 24 h following elective cesarean surgery.
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Affiliation(s)
- Yang-yang Wu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Zheng Fang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
| | - Kun-shan Liu
- Department of Anesthesiology, People's Hospital of Linquan, 109 Tongyang Road, Linquan, Anhui, China
| | - Meng-di Li
- Department of Anesthesiology, People's Hospital of Linquan, 109 Tongyang Road, Linquan, Anhui, China
| | - Xin-qi Cheng
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui, China
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14
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Olmos M, Kanter M, Karimi H, Patel J, Riesenburger R, Kryzanski J. Correlation of thecal sac cross sectional area to total volume. J Clin Neurosci 2024; 119:157-163. [PMID: 38086293 DOI: 10.1016/j.jocn.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Spinal anesthesia (SA) has been increasingly utilized in lumbar surgery due to its various advantages over general anesthesia (GA), however failure of the first dose requiring intraoperative conversion to GA occurs in as many as 3.6% of SA patients. Some studies have reported that a larger thecal sac volume may dilute the anesthetic and play a role in first dose failure. Unfortunately, easy determination of thecal sac volume has not been reported in the literature. Thus, we sought to determine whether cross-sectional area obtained from MRI accurately predicts the volume of the thecal sac. METHODS We conducted a retrospective review of 80 patients who underwent lumbar surgery with spinal anesthesia. T1 and T2-weighted MRI sequences were used to measure thecal sac area at each level between L1-S1. The volume of the thecal sac was calculated using HorosTM. A statistical model was derived relating the area at each level to the thecal sac volume. Of the 80 patients, 20% were reserved and utilized to test the accuracy of the statistical model. RESULTS The area of the thecal sac positively correlated with volume at each lumbar level. The area of the thecal sac at the L4-L5 level most accurately represented total thecal sac volume (R2 = 0.588, RMSE = 2.76). CONCLUSION Cross-sectional area of the L4-L5 spinal level obtained from MRI sequences may be utilized as a proxy for thecal sac volume.
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Affiliation(s)
- Michelle Olmos
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Matthew Kanter
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Ron Riesenburger
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA.
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15
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Grabert J, Klebach C, Osberghaus I, Jakobs P, Kim SC, Strizek B, Coburn M, Hilbert T. [Spinal needle broken in situ during elective cesarean section]. Anaesthesiologie 2024; 73:36-39. [PMID: 37947804 PMCID: PMC10791703 DOI: 10.1007/s00101-023-01358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/01/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Josefin Grabert
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Christian Klebach
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Isabelle Osberghaus
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Patrick Jakobs
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Se-Chan Kim
- Zentrum für Anästhesie, Perioperative Medizin und Schmerztherapie, Orthopädische Klinik Markgröningen, Markgröningen, Deutschland
| | - Brigitte Strizek
- Zentrum für Geburtshilfe und Frauenheilkunde, Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Mark Coburn
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Tobias Hilbert
- Klinik und Poliklinik für Anästhesiologie, und Operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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16
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Abdelrady MM, Fathy GM, Abdallah MAM, Ali WN. Comparison of the effect of adding midazolam versus fentanyl to intrathecal levobupivacaine in patients undergoing cesarean section: double-blind, randomized clinical trial. Braz J Anesthesiol 2024; 74:744385. [PMID: 35700752 PMCID: PMC10877347 DOI: 10.1016/j.bjane.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Many adjuvants are added to prolong the effects of spinal analgesia. We investigated the postoperative analgesic efficacy of the addition of midazolam or fentanyl to intrathecal levobupivacaine in women undergoing cesarean delivery. METHODS Eighty patients were randomly assigned to two groups (n = 40). Group M received 10 mg of 0.5% levobupivacaine plus 2 mg of midazolam. Group F received 10 mg of 0.5% levobupivacaine plus 25 μg of fentanyl. Assessments included motor and sensory block, APGAR score, time to first request for analgesia, postoperative pain score, total consumption of rescue analgesics, and adverse effects. RESULTS Sensory blockade was prolonged in Group M compared with Group F (215.58 ± 27.94 vs. 199.43 ± 19.77 min; p = 0.004), with no differences in other characteristics of the spinal block in intraoperative hemodynamics or APGAR score. The mean time to first request for rescue analgesia was longer in Group M (351.45 ± 11.05 min) than in Group F (268.83 ± 10.35 min; p = 0.000). The median total consumption of rescue analgesics in the first 24 hours postoperatively was 30 mg in Group M vs. 60 mg in Group F (p = 0.003). The median Visual Analog Scale (VAS) scores were lower in Group Ethan in Group F from the 8th to the 12th hour postoperatively, with no differences between the groups at other time points. The incidence of adverse effects was higher in Group F than in Group M. CONCLUSION Intrathecal midazolam (2 mg) was superior to intrathecal fentanyl (25 μg) in increasing the duration of the sensory blockade and postoperative analgesia with lower postoperative pain scores and decreasing the incidence of adverse effects.
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Affiliation(s)
- Marwa Mahmoud Abdelrady
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt.
| | - Golnar Mohammed Fathy
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt
| | | | - Wesam Nashat Ali
- Assiut University, Faculty of Medicine, Anesthesia and Intensive Care Department, Assiut, Egypt
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Valaparla VL, Banerjee P, Elnaeem A, Sharma T, Bhatt S, Memon Z, Shaltoni H, Dabi A, Rodríguez-Fernández JM. Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review. J Stroke Cerebrovasc Dis 2024; 33:107432. [PMID: 37966093 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.
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Affiliation(s)
| | - Pankhuri Banerjee
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Awab Elnaeem
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tripti Sharma
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Sandeep Bhatt
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Zeeshan Memon
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Hashem Shaltoni
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alok Dabi
- Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
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Della Corte L, Guarino MC, Dell'Aquila M, Ascione M, Guerra S, De Rosa R, Del Piano A, Bruzzese D, Bifulco G, Giampaolino P. Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia? Gynecol Obstet Invest 2023; 89:41-49. [PMID: 38091962 DOI: 10.1159/000535778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/03/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient. METHODS A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included. RESULTS Patients in group A reported less pain at 0 h (adjusted mean difference: -1.5; 95% CI: -2.3 to -0.7; p < 0.001) and after 6 h (adjusted mean difference: -1.1; 95% CI: -2.0 to -0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient's mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77-16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A. CONCLUSION In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.
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Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria Chiara Guarino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Michela Dell'Aquila
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mario Ascione
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Serena Guerra
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Rossella De Rosa
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Annaclaudia Del Piano
- Department of Anesthesiology and Intensive Care Medicine Policlinico - Federico II University Hospital, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Huang C, Li J, Guo Y, Zhang Y, Luo W, Diedrich DA, Zhang T, Huang W, Xiao Y. Ultrasound-assisted lumbar puncture with a horizontal and perpendicular paramedian approach based on positioning in patients with abnormal spinal anatomy: a case report and technical description. BMC Anesthesiol 2023; 23:410. [PMID: 38087206 PMCID: PMC10714649 DOI: 10.1186/s12871-023-02368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The use of ultrasound has been reported to be beneficial in challenging neuraxial procedures. The angled probe is responsible for the main limitations of previous ultrasound-assisted techniques. We developed a novel technique for challenging lumbar puncture, aiming to locate the needle entry point which allowed for a horizontal and perpendicular needle trajectory and thereby addressed the drawbacks of earlier ultrasound-assisted techniques. CASE PRESENTATION Patient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen. The preprocedural ultrasound scan revealed a cephalad probe's angulation (relative to the edge of the bed) in the paramedian sagittal oblique view, and then the probe was rotated 90° into a transverse plane and we noted that a rocking maneuver was required to obtain normalized views. Then the shoulders were moved forward to eliminate the need for cephalad angulation of the probe. The degree of rocking was translated to a lateral offset from the midline of the spine through an imaginary lumbar puncture's triangle model, and a needle entry point was marked. The spinal needle was advanced through this marking-point without craniocaudal and lateromedial angulation, and first-pass success was achieved in all eight lumbar punctures. Patient 2 was an elderly patient with ankylosing spondylitis who underwent spinal anesthesia for transurethral resection of the prostate. The patient was positioned anteriorly obliquely to create a vertebral rotation that eliminated medial angulation in the paramedian approach. The procedure succeeded on the first pass. CONCLUSIONS This ultrasound-assisted paramedian approach with a horizontal and perpendicular needle trajectory may be a promising technique that can help circumvent challenging anatomy. Larger case series and prospective studies are warranted to define its superiority to alternative approaches of lumbar puncture for patients with difficulties.
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Affiliation(s)
- Chanyan Huang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China
| | - Jiawen Li
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China
| | - Yuting Guo
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yuanjia Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China
| | - Wei Luo
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tao Zhang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China.
| | - Ying Xiao
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510080, Guangzhou, China.
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Joe HB, Chae YJ, Song SH, Yi IK. Comparison of the effects of dexmedetomidine and propofol on the cardiovascular autonomic nervous system during spinal anesthesia: preliminary randomized controlled observational study. J Clin Monit Comput 2023; 37:1541-1551. [PMID: 37572236 PMCID: PMC10651711 DOI: 10.1007/s10877-023-01062-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
Spinal anesthesia induces sympatholysis and is usually combined with dexmedetomidine or propofol which induce different hemodynamic changes. The purpose of this study was to compare the effect on autonomic nervous system between dexmedetomidine and propofol combined with spinal anesthesia. Patients aged 20-65 undergoing elective surgery under spinal anesthesia were randomly assigned to dexmedetomidine or propofol group. Heart rate variability (HRV) and hemodynamic variables were measured at four time points: T0, baseline; T1, 10 min after spinal anesthesia; T2, 10 min after sedative administration; and T3, 20 min after sedative administration. In 59 patients, dexmedetomidine and propofol groups had significantly different hemodynamic changes over time (time × group effect P < 0.001). The dexmedetomidine group had slower heart rate at T2 (P = 0.001) and higher blood pressures at T2 and T3 (P < 0.001) than the propofol group. Overall HRV dynamics showed a significant change over time from T0 to T3, but both groups exhibited similar trends. Compared to the baseline data within the group, the low frequency (LF) decreased in both groups but the decrease occurred at T2 in the propofol group and at T3 in the dexmedetomidine group. The high frequency (HF) increased at T2 and T3 only in the dexmedetomidine group. The LF/HF ratio decreased in the dexmedetomidine group at T3. Dexmedetomidine showed slower heart rate and higher blood pressure than propofol when combined with spinal anesthesia, however, dexmedetomidine and propofol exhibited similar trends in HRV dynamics. Compared with the baseline within each group, both agents decreased LF, but only dexmedetomidine increased HF and decreased in the LF/HF ratio significantly.
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Affiliation(s)
- Han Bum Joe
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup- ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup- ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Seung Ho Song
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup- ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - In Kyong Yi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup- ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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21
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Subedi A, Thapa P, Prajapati R, Schyns-van den Berg AMJV. Effect of height versus height/weight-based spinal bupivacaine on maternal hemodynamics for elective cesarean in short stature patients: a randomized clinical trial. J Anesth 2023; 37:905-913. [PMID: 37709952 DOI: 10.1007/s00540-023-03252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/27/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Doses of spinal bupivacaine adjusted to patient height or height/weight have been shown to provide hemodynamic stability during cesarean section. However, their effects in short stature parturients are unknown. METHODS In this double-blind, randomized clinical trial, we randomly assigned short parturients (height < 150 cm) undergoing elective cesarean section, to receive doses of intrathecal hyperbaric bupivacaine either height or height/weight-adjusted, in a 1:1 ratio. The primary outcome was post-spinal hypotension (defined as systolic blood pressure [SBP] < 90% of baseline between spinal administration and delivery of the baby). Secondary outcomes included severe post-spinal hypotension (SBP < 80% of baseline), post-delivery hypotension (SBP < 90% and < 80% of baseline), intraoperative bradycardia, nausea and vomiting, shivering, rescue analgesic needed, and spinal block characteristics. RESULTS A total of 112 patients underwent randomization. Post-spinal hypotension (SBP < 90% of baseline) occurred in 52% of the patients in the height/weight group and in 55% in the height group (difference - 3.5%: 95% confidence interval [CI] - 22 to 14.8, P = 0.705). There was no significant difference between the two groups in the occurrences of post-spinal severe hypotension (SBP < 80% of baseline), post-delivery hypotension, and spinal block characteristics. Six patients (11%) in the height/weight group needed intraoperative rescue analgesic compared to none in the height group (P = 0.027). CONCLUSION We found that height-based dosing in short parturients provides the optimal trade-off between intraoperative hemodynamic instability and provision of pain-free anesthesia. TRIAL REGISTRATION clinicaltrial.gov-NCT04082676. https://clinicaltrials.gov/ct2/show/NCT04082676 .
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Affiliation(s)
- Asish Subedi
- Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Parineeta Thapa
- Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Fierro G, Milan B, Bettinelli S, Bottari E, Bugada D, Roncagliolo I, Arosio M, Farina C, Lorini FL. Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study. J Anesth Analg Crit Care 2023; 3:49. [PMID: 38017591 PMCID: PMC10685510 DOI: 10.1186/s44158-023-00135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Systemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitate the virus' entry into the central nervous system. The principal aim of this study was to test the safety of spinal anesthesia in "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2)-positive pregnant women and to examine cerebrospinal fluid (CSF) characteristics. METHODS We conducted a prospective observational single-center study in asymptomatic or paucisymptomatic consecutive pregnant SARS-CoV-2 patients who underwent spinal anesthesia for cesarean section. Women with severe infection were excluded because they underwent general anesthesia. At the time of spinal anesthesia, we collected CSF samples, and then we performed a chemical-physical analysis to look for signs of inflammation and for SARS-CoV-2 genome. RESULTS We included 26 women. No spinal anesthesia complications were reported in the perioperative period and after 2 months. All CSF samples were crystal clear, and all physical-chemical values were within physiological ranges: the median concentration of CSF/plasma glucose ratio was 0.66, IQR 0.5500 (0.6000-0.7100), and the average CSF protein concentration value was 23.2 mg/dl (SD 4.87). In all samples, genomes of SARS-CoV-2 and other neurotropic viruses were not detected. CONCLUSIONS Spinal anesthesia was safe in SARS-CoV-2 pregnant women with mild disease; no clinical maternal complications were detected, and no CSF changes indicative of inflammatory or infectious diseases that would compromise the safety of the procedure were found.
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Affiliation(s)
- Giulia Fierro
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Barbara Milan
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy.
| | - Silvia Bettinelli
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Elisa Bottari
- Department of Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Dario Bugada
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Ilaria Roncagliolo
- Department of Anesthesia and Intensive Care, University of Milan, 20122, Milan, Italy
| | - Marco Arosio
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
- Biobank, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando Luca Lorini
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
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23
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Macias AA, Bongbong DN, Waterman RS, Simpson S, Gabriel RA. A Retrospective Analysis Investigating Whether Case Volume Experience of the Anesthesiologist Correlates with Intraoperative Efficiency for Joint Arthroplasty. J Med Syst 2023; 47:119. [PMID: 37971577 PMCID: PMC10654185 DOI: 10.1007/s10916-023-02015-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
The objective of this retrospective study was to determine if there was an association between anesthesiology experience (e.g. historic case volume) and operating room (OR) efficiency times for lower extremity joint arthroplasty cases. The primary outcome was time from patient in the OR to anesthesia ready (i.e. after spinal or general anesthesia induction was complete). The secondary outcomes included time from anesthesia ready to surgical incision, and time from incision to closing completed. Mixed effects linear regression was performed, in which the random effect was the anesthesiology attending provider. There were 4,575 patients undergoing hip or knee arthroplasty included. There were 82 unique anesthesiology providers, in which the median [quartile] frequency of cases performed was 79 [45, 165]. On multivariable mixed effects linear regression - in which the primary independent variable (anesthesiologist case volume history for joint arthroplasty anesthesia) was log-transformed - the estimate for log-transformed case volume was - 0.91 (95% confidence interval [CI] -1.62, -0.20, P = 0.01). When modeling time from incision to closure complete, the estimate for log-transformed case volume was - 2.07 (95% -3.54, -0.06, P = 0.01). Thus, when comparing anesthesiologists with median case volume (79 cases) versus those with the lowest case volume (10 cases), the predicted difference in times added up to only approximately 6 min. If the purpose of faster anesthesia workflows was to open up more OR time to increase surgical volume in a given day, this study does not support the supposition that anesthesiologists with higher joint arthroplasty case volume would improve throughput.
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Affiliation(s)
- Alvaro A Macias
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, 9300 Campus Point Drive, MC7770, La Jolla, CA, 92037-7770, USA
| | - Dale N Bongbong
- School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Ruth S Waterman
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, 9300 Campus Point Drive, MC7770, La Jolla, CA, 92037-7770, USA
| | - Sierra Simpson
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, 9300 Campus Point Drive, MC7770, La Jolla, CA, 92037-7770, USA
| | - Rodney A Gabriel
- Division of Perioperative Informatics, Department of Anesthesiology, University of California San Diego, 9300 Campus Point Drive, MC7770, La Jolla, CA, 92037-7770, USA.
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Peterson Soares Santos R, Dias de Oliveira-Filho A, de Freitas Lins Neto MÁ, Correia Lins L, Timbó Barbosa F, Felizardo Neves SJ. Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial. Braz J Anesthesiol 2023; 73:725-735. [PMID: 37247818 PMCID: PMC10625141 DOI: 10.1016/j.bjane.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). METHODS A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. RESULTS Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). CONCLUSION SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidectomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.
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Affiliation(s)
| | | | | | - Lucas Correia Lins
- Hospital Universitário Professor Alberto Antunes, Departamento de Coloproctologia, Maceió, AL, Brazil
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25
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Liu G, Zhao J, Yuan L, Shi F, Zhang L. Spinal anesthesia for L5-S1 interlaminar endoscopic lumbar discectomy: a retrospective study. BMC Musculoskelet Disord 2023; 24:818. [PMID: 37838709 PMCID: PMC10576879 DOI: 10.1186/s12891-023-06956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE This study aimed to report our experience with spinal anesthesia (SA) in patients undergoing L5-S1 interlaminar endoscopic lumbar discectomy (IELD) and clarify its advantages and disadvantages. METHODS One hundred twelve patients who underwent IELD for an L5-S1 disc herniation under SA were retrospectively analyzed. SA with 0.5% ropivacaine was administered using a 27-gauge fine needle. Intraoperatively, the volume and level of SA, surgical time, blood loss, and cardiopulmonary complications were documented. Postoperative data was collected included the number of patients who ambulated on the day of surgery, incidence of complications and were then statistically analyzed. RESULTS Analgesia was complete throughout the entire operation in all patients and no other adjuvant intraoperative analgesic drugs were needed. Mean visual analog scale scores for intraoperative and early postoperative (24 h) pain were 0 and 2.43 ± 1.66. SA was administered at the L3-4 interspace in 34 patients (30.4%) and the L2-3 interspace in 78 (69.6%). Administration was successful with the first attempt in all patients. Mean operation time was 70.12 ± 6.52 min. Mean intraoperative blood loss volume was 20.71 ± 5.26 ml. Ninety-eight patients ambulated on the same day as surgery. Mean length of hospital stay was 24.36 ± 3.64 h. Dural injury without damaging the nerve root occurred in one patient. One patient experienced recurrent disc herniation. Intraoperative hypotension and respiratory distress occurred in five (4.5%) and three (2.7%) patients, respectively. Three patients (2.7%) received postoperative analgesia therapy and two (1.8%) experienced nausea. Two patients (1.8%) developed urinary retention. Spinal headache, cauda equina syndrome, and neurotoxicity did not occur. CONCLUSION SA can achieve satisfactory pain control for patients undergoing IELD with a low incidence of adverse events. SA may be a useful alternative to local and general anesthesia for IELD surgery. Future randomized controlled trials are warranted to investigate.
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Affiliation(s)
- Guanyi Liu
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jinsong Zhao
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Fangling Shi
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Liangguang Zhang
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
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26
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Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesth Pain Med (Seoul) 2023; 18:349-356. [PMID: 37919919 PMCID: PMC10635856 DOI: 10.17085/apm.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 11/04/2023] Open
Abstract
Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.
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Affiliation(s)
| | - Benayas Begashaw
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
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Ambrose N, Sadacharam K, Burke B, Figueroa TE, Lang RS, Kjelstrom S, Hagerty J. Spinal versus general anesthesia: Comparing outcomes in pediatric patients undergoing urologic procedures. J Pediatr Urol 2023; 19:621.e1-621.e9. [PMID: 37487883 DOI: 10.1016/j.jpurol.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Available literature comparing spinal anesthesia (SA) to general anesthesia (GA) in the pediatric population describes multiple benefits in appropriately selected patients including cost reduction, lower incidence of complications, and shorter operative times. In patients undergoing urologic procedures, data are sparse. OBJECTIVE Our goal was to expand on the paucity of existing urologic literature as SA appears to be uniquely suited for a substantial number of its common pediatric procedures. METHODS Within a single institution, patients who had a urologic procedure performed under SA between May 2019 and July 2021 and were less than 18 months old were compared with a matched cohort of patients who had GA. The SA and GA groups were compared by two-sample t-tests, chi-square test for independence, and Fisher's exact test. RESULTS There were a total of 184 SA and 202 GA patients. There was no significant difference in the demographics except that SA patients were younger and weighed less than GA patients. The patients in the SA group needed less opioids both during the surgery (0% vs 26.1% p N/A) and in the immediate postoperative period when compared with GA patients (0% vs 18.2% p N/A). The patients who had SA had fewer complications necessitating PICU admission, or cancellation of surgery (0% vs 6.8% p = 0.03). Total anesthesia and emergence time were lower for SA patients (41 vs 50.2 p = 0.001 & 3.4 vs 6.1 p = 0.001). Both surgery and total OR time were not different between the groups (37.6 vs 35.5 p = 0.35 and 56.3 vs 54.4 p = 0.49). Overall, raw material cost was also found to be lower per procedure in the SA group vs the GA group ($8.90 vs $38.8: 77% reduction). Adjusted total mean costs for the surgery were not different between groups. The reduction in opioid use postoperatively also suggests reduced cost in the management of postoperative pain in the SA group. DISCUSSION Total anesthesia time, opioid use, and serious complications were all significantly lower in the SA group. We did not find significant difference in total surgery cost between two groups. However, patients who had SA had better pain control and needed less rescue analgesics in the immediate postoperative period. No patients in either group were sent home with opioids. CONCLUSION Spinal anesthesia was found to be an equally effective and appropriate alternative to GA with many proposed benefits for common pediatric urologic procedures. With further research, SA may prove to be a safer alternative in patients at risk for complications related to GA general anesthesia while also offering a cost benefit.
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Affiliation(s)
- Nicole Ambrose
- Department of Urology, Main Line Health. Bryn Mawr, PA 19010, USA.
| | - Kesavan Sadacharam
- Department of Surgery and Anesthesiology, Nemours Children's Health, Delaware. 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Brian Burke
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.
| | - T Ernesto Figueroa
- Division of Pediatric Urology, Department of Surgery, Nemours Children's Health, Delaware. 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Robert Scott Lang
- Department of Surgery and Anesthesiology, Nemours Children's Health, Delaware. 1600 Rockland Rd., Wilmington, DE 19803, USA.
| | - Stephanie Kjelstrom
- Main Line Health Center for Population Health Research at Lankenau Institute of Medical Research. Wynnewood, PA 19096, USA.
| | - Jennifer Hagerty
- Division of Pediatric Urology, Department of Surgery, Nemours Children's Health, Delaware. 1600 Rockland Rd., Wilmington, DE 19803, USA.
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Zhang YW, Guan ZY, Wang LL, Wang CM, Zhang J. The effect of music intervention on sedation in elderly patients undergoing transurethral resection of prostate under spinal anesthesia: a prospective randomized controlled clinical trial. J Anesth 2023; 37:734-740. [PMID: 37515638 DOI: 10.1007/s00540-023-03225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/06/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Music intervention is commonly used as a non-pharmacologic therapeutic modality to alleviate anxiety in perioperative patients. This study aimed to assess the sedative and anxiolytic effects of music on elderly patients receiving transurethral resection of prostate (TURP) under spinal anesthesia. METHODS This was a prospective randomized controlled trial on patients who aged over 60 and received TURP under spinal anesthesia. Participants were randomized to the music group or the control group (no music). The primary outcome was perioperative BIS values, and the secondary outcomes were patient's perioperative anxiety levels, heart rate (HR), blood pressure, and patient satisfaction score. RESULTS A total of 82 patients were analyzed. The perioperative BIS values in the music group were significantly lower than those of the control group at almost all time points (P < 0.001), as well as showed a significant reduction compared with baseline (P < 0.001), whereas the control group did not. In comparison with the control group, systolic blood pressure (SBP) significantly decreased in the music group at the beginning (mean difference, - 8.0 mmHg; 95% CI - 15.70 to 0.35; P = 0.041) and the 60th minute (mean difference, - 7.9 mmHg; 95% CI - 15.30 to 0.51; P = 0.037) of TURP. Furthermore, compared with baseline within the music group, diastolic blood pressure (DBP) and HR significant reduced at whole time points (P < 0.05), yet the control group not. CONCLUSION Music intervention effectively provided slight sedation for elderly patients when undergoing TURP under spinal anesthesia without sedatives.
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Affiliation(s)
- Yi-Wen Zhang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), No. 33 Wenyi Road, Shenyang, 110016, China
| | - Zhan-Ying Guan
- Department of Anesthesiology, Jinqiu Hospital of Liaoning Province, No. 317 Xiaonan Street, Shenyang, 110016, China.
| | - Ling-Ling Wang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), No. 33 Wenyi Road, Shenyang, 110016, China
| | - Chang-Ming Wang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), No. 33 Wenyi Road, Shenyang, 110016, China.
| | - Jing Zhang
- Department of Anesthesiology, People's Hospital of China Medical University (People's Hospital of Liaoning Province), No. 33 Wenyi Road, Shenyang, 110016, China
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Mo X, Huang F, Wu X, Feng J, Zeng J, Chen J. Intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during cesarean section: a prospective, double-blinded, randomized trial for ED 50 determination using an up-down sequential allocation method. BMC Anesthesiol 2023; 23:325. [PMID: 37749533 PMCID: PMC10519004 DOI: 10.1186/s12871-023-02275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Intrathecal dexmedetomidine, as an adjuvant to local anesthetics, has been reported to improve the quality of spinal anesthesia and reduce the required local anesthetic dose. However, the optimal dosage regimen for intrathecal dexmedetomidine combined with plain ropivacaine for cesarean section (CS) remains undetermined. The present study aimed to determine the median effective dose (ED50) of intrathecal dexmedetomidine as an adjuvant to plain ropivacaine for spinal anesthesia during CS. METHODS Sixty parturients undergoing CS were randomly assigned to either group: plain ropivacaine 8 mg (Group Rop8) or plain ropivacaine 10 mg (Group Rop10). The initial dosage of intrathecal dexmedetomidine in each group was 5 µg. The effective dose was defined as a bilateral sensory block at the level of T6 or above to pinprick attained within 10 min after intrathecal injection, without the need for supplementary intraoperative epidural anesthesia. Effective or ineffective responses were determined, followed by a 1 µg increment or decrement in the dose of intrathecal dexmedetomidine for the next parturient using up-down sequential allocation. ED50 were calculated using probit regression. RESULTS The ED50 of intrathecal dexmedetomidine with plain ropivacaine was 5.9 µg (95% confidence interval [CI], 4.9-7.4 µg) in Group Rop8 and 3.1 µg (95% CI, 0.1-4.8 µg) in Group Rop10 (P < 0.05). Hemodynamic stability, side effects, patient satisfaction and neonatal outcomes were comparable between the two groups. CONCLUSIONS The present data suggested that the ED50 of intrathecal dexmedetomidine as an adjuvant to 8 mg and 10 mg plain ropivacaine in spinal anesthesia during cesarean section was approximately 6 µg and 3 µg, respectively. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier: ChiCTR2200055928.
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Affiliation(s)
- Xiaofei Mo
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fa Huang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoying Wu
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jumian Feng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiequn Zeng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinghui Chen
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Abdel-Wahab AH, Abd Alla ES, Abd El-Azeem T. Effect of intravenous dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia in lower abdominal surgery, Randomized controlled trial. BMC Anesthesiol 2023; 23:323. [PMID: 37736711 PMCID: PMC10515039 DOI: 10.1186/s12871-023-02282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of intravenous (IV) dexamethasone on the duration of hyperbaric bupivacaine spinal anesthesia. METHODS Two hundred patients between the ages of 18 and 60, of both sexes with ASA I- II classification scheduled for lower abdominal surgery under spinal anesthesia using hyperbaric bupivacaine 0.5% were randomly divided into two groups: the dexamethasone group (Dexa group) and the control group, with 100 patients in each group. Before the administration of spinal anesthesia, the Dexa group received an intravenous infusion of 8 mg dexamethasone in 500 mL normal saline, while the control group received 500 mL normal saline only. The primary outcome of this study was to assess the effect of IV dexamethasone on the regression of hyperbaric bupivacaine spinal anesthesia. Secondary outcome measures included the total duration of sensory and motor blocks, VAS score, time of first analgesic request, total analgesic consumption within the first 24 h, and the occurrence of any side effects. RESULTS The Dexa group had significantly delayed onset of 2 dermatomes regression (P < 0.001) compared to the control group. Additionally, the Dexa group had significantly longer duration of both sensory block (P = 0.01) and motor block (P < 0.001). The Dexa group had significantly longer duration until the first postoperative analgesic request (P < 0.001) and a lower incidence of side effects compared to the control group. CONCLUSION Although the intravenous administration of dexamethasone had a limited effect on the duration of hyperbaric bupivacaine spinal anesthesia, it improved postoperative VAS scores compared to the control group and decreased overall postoperative analgesic consumption. Therefore, it can be considered a valuable addition to postoperative multimodal analgesia strategies, aiming to minimize total analgesic consumption. CLINICAL TRIAL REGISTRATION ID: NCT04778189 (2/3/2021).
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Affiliation(s)
- Amani H Abdel-Wahab
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Essam S Abd Alla
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Taghreed Abd El-Azeem
- Anesthesia and Intensive Care Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Yamada EJ, Petró GDS, Rohden GB, Marques CT, Schwarzbold AV, Backes DS. Safety of spinal anesthesia in pregnant vaccinated with one or two doses of the BNT162b2 vaccine: A retrospective observational cohort study. Perioper Care Oper Room Manag 2023; 32:100323. [PMID: 37260912 PMCID: PMC10199485 DOI: 10.1016/j.pcorm.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/12/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Purpose To evaluate the safety of spinal anesthesia in pregnant women who underwent cesarean section during the Covid-19 pandemia and were immunized with the BNT162b2 vaccine. Methods Historical cohort study that included three groups: non-vaccinated pregnant with no history of acute or previous Covid-19 [NV (n = 70)], vaccinated with one dose [1D (n = 65)] or two doses of BNT162b2 [2D (n = 45)], who underwent cesarean section with spinal anesthesia. Variables with normal distribution were analyzed with ANOVA. When one or more groups had non-normal distribution, the Kruskal-Wallis test was used. For categorical variables, the chi-square test or Kruskal-Wallis test was performed. When any variable had a frequency of less than five, the two-tailed Fisher's exact test with the Freeman-Halton extension was used. The significance level considered was p < .05. Results Apparently there is no interaction between BNT162b2 and the drugs most commonly used in spinal anesthesia for cesarean delivery. Conclusion: Performing spinal anesthesia in patients immunized with BNT162b2 does not seem to result in significant differences in outcomes compared to those not vaccinated. Apparently there is no need to change the standards of performing spinal anesthesia in patients vaccinated with the BNT162b2 vaccine.
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Affiliation(s)
- Eduardo J Yamada
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria-RS, Brazil. CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Gabriel dS Petró
- CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Guilherme B Rohden
- CET Manoel Alvarez, Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Clandio T Marques
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria, RS, Brazil
| | - Alexandre V Schwarzbold
- Chief of Clinical Research Unity (UPC), Hospital Universitário de Santa Maria (HUSM), Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Dirce S Backes
- Mestrado Profissional em Saúde Materno Infantil, Universidade Franciscana (UFN), Santa Maria, RS, Brazil
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Lu Y, Zhang Y, Xu Z, Shen F, Wang J, Liu Z. Subclavian vein ultrasound-guided fluid management to prevent post-spinal anesthetic hypotension during cesarean delivery: a randomized controlled trial. BMC Anesthesiol 2023; 23:288. [PMID: 37620761 PMCID: PMC10464078 DOI: 10.1186/s12871-023-02242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hypotension frequently occurs after spinal anesthesia during cesarean delivery, and fluid loading is recommended for its prevention. We evaluated the efficacy of subclavian vein (SCV) ultrasound (US)-guided volume optimization in preventing hypotension after spinal anesthesia during cesarean delivery. METHODS This randomized controlled study included 80 consecutive full-term parturients scheduled for cesarean delivery under spinal anesthesia. The women were randomly divided into the SCVUS group, with SCVUS analysis before spinal anesthesia with SCVUS-guided volume management, and the control group without SCVUS assessment. The SCVUS group received 3 mL/kg crystalloid fluid challenges repeatedly within 3 min with a 1-min interval based on the SCV collapsibility index (SCVCI), while the control group received a fixed dose (10 mL/kg). Incidence of post-spinal anesthetic hypotension was the primary outcome. Total fluid volume, vasopressor dosage, changes in hemodynamic parameters, maternal adverse effects, and neonatal status were secondary outcomes. RESULTS The total fluid volume was significantly higher in the control group than in the SCVUS group (690 [650-757.5] vs. 160 [80-360] mL, p < 0.001), while the phenylephrine dose (0 [0-40] vs. 0 [0-30] µg, p = 0.276) and incidence of post-spinal anesthetic hypotension (65% vs. 60%, p = 0.950) were comparable between both the groups. The incidence of maternal adverse effects, including nausea/vomiting and bradycardia (12.5% vs. 17.5%, p = 0.531 and 7.5% vs. 5%, p = 1.00, respectively), and neonatal outcomes (Apgar scores) were comparable between the groups. SCVCI correlated with the amount of fluid administered (R = 0.885, p < 0.001). CONCLUSIONS SCVUS-guided volume management did not ameliorate post-spinal anesthetic hypotension but reduced the volume of the preload required before spinal anesthesia. Reducing preload volume did not increase the incidence of maternal and neonatal adverse effects nor did it increase the total vasopressor dose. Moreover, reducing preload volume could relieve the heart burden of parturients, which has high clinical significance. CLINICAL TRIAL REGISTRATION The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2100055050) on December 31, 2021.
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Affiliation(s)
- Yan Lu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yueqi Zhang
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Fuyi Shen
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jian Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Sykes DAW, Tabarestani TQ, Chaudhry NS, Salven DS, Shaffrey CI, Bullock WM, Guinn NR, Gadsden J, Berger M, Abd-El-Barr MM. Awake Spinal Fusion Is Associated with Reduced Length of Stay, Opioid Use, and Time to Ambulation Compared to General Anesthesia: A Matched Cohort Study. World Neurosurg 2023; 176:e91-e100. [PMID: 37164209 PMCID: PMC10659088 DOI: 10.1016/j.wneu.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE There is increasing interest in performing awake spinal fusion under spinal anesthesia (SA). Evidence supporting SA has been positive, albeit limited. The authors set out to investigate the effects of SA versus general anesthesia (GA) for spinal fusion procedures on length of stay (LOS), opioid use, time to ambulation (TTA), and procedure duration. METHODS The authors performed a retrospective review of a single surgeon's patients who underwent lumbar fusions under SA versus GA from June of 2020 to June of 2022. SA patients were compared to demographically matched GA counterparts undergoing comparable procedures. Analyzed outcomes include operative time, opioid usage in morphine milligram equivalents, TTA, and LOS. RESULTS Ten SA patients were matched to 10 GA counterparts. The cohort had a mean age of 66.77, a mean body mass index of 27.73 kg/m2, and a median American Society of Anesthesiologists Physical Status Score of 3.00. LOS was lower in SA versus GA patients (12.87 vs. 50.79 hours, P = 0.001). Opioid utilization was reduced in SA versus GA patients (10.76 vs. 31.43 morphine milligram equivalents, P = 0.006). TTA was reduced in SA versus GA patients (7.22 vs. 29.87 hours, P = 0.022). Procedure duration was not significantly reduced in SA patients compared to GA patients (139.3 vs. 188.2 minutes, P = 0.089). CONCLUSIONS These preliminary retrospective results suggest the use of SA rather than GA for lumbar fusions is associated with reduced hospital LOS, reduced opioid utilization, and reduced TTA. Future randomized prospective studies are warranted to determine if SA usage truly leads to these beneficial outcomes.
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Affiliation(s)
- David A W Sykes
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Troy Q Tabarestani
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - David S Salven
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - W Michael Bullock
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey Gadsden
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Zhao Y, Luo Y, Liu Z, Chen Y, Wei L, Luo X, Zhou G, Lai J, Ji J, Lin Y, Liu J. Ferrostatin-1 ameliorates Bupivacaine-Induced spinal neurotoxicity in rats by inhibiting ferroptosis. Neurosci Lett 2023; 809:137308. [PMID: 37244447 DOI: 10.1016/j.neulet.2023.137308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Bupivacaine (BUP) has previously been shown to trigger neurotoxicity after spinal anesthesia. Further, ferroptosis has been implicated in the pathological processes associated with various central nervous system diseases. Although the impact of ferroptosis on BUP-induced neurotoxicity in the spinal cord has not been fully understood, this research aims to investigate this relationship in rats. Additionally, this study aims to determine whether ferrostatin-1 (Fer-1), a potent inhibitor of ferroptosis, can provide protection against BUP-induced spinal neurotoxicity. The experimental model for BUP-induced spinal neurotoxicity involved the administration of 5% bupivacaine through intrathecal injection. Then, the rats were randomized into the Control, BUP, BUP + Fer-1, and Fer-1 groups. BBB scores, %MPE of TFL, and H&E and Nissl stainings showed that intrathecal Fer-1 administration improved functional recovery, histological outcomes, and neural survival in BUP-treated rats. Moreover, Fer-1 has been found to alleviate the BUP-induced alterations related to ferroptosis, such as mitochondrial shrinkage and disruption of cristae, while also reducing the levels of malondialdehyde (MDA), iron, and 4-hydroxynonenal (4HNE). Fer-1 also inhibits the accumulation of reactive oxygen species (ROS) and restores the normal levels of glutathione peroxidase 4 (GPX4), cystine/glutamate transporter (xCT), and glutathione (GSH). Furthermore, double-immunofluorescence staining revealed that GPX4 is primarily localized in the neurons instead of microglia or astroglia in the spinal cord. In summary, we demonstrated that ferroptosis play a pivotal role in mediating BUP-induced spinal neurotoxicity, and Fer-1 ameliorated BUP-induced spinal neurotoxicity by reversing the underlying ferroptosis-related changes in rats.
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Affiliation(s)
- Yang Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China; Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Road, Nanchong 637000, Sichuan, China
| | - Yunpeng Luo
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China; Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou, China
| | - Ziru Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Yuanyuan Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Liling Wei
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Xi Luo
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Gang Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Jian Lai
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Jiemei Ji
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Yunan Lin
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China
| | - Jingchen Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China.
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Akinaga C, Kawashima S, Suzuki Y, Matsumoto M, Nakajima Y. Thromboelastography with platelet mapping to guide anesthetic management of emergency cesarean delivery in a patient with thrombasthenia: a case report. JA Clin Rep 2023; 9:30. [PMID: 37227540 DOI: 10.1186/s40981-023-00623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Perinatal management of congenital platelet dysfunction represents a challenge. One of the major concerns is whether neuraxial anesthesia can be applicable for cesarean delivery. We present a patient with thrombasthenia who underwent emergency cesarean delivery. CASE PRESENTATION A 34-year-old primipara was diagnosed with autosomal dominant thrombasthenia, which was not classified as any known type. A thorough examination revealed that adenosine diphosphate aggregation and collagen aggregation were suppressed. Platelet mapping of viscoelastic testing was used to observe the trajectory of platelet function during pregnancy, which was found to be normal to hypercoagulable until 38 weeks of gestation. On the basis of the results of testing and physiological status, we commenced spinal anesthesia and avoided prophylactic platelet transfusion. CONCLUSION The platelet mapping of viscoelastic testing was rapid and simple, allowing repeated examinations. We could choose the appropriate anesthesia method and determine the necessity of blood transfusion for a pregnant patient with thrombasthenia.
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Affiliation(s)
- Chieko Akinaga
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-Ku, Hamamatsu-Shi, Shizuoka, 431-3192, Japan.
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-Ku, Hamamatsu-Shi, Shizuoka, 431-3192, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-Ku, Hamamatsu-Shi, Shizuoka, 431-3192, Japan
| | - Masako Matsumoto
- Department of Obstetrics and Gynecology, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-Ku, Hamamatsu-Shi, Shizuoka, 431-3192, Japan
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Olmos M, Patel J, Kanter M, Karimi H, Kryzanski J. Evaluating the potential impact of spinal anesthesia use in lumbar surgery on global healthcare cost and climate change. Brain Spine 2023; 3:101754. [PMID: 37383465 PMCID: PMC10293309 DOI: 10.1016/j.bas.2023.101754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Introduction Despite recent evidence demonstrating its safety and efficacy, spinal anesthesia remains a seldom-utilized anesthetic modality in lumbar surgical procedures. In addition, numerous clinical advantages, such as reduced cost, blood loss, operative time, and inpatient length of stay have been consistently demonstrated with spinal anesthesia over general anesthesia. Research question In this report we aim to examine the differences between spinal anesthesia and general anesthesia with regard to accessibility and climate impact and determine whether wider adoption of spinal anesthesia would have a meaningful impact on the global population. Materials and Methods: The climate impact of spinal fusions performed under spinal and general anesthesia were obtained from recent studies published in the literature. Cost of spinal fusions was obtained from an unpublished study performed at our institution. Volume of spinal fusions performed in several countries were ascertained from published reports. Data on cost and carbon emissions were extrapolated based on volume of spinal fusions in each of the nations. Results In the U.S., use of spinal anesthesia for lumbar fusions would have resulted in savings of 343 million dollars in 2015. A similar reduction in cost was seen with each country studied. Additionally, spinal anesthesia was associated with 12,352 kg carbon dioxide equivalents (CO2e) while general anesthesia produced 942,872 kg CO2e. Similar reduction in carbon emissions was seen with each country studied. Discussion and conclusion Spinal anesthesia is safe and effective for both simple and complex spine surgeries, it reduces carbon emissions, permits lower operative times, and decreases cost.
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Affiliation(s)
| | | | | | | | - James Kryzanski
- Corresponding author. Department of Neurosurgery, Tufts Medical Center, 800 Washington St. Boston, MA, 02111, USA.
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Mazzone C, Sofia M, Sarvà I, Litrico G, Di Stefano AML, La Greca G, Latteri S. Awake laparoscopic cholecystectomy: A case report and review of literature. World J Clin Cases 2023; 11:3002-3009. [PMID: 37215416 PMCID: PMC10198068 DOI: 10.12998/wjcc.v11.i13.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.
CASE SUMMARY A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
CONCLUSION Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.
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Affiliation(s)
- Chiara Mazzone
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Maria Sofia
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Iacopo Sarvà
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Giorgia Litrico
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Andrea Maria Luca Di Stefano
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Gaetano La Greca
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
| | - Saverio Latteri
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy
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Gwanzura C, Gavi S, Mangiza M, Moyo FV, Lohman MC, Nhemachena T, Chipato T. Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section. BMC Anesthesiol 2023; 23:142. [PMID: 37106343 PMCID: PMC10134612 DOI: 10.1186/s12871-023-02098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Neonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe. METHODS We carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores. RESULTS Four hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5-10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6-23.1, sensitivity analysis E-value = 4.42). CONCLUSIONS When providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible. TRIAL REGISTRATION The clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.
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Affiliation(s)
- Chipo Gwanzura
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Samuel Gavi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Marcia Mangiza
- Department of Pediatrics, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Faith Vhenekai Moyo
- Department of Anesthesia and Critical Care Medicine, Sally Mugabe Central Hospital, PO Box ST14 Southerton, Harare, Zimbabwe
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Taazadza Nhemachena
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Zamani Habibabad H, Afrasiabifar A, Mansourian A, Mansourian M, Hosseini N. Effect of chamomile aromatherapy with and without oxygen on pain of women in post cesarean section with spinal anesthesia: A randomized clinical trial. Heliyon 2023; 9:e15323. [PMID: 37123948 PMCID: PMC10133761 DOI: 10.1016/j.heliyon.2023.e15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
Background Pain is the most common side effect in cesarean section with spinal anesthesia. It seems that oxygen therapy and chamomile aromatherapy may diminish pain. The present study was conducted to examine and compare the effect of chamomile aromatherapy with and without oxygen on the severity of pain of women following cesarean section surgery with spinal anesthesia. Methods The present randomized clinical trial study was carried out on 136 women undergoing cesarean section surgery with spinal anesthesia at Imam Sajad Hospital, Yasuj, Iran in 2020. The eligible women were assigned into four 34-member groups including oxygen therapy plus aromatherapy, oxygen therapy, aromatherapy, and control via block randomization. Each of these interventions were performed 6, 6.30 and 7 h post operation. In the first intervention group, one drop of chamomile essential oil with distilled water was poured into a small nebulizer using a simple mask connected to 6 L of oxygen. The second intervention group received oxygen without chamomile aromatherapy at similar times, and the third intervention group received chamomile aromatherapy without oxygen. The control group received only routine interventions. The instrument used in the research was visual analog scale which was completed by the researcher 6, 12, 18 h after cesarean section. The data were analyzed by the SPSS software version 20. Results There was a significant difference in the intensity of pain of patients between the various groups of study following the interventions (P < 0.001). Pain intensity reduced significantly in the group receiving combined intervention of chamomile aromatherapy plus oxygen compared to the other three groups. Moreover, the pain intensity diminished more in the groups undergoing each of these interventions alone as compared to the control group (P < 0.05). Conclusions The combined intervention of chamomile aromatherapy with oxygen was more effective than each of the chamomile aromatherapy and oxygen interventions alone in reducing the pain of cesarean section patients though each intervention alone was still effective in lowering pain post-operation.
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Affiliation(s)
| | | | - Afshin Mansourian
- Assistant Professor of Department of Anesthesiology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mahboubeh Mansourian
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Nazafarin Hosseini
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Corresponding author.
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Kang H, Lim T, Lee HJ, Kim TW, Kim W, Chang HW. Comparison of the effect of dexmedetomidine and midazolam under spinal anesthesia for cesarean delivery: a randomized controlled trial, single center study in South Korea. Anesth Pain Med (Seoul) 2023; 18:159-168. [PMID: 37183284 PMCID: PMC10183612 DOI: 10.17085/apm.22257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Cesarean section under spinal anesthesia may cause anxiety and hypotension. Administration of sedative drugs after delivery can diminish these side-effects, but may increase hemodynamic instability. We evaluated the effect of the administration of 0.7 μg/kg dexmedetomidine and compared it with that of 0.03 mg/kg midazolam for usefulness of sedation of the parturient after delivery during cesarean section. METHODS After obtaining written consent and the ethics board approval, 60 parturients aged 20-43 years who underwent elective cesarean delivery under spinal anesthesia were recruited. A total of 0.5% hyperbaric bupivacaine (8-10 mg) and intrathecal fentanyl (10 μg) was given to induce anesthesia. Parturients were then randomly allocated to receive either midazolam (0.03 mg/kg; group M) or dexmedetomidine 0.7 (μg/kg; group D) after delivery. The primary outcome measure was patient satisfaction score. Secondary outcomes included vital signs; vasopressor dosage; incidence of shivering, nausea, and vomiting; incidence of bradycardia; time to sensory and motor recovery; postoperative nausea and vomiting score; and postoperative pain visual analog scale at 6, 24, and 48 h. RESULTS Satisfaction scores for sedation were similar between the two groups. The systolic blood pressure, heart rate, oximetry saturation, and tympanic temperature were comparable between the two groups. The predicted mean systolic blood pressure of group D was 106.3 mmHg and that of group M was 107.5 mmHg. Both groups showed comparable adverse intraoperative and postoperative outcomes. CONCLUSIONS Dexmedetomidine and midazolam showed similar hemodynamic effects and patient satisfaction in parturients under spinal anesthesia.
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Affiliation(s)
- Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
| | - Taeha Lim
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
| | - Hyun Jeong Lee
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
| | - Tae Wan Kim
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
| | - Wan Kim
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
| | - Hae Wone Chang
- Department of Anesthesiology and Pain Medicine, Nowon Eulji University Hospital, Seoul, Korea
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Slaven SE, Dedeogullari ES, Parks NL, Sershon RA, Fricka KB, Hamilton WG. Spinal Anesthesia for Primary Hip and Knee Arthroplasty: Comparative Rates of Transient Neurological Symptoms and Urinary Retention using Lidocaine, Mepivacaine, and Bupivacaine. J Arthroplasty 2023; 38:S42-S46. [PMID: 36958714 DOI: 10.1016/j.arth.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Short-acting spinal anesthetics enable rapid recovery hip and knee arthroplasty, however concerns with transient neurological symptoms (TNS) cause some to avoid using lidocaine. Post-operative urinary retention (POUR) is also a concern with spinal anesthesia. We sought to study the comparative rates of TNS and POUR between lidocaine, mepivacaine, and bupivacaine in a high-volume hip and knee arthroplasty setting. METHODS Data for 1,217 primary THA, TKA, and UKA cases were reviewed and grouped by spinal anesthetic agent (Lidocaine, Mepivacaine, or Bupivacaine). Of the 1,217 cases, utilization was 523 Lidocaine, 573 Mepivacaine, and 121 Bupivacaine. The incidence of TNS and POUR requiring catheterization was measured both by clinical evaluation as well as a questionnaire sent to patients 14 days postoperatively. RESULTS The overall rate of TNS was 8%. With the numbers available, there was no difference in rates of TNS between groups (6.9% Lidocaine, 9.2% Mepivacaine, and 4.1% Bupivacaine; P=0.297). There was no difference in rates of TNS or POUR between THA and TKA/UKA. Bupivacaine had a significantly higher rate of urinary retention (9.1%; P<0.001) than mepivacaine (2.8%) or lidocaine (1.5%). CONCLUSIONS This study showed no difference in the rate of TNS between the 3 common agents used in spinal anesthesia. Short-acting spinal anesthetics such as lidocaine and mepivacaine can lower the rate of POUR requiring catheterization helping to enable rapid recovery hip and knee arthroplasty.
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Affiliation(s)
- Sean E Slaven
- Aori - Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | | | - Nancy L Parks
- Aori - Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | - Robert A Sershon
- Aori - Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | - Kevin B Fricka
- Aori - Anderson Orthopaedic Research Institute, Alexandria, VA, USA
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Hasanin AM, Abou Amer A, Hassabelnaby YS, Mostafa M, Abdelnasser A, Amin SM, Elsherbiny M, Refaat S. The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial. Anaesth Crit Care Pain Med 2023; 42:101204. [PMID: 36858257 DOI: 10.1016/j.accpm.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND This study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery. METHODS This randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes. RESULTS The final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0-0] mg), followed by the 0.02 mcg (0 [0-9] mg) and the 0.01 mcg (9 [0-18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups. CONCLUSION The use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT05279703.
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Knio ZO, Clancy PW, Zuo Z. Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: A matched-pair cohort analysis. J Clin Anesth 2023; 87:111083. [PMID: 36848778 DOI: 10.1016/j.jclinane.2023.111083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
STUDY OBJECTIVE It has not yet been established whether total hip arthroplasty complications are associated with anesthetic technique (spinal versus general). This study assessed the effect of spinal versus general anesthesia on health care resource utilization and secondary endpoints following total hip arthroplasty. DESIGN Propensity-matched cohort analysis. SETTING American College of Surgeons National Surgical Quality Improvement Program participating hospitals from 2015 to 2021. PATIENTS Patients undergoing elective total hip arthroplasty (n = 223,060). INTERVENTIONS None. MEASUREMENTS The a priori study duration was 2015 to 2018 (n = 109,830). The primary endpoint was 30-day unplanned resource utilization, namely readmission and reoperation. Secondary endpoints included 30-day wound complications, systemic complications, bleeding events, and mortality. The impact of anesthetic technique was investigated with univariate analyses, multivariable analyses, and survival analyses. MAIN RESULTS The 1:1 propensity-matched cohort included 96,880 total patients (48,440 in each anesthesia group) from 2015 to 2018. On univariate analysis, spinal anesthesia was associated with a lower incidence of unplanned resource utilization (3.1% [1486/48440] vs 3.7% [1770/48440]; odds ratio [OR], 0.83 [95% CI, 0.78 to 0.90]; P < .001), systemic complications (1.1% [520/48440] vs 1.5% [723/48440]; OR, 0.72 [95% CI, 0.64 to 0.80]; P < .001), and bleeding events requiring transfusion (2.3% [1120/48440] vs 4.9% [2390/48440]; OR, 0.46 [95% CI, 0.42 to 0.49]; P < .001). On multivariable analysis, spinal anesthesia remained an independent predictor of unplanned resource utilization (adjusted odds ratio [AOR], 0.84 [95% CI, 0.78 to 0.90]; c = 0.646), systemic complications (AOR, 0.72 [95% CI, 0.64 to 0.81]; c = 0.676), and bleeding events (AOR, 0.46 [95% CI, 0.42 to 0.49]; c = 0.686). Hospital length of stay was also shorter in the spinal anesthesia cohort (2.15 vs 2.24 days; mean difference, -0.09 [95% CI, -0.12 to -0.07]; P < .001). Similar findings were observed in the cohort from 2019 to 2021. CONCLUSIONS Total hip arthroplasty patients receiving spinal anesthesia experience favorable outcomes compared to propensity-matched general anesthesia patients.
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Affiliation(s)
- Ziyad O Knio
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America
| | - Paul W Clancy
- School of Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America.
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Echeverri Lombana MDLP, Sanín Hoyos A, Echeverri Mallarino V, García Peña Á, Gomar Sancho C. Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:140-147. [PMID: 36842680 DOI: 10.1016/j.redare.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/10/2022] [Indexed: 02/28/2023]
Abstract
BACKGROUND Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. OBJECTIVES To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. PATIENTS AND METHODS Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 min after the blockade were compared with those obtained previously. RESULTS A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. 14.8% of the patients presented MAP equal to or less than 60 mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. DISCUSSION Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.
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Affiliation(s)
- M de la P Echeverri Lombana
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - A Sanín Hoyos
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - V Echeverri Mallarino
- Departamento de Anestesiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Á García Peña
- Departamento de Cardiología, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Gomar Sancho
- Universidad de Barcelona y Universidad de Manresa, GRinDoSSeP, Spain
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Chen L, Liu S, Cao Y, Yan L, Shen Y. Effect of perioperative ultrasound guided fascia iliaca compartment block in elderly adults with hip fractures undergoing arthroplasty in spinal anesthesia-a randomized controlled trial. BMC Geriatr 2023; 23:66. [PMID: 36732687 PMCID: PMC9893664 DOI: 10.1186/s12877-023-03786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For elderly adults undergoing hip arthroplasty, fascia iliaca compartment block (FICB) is often used before spinal anesthesia to reduce the pain of posture placement. However, the impact of FICB within 48 h needs further study. METHODS 89 elderly adults scheduled to undergo arthroplasty for hip fracture were enrolled and randomized into the FICB group (n = 45) and the control group (n = 44). The fascia iliaca on the operated side was located using ultrasound, and a puncture needle was placed under the fascia iliaca. The FICB group was injected with 40 ml of 0.5% ropivacaine, and the control group was injected with 40 ml of normal saline. Spinal anesthesia was performed after 20 min. Our primary outcome measures were: duration of analgesia, muscle strength, and Quality of Recovery (QoR). RESULTS The duration of analgesia in the FICB group was 403.5 ± 39.6 min, which was longer than that (357.5 ± 35.9 min) of the control group (P = 0.012). There were 19 (42.2%) patients with muscle strength of grade 4 in the FICB group and 36 (81.8%) patients with muscle strength of grade 4 in the control group. FICB group was lower (P < 0.001). QoR-15 at 24 h after surgery was 114.1 ± 8.3 in the FICB group and 104.6 ± 8.4 in the control group (P < 0.001). QoR-15 at 48 h after surgery was 122.7 ± 8.4 in the FICB group and 120.5 ± 9.5 in the control group (P = 0.232). CONCLUSIONS For elderly adults with hip fractures, FICB provided longer analgesia and improved 24-h QoR, but reduced postoperative muscle strength. TRAIL REGISTRATION Chinese Clinical Registry Center, ChiCTR2200056937, 23/02/2022.
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Affiliation(s)
- Liang Chen
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Shuangmei Liu
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Yanyan Cao
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Lei Yan
- grid.412467.20000 0004 1806 3501Department of Anesthesiology, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
| | - Yang Shen
- grid.412467.20000 0004 1806 3501Department of Emergency Medicine, Shengjing Hospital of China Medical University, No.36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning Province China
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Oh S, Park Y, Kwoun H, Eom E, Kim DA. Three-dimensional pelvis computed tomography-assisted Taylor approach for spinal anesthesia in hip arthroplasty: a retrospective study. Korean J Anesthesiol 2023; 76:12-16. [PMID: 36116483 PMCID: PMC9902187 DOI: 10.4097/kja.22099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Needle insertion for spinal anesthesia using the Taylor approach is challenging as the L5-S1 space is difficult to locate from the surface anatomy. In this study, we suggest the use of three-dimensional (3D) pelvis computed tomography (CT) to assist anesthesiologists in locating the needle insertion point. By comparing the success rate of 3D pelvis CT-assisted Taylor approach to that of other approaches in the existing literatures, we suggest this technique as an alternative method for subarachnoid block in the L5-S1 space. METHODS In this retrospective observational study, we reviewed the records of hip arthroplasty using the 3D pelvis CT-assisted Taylor approach. An imaginary guidance line was created from the intersection point of the midline and intercristal line on the posterior view of the 3D pelvis CT to the ideal skin insertion point for Taylor approach. The primary outcome was the success rate. The secondary outcomes included the angle between the intercristal line and the guidance line, and the length of the guidance line and the distance between the ideal needle insertion point and the L5-S1 space. RESULTS We reviewed the records of the 276 patients who underwent hip arthroplasty using 3D CT-assisted Taylor approach. In this cohort, the 3D CT-assisted Taylor approach in L5-S1 subarachnoid block failed in only 25/276 patients. The success rate of 3D CT-assisted Taylor approach was 90.9%. CONCLUSIONS A 3D pelvis CT-assisted Taylor approach of spinal anesthesia can be an alternative method for subarachnoid block in the L5-S1 space with an acceptable success rate.
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Affiliation(s)
- Saecheol Oh
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, Daejeon, Korea
| | - Yoojung Park
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, Suwon, Korea
| | - Hana Kwoun
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Eunjin Eom
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dal-ah Kim
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea,Corresponding author: Dal-ah Kim, M.D. Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, KoreaTel: +82-32-280-7420Fax: +82-32-280-5416
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Yang X, Xia Q, Wang J. Acute thrombocytopenia during cesarean section. Int J Obstet Anesth 2023; 53:103612. [PMID: 36396546 DOI: 10.1016/j.ijoa.2022.103612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
We report a case of a healthy 29-year-old parturient with a normal pre-operative platelet count who received combined spinal-epidural anesthesia for cesarean section, and who suffered the sudden intra-operative onset of severe thrombocytopenia (platelet count 3 × 109/L). This event was likely due to cefoxitin administered for the prophylaxis of surgical infection.
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Affiliation(s)
- X Yang
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China
| | - Q Xia
- Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China
| | - J Wang
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Xinjiang Province, China.
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Bae J, Yoo S, Kim H, Kim Y, Kim JT, Lim YJ, Kim HS. Effect of real-time binaural music on sedation with dexmedetomidine during spinal anesthesia: A triple-arm, assessor-blind, randomized controlled trial. J Clin Anesth 2023; 84:110997. [PMID: 36371942 DOI: 10.1016/j.jclinane.2022.110997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE Binaural audio induces sedation and reduces pain and anxiety in surgical patients. This study tested the hypothesis that dexmedetomidine requirement for adequate sedation during spinal anesthesia would be lower in patients listening to music with binaural sound than that in patients listening to plain or no music. DESIGN A triple-arm, assessor-blind, randomized controlled study. SETTING Operating room. PATIENTS One hundred and eighty-nine patients undergoing orthopedic surgery under spinal anesthesia. INTERVENTIONS Patients were randomly assigned to music with binaural sound, plain music, or no music groups. Dexmedetomidine was infused for sedation during surgery. The loading infusion rate was 6 μg/kg predicted body weight (PBW)/h, followed by continuous infusion at 0.6 μg/kg PBW/hr. Loading was stopped after achieving adequate sedation, defined as the Observer's Assessment of Alertness/Sedation (OAA/S) scale score of 3. Infusion rate was adjusted every 30 min per the OAA/S scale. MEASUREMENTS Primary outcomes were the difference in the dexmedetomidine loading dose adjusted for the patient's PBW between (1) the binaural and plain music groups and (2) the binaural and control groups. Secondary outcomes were the total dose and total loading time of dexmedetomidine; Patient State Index; relative powers of the alpha, theta, and delta bands; recovery from sedation; and patient satisfaction score. MAIN RESULTS The final analyses included 184 patients. The PBW-adjusted dexmedetomidine loading dose was significantly lower in patients listening to music with binaural sound (1.15 ± 0.30 μg/kg PBW) than that in patients without music (1.33 ± 0.33 μg/kg PBW; mean difference, 0.18 μg/kg PBW; 95% confidence interval [CI], 0.06 to 0.29; P = 0.002). However, the difference was not statistically significant when compared with the plain music group (1.26 ± 0.36 μg/kg PBW; mean difference, 0.11 μg/kg PBW; 95% CI, -0.01 to 0.23; P = 0.070). Dexmedetomidine total dose, recovery from sedation, and patient satisfaction score showed no difference among the three groups. CONCLUSIONS Compared with no music, music with binaural sound reduced the dexmedetomidine loading dose; however, this sedative-sparing effect of binaural sound was not found when compared to plain music.
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Affiliation(s)
- Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hansol Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngwon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yoshida K, Hareyama I, Noji Y, Tanaka S, Watanabe K, Inoue S. The relationship between the orientation of the lateral decubitus position for spinal anesthesia and positioning pain in patients with a femoral neck fracture: randomized non-inferiority trial. JA Clin Rep 2023; 9:3. [PMID: 36703010 PMCID: PMC9879737 DOI: 10.1186/s40981-023-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To date, no clinical studies have investigated the relationship between positioning pain and orientation of the lateral decubitus position for hip fracture surgery. The aim of the present study was to test the hypothesis that performing spinal anesthesia in the lateral decubitus position with the fracture side up or down does not affect positioning pain in patients with a femoral neck fracture. METHODS This single-center, prospective, randomized non-inferiority trial examined 78 patients who received surgery for a femoral neck fracture under spinal anesthesia. By performing spinal anesthesia in the left lateral decubitus position in all patients, the positioning of the fracture up or down was randomized. Pain score during spinal anesthesia was evaluated objectively (0, calm; 1, facial grimacing; 2, moaning; 3, screaming; or 4, unable to proceed because of restlessness or agitation). RESULTS The data from 66 patients (fracture side down [n = 35] and up [n = 31]) were analyzed. There were no significant differences between the fracture side down and fracture side up groups regarding the percentage of patients who were assessed to have intense pain (score ≥ 3) when changing position from the supine to lateral position (13/35 [37%] vs 12/31 [39%]; 95% confidence interval [95% CI] for the difference of the percentage of patients of intense pain between the groups - 25.0 to 2.2; p = 1.000). CONCLUSIONS There were no significant differences in the percentage of patients experiencing severe pain between the two groups. The 95% CI exceeded the preliminarily set a margin of inferiority of 20%; thus, the present study could not demonstrate the non-inferiority of the fractured side down group in terms of pain score.
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Affiliation(s)
- Keisuke Yoshida
- grid.513837.bDepartment of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima 965-8611 Japan ,grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, 960-1297 Japan
| | - Itaru Hareyama
- grid.513837.bDepartment of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima 965-8611 Japan
| | - Yoshie Noji
- grid.513837.bDepartment of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima 965-8611 Japan
| | - Shiori Tanaka
- grid.513837.bDepartment of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima 965-8611 Japan ,grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, 960-1297 Japan
| | - Kazuhiro Watanabe
- grid.513837.bDepartment of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakmatsu, Fukushima 965-8611 Japan
| | - Satoki Inoue
- grid.411582.b0000 0001 1017 9540Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, 960-1297 Japan
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50
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Sowers M, Jacob R, Chandler K, Kuntz GE, Rajaram S, Kukreja P, Naranje S. Operative room time comparison between general and spinal anesthesia in total hip arthroplasty: an institutional study. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04775-4. [PMID: 36695906 DOI: 10.1007/s00402-023-04775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE A relatively high expense with any procedure is total operative time; two components being the time spent anesthetizing the patient and time spent transferring the patient out of the operating room (OR). Both times can be affected by the anesthetic method used. This study compares different operative time intervals for both spinal anesthesia (SA) and general anesthesia (GA), in patients undergoing a primary total hip arthroplasty (THA), to identify the most appropriate and cost-effective anesthetic method. METHODS A retrospective chart review was performed at a single institution for primary total hip arthroplasty procedures performed in the year 2019. Primary THAs without complications performed by three orthopedic surgeons were selected. Anesthesia records for 200 patients were used to compare perioperative time intervals; 100 consecutive patients that received SA and 100 consecutive patients that received GA. RESULTS The time spent transferring the patient out of the operating room was 8 min for GA and 5 min for SA (p < 0.001). Total operative time for GA was 90 min and 87 min for SA (p = 0.3330). Total pre-operative time averaged 26 min in SA compared to 25 min in GA (p = 0.5874). Non-operative total time (all time components of patient interaction excluding surgery start to surgery finish) was significantly shorter in SA with an average of 52 compared to 56 in GA (p = 0.0151). CONCLUSION Time to transfer patient out of the OR and total non-operative time was significantly shorter in patients who received spinal anesthesia. These results and the complications of both general and spinal anesthesia should be taken into consideration when anesthetizing patients undergoing primary THA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mackenzie Sowers
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Roshan Jacob
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Kelly Chandler
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - George E Kuntz
- Department of Anesthesiology, University of Alabama at Birmingham, JT 845 619 South 19th Street, Birmingham, AL, 35249, USA
| | - Sakthivel Rajaram
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA
| | - Promil Kukreja
- Department of Anesthesiology, University of Alabama at Birmingham, JT 845 619 South 19th Street, Birmingham, AL, 35249, USA
| | - Sameer Naranje
- Division of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1201 11th Ave S #200, Birmingham, AL, 35205, USA.
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