DOCSLIB.ORG

Chapter 17 Spinal, Epidural, and Caudal Anesthesia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chapter 17 Spinal, Epidural, and Caudal Anesthesia Chapter SPINAL, EPIDURAL, AND 17 CAUDAL ANESTHESIA Alan J.R. Macfarlane, Richard Brull, and Vincent W.S. Chan PRINCIPLES COMBINED SPINAL-EPIDURAL ANESTHESIA PRACTICE Technique ANATOMY CAUDAL ANESTHESIA Spinal Nerves Pharmacology Blood Supply Technique Anatomic Variations COMPLICATIONS MECHANISM OF ACTION Neurologic Drug Uptake and Distribution Cardiovascular Drug Elimination Respiratory PHYSIOLOGIC EFFECTS Infection Cardiovascular Backache Central Nervous System Nausea and Vomiting Respiratory Urinary Retention Gastrointestinal Pruritus Renal Shivering Complications Unique to Epidural Anesthesia INDICATIONS Neuraxial Anesthesia RECENT ADVANCES IN ULTRASONOGRAPHY Neuraxial Analgesia QUESTIONS OF THE DAY CONTRAINDICATIONS Absolute Relative PRINCIPLES SPINAL ANESTHESIA Factors Affecting Block Height Spinal, epidural, and caudal blocks are collectively referred Duration of the Block to as central neuraxial blocks. Significant technical, physi- Pharmacology ologic, and pharmacologic differences exist between the Technique techniques, although all result in one or a combination of Monitoring of the Block sympathetic, sensory, and motor blockade. Spinal anes- EPIDURAL ANESTHESIA thesia requires a small amount of drug to produce rapid, Factors Affecting Epidural Block Height profound, reproducible, but finite sensory analgesia. In Pharmacology contrast, epidural anesthesia progresses more slowly, is Technique commonly prolonged using a catheter, and requires a large amount of local anesthetic, which may be associated with The editors and publisher would like to thank Drs. Kenneth Dras- ner and Merlin D. Larson for contributing to this chapter in the previous edition of this work. It has served as the foundation for the current chapter. 273 Downloaded for Wendy Nguyen ([email protected]) at University Of Minnesota - Twin Cities Campus from ClinicalKey.com by Elsevier on March 26, 2018. For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved. Section III PREOPERATIVE PREPARATION AND INTRAOPERATIVE MANAGEMENT Spinal cord Aorta Intervertebral Pia mater disk Dura mater Spinal nerve T8 Arachnoid Dura mater (cut) T9 Dura mater Arachnoid T10 Epidural fat Pia mater (overlying surface of spinal cord) T11 Ligamentum Dorsal root flavum Dorsal root (spinal) ganglion T12 Ventral root Conus medullaris Spinous Lumbar process L1 artery Interspinous ligament Cauda equina Transverse Supraspinous L2 process ligament Filum terminale internum Fig. 17.2 The spine in an oblique view. (From Afton-Bird G. Atlas Fig. 17.1 Terminal spinal cord and cauda equina. (From Briden- of regional anesthesia. In Miller RD, ed. Miller’s Anesthesia. Phila- baugh PO, Greene NM, Brull SJ. Spinal [subarachnoid] blockade. delphia: Elsevier; 2005.) In Cousins MJ, Bridenbaugh PO, eds. Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia: Lippincott- Raven; 1998:203-242.) Chapter 44). Indwelling long-term spinal catheters may be inserted for chronic malignant and nonmalignant pain. systemic side effects and complications unknown to spinal anesthesia. Combined spinal and epidural techniques blur ANATOMY some of these differences but add flexibility to clinical care. The spinal cord is continuous with the medulla oblongata proximally and terminates distally in the conus medullaris PRACTICE as the filum terminale (fibrous extension) and the cauda equina (neural extension) (Fig. 17.1). This distal termination Neuraxial blockade is widely utilized in surgery, obstet- varies from L3 in infants to the lower border of L1 in adults. rics, acute postoperative pain management, and chronic The spinal cord lies within the bony vertebral column, pain relief. Single-injection spinal or epidural anesthe- surrounded by three membranes: from innermost to outer- sia is commonly used for surgery to the lower abdomen, most the pia mater, the arachnoid mater, and the dura mater pelvic organs (e.g., prostate), and lower limbs and for (Fig. 17.2). Cerebrospinal fluid (CSF) resides in the subarach- cesarean deliveries. Continuous catheter-based epidural noid (or intrathecal) space between the pia mater and the infusions are used for obstetric labor analgesia and to arachnoid mater. The pia mater is a highly vascular mem- provide postoperative pain relief for days after major brane that closely invests the spinal cord and brain. The surgery (e.g., thoracic, abdominal, lower limb). Neu raxial arachnoid mater is a delicate, nonvascular membrane that analgesia can reduce pulmonary and possibly cardiac functions as the principal barrier to drugs crossing into (and morbidity, although the mortality benefits appear mini- out of) the CSF.4 The dura is a tough fibroelastic membrane. mal.1-3 More recently, the goals of epidural analgesia Surrounding the dura is the epidural space, extend- have shifted to facilitation of fast-track surgery recovery. ing from the foramen magnum to the sacral hiatus. The Caudal blocks are mostly performed for surgical anesthe- epidural space is bounded anteriorly by the posterior sia and analgesia in children (also see Chapter 34) and for longitudinal ligament, laterally by the pedicles and inter- therapeutic analgesia in adults with chronic pain (also see vertebral foramina, and posteriorly by the ligamentum 274 Downloaded for Wendy Nguyen ([email protected]) at University Of Minnesota - Twin Cities Campus from ClinicalKey.com by Elsevier on March 26, 2018. For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved. Chapter 17 Spinal, Epidural, and Caudal Anesthesia Spinous process Superior articular Cervical Lamina process Vertebral Transverse foramen process (spinal canal) Pedicle Thoracic Vertebral body Fig. 17.4 Typical thoracic vertebra. (From Covino BG, Scott DB, III Lambert DH. Handbook of Spinal Anaesthesia and Analgesia. Phila- delphia: WB Saunders; 1994.) the interspinous ligaments (that connect the spinous pro- cesses). Finally there is the supraspinous ligament, which Lumbar extends from the external occipital protuberance to the coccyx and attaches to the vertebral spines (see Fig. 17.2). There are 7 cervical, 12 thoracic, and 5 lumbar ver- tebrae and a sacrum (Fig. 17.3). The vertebral arch, spinous process, pedicles, and laminae form the pos- terior elements of the vertebra, and the vertebral body Sacral forms the anterior element (Fig. 17.4). The vertebrae are joined together anteriorly by the fibrocartilaginous joints with central disks containing the nucleus pulpo- Coccyx sus, and posteriorly by the zygapophyseal (facet) joints. Thoracic spinous processes are angulated more steeply Fig. 17.3 The vertebral column from a lateral view exhibits four caudad as opposed to the almost horizontal angula- curvatures. (From Covino BG, Scott DB, Lambert DH. Handbook tion of the lumbar spinous processes. The differences of Spinal Anaesthesia and Analgesia. Philadelphia: WB Saunders; between the caudal and lumbar spinous processes are 1994:12-24.) clinically important for needle insertion and advance- ment (Fig. 17.5). flavum. Contents include nerve roots, fat, areolar tissue, The sacral canal contains the terminal portion of the lymphatics, and blood vessels. dural sac, which typically ends at S2 in adults and lower The ligamentum flavum (the so-called “yellow liga- in children. The sacral canal also contains a venous plexus. ment”) also extends from the foramen magnum to the sacral hiatus. Although classically portrayed as a single Spinal Nerves ligament, it is actually composed of the right and left lig- amenta flava, which join to form an acute midline angle Dorsal (afferent) and ventral (efferent) nerve roots merge with a ventral opening (see Fig. 17.2).5 The ligamentum distal to the dorsal root ganglion to form spinal nerves flavum thickness, distance to the dura, and skin-to-dura (Fig. 17.6). There are 31 pairs of spinal nerves (8 cervi- distance vary with the area of the vertebral canal. The cal, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal). The vertebral canal is triangular and largest in area at the nerves pass through the intervertebral foramen, becoming lumbar levels, and it is circular and smallest in area at ensheathed by the dura, arachnoid, and pia, which, respec- the thoracic levels. Immediately posterior to the ligamen- tively, become the epineurium, the perineurium, and the tum flavum are either the lamina of vertebral bodies or endoneurium. Preganglionic sympathetic fibers originate 275 Downloaded for Wendy Nguyen ([email protected]) at University Of Minnesota - Twin Cities Campus from ClinicalKey.com by Elsevier on March 26, 2018. For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved. Section III PREOPERATIVE PREPARATION AND INTRAOPERATIVE MANAGEMENT in the intermediolateral gray columns between T1 and L2 and pass via the ventral nerve root to the paravertebral sympathetic ganglia and more distant plexuses (Fig. 17.7). 90° Blood Supply 40° B C Two posterior spinal arteries supply the posterior one third of the spinal cord, whereas the anterior two thirds of the T6 spinal cord are supplied by a single anterior spinal artery (Fig. 17.8). One of the largest anastomotic feeder arter- ies to the anterior system is the artery of Adamkiewicz, T7 which arises from the aorta and enters an intervertebral foramen between T7 and L4 on the left. Ischemia within the anterior system leads to anterior spinal artery syn- L2 drome, manifested as anterior horn motor neuron injury along with disruption
Load more

Recommended publications
  • Spinal Anaesthesia for Laparoscopic Cholecystectomy
    Rev. Col. Anest. Mayo-Julio 2009. Vol. 37- No. 2: 111-118 Spinal anaesthesia for laparoscopic cholecystectomy PatIents and MethOds • Patients aged less than 18 and older than 75; -2 • Patients having greater than 30 Kg/m body A descriptive pros­pective study was carried out mass index (BMI); between June and September 2008 in the Caribe teaching hospital in the city of Cartagena in Co- • Sick patients having contraindication for lapa- lombia, South America. Once the Caribe teaching roscopic surgery; hospital’s medical ethics’ committee’s approval had • Patients having contraindication for spinal been sought and given, patients were included in anaesthesia; the study who had biliary lithiasis accompanied by a clinical picture of chronic cholecystitis as well as • Patients who preferred general anaesthesia; those having a clinical picture of subacute cholecys- and titis diagnosed during preoperative exam. • An inability for carrying out posto­perative follow- Patients who had been previously diagnosed as up. having complicated biliary lithiasis (acute chole- Inclusion criteria consisted of ASA I – II patients cystitis, choledocoli­thiasis, acute cholangitis, acute aged 18 to 75. All the patients complied with a biliary pancreatitis, etc.) were excluded. Other ex- minimum 8 hours fast; antibiotic prophylaxis was clusion criteria were as follows: 115 Anestesia espinal para colecistectomia laparoscópica - Jiménez J.C., Chica J., Vargas D. Rev. Col. Anest. Mayo-Julio 2009. Vol. 37- No. 2: 111-118 administered 15 minutes before the procedure (1 g tolerance to oral route had been produced and the intravenous cephazoline) anaesthesiologist had verified the absence of any type of complication. All patients were prescribed ANAESTHETIC TECHNIQUE ibuprofen as analgesia to be taken at home (400 mgr each 8 hours for 3 days).
    [Show full text]
  • Sedative Effect of Propofol and Midazolam in Surgery Under Spinal Anaesthesia: a Comparative Study
    Indian Journal of Clinical Anaesthesia 2020;7(1):187–191 Content available at: iponlinejournal.com Indian Journal of Clinical Anaesthesia Journal homepage: www.innovativepublication.com Original Research Article Sedative effect of propofol and midazolam in surgery under spinal anaesthesia: A comparative study Jalpen N Patel1, Jyotsna F Maliwad2,*, Purvi J Mehta1, Raman D Damor3, Kalpita S Shringarpure3 1Dept. of Anesthesiology, Shri M P Shah Medical College, Jamnagar, Gujarat, India 2Dept. of Anasthesiology, Medical College, Baroda, Gujarat, India 3Dept. of Community Medicine, Medical College, Baroda, Gujarat, India ARTICLEINFO ABSTRACT Article history: Introduction: Intravenous medications are invariably required to allay anxiety related to surgical Received 27-11-2019 procedures, in patients undergoing surgery under regional anesthesia. A thorough pre anaesthetic check Accepted 30-11-2019 up and details of the surgical procedure planned are necessary before administration of sedative agents to Available online 28-02-2020 attain desirable levels of sedation and avoid unwanted adverse events. Objective: To observe, record and analyse sedative effect of intravenous Propofol and Midazolam in lower extremities and lower abdominal surgery scheduled under regional anesthesia techniques. Keywords: Materials and Methods: A single blinded comparative study conducted in tertiary care hospital of Gujarat. Sedative effect Sixty patients with no organic pathology & a moderate but definite systemic disturbance categorized into Subarachnoid block two groups labeled as propofol group (n=30) and Midazolam group (n=30) of either gender and shortlisted Anxiety for surgery using subarachnoid block. Observer’s Assessment of Alertness/Sedation Scale (OAA/S Scale) and Ramsay sedation scale was used to assess effective sedation. Results: Basic patients characteristics, Mean age (SD) was 31.57 + 10.57 years in category I (P group) and 35.33 + 9.98 years in category II (M group) was comparable between the groups.
    [Show full text]
  • EPIDURAL ANAESTHESIA Dr Leon Visser, Dept
    Update in Anaesthesia 39 EPIDURAL ANAESTHESIA Dr Leon Visser, Dept. of Anesthesiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA INTRODUCTION l Vascular reconstruction of the lower limbs. Epidural anaesthesia is a central neuraxial block Epidural anaesthesia improves distal blood flow in technique with many applications. The epidural space patients undergoing arterial reconstruction surgery. was first described by Corning in 1901, and Fidel l Amputation. Patients given epidural anaesthesia Pages first used epidural anaesthesia in humans in 48-72 hours prior to lower limb amputation may have 1921. In 1945 Tuohy introduced the needle which is a lower incidence of phantom limb pain following still most commonly used for epidural anaesthesia. surgery, although this has not been substantiated. Improvements in equipment, drugs and technique l Obstetrics. Epidural analgesia is indicated in have made it a popular and versatile anaesthetic obstetric patients in difficult or high-risk labour, e.g. technique, with applications in surgery, obstetrics breech, twin pregnancy, pre-eclampsia and prolonged and pain control. Both single injection and catheter labour. Furthermore, Caesarean section performed techniques can be used. Its versatility means it can under central neuraxial block is associated with a lower be used as an anaesthetic, as an analgesic adjuvant to maternal mortality owing to anaesthetic factors than general anaesthesia, and for postoperative analgesia under general anaesthetic. in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. l Low concentration local anaesthetics, opioids, or combinations of both are effective in the control of INDICATIONS postoperative pain in patients undergoing abdominal General and thoracic procedures. Epidural analgesia has Epidural anaesthesia can be used as sole anaesthetic for been shown to minimise the effects of surgery on procedures involving the lower limbs, pelvis, perineum cardiopulmonary reserve, i.e.
    [Show full text]
  • Your Spinal Anaesthetic This Leaflet Explains What to Expect When You Have an Operation with a Spinal Anaesthetic
    Your spinal anaesthetic This leaflet explains what to expect when you have an operation with a spinal anaesthetic. It has been written by anaesthetists, patients and patient representatives, working together. Introduction This leaflet explains: ■ what a spinal anaesthetic is ■ how it works ■ why you could benefit from having one for your operation. What is a ‘spinal’? For many operations it is usual for patients to have a general anaesthetic. However, for operations in the lower part of the body, sometimes it is often possible for you to have a spinal anaesthetic instead. This is when an anaesthetic is injected into your lower back (between the bones of your spine). This makes the lower part of the body numb so you do not feel the pain of the operation and can stay awake. Typically, a spinal lasts one to two hours. Other drugs may be injected at the same time to help with pain relief for many hours after the anaesthetic has worn off. During your spinal anaesthetic you may be: ■ fully awake ■ sedated – with drugs that make you relaxed, but not unconscious. For some operations a spinal anaesthetic can also be given before a general anaesthetic to give additional pain relief afterwards. Your anaesthetist can help you decide which of these would be best for you. rcoa.ac.uk/patientinfo | 1 Your spinal anaesthetic Many operations in the lower part of the body are suitable for a spinal anaesthetic with or without a general anaesthetic. Depending on your personal health, there may be benefits to you from having a spinal anaesthetic.
    [Show full text]
  • Long QT Syndrome
    orphananesthesia Anaesthesia recommendations for patients suffering from Long QT syndrome Disease name: Long QT syndrome ICD 10: I45.8 Synonyms: LQTS Related syndromes: Romano-Ward S., Jervell and Lange-Nielsen S., Timothy S. Long QT syndrome (LQTS) is a cardiac disorder resulting from malfunction of cardiac ion channels. It can be divided in congenital (c-LQTS) and acquired (a-LQTS) forms. Typical is a prolongation of the QT interval on ECG and a propensity to ventricular tachyarrhythmias which can lead to a characteristic polymorphic ventricular tachycardia known as “torsades de pointes”. There is a risk of syncope, cardiac arrest or sudden death. The diagnosis is based on ECG findings, clinical and family history. The Schwartz score defines the probability of LQTS according to three categories: 1 point, low probability of LQTS; (2) 2 or 3 points, intermediate probability of LQTS; and (3) ≥3.5 points, high probability of LQTS. THE TABLE OF THE SCHWARTZ SCORE should be added here: Table 2 of the paper Schwartz PJ and Crotti L. QTc behavior during exercise and genetic testing for the Long-QT Syndrome: Circulation 2011;124:2181-2184. Medicine in progress Perhaps new knowledge Every patient is unique Perhaps the diagnostic is wrong Find more information on the disease, its centres of reference and patient organisations on Orphanet: www.orpha.net 1 Typical surgery The typical surgery for LQTS is left cardiac sympathetic denervation, which is recommended in patients symptomatic for cardiac events despite beta-blocker (BB) therapy or in patients in whom BBs are contraindicated or not tolerated. For therapeutic reasons the implantation of a cardioverter defibrillator (ICD) is recommended in patients with a previous cardiac arrest or in patients with recurrent syncopal events despite antiadrenergic interventions.
    [Show full text]
  • The Safe Spinal Anaesthetic Spinal Anaesthesia Is Not Without Its Complications and Should Only Be Performed for the Correct Indications
    The safe spinal anaesthetic Spinal anaesthesia is not without its complications and should only be performed for the correct indications. Mariane Gertruida Senekal, BMedSc, MB ChB, DA, MMed (Anaesthesiology) Principal Specialist, Department of Anaesthesiology, 3 Military Hospital, and Senior Lecturer, Department of Anaesthesiology, University of the Free State, Bloemfontein Mariane Senekal did her undergraduate training at Stellenbosch University and her postgraduate anaesthesia training at the University of the Free State where she obtained the MMed (Anaesthesiology) in 2005. She has an interest in obstetric anaesthesia, orthopaedic anaesthesia, anaesthesia-related physiology and teaching and training of anaesthesia. Correspondence to: M Senekal ([email protected]) Spinal anaesthesia is relatively easy to must be titrated with care. During the avoided. Indications and contra-indications perform and can potentially be excellent postoperative period the patient should are listed in Table 1. for below the umbilicus. However, it be admitted to the recovery room and can also give rise to serious side-effects monitored. Physiology and complications. To perform a safe Local anaesthetic solution injected into the procedure, the anaesthetist must have A spinal anaesthetic subarachnoid space blocks conduction of adequate knowledge of the indications should only be impulses along all nerves with which it comes and contra-indications, and of the relevant in contact. It acts mainly at spinal nerve roots, anatomy, physiology and pharmacology performed for the although some effect is possible at the cord of spinal anaesthesia. The patient must correct indications. itself. Smaller autonomic and sensory fibres be assessed before administration of the are blocked more easily than motor fibres.
    [Show full text]
  • Safety and Efficacy of Spinal Vs General Anaesthesia in Bone Marrow Harvesting
    Bone Marrow Transplantation, (1998) 21, 1145–1148 1998 Stockton Press All rights reserved 0268–3369/98 $12.00 http://www.stockton-press.co.uk/bmt Safety and efficacy of spinal vs general anaesthesia in bone marrow harvesting ¨ M-A Burmeister1, T Standl1, P Brauer1, K Ramsperger1, N Kroger2, A Zander2 and J Schulte am Esch1 1Department of Anaesthesiology, Bone Marrow Transplantation Unit, and 2Department of Oncology and Haematology, University Hospital Hamburg, Germany Summary: gesia requirement have been demonstrated with RA.4 SPA may also be of interest for economical reasons. Bone marrow harvesting (BMH) can be performed with Nevertheless, SPA with the patient in the prone position either general (GA) or spinal anaesthesia (SPA). Whether is still controversial. One of the main arguments against SPA is advantageous in BMH and if this technique is safe SPA in the prone position is the difficulty in adequately for procedures performed in the prone position is still con- ventilating the patient in the event of respiratory insuf- troversial. To evaluate the safety and efficacy of both ficiency. Several reports have presented cases with cardio- anaesthetic techniques in BMH, 37 allogeneic donors (nine pulmonary arrest and resuscitation during SPA.5–7 female, 28 male; 34.3 ؎ 9 years; ASA class 1–2) received The present prospective study was designed to evaluate either spinal (group 1, n = 20) or general anaesthesia the safety and efficacy of the two different anaesthetic tech- (group 2, n = 17) according to their personal wishes. niques in healthy allogeneic donors undergoing BMH. Under standardised harvesting conditions, haematology parameters, cell counts (MNC, CD34+), haemodynamic parameters, adverse reactions and patient satisfaction Patients and methods were registered.
    [Show full text]
  • Unilateral Fascia Iliaca Block (FIB) for Postoperative Analgesia in Fracture
    ORIGINAL ARTICLE Unilateral Fascia Iliaca Block (FIB) for Post-operative Analgesia in Fracture Neck of Femur Surgery; Comparison with Standard Post-operative Analgesia RIAZ HUSSAIN, TAHIR NAZEER, ASLAM ASIM ABSTRACT Aim: To compare the comfort and post-operative pain in patients undergoing fascia iliaca block with standard post-operative analgesia in fracture neck of femur surgery. Method: 100 patients with ASA class P1, P2 and P3 undergoing surgery were included in this study. Fascia iliaca block (FIB) was applied at the end of surgery. All surgeries were performed under spinal anaesthesia. In group A 50 patients received FIB along with standard postoperative analgesia and in group B, 50 patients received only standard post-operative analgesia with injection diclofenac sodium 75mg IM, 8 hourly and rescue analgesia with 2mg injection nalbuphine according to patient complaint of pain. Results: The degree of pain was significantly lower in patients receiving FIB and they were more comfortable after surgery and quantity of injection nalbuphine rescue analgesia was significantly reduced, compared with patients receiving standard post-operative analgesia only. Conclusion: FIB provides effective post operative analgesia and is associated with markedly reduced analgesia consumption and patient remains more comfortable and satisfied after surgery. Keywords: Nerve blocks, postoperative analgesia, fascia iliaca block, spinal anaesthesia. INTRODUCTION 10 control for at least 24 hours with single short . Post-operative surgical pain is a nightmare
    [Show full text]
  • Spinal Anaesthesia;
    SPINAL ANAESTHESIA The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-2764 SPINAL ANAESTHESIA; COMPARISON BETWEEN PROPHYLACTIC LOW DOSE KETAMINE AND ONDANSETRON FOR PREVENTION OF SHIVERING DURING SPINAL ANAESTHESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES Dr. Muhammad Yousuf1, Dr. Syed Aftab Haider2, Dr. M. Mudassir Aziz3, Dr. Salman Waris4 1. Associate Professor ABSTRACT… Perioperative shivering is a common problem during spinal anaesthesia. It Nishtar Medical College & Hospital, causes tremendous deleterious effects on metabolism of body. Despite of re-warming and Multan 2. Assistant Professor raising the ambient temperature, several drugs are under research to evaluate their preventive Nishtar Medical College & Hospital, role in shivering during anaesthesia like tramadol, butorphanol, midazolam, ketamine and Multan ondansetron. The present study was conducted to evaluate the effect of prophylactic low dose 3. Medical Officer, Nishtar Medical College & Hospital, ketamine and ondansetron for prevention of shivering during spinal anaesthesia. Objective: Multan To compare prophylactic low dose ketamine with ondansetron for prevention of shivering 4. Professor during spinal anaesthesia in patients undergoing lower abdominal surgeries. Study Design: Nishtar Medical College & Hospital, Randomized controlled trial. Setting: Department of Anaesthesia, Nishtar Hospital Multan. Multan Period: November 2012 to May 2013. Material and methods: A total of 256 patients were Correspondence Address: included in the study divided
    [Show full text]
  • The Effect of Anaesthesia and Adrenergic Therapy on the Distribution and Elimination of a Crystalloid Solution Studied by Volume Kinetic Analysis
    The Department of Anaesthesia and Intensive Care Södersjukhuset KAROLINSKA INSTITUTET STOCKHOLM, SWEDEN The Effect of Anaesthesia and Adrenergic Therapy on the Distribution and Elimination of a Crystalloid Solution Studied by Volume Kinetic Analysis Carl-Arne Ewaldsson Stockholm 2006 Previously published papers were reproduced with the permission of the publisher. Published and printed by Karolinska University Press Box 200, SE-171 77 Stockholm, Sweden © Carl-Arne Ewaldsson, 2006 ISBN 91-7140-914-9 2 1 ABSTRACT Intravenous fluid therapy is a mandatory measure during anaesthesia and surgery. It is sometimes combined with adrenergic therapy to maintain haemodynamic stability. It is of great importance to know how the body handles the distribution of fluid in these circumstances in order to minimize the risk of fluid overload. The objective of this thesis was to examine intravenous fluid handling by studying changes in cardiovascular parameters and by using a volume kinetic method to analyze fluid volumes in the body. Methods: In Paper I we studied whether anaesthesia and surgery affect the sensitivity of the β-2 adrenergic receptor in vivo. 10 patients and 10 volunteers were given an intravenous infusion of epinephrine (50 ng/kg/min). Both cardiovascular and biochemical changes were measured for which the ratios of the areas under the curve were calculated. In Paper II an animal model was used to evaluate how different adrenergic stimuli affect the distribution and elimination of crystalloid fluid bolus. The impact of three different drugs (dopamine 50 µg/kg/min, isoprenaline 0.1 µg/kg/min and phenylephrine 3 µg/kg/min) on the relationship between plasma dilution and haemodynamics was evaluated.
    [Show full text]
  • Comparison of Outcomes of Using Spinal Versus General Anesthesia in Total Hip Arthroplasty He Role of Spirin
    An Original Study Comparison of Outcomes of Using The Role of Spinal Versus General Anesthesia in Aspirin Total Hip Arthroplasty Keith R Stephen G. Maurer, MD, Andrew L. Chen, MD, Rudi Hiebert, MSc, Gavin C. Pereira, FRCS, and Paul E. Di Cesare, MD Studies comparing epidural regional versus GA in Abstract patients undergoing THA have reported a correlation Blood loss, operative time, and rate of complications were compared in 606 patients undergoing primary unilateral total between regional anesthesia and shorter operative time, hip arthroplasty with either spinal anesthesia (SA) or general decreased intraoperative and postoperative blood loss, anesthesia (GA). Patients were followed for 2 years after reduced blood replacement, and fewer thromboembolic surgery. Compared with GA, SA resulted in mean reductions complications.6-15 A search of the literature revealed no of 12% in operative time, 25% in estimated intraoperative reports of clinical outcomes in unilateral THA related to blood loss, 38% in rate of operative blood loss, and 50% use of SA. Differences in type, dosage, and placement of in intraoperative transfusion requirements. Compared with anesthesia and consequent differences in benefits and risks patients receiving GA, patients receiving SA had higher between epidurals and SA merit a separate study. The pur- hemoglobin levels on postoperative days 1 and 2 and a 20% pose of this study was to determine whether SA is superior lower total transfusion requirement. SA appears superior to to GA for primary unilateral THA. GA for this procedure. MATERIALS AND METHODS atients undergoing unilateral total hip arthroplasty The study population consisted of all cases of primary (THA) may be offered either regional or general unilateral THA at the Hospital for Joint Diseases between anesthesia (GA).
    [Show full text]
  • Review Course Lectures
    Review Course Lectures International Anesthesia Research Society IARS 2011 REVIEW COURSE LECTURES The material included in the publication has not undergone peer review or review by the Editorial Board of Anesthesia and Analgesia for this publication. Any of the material in this publication may have been transmitted by the author to IARS in various forms of electronic medium. IARS has used its best efforts to receive and format electronic submissions for this publication but has not reviewed each abstract for the purpose of textual error correction and is not liable in any way for any formatting, textual, or grammatical error or inaccuracy. 2 ©2011 International Anesthesia Research Society. Unauthorized Use Prohibited IARS 2011 REVIEW COURSE LECTURES Table of Contents Perioperative Implications of Emerging Concepts In Management of the Malignant Hyperthermia Vascular Aging, Health And Disease Patient In Ambulatory Surgery Charles W. Hogue, MD ..............................1 Denise J. Wedel, MD ...............................38 Professor of Anesthesiology and Professor of Anesthesiology, Mayo Clinic Critical Care Medicine Rochester, Minnesota Chief, Division of Adult Anesthesia The Johns Hopkins University School of Medicine, Central Venous Access Guideline The Johns Hopkins Hospital Development and Recommendations Baltimore, Maryland Stephen M. Rupp, MD ..............................41 Anesthesiologist Perioperative Management of Pain and PONV in Medical Director, Perioperative Services Ambulatory Surgery Virginia Mason Medical Center, Seattle, Washington Spencer S. Liu, MD .................................5 Clinical Professor of Anesthesiology Pediatric Anesthesia and Analgesia Outside the OR: Director of Acute Pain Service What You Need To Know Hospital for Special Surgery Pierre Fiset, MD, FRCPC............................47 New York, New York Department Head, Anesthesiology Montreal Children’s Hospital Colloid or Crystalloid: Any Differences In Outcomes? Montreal, Quebec, Canada Tong J.
    [Show full text]