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Epidural Anesthesia (epidural + anesthesia)

Distribution by Scientific Domains

Medical Sciences	86%
Life Sciences	13%

Selected Abstracts

Post-Dural Puncture Headache: Part II , Prevention, Management, and Prognosis

HEADACHE, Issue 9 2010
David Bezov MD
Post-dural puncture headache (PDPH) is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. As PDPH can be disabling, clinicians who perform these procedures should be familiar with strategies for preventing this disorder. Since the best preventative measures sometimes fail, clinicians should also be familiar with the therapeutic approaches for PDPH. Herein, we review the procedure-related risk factors for PDPH, the prognosis of PDPH and the studies of PDPH treatment. We divide the therapeutic approach to PDPH into 4 stages: conservative management, aggressive medical management, conventional invasive treatments, and the very rarely employed less conventional invasive treatments and provide management algorithm to facilitate treatment. [source]

Isolated Cortical Venous Thrombosis Associated With Intracranial Hypotension Syndrome

HEADACHE, Issue 6 2009
Sait Albayram MD
The association of intracranial hypotension syndrome with cerebral venous thrombosis is rare. We report our experience with isolated cortical venous thrombosis, which developed after unsuccessful epidural anesthesia. Magnetic resonance imaging showed characteristic imaging findings of intracranial hypotension syndrome, such as dural thickening and brain sagging. We also detected right parietal venous hemorrhagic infarction secondary to right-sided cortical venous thrombosis. After the treatment of intracranial hypotension via epidural blood patch, heparin was used to treat cortical venous thrombosis. [source]

Adjuvant hydrodistension under epidural anesthesia for interstitial cystitis

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2003
TETSUO YAMADA
ABSTRACT Background: Hydrodistension is the first choice of treatment for interstitial cystitis because it allows for diagnosis, bladder biopsy and treatment. However, the method and efficacy of hydrodistension are variable. We performed adjuvant hydrodistension and examined the efficacy and factors that influence prognosis. Methods: Fifty-two patients participated in the present study as subjects; they satisfied the diagnostic inclusion and exclusion criteria established by the National Institute of Diabetes, Digestive and Kidney Disease (NIDDK) in 1987, USA. Under epidural anesthesia, the bladder was repeatedly distended up to the maximal bladder capacity for treatment, diagnosis and biopsy. Hydrodistension was performed again on the following day for approximately 30 min under epidural anesthesia in a ward until macroscopic hematuria disappeared. Results: Five patients were classified into the good, 30 into the moderate and 17 into the poor response group. In the good response group, three patients had type I allergy and one patient did not fulfil all of the positive factors in the NIDDK criteria. The poor response group included one patient with collagen disease. The poor response group was further divided into two subgroups based on bladder capacity. One subgroup included eight patients with a bladder capacity of less than 100 mL and vesicoureteral reflux (VUR). The other subgroup included nine patients with a bladder capacity of more than 100 mL. Among these nine patients there were five patients who lacked one or two positive factors in the NIDDK criteria. Conclusion: Adjuvant hydrodistension under epidural anesthesia is effective for about 70% of patients for more than 3 months. It can be performed in a ward without any serious complications. It was observed that patients lacking one or two positive factors were included in the good and poor response groups. [source]

Histologic upgrading of prostate cancer occurs frequently over a short period of time: Single hospital experiences of radical prostatectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2001
Hideki Mukouyama
Abstract A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2,3 weeks postoperatively and had regular follow-up treatment. The mean age (± SD) was 68.75 (± 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months). [source]

Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009
Y. GINOSAR
Background: The pulse oximeter perfusion index (PI) has been used to indicate sympathectomy-induced vasodilatation. We hypothesized that pulse oximeter PI provides an earlier and clearer indication of sympathectomy following epidural anesthesia than skin temperature and arterial pressure. Methods: Forty patients received lumbar epidural catheters. Patients were randomized to receive either 10 ml 0.5% bupivacaine or 10 ml 0.25% bupivacaine. PI in the toe, mean arterial pressure (MAP) and toe temperature were all assessed at baseline and at 5, 10 and 20 min following epidural anesthesia. The effect of epidural anesthesia over time was assessed by repeated measures analysis of variance. Additionally, we defined clinically evident sympathectomy criteria (a 100% increase in the PI, a 15% decrease in MAP and a 1 °C increase in toe temperature). The numbers of patients demonstrating these changes for each test were compared using the McNemar test for each time point. Results: Twenty-nine subjects had photoplethysmography signals that met a priori signal quality criteria for analysis. By 20 min, PI increased by 326%, compared with a 10% decrease and a 3% increase in MAP and toe temperature, respectively. For PI 15/29, 26/29 and 29/29 of the subjects met the sympathectomy criteria at 5, 10 and 20 min, respectively, compared with 4/29, 6/29 and 18/29 for MAP changes and 3/29, 8/29 and 14/29 for toe temperature changes. Conclusions: PI was an earlier, clearer and more sensitive indicator of the development of epidural-induced sympathectomy than either skin temperature or MAP. [source]

Sling operations in the treatment of stress urinary incontinence: How to adjust sling tension

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2003
Ibraheem Mahmoud Ezzat
Abstract Aim:, To find an objective method of adjusting sling tension in order to avoid postoperative urinary obstruction. Methods:, Thirty-five female patients with type II/III and type III stress urinary incontinence were treated using a sling procedure. Pubovaginal fascial slings were implanted in 20 patients and polytetrafluoroethylene patch slings with nylon sutures were implanted in 15 patients. During the procedures the urinary bladder was partially full and the patients, who were under spinal or epidural anesthesia, were asked to cough and strain. The proper tension that effectively prevents urine leakage was selected and the corresponding suture length was marked. An objective new method to adjust sling tension was used. As part of this method, the abdominal bulge index is added to the suture length before tying. Results:, Short-term follow-up of 6,12 months showed that 33 of 35 patients reported no leakage of urine (94%). Two patients had unsatisfactory urge incontinence. We did not encounter postoperative urinary retention in any patient. No significant post-voiding residual urine was reported. None of our patients in this series have complained of difficulties during micturition or the need to strain during voiding. Conclusion:, Proper adjustment of sling tension using the abdominal bulge index has eliminated postoperative urinary retention and obstructed urine flow, including any appreciable amount of post-voiding residual urine. This method has been found to be both objective and reproducible. [source]

Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2007
B. C. H. Tsui
Background:, Continuous cervical epidural anesthesia can provide excellent peri- and post-operative analgesia, although several factors prevent its widespread use. Advancing catheters from thoracic levels to the cervical region may circumvent these barriers, provided they are accurately positioned. We hypothesize that guiding catheters from thoracic to cervical regions using low-current epidural stimulation will have a high success rate and enable excellent analgesia in adults undergoing total shoulder arthroplasty. Methods:, After Institutional Review Board approval, adult patients were studied consecutively. A 17-G Tuohy needle was inserted into the thoracic epidural space using a right paramedian approach with loss of resistance. A 20-G styletted epidural catheter, with an attached nerve stimulator, was primed with saline and a 1,10 mA current was applied as it advanced in a cephalad direction towards the cervical spine. Muscle twitch responses were observed and post-operative X-ray confirmed final placement. After a test dose, an infusion (2,8 ml/h) of ropivacaine 2 mg/ml and morphine 0.05 mg/ml (or equivalent) was initiated. Verbal analog pain scale scores were collected over 72 h. Results:, Cervical epidural anesthesia was performed on 10 patients. Average current required to elicit a motor response was 4.8 ± 2.0mA. Post-operative X-ray of catheter positions confirmed all catheter tips reached the desired region (C4,7). The technical success rate for catheter placement was 100% and excellent pain control was achieved. Catheters were positioned two to the left, four to the right and four to the midline. Conclusion:, This epidural technique provided highly effective post-operative analgesia in a patient group that traditionally experiences severe post-operative pain and can benefit from early mobilization. [source]

Postnatal effects of obstetrical epidural anesthesia on allergic sensitization

ALLERGY, Issue 1 2007
P. V. Kirjavainen
No abstract is available for this article. [source]

Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2002
F. Bach
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation-dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB. Methods: We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 µg · kg,1 · min,1) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time-matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [(body height (cm) , 100) · 10,1=ml·h,1] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF-,), soluble TNF receptor, human soluble intercellular adhesion molecule-1, C-reactive protein (CRP) and leukocyte count were measured as parameters of inflammation. Results: All parameters significantly increased following CPB. Increases of PCT, TNF-, and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON-group. Conclusion: These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti-inflammatory effects. [source]

Pupillary reflex dilation and skin temperature to assess sensory level during combined general and caudal anesthesia in children,

PEDIATRIC ANESTHESIA, Issue 9 2004
John Emery MBBS, frca
Summary Background:, Regional anesthesia causes sympathetic blockade, vasodilation and higher skin temperature in anesthetized dermatomes. Measurement of skin temperature changes might provide a useful estimate of the level of caudal anesthesia in children. Pupillary reflex dilation (PRD) allows estimation of the sensory level during combined general/epidural anesthesia in adults, but has not been assessed in children. This study was designed to evaluate skin temperature and PRD as methods of estimating sensory level in children receiving combined general/caudal epidural anesthesia. Methods:, Twenty ASA I and II children aged 10 months,5 years were enrolled. Anesthesia was induced with sevoflurane and N2O in O2 and maintained with 1 MAC isoflurane and air in O2. Caudal epidural anesthesia was achieved by injection of 1 ml·kg,1 0.25% bupivacaine. Skin temperature was measured by rapid response infrared thermometry. PRD was measured using an ophthalmic ultrasound biomicroscope (UBM). The three criteria used to estimate sensory level were a drop in skin temperature of 0.5°C between dermatomes, PRD of 50% and PRD of 0.2 mm. Results:, A drop in skin temperature of 0.5°C between dermatomes allowed estimation of the sensory level in only 20% of patients. PRD of 50%, and PRD of 0.2 mm allowed estimation of the sensory level in 45 and 100% of patients, respectively. PRD was significantly greater above the T10 dermatome compared with L2 (P < 0.01). The maximum pupillary dilation was significantly greater in children over 2 years of age [1.3 ± 0.8 mm sd)] compared with children less than two years of age [0.6 ± 0.3 mm sd)]. Conclusions:, Skin temperature cannot be used to estimate sensory level during combined general/caudal epidural anesthesia. PRD of 0.2 mm is sensitive to the loss of analgesia but is not clinically useful. PRD may be useful above 2 years of age. [source]

Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment options

PRENATAL DIAGNOSIS, Issue 3 2009
Waldo Sepulveda
Abstract Objective To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques. Methods Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage. Results The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery. Conclusions There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Teaching of Anatomy of Genital Organs in the Large Animals

ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 2005
G. M. Constantinescu
At the University of Missouri-Columbia, USA, teaching the anatomy of genital organs in large (and in small) animals is clinically oriented. In the male horse, ox, and pig, the descriptive anatomy of the structures is taught in that order as they are listed in Nomina Anatomica Veterinaria. Clinical correlates are immediately mentioned in relation to each of the following structures. The testicle, epididymis, ductus deferens, spermatic cord, and tunics of spermatic cord and testis are correlated to the castration, criptorchidism, ectopic testicles, and inguinal herniae, as well as to the landmarks and approaches to different clinical techniques. The penis and male urethra are correlated to the prolapse of the prepuce, ulcerative posthitis, balanitis, penile deviation, penischisis, persistent penile frenulum, short retractor penis muscle, catheterization of the urethra, the contagious equine metritis (CEM), etc. In the female horse, ox and pig, following the similar order as in the male species, the ovary and the salpinx are correlated to the diagnosis of pregnancy by rectal exploration, ovarian hypoplasia, ectopic pregnancy, and ovariectomy. The uterus is correlated to the different aspects of metritis and endometritis, to the retained placenta, pyometra, uterine torsion, uterine prolapse and eversion, Caesarian section, diagnosis of pregnancy and different stages of oestrus by rectal exploration, double external ostium of the cervix, distocia, and the assessment of possible difficulties in the birth process. The vagina and vestibulum vaginae are correlated to the gaertneritis, vaginal and cervical prolapse, vaginitis, catheterization of the urinary bladder, and pelvimetry. The vulva and clitoris are correlated to vulvitis, balanitis, distocia, episiotomy, and transmissible genital diseases. Different kinds of udder diseases (mastitis) are based on the thorough knowledge of the anatomy of the udder including the blood and nerve supply and the lymphatic system. The two techniques of epidural anesthesia (Magda and Farquharson in ruminants) and subsacral anaesthesia (Popescu) for diagnosis and treatment purposes are explained in detail. [source]