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Hyperbaric Bupivacaine (hyperbaric + bupivacaine)
Selected AbstractsUnilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine,clonidine combinationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2009R. MERIVIRTA Backround: Low-dose hyperbaric bupivacaine has been used to produce unilateral spinal anaesthesia for outpatient surgery. Unilateral spinal anaesthesia is associated with reduction of hypotension, faster recovery and increased patient satisfaction. Small doses of clonidine have shown effectiveness in intensifying spinal anaesthesia. We investigated the effect of adding 15 ,g of clonidine to 5 mg hyperbaric bupivacaine on unilaterality. Methods: Sixty patients undergoing outpatient knee arthroscopy were randomly allocated to receive either 1.2 ml (6 mg) of hyperbaric bupivacaine or a 1.2 ml solution containing 1.0 ml (5 mg) hyperbaric bupivacaine, 0.1 ml (75 ,g) clonidine and 0.1 ml sterile water. The motor block was assessed by a modified Bromage scale and the sensory block by a pinprick. Results: There was a significant difference in the spread of anaesthesia between the operated and contralateral sides in both groups. Seventy-seven per cent of the blocks were unilateral in group B and 73% in group B-C. There was no significant difference between the groups, in unilaterality. The motor block was prolonged in group B-C but it did not affect home-readiness. Patients receiving clonidine needed more vasopressors. There was a significant difference in blood pressures between the groups, being lower in group B-C after 1 h 45 min. Conclusion: Using 5 mg hyperbaric bupivacaine with 15 ,g of clonidine, the unilaterality can be achieved and spinal anaesthesia intensified without affecting home-readiness. More vasopressors are needed in the beginning, but after the surgery patients experienced less pain. [source] Intrathecal neostigmine with bupivacaine for infants undergoing lower abdominal and urogenital procedures: dose responseACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009Y. K. BATRA Background: Intrathecal (IT) neostigmine produces dose-dependent analgesia in adults. However, the dose of spinal neostigmine has not been investigated in infants. The purpose of this study was to assess spinal anesthesia (SA) duration provided by four doses of spinal neostigmine added to bupivacaine for lower abdominal and urogenital procedures in infants. Methods: Seventy-five infants were randomized into five groups. The control group B received IT plain 0.5% hyperbaric bupivacaine. Groups BN.25, BN.50, BN.75, and BN1.0 received bupivacaine with 0.25, 0.5, 0.75, and 1 ,g/kg of neostigmine, respectively. The primary variable was the duration of anesthesia assessed by recovery of hip flexion. Postoperative pain with facial expression, leg activity, arm activity, crying and consolability scale score,and rescue analgesic requirements were the secondary variables measured, and the side effects were noted. Results: Seventy-three infants completed the study. There was a significant linear increase in SA duration with IT neostigmine to 65.2 (4.3) min with 0.5 ,g/kg (P<0.01), 88.2 (5.1) with 0.75 ,g/kg (P<0.001) and 92 (4.3) with 1 ,g/kg (P<0.001) from 52.4 (4.3) min with bupivacaine alone. SA duration showed no significant difference between plain bupivacaine and BN.25 (P=0.100) or between groups BN.75 and BN1.0 (P=0.451). Groups BN.75 and BN1.0 had significantly reduced pain scores, and the median duration before the first dose rescue analgesic was requested prolonged significantly (P<0.001) compared with the other three groups. Conclusions: IT neostigmine at a dose of 0.75 ,g/kg added to bupivacaine significantly prolonged SA duration with reduced postoperative pain scores and rescue analgesic requirements in infants undergoing lower abdominal and urogenital procedures. No additional benefits were provided on increasing it to 1 ,g/kg. [source] Discharge home in 3 h after selective spinal anaesthesia: studies on the quality of anaesthesia with hyperbaric bupivacaine for ambulatory knee arthroscopy,ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2006A.-M. Korhonen No abstract is available for this article. [source] Feasibility of electromyography (sEMG) in measuring muscular activity during spinal anaesthesia in patients undergoing knee arthroplastyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005L. Niemi-Murola Background:, Bromage scale (0,3) is used to measure the degree of motor block during spinal anaesthesia. However, an estimation of motor block is difficult during surgery. The purpose of this study was to evaluate the feasibility of surface EMG describing spontaneous muscular activity in the lower extremities during spinal anaesthesia. Methods:, In part I of the study, 13 patients undergoing day case surgery were studied. They received 10 mg hyperbaric bupivacaine at interspace L3,4. EMG, sensory and muscular block were measured at 5-min intervals during the first 30 min and then every 15 min until the patient was able to flex the knee. In part II of the study, 16 patients undergoing knee arthroplasty received 10 mg bupivacaine through spinal catheter at interspace L3,4 (Group CSA). An additional bolus of 2.5 mg was administered using EMG-guidance, if needed. Another group, 15 patients, received a single bolus of bupivacaine (15,20 mg) at L3,4 (Group Bolus). EMG, muscular and sensory block were monitored as described above. The epidural catheter was used as rescue. Results:, Part I: EMG compared to modified Bromage scale showed a significant correlation (P < 0.01, Spearman rank correlation). Part II: The amount of bupivacaine was significantly reduced with EMG guidance when compared with the single bolus group (14.0 mg vs. 17.0 mg) (P < 0.05 Mann,Whitney U). Motor block started to recover before the sensory block in 7/15 CSA patients vs. 1/15 Bolus patient. Conclusion:, Stable maximal sensory block does not necessarily correlate with adequate motor block in patients receiving spinal anaesthesia induced with small bolus doses. In spite of electrical noise, EMG-guided administration of spinal anaesthesia significantly reduced the amount of bupivacaine compared to the hospital routine. Further studies are needed to develop the method. [source] Posture-related distribution of hyperbaric bupivacaine in cerebro-spinal fluid is influenced by spinal needle characteristicsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2001C. Mardirosoff Background: No studies have evaluated the relationship between duration of time sitting and spinal needle type on the maximal spread of local anaesthetics. The few trials available have studied the influence of time spent sitting on the spread of anaesthesia without standardising spinal needle types, and have not found any effect. Methods: In this randomised, blinded study, 60 patients scheduled for elective orthopaedic surgery of the lower limbs were divided into 4 groups. With the patient sitting erect, 15 mg hyperbaric bupivacaine were injected in a standard manner through a 24G Sprotte or a 27G Whitacre needle and patients were placed supine after 1 min (24G/1 group and 27G/1 group) or 4 min (24G/4 group and 27G/4 group). Results: Time to achieve maximum block height after injection was similar in all groups. Block height levels were significantly lower at all time points for the 24G/4 group. Maximum block heights were Th4 in the 24G/1, 27G/1 and 27G/4 groups, and Th6 in the 24G/4 group (P<0.0001). Conclusion: In a standard spinal anaesthesia procedure, when different lengths of time spent sitting are compared, spinal needle characteristics influence the maximum spread of hyperbaric bupivacaine. However, within the limits of our study, a two-segment difference in block height is too small to consider using spinal needles as valuable tools to control block height during spinal anaesthesia in our daily practice. [source] The effect of intrathecal fentanyl on Cerebral State Index-guided sedation during spinal anaesthesia,ANAESTHESIA, Issue 12 2009J. Y. Kim Summary This study investigated the effect of intrathecal fentanyl on the dose of propofol during sedation guided by Cerebral State Index monitoring. Seventy patients were randomly assigned to receive either fentanyl 25 ,g (n = 35) or normal saline (n = 35) with hyperbaric bupivacaine 12.5 mg for spinal anaesthesia. Propofol was infused to maintain a Cerebral State Index value of 65,75 for 30 min. The propofol infusion time and dose required to reach a Cerebral State Index value of 75 were recorded together with the time required to reach a Cerebral State Index value higher than 90 after cessation of sedation. The onset time for sedation was faster and the recovery time was slower in the fentanyl group compared to those in the saline group (p = 0.018 and 0.027, respectively). The propofol doses required for onset and maintenance of sedation were significantly lower in the fentanyl group compared to those in the control group (p = 0.018 and < 0.001, respectively). In conclusion, adding intrathecal fentanyl 25 ,g during spinal anaesthesia significantly reduced the dose of propofol required for sedation and prolonged the subsequent recovery time. [source] | ||||||||||