Anesthetic Technique In Patients Research Articles

Anesthesia for Intracavitary Brachytherapy: a 19-month Experience at the Philippine General Hospital during the COVID-19 Pandemic.

Brachytherapy is the only demonstrated technique of delivering the high radiation dose required to control cervical cancer (>80 Gray [Gy]) without causing unwanted side effects. There is still limited data available in the Philippines regarding the anesthetic management of patients receiving intracavitary brachytherapy for cervical cancer. It is the aim of this study to present the anesthetic management of these procedures performed in a non-operating site remote from the main hospital during the first 1 ½ years of the COVID-19 pandemic. A retrospective review of 446 eligible charts was made. Data collected included demographic variables, ASA physical status classification, anesthetic technique, anesthetic agents used, oxygen supplementation device, duration of procedure, intra-procedure complication, intra-procedure pain medications, post-procedure pain medications, recovery room (RR) rescue medications, time to fulfill discharge criteria, and patient disposition. Four hundred forty-six (446) anesthetic encounters involving 117 patients is presented. Charts from 46 patients were excluded as it cannot be located. Mean age of the patients was 49 years with majority having normal BMI. Spinal anesthesia (SA) was more frequently (75%) used compared to total intravenous anesthesia (TIVA). Less than 5% immediate anesthesia-related complications were recorded and all patients were discharged on the same day. Spinal anesthesia and TIVA are safe and effective anesthetic techniques in patients with cervical cancer undergoing high dose intracavitary brachytherapy. Prospective studies to assess other aspects of their care as well as anesthesia-related long-term effects from repetitive anesthetic exposure is recommended.

Regional Anesthesia In Patients With Parkinson's Disease

Parkinson's disease is a degenerative disease of the central nervous system, which occurs in 1% of the population over 60 years of age. This disease is caused by the loss of dopaminergic nerve fibers in the basal ganglia of the brain due to an immune response. Parkinsonism is the name given to a clinical syndrome consisting of disorders of voluntary movement (hypokinesia), stiffness, and tremors. The typical pathological picture is the destruction of nerve cells containing dopamine in the substantia nigra of the basal ganglia. The selection of anesthetic techniques in patients with Parkinson's disease plays an important role in minimizing complications and patient morbidity and mortality. Anesthetic concerns in patients with Parkinson's disease are the presence or absence of interactions with anti-Parkinson's drugs that the patient is taking, decreased organ function due to old age, such as decreased cardiovascular, respiratory, and autonomic nerve function. In this case, the patient with Parkinson's disease will undergo repositioning of the left femoral head due to the dislocation. We chose regional anesthesia because it has several advantages over general anesthesia. The results during and after surgery were good, there were no complications and the patient returned to the room.

Regional Pain Blocks and Perioperative Pain Control in Patients Undergoing Breast Implant Removal With Capsulectomy.

Demand for breast implant removal is on the rise, with more than 36,000 explants performed in 2020, an increase of 7.5% from previous years. Postoperative (PO) analgesia is an important consideration in this patient group due to scar tissue surrounding the implant and the potential for extensive dissection during capsulectomy. The authors sought to compare perioperative pain control between three different types of ultrasound (US)-guided regional anesthetic techniques in patients undergoing implant removal with capsulectomy. The authors reviewed all patients who received an US-guided block and underwent breast implant removal with capsulectomy at their outpatient surgical center over a 2-year period. They compared intraoperative (IO), PO opioid requirement, and patient-reported pain on the first postoperative day (POD1) between 3 different block techniques using chi-square analysis. A P-value of <.05 was considered statistically significant. A total of 352 patients were included. Twenty-six patients (7.4%) underwent a serratus plane (SP) block, 13 (3.7%) underwent an erector spinae combined with pectointercostal fascial plane (ES + PIFP) block, and 313 (88.9%) underwent an erector spinae combined with pectoral nerve (ES + PECS1) block. ES + PECS1 was associated with less IO and PO opioid use compared with SP and ES + PIFP (1.9% vs 19.2% vs 61.5%, P < .001 for IO, 26.8% vs 34.6% vs 38.5% PO, P < .001). The ES + PECS1 block was associated with mild pain on POD1 compared with the other 2 regional block techniques (P = .001). Regional pain blocks, and specifically the ES block, offer effective pain control for patients undergoing breast implant removal with capsulectomy, demonstrating high patient satisfaction in the PO period with low opioid requirements.

A prospective study of various anesthetic techniques in patients with acyanotic congenital heart diseases undergoing device closure.

Transcatheter device closure of congenital heart defects (CHD) has recently gained popularity. As limited literature exists regarding the ideal anesthetic technique for these procedures, we studied the perioperative anesthetic management and its effects on hemodynamics and complication rate in patients undergoing device closure. In this prospective observational study, all patients of 1 month to 50 years of age with acyanotic congenital heart diseases undergoing device closure were included. The anesthesia technique, i.e., general anesthesia with endotracheal tube (GETA)/supraglottic airway device (SGD) or conscious sedation with face mask (S-FM), and intravenous induction agent used was noted. Intraoperatively vital parameters, use of transesophageal echocardiography (TEE), and perioperative complications if any, were noted. Descriptive statistical analysis was done using a statistical package for the social sciences (SPSS) version 15. GETA was used in the atrial septal defect (ASD) (62.8%), patent ductus arteriosus (PDA) (66.7%), ventricular septal defect (VSD) (65%) patients, SGD in ASD (6.3%), PDA (16.7%), and VSD (13.3%) patients. S-FM in ASD (31.3%), PDA (16.7%) and VSD (21.7%) patients. Etomidate was used as an induction agent in 30.61% of the patients and propofol in 69.39% of the patients. The mean arterial pressure (MAP) in the etomidate and propofol groups was statistically insignificant while decreased heart rate was noted in both groups. Complications like SGD dislodgement, supraventricular tachycardia, and device dislodgements were seen. In PDA device closure patients, GETA should be preferred. Patients for VSD device closure should receive general anesthesia as complications are common. In ASD device closure, patients without TEE use can be done under general anesthesia with SGD.

Axilary Block Ultrasound Guiding in Patient with Pseudoaneurysm Regio Brachii Sinistra pro Repair Pseudoaneurysm

Background: An aneurysm may be a true aneurysm or a pseudoaneurysm. Pseudoaneurysm is defined as a defect in the arterial wall, making a connection between the lumen and the extraluminal space. The main etiology of brachial artery pseudoaneurysm is incidental arterial puncture during venous cannulation for hemodialysis. Case:: Anesthetic management was performed on a female patient 56 years old, body weight 45 kg, height 150 cm. The patient had other comorbidities such as hypertension, diabetes mellitus, chronic renal kidney with a diagnosis of left brachial pseudoanuerysm. Pro Pseudoanurysm repair surgery. The anesthetic technique uses axillary peripheral nerve block with ultrasound guiding. The duration of surgery is ± 120 minutes. After the operation, the patient was treated in the hospital ward. Conclusion: Choosing the most appropriate anesthetic technique for patients with renal impairment is necessary to maintain normovolemia and normotension in order to avoid unexpected complications. Using regional anesthetic technique for sympathetic nerve block may be favorable in these patients. With ultrasound guiding, the incidence of failure is lower, the time required is shorter, the latency is shorter, the blockade is longer, and the risk of accidental vascular puncture is lower so that vascular lesions are less likely.

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

Background: Patients undergoing amputation of the lower extremities usually have poor circulation and other comorbidities and, therefore, present a challenge to the anesthesiologist. The combination of sciatic and femoral nerve block is reported to be an effective anesthetic technique for patients undergoing knee surgery, and it is known to be an effective method of postoperative analgesia in patients undergoing major surgery on the subject's lower extremities. Case: A 70-year-old man with a recent embolism stroke, death of his limb on the right cruris region, and underwent an amputation above the knee. Preoperative physical examination showed GCS E4 V, motor aphasia M6, blood pressure 131/82 mmHg, pulse 114 bpm, RR 20 times/minute with bodyweight 70 kg, height 160 cm, SpO2 97%. There was cyanosis in the right cruric region with motor power of 1/5 1/5. The value of leukocytes 18,600/ul, platelets 309,000/ul, Prothrombin Time (PT) 15.8 seconds, Activated partial thromboplastin time (APTT) 25.9 seconds, International normalized ratio (INR) 1,330, neutrophils 81.7%, lymphocytes 12.6%, creatinine 1.8 mg/dl, urea 137 mg /dl, blood sugar at the time 258 mg/dl, Cl 95 mmol/l. This case report suggests that ultrasound-guided peripheral nerve blocks may be useful for major lower extremity surgery in patients with severe hemodynamic impairment. Conclusion: Perioperative management of embolism stroke patients undergoing above-knee amputation requires special attention in selecting anesthetics. Ultrasound-guided peripheral nerve blocks minimize patient hemodynamic changes and provide better postoperative pain control.

Regional anaesthesia in patients with diabetes.

Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and non-infective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes.

Caesarean section for placenta praevia: A retrospective study of anaesthetic technique and foeto-maternal

Introduction: Placenta praevia complicates approximately 0.3-0.8% of pregnancies in multiparous parturient and there is an increased risk in those with previous Caesarean section. The choice of anaesthetic technique usually poses dilemma to the attending anaesthetist. The aim of this study was to review the choice of anaesthetic technique for caesarean section complicated by placenta praevia and determine foeto-maternal outcome.Patients and Methods: This was a retrospective survey covering a period of four years (January 2013 - December 2016). After Ethics Committee approval, information was obtained from the anaesthetic and theatre records and the patients’ case notes. The information obtained were: patients’ characteristics, obstetric history, grade of placenta praevia, indications for surgery, choice of anaesthetic technique, PCV/haemoglobin level, haemodynamic changes, blood transfusion, maternal and foetal outcome. The data were analysed using IBM SPSS version 20.Results: A total of 4,388 Caesarean sections were carried out during the 4- year period of review. One hundred and forty-five cases (3.3%) with different degrees of placenta praevia progressing to Caesarean section were identified. The mean age (years) was 32.6+5.3 with a mean gestational age(weeks) of 36.7±1.11. Thirty-nine (26.9%) patients were offered general anaesthesia while 106 (73.1%) were done under spinal anaesthesia. The mean blood loss in the GA and spinal group was 1,080 + 970.53 and 753.77 + 568.19 ml respectively (P = 0.0135). 87.6% neonates were delivered alive. Seventy-nine (54.5%) were elective procedure with adequate preparation. There were two (1.4%) cases of maternal mortality and perinatal mortality of 12.4%.Conclusion: The anaesthetic technique for patients with placenta praevia should be determined by the patient’s haemodynamic status and the grade of the placenta praevia.

Combined Interscalene and Superficial Cervical Plexus Block for Clavicle Surgery: Case Series

General Anesthesia is preferred over regional anesthesia in clavicle surgery. We report 3 cases of clavicle fracture which was performed under USG guided combined Interscalene and Superficial cervical plexus block. All the patients were comfortable and there was no need for additional analgesia. Thus regional anesthesia can be used as a sole anesthetic technique in patients with clavicle fracture and can be an alternative where general anaesthesia and its adverse effects needs to be avoided.&#x0D; Keywords: clavicle fracture; interscalene brachial plexus block; superficial cervical plexus block. Correspondance: Dr.

Assessment of Complications Associated with Various Anesthetic Techniques in Patients Undergoing Hip Replacement Surgeries: A Retrospective Study

Background: Hip fracture in the elderly is a very common fracture, which mainly requires surgical treatment. Hence; we planned the present study to assess various complications associated with various anesthetic techniques in patients undergoing hip replacement surgeries. Subjects and Methods: Analysis of data files of a total of 160 patients was done.&nbsp; Retrieval of complete demographic and clinical data of all the subjects included in the present study was done.&nbsp; Recording of following parameter was done: Form of anaesthetics technique, Surgical procedure duration, and Fluid type and amount administered. Complication of the results was done by SPSS software. &nbsp;Results: Most commonly observed complications observed in the present study were hypotension, bleeding, embolism and cardiac arrest. Non- significant results were obtained while comparing the occurrence of complications among different study groups. Conclusion: Various types of anaesthetics techniques can be used with equal effectiveness among patients undergoing Hip replacement surgery.

Efficacy of Epidural Dexamethasone Combined with Intrathecal Nalbuphine in Lower Abdominal Oncology Operations.

Background:Dragging pain during lower abdominal surgeries under intrathecal anesthesia is a common problem. Epidural steroid seemed to be effective in reducing intra and postoperative pain. Kappa receptor agonist like nalbuphine helps in reduction of visceral pain. Hence, this study was designed to detect the efficacy of epidural steroid dexamethasone with intrathecal Kappa opioid as a sole anesthetic technique in patients subjected to lower abdominal oncology operations.Patients and Methods:Patients were randomly allocated into two groups; epidural placebo group–control group (Group P) – Intrathecal injection of 20 μg fentanyl followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5%, then (epidural injection placebo 15 mL volume of sterile saline 0.9%). Epidural dexamethasone group–study group (Group D) – Intrathecal injection of 0.6 mg nalbuphine followed by intrathecal injection of (15 mg) of hyperbaric bupivacaine 0.5% then (epidural injection of 8 mg dexamethasone in 15 mL total volume using sterile saline 0.9%).Results:Group D recorded significantly longer times to 1st analgesic request, sensory regression to S1 and modified bromage Score 0 with significant lower number of patients that had abdominal dragging pain in comparison with Group P. Visual analog score in the first four postoperative hours, total postoperative nalbuphine dose in 1st 24 h and incidence of nausea and vomiting were significantly lower in Group D. Heart rate and mean arterial pressure were comparable in both groups. Postoperative headache incidence was comparable in both groups. Both patient and surgeon satisfaction were significantly higher in Group D compared to Group P.Conclusion:Combined epidural dexamethasone with intrathecal nalbuphine as a sole anesthetic technique during lower abdominal oncology operations could be an efficient anesthetic technique that offered better block characteristics, with more analgesia and as a result it gained better patient and surgeon satisfaction.

Comparative study between combined spinal-epidural anesthesia versus femoral/sciatic nerve block under ultrasound and nerve stimulator guidance for both-bone leg fractures

Background General anesthesia has a lot of complications, so alternative procedures like combined spinal-epidural anesthesia (CSEA) are better but with their adverse effects on cardiovascular and pulmonary functions. New era tend toward ultrasound (US) guidance and nerve stimulator for nerve block to ensure better effects without any complications. Aim The aim of this study was to compare CSEA versus femoral/sciatic nerve block (FSNB) by US guidance and nerve stimulator as anesthetic technique for patients with both-bone leg (BBL) fractures. Patients and methods Ninety adult patients, ASA I–II, scheduled for fracture BBL were included in the study. Patients were randomized into two equal groups. Group I CSEA received intrathecal 5 mg of hyperbaric bupivacaine 0.5+15% μg fentanyl, and then 7 ml of epidural (0.375% of plain bupivacaine+fentanyl 2 μg/ml) was injected as a loading dose. Finally, an additional epidural of 4 ml of 2% lidocaine was given if the desired sensory level was not reached till after 20 min or the operation lasted more than 80 min. Group II underwent FSNB by using US guidance and nerve stimulator. We first blocked the sciatic nerve by injection of 15 ml of 0.25% bupivacaine and 10 ml of 1% lidocaine. Then femoral nerve block was done by injection of 20 ml of bupivacaine 0.25% and 10 ml of 1% lidocaine. Results There was no significant difference between both groups in demographic data and failure rate. The onset of sensory and motor block was shorter in CSEA group, but the duration of sensory and motor block was prolonged in FSNB group. First dose of analgesia required was earlier in CSEA group. Heart rate and mean arterial blood pressure showed significant decrease in CSEA group at 5, 15, and 30 min intraoperatively. Visual analogue pain scale was higher and need for rescue analgesia was earlier in CSEA group. Conclusion FSNB by US guidance nerve stimulation technique provides better block characteristics, longer duration of analgesic, better intraoperative hemodynamics, and decreased the need for postoperative rescue analgesia in comparison with CSEA in patients with BBL fractures.

Experiences with Regional Anesthesia for Analgesia During Prolonged Aeromedical Evacuation.

There is much debate regarding the appropriate analgesic management of patients undergoing medical evacuation following combat trauma. Our primary objective was to review the utility of regional anesthetic techniques in patients undergoing aeromedical evacuation following surgical limb amputation as treatment for combat trauma. This study was conducted as an observational retrospective cohort whereby acutely injured amputee patients were identified via the U.S. Transportation Command's patient movement database. The Theater Medical Data Store was cross-referenced for additional patient care data including opioid consumption, duration of regional technique, pain scores, and rates of intubation. Eighty-four records were retrieved from the Theater Medical Data Store. All 84 patients were victims of improvised explosive device detonation requiring limb amputation and subsequent transport from Kandahar Airfield or Camp Bastion, Afghanistan, to the United States. The majority of interventions remained in place throughout the evacuation process. A significant decrease in opioid consumption in patients receiving regional anesthesia was identified at each leg of the medical evacuation process. Pain scores were sporadically reported and not statistically different. Higher rates of intubation were identified in the nonregional anesthetic group. Our analysis demonstrates the feasibility and effectiveness of applying regional anesthetic techniques for pain management to our combat wounded trauma patients throughout multiple stages of aeromedical evacuation. Benefits include the potential for less sedation and less opioid consumption while potentially foregoing the requirement for intubation during transport.Carness JM, Wilson MA, Lenart MJ, Smith DE, Dukes SF. Experiences with regional anesthesia for analgesia during prolonged aeromedical evacuation. Aerosp Med Hum Perform. 2017; 88(8):768-772.

Lidocaine and Dexamethasone for Paracervical Block Anesthesia in Women with Missed Abortion : Randomized Controlled Trial

Aim of the work: nerve block is a technique whereby local anesthetic solutions are infiltrated around a nerve (or perineurally) to provide anesthesia and analgesia. Nerve block for intraoperative and postoperative pain management is associated with improved analgesia, fewer opioid-related adverse events, earlier ambulation and shorter hospital stay when compared to intravenous opioid analgesia alone.This study aimed to assess the efficacy of adding dexamethasone to lidocaine for cervical block anesthesia for prolonging the duration and anesthetic effect in women with missed abortion undergoing vacuum evacuation. Patients and methods: this study is a randomized controlled trial and it was conducted in accordance with the ethical committee protocols and informed consent procedures of Ain Shams University Maternity Hospital during the period between Augusts to December 2016.Sample size was calculated using PASS® version 11 programs, setting the type-1 error (α) at 0.05 and the power (1-β) at 0.8. Conclusion: para cervical block can be used as a safe and effective anesthetic technique in patients who need surgical uterine evacuation of missed abortion. Adding dexamethasone can increase effectiveness and duration of para cervical block. Intraoperative pain level was accepted in 80% of patients, these patients had no or mild to moderate accepted pain. We did not detect any postoperative complications in our patients including (excessive vaginal bleeding, hematoma or general manifestations of lidocaine toxicity) and It is recommended to apply PCB for cases of first trimester missed abortion who require uterine suction evacuation. Lidocaine is preferably mixed with dexamethasone to have better results as regards pain score. It is the anesthetic method of choice especially when general anesthesia is a high risk procedure.

Anesthesia for Hip Arthroscopy

(Abstracted from Can J Anesth, 63:1277–1290, 2016) The purpose of this narrative review was to examine anesthetic regimens for hip arthroscopy after an overview of the indications for the procedure and preoperative assessment with emphasis on anesthetic technique, analgesic adjuncts, and potential complications. The findings and conclusions were arrived at after reading of text chapters and analyzing 45 of 63 peer-reviewed articles discussing anesthetic techniques in patients undergoing hip arthroscopy.

The Type of Anesthesia Technique Does Not Have an Impact on 30-Day Mortality in Geriatric Patients Undergoing Lower Extremity Amputation

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P = 0.001). The use of antiplatelet drugs (P = 0.001) and the number of transfusions were higher (P = 0.045) in the GA group. No significant difference was found between the groups in terms of mortality and postoperative cardiac or pulmonary complication rates. We determined that the anesthesia technique does not have an effect on 30-day mortality and complication rates. The regional anesthesia technique may be preferred in geriatric patients who will undergo major lower extremity amputation because of the shorter hospital stay and theoretical advantages. However, considering the general functional status of patients, the importance of patient-based evaluation should not be forgotten.

EP 13. Tailored anesthetic techniques in patients with severe Tourette Syndrome undergoing surgery for Deep Brain Stimulation

Introduction Patients with severe Tourette syndrome are potential candidates for deep brain stimulation (DBS). We have shown that bilateral thalamic as well as pallidal stimulation can be effective in reducing the severity of motor and vocal tics. However, one of the challenges is the anesthetic approach in this type of surgery. During surgery there is an ’awake’ and an ’asleep’ phase. In the ’awake’ phase, anesthesia has three goals. First, to reduce the intraoperative tics to avoid the dislocation of the stereotactic frame. Second, adequate level of consciousness to allow intraoperative testing of stimulation effects. Third, avoid interference with the single-unit electrophysiological recordings. To date there is no consensus on how to reach these goals. In this study, we report our own experience in the past 15 years. In the ‘asleep’ phase there is the internalization of the extension leads and pulsgenerator. Methods From 1999 to 2015 surgery was performed in 15 patients (12 males and 3 females) with severe Tourette syndrome. Eight patients were operated in the thalamic target (cross point of the centromedian nucleus-substantia periventricularis-nucleus ventro-oralis internus) and 7 in the pallidal target (the anteromedial part of the internal globus pallidus). During the procedure different short-acting anesthetic regimens were used. In the ’awake’ phase we used a combination of propofol and remifentanil, remifentanil and clonidine, and remifentanil as a single anesthetic. In the asleep phase all patients were intubated and received a combination of propofol and remifentanil. Results With our awake-asleep anesthetic protocols, none of the patients experienced dislocation of the stereotactic frame during surgery. In the awake phase, all patients were cooperative and neuropsychological testing was possible. Moreover, stimulation related side effects could be screened. We obtained adequate single-unit recordings from the thalamic and pallidal neurons. Conclusion Tailored anesthetic techniques with low-dose sedation make it possible to achieve adequate tic reduction in the ‘awake’ phase, allowing intraoperative clinical testing, and obtain good neurophysiological recordings.

Spinal Anesthesia in a 21-Year-Old Woman With Osteogenesis Imperfecta: A Case Report

Introduction: The choice of anesthetic technique in patients with osteogenesis imperfecta (OI) can be a challenge for anesthesiologists and must be adjusted based on specific circumstances and abnormalities. We report our anesthetic technique in an OI patient to emphasize this point, and to frame a discussion of this subject. According to the accessible data, we report one of the rare OI patients who have undergone spinal anesthesia for emergency surgery. Case Presentation: The patient was a 21-year-old female with OI type IV, who was admitted due to severe anal pain. The surgeon decided to perform an emergency reduction of a prolapsed rectum, with late permanent fixation. Considering the circumstances, we decided to perform spinal anesthesia for the operation, which lasted for 30 minutes. The patient underwent rectal prolapse reduction via rectosigmoidoscopy, of up to 25 cm of rectum. She was transferred to the post-anesthesia care unit after her vital signs were stabilized. After gaining lower extremity strength, she was transferred to the surgery ward. The next day, she was discharged from the hospital. Conclusions: Although most authors believe that general anesthesia following fiberoptic intubation is the preferred method for OI patients, it is likely that spinal anesthesia is acceptable in such patients. Although it is technically difficult, the procedure can be performed by expert anesthesiologists.

Segmental epidural anesthesia for percutaneous kyphoplasty:comparison with general anesthesia.

This is a feasibility study evaluating whether segmental epidural anesthesia is an alternative anesthetic approach to general anesthesia for percutaneous kyphoplasty. After ethics committee approval was obtained, 52 ASA class I-III patients scheduled for elective, single-level percutaneous kyphoplasty were recruited. The patients were divided into two equal groups. In Group E (Group Epidural) segmental epidural anesthesia was performed using the loss of resistance technique with saline. In Group G (Group Control) general anesthesia was performed. Hemodynamic parameters, intraoperative and postoperative analgesic requirements, visual analogue scale (VAS) scores, length of stay in the postanesthesia care unit (PACU), and complications were recorded. Hemodynamics were similar between the two groups. Postoperative analgesic requirement was significantly higher in Group G than in Group E (P < 0.004). VAS scores were significantly lower in Group E than in Group G (P < 0.05). Time to first pain experience at the first postoperative 4 h was significantly longer and length of stay in the PACU was significantly shorter in Group E than in Group G (P < 0.001). Segmental epidural anesthesia is a safe anesthetic technique for percutaneous kyphoplasty. This technique offered advantages over general anesthesia in terms of postoperative analgesia, analgesic consumption, early recovery, and short PACU stay. Therefore, it should be considered a suitable anesthetic technique in patients undergoing single level percutaneous kyphoplasty.

Incidence of post-operative cardiac complications in cardiac patients undergoing urological procedures

Context: There are limited studies indicating the incideance of post operative morbidity and mortality in high risk patients. Urological procedures constitute a major portion of geriatric surgeries where a cardiac obligation is almost inevitable and selected for this study purpose.Aims: To compare the incidence of post operative cardiovascular complications during regional and general anesthetic techniques in patients with known cardiac risk undergoing urological surgeriesSettings and Design: Prospective randomized double blind study.Methods and Material: 40 patients aged above 50 years posted for elective urological surgeries were enrolled in the study after obtaining approval from hospital ethics committee and written informed consent from the patients. Patients were divided into two groups A&amp; B. Group A (n=20) received general and group B (n=20) received regional anaesthesia (spinal/ Epidural). All the patients received standard premedication and their basal vitals( BP, HR, ECG pattern) were recorded. The same parameters were monitored in the post operative period at regular intervals.Statistical analysis used: Student T test is used to test the significance of stastical difference in the variables between the two groups.Results: The mean heart rate and the mean arterial blood pressure were increased (P&lt;0.01) in the general anaesthesia group. Group A showed 10% incidence of ECG changes and group B showed 35% incidence of ECG changes. But the changes in the hemodynamics were not significant.Conclusions: There is no difference between regional anaesthesia and general anaesthesia regarding the post operative outcome after urological procedures with respective hemodynamic changes.