Cervical Epidural Anesthesia Research Articles

Efficacy of the use of Cervical Epidural Anesthesia in Shoulder Girdle Surgery

Introduction: The study of the efficacy of the cervical epidural block in shoulder girdle surgery allows us to identify the most frequent complications in order to prevent them and to be able to compare this technique with others. Objective: To describe the efficacy of the use of cervical epidural anesthesia in shoulder girdle surgery. Methods: Observational, descriptive and cross-sectional study at the Martín Chang Pug Teaching General Hospital in the Neuritis municipality, Camagüey province, between January 2021 and December 2022. The sample consisted of 25 patients undergoing shoulder girdle surgery who underwent surgery. Cervical epidural anesthesia was applied. Results: There was a predominance of males (18 out of 25 patients), and most of the patients were between 19 and 59 years old. Patients classified as ASA II (17 patients) predominated. Heart rate and mean arterial pressure followed a Gaussian distribution at 30 and 60 min after starting the cervical epidural block (df: 25; p>0.05). Both heart rate, mean arterial pressure, and partial oxygen saturation decreased significantly 60 min after the anesthetic technique was applied, but remained within normal limits. 100% of them reported having felt satisfied with the anesthetic procedure. Conclusions: The hemodynamic values remained within normal limits in the first hour of the intraoperative period, and all the patients were satisfied with the results of the analgesia achieved by this method. The use of cervical epidural anesthesia in shoulder girdle surgery is effective and safe.

Unilateral neurostimulation-assisted cervical epidural anesthesia for upper limb surgeries—a case series

BackgroundThe role of neurostimulation-aided cervical epidural anesthesia (CEA) in shoulder surgery has been described in the literature. The use of nerve stimulators and the infusion of local anesthetic (LA) in the cervical epidural space has also been mentioned. Epidural needle rotation prior to insertion of the catheter is not described, and it is not clear if general anesthesia was administered in these cases.Case presentationIn this case series, we performed CEA at the level of C7-T1 in 12 patients undergoing various surgeries on the proximal open shoulder and mid humerus after informed consent. Ipsilateral motor responses elicited by continuous electrical stimulation were used to identify lateralization of the epidural catheter tip. The placement of catheters was confirmed under an intraoperative image intensifier. Using the median approach at the level of C7-T1, an ipsilateral twitch was noted in all patients. Neurostimulation persisted with an advancement of stimulating catheter 3–4 cm in the cervical epidural space in all patients. A cervical radiograph confirmed the placement of an ipsilateral catheter and contrast injection there upon revealing the spread of the LA agent. All patients had successful awake shoulder and mid-humerus surgeries under sole cervical epidural anesthesia as evidenced by the absence of pain response at the surgical incision.ConclusionsIpsilateral CEA can be offered for unilateral upper limb surgeries. Low volumes of LA can be injected after precise placement of the tip of the catheter corresponding to the level of surgical incision.

Application of Cervical Epidural Anesthesia and Analgesia to the Patient with 90% Burnt Surface Area.

Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization and nutrition applied to the patient's recovery.

Cervical Epidural Anaesthesia in a Patient with Ebstein’s Anomaly requiring Total Thyroidectomy

Ebstein’s anomaly is a congenital malformation of the tricuspid valve with myopathy of the right ventricle leading to dilatation and atrialisation of the right ventricle, with varying degrees of malformation along with restriction of diastolic filling of ventricles. Disease severity in Ebstein’s anomaly can range from asymptomatic patients to severe debilitating disease. These patients are at increased risk of developing ventricular and supraventricular tachycardia, congestive cardiac failure and death. This case report is about a 37-year-old female with Ebstein’s anomaly who presented with atrial fibrillation and right-sided heart failure. She successfully underwent total thyroidectomy under cervical epidural anaesthesia.

Potency of propofol for inducing loss of consciousness in end-stage kidney disease patients

It can be difficult for anesthesiologists to determine the optimal dose of propofol for end-stage kidney disease (ESKD) patients due to changes in drug disposition. The purpose of this study was to evaluate the potency of propofol for inducing loss of consciousness in ESKD patients. Patients with normal kidney function (Control group, n = 15), those with ESKD (ESKD group, n = 15), and those with ESKD undergoing cervical epidural anesthesia (ESKD-CEB group, n = 15) were administered propofol by target-controlled infusion (TCI) using the Schneider model. The effect-site concentration (Ce) of propofol started at 0.5 μg/ml and increased in increments of 0.5 μg/ml until the patient did not respond to verbal commands. The relationship between the probability (P) of loss of consciousness and the Ce of propofol was analyzed in each group using logistic regression. The Ce values of propofol at the time of loss of consciousness were 4.3 ± 0.9, 3.7 ± 0.9, and 3.3 ± 1.0 μg/ml for the Control, ESKD, and ESKD-CEB* groups, respectively (*significant difference vs. control, P < 0.05). The estimated Ce50 values for lost ability to respond to verbal command were 4.56, 3.75, and 3.21 μg/ml for the Control, ESKD, and ESKD-CEB groups, respectively. In conclusion, when inducing anesthesia in ESKD patients, we recommend using an initial dose similar to that of patients with normal kidney function, or rather starting with a lower dose.

A study of Efficacy and Safety of Ropivacaine (0.5%) versus Levo Bupivacaine (0.5%) in Cervical Epidural Anaesthesia for Upper Limb Surgery

A study of Efficacy and Safety of Ropivacaine (0.5%) versus Levo Bupivacaine (0.5%) in Cervical Epidural Anaesthesia for Upper Limb Surgery

Quality of postoperative recovery after upper-arm vascular surgery for hemodialysis in patients with end-stage renal disease: A prospective comparison of cervical epidural anesthesia vs general anesthesia.

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.

Cervical Epidural Anesthesia for Radical Mastectomy in an Elderly Patient with Severe Respiratory Compromise

Cervical epidural anesthesia for breast surgery has been described in a few trials on patients with good physical status. This case report describes the successful use of cervical epidural anesthesia in a patient with severe respiratory compromise without any complication. A 72-year-old female patient having infiltrating duct carcinoma of the right breast with coexisting chronic obstructive airway disease and bronchial asthma was planned for modified radical mastectomy with axillary clearance. Her forced vital capacity (VC) was 28% predicted with reversibility of 24% and forced expiratory volume in 1 s was 31% predicted with 35% reversibility. After discussion with the surgical team, a regional anesthetic was planned for the patient and a cervical epidural catheter placed at C7–T1 interspace was used to provide adequate dermatomal anesthesia for the surgery. Dexmedetomidine was used to achieve sedation for patient comfort with minimal respiratory depression. The SpO 2 and end-tidal CO 2 recordings remained stable throughout the procedure, with excellent intra- and postoperative analgesia. Despite the concerns of bilateral phrenic nerve palsy with the use of cervical epidural anesthesia and associated decrease in VC, a carefully conducted cervical epidural anesthesia can be used for patients with respiratory compromise undergoing major breast surgery. Radical mastectomy, cervical epidural anesthesia, low FEV1, FVC, dexmedetomidine.

Comparison of 0.25% bupivacaine and 0.375% ropivacaine in combination with fentanyl for modified radical mastectomy under cervical epidural Anaesthesia

Comparison of 0.25% bupivacaine and 0.375% ropivacaine in combination with fentanyl for modified radical mastectomy under cervical epidural Anaesthesia

Cervical Epidural Anesthesia for Thyroidectomy in a Patient with a Potential Difficult and Compromised Airway

We report a case of a 45-year-old man with a large thyroid swelling with the potential to cause a difficult and compromised airway. Cervical epidural anesthesia was planned and successfully performed to avoid difficult airway management. We conclude that cervical epidural anesthesia can be used for thyroidectomy in a patient with potential difficult and compromised airway. Keywords: Cervical epidural, thyroidectomy.

A case of subclavian artery aneurysm with history of ischemic heart disease operated under cervical epidural anesthesia

Subclavian artery aneurysm is usually operated under general anesthesia (GA), but in specific situations, it can also be conducted under regional anesthesia (RA) such as cervical epidural anesthesia (CEA). A 48-year-old male presented with chief complaint of progressive swelling in the right side of the neck for the past 3 months following trauma. He was diagnosed as subclavian artery aneurysm, and surgical intervention was advised. He had previous history of angina 4 months back for which tablet aspirin 75 mg and tablet clopidogrel 75 mg once daily was prescribed. Cardiological evaluation revealed of an ejection fraction of around 30% with mild left ventricular hypokinesia and grade 2 diastolic dysfunction. Due to the poor cardiac functional status of the patient, RA with CEA was planned. The risk with GA in cases with a history of myocardial ischemia is more than RA, hence, it is better to use CEA which is equally efficacious in such high-risk cases.

Feasibility of Cervical Epidural Anesthesia for Breast Cancer Surgery

Background Effects of perioperative cervical level neuraxial blocks on the dissemination of cancer metastases have become a matter of substantial interest. However, experience with these catheters has been limited and data on feasibility and efficacy is sparse. Methods Data from 39 patients scheduled to undergo breast cancer surgery while awake with a cervical epidural alone was retrospectively analyzed. Results In 26 patients (66,7%, 95% CI 51,7–81,7) the cervical epidural catheter was sufficient for surgery. In one patient (2.6%, 95% CI 0–7.6) identification of the epidural space was not possible. Four patients (10.3%, 95% CI 0,7–19,9) had an insufficient sensory block. Seven patients (17.9%, 95% CI 5,7–30,1) had a partially insufficient sensory block. Rates of failed epidural blocks were not significantly different between different insertion levels. 21 patients (80.8%, 95% CI 65,4–96,1) developed hypotension and required an intravenous vasopressor. One patient developed nausea. In one patient the dura was accidentally punctured. No neurological damage was observed. No other major complications were observed. Discussion Epidural punctures in the cervical region are feasible but do bear potential for major complications. Anesthesiologists should familiarize themselves with high epidural block techniques.

Comparative evaluation of dexmedetomidine and clonidine with low dose ropivacaine in cervical epidural anesthesia for modified radical mastectomy: A prospective randomized, double-blind study.

Context:Alpha-2 adrenergic agonists clonidine and dexmedetomidine, are well known to produce analgesia through an opioid independent mechanism. Alpha-2 agonists are used as an adjuvant to local anesthetic agents to extend the duration of spinal, epidural and brachial plexus blocks.Aims:We compared clonidine and dexmedetomidine as an adjuvant to Ropivacaine in cervical epidural anesthesia (CEA) with respect to onset and duration of sensory block, duration of analgesia and adverse effects.Subjects and Methods:A total 150 American Society of Anesthesiologists Class I or II adult female patients who were scheduled to undergo modified radical mastectomy were randomly allocated to the following two groups to receive CEA: Group D receive 15 mL of 0.375% ropivacaine combined with 1 μg/kg of dexmedetomidine; Group C received 15 mL of 0.375% ropivacaine combined with 1.5 μg/kg of clonidine. The onset of sensory block, duration of analgesia, mean arterial pressure (MAP), heart rate (HR), sedation scores, and the incidences of adverse effects, such as hypotension, bradycardia, and oxygen desaturation were recorded.Results:The addition of dexmedetomidine to ropivacaine (Group D) resulted in faster onset of sensory block time compared with the addition of clonidine to ropivacaine (Group C) (95% confidence interval [CI]: 14.53 ± 2.96 vs. 16.72 ± 4.43 P = 0.032). The duration of analgesia block in Group D was significantly longer than that in Group C (95% CI: 234.65 ± 23.76 vs. 286.76 ± 34.65; P = 0.037). The Ramsay sedation score at in Group D were significantly higher between 20 and 60 min as compared to Group C (P < 0.022). MAP level and HR level in Group D and Group C were comparable.Conclusion:The addition of dexmedetomidine to low dose ropivacaine for CEA could shorten the onset of sensory block and extend the duration of analgesia with optimum sedation without episodes of hypoxemia as compared to addition of clonidine to ropivacaine.

Cervical Epidural Anaesthesia with Ropivacaine for Modified Radical Mastectomy

Cervical epidural anaesthesia (CEA) using local anesthetics (LA) is a well established technique for the surgeries in the neck, chest and upper arms. Recently ropivacaine is introduced with better safety profile. The aim was to observe the safety of Cervical epidural anaesthesia as an anaesthetic technique and to compare the efficacy of epidural 0.25% bupivacaine with 0.375% ropivacaine for radical mastectomies. A double blind study was conducted on 40 ASA grade I / II females who received CEA with 10 ml of 0.25% of bupivacaine +25μg of fentanyl in group B (n=20) and 10 ml of 0.375% of ropivacaine +25μg of fentanyl in group R (n=20) epidurally. Assessment of the block, vital monitoring and complications noted. No significant differences observed in the onset of sensory block (5.05 min and 5.4 min in group B and R respectively, P>0.05).The mean motor blockade score, time to achieve complete blockade and time to grade I motor recovery was significantly longer in group B (2.3, 22.5 and 79.5 minutes respectively) as compared to group R (1.5, 18.3 and 66.3 minutes respectively, P<0.05). Respiratory distress developed in two patients of group B that required general anaesthesia (GA) with intubation. Use of 0.37% ropivacaine is safer than 0.25% bupivacaine for CEA for radical mastectomy. It provides good surgical anaesthesia with lesser degree of motor blockade and the respiratory effects.

Thyroidectomy Under Regional Anaesthesia: An ORL Perspective.

The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. This prospective study was performed at a university - affiliated hospital. Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. Z-test and validity test. In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries.

Application of cervical epidural anesthesia in patients with head and neck carcinoma

In head and neck carcinoma surgery, we often encounter patients for whom there is high risk in operations under general anesthesia (GA) with artificial ventilation management, such as elderly patients or those with comorbidities or impaired organ function. Three patients with head and neck carcinoma for whom risks were high under general anesthesia underwent surgery under cervical epidural anesthesia (CEA). The first case is 67-year-old male with cT2N3M0 laryngeal carcinoma. The patient had several medical history such as angina pectoris, renal impairment developed following cisplatin administration and combined ventilator impairment. Right neck dissection was performed (Level I–IV) under CEA. A decrease in blood pressure was observed during surgery, but was controlled with a small dose of vasopressor and fluid replenishment. The second case is 83-year-old female with cT4aN0M0 submandibular gland carcinoma. She had a history of chronic thoracic empyema and severe respiratory dysfunction was observed. Right submandibular gland carcinoma resection and neck dissection (Level I) were performed under CEA. As respiratory depression occurred following anesthesia induction, tracheotomy was performed and artificial ventilation management was still required after surgery had been completed. The third case is 87-year-old male with rT2N0M0 laryngeal carcinoma. Total laryngectomy was performed under CEA. In Case 2, other than the respiratory problems, no other complications were observed during or after surgery. Operation time and amount of hemorrhage were again comparable to those for surgery under GA. For patients at high risk under GA or with systemic diseases or impaired organ function, CEA represents a therapeutic option.

Etiology and use of the "hanging drop" technique: a review.

Background. The hanging drop (HD) technique presumably relies on the presence of subatmospheric epidural pressure. It is not clear whether this negative pressure is intrinsic or an artifact and how it is affected by body position. There are few data to indicate how often HD is currently being used. Methods. We identified studies that measured subatmospheric pressures and looked at the effect of the sitting position. We also looked at the technique used for cervical and thoracic epidural anesthesia in the last 10 years. Results. Intrinsic subatmospheric pressures were measured in the thoracic and cervical spine. Three trials studied the effect of body position, indicating a higher incidence of subatmospheric pressures when sitting. The results show lower epidural pressure (−10.7 mmHg) with the sitting position. 28.8% of trials of cervical and thoracic epidural anesthesia that documented the technique used, utilized the HD technique. When adjusting for possible bias, the rate of HD use can be as low as 11.7%. Conclusions. Intrinsic negative pressure might be present in the cervical and thoracic epidural space. This effect is more pronounced when sitting. This position might be preferable when using HD. Future studies are needed to compare it with the loss of resistance technique.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.

Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.

Intérêt de l’anesthésie péridurale cervicale dans la gestion périopératoire d’une thyroïdectomie chez une patiente à haut risque anesthésique

Cervical epidural anesthesia is an anesthetic technique that can be useful in patients with high perioperative risk undergoing to cervical surgery. We report the case of a patient of 49years old with hypertension, diabetes mellitus, epilepsy, left hemiparesis sequelae of stroke and congestive left ventricular failure. The patient underwent total thyroidectomy under cervical epidural anesthesia. No difficulty breathing or decompensation of chronic underlying diseases were noted in the postoperative.

Comparison of Cervical Epidural Anesthesia and General Anesthesia for Thyroid Surgery

ABSTRACTIntroductionNational trends are showing statistically significant increase in the thyroid surgeries being performed by otorhinolaryngologist surgeons. There is a rising interest among the otorhinolaryngology surgeons subspecializing in head and neck surgeries to increase the horizons in the advancements in thyroid surgeries. Cervical epidural anesthesia (CEA) for thyroid surgeries is gaining popularity over general anesthesia (GA) for the various advantages it offers.ObjectiveThis prospective study was designed to evaluate the effectiveness and ease of thyroidectomy under CEA as compared to GA.Materials and methodsA prospective study of total of 30 patients undergoing thyroid surgery from two teaching hospitals. They were randomly allotted into CEA and GA groups of 15 members each.ResultsIn the CEA group, postoperative comfort and economic feasibility were found to be better compared to GA group. The blood volume loss was lesser in the CEA group. The CEA group also offered the added advantage of vocal cord monitoring by voice contact during the surgery. Both the CEA and GA group maintained hemodynamic stability. There were no complications in both the groups.ConclusionEven though thyroid surgery is currently being performed mostly under GA, CEA must be considered for thyroid surgeries routinely. CEA offers a number of advantages of GA in selected cases. This study has proved that CEA has distinct advantages over GA in thyroidectomies. Considering the ease and effectiveness of CEA, it is as good as GA, if not better, even in routine thyroidectomies.How to cite this articleMohammed S, Santosh UP, Pereira N. Comparison of Cervical Epidural Anesthesia and General Anesthesia for Thyroid Surgery. Int J Otorhinolaryngol Clin 2014;6(1):1-4.