Continuous Spinal Technique Research Articles

Continuous spinal technique in surgery and obstetrics.

Continuous Spinal Anaesthesia (CSA) technique has all the advantages of single-shot spinal anaesthesia with the added benefit of prolonging the duration of anaesthesia. CSA has been used as a primary method of anaesthesia as an alternative to general anaesthesia in high-risk and elderly patients for various elective and emergency surgical procedures involving the abdomen, lower limbs, and vascular surgeries. CSA has also been used in some obstetrics units. Despite its advantages, CSA technique remains underutilised because it is surrounded with myths, mysteries, and controversies concerning neurological, other morbidities and minor technical difficulties. This article includes a description of CSA technique compared to other contemporary central neuraxial blocks. It also discusses the perioperative applications of CSA for different surgical and obstetrics procedures, advantages, disadvantages, complications, problems, and pointers on how to perform the technique safely.

Successful treatment for bladder rupture after explosion during transurethral resection of prostate: a case report

Extra or intraperitoneal bladder explosion is a rare complication of transurethral resection of the prostate (TURP) or bladder tumor resection associated with high morbidity. There were just over 25 reports of bladder explosion described in the literature until 2015. We report the case of a 56-year-old black man, diagnosed with prostatic adenocarcinoma and scheduled for tunneling by transurethral resection of prostate (TURP). His medical history included diabetes mellitus, hypertension, retinopathy with bilateral amaurosis, ischemic stroke, and myocardial infarction. He was successfully submitted to a continuous spinal technique and sedation. During the hemostatic phase of the procedure, a loud “pop sound” was heard in the operating room and the patient presented sudden arterial hypotension and abdominal distention. An exploratory laparotomy was done to manage the bladder explosion. The adequate resolution of this adverse event requires awareness and high clinical suspicion for prompt intervention.

Managing anesthesia for cesarean section in obese patients: current perspectives.

Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients.

An overview of the regulatory aspects of medical devices from the viewpoint of research and device manufacturing.

To review the Food and Drug Administration's regulatory requirements for bringing a new or substantially changed medical device to market in the United States, noting the history and current requirements for the continuous spinal catheter. The relevant laws and guidelines for classifying, testing, and submitting a device to Food and Drug Administration approval are reviewed. The Food and Drug Administration categorizes medical devices into three classes, based on potential risk for illness or injury presented by a malfunction or failure. Class III devices are the most critical ones, and require a Premarket Approval that includes clinical trials before market introduction. Classes I and II usually require a 510(k), or premarket notification, which usually does not need any clinical data. Testing requirements include biocompatibility testing; physical, functional, and packaging testing; and sterility testing. The continuous spinal catheter (25-32 gauge) was marketed under a 510(k) claiming substantial equivalence to the Bizzarri-Giuffrida 24-gauge catheter, which was a pre-Amendment device. After incidences of cauda equina syndrome were reported with use of the continuous spinal technique, the Food and Drug Administration reclassified the small-gauge catheters as Class III devices, which require a Premarket Approval before being marketed.

Continuous Spinal Anesthesia With Combined Hyperbaric and Isobaric Bupivacaine in a Patient With Scoliosis

We describe the anesthetic management of labor and cesarean delivery after failed epidural anesthesia using a continuous spinal technique with a combination of hyperbaric and isobaric local anesthetic solutions in a patient with severe kyphoscoliosis and congenital heart disease.

The role of pH in the development of tachyphylaxis to local anesthetic agents.

Evidence for tachyphylaxis to the local anesthetic agents lidocaine and mepivacaine has been found in a study of continuous caudal anesthesia in obstetrical patients. Seduced response to these drugs is shown to be independent of the increasing pain of labor. An experimental study of tachyphylaxis in the dog was undertaken, utilizing 14C-lidocaine and 24C-procaine administered by a continuous spinal technique. Repeated injections of the acid anesthetic salt were associated with continued decreases in pH of the cerebrospinal fluid and proportionate increases in the concentration of local anesthetic- Calculations of the percentages of the free base form (lipid-soluble) indicated significant shifts with minor changes in pH. It is suggested that tachyphylaxis to local anesthetic agents may be associated with changes in pH and shifts in the amounts of ionized and nonionized forms. The limited buffer reserve available in the cerebrospinal fluid (and presumably, the extradural space) makes these areas especially vulnerable.