Intrathecal Anesthesia Research Articles

Anesthetic Management of Parturients With Achondroplasia During Labor and Delivery: A Narrative Review

Achondroplasia accounts for approximately 70% of all forms of dwarfism. Cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. There is no consensus on the optimal management for cesarean delivery considering the difficulties in both general and regional anesthesia in patients with achondroplasia. The aim of this study was to explore the literature for prior case reports and series to determine the optimum anesthetic management for cesarean delivery in achondroplastic patients. We conducted a review of the literature using Embase, Medline, Scopus, and Web of Science database searches for case series and case reports on achondroplasia and pregnancy through January 2024. Conference abstracts >3 years old were excluded, as well as data on forms of dwarfism other than achondroplasia, patients taller than 147 cm, and non-English language papers. Extracted data included demographic information, anesthetic management, and reported complications. The literature review resulted in 57 manuscripts with a total of 80 anesthetics. Anesthetic management consisted of planned general anesthesia (n = 16), single injection spinal (n = 28), epidural (n = 17), combined spinal-epidural (n = 12), and intrathecal catheter (n = 1). Six patients required conversion from neuraxial anesthesia to general anesthesia due to failed neuraxial placement (n = 3), inadequate blockade (n = 2), and high neuraxial block (n = 1). Reduced dose of intrathecal bupivacaine was common in this population. Complications such as hypotension (4 in 64), inadvertent dural puncture (1 in 64), and transient paresthesia (3 in 64) during neuraxial technique were reported but were infrequent. Neuraxial anesthesia is more common and a viable option in carefully selected parturients with achondroplasia. We recommend reduction of intrathecal local anesthetic as part of a titratable neuraxial technique (ie, combined spinal-epidural) that minimizes the risk of hypotension, high spinal, and emergent intubation.

Dexmedetomidine as an Adjuvant to either Hyperbaric Prilocaine (2%) or Bupivacaine (0.5%) in Intrathecal Anesthesia for Elective Cesarean Section: A Comparative Study

Dexmedetomidine as an Adjuvant to either Hyperbaric Prilocaine (2%) or Bupivacaine (0.5%) in Intrathecal Anesthesia for Elective Cesarean Section: A Comparative Study

Intrathecal magnesium sulphate as an adjuvant to bupivacaine for infraumbilical surgeries: An updated systematic review and meta-analysis

Background and Aims: Intrathecal anaesthesia is widely used for infraumbilical surgeries due to its effectiveness in providing pain relief during and after the operation. Adding magnesium sulphate (MgSO4) to intrathecal local anaesthetics can prolong analgesia, reduce postoperative analgesic requirements and improve the management of shivering perioperatively. This review aims to investigate the use of intrathecal adjuvant MgSO4 for anaesthesia in infraumbilical surgeries. Methods: We performed a meta-analysis (PROSPERO ID: CRD42023432378) of trials, which included patients who underwent a variety of surgical procedures under spinal anaesthesia with intrathecal MgSO4 as an adjuvant to spinal local anaesthetics. The analysed outcomes included sensory and motor effects and adverse effects. We presented dichotomous outcomes as risk ratios with 95% confidence intervals (CI), while continuous outcomes were measured as mean differences (MDs) with 95% CI. We considered the results significant if the P value was < 0.05. Results: Thirty-two studies (2379 patients) were included. Adding intrathecal MgSO4 to bupivacaine significantly prolonged the time for regression of two segments from the maximum height (MD: 27.18 min; 95% CI: 12.56, 41.79; P = 0.0003), delayed the onset of sensory block to T10 (MD: 1.93 min; 95% CI: 1.10, 2.77; P < 0.0001), prolonged the duration of motor block (Bromage score = 0) (MD: 15.13 min; 95% CI: 4.59, 25.66; P = 0.005) and extended time for first rescue analgesia (MD: 43.80 min; 95% CI: 26.47, 61.14; P < 0.00001). No significant effect for MgSO4 on side effects was observed. Conclusion: Our review underscores intrathecal MgSO4’s benefits in prolonging block duration and improving pain management, but highlights significant heterogeneity, limiting the strength of these findings.

A Comparison of Intrathecal Dexmedetomidine and Fentanyl as Adjuvants to 0.5% Hyperbaric Levobupivacaine for Lower Abdominal Surgeries: A Prospective, Double-Blinded, Randomized Controlled Trial.

Background Due to its affordability and ease of application, the subarachnoid block is the most frequently used method for lower abdominal procedures. Levobupivacaine has an onset of sensory and motor blockade comparable to that of bupivacaine and prolongs the duration of analgesia while facilitating quick recovery from motor block. Fentanyl and dexmedetomidine, when used as additives to intrathecal local anesthetic, can extend the duration of sensory and motor blockade and enhance postoperative analgesia. Aims and objectives The purpose of this study is to examine and compare the effectiveness of fentanyl and dexmedetomidine administered as adjuvants to 0.5% hyperbaric levobupivacaine intrathecally in lower abdominal operations with respect to block characteristics, postoperative analgesia as measured by visual analog scale(VAS) scores, hemodynamic changes, and adverse effects. Materials and methods Seventy patients were randomized into two groups of 36 each. Group LF received 15mg of 0.5% hyperbaric levobupivacaine with 25mcg of fentanyl, and Group LD received 15mg of 0.5% hyperbaric levobupivacaine with 10mcg of dexmedetomidine intrathecally. Results Patients in Group LD had a significantly longer duration of sensory and motor block than those in Group LF. In Group LF, the onset of sensory and motor blockade was faster (6.25 ± 1.89 minutes and 9.00 ± 3.24 minutes) compared to Group LD (8.70 ± 1.93 minutes and 10.95 ± 4.03 minutes). The length of sensory and motor blockade in Group LD was longer than in Group LF (308.28 ± 6.36 minutes vs. 232.28 ± 7.01 minutes and 198.20 ± 6.52 minutes vs. 157.45 ± 6.30 minutes, respectively). The total postoperative requirement for analgesics in the initial 24 hours, and the mean VAS scores were lower in Group LD. Conclusion Patients in Group LD experienced a significantly longer duration of sensory and motor block than those in Group LF. The onset of sensory and motor blockade was significantly faster in Group LF than in Group LD. The total postoperative requirement for analgesics in the initial 24 hours and the mean VAS scores were lower in Group LD. This concludes that the use of dexmedetomidine as an adjuvant to 0.5% hyperbaric levobupivacaine during the subarachnoid block provides prolonged postoperative analgesia, reduces total analgesic requirements, and maintains stable hemodynamics, while the use of fentanyl as an adjuvant to hyperbaric levobupivacaine enhances the onset of both sensory and motor blockade.

Efficacy of Intrathecal 0.5% Hyperbaric Ropivacaine for Day Care Gynaecological Procedures: An Interventional Study from a Tertiary Care Centre, Telangana, India

Introduction: Although various beneficial effects of intrathecal local anaesthetics have been proven, their use is limited by dosedependent adverse effects. Ropivacaine, a local anaesthetic, has been demonstrated to provide safe and reliable spinal anaesthesia of the required duration, with a relatively shorter duration of motor block that encourages earlier mobilisation in patients. Aim: To examine the efficacy of a hyperbaric solution of ropivacaine for spinal anaesthesia in minor gynaecological surgeries in a day care setting. Materials and Methods: This was an interventional study involving 60 subjects undergoing day care gynaecological surgery. The subjects were between 18 and 65 years old. Basic vital signs were recorded. All patients were preloaded with 15 mL/kg of Ringer’s lactate 15 minutes before surgery. Lumbar puncture was performed at the L3-L4 space. Patients received 3 mL of 0.5% hyperbaric ropivacaine (2 mL of 0.75% ropivacaine combined with 1 mL of 5% dextrose). Variations in vital signs were recorded during all phases of surgery. The onset and total duration of sensory and motor blockade, variations in vital signs at preoperative and postoperative phases, side-effects, time for ambulation and time for rescue analgesics were assessed. The values were expressed as means, frequencies and percentages. IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0 was used to analyse all the data. Results: The onset of sensory blockade to reach T10 occurred in 214.90 seconds, while the onset of motor blockade occurred in 205.13 seconds. The sensory blockade persisted for 366.17 minutes, whereas the motor blockade continued for 153.57 minutes. Significant changes were observed from the preoperative period to 60 minutes in the mean values of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) (p-value<0.05), while there was no change in Heart Rate (HR) and Oxygen Saturation (SpO2 ). Conclusion: Day care surgery can be performed effectively with spinal anaesthesia using intrathecal ropivacaine. The more reliable and effective anaesthesia provided by intrathecal ropivacaine improves the expediency for anaesthetists.

Development and validation of a predictive model for the efficacy of ropivacaine lumbar-square muscle block for analgesia after cesarean delivery

BackgroundEffective postoperative analgesia is essential in the clinical management of cesarean sections, with the lumbar square muscle block (Quadratus Lumborum Block, QLB) recognized as a viable analgesic option. Nonetheless, the development of a predictive model for its analgesic efficacy postoperatively remains underexplored.ObjectiveThis study aims to establish a predictive model for the postoperative analgesic effects of QLB through retrospective analysis, thereby offering a scientific foundation for clinical practice.MethodsA total of 338 patients who underwent cesarean sections under intrathecal anesthesia, accompanied by QLB, at the Second Affiliated Hospital of Xinjiang Medical University from February 2018 to December 2023 were included in this analysis. The predictive model was developed utilizing univariate analysis, Lasso regression, and multifactorial logistic regression analysis, with validation conducted through Receiver Operating Characteristic (ROC) curves, calibration curves, and the Hosmer–Lemeshow test.ResultsThe model demonstrated high accuracy and calibration.ConclusionThe predictive model developed in this study holds significant potential for early assessment of the analgesic effects of QLB, thereby equipping clinicians with a scientifically grounded and precise tool for pain management.

Fire dragon cupping in treating a parturient woman with gastrointestinal dysfunction after cesarean section: A case report.

The postoperative gastrointestinal dysfunction after cesarean section is commonly presented as uncomfortable symptoms such as abdominal pain and distension. As a novel traditional Chinese medicine characteristic therapy, the fire dragon cupping can effectively enhance intestinal peristalsis and improve the gastrointestinal discomforts by using the manipulation and moxibustion heat to stimulate acupuncture points. The purpose of this report is to provide a new approach and new ideas for rapid rehabilitation of gastrointestinal dysfunction after cesarean section. A parturient woman, 39 years old, pregnancy 4, delivery 2, underwent lower uterine segment cesarean section under intrathecal anesthesia due to scarred uterus. On the 3rd day after cesarean section, the anus still did not exhaust and defecate, so this parturient woman complained of obvious abdominal pain, abdominal distension, nausea, and vomiting. The measured abdominal circumference was 96 cm, and the bowel sounds weakened on auscultation; the plain abdominal radiograph indicated a small amount of pneumomediastinum, thus the incomplete intestinal obstruction was considered. The parturient woman was treated with fire dragon cupping treatment in her back and abdomen once a day, each time about 30 to 40 minutes, 3 consecutive days of treatment. On the 4th day after cesarean section, the parturient woman naturally had anal exhaust and defecated watery stools twice, without complaint of abdominal pain distension. Under the guidance of the concept of rapid rehabilitation nursing in obstetrics, according to the principle of making gradual and orderly progress, risk management of gastrointestinal dysfunction after cesarean section is carried out in the early stage, the fire dragon cupping and individualized rehabilitation scheme are implemented, and the parturient women with gastrointestinal dysfunction after cesarean section are actively treated.

The Effect of Intrathecal Anesthesia during Emergency Caesarean Section for Severe Preeclampsia and Eclampsia Patients in a Tertiary Care Hospital

Background: Severe preeclampsia and eclampsia are common in Bangladesh and are one of the leading cause of perinatal morbidity and mortality. The aim of the study is to observe the effect and hazards of intrathecal anesthesia for the mangement of caesarean section for severe pre-eclampsia and eclampsia patients. Management of these patients is very much important for the strenuous obstetrician and anesthesiologist both. Materials and Methods: This retrospective observational study was conducted in the Department of Anesthesiology and ICU of the IAHS (Institute of Applied Health Sciences) Chattogram from January 2022 to December 2022. Total 50 ASA grade 1 or 11, aged between 18-40 years, need urgent LSCS of 1-2 hours duration cases were selected purposively for intrathecal anesthesia. Patients with known cardiovascular and pulmonary diseases, fetal distress, severe maternal distress, uncontrolled DM, presence of any contraindication, patient’s refusal for SAB, septicemia, BP>170/120 mmhg, altered coagulation profile, APH, IUD were excluded from this study. Results: Among the study subjects, 30(59.68%) cases were primigravida patients- out of which five had severe pre eclampsia and 25 had eclampsia. Intraoperative shivering was observed in 18(29.03%) cases, postoperative shivering was observed in 16(25.80%) cases. Acute renal failure was found in 3(6%) cases, HELLP syndrome 10%, DIC 8%, abruption placentae 14%, pulmonary edema 4%, septicemia 16%, PPH 12% and postpartum eclampsia 22% cases. Apgar score <7 at 5 minutes in severe PET was observed in 04(6.45%) cases and eclampsia in 07 (14.51%) cases. Among them 10(20.96%) were eclamptic and 02(4.83%) had PET. p value was found 0.000 which is very highly significant. Conclusion: The outcome results of intrathecal anesthesia is better than general anesthesia. IAHS Medical Journal Volume 6(2) December 2023; 58-63

Dexmedetomidine Or Fentanyl as An Adjuvant to Single Low-Dose Bupivacaine Intrathecal Anesthesia for Management of Normal Labor Pain, A Randomized Control Study

Dexmedetomidine Or Fentanyl as An Adjuvant to Single Low-Dose Bupivacaine Intrathecal Anesthesia for Management of Normal Labor Pain, A Randomized Control Study

Effects of Intrathecal Versus General Anesthesia on Postoperative Cognitive Function in Elderly Hip Fracture Patients: a System Review and Meta Analysis Protocol

Randomized controlled studies have shown that the incidence of postoperative cognitive function in elderly patients undergoing hip fracture surgery varies significantly by anesthesia type. The aim of this study was to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function in elderly hip fracture by system review and meta-analysis. This study followed the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-analyses. First, the Cochrane Library, Web of Science, PubMed, EMBASE, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials Database were searched. Second, the literature was screened and identified for inclusion step by step according to the established inclusion and exclusion criteria using Endnote. Further, Excel 2010 was used to record the basic characteristics and relevant data of the included literature, and the Cochrane Risk of Bias Assessment Tool was used to rate the quality of each included study. Subsequently, meta-analysis was performed using RevMan 5.3 software to assess the effects of intrathecal anesthesia and general anesthesia on postoperative cognitive function of hip fracture in the elderly, and funnel plots were drawn to assess publication bias. The results of this systematic evaluation and meta-analysis will be published in a peer-reviewed journal.

Analgesic Effect of Intrathecal Nalbuphine versus Intrathecal Fentanyl as Adjuvant to 0.5% Bupivacaine for Cesarian Section under Spinal Anaesthesia

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objective To assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl. Methods This randomized comparative clinical trial was conducted in Ain Shams University Hospitals’ operating rooms on 48 patients undergoing cesarean section within a period of six months after approval of ethical committee of Faculty of Medicine, Ain Shams University. Results This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine. It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine. Conclusion Either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 μg) combined with Bupivacaine improves intraoperative analgesia and prolongs post- operative analgesia in cesarean section. There was statistically significant difference between them, intrathecal nalbuphine had a prolonged duration of post-operative analgesia, lesser amount of rescue analgesia needed and fewer side effects than intrathecal fentanyl.

Randomized Double-Blind Study of the Effect of Injectate Temperature on Intrathecal Bupivacaine Dose Requirement in Spinal Anesthesia for Cesarean Delivery.

Increasing the temperature of intrathecal local anesthetics has been shown to increase the speed of onset and block height of spinal anesthesia. However, how this influences dose requirement has not been fully quantified. The aim of this study was to determine and compare the effective dose for anesthesia for cesarean delivery in 50% of patients (ED50) of intrathecal bupivacaine given at temperatures of 37 °C (body temperature) or 24 °C (room temperature). Eighty healthy parturients having elective cesarean delivery under combined spinal-epidural anesthesia were randomly assigned to receive intrathecal hyperbaric bupivacaine stored at 37 °C (body temperature group) or 24 °C (room temperature group). The first subject in each group received a bupivacaine dose of 10 mg. The dose for each subsequent subject in each group was varied with an increment or decrement of 1 mg based on the response (effective or noneffective) of the previous subject. Patients for whom the dose was noneffective received epidural supplementation after data collection with lidocaine 2% as required until anesthesia was sufficient for surgery. Values for ED50 were calculated using modified up-down sequential analysis with probit analysis applied as a backup sensitivity analysis. These values were compared and the relative mean potency was calculated. The ED50 (mean [95% confidence interval, CI]) of intrathecal hyperbaric bupivacaine was lower in the body temperature group (6.7 [5.7-7.6] mg) compared with the room temperature group (8.1 [7.7-8.6] mg) (P < .05). The relative potency ratio for intrathecal bupivacaine for the room temperature group versus the body temperature group was 0.84 (95% CI, 0.77-0.93). Warming hyperbaric bupivacaine to body temperature reduced the dose requirement for spinal anesthesia for cesarean delivery by approximately 16% (95% CI, 7%-23%).

Comparison of Hepatic and Renal Functions during Intraoperative Sedation with Remimazolam in Elderly Patients under Intrathecal Anesthesia

Background: Remimazolam mesylate for injection (RM) is a new benzodiazepine sedative drug. The aim of this trial was to evaluate the effects of drug metabolism on patients’ hepatic and renal functions by comparing liver and renal function laboratory tests 24 hours before and 24 hours after surgery when using Remimazolam mesylate for injection (RM) for intraoperative sedation. Methods: 40 surgical patients who underwent prostate electrocision under elective intrathecal anesthesia were included in this trial. Changes in the patients’ perioperative hepatic and renal function indexes were analyzed using paired t-tests to assess the safety of Remimazolam mesylate for injection (RM) used for sedation in elderly patients under intrathecal anesthesia. Results: The patients’ preoperative 24-hour ALT (u/L) was 18.10 ± 4.97; the postoperative 24-hour ALT (u/L) was 18.08 ± 5.72; P = 0.975. The preoperative 24-hour AST (u/L) was 18.83 ± 4.89; the postoperative 24-hour AST (u/L) was 19.73 ± 4.91; P = 0.358. The preoperative 24-hour TBil (μmol/L) was 10.34 ± 6.16; the postoperative 24-hour TBil (μmol/L) was 12.03 ± 5.25; P = 0.008. The preoperative 24-hour sCr (μmol/L) was 79.43 ± 26.31; the postoperative 24-hour sCr (μmol/L) was 71.80 ± 22.93; P = 0.001. The preoperative 24-hour BUN (mmol/L) was 5.85 ± 1.75; the postoperative 24-hour BUN (mmol/L) was 4.83 ± 1.71; P &lt; 0.001. The preoperative 24-hour GFR (ml/min) was 82.73 ± 29.88; the postoperative 24-hour GFR (ml/min) was 125.23 ± 60.02; P &lt; 0.001. Important vital signs of the patients during the trial were stable, and laboratory tests of liver and renal function showed no abnormal changes of clinical significance. Conclusion: The intraoperative vital signs of the patients were stable, and no significant adverse reactions were observed in liver and kidney functions when Remimazolam mesylate for injection (RM) was used for intrathecal anesthesia-assisted sedation in elderly patients.

Strategy to secure the neuraxial route in anaesthesia: Risk mapping and feedback from the application of the ISO 80369-6 standard NRFit® connectors

In anesthesia, a medication error would occur every 20 to 133anesthesia procedures, and 14% is related to a route administration error. To secure neuraxial route, ISO group published a norm in 2016 to develop specific connectors, the "NRFit® connector". The main objective of this work, is to develop a risk mapping related to neuraxial medication errors therefore prepare the NRFit® implementation in anesthesia units in a French Universitary Hospital. Failure modes, effects and criticality analysis (FMECA) methodology was used for our risk mapping which was divided in 3 anesthesia specialities. For each, the analysis was performed for accidental neuraxial administration of intravenous drugs, and its opposite error. Secondly, NRFit® devices were tested for 1month by 3 experimented anesthetists. The majority of reported errors concerns epidural and intrathecal anesthesia, and more frequently in the field of obstetrics. Opioids and tranexamic acid, administered in neuraxial route, are drugs with the highest criticality. The tests were rather conclusive and made it possible to highlight the additional needs in medical devices. Obstetrics is the riskiest area due to the frequency of epidural anesthesia, the administration of critical drugs in intravenous and neuraxial route. This work increased the awareness of our group, improved the measure of this risk and harmonized practices. This work is the first step of the project to prevent administration route error in anesthesia during patient's drug management. The next step will be the NRFit® implementation for epidural and combined spinal-epidural anesthesia in our hospital.

Risk factor analysis and prediction model construction for surgical patients with venous thromboembolism: A prospective study

Abstract Objective: Patients undergoing surgery are at high risk of developing venous thromboembolism (VTE). This study aimed to determine the predictive value of risk factors for VTE in surgical patients and to develop a prediction model by integrating independent predictors. Methods: A total of 1111 patients who underwent surgery at clinical departments in a tertiary general hospital were recruited between May and July 2021. Clinical data, including patient-related, surgery-related, and laboratory parameters, were extracted from the hospital information system and electronic medical records. A VTE prediction model incorporating ten risk variables was constructed using artificial neural networks (ANNs). Results: Ten independent factors (X1: age, X2: alcohol consumption, X3: hypertension, X4: bleeding, X5: blood transfusions, X6: general anesthesia, X7: intrathecal anesthesia, X8: D-dimer, X9: C-reactive protein, and X10: lymphocyte percentage) were identified as associated with an increased risk of VTE. Ten-fold cross-validation results showed that the ANN model was capable of predicting VTE in surgical patients, with an area under the curve (AUC) of 0.89, a Brier score of 0.01, an accuracy of 0.96, and a F1 score of 0.92. The ANN model slightly outperformed the logistic regression model and the Caprini model, but a DeLong test showed that the statistical difference in the AUCs of the ANN and logistic regression models was insignificant (P&gt;0.05). Conclusion: Ten statistical indicators relevant to VTE risk prediction for surgical patients were identified, and ANN and logistic regression both showed promising results as decision-supporting tools for VTE prediction.

Role of Preoperative Albumin Quotient in Surgical Planning for Posttraumatic Syringomyelia: A Comparative Cohort Study.

Surgical procedures for patients with posttraumatic syringomyelia (PTS) remain controversial. Until now, there have been no effective quantitative evaluation methods to assist in selecting appropriate surgical plans before surgery. We consecutively enrolled PTS patients (arachnoid lysis group, n = 42; shunting group, n = 14) from 2003 to 2023. Additionally, 19 intrathecal anesthesia patients were included in the control group. All patients with PTS underwent physical and neurological examinations and spinal magnetic resonance imaging preoperatively, 3-12 months postoperatively and during the last follow-up. Preoperative lumbar puncture was performed and blood-spinal cord barrier disruption was detected by quotient of albumin (Qalb, cerebrospinal fluid/serum). The ages (p = 0.324) and sex (p = 0.065) of the PTS and control groups did not differ significantly. There were also no significant differences in age (p = 0.216), routine blood data and prognosis (p = 0.399) between the arachnoid lysis and shunting groups. But the QAlb level of PTS patients was significantly higher than that of the control group (p < 0.001), and the shunting group had a significantly higher QAlb (p < 0.001) than the arachnoid lysis group. A high preoperative QAlb (odds ratio, 1.091; 95% confidence interval, 1.004-1.187; p = 0.041) was identified as the predictive factor for the shunting procedure, with the receiver operating characteristic curve showing 100% specificity and 80.95% sensitivity for patients with a QAlb > 12.67. Preoperative QAlb is a significant predictive factor for the types of surgery. For PTS patients with a QAlb > 12.67, shunting represents the final recourse, necessitating the exploration and development of novel treatments for these patients.

Prophylactic infusion of norepinephrine does not affect the rostral spread of spinal anesthesia in pregnancy: a prospective, randomized, double-blinded study.

Background: The infusion of phenylephrine to prevent spinal-induced hypotension (SIH) in cesarean delivery may decrease the rostral spread of a spinal local anesthetic. We hypothesized that infusion of norepinephrine may decrease the rostral spread of spinal anesthesia, similar to that caused by phenylephrine. The aim of this study was to compare the block height of spinal anesthesia in the presence or absence of norepinephrine infusion administered to prevent SIH during cesarean delivery. Methods: Eighty patients were enrolled and allocated into groups receiving a norepinephrine infusion (group N) or saline infusion (group C). After intrathecal injection of hyperbaric bupivacaine 10mg, the block height for cold and pinprick sensation was checked 10 and 20min after the injection. The demographic characteristics, spinal anesthesia, side effects, and neonatal outcomes were also recorded. Results: The block height for cold and pinprick sensation was similar between the two groups, although the incidence of hypotension was significantly lower (p < 0.00) in group N than in group C. Systolic blood pressure was also more stable in group N than in group C, with the incidence of interventions being significantly lower in group N. There was no significant difference in patient satisfaction between the two groups. Conclusion: Evidence from this study suggested that prophylactic norepinephrine infusion does not reduce the rostral spread of spinal anesthesia in pregnancy. We suggest that it is not necessary to increase the dose of an intrathecal local anesthetic for cesarean delivery when prophylactic norepinephrine is administered. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=152899, identifier [ChiCTR2200057439].

Intrathecal Fentanyl Versus Intravenous Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study

Background: The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication in Cesarean section with potential negative impacts on patient outcomes. The present study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients. Materials and Methods: A randomized controlled trial was conducted from Feb 2023 to August 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The study subjects were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only IV fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during procedure in the study. Results: The incidence of shivering was significantly lower in the Intrathecal fentanyl and IV ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and IV ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. Conclusion: The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in C-section patients. The present study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.

Effects of Intrathecal Anesthesia with Hyperbaric Bupivacaine for Hind Limb Orthopedic Surgery in Calves

Anesthesia obtained by the injection of local anesthetic into the cerebrospinal fluid is defined as intrathecal or spinal anesthesia. This study aimed to compare intrathecal anesthesia with gas anesthesia in calves operated for hind limb fractures. Twelve calves with hind leg femur and tibia fractures were included in the study. Six of these calves were subjected to intrathecal anesthesia (IT) and the other 6 to gas anesthesia (GA). Sedation with xylazine was performed after general operative preparations. In the IT group, hyperbaric bupivacaine was injected lumbosacrally, while in the GA group, general anesthesia was achieved with isoflurane after mask induction. Anesthesia onset, operation and anesthesia durations, and intraoperative parameters were recorded. Systolic and diastolic blood pressure, pulse, respiratory rate, body temperature, and electrocardiography were monitored and recorded. In addition, postoperative pain was evaluated with the postoperative pain visual analog scale (VAS), simple descriptive pain scale (SDS), and bovine pain assessment scale (BPAS). Although there were statistical differences between the hemodynamic values measured in the study, they remained within reference ranges. In conclusion, it can be said that intrathecal anesthesia is practical for hind leg surgery in calves and has advantages, especially in terms of postoperative pain management.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (&lt;0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.