Lumbar Epidural Anesthesia Research Articles

Conquering Post-Dural Puncture Headache: A Systematic Review of Effective Treatments

Post-dural puncture headache (PDPH) is a common complication following spinal procedures, particularly lumbar punctures and epidural anesthesia. This systematic review aims to evaluate and compare the effectiveness of various management strategies for PDPH. A comprehensive search was conducted across major databases for relevant articles published up to January 2024. The inclusion criteria comprised studies assessing interventions for post-dural puncture headache (PDPH) management in adult populations. Data extraction and quality evaluation were conducted independently by two reviewers. Analysis involved 34 studies meeting the inclusion criteria. The results indicate that conservative approaches, including bed rest, hydration, caffeine, and analgesics, continue to serve as the fundamental components of PDPH management. Additionally, epidural blood patch (EBP) emerged as the most effective intervention for refractory cases. However, further research is needed to optimize treatment protocols and explore emerging therapies.

Ultrasound-Guided Lumbar Plexus-Sciatic Nerve Blocks Versus Epidurals for Orthopaedic Surgeries: A Study to Compare the Competency of Novice Anaesthesiology Residents in a High-Volume Level 1 Trauma Centre.

The relative merits of peripheral nerve blocks (PNB) over central neuraxial anaesthesia and the advantages of the above two techniques over general anaesthesia for surgical interventions of the lower limb are well established. The competency of anaesthetic trainees in a high-volume level 1 trauma centre in administering dual ultrasound and nerve stimulator-guided lumbar plexus-sciatic nerve block(DUNLuPS) vs. epidural anaesthesia (EA) was compared by reporting the adequacy of anaesthesia with the two techniques, time taken for the performance of block, time of onset of sensoryblock (TOSB), and time of onset of motor block (TOMB). This prospective, randomized, study enrolled 92 patients aged 18-80 years with lower limb fractures admitted in trauma triage and scheduled for surgery. Thepatients were randomly allocated equally into the EA group and the DUNLuPS group. A total of 20 anaesthesia trainees in the third year of residencywith clinical experience of more than 15 independent lumbar plexus-sciatic nerve blocks were included in the study.A volume of 20 ml of 0.5% ropivacaine was administered in the lumbar plexus (Shamrock technique) but the volume used for sciatic nerve (subgluteal approach) was varied so that the cumulative dose did not exceed 3 mg/kg. For each block, the onset of nerve blockade was assessed every five minutes, and the assessments continued for an additional 30 minutes after the nerve blocks were finished. Clinical characteristics and adequacy of anaesthesia were comparable, i.e., 95.65% and93.47% success in the EA (n = 46) and DUNLuPS (n = 46) groups, respectively. Performance time was significantly more in the DUNLuPS group but followed by significantly less TOSB and TOMB. The time for the first analgesic request was 351.63 ± 148.70 minutes in the DUNLuPS group and 147.60 ± 52.65 minutes in the EAgroup (p < 0.0001). Both EA and DUNLuPS provide effective and comparable intra-operative anaesthesia for orthopaedic lower limb surgeries (OLLS) when administered by residents with more than two years of experience (third year of residency)in ultrasound-guided regional nerve blocks in a high-volume level 1 trauma centre. Statistically significant differences in the block performance characteristicshad no clinical advantage as it was compensated by the faster onset time in the DUNLuPS group. Post-operative pain management was better in the DUNLuPS group, sothe practice and conduct of anaesthesia for trauma patients should focus on the establishment of "block rooms" and timely training of residents in the former so that the advantages can be extended to the patient population.

Epidural lumbar pneumocysts and radiculopathy: description of a clinical case of diagnosis and treatment

Epidural pneumocysts are a rare but significant cause of severe low back pain in patients. A clinical case of diagnosis and treatment of this disease, which often remains poorly studied in the literature, is presented. It should be noted that descriptions of nerve root compression by a gas bubble are found in both domestic and foreign publications, but they are rare, which makes the problem relevant and interesting for the medical community.

Transverse ultrasound scanning of lumbar-epidural depth and its co-relation with conventional method: A prospective observational study in obese Indian parturients

Pre-procedural ultrasound (US) imaging as a tool of determining the proper insertion site and assessing lumbar-epidural depth in obese Indian parturients. The current study’s goal was to assess the epidural depth space in obese Indian parturients by ultrasound imaging with conventional technique and also to assess whether if it decreases the failure rate and number of attempts. Twenty-five obese parturients with a BMI of more than 30 kg/m who were scheduled for elective lower segment caesarean sections under lumbar epidural anesthesia and were classified as American Society of Anaesthesiology grade I &amp; II were included. Using a curvilinear US probe (frequency 2–5 MHz), ultrasound depth-UD (lumbar epidural) was recorded in the transverse axial plane at the L3–L4 and L4–L5 intervertebral regions. Afterwards, the needle depth (ND) was monitored using a sterile linear scale during the epidural administration process using the traditional loss of resistance (LOR) approach. Any modifications to the intervertebral spacing, needle reorientation, or the quantity of tries were recorded. The results showed that UD and ND were, respectively, 4.6140 ± 0.252 cm (range 4.20–5.30 cm) and 4.720 ± 0.271 cm (range 4.2–5.5 cm). Pearson's correlation coefficient (r) for UD and ND was 0.953 (95% confidence interval: 0.8948–0.9793, r = 0.908, P &amp;#60; 0.001), and the 95% limits of agreement were found to be 0.266 to 0.546 cm using Bland-Altman analysis. Of all the subjects, 92% needed only one try to put the epidural, whereas 8% needed two. The current study demonstrates a significant association of ultrasound (UD) and needle depth (ND) in obese pregnant females (BMI &amp;#62;30 kg/m). For lumbar epidurals, a preprocedural US scan in the transverse-axial plane provides a precise needle entry site with a high success rate.

Hemodynamic instability caused by pneumorrachis and pneumomediastinum following epidural analgesia: a case report

BackgroundPneumomediastinum and pneumorrachis are rare complications following epidural analgesia, that can either be asymptomatic or rarely can produce mild to moderate severity symptoms. Most reported cases regarding the presentation of these two entities with epidural analgesia concern asymptomatic patients, however there are cases reporting post-dural puncture headache and respiratory manifestations.Case presentationWe present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia.ConclusionAnesthesiologists should be aware that epidural analgesia using the LOR to technique injecting air could produce a pneumomediastinum and pneumorrachis, which in turn could produce hemodynamic instability via parasympathetic stimulation.

Comparison of Suprainguinal Fascia Iliaca Nerve Block and Epidural Analgesia in Patients Undergoing Periacetabular Osteotomy.

Adequate pain control and early mobilization are critical in the postoperative period after periacetabular osteotomy (PAO). Regional anesthesia can reduce postoperative pain, but certain techniques can increase the risk of postoperative motor block and delayed functional recovery. Continuous lumbar epidurals can provide excellent analgesia but also create challenges with early ambulation. Recently, suprainguinal fascia iliaca (SIFI) single-shot blocks have been shown to provide effective analgesia in PAO patients. The goal of this study was to compare opioid use, time to achieve inpatient physical therapy (PT) goals, and length of stay (LOS) between a cohort of patients receiving SIFI blocks and a cohort of patients receiving epidural analgesia (EA). This retrospective single-surgeon comparative cohort study included all patients who underwent a PAO between 2012 and 2022. Regional anesthetic technique (SIFI vs EA), length of hospital stay, intraoperative and postoperative opioid use, pain scores, and time to achievement of PT milestones before discharge were recorded. Patients were excluded if they had any preexisting neuromuscular syndrome or neurosensory deficit. All opioid use was converted to morphine-milligram equivalents using standard conversions. Two hundred four surgeries were done over the study period; 164 patients received EA, and 40 received a SIFI block. The average age of our cohort was 19.5 years (±6 yrs). The SIFI cohort had a significantly shorter mean LOS than the EA cohort (2.9 vs 4.1 days, P < 0.001). Patients in the SIFI cohort achieved all PT ambulation goals significantly sooner than the lumbar epidural group (P < 0.001), with lower total opioid use on each postoperative day. No notable differences were observed in sex, race, BMI, or pain scores at inpatient PT visits before discharge. After PAO surgery, the SIFI block is associated with shorter hospital LOS, reduced postoperative opioid use, and earlier mobilization when compared with those who were managed with an epidural.

Regional anesthesia for hip surgery in children: A review

Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.

Regional anaesthesia training in the UK – a national survey

BackgroundAdequate training of anaesthetists in regional anaesthesia is important to ensure optimal patient access to regional anaesthesia. MethodsWe undertook a national survey of UK trainee anaesthetists and Royal College of Anaesthetists (RCoA) tutors to assess experiences of training in regional anaesthesia. We performed descriptive statistics for baseline characteristics, and logistic regression of training indices and tutor confidence that their hospital could provide regional anaesthesia training at all three stages of the RCoA 2021 curriculum. ResultsA total of 492 trainees (19.2%) and 114 tutors (45.2%) completed the survey. Trainees were less likely to have received training in chest/abdominal wall compared with upper/lower limb blocks {erector spinae vs femoral block (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.16–0.39), P<0.001}, or achieved >20 chest/abdominal wall blocks by Stage 3 of training (chest vs lower limb block [OR 0.09, 95% CI 0.05–0.15, P<0.001]. There was a strong association between training received, number of blocks performed (>20 vs 0–5 blocks), and self-reported ability to perform blocks independently, OR 20.9 (95% CI 9.38–53.2). 24/182 (13%) and 10/182 (5.5%) of trainees had performed ≥50 non-obstetric lumbar and thoracic epidurals, respectively, by Stage 3 training. There was a positive association between having a lead clinician for regional anaesthesia, particularly those with paid sessions, and reported confidence to provide regional anaesthesia training at all stages of the curriculum (Stage 3 OR 7.27 [95% CI 2.64–22.0]). ConclusionOur results confirm the importance of clinical experience and access to training in regional anaesthesia, and support the introduction of departmental regional anaesthesia leads to improve equity and quality in training opportunities.

The Improvement Effect of Combined Lumbar Epidural Anesthesia on Intraoperative Analgesia and Muscle Relaxation in Patients with Lumbar Disc Herniation and Adverse Reactions

The Improvement Effect of Combined Lumbar Epidural Anesthesia on Intraoperative Analgesia and Muscle Relaxation in Patients with Lumbar Disc Herniation and Adverse Reactions

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

Background: During the past 20 years, numerous publications have described the usefulness of systolic pressure variation, pulse pressure variation, stroke volume variation, etc., to guide intraoperative fluid administration. However, we still lack robust noninvasive physiological variables to successfully predict the response to fluid loading. Aims and Objectives: The present study was designed to evaluate the utility of plethysmography variability index (PVI) to optimize fluid management during intra-abdominal surgery in cancer patients. Materials and Methods: After the Institutional Ethics Committee approval and consent, 60 patients scheduled for elective lower abdominal cancer surgeries were randomized to receive fluid by either PVI-directed management (2 mL/kg/h) or using central venous pressure (8 mL/kg/h) after standardized technique of general and lumbar epidural anesthesia. The PVI was calculated by measuring changes in the PI during the respiratory cycle (PVI = [(PImax - PImin)/PImax] × 100). Arterial blood samples were taken at the time of incision and after 6 h postoperatively. Instances of intraoperative hypotension and oliguria were recorded. Results: Among the 60 patients enrolled in the study, demographic data, ASA status, duration of surgery, and hemodynamics were found to be comparable. The amount of crystalloid given was significantly lesser in Group P (984.70±51.16) as compared to Group C (2395.27±209.68) (P&lt;0.001). Four patients in Group P and three patients in Group C required vasopressors. Conclusion: The use of PVI-guided fluid management was associated with lower lactate levels and crystalloid requirement. Reduced lactate levels in PVI-guided patients suggest that PVI-guided fluid management may be tailored to everyone’s needs.

Posteriorly migrated epidural lumbar disc extrusion with contralateral neurodeficit: An unusual presentation

Abstract The posterior epidural migration of lumbar disc herniation is a rare condition, and the overall reported incidence is 0.4%–1.04%. Most of these cases present with cauda equina syndrome or polyradiculopathy on ipsilateral side. We report a case of posterior epidural migration of lumbar disc causing contralateral neurodeficit. A 66-year-old gentleman presented with axial pain radiating to the left anterolateral thigh since 15 days after heavy weight lifting. Neurological examination revealed hypoesthesia over left L3 dermatome and left knee extensor weakness (Medical Research Council grade 3/5). Magnetic resonance imaging with contrast showed L2–L3 right-side extruded disc fragment migrated posteriorly in epidural space. Contralateral monoradiculopathy was an unusual presentation. Interlaminar decompression and discectomy were able to achieve complete neurological recovery at three months. To the best of our knowledge, this is the second case with contralateral neurodeficit due to posteriorly migrated lumbar disc herniation.

Extensive spinal epidural abscess after nerve root injection in a young non-immunocompromised Patient. Case Report and Literature Review.

Epidural injections are frequent and safe procedures. Severe complications are infrequent, and they have been reported in elderly comorbid patients with predisposing factors. The objectives of this work are to present a case of an extensive epidural lumbar abscess in a young non-comorbid male patient after a therapeutic L5-S1 injection and a literature review about this subject. An otherwise healthy 24-year-old man who present a case of an extensive epidural lumbar abscess after a therapeutic nerve root block due to a disc herniation. After 7 days of fever and low back pain, he required two surgical interventions and intravenous antibiotic therapy. We reviewed 18 patients with epidural abscess consequence of spinal injections. Their mean age was 54.5 y.o, 66.5% were male, and 66.5% had at least one predisposing risk factor. Symptoms Onset occurred at 8 days on average after the procedure, but the correct diagnosis was made at the 25th-day average. Only 22% presented the classic diagnostic triad, the most frequently isolated germ was Staphylococcus Aureus (66%) and 89% were treated surgically with a 33% rate of complete recovery, 17% mortality and 28% remained with neurological sequelae. Epidural abscesses are infrequent and serious, complication after spinal diagnostic and therapeutic injections, even in young patients without comorbidities. We consider it fundamental to maintain a diagnostic suspicion, even in this subgroup of patients.

Perioperative management of a patient with incidentally detected pulmonary artery aneurysm undergoing non-cardiac surgery—a case report

BackgroundThere are few case reports in which non-cardiac surgery under regional anesthesia has been described in a patient with a pulmonary artery aneurysm. We report a case in which we managed a 74-year-old lady with a hip fracture for fixation under spinal anesthesia after thorough evaluation and meticulous planning. The patient was discharged home after 5 days without any perioperative events.Case presentationA 74-year-old, hypertensive lady with an incidentally detected pulmonary artery aneurysm was posted for a dynamic hip screw. Two-dimensional echocardiography revealed normal biventricular function with an ejection fraction of 60%, no regional wall motion abnormalities, concentric right ventricular hypertrophy (tricuspid annular plane systolic excursion or TAPSE of 19 mm), severe calcific pulmonary stenosis (PS) with pressures 90/61 mm Hg, pulmonary valve annulus of 12 mm, and pulmonary artery systolic pressure of 35 mm Hg. The left and right pulmonary artery diameters were 17 mm and 20 mm, respectively. She was clinically asymptomatic with an oxygen saturation of 98% on room air. A sequential lumbar epidural anesthesia was planned for this patient given her age, overall frail condition, and to avoid airway instrumentation. As epidural was difficult due to fused spaces, a sub-arachnoid block was administered with continuous monitoring. Surgery was uneventful and the patient was discharged on the 5th postoperative day.ConclusionsWith this case report, we suggest that a central neuraxial blockade could be administered in presence of severe PS with meticulous monitoring and careful planning.

Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals.

Introduction: Lumbosacral spinal cord neuromodulation has shown the ability to restore voluntary control and stepping in individuals with chronic spinal cord injury. Methods: We combined cervical transcutaneous and lumbar epidural stimulation to explore the brain-spinal connectomes and their influence in spinal excitability and interlimb coupling. Four individuals with a prior implanted lumbosacral spinal cord epidural stimulator participated in the study. We assessed lower extremity muscle activity and kinematics during intentional stepping in both non-weight bearing and weight-bearing environments. Results: Our results showed an inhibition of motor evoked potentials generated by spinal cord epidural stimulation when cervical transcutaneous stimulation is applied. In contrast, when intentional stepping is performed in a non-weight bearing setting, range of motion, motor output amplitude, and coordination are improved when cervical transcutaneous and lumbar epidural stimulations are combined. Similarly, with both stimulations applied, coordination is improved and motor output variability is decreased when intentional stepping is performed on a treadmill with body weight support. Discussion: Combined transcutaneous cervical and epidural lumbar stimulation demonstrated an improvement of voluntary control of stepping in individuals with chronic motor complete paralysis. The immediate functional improvement promoted by the combination of cervical and lumbar stimulation adds to the body of evidence for increasing spinal excitability and improvement of function that is possible in individuals with chronic paralysis.

Different Doses of Lumbar Epidermal Methylprednisolone Injection and their effect on Pain Control and Blood Glucose Level in Diabetic patients

Background: Frequency of diabetes mellitus is high between people suffering from lumbar spinal degenerative sickness Despite the fact that injection of steroid in epidural space are recognised to rise the glycaemic Blood amount postoperatively, therefore it is inquiry that decrease dose of methylprednisolone (40mg) cannot rise blood glycaemic level as compare to higher dose of methylprednisolone (80mg) and their effect on pain management of patients. Aim: To evaluate 2 common doses (80mg &amp; 40mg) of methylprednisolone effects which is given through Epidural lumbar route, on glycaemic Blood level and pain management of diabetes mellitus patients to determine an adequate epidural steroid dose. Methods: This was an observational prospective study was conduct at Department of Anaesthesia Hayatabad Medical Complex Peshawar in June 2022. Overall 110 Diabetes mellitus patients were participated. They acquired lumbar epidural, methylprednisolone for spinal stenosis radiculopathy or failed back surgery syndrome. Methylprednisolone dose were given to patients, either 80mg (Group A) or 40 mg (Group B) was determined clinically after the procedure type. Results: HbA1c level was noted in group A 6.21mmol/L while in group B 6.52 mmol/L (p =0.991). The increase in fasting blood glucose (FBG) were greater significantly A Group than in B Group on post procedure day (PPD)1,2&amp;3 (PPD1: 179 mg/dL A Group Vs 146mg/dL in B Group ), (PPD2: 221 mg/dL in A Group Vs 152mg/dL in B Group ) &amp; (PPD3: 202mg/dL in A Group Vs 175mg/dL in B Group ). Fasting blood glucose incidence was &gt;180mg/dL were greater in A Group than in B Group on post procedure day 1&amp;2 (PPD1: A Group=11 vs B Group=5) and (PPD2: A Group=13 Vs B Group= 4). Conclusion: Methylprednisolone increase dose 80mg rise FBG and PDG greater than a decrease dose 40mg with no effect on pain management, employment status, or clinical outcome. Thus, it is recommended that methylprednisolone 40mg will b given rather than 80mg in diabetes mellitus patients with respect to pain management and blood glycaemic level Keywords: Epidural methylprednisolone, back pain, blood glucose.

A cross-sectional observation study to evaluate the efficacy and complications of epidural analgesia in paediatric population.

With advances in pediatric surgery, pediatric epidurals are increasingly being used for analgesia. As there is scarcity of data in India about the pediatric epidurals, we sought to determine the efficacy and complications of epidural analgesia. The aim of this study was to determine the efficacy of pediatric epidural analgesia and the incidence of complications aimed at improving the quality of care. It was a prospective observational study in tertiary care hospital in the Southern part of India. Newborns to children aged 18 years in whom continuous epidural analgesia was planned were recruited. They were followed up postoperatively at specified intervals wherein pain scores were used to determine analgesic efficacy. Complications were noted in a specified format and the level of satisfaction of patient and surgeon was noted objectively. All the statistical analyses were performed using SPSS 25.0. 100 children were recruited of which 63 received thoracic epidurals and 37 lumbar epidurals. Overall efficacy of epidural in pain management was 90.96% with the highest efficacy for lower abdominal epidurals (94.9%). Kinking of a catheter was the most common complication encountered (11%), followed by migration of catheter, occlusion of pump, and motor block. Continuous epidural analgesia has proven to be a safe and effective method to provide analgesia to the children in a protected environment and experienced hands.

Lumbar Epidural Anesthesia in a High-Risk Patient with Advanced Lung Cancer, Multi-Organ Metastasis and Hydropneumothorax

Epidural anesthesia (EA) can be applied in the perioperative period (PP) in addition to general anesthesia (GA) or as a stand-alone anesthesia technique. EA provides better hemodynamic stability in high-risk patients, reduced neurohormonal surgical stress response, and preserved airway reflexes with spontaneous breathing. In addition, EA prevents pulmonary dysfunction through decreasing multifactorial mediators, improves pulmonary functions by reducing the decrease in functional residual capacity, and protects spontaneous respiratory and airway reflexes. Herein, we wanted to emphasize the importance of the perioperative approach, the choice of anesthesia technique, and the effects of this choice on the postoperative period in a high-risk patient with incidental stage four lung adenocarcinoma, right parietal brain, lumbar vertebral, liver, and adrenal metastasis, as well as hydropneumothorax. With a successful epidural catheterization and anesthesia, the patient was follow-up without any problems. As in our patient, we should adopt a multimodal approach in the perioperative period, perform a detailed examination before the operation, and evaluate all risks and benefits comparatively when choosing the most appropriate anesthesia technique. Thus, it should be kept in mind that the chosen technique will significantly affect perioperative complications, morbidity and mortality, drug use, length of hospital stay, and cost.

Development and validation of a risk prediction scale for hypothermia during cesarean section: A prospective study.

Evidence shows that active insulation can reduce the incidence of hypothermia during cesarean section; however, compliance is lower than recommended. Moreover, several aspects of temperature management via active heat preservation remain unclear, including patient indications, timing, methods, and duration. Therefore, promptly identifying parturients at a high risk for hypothermia during cesarean section is crucial. To develop and validate a scale for predicting hypothermia in parturients during cesarean section. Prospective study. Three grade A hospitals in Hunan Province, China. The prediction scale was developed based on data from 369 parturients who underwent cesarean section from July 2018 to January 2019. Inclusion criteria were as follows: cesarean section under lumbar anesthesia, epidural anesthesia, or combined lumbar and epidural anesthesia; voluntary participation in the study and completion of the informed consent form; age >18 years. Univariate and multivariate analyses were used to determine factors influencing hypothermia and establish the predictive model for hypothermia risk during cesarean section. The Hosmer-Lemeshow test was used to determine the goodness of fit of the prediction tool, and the area under the receiver operating characteristic curve was used to determine the predictive ability of the proposed scale. The cutoff value of the prediction scale was determined according to the Youden index. In the logistic regression prediction model, the Hosmer-Lemeshow goodness-of-fit test yielded a p-value of 0.425. The area under the receiver operating characteristic curve was 0.888. The model exhibited a good fitting effect and discriminant validity. Total risk scores for hypothermia ranged from 0 to 11. A score of 7 was used as the diagnostic cutoff value. Parturients during the operation who had total scores of ≥7 and <7 were considered the high-risk and low-risk groups, respectively. The area under the receiver operating characteristic curve for the scale was 0.891. The authenticity evaluation indicated that the incidence of hypothermia was significantly higher in the high-risk group than in the low-risk group. The risk prediction scale developed in this study exhibits moderately predictive efficiency, sensitivity, and specificity for identifying parturients at high risk of hypothermia during cesarean section. Implementing this scale in clinical practice may help to decrease the incidence of hypothermia in such patients. . This new predictive model can identify women who are at a high risk of hypothermia during cesarean section.

Use of a Combined Anaesthetic Technique and Minimally Invasive Hemodynamic Monitoring in a Primigravid with Uncorrected Tetralogy of Fallot for Caesarean Section

Tetralogy of Fallot (TOF) in pregnancy is a rare occurrence which poses a high risk for detrimental effects on bothmother and fetus. This paper reports a 21-year-old primigravid diagnosed with uncorrected TOF who had a successful caesarean section at 32 weeks of gestation. To address the hemodynamic challenges, the anaesthetic management involved the use of a minimally invasive hemodynamic monitor, controlled mechanical ventilation and a combined technique of intravenous anaesthesia using remifentanil and lumbar epidural anaesthesia using levobupivacaine.

The Anesthetic Effect and Safety of Dexmedetomidine in Cesarean Section: A Meta-Analysis.

Objective To evaluate the anesthetic effect and safety of dexmedetomidine in cesarean section. Methods The Cochrane Library, EMBASE, and PubMed databases (established until September 2020) were searched by computer. Two authors independently screened and extracted literature related to the application of dexmedetomidine in the cesarean section according to inclusion and exclusion criteria. The control group received either subarachnoid block (lumbar anesthesia) or combined lumbar anesthesia and epidural anesthesia (combined lumbar epidural anesthesia) with bupivacaine or combined bupivacaine and fentanyl. The observation group was additionally given dexmedetomidine based on the control group, to analyze the anesthetic effect and safety of dexmedetomidine in cesarean section. Results A total of 580 cesarean delivery women were included in 8 studies, and the results showed that the peak time of sensory block in the observation group was shorter than that in the control group (standard mean difference = −0.28; 95% confidence interval: -0.48, -0.08; P = 0.006), sensory block lasted longer than that in the control group (standard mean difference = 1.49; 95% confidence interval: 1.21, 1.78; P < 0.00001), the sedation rate was higher than that in the control group, the onset of the first postoperative pain was significantly delayed compared with that in the control group, and the incidence of postoperative pain, nausea and vomiting, postoperative chills, and fever was lower than that in the control group (P < 0.05). Conclusion Dexmedetomidine combined with lumbar anesthesia or combined lumbar epidural anesthesia for women in cesarean section has more clinical benefits and better safety.