Neuroaxial Anesthesia Research Articles

The Benefits of Awake Spinal Surgery on Minimizing Positioning-related Complications

Study Design. Literature review and institutional analysis. Objective. This review examines the potential advantages of awake spinal surgery under neuroaxial anesthesia in minimizing positioning-related complications compared to traditional general anesthesia. Summary of Background Data. Spinal surgeries performed in the prone position under general anesthesia are associated with perioperative complications, such as ocular injury and vision loss, nerve damage, and pressure ulcers. Methods. A comprehensive literature search was conducted for articles published from 1986 to 2023 focusing on awake spinal surgery and positioning-related complications. Additionally, insights from the Mayo Clinic team were incorporated to assess the potential benefits of awake spine surgery. Results. The review identified several positioning-related complications associated with prone positioning during spine surgery, including perioperative visual loss, neuropathies, pressure ulcers, and intraabdominal hypertension leading to systemic cardiovascular effects and potential organ dysfunction. Advances at the Mayo Clinic have enabled the use of awake spinal surgery under neuroaxial anesthesia for complex procedures such as robotic transforaminal lumbar interbody fusion. The use of awake lumbar spine surgery has demonstrated advantages, including reduced positioning-related complications, immediate patient feedback to avoid harmful maneuvers, shorter operating room times, and improved hemodynamic stability. Conclusions. Awake lumbar spine surgery offers notable advantages in reducing positioning-related complications and presents a promising alternative to general anesthesia.

Incidental Finding of Parasagittal Meningioma Following the Occurrence of Myoclonic Seizure after the Spinal Anesthesia

In the present manuscript, an 87-year-old man, who was a candidate for knee joint replacement surgery due to severe osteoarthritis of the right knee, was case reported. He underwent neuroaxial anesthesia. Following spinal anesthesia with bupivacaine 0.5% in the fourth and fifth lumbar vertebra, the patient developed myoclonic seizures in the lower limbs and abdomen that lasted during the surgery, as well. Due to the continuation of the seizures, the necessary examinations were performed and an extra-axial tumor in the left parasagittal was detected in the patient’s brain imaging.

Anestesia neuroaxial guiada por ultrasonido vs. reparos anatómicos en ancianos: Estudio de cohorte prospectivo

Introduction: Spinal anesthesia requires palpation of surfaces in order to identify the intervertebral spaces in the lumbar spine. In elderly individuals, the procedure is more challenging due to age-related degenerative changes in the spine. Objective: To determine which technique between ultrasound (US) guidance or the use of anatomical landmarks to guide spinal anesthesia ensures a higher success rate in elderly patients. Methods: Prospective observational cohort study in patients with an indication to receive subarachnoid anesthesia, regardless of the type of surgical intervention, carried out at Hospital Universitario del Valle and Fundación Hospital San José Buga. Data were collected over a 12-month period at the time of making the puncture. The treating anesthetists were free to choose between US guidance or the use of anatomical landmarks. Results: Overall, 80 patients were assessed, including men and women over 65 years of age (mean 78.50±9.04). The number of punctures as well as needle redirections were significantly lower in the US-guided group. Additionally, in the group in which anatomical landmarks were used to guide the puncture, the marked site did not coincide with the actual puncture site confirmed with US in 37.5% of cases (p<0.001). This could result in inadequate block or complications associated with intradural puncture. Conclusions: US-guided neuroaxial anesthesia in elderly individuals could facilitate success on the first attempt.

6301976 Service evaluation of current trends in rescue analgesia during Lower Segment Caesarean Sections under neuroaxial anaesthesia

6301976 Service evaluation of current trends in rescue analgesia during Lower Segment Caesarean Sections under neuroaxial anaesthesia

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study.

Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects. To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia. Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant. Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size. The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

Anesthesia in patients with chronic liver disease: An updated review.

Anesthesia in chronic liver disease patients can be challenging because of the medications given or interventions performed and their effects on liver physiology. Also, the effects of liver disease on coagulation and metabolism should be considered carefully. This review focuses on anesthesia in patients with different chronic liver disease stages. A literature search was performed for Scopus and PubMed databases for articles discussing different types of anesthesia in patients with chronic liver disease, their safety, usage, and risks. The choice of anesthesia is of crucial importance. Regional anesthesia, especially neuroaxial anesthesia, may benefit some patients with liver disease, but coagulopathy should be considered. Regional anesthesia provides optimum intraoperative relaxation and analgesia that extends to the postoperative period while avoiding the side effects of intravenous anesthetics and opioids. Pharmacodynamics and pharmacokinetics of anesthetic medications must guard against complications related to overdose or decreased metabolism. The choice of anesthesia in chronic liver disease patients is crucial and could be tailored according to the degree of liver compensation and the magnitude of the surgical procedure.

Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review.

Miniaturized PCNL (mi-PCNL) for stone disease is performed under a general anesthesia. However, the role of loco-regional anesthesia in mi-PCNL and its outcomes are not well defined yet. Here, we review the outcomes and complications of loco-regional anesthesia for mi-PCNL. A Cochrane-style review was performed in accordance with the preferred reporting items for systematic reviews to evaluate the outcomes of loco-reginal anesthesia for URS in stone disease, including all English language articles from January 1980 and October 2021. Ten studies with a total of 1663 patients underwent mi-PCNL under loco-regional anesthesia. The stone-free rate (SFR) for mi-PCNL under neuro-axial anesthesia ranged between 88.3 and 93.6%, while it ranged between 85.7 and 93.3% for mi-PCNL under local anesthesia (LA). The conversion rate to another anesthesia modality was 0.5%. The complications ranged widely between 3.3 and 85.7%. The majority were Grade I-II complications and none of the patients had grade V complications. Our review shows that mi-PCNL under loco-regional anesthesia is feasible with good SFR and a low risk of major complications. The conversion to general anesthesia is needed in a small minority, with the procedure itself being well tolerated and a big step towards establishing an ambulatory pathway for these patients.

Cedera Saraf Setelah Anestesi Neuraksial Nerves Injury Post Neuroaxial Anesthesia

&#x0D; &#x0D; &#x0D; &#x0D; Neural injury post neuroaxial anesthesia procedure is a rare complication but feared by many anesthesiologists. Neural injury incidence range is 0,03 to 0,1% among all neruaxial block patients. Neural injury is happened due to infection, needle-trauma to vertebrae or vertebral neural cord directly, medulla spinalis ischaemia or neurotoxicity. Most causes of neural injury are hematoma and infection. &#x0D; Whenever suspect a neural injury, rapid diagnosis and treatment are needed. MRI and CT-scan examination are the best of choice in imaging neural injury. Mild symptoms without objective neural deficit, mostly showed good prognosis and whenever they are deteriorate, a neurologic consultation must be done. Lesion with moderate or severe deficit neulogic is an indication for advanced neurologic consultation, neurophysiologic examination (neural conduction study and electromyography) or MRI/CT Scan examination. A complete or progressive neural deficit needs to be evaluated by a neurologist or neurosurgeon. &#x0D; Neural injury with mild symptoms can be treated with steroid, NSAID, neurotropic vitamins, and physiotherapy. Neural trauma due to compression, needs to be decompressed. Recovery process has a direct relationship with the early decompression treatment. &#x0D; &#x0D; &#x0D; &#x0D;

Evidence-based practical Guideline on the Management of Failed Spinal Anesthesia in pregnant mothers undergoing Caesarean Section in a Resource constrained area; Systematic Review Article

Neuroaxial anesthesia is regarded as the most effective form of anesthesia for cesarean procedures. Although generally reliable, Neuraxial operations can fail totally or partially and may need further assistance.

EVALUATION OF CHANGE IN BLOOD PRESSURE IN REPOSITIONING FROM LITHOTOMY TO SUPINE POSITION IN PATIENTS UNDERGOING SURGERIES UNDER SUB-ARACHNOID BLOCK- AN OBSERVATIONAL STUDY

Objective: Spinal anaesthesia is associated with variety of hemodynamic alterations, because of sympathetic blockade. Hemodynamics are also affected by a variety of surgical techniques. The lithotomy posture and the effects of autotransfusion increases the Systolic Arterial Pressure in the sub-extremities. Study was designed to evaluate the changes in blood pressure in repositioning from lithotomy position to supine position in patients undergoing surgeries under sub-arachnoid block. This Methods: observational study was performed in 41 patients who underwent for elective/ emergency surgeries under subarachnoid block requiring lithotomy position. Demographic information such as age, height, weight, BMI, ASA grade, height of sensory block, quality of motor block and hemodynamics such as Heart Rate (HR), Pulse Oximetry (SpO2), non invasive Blood Pressure (NIBP) during lithotomy position and repositioning to supine position were also recorded. In this study there is no signi Results: cant difference was observed in patients in repositioning from lithotomy position to supine position following sub-arachnoid block. There is slightly increased in Systolic blood pressure in patients in lithotomy position compared to supine position. This study was performe Conclusion: d on 41 patients who underwent surgeries under subarachnoid block requiring lithotomy position and this study concluded that there is no difference was observed in patients in repositioning from lithotomy position to supine position. The purpose of the study is to take necessary precautions will be taken to prevent blood pressure changes intraoperatively. Spinal anaesthesia is most commonly used neuro-axial anaesthesia technique, where the local anaesthesia is directly injected into the intrathecal space (sub-arachnoid block). The uid that surrounds the brain and spinal cord is called cerebro-spinal uid, is present in the sub-arachnoid region (1). Spinal Anaesthesia is usually given in patients in lateral position or sitting position, Trendelenburg position will produce higher level of block as compared to supine position (2). The spinal anaesthesia was rst performed in 1885 by Dr. James Corning of New York City. He used cocaine and the patient was a dog. However, August Bier performed the rst sub-arachnoid block surgery in Germany in 1898. Sub-arachnoid block is the type of regional anaesthetic that was most frequently used for obstetrics and caesarean sections after the 1950s (3). Spinal anaesthesia is used in patients undergoing procedures: femur, ankle orthopaedic hip, tibia and knee surgery, including haemorrhoidectomy and leg vascular surgery, Endovascular aortic aneurysm repair, joint replacement, arthroplasty, Hernia (inguinal or epigastric), Combined general anaesthesia and cystectomy, nephrectomy, transurethral resection of bladder tumours, Transurethral excision of the prostate and Caesarean sections, various hysterectomy methods, cases of urology. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. By using spinal anaesthesia, a patient can avoid the hazards of a difcult airway, consciousness, and aspiration that come with general anaesthesia in pregnant patients. (4) . Hypotension is the most common complication of spinal anaesthesia, which is linked to a variety of haemodynamic abnormalities. The sympathetic blockade, which causes venous and arterial dilatation, are the primary mechanism (5). Total peripheral resistance reduces as a result of arterial dilatation, and cardiac output and venous return both decrease, which can result in severe hypotension (6). Hypotension do occur in almost all patients and signicant hypotension (systolic BP)

Residual anti-Xa activity in plasma of patients presenting for electively planned neuraxial regional anesthesia

ObjectiveTo determine the incidence of increased anti-Xa activity within plasma levels 24 hours after administration of therapeutic dose low-molecular-weight heparin in patients presenting for elective neuraxial anesthesia.BackgroundGuidelines for neuroaxial regional...

Effect of the method of anesthetic aid on cellular immunity in periprosthetic infection of the hip joint: : a prospective open randomized study

BACKGROUND: Periprosthetic infection after primary hip replacement is a serious complication. For the anesthetic support of revision operations, both general and neuroaxial anesthesia methods can be used. The question of choosing an anesthetic aid that, with adequate modulation of the operational stress response, would have a minimal immunosuppressive effect is relevant.&#x0D; AIM: To examine the effect of general and combined spinalepidural anesthesia during revision operations in patients with periprosthetic hip joint infection on the parameters of cellular immunity.&#x0D; MATERIALS AND METHODS: An open prospective randomized study was performed on 25 patients (11 women and 14 men). The patients underwent surgical interventions of revision prosthetics with the replacement of all components of the prosthesis. Group 1 (n=10) underwent general anesthesia (GA), and group 2 (n=15) underwent surgery under combined spinalepidural anesthesia (CSEA). The indices of cellular immunity, namely, CD4+, CD8+, CD4+/CD8+, and B-lymphocytes, were evaluated. Blood sampling was performed in the morning on the day of surgery and then on days 1, 3, 5, and 7 after surgery.&#x0D; RESULTS: The CD4+ (%) level in the CSEA group was significantly higher than in the GA group on days 3 and 7 after surgery (p 0.05). Changes in the percentage of CD8+ lymphocytes, the immunoregulatory index, and the percentage of B-lymphocytes between the groups had no statistically significant differences.&#x0D; CONCLUSION: The CD4+ (%) level in the CSEA group was significantly higher than that in the GA group on days 3 and 7 after surgery (p 0.05). Statistically significant differences in the dynamics of CD8+, immunoregulatory index, and B-lymphocytes were not found, which may indicate a lesser effect of the type of anesthesia on these indicators.

General Anesthetics in CAncer REsection Surgery (GA-CARES) randomized multicenter trial of propofol vs volatile inhalational anesthesia: protocol description

BackgroundStudies indicate that patients can be “seeded” with their own cancer cells during oncologic surgery and that the immune response to these circulating cancer cells might influence the risk of cancer recurrence. Preliminary data from animal studies and some retrospective analyses suggest that anesthetic technique might affect the immune response during surgery and hence the risk of cancer recurrence. In 2015, experts called for prospective scientific inquiry into whether anesthetic technique used in cancer resection surgeries affects cancer-related outcomes such as recurrence and mortality. Therefore, we designed a pragmatic phase 3 multicenter randomized controlled trial (RCT) called General Anesthetics in Cancer Resection (GA-CARES).MethodsAfter clinical trial registration and institutional review board approval, patients providing written informed consent were enrolled at five sites in New York (NY) State. Eligible patients were adults with known or suspected cancer undergoing one of eight oncologic surgeries having a high risk of cancer recurrence. Exclusion criteria included known or suspected history of malignant hyperthermia or hypersensitivity to either propofol or volatile anesthetic agents. Patients were randomized (1:1) stratified by center and surgery type using REDCap to receive either propofol or volatile agent for maintenance of general anesthesia (GA). This pragmatic trial, which seeks to assess the potential impact of anesthetic type in “real world practice”, did not standardize any aspect of patient care. However, potential confounders, e.g., use of neuroaxial anesthesia, were recorded to confirm the balance between study arms. Assuming a 5% absolute difference in 2-year overall survival rates (85% vs 90%) between study arms (primary endpoint, minimum 2-year follow-up), power using a two-sided log-rank test with type I error of 0.05 (no planned interim analyses) was calculated to be 97.4% based on a target enrollment of 1800 subjects. Data sources include the National Death Index (gold standard for vital status in the USA), NY Cancer Registry, and electronic harvesting of data from electronic medical records (EMR), with minimal manual data abstraction/data entry.DiscussionEnrollment has been completed (n = 1804) and the study is in the follow-up phase. This unfunded, pragmatic trial, uses a novel approach for data collection focusing on electronic sources.Trial registrationRegistered (NCT03034096) on January 27, 2017, prior to consent of the first patient on January 31, 2017.

Choice of Anesthesia for Orthopedic Surgery in Elderly and Senile Patients (Review)

Management of elderly and senile patients is a major challenge due to significant comorbidity, especially in surgery under general anesthesia.The aim of the review was to identify the optimal method of anesthesia for knee arthroplasty in elderly patients based on the available clinical and experimental studies.We searched PubMed, Medline, and Elibrary.ru databases for relevant sources. Out of more than 300 publications initially analyzed, 113 literature sources (dating from 1951 to 2021) were included in the review, of which 80 were published within the last five years (2016–2021). The inclusion criteria were high informative value and relevance, except for sources cited as historical references. Both randomized multicenter studies and individual case reports were included in the review. Exclusion criteria were low informative value, outdated and repetitive data.We reviewed the physiology of elderly and senile patients, various variants of anesthesia, the use of neuroaxial anesthesia and peripheral regional blocks, xenon-based general anesthesia, assessed the advantages and drawbacks of each method, and discussed the monitoring of the depth of anesthesia and the issues of inraoperative awareness during knee arthroplasty in elderly and senile patients.Conclusion. The choice of anesthesia for knee arthroplasty in elderly and senile patients should be based on the risks of decompensation of cardiovascular comorbidities and cognitive impairment. No known anesthetic method is ideal in terms of safety. The use of xenon as the main anesthetic seems promising due to its cardio- and neuroprotective properties. However, its use is limited due to relatively high cost. Therefore, the search for optimal (lower than recommended) inhalation concentrations may lead to expanding use of xenon in elderly and senile patients. At the same time, the use of lower concentrations of the drug is associated with the intraoperative awakening and the need for its combination with narcotic analgesics or amnestic agents, which may not be optimal. In addition, the protective effect of xenon retrograde amnesia against the stress of unintended intraoperative awakening has not been studied, and routine methods of monitoring the depth of hypnosis when using xenon often yield skewed measurement results inconsistent with the clinical manifestations of anesthesia.Therefore, there is a need for further studies concerning the retrograde amnesic effect of xenon and search for optimal methods of assessing the depth of hypnosis when using this gas to safely reduce its inhalation concentration.

Neuroaxial Verses General Anesthesia for Gynecological Surgeries

Objective: To evaluate the anaesthetic effects, patient satisfaction, and the Oxidative Stress Index between neuroaxial anaesthesia (NA) and general anaesthesia (GA) during gynecologic laparoscopic surgery. Study Design: Prospective randomized study Place and Duration: Lady Reading Hospital Peshawar.1st Jan, 2021 to 30 June, 2021. Methods: The research involved ninety women between the ages of 20 and 55 who were scheduled to undergo diagnostic laparoscopy and hysteroscopy for unexplained infertility and had an ASA I-II physical status.Age, BMI and laparotomy indication were documented after obtaining informed written permission from each patient. Patients were equally divided in two groups group I received neuroaxial anesthesia and group II received general anesthesia. Post-operative outcomes among both groups were compared. SPSS 22.0 was used to analyze complete data. Results:Mean age of the patients in group I was 33.4±11.32 years and had mean BMI 25.4±7.81 kg/m2 while in group II mean age was 30.7±14.63 years with mean BMI 22.8±9.52 kg/m2. In group I 28 (62.2%) cases had ASA class I and in group II 30 (66.7%) cases had ASA class I. Diagnostic laparoscopy was majority in numbers among both groups 29 (64.4%) in group I and 26 (57.8%) in group II. Among both groups paratubal cystectomy was most common symptom found in 6 (13.3%) cases and 7 (15.6%) cases. Mean operative time in neuroaxial group was lower 45.3±6.52 minutes as compared to group II was 54.8±11.42 minutes. Mean time of anesthesia was also lower in group I as compared to group II with p value &lt;0.003. Mean pain score was significantly reduced in group I 3.6±8.61 as compared to group II 6.8±11.92. Heart rate and arterial pressure was lower in group I. Post-operative Oxidative Stress index among patients of group II was higher 1.9±4.45 as compared to group I 0.9±0.42. Conclusion:We concluded in this study that the use of neuroaxial anesthesia undergoing gynecologica laparoscopy was effective and useful as compared to general anesthesia in terms of less pain score and oxidative stress index. Except this frequency of adverse events were also lower in neuroaxial group. Keywords: Laparoscopy, Nueroaxial Anesthesia, General Anesthesia, Complication, Pain score

CURRENT APPROACHES TO PERIOPERATIVE MANAGEMENT OF PATIENTS WITH INGUINAL HERNIAS (LITERATURE REVIEW)

The article provides literature review on current approaches to perioperative treatment of patients with inguinal hernias (IH) based on the principles of enhanced recovery after surgery (ERAS). The ERAS algorithm includes all evidence-based perioperative elements that affect rapid recovery after surgery, reduce the incidence of complications and potential mortality. There are three stages of patient management: preoperative examination, selection of an adequate method of surgical treatment, anesthesia during surgery and in the postoperative period. Thorough examination of patients before surgery and identification of potential risk factors associated with comorbidities are important to reduce the risk of morbidity and recurrences. Effective dynamic perioperative pain management is a prerequisite for optimal recovery after surgery. The first step in managing pain under the ERAS concept is choosing the correct type of surgery. Preference should be given to the least traumatic operations, i.e., laparoscopic or endoscopic hernioplasty. According to PROSPECT recommendations, analgesics should be started before and continued during surgery, which will provide adequate analgesia in the early postoperative period. The combination of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) and a selective cyclooxygenase-2 inhibitor (COX-2) provides good analgesia and reduces opioid use. The transverse abdominal block (TAP block), as a type of regional anesthesia, is safe for patients with IH, reduces the postoperative need for narcotic analgesics, reduces the frequency of postoperative nausea and vomiting and pain intensity. Regional anesthesia reduces the length of a patient’s stay in the operating room and is associated with a lower risk of urinary retention in the postoperative period (compared to neuroaxial anesthesia). After the operation patient should be activated as soon as possible, and this is possible under conditions of sufficient analgesia, which is best achieved by combining systemic analgesics and TAP block. Antimicrobial prophylaxis should be performed in all patients undergoing elective surgery for IH. Since some patients experience significant limitations in daily activities due to chronic postoperative inguinal pain, it is necessary to consider all risk factors for chronic pain after surgery to prevent its development.

Choice of local anesthetic in obstetric anesthesiology: literature review and demonstration of our own experience

Regional anesthesia is widely used in obstetric practice, and in many cases is the method of choice. It in­cludes neuroaxial anesthesia (spinal, epidural, combined spinal­epidural, epidural with dura mater puncture), region­al blocks (eg, TAP block, QL block, ESP block, pudendal block, etc.), as well as local infiltration anesthesia, which is used for both anesthesia and postoperative analgesia. The correct choice of local anesthetic, its dose and concentration is of fundamental importance in obstetric anesthesiology, as it is necessary to ensure the highest quality blockade with mini­mal side effects on mother and fetus.

Central Neuroaxial Block Anesthesia: A Safe Choice for Caesarean Section in Patients with Mitral Stenosis

Background: Mitral stenosis heart valve abnormalities in pregnant women is a complication of pregnancy that is quite common, accompanying rheumatic heart disease, endocarditis, and congenital abnormalities. In pregnancy, there have been changes in the cardiorespiratory system caused by increased cardiac output, which the presence of mitral valve stenosis can then exacerbate. Anesthesia management plays an essential role in the safety of the mother and baby during and after surgery. The choice of technique and anesthesia management depends on the abnormality’s severity. Case: We report the successful management of anesthesia with pure central neuraxial epidural block and combined spinal epidural (CSE) in two cases of a cesarean section of 3rd-trimester pregnant women with mitral stenosis and class II functional heart failure caused by rheumatic heart disease. Conclusion: Central neuraxial block epidural anesthesia and combined spinal epidural (CSE) anesthesia are safe anesthesia techniques for both mother and baby because they can maintain hemodynamic stability.

PRO AND CONTRA ON ADJUVANTS TO NEUROAXIAL ANESTHESIA AND PERIPHERAL NERVE BLOCKS.

Modern approach in surgical treatment and in managing acute and chronic pain is nowadays more and more based on the implementation of all possible techniques of regional anesthesia (RA). Local anesthetics (LA) are needed to achieve standard regional anesthesia. Local anesthetics are primarily characterized by time constraints and duration of action, and depending on the amount applied, adverse effects on the cardiac and central nervous system may occur. Adjuvants are drugs used together with LA due to their synergistic effect, i.e. they improve start latency and duration of sensory and motor blockade and enable reduction of cumulative dose of LA and reduction of adverse effects on cardiac and nervous system. Nowadays, there is a huge variety of drugs that can be administered in combination with LA, and they, in general, can be divided into opioid and non-opioid adjuvants. The administration of opioids in RA over an extended time period was accompanied by some negative characteristics as respiratory depression, nausea, vomiting. So, their usage is still under a special control. Due to the positive effects shown by drugs from non-opioid adjuvants group (e.g. adrenaline, alpha adrenergic agonists, steroids, magnesium, midazolam, ketamine etc.), indications for their administration broadened. However, there are still some restrains in clinical practice based on the fact that neurotoxicity and demonstration of neurological complications in regional anesthesia haven't been properly researched yet.

Impact of anesttesia method on foetus condition

Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus. Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.