Management Of Spinal Anesthesia Research Articles

Evaluation of Hemodynamic Changes and Fluid Response during Anesthesia in Lumbar Disc Hernias with Pleth Variability Index (PVI).

The study aimed to assess the pleth variability index (PVI) in patients undergoing lumbar disc herniation surgery under general and spinal anesthesia, exploring its correlation with fluid responsiveness, position, and hemodynamic parameters. Methods: This prospective study included 88 ASA 1-2 patients, aged 18-65, undergoing 1-3 h elective lumbar disc herniation surgery. Patients in groups GA and SA were observed for demographic, operative, and hemodynamic parameters at specified time points. (3) Results: PVI values were comparable between the GA and SA groups. After 250 mL of fluid loading, both groups showed a significant decrease in basal PVI at T2. Prone positions in GA exhibited higher PI values than in SA. The transition from a prone to supine position maintained PVI, while pulse and MAP decreased.; (4) Conclusions: PVI values were comparable in elective lumbar disc herniation surgery with general and spinal anesthesia. Both groups exhibited significant a PVI decrease at T2 after 250 mL of fluid loading, indicating fluid responsiveness. In general anesthesia, the prone position showed a lower MAP and higher PI values compared to spinal anesthesia. PVI and PI, sensitive to general anesthesia changes, could have beneficial additions to standard hemodynamic monitoring in spinal anesthesia management.

Spinal anesthesia in a patient with Darier’s disease: A case report

Darier’s Disease (Darier-White Disease, keratosis follicularis) is a rare genodermatosis characterized by keratinisation defects that affects the skin, nails and mucosal membranes; it is autosomal and dominantly inherited. To the best of our knowledge, only one case has been reported regarding spinal anesthesia management in a patient suffering from Darier’s disease—this was during Cesarean section. Here, we describe a case of spinal anesthesia with standard skin preparation for inguinal hernia surgery in a Darier’s patient. Spinal anesthesia is a safe anesthesia choice when administered in lesion-free areas.

Spinal Anesthesia in Caesarean Section with Ovarian Cyst Permagna with Meigs Syndrome

<p><strong>Background:</strong> The ovarian cyst is the very common cyst intra-abdominal in the ovary. If it need termination, the common procedure is cesarean section then the best anesthesia technique that suitable is spinal anesthesia. The Meigs Syndrome is an uncommon clinical condition, in which benign ovarian tumors are usually accompanied by ascites and pleural effusion. About 1% of ovarian tumors can indicate Meigs syndrome. Meigs Syndrome case have been reported in woman before 30 years old.</p><p><strong>Case Illustration:</strong> We reported an evaluation of a 29 years old woman, Gestational 1 Partus 3 Abortus 0, 60 kg weight and 165 cm height came to hospital with enlargement of abdomen since 3 months ago. There wasn’t history of bleeding and fluid discharged from genital. There’s no complaint in urination and defecation. The patient has felt an enlarged abdomen since the age of 7 months of pregnancy during antenatal care to a obstetrician. The patient hemodynamic and vital signs are stable and the pregnancy already in 37-38<sup>th</sup> week. Based on that the obstetrician decided to terminate the pregnancy, we choose to do spinal anesthesia in the cesarean section because it’s easy, common, and best technique for short surgical procedures.</p><p class="Default"><strong>Conclusion:</strong> In patient with Ovarian Cysts Permagna with Meigs Syndrome in Pregnancy, we need to understand the risk of complication of ovarian cyst is higher in the prenatal period than after birth. The diagnosis of fetal ovarian cyst should not affect the schedule and method of delivery. The management of Meigs Syndrome in Pregnancy this time we terminate the pregnancy because it’s already in 37-38th week, the spinal anesthesia management is nothing different with the normal pregnancy.</p>

Type, management, and associated factors of failed spinal anesthesia in cesarean section. Prospective cohort study

BackgroundSpinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort. ObjectiveTo assess the type, management, and related factors of failure of spinal anesthesia at cesarean section. MethodsMulticenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff. ResultOf 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47–6.90), patient position (AOR = 14.43,95%CL, 2.65–78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69–15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90–13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12–3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33–5.53) were found to be statistically significant associated with failed spinal anesthesia. Conclusion and recommendationExperience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines.

Abdominal Crunch Position In Spinal Anesthesia: a Novel Sitting Position

Previous evidences suggested that traditional sitting position (flexion of knees approximately 90° and adduction of hips while feet rest on a stool) and lateral decubit position (sitting position with maximum extension of knees, adduction of hips, and forward bending) both reversed the lumbar lordosis and the number of spinal needle-bone contacts were identical when placing patients in these positions for neuraxial block. In this study, we suggested that abdominal crunch position reverses the lumbar lordosis and increase the gap of interspinal distance better than a traditional sitting position and lateral decubit position. One hundred patients ASA (American Society of Anesthesiologist) class I or II aged over 18 years old scheduled for elective surgeries under elective spinal anesthesia. We compared the traditional sitting, lateral decubit position, and abdominal crunch position. Our primary endpoint was to detect the increasing of interspinal gap by ultrasound. The gap of interspinal distance was statistically higher in the abdominal crunch position compared to traditional sitting position and lateral decubit position (P = 0.01). We suggested that the abdominal crunch position can to help our colleagues especially with the maximum spinal interval in the spinal anesthesia management.

Spinal anesthesia in a patient with Schwartz\u2013Jampel syndrome

BackgroundSchwartz–Jampel syndrome (SJS) is a very rare inherited disorder characterized by multiple skeletal deformities, limited joint mobility, micrognathia, blepharophimosis, myotonia, and growth retardation. SJS is caused by mutations in the gene encoding perlecan (heparan sulfate proteoglycan). Anesthetic management of these patients is challenging. The use of spinal anesthesia in these patients has not been reported.Case presentationA 14-year-old boy was scheduled for inguinal hernia and hydrocele repair. The diagnosis of SJS was based on his dysmorphic features, electromyographic (EMG) pattern and genetic testing. General anesthesia may encounter difficult airway management, resistance to muscle relaxants, or possibility of malignant hyperthermia. Regional anesthesia may be difficult or even harmful due to skeletal deformities. We report successful management of spinal anesthesia and surgery was done. The patient had an uneventful recovery and was discharged home. We describe the special precautions against pitfalls for using this technique in patients with SJS.ConclusionSpinal anesthesia may be an effective and safe technique for patients with SJS and it may

A Mixed-Method Design Evaluation of the SAFE Obstetric Anaesthesia Course at 4 and 12-18 Months After Training in the Republic of Congo and Madagascar.

BACKGROUND:Maternal mortality in low- and middle-income countries (LMICs) is higher than in high-income countries (HICs), and poor anesthesia care is a contributing factor. Many anesthesia complications are considered preventable with adequate training. The Safer Anaesthesia From Education Obstetric Anaesthesia (SAFE-OB) course was designed as a refresher course to upgrade the skills of anesthesia providers in low-income countries, but little is known about the long-term impact of the course on changes in practice. We report changes in practice at 4 and 12–18 months after SAFE-OB courses in Madagascar and the Republic of Congo.METHODS:We used a concurrent embedded mixed-methods design based on the Kirkpatrick model for evaluating educational training courses. The primary outcome was qualitative determination of personal and organizational change at 4 months and 12–18 months. Secondary outcomes were quantitative evaluations of knowledge and skill retention over time. From 2014 to 2016, 213 participants participated in 5 SAFE-OB courses in 2 countries. Semistructured interviews were conducted at 4 and 12–18 months using purposive sampling and analyzed using thematic content analysis. Participants underwent baseline knowledge and skill assessment, with 1 cohort reevaluated using repeat knowledge and skills tests at 4 months and another at 12–18 months.RESULTS:At 4 months, 2 themes of practice change (Kirkpatrick level 3) emerged that were not present at 12–18 months: neonatal resuscitation and airway management. At 12–18 months, 4 themes emerged: management of obstetric hemorrhage, management of eclampsia, using a structured approach to assessing a pregnant woman, and management of spinal anesthesia. With respect to organizational culture change (Kirkpatrick level 4), the same 3 themes emerged at both 4 and 12–18 months: improved teamwork, communication, and preparation. Resistance from peers, lack of senior support, and lack of resources were cited as barriers to change at 4 months, but at 12–18 months, very few interviewees mentioned lack of resources. Identified catalysts for change were self-motivation, credibility, peer support, and senior support. Knowledge and skills tests both showed an immediate improvement after the course that was sustained. This supports the qualitative responses suggesting personal and organizational change.CONCLUSIONS:Participation at a SAFE-OB course in the Republic of Congo and in Madagascar was associated with personal and organizational changes in practice and sustained improvements in knowledge and skill at 12–18 months.

Clinical Assessment of 0.5% Levobupivacaine with 0.5% Bupivacaine Administration in the Management of Spinal Anaesthesia

Clinical Assessment of 0.5% Levobupivacaine with 0.5% Bupivacaine Administration in the Management of Spinal Anaesthesia

The Management of Spinal Anesthesia in a Patient with Advanced Kyphoscoliosis and Cardiac Arrhythmia

The Management of Spinal Anesthesia in a Patient with Advanced Kyphoscoliosis and Cardiac Arrhythmia

Spinal anesthesia in an extremely low birth weight infant

A case of spinal anesthesia in an extremely low birth weight male infant (body weight of 930 g at time of surgery) is presented. He was born prematurely at a gestational age of 27 weeks because of a placenta tumor and had to undergo inguinal herniotomy at 34 weeks postconceptional age. He had bronchopulmonary dysplasia and oxygen supply was still required because of frequent deterioration of oxygen saturation. Spinal anesthesia was performed successfully without any complications. Relevant aspects concerning the technique and management of spinal anesthesia in preterm infants are discussed.

Clinical Management of Spinal Anesthesia

Clinical Management of Spinal Anesthesia