Subarachnoid Anesthesia Research Articles

Comparison of prophylactic use of midazolam, ketamine, and ketamine plus midazolam for prevention of shivering during regional anaesthesia: a randomized double-blind placebo controlled trial

BackgroundRegional anaesthesia, like general anaesthesia, influences the thermoregulatory process. The aim of the present study was to compare the efficacy of low-dose prophylactic midazolam with that of placebo, ketamine, and a combination of ketamine and midazolam in the prevention of shivering caused by regional anaesthesia. MethodsIn this double-blind study, 120 ASA I and II patients undergoing orthopaedic surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (Group C), ketamine 0.5 mg (Group K), midazolam 75 μg kg−1 (Group M), or ketamine 0.25 mg+midazolam 37.5 μg kg−1 (Group KM). During surgery, a shivering score was recorded at 5 min intervals. Tympanic and axillary temperature were recorded at 10 min intervals during the perioperative period. ResultsAfter 15 min, the incidences of shivering in Groups C, M, K, and KM were 60%, 50%, 23.3%, 3.3%, respectively (P=0.000). The differences between Group KM and Groups M, K, and C were statistically significant (P=0.000, P=0.026, P<0.001, respectively). The number of patients with a shivering score of ≥3 was significantly higher in Group C compared with Groups M, K, and KM (8 vs 4, 1, and 0, respectively, P=0.040). ConclusionsProphylactic use of ketamine 0.25 mg kg−1+midazolam 37.5 μg kg−1 i.v. was more effective than ketamine 0.5 mg kg−1 i.v. or midazolam 75 μg kg−1 i.v. in preventing shivering developed during regional anaesthesia.

Quality in Anaesthesia: Causes of Customer Dissatisfaction After Subarachnoid Anaesthesia in Elderly Patients

The first step towards quality improvement is the evaluation of quality previous to the implementation of a programme. The goal of this study is to seek causes underlying dissatisfaction of elderly patients who underwent endoscopic urological surgery under subarachnoid anaesthesia. During the preoperative visit, techniques and effects of subdural anaesthesia were showed to patients; they were interviewed 48 hours after the operation, focusing on causes of dissatisfaction. The first cause was a postoperative state of agitation, followed by intraoperative psychomotor agitation, fear of lumbar puncture and other causes unrelated to anaesiological technique performed. Results of data showed how preoperative anaesthesiological information is crucial and has to be carefully provided, especially with elderly patients; if needed, a relative can be involved in order to avoid postoperative state of agitation. Important also to reexame anaesthetic premedication, or combining it with an intraoperative sedation that can reduce patients' sensitivity without altering their consciousness.

234. Quality in Anaesthesia: Causes of Customer Dissatisfaction After Subarachnoid Anaesthesia in Elderly Patients

234. Quality in Anaesthesia: Causes of Customer Dissatisfaction After Subarachnoid Anaesthesia in Elderly Patients

234: Quality in Anaesthesia: Causes of Customer Dissatisfaction After Subarachnoid Anaesthesia in Elderly Patients

234: Quality in Anaesthesia: Causes of Customer Dissatisfaction After Subarachnoid Anaesthesia in Elderly Patients

Análisis costo-efectividad del uso de la técnica anestésica subaracnoidea comparada con la técnica anestésica general para colecistectomía abierta

La anestesia general, así como la anestesia subaracnoidea, son alternativas en pacientes programados para colecistectomía abierta, siendo la segunda técnica una opción costo efectiva (p<0.001). Los estudios de costos en anestesia regional para este procedimiento en nuestro medio son relativamente inexistentes. Se plantea generar las evidencias propias que permitan soportar la toma de decisiones en pacientes que cumplan criterios de inclusión. Valorar económicamente la anestesia subaracnoidea para colecistectomía abierta como una opción costo efectivo comparado con la anestesia general, en pacientes entre 20 y 70 años. Se plantean dos tipos de estudios: a) Un estudio descriptivo, prospectivo, tipo serie de casos, de ambos géneros con indicación quirúrgica para colecistectomía abierta, que cumplan todos los criterios de inclusión para anestesia subaracnoidea o anestesia general, con edades entre 20 y 70 años; b) Un análisis de costo efectividad en la cual se compararán las dos técnicas anestésicas utilizadas en colecistectomía abierta. 73 pacientes fueron incluídos, la distribución es 7 mujeres por cada hombre, con promedio de edad 51.2 años para el grupo bajo anestesia general con un IMC promedio de 26.2 kg/m 2 y 46.4 años para el grupo bajo anestesia subaracnoidea, con IMC promedio de 25.7 kg/m 2 . No hubo alteraciones hemodinámicas importantes. Las dos técnicas anestésicas fueron efectivas. Los costos por caso mostraron que la anestesia subaracnoidea es 2.5 veces más económica para el mismo procedimiento quirúrgico realizado bajo anestesia general (p<0.001). La anestesia subaracnoidea para la colecistectomía abierta es una útil alternativa costo efectiva, reproducible en cualquier zona de la geografía colombiana. General anesthesia such as subarachnoid anesthesia, represent alternatives for patients scheduled for an open cholecystectomy intervention. The second, being a cost-effective option (p<0.001). Cost studies on regional anesthesia for this procedure in our region are relatively inexistent. It is proposed to generate evidence which allows self decisión making, in patients who meet criteria for inclusión in application of the technique in discussion. To appraise subarachnoid anesthesia for open cholecystectomy as a cost-effective option compared to general anesthesia in patients between 20 and 70 years of age. Two types of studies are proposed: a) a descriptive prospective series of cases, both gender type of study, with surgical indication for open cholecystectomy, which satisfy all of the criteria for inclusion to subarachnoid anesthesia or general anesthesthesia, with patients between 20 and 70 years of age. b) an analysis of cost-effectiveness in which the two anesthetic techniques used in open cholecystectomy will be compared. 73 patients were included, with a distribution of 7 females for every male, with an average age of 51.2 years, for the group under general anesthesia, with an average BMI of 26.2 kg/m 2 , and 46.4 years of age for the group under subarachnoid anesthesia with average BMI of 25.7 kg/m 2 . There were no important hemodynamic alterations. Both anesthetic techniques were effective. Costs per case showed that subarachnoid anesthesia is 2.5 times more economical for the same.surgical procedure performed under general anesthesia (p<0.001). Subarachnoid anesthesia for open cholecystectomy is a cost- effective alternative which can be reproduced in any area of the Colombian geography.

Epidural volume extension and role of baricity

Reply EDITOR: We thank Dr Tyagi for her interest in our study and her comments [1]. In our study, after EVE, the segmental spread of spinal anaesthesia either with hyperbaric or plain bupivacaine and times to reach maximal dermatomal level were investigated. We found a significant difference in sensory block level between Groups A and C and it was mainly thought to be related to the baricity of the local anaesthetic. These findings were consistent with Yamazaki and colleagues' study, investigating the effect of EVE on spinal anaesthesia with hyperbaric or plain tetracaine in non-obstetric patients [2]. Similarly, time to reach T4 was significantly shorter in the plain bupivacaine groups than in the hyperbaric bupivacaine groups. However, there was no significant difference between Groups A and B, and between Groups C and D. That is, although baricity did affect the time to reach the maximal dermatomal level, the addition of EVE to spinal anaesthesia did not offer any advantage in the enhancement of segmental spread of spinal block regardless of plain or hyperbaric bupivacaine use. Finally, we found a faster onset time and higher sensory block level in Groups C and D than in Groups A and B, and we believe that these effects were mainly related to the baricity of local anaesthetic, but not with the addition of EVE to spinal anaesthesia. It has been speculated by Dr Tyagi that the effect of EVE could be expected to be different between varying patient positions. In fact, studies have found little correlation with adult patient height, weight or body mass index and level of sensory block after subarachnoid anaesthesia with iso- or hyperbaric local anaesthetic solutions [3]. Furthermore, it has also been demonstrated that the spread of sensory blockade after intrathecal injection in the lateral position is less likely to be influenced by baricity than when injected, with patients in the sitting position [4]. As the ideal time to epidural volume injection is yet to be found to provide an extension in spinal anaesthesia, choice of ideal time to epidural injection to achieve the desired clinical effect might be important, as stated in the Discussion section. Some authors injected epidural volume just after subarachnoid injection, and some after 5, 10 and 20 min [5-7]. In our study, epidural saline was injected 5 min after spinal block and this was consistent with the previous studies investigating the time effect of EVE [5-7]. Although ultrasonographic or radiographic techniques have been proposed to identify epidural space, it has been reported that the most popular method for detecting the epidural space is the loss-of-resistance technique [8]. In our study, as pointed out in the Method section, in identification of epidural space, loss-of-resistance technique (LOR) was used with less than 0.5 mL of saline. In our opinion, confirmation of the correct placement of epidural catheter for Caesarean section by other methods (radiographic techniques) is not practical and is too time-consuming. As far as we know, alternative methods for detecting the epidural space are not routinely used.

The Effects of Intravenous Granisetron on the Sensory and Motor Blockade Produced by Intrathecal Bupivacaine

We hypothesized that pretreatment with i.v. granisetron would affect the sensory and motor components of spinal blockade through 5-HT(3) receptor blockade. Forty unpremedicated patients scheduled for elective knee arthroscopy under spinal anesthesia were randomly allocated to receive either i.v. granisetron 1 mg (granisetron group) or saline (control group) on arrival to the operating room. Two and half milliliters (12.5 mg) of hyperbaric bupivacaine 0.5% was injected intrathecally. Regression of the sensory level and motor blockade, and the hemodynamic changes were evaluated. There were no significant differences between the two groups in the maximum cephalad spread of sensory block or the time to maximum sensory level. Compared with the control group, patients who received granisetron had significantly faster sensory regression times by two segments (69.8 +/- 25.5 min vs 88.0 +/- 27.8 min, P = 0.036), to segment T12 (105.5 +/- 25.1 min vs 127.0 +/- 30.5 min, P = 0.019) and to segment S1 (162.8 +/- 41.1 min vs 189.8 +/- 39.8 min, P = 0.041), respectively. In contrast, motor block did not differ between the two groups at any study time. No significant differences were detected between the two study groups in the hemodynamic data. We concluded that i.v. granisetron facilitated a faster recovery of sensory block after bupivacaine subarachnoid anesthesia.

Pharmacoeconomic Evaluation Of General Anaesthesia And Subarachnoid Block For Elective Caesarean Section For Elective Caesarean Section

To encourage a logical and cost effective selection of anaesthetic technique for elective caesarean section, retrospective analysis of the types of anaesthesia for elective surgical delivery was conducted. The patients who had caesarean section over a year period were identified. The perioperative record for each patient was reviewed to determine quantity of anaesthetic drugs, fluid therapy and other adjuvant medications. Resource consumption was then established for each patient. During the one year period, 51 patients had elective caesarean section. Thirty-five (68.6%) of these had general anaethesia (GA) while 16(31.4%) had subarachnoid block (SAB). The mean cost for GA was N2, 450:25 as against N1, 864:00 for SAB (p Keywords : Caesarean section, General, Subarachnoid (spinal) Anaesthesia, Costs. Annals of Biomedical Science Vol. 2 (1) 2003: pp. 36-41

Postoperative Renal Function Evaluation, through RIFLE Criteria, of Elderly Patients Who Underwent Femur Fracture Surgery under Spinal Anesthesia

Introduction. The postoperative acute renal failure (ARF) incidence in different kinds of surgery has rarely been studied. Age, cardiac dysfunction, previous renal dysfunction, intraoperative hypoperfusion, and use of nephrotoxic medications are mentioned as risk factors for ARF at the postoperative period. The postoperative ARF definition was based on the creatinine increase by the RIFLE classification (R = risk, I = injury, F = failure, L = loss, E = end stage), which corresponds to a 1.5 creatinine increase, two to three times, respectively, above the basal value. This study aimed to evaluate the postoperative ARF incidence in elderly patients who underwent femur fracture surgery under subarachnoid anesthesia and stratify it by the RIFLE criteria. Methods. Ninety patients older than 65 years under spinal anesthesia with fixed dosage of 15 mg of 0.5% isobaric bupivacaine associated with morphine 50 μg were studied. Immediate postoperative creatinine was considered basal and compared with maximal creatinine evaluated at 24, 48, and 72 postoperative hours. Results. The mean age of the patients was 80.27 years. ARF incidence was 24.44% and stratified this way: R = 21.11% and I = 3.33%. Conclusions. In conclusion, the postoperative ARF incidence after femur fracture surgery in patients over 65 years was 24.44%. By analyzing the stratification based on the RIFLE classification, the incidence was categorized as Risk (R) = 21.11% and Injury (I) = 3.33%.

Diaphragmatic Response Is Influenced by Previous Muscle Activity

Previous muscle activity can alter muscle contractility and lead to strength underestimation or overestimation in functional measurements. The objective of this study was to evaluate changes in the maximum pressure produced by the diaphragm after different series of spontaneous near-to-maximal isometric contractions. Duplicate studies were performed on 6 dogs with a mean (SD) weight of 26 (7) kg. The supramaximal response of the diaphragm was achieved by simultaneous supramaximal stimulation of both phrenic nerves, both under basal conditions and after series of 5, 10, and 20 spontaneous inspiratory efforts against the occluded airway, performed before and after spinal anesthesia (which eliminates the ventilatory contribution of the intercostal muscles). The response was measured using the twitch gastric pressure (Pga) and twitch esophageal pressure (Pes) and by muscle shortening (sonomicrometry). The short series of 5 inspiratory efforts and, in particular, the medium series of 10 efforts produced potentiation of the contractile response, with a rise in the Pga from 3.2 (0.4) cm H(2)O to 3.7 (0.3) cm H(2)O, and from 3.5 (0.3) cm H(2)O to 3.9 (0.3) cm H(2)O, respectively (P=.05 in both cases). The potentiation was somewhat greater after subarachnoid anesthesia (an increase in the Pga of 21% after the medium series of 10 efforts with anesthesia vs 11% without anesthesia). However, the long series of 20 efforts produced a fall in the response, with a decrease in the Pga from 3.2 (0.4) cm H(2)O to 2.5 (0.3) cm H(2)O (P< .05), probably due to fatigue overcoming the effect of potentiation. Previous effort affects the contractile capacity of the diaphragm and it is difficult to predict the predominance of fatigue or potentiation in the response. This factor must be taken into account when determining the maximum respiratory pressures in daily clinical practice.

Preoperative Gabapentin: The Effect on Ropivacaine Subarachnoid Block and Hemodynamics

Gabapentin is an adjuvant analgesic and may enhance the spread of subarachnoid block. We investigated the effects of pretreatment with gabapentin on subarachnoid block characteristics and hemodynamics. Seventy patients undergoing transurethral procedures under subarachnoid anesthesia with 2.2 mL of 0.75% ropivacaine were randomly assigned to receive preoperatively 400 mg of gabapentin 6 hourly, up to a total dose of 1200 mg, or placebo. Sensory and motor blocks were assessed every 30 min until regression of sensory block to L4. At the same time intervals, systolic and diastolic arterial blood pressures and heart rate were recorded. There were no differences between groups in the sensory block levels or degree of motor block. Sensory block 150 min after the subarachnoid injection had regressed to L4 in 26 of 32 patients in the gabapentin group and in 25 of the 33 patients in the control group. Systolic arterial blood pressure was decreased in the gabapentin group (P = 0.002 for the main effect of group, and P = 0.03 at 60 min between the groups). The diastolic arterial blood pressure did not differ between the groups, but overall, the heart rate was more rapid in the gabapentin group (P = 0.002, but only for baseline values between the groups, P = 0.036). Pretreatment with gabapentin had no effect on the spread of sensory block or the regression of motor block but was associated with lower systolic arterial blood pressure values in patients undergoing subarachnoid anesthesia with ropivacaine.

Analgoanestesia subaracnoidea continua para trabajo de parto y cesárea en paciente intervenida de ependimoma

We report the case of a 38-year-old primipara who had undergone surgery 2 years earlier for an intradural ependymoma at L2-L3 and who was currently asymptomatic. A combined epidural-subarachnoid block was performed for analgesia during labor but this technique was only effective for the first 2 hours. When analgesia via epidural cannula was no longer adequate, it was decided to perform a continuous subarachnoid block. Later, the fetus's head was seen to be too large to fit through the pelvis; for cesarean section, the mother was administered fractionated doses of local anesthetic via the subarachnoid cannula until analgesia reached T4. The patient did not develop postdural puncture headache. Continuous subarachnoid anesthesia may be considered the technique of choice where the patient has a history of spinal surgery.

Quality in anaesthesia: Causes Of Customer Dissatisfaction After Subarachnoid Anaesthesia In Elderly Patients

The first step towards quality improvement is the evaluation of quality previous to the implementation of a programme. The goal of this study is to seek causes underlying dissatisfaction of elderly patients who underwent endoscopic urological surgery under subarachnoid anaesthesia. During the preoperative visit, techniques and effects of subdural anaesthesia were showed to patients; they were interviewed 48 hours after the operation, focusing on causes of dissatisfaction. The first cause was a postoperative state of agitation, followed by intraoperative psychomotor agitation, fear of lumbar puncture and other causes unrelated to anaesiological technique performed. Results of data showed how preoperative anaesthesiological information is crucial and has to be carefully provided, especially with elderly patients; if needed, a relative can be involved in order to avoid postoperative state of agitation. Important also to reexame anaesthetic premedication, or combining it with an intraoperative sedation that can reduce patients' sensitivity without altering their consciousness.

Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: A 23‐year survey in a district general hospital

Post dural puncture headache can be a debilitating complication of epidural and subarachnoid anaesthesia for a new mother. In a survey of 18,337 epidurals and 5021 subarachnoid blocks performed for obstetric procedures over a 23-year period in a district general hospital maternity unit, there were 167 recognised accidental dural punctures after epidurals (0.91%), with 147 patients (88%) developing post dural puncture headache. In addition there were 52 post dural puncture headaches after subarachnoid blocks (1.04%). Successful management of accidental dural puncture and post dural puncture headache requires adherence to clear policies and protocols, with close follow-up of patients by an experienced obstetric anaesthetist.

Transient Neurological Symptoms After Isobaric Subarachnoid Anesthesia with 2% Lidocaine: The Impact of Needle Type

The reported incidence of transient neurological symptoms (TNS) after subarachnoid lidocaine administration is as high as 40%. We designed this clinical trial to determine the incidence of TNS with two different pencil-point spinal needles: one-orifice (Atraucan) and two-orifice (Eldor) spinal needles. Ninety-nine ASA physical status I or II patients undergoing surgical procedures of the urinary bladder or prostate were prospectively allocated to receive spinal anesthesia with 40 mg, 2% isobaric lidocaine plus fentanyl injected through either a 26-gauge Atraucan (n = 52) or a 26-gauge Eldor (n = 47) spinal needle. During the first three postoperative days, patients were observed for postoperative complications, including TNS. The primary end-point for this trial was the percentage of TNS in both double- and single-orifice spinal needle procedures. The incidence of TNS was higher when spinal anesthesia was done through the Atraucan needle (28.8% vs 8.5%, P = 0.006). Fifty percent of the patients in the double-orifice group versus 100% of the single-orifice group developed TNS after surgery in the lithotomy position (P = 0.014). The relative risk for developing TNS with the Eldor needle was 0.29 (95% CI: 0.07-0.75) compared with the Atraucan needle. The use of a double-orifice spinal needle was associated with a lower incidence of TNS, which may have been due to the needle design.

Tryptophan metabolism via serotonin in human CSF of different brain sites using a new neuroendoscopic technique

Abstract A new neuroendoscopic technique has permitted a precise and accurate exploration of all the cerebral ventricles, making possible the study of the CSF of the lateral ventricles and, above all, the CSF adjacent to the walls of the third ventricle in humans. The concentrations of tryptophan and its metabolites via serotonin were measured in the CSF of different sites of the cerebral cavity, in particular in the third ventricle. Patients affected with non-communicating hydrocephalus undergoing neuroendoscopic third ventriculostomy were enrolled in the study. As controls, subjects not suffering from any neurological disease, who underwent lumbar subarachnoid anaesthesia for minor surgical procedures, provided lumbar CSF, and patients affected by Chiari malformation provided cisternal and right ventricular CSF. Tryptophan concentration was higher in right ventricular CSF than in lumbar CSF. Serotonin (5-HT) was detectable in the CSF of the right ventricle of hydrocephalic individuals. 5-Hydroxyindoleacetic acid (5-HIAA) was higher in the right ventricular CSF than in the cisternal and lumbar CSF both in controls and hydrocephalic subjects. However, the 5-HIAA level was higher in the right ventricular and cisternal CSF in hydrocephalic individuals in comparison to controls. 5-HT presented the highest concentration in the pineal recess, whereas the highest amounts of 5-HIAA were found in the choroids plexus, third and right ventricles and the lowest in the pineal recess, subarachnoid space and intepeduncular cistern. Melatonin is more concentrated within the ventricles, in particular the third ventricle, and in the CSF pineal recess. The use of this neuroendoscopic technique in hydrocephalic patients provides new insight into the metabolic pathway of tryptophan via serotonin in the CSF.

Anestesia subaracnóidea para cesariana em paciente portadora de esclerose múltipla: relato de caso

Multiple sclerosis is an acquired disease characterized by demyelinated areas in the brain and spinal cord. The clinical presentation depends on the anatomical areas involved. The main causes of death are infection, respiratory failure, and status epilepticus. It affects genetically predisposed patients after contact with environmental factors, especially viruses. The objective of this report was to present the anesthetic technique used in a patient with multiple sclerosis undergoing cesarean section.A 32-year old patient, 60 kg, with multiple sclerosis, treated with methylprednisolone, was admitted to the obstetric ward for a cesarean section. After monitoring, subarachnoid anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg) associated with morphine (0.1 mg). The procedure evolved without any intercurrences and the patient was discharged from the hospital 48 hours after delivery without worsening of her symptoms.This case suggests that spinal anesthesia can be administered in patients with multiple sclerosis without the acute worsening of their symptoms in the postoperative period.

Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron

The aim of the present study was to compare placebo, ketamine, granisetron and a combination of ketamine and granisetron in the prevention of shivering caused by regional anaesthesia. In this prospective, randomized, double-blind study, 160 ASA I and II patients undergoing urological surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (group P, n= 40), ketamine 0.5 mg (group K, n= 40), granisetron 3 mg (group G, n= 40) or ketamine 0.25 mg + granisetron 1.5 mg (group KG, n= 40). Shivering was graded as 0 = no shivering, 1 = piloerection or peripheral vasoconstriction but no visible shivering, 2 = muscular activity in only one muscle group, 3 = muscular activity in more than one muscle group but not generalized, and 4 = shivering involving the whole body. If 15 min after spinal anaesthesia and concomitant administration of a prophylactic dose of one of the study drugs, the patients shivered according to at least grade 3, the prophylaxis was regarded as ineffective and intravenous (i.v.) pethidine 25 mg was administered. After 15 min, the number of patients with observed shivering was 22 in group P, 6 in group G, 7 in group GK and 0 in group K. The difference between group K and all the other groups was statistically significant (P < 0.0001). The number of patients with a shivering score of 3 was statistically significantly higher in group P compared with the other groups. The prophylactic use of 0.5 mg/kg i.v. ketamine was effective in preventing shivering developed during regional anaesthesia.

Spinal anaesthesia in lower abdominal and limb surgery: A review of 200 cases

Background: Modern technology has produced better equipment than was available hitherto with the result that spinal anaesthesia is undoubtedly simpler, cheaper and above all, safer than it used to be. These notwithstanding, it is used infrequently. The aim of the study was to evaluate the safety, benefits and applicability of subarachnoid spinal anaesthesia in a tertiary referral centre in a developing country.Methods: This was a prospective analysis involving 200 patients requiring anaesthesia for lower abdominal and limb surgery at the Jos University Teaching Hospital, Jos. Subarachnoid spinal anaesthesia was performed through the L2/L3 or L3/L4 interspace employing either 0.5% bupivacaine hydrochloride in 8% glucose monohydrate (Marcain heavy Astra) 2-4mls or 5% lignocaine (heavy xylocaine Astra) 1-2mls. Patients with uncorrected or undercorrected hypovolaemia, uncorrected anaemia or heart disease, local sepsis and those on anticoagulant therapy or who had bleeding disorders were excluded. Also excluded were children. Results: A total of 200 patients with age range of 15-90 years and a mean age of 34.48 years were studied. The male to female ratio was 1:1.74. Eighty of them underwent caesarean section (38 emergency and 42 electives), 26 prostatectomy, 24 appendicectomy, 19 herniorraphy, 11 haemorrhoidectomy, 9 fissurectomy, 7 total abdominal hysterectomy, 5 Manchester operation, 4 myomectomy, while the remaining 15 were for other procedures involving the lower abdomen or limb. Complications noted were: nausea (17.50%) and vomiting (3.5%), pain at injection site (15.5%), chills/shivering (15.0%), post-spinal headache (0.5%) and hypotension (3.0%). Subarachnoid anaesthesia was non-fatal. One hundred and ninety patients (95%) were satisfied with spinal anaesthesia. Conclusion: Spinal anaesthesia though safe is not without hazards. Spinal anaesthesia may be used for most operations in the lower abdomen (including caesarean section), perineum or leg. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 226-230

Anaphylaxis to intrathecal diamorphine

A 42-year-old male underwent a total hip arthroplasty under subarachnoid anaesthesia with intrathecal bupivacaine and diamorphine. Shortly after the start of surgery, he suffered an allergic reaction that, at first, was difficult to distinguish from the recognised side-effects of intrathecal diamorphine. Once the diagnosis was made, he was treated with adrenaline and made a full recovery. The serum concentration of mast cell tryptase approximately 1.5h after the onset of the adverse incident confirmed an anaphylactic reaction. Skin prick testing several weeks later identified diamorphine as the likely causative agent, a drug overlooked initially as a potential cause. We believe this is the first report of intrathecal diamorphine causing anaphylaxis.