scholarly journals 1299 Observational Study of The Use of Spinal Anaesthesia As an Alternative to General Anaesthetic For Ureteroscopy During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Longshaw ◽  
W Gallagher ◽  
A Dickinson
Keyword(s):  
Spinal Anaesthesia ◽  
General Anaesthetic ◽  
Procedure Time ◽  
First Line ◽  
Day Case ◽  
Valuable Alternative ◽  
Spinal Anaesthetic ◽  
Change In Practice ◽  
Anaesthetic Time ◽  
Residual Fragments

Abstract Introduction General anaesthetic has traditionally been felt to be more appropriate than spinal anaesthesia for patients undergoing ureteroscopy as it is difficult to achieve a suitably high block. During the COVID-19 pandemic, our centre moved elective operating to an alternative day-case surgical environment where the anaesthetic team performed predominantly spinal anaesthesia and were therefore very experienced with this modality. In view of concerns of COVID-19 transmission by aerosolisation during the intubation and extubation phases of general anaesthetic, spinal anaesthesia as an alternative first line modality was trialled with the option of converting to general anaesthesia if surgery could not be achieved safely and comfortably for the patient. Method During a three-month period, unless contraindicated, spinal anaesthesia was used as the first line anaesthetic for ureteroscopy cases. A retrospective study of outcomes was then undertaken. Results 44 patients were treated with a conversion rate to general anaesthetic of 9% (n = 4). There was a complication rate of 20% (n = 9); 4 partial procedures, 4 readmissions with symptomatic residual fragments or sepsis and 1 patient required post-operative overnight stay due to anaesthetic. Spinal anaesthetic time averaged 25minutes. Conclusions The global COVID-19 pandemic has led to change in practice and we have demonstrated that spinal anaesthesia is a valuable alternative to general anaesthetic in the majority of ureteroscopy cases. When undertaken by an experienced anaesthetic team, using this method does not significantly add to procedure time.

scholarly journals Neonatal Apgar Score Outcomes in Spinal Versus General Anaesthesia at the University Teaching Hospital (UTH), Lusaka.

2020 ◽  
Vol 4 (4) ◽  
pp. 18-24
Author(s):  
Carol Muloshi ◽  
Keyword(s):  
Logistic Regression ◽  
Caesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Apgar Score ◽  
University Teaching ◽  
General Anaesthetic ◽  
Spinal Anaesthetic ◽  
The University ◽  
General Anaesthesia Group

Background: The knowledge gap was from the fact that the type of anaesthetic drug administered during caesarean section can have effects on neonatal outcome like low Apgar score with most hospitals in developed countries now using more modern inhalational anaesthetic agents with fewer or no cardio-respiratory depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still being used for maintenance of general anaesthesia despite well documented cardio-respiratory depressant effects with very limited research done on its effects on neonatal Apgar score. The Apgar score is a means of rapid evaluation of the physical condition of infants shortly after birth. Thus this study investigated the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Objective and study design: With the view of determining the type of anaesthesia administered during caesarean section with the least effects on neonatal wellbeing shortly after birth, a prospective observational cohort study was conducted at the University Teaching Hospital between May 2015 and January 2016.The scientific objective was to determine the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. This study involved 70 neonates, 54 were born from mothers that had undergone caesarean section under spinal anaesthesia and 16 from mothers that had undergone general anaesthesia. The data was analysed using SPSS version 16.0. Inferential analysis was conducted using logistic regression. Results: 20 neonates out of 54 (37%) in the spinal anaesthetic group had an Apgar score less than 8 at 1 minute[Fig 1]. Out of the 16 neonates in the general anaesthesia group, 14 (87.5%) had Apgar score less than 8 at 1 minute[Fig 1]. One (1.9%) neonate had an Apgar score less than 8 at 5 minutes in the spinal anaesthesia group. While 4 (25%) neonates had Apgar score less than 8 in the GA group[Fig2] The logistic regression at 1 minute Showed that it is over 11 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 11.9), [Table 3]. The Apgar score at 1 minute in the Spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.002). The logistic regression at 5 minutes Showed that it is over 17 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 17.7), [Table 4]. Further, the 5 minutes Apgar score in the spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.014),[Table 4]. Conclusion: With the results pointing to the fact that there is significant difference in neonatal Apgar score outcomes in spinal versus general anaesthesia, the researcher therefore rejected the null hypothesis. It is therefore inferred that spinal anaesthesia method has better neonatal outcomes by Apgar score measure than general anaesthesia method.

scholarly journals Prevention of Hypotension following Spinal Anaesthesia in Caesarean Section - then and now

2012 ◽  
Vol 8 (4) ◽  
pp. 415-419
Author(s):  
J K Mitra
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
High Risk ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Limited Data ◽  
First Line ◽  
High Risk Patients ◽  
Risk Patients ◽  
Poor Efficacy

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Aortocaval compression counteraction does not help to prevent hypotension. Intravenous crystalloid prehydration has poor efficacy; thus, the focus has changed toward co-hydration and use of colloids. Phenylephrine is established as a first- line vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.http://dx.doi.org/10.3126/kumj.v8i4.6242 Kathmandu Univ Med J 2010;8(4):415-19   

Plain Articaine or Prilocaine for Spinal Anaesthesia in Day-Case Knee Arthroscopy, a Double-Blinded Randomised Clinical Trial

2008 ◽  
Vol 33 (Sup 1) ◽  
pp. e32
Author(s):  
M. P. Hendriks ◽  
C. J.M. de Weert ◽  
M. A.L. Pluim ◽  
H. P. Hu ◽  
M. M.J. Snoeck ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Anaesthesia ◽  
Knee Arthroscopy ◽  
Randomised Clinical Trial ◽  
Day Case ◽  
Double Blinded

Paediatric day-case otoplasty: local versus general anaesthetic

The Surgeon ◽  
2003 ◽  
Vol 1 (2) ◽  
pp. 96-98 ◽  
Author(s):  
J.L. Lancaster ◽  
T.M. Jones ◽  
A.R. Kay ◽  
D.D. McGeorge
Keyword(s):  
General Anaesthetic ◽  
Day Case

scholarly journals Effect of manual aspiration thrombectomy using large-bore aspiration catheter for acute basilar artery occlusion: comparison with a stent retriever system

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jin Wook Choi ◽  
Miran Han ◽  
Jung Hyun Park ◽  
Woo Sang Jung
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Treatment Method ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Procedure Time ◽  
First Line ◽  
Aspiration Thrombectomy ◽  
First Pass ◽  
First Line Treatment

Abstract Background A large-bore aspiration catheter can be employed for recanalization of acute basilar artery occlusion. Here we compare the results of mechanical thrombectomy using a stent retriever (SR) and manual aspiration thrombectomy (MAT) using a large-bore aspiration catheter system as a first-line recanalization method in acute basilar artery occlusion (BAO). Methods The records of 50 patients with acute BAO who underwent mechanical thrombectomy were retrospectively reviewed. Patients were assigned to one of two groups based on the first-line recanalization method. The treatment and clinical outcomes were compared. Results Sixteen (32%) patients were treated with MAT with a large-bore aspiration catheter and 34 (68%) with a SR as the first-line treatment method. The MAT group had a shorter procedure time (28 vs. 65 min; p = 0.001), higher rate of first-pass recanalization (68.8% vs. 38.2%, p = 0.044), and lower median number of passes (1 vs 2; p = 0.008) when compared with the SR group. There was no significant difference in the incidence of any hemorrhagic complication (6.3% vs. 8.8%; p = 0.754) between the groups. However, there were four cases of procedure-related subarachnoid hemorrhage (SAH) in the SR group and one death occurred due to massive hemorrhage. Conclusions Selection of MAT using a large-bore aspiration catheter for acute BAO may be a safe and effective first-line treatment method with higher first-pass recanalization rate and shorter procedure time than SR.

scholarly journals Spinal Anaesthesia for Caesarean Section in the Solomon Islands

1994 ◽  
Vol 22 (2) ◽  
pp. 187-191 ◽  
Author(s):  
C. J. Sparks ◽  
H. Perndt ◽  
K. Agiomea ◽  
J. Fa'Arondo
Keyword(s):  
Pacific Ocean ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Pacific Islands ◽  
Solomon Islands ◽  
General Anaesthetic ◽  
Tropical Country ◽  
The Pacific ◽  
The Pacific Ocean

Results were kept on 43 spinal anaesthetics performed for caesarean section in the Solomon Islands, a developing tropical country in the Pacific Ocean. A 25-gauge Quincke needle was used and either 2.5 ml of heavy bupivacaine 0.5% or 2.0-2.5 ml of plain bupivacaine 0.5% were injected. Hypotension down to 85 mmHg occurred in four patients and there were no spinal headaches. Five patients had to be given a general anaesthetic. We recommend this technique to other doctors working in the Pacific Islands.

641. Plain Articaine or Prilocaine for Spinal Anaesthesia in Day-Case Knee Arthroscopy, a Double-Blinded Randomised Clinical Trial

2008 ◽  
Vol 33 (Suppl 1) ◽  
pp. e32.1-e32
Author(s):  
M. P. Hendriks ◽  
C. J.M. de Weert ◽  
M. A.L. Pluim ◽  
H. P. Hu ◽  
M. M.J. Snoeck ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Anaesthesia ◽  
Knee Arthroscopy ◽  
Randomised Clinical Trial ◽  
Day Case ◽  
Double Blinded

scholarly journals Spinal Anaesthesia—Early Australian Experience

2005 ◽  
Vol 33 (1_suppl) ◽  
pp. 39-44 ◽  
Author(s):  
L. J. Mcbride
Keyword(s):  
Lumbar Puncture ◽  
Spinal Anaesthesia ◽  
Cardiac Failure ◽  
European Settlement ◽  
Spinal Anaesthetic ◽  
Communication Difficulties ◽  
Land Mass ◽  
Second Year ◽  
Australian Experience ◽  
The Town

Australia in 1902 was a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous land mass, although some bold adventurers in search of gold and farmland had struggled their way into the interior. Horsham, situated 300 km northwest of Melbourne in the state of Victoria, was founded in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham Hospital on January 7, 1902 that Dr Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie performed a lumbar puncture at the L3–4 level, injected 2 ml of 2% cocaine solution and waited for a total of 20 minutes before realising that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water. Strychnine injections were administered four hourly postoperatively. The adoption of the technique of spinal anaesthesia spread quickly in Australia despite communication difficulties at that time.

scholarly journals Evaluating the safety and efficacy of regional citrate compared to systemic heparin as anticoagulation for continuous renal replacement therapy in critically ill patients: A service evaluation following a change in practice

2017 ◽  
Vol 18 (3) ◽  
pp. 184-192 ◽  
Author(s):  
Roberta Borg ◽  
Debra Ugboma ◽  
Dawn-Marie Walker ◽  
Richard Partridge
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Service Evaluation ◽  
First Year ◽  
First Line ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
Change In Practice ◽  
Median Lifespan

Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h. Filters anticoagulated with citrate had significantly longer median lifespan (33 h vs 17 h; p = 0.001), shorter downtime (0 h vs 5 h; p = 0.015) and less filter sets per patient day (0.37 vs 0.67; p = 0.002). Filters anticoagulated with heparin were commonly interrupted due to clotting (50% vs 16.4%), whereas filters anticoagulated with citrate were often stopped electively (53.4% vs 24.6%). Patients on heparin filters had significantly higher APPTs, some at potentially dangerous levels (>180 s), whilst patients on citrate filters had significantly higher levels of bicarbonate. Therefore, we conclude that citrate is superior in terms of safety and efficacy, with longer filter lifespan. It has become our first line anticoagulant for continuous renal replacement therapy.

Sign in / Sign up

Export Citation Format

Share Document