Combined spinal and general anaesthesia in 58 cats undergoing various surgical procedures: description of technique and retrospective perioperative evaluation

2018 ◽  
Vol 21 (12) ◽  
pp. 1127-1133
Author(s):  
Diego Sarotti ◽  
Andrea Cattai ◽  
Paolo Franci
Keyword(s):  
Perioperative Complications ◽  
Intrathecal Injection ◽  
Inclusion Criteria ◽  
Physical Status ◽  
Median Dose ◽  
Rescue Analgesia ◽  
Arterial Blood ◽  
American Society ◽  
Lateral Recumbency ◽  
Observation Period

Objectives The aim of this retrospective study was to describe the spinal anaesthesia (SA) technique and evaluate the incidence of perioperative complications in cats. Methods The anaesthetic records of cats of American Society of Anaesthesiologists physical status I, II and III, which received general and SA for different surgeries between 2012 and 2016, were examined. SA was administered through a 25 G Quincke needle, using an isobaric solution of bupivacaine and morphine at the level of either the L7–S1 interspaces (sternal recumbency) or the L5–6/L6–7 interspaces (lateral recumbency). Procedural failure rate (PFR), drugs and dose used, heart rate (HR), arterial blood pressure, incidence of bradycardia (HR <100 bpm) and hypotension (mean arterial pressure [MAP] <60 mmHg for at least 5 mins), intraoperative rescue analgesia (iRA) and any other detrimental events and their treatment until discharge were recorded. Abdominal surgery cases were excluded from the intraoperative evaluation. Results A total of 58 anaesthetic records met the inclusion criteria and were analysed. PFR related to the space of injection (L7–S1 vs L5–6/L6–7) was 3/11 (27%) and 1/47 (2%), respectively ( P = 0.017). The total median dose of intrathecal bupivacaine and morphine was 0.8 (range 0.5–1.6 mg/kg) and 0.10 (0.05–0.18 mg/kg), respectively. Nine of 46 (20%) cats received iRA, and no iRA cases were reported with a dose of bupivacaine higher than 0.8 mg/kg. Median HR and MAP before intrathecal injection (T0) and 10 mins after (T1) were, respectively, 118 bpm (range 74–190 bpm) and 106 bpm (67–160 bpm) ( P = 0.005), and 65 mmHg (range 50–94 mmHg) and 52 mmHg (range 35–85 mmHg) ( P = 0.003). Bradycardia was reported in 18/46 (39%) cats and hypotension in 23/46 (50%) cats. No complications were recorded during the observation period. Conclusions and relevance SA was characterised by a low PFR when performed at the L5–6/L6–7 interspaces and low postoperative complications. Hypotension and bradycardia were the most common side effects.

scholarly journals Effects of intramuscular alfaxalone-midazolam combination in pigs

2019 ◽  
Vol 88 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Cecilia Vullo ◽  
Marina Meligrana ◽  
Adolfo Maria Tambella ◽  
Angela Palumbo Piccionello ◽  
Fabrizio Dini ◽  
...  
Keyword(s):  
Repeated Measure ◽  
Intramuscular Administration ◽  
Arterial Oxygen ◽  
Neck Muscle ◽  
Pain On Injection ◽  
Arterial Blood ◽  
Measure Analysis ◽  
American Society ◽  
Lateral Recumbency

The aim of this experimental study was to evaluate the sedative and cardiorespiratory effects of alfaxalone and midazolam after intramuscular administration in pigs. Fourteen pigs, weighing 18 to 22 kg, aged between 55 and 70 days, American Society of Anaesthesiologists classification 2, affected by congenital reducible umbilical hernia, were included in the study. Alfaxalone (5 mg/kg) and midazolam (0.5 mg/kg) mixed in the same syringe were administered into the neck muscle. Pain on injection, quality of sedation and time to achieve lateral recumbency were recorded. Heart rate (HR), respiratory frequency (fR), and rectal temperature (RT) were recorded at 0 (baseline: before drug administration), 10, 15, and 20 min after the injection. Oxygen saturation of haemoglobin (SpO2), arterial blood pH, arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions and bicarbonate concentration (HCO3-) were recorded at 10, 15, and 20 min after injection. Continuous data were analysed using a repeated-measure analysis of variance (ANOVA) and a P-value < 0.05 was considered significant. Ten animals out of fourteen showed no pain on injection, whereas the remaining four exhibited mild pain. The time from the end of injection to lateral recumbency was 266 ± 40 s. The quality of sedation ranged between good to very good. No significant changes in the variables monitored were observed between the time points. In conclusion, the intramuscular administration of alfaxalone and midazolam in pigs at the doses used induced reliable and fast sedation, without pain on injection and moderate respiratory effects.

Hypobaric intrathecal anaesthesia for partial hemipelvectomy in a dog

2008 ◽  
Vol 21 (01) ◽  
pp. 89-93 ◽  
Author(s):  
B. Carobbi ◽  
N. J. Bacon ◽  
R. A. S. White ◽  
L. Novello
Keyword(s):  
Spinal Anaesthesia ◽  
Hind Limb ◽  
Intrathecal Injection ◽  
Sartorius Muscle ◽  
Rescue Analgesia ◽  
Anaesthetic Solution ◽  
Plasma Target ◽  
Inhalational Anaesthesia ◽  
Proprioceptive Deficit ◽  
Lateral Recumbency

Summary Objective: To report the intrathecal use of a hypobaric anaesthetic solution for partial hemipelvectomy in a nine-year-old, neutered female, Golden Retriever dog, weighing 34 kg. Methods: Under inhalational anaesthesia, with the dog lying in lateral recumbency and the surgical side uppermost, 1.9 ml of a hypobaric solution containing 3.42 mg of bupivacaine and 0.66 mg of morphine were administered in the subarachnoid space at L5–6 level 30 minutes before surgery. Following the intrathecal injection the dog was maintained for five minutes in a 10° head-down position, then for three minutes in a 10° head-up position. Results: Apart from a transient increase in heart and respiratory rates during resection of the sartorius muscle, which was treated with a plasma Target Controlled Infusion (TCI) of fentanyl, spinal anaesthesia provided cardiovascular stability and excellent relaxation of the surgical site. Neither motor blockade nor proprioceptive deficit were apparent in the contra-lateral hind limb at recovery, 200 minutes after injection. Postoperatively, rescue analgesia was not required in the 48 hours following surgery. Clinical significance: In dogs, the use of intrathecal hypobaric bupivacaine and morphine as a part of a balanced anaesthetic protocol should be considered during unilateral major orthopaedic surgeries of the pelvis and hind limb, as it allowed a reduction in the dose administered compared to isobaric solutions, providing selective spinal anaesthesia, excellent longlasting analgesia, and rapid recovery of ambulation.

scholarly journals Spinal anaesthesia in children under sedation

Mediscope ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 18-24
Author(s):  
AA Maruf ◽  
M Alam ◽  
MB Ali ◽  
S Nazrina
Keyword(s):  
Side Effects ◽  
Spinal Anaesthesia ◽  
Operation Time ◽  
Perioperative Period ◽  
Lateral Position ◽  
Physical Status ◽  
Serious Adverse Events ◽  
Arterial Blood ◽  
The Mean ◽  
American Society

Spinal anaesthesia in children evolved more than hundred years ago and gaining considerable popularity worldwide. In our setups in Bangladesh, this technique has not gained popularity yet but over the past few years this technique has been practiced in some centers. The objective of the present study was to observe the efficacy and safety of spinal anaesthesia under sedation in children scheduled for infra-umbilical surgical procedures. In this study, 67 children of age ranging from 2 to 10 years of either sex, with American Society of Anaesthesioloists physical status I and II, undergoing infra-umbilical surgeries were included. Spinal anaesthesia was administered with Quincke 27 gauge needles between L4–L5 or L5-S1 interspace in the lateral position under sedation with ketamine and midazolam. Heart rate, mean arterial blood pressure and oxygen saturation (SpO2) were monitored throughout perioperative period. Complications of sedation and spinal anaesthesia were recorded and managed accordingly. Among 67 children, male and female were 62 (92.5%) and 5(7.5%), respectively. The mean (SD) age, body weight, American Society of Anaesthesiologists physical status I and II was 5.2 (2.1) years, 15.5 (4.8) kg, 60 (89.6%) and 7 (10.5%), respectively. Successful spinal anaesthesia was done in all cases. The incidences of side effects of sedation were transient apnoea 1 (1.5%), desaturation (SpO2<93%) 3 (4.5%), stridor 1 (1.5%), laryngospasm 1 (1.5%) and agitation 4 (6.0%). Side effects were transient, self limiting and managed conservatively. Complications of spinal anaesthesia were hypotension 2 (3.0%), bradycardia 1 (1.5%), shivering 1 (1.5%), nausea and vomiting 1 (1.5%) and backache 1 (1.5%). The complications were minor and managed accordingly. There were no serious adverse events reported in any child. The mean (SD) operation time and recovery time from anaesthesia was 49.2 (8.4) minutes and 91.2 (9.2) minutes, respectively. Spinal anaesthesia under sedation with ketamine and midazolam is safe and effective technique for paediatric infraumbilical surgery.Mediscope Vol. 4, No. 1: Jan 2017, Page 18-24

scholarly journals FRI0505 TOCILIZUMAB DISCONTINUATION AFTER REMISSION ACHIEVEMENT IN PATIENTS WITH ADULT STILL’S DISEASE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 851.2-851
Author(s):  
H. Tamai ◽  
Y. Kaneko ◽  
T. Takeuchi
Keyword(s):  
Laboratory Data ◽  
Good Control ◽  
Still’S Disease ◽  
Median Dose ◽  
Chugai Pharmaceutical ◽  
Still's Disease ◽  
Adult Still's Disease ◽  
The Mean ◽  
Recurrence Group ◽  
Observation Period

Background:The efficacy of tocilizumab, an interleukin (IL)-6 receptor inhibitor, has been proved in patients with adult Still’s disease on suppressing systemic inflammation and decreasing glucocorticoid dose. However, whether tocilizumab can be discontinued after remission achievement is unclear.Objectives:To clarify the possibility of tocilizumab discontinuation in patients with adult Still’s disease who achieved remission with tocilizumab.Methods:Consecutive patients with adult Still’s disease diagnosed according to the Yamaguchi’s criteria in our hospital from April 2012 until September 2019 were retrospectively reviewed. Patients who were in good control with tocilizumab were included in the analysis, and their clinical courses were collected from their medical charts. Patients were divided according to the presence of recurrence after tocilizumab discontinuation and compared.Results:Among 42 patients with adult Still’s disease who had a history of intravenous tocilizumab of 8mg/kg use, 13 patients discontinued tocilizumab following a good disease control. During the mean observation period of 26.4 months, six patients (46%) remained in remission while seven patients (54%) developed recurrence after tocilizumab discontinuation. The sex and the mean observation period were not different between the patients with recurrence and those without (71% vs 50%, p=0.43; 27.3 months vs 25.4 months, p=0.93, respectively), but the age at tocilizumab discontinuation tended to be higher in the recurrence group than the non-recurrence group (64.0 years vs 46.5 years, p=0.08). The disease activity including swollen joint counts and laboratory data at tocilizumab discontinuation were comparable between the two groups (serum ferritin levels, 88 ng/mL vs 122 ng/mL, p=0.67). While the duration of tocilizumab use was not different between the two groups (29.4 months vs 39.5 months, p=0.40), the mean interval of tocilizumab infusion at tocilizumab discontinuation in the recurrence group was 3.6 weeks, shorter than the 6.7 weeks in the non-recurrence group (p=0.03). The median dose of prednisolone at tocilizumab discontinuation was 5.0 mg/day in the recurrence group and 0.0 mg/day in the non-recurrence group (p=0.06). In the recurrence group, the duration from the last tocilizumab administration to recurrence was 7.8 months, and the median dose of prednisolone at recurrence was 5.0 mg/day.Conclusion:Patients with adult Still’s disease remaining in remission with a longer interval of tocilizumab administration and a lower dose of prednisolone was likely to succeed in withdrawal of tocilizumab.Disclosure of Interests:Hiroya Tamai: None declared, Yuko Kaneko Speakers bureau: Dr. Kaneko reports personal fees from AbbVie, personal fees from Astellas, personal fees from Ayumi, personal fees from Bristol-Myers Squibb, personal fees from Chugai, personal fees from Eisai, personal fees from Eli Lilly, personal fees from Hisamitsu, personal fees from Jansen, personal fees from Kissei, personal fees from Pfizer, personal fees from Sanofi, personal fees from Takeda, personal fees from Tanabe-Mitsubishi, personal fees from UCB, Tsutomu Takeuchi Grant/research support from: Eisai Co., Ltd, Astellas Pharma Inc., AbbVie GK, Asahi Kasei Pharma Corporation, Nippon Kayaku Co., Ltd, Takeda Pharmaceutical Company Ltd, UCB Pharma, Shionogi & Co., Ltd., Mitsubishi-Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co. Ltd., Consultant of: Chugai Pharmaceutical Co Ltd, Astellas Pharma Inc., Eli Lilly Japan KK, Speakers bureau: AbbVie GK, Eisai Co., Ltd, Mitsubishi-Tanabe Pharma Corporation, Chugai Pharmaceutical Co Ltd, Bristol-Myers Squibb Company, AYUMI Pharmaceutical Corp., Eisai Co., Ltd, Daiichi Sankyo Co., Ltd., Gilead Sciences, Inc., Novartis Pharma K.K., Pfizer Japan Inc., Sanofi K.K., Dainippon Sumitomo Co., Ltd.

Open Hemorrhoidectomy With Ligasure™ Under Local or Spinal Anesthesia: A Comparative Study

2021 ◽  
pp. 000313482110385
Author(s):  
Claudio F. Feo ◽  
Chiara Ninniri ◽  
Cinzia Tanda ◽  
Giulia Deiana ◽  
Alberto Porcu
Keyword(s):  
Spinal Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Outpatient Clinic ◽  
Perioperative Complications ◽  
Study Groups ◽  
Reoperation Rate ◽  
Hyperbaric Bupivacaine ◽  
Open Hemorrhoidectomy ◽  
American Society

Background There is increasing evidence that many anorectal surgical procedures may be performed under local anesthesia. The aim of the present study was to evaluate the safety and efficacy of local anesthesia in the outpatient clinic vs spinal anesthesia in the operating room for open hemorrhoidectomy. Methods Sixty-two patients with grade III or IV hemorrhoids underwent open hemorrhoidectomy with LigaSure™ between 2018 and 2020. Of them, 32 procedures were performed in the operating room under spinal anesthesia with hyperbaric bupivacaine and other 30 procedures were undertaken in the outpatient clinic under local anesthesia with ropivacaine. Results There were no significant differences regarding age, gender, American Society of Anesthesiologists class, and Goligher’s grade in between groups. No significant differences were observed in postoperative pain score (P = .85), perioperative complications (P = .51), and reoperation rate (P = .96). No recurrences and no differences in patients’ satisfaction degree (P = .76) were documented at long-term follow-up in both study groups. Discussion Our results suggest that open hemorrhoidectomy with LigaSure™ performed in selected patients under local anesthesia in the outpatient clinic is a well-tolerated, safe, and effective procedure.

scholarly journals Assessment of Accuracy of Continuous Noninvasive versus Invasive Method of Hemoglobin Estimation in Patients Undergoing Pituitary Surgery

2018 ◽  
Vol 05 (03) ◽  
pp. 168-172
Author(s):  
Indu Kapoor ◽  
Charu Mahajan ◽  
Ruhi Mamuliya ◽  
Hemanshu Prabhakar
Keyword(s):  
Pituitary Surgery ◽  
Poor Correlation ◽  
P Value ◽  
Arterial Line ◽  
Female Ratio ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Invasive Method ◽  
American Society ◽  
Hb Concentration

Abstract Aim Determination of hemoglobin (Hb) concentration by standard methods is time consuming, invasive, and intermittent. Noninvasive (NI) methods of Hb estimation are less time consuming, and reduce the risk of infection, number of required working personnel, and long-term costs. In this study, we aimed to find the accuracy of Hb values at various time points using noninvasive (NI) Hb monitoring and standard invasive techniques such as laboratory (LabHb) and arterial blood gas (ABG). Methods All American Society of Anesthesiologists (ASA) physical grade I and II adult patients between 18 and 65 years of either gender undergoing pituitary surgery under general anesthesia were included over a period of 1 year. Samples were collected for Hb estimation from the arterial line (aHb) using ABG analyzer machine and LabHb using automated Hb analyzer. Simultaneously, Hb reading from the NI Hb monitor was recorded using Masimo Spot Hemoglobin Check Device. Bland–Altman plot was used to find out agreement between Hb values drawn from three different techniques. A p-value < 0.05 was considered significant. Results A total of 30 patients participated in the study. The male to female ratio was 13:17. Statistical analysis showed poor correlation between the invasive and NI methods of Hb estimation. Conclusion NI method of Hb estimation may be successfully used in clinical practice, replacing estimation from ABG analysis or laboratory tests. However, NI method cannot replace the invasive methods of Hb estimation.

scholarly journals Epidural Anaesthesia Saved A Patient With Multiple Co-Morbid Condition

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 729-730
Author(s):  
Rahena Khatun ◽  
Md Zulfikar Ali
Keyword(s):  
Epidural Anaesthesia ◽  
Postoperative Recovery ◽  
Morbid Condition ◽  
Physical Status ◽  
Uncontrolled Diabetes ◽  
Life Saving ◽  
Diabetic Gangrene ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Morbid Conditions

Epidural anaesthesia has been routinely used for many years and widely accepted as an effective mathod of pain relief . The procedure is commonly performed as a sole anaesthesic or in combination with spinal or general anaesthesia. In our case Md. Alauddin, 59 years old male was admitted in KYAMCH with complaints of diabetic gangrene of right foot with features of septicemia and he has a long history uncontrolled diabetes mellitus and hypertension leading to developed ischemia heart disease and CRF. After proper evaluation patient's physical status was graded as ASA (American society of Anesthesiologists) class-IV, and selected for above knee amputation of right lower limb but patient was unfit for anesthesia due to his co morbid conditions. As a life saving procedure the operation was done under epidural anesthesia and per- operative and postoperative recovery was uneventful.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 729-730

Effect of Fresh Gas Flow on Isoflurane Concentrations during Low-flow Anaesthesia

2005 ◽  
Vol 33 (5) ◽  
pp. 513-519 ◽  
Author(s):  
J-Y Park ◽  
J-H Kim ◽  
W-Y Kim ◽  
M-S Chang ◽  
J-Y Kim ◽  
...  
Keyword(s):  
Gas Flow ◽  
Low Flow ◽  
Physical Status ◽  
Closed Circle ◽  
Haemodynamic Changes ◽  
Low Flow Anaesthesia ◽  
Baseline Values ◽  
American Society ◽  
End Tidal ◽  
Closed Circle System

The effect of fresh gas flow (FGF) on isoflurane concentrations at given vaporizer settings during low-flow anaesthesia was investigated. Ninety patients (American Society of Anaesthesiologists physical status I or II) were randomly allocated to three groups (FGF 1 l/min, FGF 2 l/min and FGF 4 l/min). Anaesthesia was maintained for 10 min with vaporizer setting isoflurane 2 vol% and FGF 4 l/min for full-tissue anaesthetic uptake in a semi-closed circle system. Low-flow anaesthesia was maintained for 20 min with end-tidal isoflurane 1.5 vol% and FGF 2 l/min. FGF was then changed to FGF 1 l/min, FGF 2 l/min or FGF 4 l/min. Measurements during the 20-min period showed that inspired and end-tidal isoflurane concentrations decreased in the FGF 1-l/min group but increased in the FGF 4-l/min group compared with baseline values. No haemodynamic changes were observed. Monitoring of anaesthetic concentrations and appropriate control of vaporizer settings are necessary during low-flow anaesthesia.

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