scholarly journals Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients: a randomized controlled trial

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Yilu Zhou ◽  
Wei Chen ◽  
Shuangqiong Zhou ◽  
Yiyi Tao ◽  
Zhendong Xu ◽  
...  
Keyword(s):  
Success Rate ◽  
Adverse Reactions ◽  
Operation Time ◽  
Obese Patients ◽  
Total Operation Time ◽  
Median Approach ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Positioning Time ◽  
Approach Group

Abstract Background Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound. Methods One hundred obese patients (BMI ≥ 30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First-attempt success rate, the median positioning time and total operation time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, anesthesia adverse reactions, complications after anesthesia, and patients’ satisfaction with the epidural puncture were recorded. Results The first-attempt success rate was significantly different between the two groups [92% (46/50) vs. 76% (38/50), P  =  0.029]. The median positioning time and total operation time in the paramedian approach group were higher than those in the median approach group (227.7 s vs. 201.6 s, P  =  0.037; 251.3 s vs. 247.4 s, P  =  0.145). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs. 12%, P  =  0.026), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P  =  0.032). Conclusion The ultrasound-guided paramedian approach for CSEA is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction. Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019

scholarly journals Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery obese patients: A randomized controlled trial

2020 ◽  
Author(s):  
Yilu Zhou ◽  
Zhendong Xu ◽  
Zhiqiang Liu
Keyword(s):  
Patient Satisfaction ◽  
Cesarean Section ◽  
Success Rate ◽  
Epidural Anesthesia ◽  
Adverse Reactions ◽  
Obese Patients ◽  
Median Approach ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Approach Group

Abstract Background: Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound.Methods: One hundred obese patients (BMI≧30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First puncture success rate, ultrasonic time needed for positioning and puncture time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, adverse reactions to anesthesia, complications after anesthesia, and patient satisfaction with the epidural puncture were recorded.Results: The first puncture success rate was significantly different between the two groups (92% vs 86%, P <0.05). The positioning time and total puncture time in the paramedian approach group were higher than those in the median approach group (217.7 s vs 201.6 s, P <0.05; 251.3 s vs 247.4 s, P＞0.05). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs 12%, P <0.05), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P <0.05).Conclusion: The ultrasound-guided paracentesis approach for intrauterine spinal anesthesia for cesarean section patients is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction.Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019.

scholarly journals Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients

2022 ◽  
Vol 18 (6) ◽  
pp. 90-96
Author(s):  
N. V. Davydov ◽  
I. G. Trukhanova ◽  
А. D. Gureev ◽  
Yu. G. Kutyreva
Keyword(s):  
Cardiac Output ◽  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Obese Patients ◽  
Hemodynamic Parameters ◽  
Combined Spinal Epidural ◽  
Group 2 ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Group 1

The objective: to substantiate the safety of using combined spinal epidural anesthesia with expansion of the epidural space in hernioplasty in obese patients.Subjects and Methods. Hemodynamic parameters were studied in 100 obese patients who underwent elective hernioplasty of the anterior abdominal wall using the neuroaxial block of two types ‒ combined spinal epidural anesthesia with epidural volume extension (CSEA with EVE) and spinal anesthesia (SA). The patients were randomly divided into two groups: Group 1 (n = 60) ‒ patients operated under combined spinal epidural anesthesia with the epidural volume extension, Group 2 (n = 40) ‒ patients operated under spinal anesthesia. The assessment of changes in main parameters of central hemodynamics, stroke volume (SV), cardiac output (CO), and cardiac index (CI) was performed using the Estimated Continuous Cardiac Output technology based on the measurement of pulse wave transit time.Results. It was revealed that in Group 1 patients, the listed parameters fluctuated slightly during the entire follow-up period. The average values were: SV 76.4 ± 0.37 ml, CO 5.8 ± 0.04 l/min, CI 3.56 ± 0.03 l/min/m2. In patients of Group 2, there was an increase in SV by 35.5%, CO by 24.2%, and CI by 23.6% at minutes 2-4 of the regional blockade.Conclusions. The most obvious fluctuations in hemodynamic parameters are observed in the group of patients who underwent spinal anesthesia using relatively high doses of local anesthetic. When using CSEA with EVE with low doses of bupivacaine, stable hemodynamic parameters are noted with a constant level of the neuroaxial block.

scholarly journals Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Bo Qu ◽  
Luying Chen ◽  
Yuling Zhang ◽  
Mengting Jiang ◽  
Caineng Wu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Success Rate ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Needle Insertion ◽  
Success Rates ◽  
First Pass ◽  
Spinal Epidural ◽  
Ultrasound Group

Abstract Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blind, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into either the landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: All patients,40 in each group, completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The number of needle insertion attempts and passes in the landmark group were 2 (1, 2) and 3 (2, 4), respectively; values of 1 (1, 1) and 1 (1, 2) were documented for the ultrasound group (median [interquartile range], all P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a satisfaction score of 4–5 (P = 0.007). Subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register, ChiCTR1900020819. Registered January 20, 2019, http://www.chictr.org.cn/showprojen.aspx?proj=34634

Influence of table height on the performances of residents while training to administer combined spinal-epidural anesthesia: a randomised trial.

2020 ◽  
Author(s):  
Juan Gu ◽  
Juan Ni ◽  
Yushan Ma ◽  
Yaqin Xiong
Keyword(s):  
Success Rate ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Operating Table ◽  
Success Rates ◽  
Insertion Point ◽  
Xiphoid Process ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background The present study aimed to evaluate whether the operating table height affected the success rate and incidence of complications of combined spinal-epidural anesthesia administered by residents during training. Methods One-hundred-and-eighty pregnant women, ASA I-II, were randomly allocated according to landmarks on the resident’s body: umbilicus (group U), lowest rib margin (R), and xiphoid process (X). The success rates of combined spinal-epidural anesthesia, the incidence of paresthesia and intravascular cannulation were recorded. Results There were no differences between the three groups in the success rates of combined spinal-epidural anesthesia, and the incidence of paresthesia and intravascular cannulation. However, paresthesia during epidural catheter advancement was more common on the left side (66.7%) than the right side (33.3%) (P=0.03). In group R, the success rate of epidural space puncture was higher during the residents’ third time (100%) than their first time (50%; P=0.01). Most residents (83%) preferred the table height at which the needle insertion point was at the level of their lowest rib margin. Conclusions The success rates of CESA during training did not be influenced by the operating table height which below the standing residents’ xiphoid process. But it may be helpful to suggest the residents to move the puncture point to the patients’ right slightly. It may be better to keep the table height at which the needle insertion point was level with the residents’ lowest rib margin. It was not just preferred by most of residents but also better for their training of performing epidural anesthesia.

Acute Dystonia after a Single Dose of Intravenous Metoclopramide during Elective Cesarean Section: A Case Report.

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Danielle Levin
Keyword(s):  
Single Dose ◽  
Case Report ◽  
Cesarean Section ◽  
Epidural Anesthesia ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Dystonic Reaction ◽  
Elective Cesarean ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

We would like to present the first report of severe acute dystonic reaction after a single administration of metoclopramide during cesarean section under combined spinal-epidural anesthesia.  During elective cesarean section, a 30-year-old female vomited four times and was treated with 10mg intravenous metoclopramide and 8mg intravenous ondansetron.  Nausea subsided with the antiemetic treatment, but two minutes later, patient had rapid eye blinking, uncontrollable head movement, and became unresponsive.  Bolus of 50mg intravenous diphenhydramine resolved the acute dystonic symptoms within seconds.  Patient was again oriented times three, with no recollection of symptoms, and remained symptom free for the rest of admission. 

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

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