Respiratory Depression and Difficult Ventilation After Inadvertent Epidural Administration of Remifentanil

2007 ◽  
Vol 104 (4) ◽  
pp. 1004 ◽  
Author(s):  
Xuebing Xu ◽  
Shouzhang She ◽  
Shanglong Yao ◽  
Martin Mok ◽  
Zhiyi Zuo
Keyword(s):  
Respiratory Depression ◽  
Epidural Administration ◽  
Difficult Ventilation

A prospective study on the comparison of general anesthesia and tea (thoracic epidural anesthesia) for perioperative outcomes in patients undergoing modified radical mastectomy

2021 ◽  
Vol 12 (1) ◽  
pp. 631-635
Author(s):  
Goutham V V N ◽  
Venkata Ganesh M ◽  
Lavanya P V S ◽  
Mrudula Vandana ◽  
Ravikanth S
Keyword(s):  
General Anesthesia ◽  
Respiratory Depression ◽  
Demographic Data ◽  
Radical Mastectomy ◽  
Breast Cancer Surgery ◽  
Perioperative Outcomes ◽  
Epidural Administration ◽  
Thoracic Epidural ◽  
Intraoperative Hypotension ◽  
A Prospective Study

The 2nd most common tumor among women is breast cancer. Surgery is usually done by general anesthesia (GA). TEA is one of the anesthetic procedures that can be performed using local anesthetic epidural administration. TEA may boost pain relief without the potential for respiratory muscle weakness and sedation. An epidural catheter was inserted in T4 to T5 for the T-group, with a 10-15 ml injection of 0.75% ropivacaine. Intermittent supplements of 5-10 ml 0.75% ropivacaine maintained anesthesia. General anesthesia was caused by fentanyl of 1-2 μg/kg, accompanied by propofol (1.5-2 mg/kg), with sevoflurane. We evaluated intraoperative hemodynamics, post-operative patient parameters like nausea and vomiting, shivering, respiratory depression. Overall patient satisfaction is compared between two groups.  The demographic data was similar in both groups. Intraoperative hypotension observed in 33.3% of group T patients and 16.6% of group G patients. 20% of the group T patients showed intraoperative bradycardia, whereas 6.66% of group G patients showed intraoperative bradycardia. Incidence of vomiting & nausea is 26.6% in group G, whereas in group T it is 6.66%. The incidence of post-operative shivering is equal in both groups. Post-operative respiratory depression is not observed in both groups. 86.6% of the group T patients are satisfied overall, whereas it is 60% in group G.

Comparison between Intrathecal Nalbuphine and Bupivacaine versus Fentanyl and Bupivacaine For Postoperative Analgesia After Lower Abdominal Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S F Ibrahim ◽  
R Y Ataallah ◽  
F A Abdelmalek ◽  
M M Hamisa
Keyword(s):  
Side Effects ◽  
Respiratory Depression ◽  
Postoperative Analgesia ◽  
Motor Block ◽  
Intrathecal Injection ◽  
Arterial Oxygen ◽  
Epidural Administration ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Fentanyl Group

Abstract The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation. Aim of Study The purpose of this study was to assess the spinally mediated analgesic effects postoperativally of intrathecal Nalbuphine plus bupivacaine after lower abdominal surgeries in comparison to intrathecal bupivacaine plus fentanyl Patients & Methods : 60 patients came to Ain-shams Hospital for lower abdominal surgeries, They were randomly allocated into two equal groups (30 patients each) group F and group N. Group F : Bupivacaine-Fentanyl Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl. Group N: Bupivacaine-Nalbuphin Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.5 mg) Nalbuphine. All patients were assessed and monitored for: Hemodynamics: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, onset of motor block, duration of analgesia & 1st rescue analgesia, duration of motor block, adverse effects as: hypotension, bradycardia, respiratory depression, pruritus, shivering, nausea and vomiting were recorded. Results & Conclusion Addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia the duration of postoperative analgesia is nearly the same in nalbuphine group & the fentanyl group. There is more rapid onset of motor block in fentanyl group than in nalbuphine group but with no difference in sensory or motor block regression. No respiratory depression or degree of sedation occurs in both groups. Hemodynamic stability & side effects incidence are the same in both groups

scholarly journals Cisternal Cerebrospinal Fluid Concentrations of Morphine following Intrathecal and Epidural Administration in the Baboon

1987 ◽  
Vol 15 (4) ◽  
pp. 445-450 ◽  
Author(s):  
W. A. Hampton ◽  
N. G. Lavies ◽  
J. W. Downing ◽  
J. G. Brock-Utne ◽  
R. T. Salisbury ◽  
...  
Keyword(s):  
High Pressure ◽  
Cerebrospinal Fluid ◽  
Respiratory Depression ◽  
Intrathecal Injection ◽  
Maximum Level ◽  
Epidural Administration ◽  
Epidural Group ◽  
Liquid Chromatograph ◽  
Lumbar Level ◽  
High Pressure Liquid Chromatograph

Eleven baboons, anaesthetised with ketamine, had catheters introduced into the cisterna magna. Morphine was injected at lumbar level intrathecally in six and epidurally in five. Cisternal CSF was sampled hourly and the morphine concentration measured using a high pressure liquid chromatograph. In two cases following intrathecal injection peaks of 180 ng/ml at 4 hours, and 2,200 ng/ml at 3 hours were detected. In the latter case there was associated error in sampling therefore this baboon had a repeat injection four weeks later. The maximum level of morphine obtained then was 139 ng/ml at 4 hours. In the epidural group peaks of 113 ng/ml and 53 ng/ml at 1 hour were measured in 2 baboons and 27 ng/ml at 6 hours in a third. In all six other baboons following either procedure no morphine was detected in the cisterna. We conclude that morphine injected either intrathecally or epidurally in primates does migrate centrally in varying quantities. This finding would seem to have some bearing on the unpredictability of reported episodes of respiratory depression following intraspinal morphine.

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