scholarly journals COMBINED SPINAL-EPIDURAL ANESTHESIA WITH MINIDOSE BUPIVACAINE-FENTANYL FOR HIP SURGERY IN ELDERLY PATIENTS

2019 ◽  
Author(s):  
feyzi celik ◽  
Zeynep Baysal -Yildirim1 ◽  
Haktan Karaman ◽  
Abdulmenap Güzel
Keyword(s):  
Epidural Anesthesia ◽  
Hip Surgery ◽  
Anesthetic Technique ◽  
Hemodynamic Parameters ◽  
Sensory Blockade ◽  
Arterial Blood ◽  
Combined Spinal Epidural ◽  
Duration Of Surgery ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background: In this study, the effects of mini-dose isobaric bupivacaine with fentanyl on motor and sensory blockade with combined spinal epidural anesthesia were evaluated in patients > 65 years undergoing total hip arthroplasty. Methods: A total of 100 American Society of Anesthesiologists (ASA) class III–IV patients > 65 years were enrolled. The patients received a combined spinal epidural into the intrathecal catheter space of 5 mg 0.5% bupivacaine and 10 µg fentanyl (total 1.1 ml). Levels of sensory and motor blockade, hemodynamic parameters, and the resulting complications were recorded. Results: The mean age of patients (44 females and 56 males) was 79 ± 5.70 (range: 70–93) years. Of the 100 patients, 88 were classified as ASA III and 12 as ASA IV. The average duration of surgery was 59 ± 10 min. Comorbidities in patients with hip prostheses were examined. Heart rate and mean arterial blood pressure values were stable and similar at all times. The time to reach the T10 level of sensory blockade after spinal anesthesia was 10 ± 5.03 min. Motor block regression time was 132.06 ± 14.12 min. Conclusion: An anesthetic technique was applied considering the physiological changes in elderly hip surgery patients. The 5 mg isobaric bupivacaine and 10 µg fentanyl combination provided adequate anesthesia without affecting the hemodynamic parameters.

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 Spinal subdural hematoma and subdural anesthesia following combined spinal–epidural anesthesia: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanmei Bi ◽  
Junying Zhou
Keyword(s):  
Epidural Anesthesia ◽  
Subdural Hematoma ◽  
Cauda Equina ◽  
Vital Signs ◽  
Epidural Administration ◽  
Single Shot ◽  
Combined Spinal Epidural ◽  
Spinal Subdural Hematoma ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal–epidural anesthesia. Case presentation A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34+ 5 weeks underwent cesarean delivery. Routine combined spinal–epidural anesthesia was planned; however, no cerebrospinal fluid outflow was achieved after several attempts. Bupivacaine (2.5 mL) administered via a spinal needle only achieved asymmetric blockade of the lower extremities, reaching T12. Then, epidural administration of low-dose 2-chlorprocaine caused unexpected blockade above T2 as well as tinnitus, dyspnea, and inability to speak. The patient was intubated, and the twins were delivered. Ten minutes after the operation, the patient was awake with normal tidal volume. The endotracheal tube was removed, and she was transferred to the intensive care unit for further observation. Postoperative magnetic resonance imaging suggested a spinal subdural hematoma extending from T12 to the cauda equina. Sensory and motor function completely recovered 5 h after surgery. She denied headache, low back pain, or other neurologic deficit. The patient was discharged 6 days after surgery. One month later, repeat MRI was normal. Conclusions All anesthesiologists should be aware of the possibility of SSDH and subdural block when performing neuraxial anesthesia, especially in patients in whom puncture is difficult. Less traumatic methods of achieving anesthesia, such as epidural anesthesia, single-shot spinal anesthesia, or general anesthesia should be considered in these patients. Furthermore, vital signs and neurologic function should be closely monitored during and after surgery.

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