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 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 Combined Spinal Epidural Anesthesia for Total Hip Replacement Surgery in Birendra Army Hospital

2012 ◽  
Vol 10 (1) ◽  
pp. 32-36
Author(s):  
NB KC ◽  
S Rai ◽  
P Chand ◽  
A Joshi ◽  
BR Kunwar
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Hip Replacement ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Introduction: Total Hip Replacement surgery is one of the most commonly performed surgeries worldwide. Epidural anaesthesia have shown decrease incidence of DVT in these patient. Hence, combined spinal epidural spinal anesthesia is now a preferred technique over spinal anesthesia alone. We have been practicing combined spinal epidural anesthesia routienely in total joint replacement, but have not analyzed the result. The aim of this study was to analyse various aspect of combined spinal epidura anesthesia. Methods: thirteen cases of ASA I and II who underwent Total Hip Arthroplasty under combined spinal epidural anesthesia were analysed. First epidural was given in space L2-3/L3-4 and patency was confirmed with test dose with InjXylocaine 2% with Adrenaline 3 ml, followed by Spinal anesthesia one space below with Bupivacaine 0.5% 3 ml. Results: Intra operative Mean Blood Pressure had dropped up to 55 mm of Hg.To maintain Blood pressure, Intravenous Fluid was given in average is 2423.077 ml and Vasopressure drug (Mephenteramine Maleate) was given in average of14.769 mg. Dura was accidentally puncture in one patient during epidural insertion and two epidural failed to provide post operative analgesia. Post operative rehabilitation was easy, one one patient developed DVT after 4 weeks of surgery. Conclusion: Combined epidural analgesia effectively manages postoperative pain, allows early ambulation and reduces the risk of deep vein thrombosis and thromboembolism, Although significant drop of Blood pressure was noted in all cases. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6447 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 32-36

Combined Spinal-Epidural Anesthesia for Outpatient Surgery

1995 ◽  
Vol 83 (3) ◽  
pp. 528-534. ◽  
Author(s):  
William F. Urmey ◽  
Jennifer Stanton ◽  
Margaret Peterson ◽  
Nigel E. Sharrock
Keyword(s):  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Initial Dose ◽  
Knee Arthroscopy ◽  
Outpatient Surgery ◽  
Motor Blockade ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Prospective Study Design

Background Combined spinal-epidural anesthesia (CSE) may offer theoretic advantages for outpatient surgery, because it produces the rapid onset of spinal anesthesia, with the option to extend the blockade with an epidural catheter. In this study, the authors attempted to determine an appropriate initial dose of a short-acting local anesthetic, 2% lidocaine, to administer for outpatient knee arthroscopy using CSE. Methods Data were collected from 90 patients undergoing outpatient knee arthroscopy. Using a double-blinded, prospective study design, patients were randomly assigned to receive CSE with an initial dose of intrathecal 2% lidocaine of 40, 60, or 80 mg. A 27-G 4 11/16-inch Whitacre needle was placed through a 17-G Weiss needle. Onset and regression of sensory anesthesia and motor blockade were measured by a blinded observer at frequent intervals. Results All 90 patients had adequate anesthesia. Durations of thoracic and lumbar sensory and lower limb motor blockade were significantly shorter in the 40-mg group compared with the 60- or 80-mg groups (P < 0.0002 Mantel-Cox, Survivorship Analysis). Indices of neural blockade resolved 30-40 min more rapidly in the 40-mg group than in either the 60- or 80-mg group. Times to urinate, site upright in a chair, take oral fluids, and be discharged were all significantly shorter (between 30 and 60 min) in the 40-mg group compared with the 60- and 80-mg groups (P < 0.01). Seven patients required intraoperative epidural supplementation: three in the 40-mg group, three in the 60-mg group, and one in the 80-mg group. Conclusions Combined spinal-epidural anesthesia with a 40-mg initial intrathecal dose of lidocaine provided reliable anesthesia for knee arthroscopy. Duration of spinal anesthesia with lidocaine was dose related.

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