scholarly journals Analysis of Epidural Waveform to Determine Correct Epidural Catheter Placement After CSE Labor Analgesia

2021 ◽  
Vol Volume 14 ◽  
pp. 103-108
Author(s):  
Alessandra Coccoluto ◽  
Giorgio Capogna ◽  
Michela Camorcia ◽  
Mark Hochman ◽  
Matteo Velardo
2017 ◽  
Vol 125 (6) ◽  
pp. 1969-1974 ◽  
Author(s):  
Albert Moore ◽  
Valerie Villeneuve ◽  
Bruno Bravim ◽  
Aly el-Bahrawy ◽  
Eva el-Mouallem ◽  
...  

2021 ◽  
pp. rapm-2020-102352
Author(s):  
Sarah A Bachman ◽  
Johan Lundberg ◽  
Michael Herrick

Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.


2019 ◽  
Author(s):  
Lutz Kaufner ◽  
Phil Niggemann ◽  
Tobias Baum ◽  
Sara Casu ◽  
Jalid Sehouli ◽  
...  

Abstract Background: General (GA)- and epidural-anesthesia may cause a drop in body-core-temperature (BCTdrop), and hypothermia, which may alter tissue oxygenation (StO2) and microperfusion after cytoreductive surgery for ovarian cancer. Cell metabolism of subcutaneous fat- or skeletal muscle cells, measured in microdialysis, may be affected. We hypothesized that forced-air prewarming during epidural catheter placement and induction of GA maintains normothermia and improves microperfusion. Methods: After ethics approval 47 women scheduled for cytoreductive surgery were prospectively enrolled. Women in the study group were treated with a prewarming of 43°C during epidural catheter placement. BCT (Spot on®, 3M) was measured before (T1), after induction of GA (T2) at 15 min (T3) after start of surgery, and until 2h after ICU admission (TICU2h). Primary endpoint was BCTdrop between T1 and T2. Microperfusion-, hemodynamic- and clinical outcomes were defined as secondary outcomes. Statistical analysis used the Mann-Whitney-U- and non-parametric-longitudinal tests. Results: BCTdrop was 0.35 °C with prewarming and 0.9 °C without prewarming (p< 0.005) and BCT remained higher over the observation period (ΔT4 = 0.9 °C up to ΔT7 = 0.95 °C, p<0.001). No significant differences in hemodynamic parameters, transfusion, arterial lactate and dCO2 were measured. In microdialysis the ethanol ratio was temporarily, but not significantly, reduced after prewarming. Lactate, glucose and glycerol after PW tended to be more constant over the entire period. Postoperatively, six women without prewarming, but none after prewarming were mechanical ventilated (p< 0.001). Conclusion: Prewarming at 43°C reduces the BCTdrop and maintains normothermia without impeding the perioperative routine patient flow. Microdialysis indicate better preserved parameters of microperfusion. Trial registration: ClinicalTrials.gov; ID: NCT02364219; Date of registration: 18-febr-2015


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