scholarly journals ADMINISTRATION OF SALINE INJECTION IN EPIDURAL SPACE AVOIDS INTRAVASCULAR CATHETER INSERTION IN PATIENTS UNDERGOING CAESARIAN SECTION: A RANDOMIZE CONTROLLED TRIAL

2016 ◽  
Vol 21 (4) ◽  
pp. 257
Author(s):  
Muhammad Azam ◽  
Naila Akthar ◽  
Tanvir Akhtar Butt
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
P Value ◽  
Intravascular Catheter ◽  
Epidural Catheter Placement ◽  
Significant Difference ◽  
Group A

AbstractObjective:The objective of this study was to determine if injecting 10 ml saline in epidural space before epidural catheter placement in pregnant women undergoing cesarean section can decrease the frequency of inadvertent intravascular catheter placement.Study Design:Randomize Controlled Trail.Place and Duration of Study:Department of Anaesthesia at Gynaecology and Obstetrics operation theater, Jinnah Hospital, Lahore affiliated with College of Physician and Surgeon Pakistan from April 2008 to March 2009.Methodology:Sixty pregnant patients (ASA I and II) randomly allocated in Group A and B equally for elec-tive cesarean section were selected. In each patient epidural space was identified with LOR technique using air in sitting position. In Group A (dry group), no saline was injected while in Group B (saline gro-up), 10 ml saline was injected before epidural catheter placement. Using 16 G Toughy needle, catheter was inserted up to 4 cm in the epidural space. To find out inadvertent intravascular catheter placement, epidural catheter was aspirated to exclude blood. After negative aspiration, test dose of 3ml injection xylocain 2% (with adrenaline 1:200,000) was administrated and patient were monitored one minute for increase in heart rate (> 20% of baseline), tinnitus and perioral numbness.Results:In both group data collected was analyzed in SPSS version 11 and Chi-square test was applied. P value of 0.05 or less was taken significant. Percentage of positive inadvertent intravascular catheterization in term of bloody aspirate (20 and 13.3%) was not signi-ficantly different between two groups (P value = 0.488). Increase in heart rate, tinnitus and perioral numbness was not observed in any patient.Conclusion:There was no significant difference in accidental intravascular catheterization if 10 ml saline is injected through needle before catheter insertion.Key word:Epidural catheter, accidental intravascular catheterization, anaesthesia.

Fluoroscopic Guidance Increases the Incidence of Thoracic Epidural Catheter Placement Within the Epidural Space

2017 ◽  
Vol 42 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Michelle C. Parra ◽  
Kristin Washburn ◽  
Jeremiah R. Brown ◽  
Michael L. Beach ◽  
Mark P. Yeager ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
Fluoroscopic Guidance ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Thoracic Epidural Catheter

Real-time ultrasound-guided low thoracic epidural catheter placement: technical consideration and fluoroscopic evaluation

2021 ◽  
pp. rapm-2021-102578
Author(s):  
Doo-Hwan Kim ◽  
Jong-Hyuk Lee ◽  
Ji Hoon Sim ◽  
Wonyeong Jeong ◽  
Dokyeong Lee ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Catheter Placement ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Us Guidance ◽  
Thoracic Epidural Catheter ◽  
First Pass

Background and objectiveThoracic epidural analgesia can significantly reduce acute postoperative pain. However, thoracic epidural catheter placement is challenging. Although real-time ultrasound (US)-guided thoracic epidural catheter placement has been recently introduced, data regarding the accuracy and technical description are limited. Therefore, this prospective observational study aimed to assess the success rate and describe the technical considerations of real-time US-guided low thoracic epidural catheter placement.Methods38 patients in the prone position were prospectively studied. After the target interlaminar space between T9 and T12 was identified, the needle was advanced under real-time US guidance and was stopped just short of the posterior complex. Further advancement of the needle was accomplished without US guidance using loss-of-resistance techniques to normal saline until the epidural space was accessed. Procedure-related variables such as time to mark space, needling time, number of needle passes, number of skin punctures, and the first-pass success rate were measured. The primary outcome was the success rate of real-time US-guided thoracic epidural catheter placement, which was evaluated using fluoroscopy. In addition, the position of the catheter, contrast dispersion, and complications were evaluated.ResultsThis study included 38 patients. The T10–T11 interlaminar space was the most location for epidural access. During the procedure, the mean time for marking the overlying skin for the procedure was 49.5±13.8 s and the median needling time was 49 s. The median number of needle passes was 1.0 (1.0–1.0). All patients underwent one skin puncture for the procedure. The first-pass and second-pass success rates were 76.3% and 18.4%, respectively. Fluoroscopic evaluation revealed that the catheter tips were all positioned in the epidural space and were usually located between T9 and T10 (84.2%). The cranial and caudal contrast dispersion were observed up to 5.4±1.6 and 2.6±1.0 vertebral body levels, respectively. No procedure-related complications occurred.ConclusionReal-time US guidance appears to be a feasible option for facilitating thoracic epidural insertion. Whether or not this technique improves the procedural success and quality compared with landmark-based techniques will require additional study.Trial registration numberNCT03890640.

scholarly journals Epidural Catheter Placement in Morbidly Obese Parturients with the Use of an Epidural Depth Equation prior to Ultrasound Visualization

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Sukhdip Singh ◽  
Keith M. Wirth ◽  
Amy L. Phelps ◽  
Manasi H. Badve ◽  
Tanmay H. Shah ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Epidural Space ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Needle Insertion ◽  
Catheter Placement ◽  
Morbidly Obese ◽  
Clinical Correlation ◽  
Epidural Catheter Placement ◽  
Labor Epidural

Background. Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients.Methods. One hundred sixty morbidly obese (≥40 kg/m2) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded.Results. Pearson’s correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively.Conclusion. Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone.

scholarly journals COMPARISON OF FREQUENCY OF CESAREAN SECTION IN ELECTIVE INDUCTION OF LABOUR AT 40 +0 AND 41 +0 WEEKS OF GESTATION

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S113-17
Author(s):  
Saira Saeed ◽  
Badar Murtaza ◽  
Zulekha Nasim ◽  
Sohail Raziq
Keyword(s):  
Cesarean Section ◽  
Induction Of Labour ◽  
P Value ◽  
Cross Sectional ◽  
Fetal Heart Rate Monitoring ◽  
Significant Difference ◽  
Elective Induction ◽  
Group A ◽  
Group B ◽  
Vertex Presentation

Objective: To compare the frequency of cesarean section in elective induction of labour at 40 weeks and 41weeks of gestation. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Gynecology & Obstetrics, Sialkot, from July to Dec 2017. Methodology: The pregnant females at full-term were divided in 2 groups. All patients aged 20-35 years andparity less than 5 with singleton alive pregnancy and vertex presentation at 40+0 weeks gestation were placedin group A and all singleton alive pregnancies with vertex presentation at 41+0 weeks in group B. Group A wasinduced at 40+0 weeks and group B was induced at 41+0 weeks of gestation. Induction of labour was performed and fetal heart rate monitoring was conducted every 15 minutes. Augmentation was completed and frequency of cesarean section recorded in both groups. Results: In this study a total of 100 patients were included. The mean age of the patients was 27.33 ± 4.87 years(range 20-35 years) with mean age of 26.54 ± 4.66 and 28.12 ± 4.99 years in group A and group B respectively.The cesarean section was performed in 20 (20%) patients, with 14 (28%) in group A and 6 (12%) in group B.Statistically significant difference of cesarean section was noted in both groups (p-value=0.046). Conclusion: There was a significantly lower rate of cesarean section in elective induction of labour at 41weeks as compared to 40 weeks of gestation.

scholarly journals Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

2017 ◽  
Vol 6 (10) ◽  
pp. 2522
Author(s):  
Ritu Bala ◽  
Harminder Singh ◽  
. Rupali ◽  
Kuhu Verma
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
P Value ◽  
Biochemical Tests ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Hypertension is the most prevalent cardiovascular disease and the relevant data suggest that the burden, risk factors and co-morbidities associated with the essential hypertension is increasing with every passing day. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. Aim: The aim of the study was to compare effects of cilnidipine and amlodipine on the blood pressure (BP), heart rate and proteinuria among patients of hypertension with chronic kidney disease.Methods: 100 patients were included in this study. Patients were randomly assigned into two groups Group A and Group B (50 each). Group A: Patients received Cilnidipine (5-10mg/day). Group B: Patients received amlodipine (5-10mg/day).Results: No significant difference in SBP, DBP, MBP and proteinuria while comparing both the groups of patients taking cilnidipine and amlodipine at baseline i.e. 0 to 12 week, 12 to 24 weeks and 0 to 24 weeks. Cilnidipine caused decrease in HR 0 to 12 week (p value 0.001), 12 to 24 weeks (p value 0.001) and 0 to 24 weeks (p value 0.0001). Amlodipine had increased heart rate from baseline to 12 weeks (p value 0.0001), 12 to 24 weeks (p value 0.051) and 0 to 24 weeks (p value 0.001). No significant difference was seen in any biochemical readings.Conclusions: There was a significant change in all the parameters including BP, heart rate, proteinuria and other biochemical tests when they compared within the group but no significant difference while comparing both the groups.

scholarly journals Audit on the Management of Bronchiolitis: A Single Centre Real World Experience in Bangladesh Can We do Better ?

2015 ◽  
Vol 14 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Farzana Hamid ◽  
Syed Moosa MA Quaium ◽  
Azizur Rahman ◽  
AT Reza Ahmad ◽  
Shahariar Khan ◽  
...  
Keyword(s):  
Heart Rate ◽  
Oxygen Saturation ◽  
Hospital Stay ◽  
Respiratory Rate ◽  
P Value ◽  
Supportive Treatment ◽  
Significant Difference ◽  
Group A ◽  
Syncytial Virus ◽  
Group B

Background: Bronchiolitis is the most common reason for hospitalization of children in many countries.Though Respiratory Syncytial Virus (RSV) is the most common organism causing bronchiolitis, but antibiotics are used widely.So the aim of the present study is to establish whether antibiotic has any role in bronchiolitis management along with supportive treatment. Methods:This retrospective study included 100 infants and children between 2-24 months of age admitted with clear cut sign symptoms of bronchiolitis. Patients were divided into Group A (supportive + antibiotic Rx) comprised 72 patients and group B (supportive Rx only) comprised 28 patients.After 3-5 days of hospital stay, clinical responses were evaluated in terms of improvement in symptoms and clinical parameters- respiratory rate, heart rate and oxygen saturation. Results: Mean age of patients was 6.6 (±5.6) months in Group A and 6.3 (±4.8) months in Group B. Most of the patients in both study groups were male (M: F=1.6:1). All the cases in both groups presented with cough, running nose, and respiratory distress. Fever and feeding difficulty were present in 83.3% & 90.3% in Group A and 82.1% & 89.3% in Group B respectively. Majority of cases were from lower socioeconomic status and lived in urban area. In Group A, after therapy mean respiratory rate 53.7 (±4.3) and oxygen saturation 97.9 (±1.9) had significantly improved in comparison to respiratory rate 65.6 (±4.8) and oxygen saturation 89.7 (±4.4) before therapy (p=<.001 in all parameter). Heart rate also significantly increased after therapy (149.4 ±10.2 versus 104.5 ±8.7) (p=<.001). In Group B, after therapy mean respiratory rate 53.5 (±4.1) and oxygen saturation 97.8 (±1.7) had also significantly improved in comparison to respiratory rate 65.3 (±4.1) and oxygen saturation 88.8 (±2.8) before therapy (p=<.001 in all parameter). Heart rate also significantly increased after therapy (150.8 ±9.8 versus 105.0 ±6.2) (p=<.001). In comparison between two modalities of treatment, no significant difference was found (p value=>.05 in all parameters). No statistical significant difference was observed in the length of hospital stay in two groups. Conclusion: The study highlighted the importance of supportive treatment in bronchiolitis management. Antibiotics should not be used without clinical and laboratory evidence of bacterial infection. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22871 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 6-10

scholarly journals An optimal epidural catheter placement site for post-cesarean section analgesia with double-space technique combined spinal–epidural anesthesia: a retrospective study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuya Murata ◽  
Kumiko Yamada ◽  
Yuto Hamaguchi ◽  
Soichiro Yamashita ◽  
Makoto Tanaka
Keyword(s):  
Cesarean Section ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Lower Extremities ◽  
Catheter Placement ◽  
Motor Weakness ◽  
Epidural Catheter Placement ◽  
Analgesic Effects ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background Epidural anesthesia affects lower extremities, which often prevents early mobilization postoperatively. The incidence of numbness and motor weakness in the lower extremities with respect to epidural catheter placement site in cesarean section (CS) is uncertain. We aimed to investigate the effect of catheter placement site on postoperative lower extremities numbness and motor weakness in patients who received combined spinal–epidural anesthesia (CSEA) for CS including analgesic effects and optimal epidural placement site in CS. Methods We retrospectively included 205 patients who underwent CS with CSEA at the University of Tsukuba Hospital between April 2018 and March 2020, and assessed numbness and motor weakness in the lower extremities. We also examined whether differences in the intervertebral space of epidural catheter placement and epidural effect on the lower extremities are related to analgesic effects. ANOVA and Mann–Whitney U test were used for statistical analysis. Results The incidence of numbness and motor weakness were 67 (33%) and 28 (14%), respectively. All patients with motor weakness had numbness. A more caudal placement was associated with increased incidence of affected lower extremities. There was no significant difference in the analgesic effect depending on the catheter placement site. When the lower extremities were affected, the number of additional analgesics increased (p < 0.001). Patient-controlled epidural analgesia was used for fewer days in patients with motor weakness (p = 0.046). Conclusion In CS, epidural catheter placement at T10–11 or T11–12 interspace is expected to reduce effect on the lower extremities and improve quality of postoperative analgesia.

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