Response of unilateral spinal anaesthesia in elderly patients admitted to BMC & Allied Teaching Hospital in District BANNU-KPK.

Objectives: The objective of this study was to investigate the possible restriction effects of unilateral spinal anaesthesia on sympathetic block to evade unwanted cardiac effects in elderly patients. Study Design: Cross section study. Setting: Department of Surgery, BMC Allied Teaching Hospitals District Bannu-KPK. Period: June 2018 to January 2020. Material & Methods: In this study, 30 ASA III and ASA IV male adults having an age 55-65 and receiving lower limb surgery were included. The patients were given unilateral spinal anaesthesia (using 0.5% Bupivacaine). All the subjects were maintained in a lateral position having their operated side downwards and were kept in position for a period of 15 minutes. The assessment of the sensory and motor nerves was done, and hemodynamic changes were recorded following spinal anaesthesia. The monitoring was done for half an hour. Results: The observed hemodynamic effects in elderly patients were minimum which demonstrated the effectiveness of unilateral spinal anaesthesia in limiting the sympathetic block, evading the unwanted cardiac effects thus providing high cardiovascular stability. It was observed that the preparation time required for unilateral spinal anaesthesia was a bit longer as compared to conventional method. The technique also proved to be acceptable for patients with an elevated autonomy following surgical procedure and lesser urine retention. Conclusion: When unilateral spinal anaesthesia was administered in admitted patients using lower flow injection method and low volume, stable hemodynamic results were achieved. Patients were more satisfactory. Thus, unilateral spinal anaesthesia is effective in limiting the sympathetic block in old age patients.

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COMPARATIVE STUDY OF HAEMODYNAMIC CHANGES BETWEEN 6% HYDROXYETHYLSTARCH 130/0.4 AND RINGER LACTATE COLOADING IN ELDERLY PATIENTS UNDERGOING LOWER LIMB ORTHOPAEDIC SURGERY UNDER SPINAL ANAESTHESIA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.289 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Jayanta Chakraborty ◽

Uma Mandal

Keyword(s):

Elderly Patients ◽

Spinal Anaesthesia ◽

Lower Limb ◽

Orthopaedic Surgery ◽

P Value ◽

Ringer Lactate ◽

Lower Limb Surgery ◽

Group A ◽

Group B ◽

Lactate Solution

Background: Anaesthesia for the lower limb surgeries could be either general or regional. Studies had shown that regional anaesthesia for lower limb surgery results in better postoperative outcomes, including improved respiratory function, less nausea vomiting, less pain and lower incidence of deep vein thrombosis. Among all the regional anaesthetic techniques spinal anesthesia remained most preferred technique for its fast, predictable, profound, high quality sensory and motor block. However some complications like hypotension, bradycardia, post dural puncture headache, urinary retention were unavoidable and hypotension remained the most common one and found to be more in the elderly population with incidence of 25–82%. Treating spinal anaesthesia-induced hypotension included intravenous (IV) volume administration. IV Fluid infused before and at the time of spinal anaesthesia was referred to as preloading and coloading respectively. Although merit of coloading and the choice of fluid to be infused had remained a matter of debate, till today no definitive study had indicated any superiority of colloids over crystalloids decisively moreover large amount crystalloids to counter hypotensin remained a threat to the cardiovascular overload for elderly patients. Role of vasopressors in elderly remained controversial too. So this observational prospective study was undertaken to compare the effiicacy of coloading of infusion 6%HES 130/0.4 (colloid) and Ringer Lactate solution (crystalloid) to maintain the intra operative haemodynamics in elderly patients undergoing lower limb orthopaedic surgery under spinal anaesthesia. Objectives: To assess and to compare the efficacy of infusion 6%HES 130/0.4 and infusion Ringer lactate solution coloading in preventing the intra-operative hypotension. Materials and method: On approval of the Ethics Committee of Burdwan Medical College (BMC&H), 80 patients were included and equally divided into two groups group A and group B where groupp A received 6% HES as coloading fluid and groupp B received RL as coloading fluid at the start of spinal anaesthesia. On entering Operation Theatre baseline parameters were noted for each patient and lumbar puncture for spinal anaesthesia was performed following strict aseptic precautions, in sitting position. Upon achieving adequate block episodes of hypotension were noted and treated according to the study protocol. Results: Statistical analysis for Continuous and categorical variables were done using Mann-Whitney U test and Pearson’s Chi Square test accordingly and p values less than 0.05 were considered significant. In group A, 17.5 % patients developed one episodes of hypotension whereas in group B, 37.5% patients developed one episodes of hypotension which was statistically significant with p value 0.0465. In group A none of the patients developed further episodes of hypotension but in group B 5% affected patients developed one more episodes of hypotension and 2.5% affected patients developed two more episodes of hypotension. Average intravenous dose of mephentermine required to treat hypotension was 1.05 mg for group A and 2.70 mg for group B and found to be statistically significant with p value 0.039. Total fluid consumption In group A was 654.95 ml whereas in group B was 976.73 ml and also found to be statistically significant with p value <0.001. Conclusion: The study found that coloading with 6% HES was significantly effective than Ringer Lactate solution in preventing episodes of hypotension in spinal anaesthesia induced elderly patients undergoing lower limb surgery without any noticeable adverse effect. Key Words: Spinal anaesthesia, lower limb surgery, elderly patients, coloading

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SITTING VERSUS LATERAL POSITION FOR INDUCTION OF SPINAL ANESTHESIA IN ELDERLY PATIENTS – A RANDOMIZED CONTROLLED TRIAL

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i2.15523 ◽

2017 ◽

Vol 10 (2) ◽

pp. 262

Author(s):

Showkat Hussain Tali ◽

Showkat Ahmad Bhat ◽

Kumar Nm ◽

Shagufta Yousuf

Keyword(s):

Randomized Controlled Trial ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Motor Block ◽

Controlled Trial ◽

Sensory Block ◽

Lateral Position ◽

Hemodynamic Parameters ◽

Randomized Controlled

Objectives: To compare the effect of induction position (sitting versus lateral) for spinal anaesthesia in the elderly patient on hemodynamic, sensory block and motor block characteristics and patient satisfaction.Material and methods: Randomized controlled trial of patients undergoing spinal anaesthesia for lower abdominal, pelvic, lower limb and urological surgeries aged more than 60 years. Hyperbaric Bupivacain (0.05%) was injected into the spinal space while the patients were either in sitting or lateral position. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.Results: Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of adverse effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable for elderly patients (P= 0.03).Conclusions: Induction position for administration of spinal anaesthesia has no effect on hemodynamic parameters or block characteristics except that patients feel more comfortable in lateral position.Keywords: Spinal anesthesia, Induction position, Hyperbaric bupivacaine.

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Haemodynamic Effects and Complications of Unilateral Spinal versus Standard Spinal Anesthesia in Elderly with Low Ejection Fraction Undergone Lower-Limb Surgery

Delta Medical College Journal ◽

10.3329/dmcj.v5i1.31426 ◽

2017 ◽

Vol 5 (1) ◽

pp. 20-24

Author(s):

Md Mushfiqur Rahman ◽

Md Mahbubul Hasan Munir ◽

Raihanuddin ◽

Shafiul Alam Shaheen ◽

Md Abdus Salam Khan ◽

...

Keyword(s):

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Lower Limb ◽

Motor Block ◽

Sympathetic Block ◽

Hyperbaric Bupivacaine ◽

Unilateral Spinal Anesthesia ◽

Lower Limb Surgery ◽

Group A ◽

Group B

Background: Cardiovascular system may be profoundly affected by spinal anaesthesia due to unavoidable sympathetic blockade which is more prominent in elderly.A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes.Objective: To assess whether a unilateral spinal anaesthesia using 0.5% hyperbaric bupivacaine will restrict the sympathetic block to avoid the undesired cardio vascular effects.Materials and method: In this prospective study 60 ASA Ill and IV patients aged between 60-90 years undergoing unilateral lower limb surgery were included. Patients were divided into two groups. In group-A, dural puncture was performed with the patient in the lateral decubitus position with 1.5 mL of hyperbaric bupivacaine. In group-B, it was performed with the patient in a seated position using 1.5 mL hyperbaric bupivacaine. Each patient was then placed in supine position. The speed of injection was 1 mL/30s. Patients were placed in the lateral position with operated side down and kept in this position for 10 minutes. Motor and sensory levels were assessed, and haemodynamic alterations were monitored just after block, 5, 10, 15 and 30 minutes of spinal anaesthesia.Results: The demographic data were found similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group-B. The duration of motor and sensory block was significantly shorter in group-A. Haemodynamically all the parameters revealed better out come in unilateral spinal anesthesia. The incidence of complications (nausea, headache, and hypotension) was also lower in group A.Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during surgery on a lower limb. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.Delta Med Col J. Jan 2017 5(1): 20-24

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P4-256: Cardiac effects of rivastigmine patch in elderly patients with Alzheimer disease

Alzheimer s & Dementia ◽

10.1016/j.jalz.2011.05.2281 ◽

2011 ◽

Vol 7 ◽

pp. S795-S796

Author(s):

Ahmet Turan Isik ◽

Ergun Bozoglu ◽

Mehmet Kolukisa ◽

Engin Eker

Keyword(s):

Alzheimer Disease ◽

Elderly Patients ◽

Cardiac Effects ◽

Rivastigmine Patch

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For induction of spinal anaesthesia is sitting really the same as the lateral position?

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2010.03.008 ◽

2010 ◽

Vol 19 (3) ◽

pp. 343

Author(s):

I.F. Russell

Keyword(s):

Spinal Anaesthesia ◽

Lateral Position

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A New Non-touch Technique (Partha’s Technique) of Administering Spinal Anaesthesia in Paediatric Age Group- A Pilot Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44452.13848 ◽

2020 ◽

Author(s):

S Parthasarathy ◽

Indubala Maurya

Keyword(s):

Pilot Study ◽

Failure Rate ◽

Spinal Anaesthesia ◽

Lateral Position ◽

The Novel ◽

Age Group ◽

Medical College ◽

Paediatric Age ◽

Group A ◽

Gandhi Medical College

Introduction: Paediatric spinal anaesthesia is often the technique of choice in many short duration surgeries. However, the failure rate is higher with spinal anaesthesia in children than in adults. Aim: To evaluate if a non-touch technique of paediatric spinal anaesthesia can reduce anaesthetic failure. Materials and Methods: A pilot study was done in 10 paediatric patients from January 2018 to July 2018 in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Ten children posted for infra-umbilical surgeries in the age group of 4-10 years were given a sedative premedication with a combination of Pethidine and Midazolam They were kept in lateral position with the back much inside the edge of the table so that there was a considerable space between the table edge and the baby. Identification of the L3-L4 space was done by touching the patient. The 25-gauge quincke needle was pricked and the hub was held with the hand in the table without touching the patient. Results: The anaesthesia was successful with adequate level in all the patients; T8 in five patients and T10 in the other five patients. There were no significant side effects. Conclusion: From this pilot study on 10 patients, it can be suggested that the novel non-touch Partha’s technique is feasible and more successful with absent failure rate when administering spinal anaesthesia in the paediatric age group.

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