Faculty Opinions recommendation of Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block.

2008 ◽  
Author(s):  
Brendan Finucane
Keyword(s):  
Spinal Block ◽  
Trendelenburg Position ◽  
Spinal Anaesthetic ◽  
Hip Flexion

scholarly journals Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249808
Author(s):  
Jorge Kiyoshi Mitsunaga ◽  
Vinicius Fernando Calsavara ◽  
Elton Shinji Onari ◽  
Vinicius Monteiro Arantes ◽  
Carolina Paiva Akamine ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Laparoscopic Surgery ◽  
General Anesthesia ◽  
Controlled Trial ◽  
Spinal Block ◽  
Trendelenburg Position ◽  
General Anesthesia Group ◽  
Randomized Controlled ◽  
Anesthesia Group ◽  
Oncologic Patients

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

scholarly journals Anæsthesia in Gynæcology

1933 ◽  
Vol 27 (2) ◽  
pp. 105-112
Author(s):  
H. P. Fairlie
Keyword(s):  
Blood Pressure ◽  
Pelvic Surgery ◽  
Depth Of Anaesthesia ◽  
Trendelenburg Position ◽  
Safe Method ◽  
Spinal Anaesthetic ◽  
Group 2 ◽  
Minor Operations ◽  
Type Of Anaesthesia ◽  
Group 1

The operations of gynæcology are divided into two classes: (1) Minor: including perineal repairs, colporrhaphies, vaginal hysterectomies, dilatations and curettings, etc., and (2) Major: abdominal sections. For both groups routine premedication is a combination of morphia and nembutal, the former in ⅙-grain, and the latter in 3-grain doses. For Group 1 three methods of anæsthesia are described: ( a) Ethylene and oxygen, producing in nearly all cases an adequate depth of anæsthesia without the addition of ether. A safe type of anæsthesia and one from which recovery takes place quickly. ( b) Planocaine in 20% solution, made up with sodium bisulphate, as a spinal anæsthetic, described by Mr. Dickson Wright. The dose usually injected is 0·5 c.c. ( c) Sodium evipan given intravenously, though rather uncertain in action seems to serve well for such minor operations as curettage and insertion of radium. In Group 2 (major operations), the author's choice is between ( a) ether administered with a little additional oxygen to counteract the asphyxial tendency which the Trendelenburg position occasions, and ( b) spinal anæsthesia with percaine. For intra-abdominal pelvic surgery the latter is a very safe method for two reasons: (1) The dose required is comparatively small, and (2) the Trendelenburg position helps materially to prevent the fall of blood-pressure which a spinal anæsthetic tends to produce.

scholarly journals Analgesia for positioning of spinal anesthesia in elderly patients with proximal femoral fracture under dexmedetomidine infusioin: Ketamine versus fentanyl

2019 ◽  
Author(s):  
Ki Hwa Lee ◽  
Sang Eun Lee ◽  
Jaehong Park ◽  
Myoung Jin Ko ◽  
Se Hun Kim ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Femoral Fracture ◽  
Lateral Position ◽  
Proximal Femoral Fracture ◽  
Fracture Site ◽  
Spinal Block ◽  
Postural Changes ◽  
Hip Flexion ◽  
Lateral Positioning

Abstract Background Changes in posture due to spinal anesthesia in instances of femur fracture can cause severe pain and stress in elderly patients. Dexmedetomidine (DEX) infusion is effective in preventing stress and inducing sleep, but DEX alone has limitations in controlling the pain caused by postural changes. To improve pain relief, we compared the analgesic effects of intravenous DEX–ketamine and DEX–fentanyl combinations to facilitate lateral positioning for spinal anesthesia in proximal femoral fractured patients. Methods Forty-six patients were randomly assigned to the group K or group F. Group K was intravenously given ketamine (1 mg/kg) for 10 minutes, while group F received intravenous fentanyl (1 mcg/kg) for 10 minutes. All patients in both groups received concomitantly a bolus of DEX 1 μg/kg over 10 minutes. Ten minutes after the administration of ketamine with DEX or fentanyl with DEX, patients were placed in the lateral position with the fracture site positioned up. Pain score and quality scores during spinal anesthesia (i.e., lateral positioning, hip flexion, and spinal block) were recorded. Results Pain scores during lateral positioning and hip flexion were significantly lower in group K than in group F (P < 0.0001). The quality scores of patients during all periods of spinal anesthesia were significantly lower in Group K than in Group F (P < 0.05). Hemodynamic parameters were not significantly different between the two groups. Conclusions Intravenous DEX–ketamine is a more effective combination of the lateral position for spinal anesthesia in patients undergoing surgery for proximal femoral fracture in comparison with intravenous DEX–fentanyl.

Hip flexion for lumbar puncture - not easy in obstetric practice

Anaesthesia ◽  
2001 ◽  
Vol 56 (10) ◽  
pp. 1023-1024 ◽  
Author(s):  
F. Plaat ◽  
L. McCready-Hall
Keyword(s):  
Lumbar Puncture ◽  
Obstetric Practice ◽  
Hip Flexion

Legal Update: North Dakota Supreme Court: Third Edition of Guides is “Most Current”

1999 ◽  
Vol 4 (1) ◽  
pp. 6-7
Author(s):  
James J. Mangraviti
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Measurement Techniques ◽  
Fourth Edition ◽  
Hip Motion ◽  
The Difference ◽  
The Right ◽  
Hip Flexion ◽  
Hip Rotation ◽  
Hip Extension

Abstract The accurate measurement of hip motion is critical when one rates impairments of this joint, makes an initial diagnosis, assesses progression over time, and evaluates treatment outcome. The hip permits all motions typical of a ball-and-socket joint. The hip sacrifices some motion but gains stability and strength. Figures 52 to 54 in AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, illustrate techniques for measuring hip flexion, loss of extension, abduction, adduction, and external and internal rotation. Figure 53 in the AMA Guides, Fourth Edition, illustrates neutral, abducted, and adducted positions of the hip and proper alignment of the goniometer arms, and Figure 52 illustrates use of a goniometer to measure flexion of the right hip. In terms of impairment rating, hip extension (at least any beyond neutral) is irrelevant, and the AMA Guides contains no figures describing its measurement. Figure 54, Measuring Internal and External Hip Rotation, demonstrates proper positioning and measurement techniques for rotary movements of this joint. The difference between measured and actual hip rotation probably is minimal and is irrelevant for impairment rating. The normal internal rotation varies from 30° to 40°, and the external rotation ranges from 40° to 60°.

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