scholarly journals Spinal Anesthesia for Removal of Thoraco-Lumbar Pedicle Screw

2019 ◽  
Vol 1 (1) ◽  
pp. 35-39
Author(s):  
Nirmal Kumar Gyawali
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Lateral Position ◽  
Anesthetic Technique ◽  
Postoperative Pain Control ◽  
American Society ◽  
A Prospective Study ◽  
Cardiovascular Stability

Background: Spinal anesthesia compared to the general anesthesia has advantages of decreased blood loss, better cardiovascular stability, and postoperative pain control. This study was designed to evaluate pedicle screw removal at the lateral position under spinal anesthesia. Methods: It is a prospective study done in patients with ASA (American Society of Anaesthesiologist) I and II with ages between 17 to 75 years of both sex admitted for pedicle screw removal surgery during the period   March 2018 to April 2019 AD in Western Hospital and research center Nepalgunj. All patients were informed about the risk of conversion to general anesthesia in detail. Spinal anesthesia was given to all 83 patients who came for pedicle screw removal. Result: Out of all patients 54% were from Hills and the remaining 46% were from Terai. The commonest cause of injury was fall from a tree which was in 48 (57.8%) out of 83 cases. The commonest level of injury was L1 followed by L2. The operation was completed under spinal anesthesia. None of the patients required conversion to general anesthesia. And 69 (83.1%) patients did not require any additional medications whereas the remaining 14 (16.86%) needed additional medications. Conclusion: Spinal anesthesia is the safe and effective anesthetic technique for short duration spinal surgery eg pedicle screw removal in terms of perioperative events and in prolonged postoperative analgesia, as well as in terms of patient and surgeon’s satisfaction.   Keywords: Spinal Anesthesia, Thoracolumbar, Pedicle Screw

scholarly journals Awake spinal surgery: simplifying the learning curve with a patient selection algorithm

2021 ◽  
Vol 51 (6) ◽  
pp. E2
Author(s):  
Vijay Letchuman ◽  
Nitin Agarwal ◽  
Valli P. Mummaneni ◽  
Michael Y. Wang ◽  
Saman Shabani ◽  
...  
Keyword(s):  
Learning Curve ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Patient Selection ◽  
Spinal Surgery ◽  
Lumbar Surgery ◽  
Inclusion Criteria ◽  
Selection Algorithm ◽  
The Mean ◽  
Selection For

OBJECTIVE There is a learning curve for surgeons performing “awake” spinal surgery. No comprehensive guidelines have been proposed for the selection of ideal candidates for awake spinal fusion or decompression. The authors sought to formulate an algorithm to aid in patient selection for surgeons who are in the startup phase of awake spinal surgery. METHODS The authors developed an algorithm for selecting patients appropriate for awake spinal fusion or decompression using spinal anesthesia supplemented with mild sedation and local analgesia. The anesthetic protocol that was used has previously been reported in the literature. This algorithm was formulated based on a multidisciplinary team meeting and used in the first 15 patients who underwent awake lumbar surgery at a single institution. RESULTS A total of 15 patients who underwent decompression or lumbar fusion using the awake protocol were reviewed. The mean patient age was 61 ± 12 years, with a median BMI of 25.3 (IQR 2.7) and a mean Charlson Comorbidity Index of 2.1 ± 1.7; 7 patients (47%) were female. Key patient inclusion criteria were no history of anxiety, 1 to 2 levels of lumbar pathology, moderate stenosis and/or grade I spondylolisthesis, and no prior lumbar surgery at the level where the needle is introduced for anesthesia. Key exclusion criteria included severe and critical central canal stenosis or patients who did not meet the inclusion criteria. Using the novel algorithm, 14 patients (93%) successfully underwent awake spinal surgery without conversion to general anesthesia. One patient (7%) was converted to general anesthesia due to insufficient analgesia from spinal anesthesia. Overall, 93% (n = 14) of the patients were assessed as American Society of Anesthesiologists class II, with 1 patient (7%) as class III. The mean operative time was 115 minutes (± 60 minutes) with a mean estimated blood loss of 46 ± 39 mL. The median hospital length of stay was 1.3 days (IQR 0.1 days). No patients developed postoperative complications and only 1 patient (7%) required reoperation. The mean Oswestry Disability Index score decreased following operative intervention by 5.1 ± 10.8. CONCLUSIONS The authors propose an easy-to-use patient selection algorithm with the aim of assisting surgeons with patient selection for awake spinal surgery while considering BMI, patient anxiety, levels of surgery, and the extent of stenosis. The algorithm is specifically intended to assist surgeons who are in the learning curve of their first awake spinal surgery cases.

Rapid Sequence Spinal Anesthesia Vs General Anesthesia for Category-I Urgency Caesarean Section

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dr. Ravi Gurvani ◽  
Dr. Dharam Veer Chandrakar
Keyword(s):  
Caesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Pregnancy Termination ◽  
P Value ◽  
Group I ◽  
Rapid Sequence ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Aims of study - Rapid Sequence spinal anesthesia Vs general anesthesia for category-I urgency caesarean section. Background - Pregnancy termination by caesarean section (CS) is rapidly increasing all over the world. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Materials and Methods - As per American Society of Anesthesiologists physical status (ASAPS) I 50 patients of category 1 were included in this study and divided into two equal groups, 25 in each group. Group I received GA and group II received RSSA. Result - Time for anesthesia was more in the RSGA group than the RSSA group, which was statistically significant (P < 0.001). The time for surgical readiness was also significantly higher in the RSGA group in comparison to the RSSA group with P value of < 0.001, which was statistically significant but there was no significant difference in Incision to delivery time.

Anesthetic Technique (Spinal vs. General Anesthesia) in Holmium Laser Enucleation of the Prostate: Retrospective Analysis of Procedural and Functional Outcomes among 1,159 Patients

2021 ◽  
pp. 1-8
Author(s):  
Hang Yu ◽  
Philipp Gild ◽  
Raisa S. Pompe ◽  
Malte W. Vetterlein ◽  
Tim A. Ludwig ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Functional Outcomes ◽  
Maximum Flow ◽  
Holmium Laser ◽  
Anesthetic Technique ◽  
Study Cohort ◽  
Laser Enucleation ◽  
American Society ◽  
The Impact ◽  
Holmium Laser Enucleation

<b><i>Objective:</i></b> The aim of the study was to compare procedural efficacy, early and late functional outcomes in holmium laser enucleation of the prostate (HoLEP) under spinal anesthesia (SA) versus general anesthesia (GA). <b><i>Methods:</i></b> We retrospectively reviewed patients undergoing HoLEP at our institution between 2012 and 2017. Standard pre-, peri-, and postoperative characteristics were compared according to anesthetic technique. Multivariable logistic regression analyses (MVAs) were employed to study the impact of SA on procedural efficacy and postoperative complications. <b><i>Results:</i></b> Our study cohort consisted of 1,159 patients, of whom 374 (32%) underwent HoLEP under SA. While a medical history of any anticoagulation/antiplatelet therapy except low-dose acetylsalicylic acid was significantly more common among patients undergoing GA (16% vs. 10%, <i>p</i> = 0.001), no other significant differences in preoperative characteristics were noted including age, body mass index, American Society of Anesthesiologists Classification (ASA), prostate size, or International Prostate Symptom Score (IPSS), and quality of life scores. Patients under SA exhibited shorter times of enucleation 42 min (interquartile range [IQR]:27–59 vs. 45 min [IQR: 31–68], <i>p</i> = 0.002), and combined time of enucleation/morcellation/coagulation (57 min [IQR: 38–85] vs. 64 min [IQR: 43–93], <i>p</i> = 0.002), as well as fewer complications (Clavien-Dindo ≥3) (12 [3.2%] vs. 55 [7%], <i>p</i> = 0.013). These associations were confirmed in MVA. Patients did not differ significantly with regard to early micturition including post-void residual volume and maximum flow-rate improvement. At a median follow-up of 33 months (IQR: 32–44), patients with SA had a lower IPSS score (median 3 [IQR: 1–6] vs. 4 [IQR: 2–7], <i>p</i> = 0.039). However, no significant differences were observed with respect to any urinary incontinence, urge symptoms, and postoperative pain. <b><i>Conclusion:</i></b> In this large retrospective series, HoLEP under SA was a safe and efficacious procedure with comparable early and long-term functional outcomes.

scholarly journals Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients

2017 ◽  
Vol Volume 10 ◽  
pp. 91-98 ◽  
Author(s):  
John Pierce ◽  
Guy Kositratna ◽  
Mark Attiah ◽  
Michael Kallan ◽  
Rebecca Koenigsberg ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Retrospective Analysis ◽  
Spinal Surgery ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

Stellenwert der Navigation

2017 ◽  
Vol 01 (04) ◽  
pp. 317-334
Author(s):  
Jan-Sven Jarvers ◽  
Ulrich Spiegl ◽  
Stefan Glasmacher ◽  
Christoph Heyde ◽  
Christoph Josten
Keyword(s):  
Patient Safety ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Intraoperative Imaging ◽  
Intraoperative Navigation ◽  
Advantages And Disadvantages ◽  
Tumor Diseases ◽  
Intraoperative Control ◽  
Improved Technology

Abstract Importance of Navigation Navigation and intraoperative imaging have undergone an enormous development in recent years. By using intraoperative navigation, the precision of pedicle screw implantation can be increased in the sense of patient safety. Especially in the case of complex defects or tumor diseases, navigation is a decisive aid. As a result of the constantly improved technology, the requirements for reduced radiation exposure and intraoperative control can also be met. The high costs of the devices can be amortized, for example by a reduced number of revisions. This overview presents the principles of navigation in spinal surgery and the advantages and disadvantages of the different navigation procedures.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Scenario of General Anesthesia for Cesarean Section in Rural Tertiary Care Center in High Altitude Karnali Academy of Health Sciences

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Ramesh Bhattarai ◽  
Rajiv Shah ◽  
Sita Dhakal ◽  
Pragya Malla ◽  
Srijana Sapkota
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
High Altitude ◽  
Spinal Anesthesia ◽  
Neonatal Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Health Sciences ◽  
Tertiary Care Center ◽  
Cord Prolapse

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period   in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request  two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal   Conclusions:  General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.  

scholarly journals A prospective study on the incidence of sore throat after use of laryngeal mask airway during general anesthesia

2021 ◽  
pp. 102595
Author(s):  
kourosh Farazmehr ◽  
Mohamad Aryafar ◽  
Farshid Gholami ◽  
Giti Dehghanmanshadi ◽  
Seyed Sepideh Hosseini
Keyword(s):  
Laryngeal Mask Airway ◽  
Prospective Study ◽  
General Anesthesia ◽  
Sore Throat ◽  
Laryngeal Mask ◽  
A Prospective Study

scholarly journals Cholinesterase activity in serum during general anesthesia in patients with or without vascular disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yitzhak Brzezinski-Sinai ◽  
Ester Zwang ◽  
Elena Plotnikova ◽  
Ester Halizov ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
General Anesthesia ◽  
Vascular Disease ◽  
Cholinesterase Activity ◽  
Serum Cholinesterase ◽  
Hemodynamic Support ◽  
System A ◽  
Lower Baseline ◽  
Increased Risk ◽  
A Prospective Study

AbstractMaintaining hemodynamic stability during the induction and maintenance of anesthesia is one of the challenges of the anesthesiologist. Patients with vascular disease are at increased risk of instability due to imbalance between the sympathetic and parasympathetic parts of the autonomic nervous system, a balance accessible by serum cholinesterase activity. We aim to characterize the dynamics of cholinesterase activity in patients undergoing general anesthesia (GA) and surgery. This was a prospective study of 57 patients undergoing ambulatory or vascular surgery under GA. Cholinesterase activity was measured before the induction of anesthesia, after 15 min and at the end of surgery by calculating the capacity of serum acetylcholinesterase (AChE) and butyrylcholinesterase to hydrolyze AcetylThioCholine. Data on atherosclerotic disease, anesthesia management were analyzed. Both AChE and total cholinergic status (CS) decreased significantly after GA induction at 15 min and even more so by the end of surgery. Vascular surgery patients had lower baseline cholinesterase activity compared to ambulatory surgery patients. Patients requiring intraoperative administration of phenylephrine for hemodynamic support (21.1%) had a significantly lower level of AChE and CS compared to untreated patients. Our findings serve as a mirror to the sympathetic/parasympathetic imbalance during GA, with a marked decrease in the parasympathetic tone. The data of a subgroup analysis show a correlation between low cholinesterase activity and an increase in the need for hemodynamic support.

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