Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients

The objective: to substantiate the safety of using combined spinal epidural anesthesia with expansion of the epidural space in hernioplasty in obese patients.Subjects and Methods. Hemodynamic parameters were studied in 100 obese patients who underwent elective hernioplasty of the anterior abdominal wall using the neuroaxial block of two types ‒ combined spinal epidural anesthesia with epidural volume extension (CSEA with EVE) and spinal anesthesia (SA). The patients were randomly divided into two groups: Group 1 (n = 60) ‒ patients operated under combined spinal epidural anesthesia with the epidural volume extension, Group 2 (n = 40) ‒ patients operated under spinal anesthesia. The assessment of changes in main parameters of central hemodynamics, stroke volume (SV), cardiac output (CO), and cardiac index (CI) was performed using the Estimated Continuous Cardiac Output technology based on the measurement of pulse wave transit time.Results. It was revealed that in Group 1 patients, the listed parameters fluctuated slightly during the entire follow-up period. The average values were: SV 76.4 ± 0.37 ml, CO 5.8 ± 0.04 l/min, CI 3.56 ± 0.03 l/min/m2. In patients of Group 2, there was an increase in SV by 35.5%, CO by 24.2%, and CI by 23.6% at minutes 2-4 of the regional blockade.Conclusions. The most obvious fluctuations in hemodynamic parameters are observed in the group of patients who underwent spinal anesthesia using relatively high doses of local anesthetic. When using CSEA with EVE with low doses of bupivacaine, stable hemodynamic parameters are noted with a constant level of the neuroaxial block.

Integrating ultrasound with the combined spinal-epidural kit as a rescue technique during difficult spinal anaesthesia

Conducting spinal anaesthesia in patients with elevated body mass index is commonly difficult, yet there are no guidelines to direct best practice. Landmark techniques are sometimes insufficient, leading to increased failure rates and suboptimal patient outcomes. Although ultrasound-guided techniques are now considered standard care for central venous access and regional anaesthesia, there has been relatively sparse uptake of this widely available resource for central neuraxial block, despite evidence of its efficacy.This article outlines a successful case of ultrasound-assisted spinal anaesthesia, after landmark techniques failed, in conjunction with a combined spinal-epidural kit. This unique combination of techniques has not been published as an amalgamated rescue strategy for difficult spinal anaesthesia. This article adds to current evidence by highlighting the potential benefits of combining these techniques into a novel approach either when difficulties are expected or as a rescue technique after failed landmark-based attempts.

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine Compared to Addition of Fentanyl in Patients undergoing Lower Limb Orthopedic Surgery under Combined Spinal Epidural Anathesia

Background The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use. Objectives The purpose of this study was to assess the postoperative analgesic requirements and the analgesic effect of adding magnesium sulphate to epidural bupivacaine compared to addition of fentanyl in patients undergoing lower limb orthopedic surgery under combined spinal epidural anathesia. Patients and Methods After approval of ethical committee in our study and obtaining written informed consent from eligible patients the study was conducted on 60 patients classified to ASA I and II scheduled for lower limb orthopedic surgery. The study presents double armed randomized interventional prospective study including patients allocated into two equal groups each consists of 30 patients. Group (A): patients received magnesium sulphate added to bupivacaine in epidural, Group (B): patients received fentanyl added to bupivacaine in epidural Results The results of their study showed that the maximum level of sensory blockade was significantly higher in the combined fentanyl with magnesium group as compared with fentanyl group alone and magnesium sulphate group alone. The duration of sensory blockade of the combined fentanyl and magnesium group was significantly prolonged as compared to the other two groups as for the other two group the difference in the blockade duration was insignificant Conclusion We concluded that either magnesium sulfate (75 mg) combined with (10 ml) 0.25% Bupivacaine or fentanyl (1 µg/kg) combined with (10 ml) 0.25% Bupivacaine in combined spinal epidural improves intraoperative analgesia and prolongs early postoperative analgesia in lower limb orthopedic surgeries. The duration of analgesia was more prolonged in magnesium sulphate group than in the fentanyl group and this difference was statistically significant.