Regional Anesthesia
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2021 ◽  
Vol 17 (5) ◽  
pp. 74-78
G.S. Dorofeeva

Given a reduced cognitive reserve in patients in ophthalmic surgery, an anesthesiologist should pay special attention when choosing a method of anesthesia to prevent the development of postoperative cognitive dysfunction. The concept of multimodal anesthesia makes it possible to reduce the total number of narcotic analgesics and ataractics used intraoperatively while maintaining an adequate level of anesthesia and sedation, both intraoperatively and in the postoperative period. In ophthalmic surgery, regional anesthesia (pterygopalatine fossa blockade) is used before surgery in combination with infusion of dexmedetomidine. Materials and methods. The study was conducted at the premises of Dnipropet­rovsk Regional Clinical Ophthalmologic Hospital, 61 patients were examined after penetrating keratoplasty. The age of the subjects ranged from 18 to 60 years (mean age of 52.1 ± 2.0 years). Patients were randomized into two groups. Group d (n = 30) are patients who received anesthesia according to the following scheme: premedication for 40 min — infusion of dexmedetomidine, ondansetron 4 mg, dexamethasone 4 mg, ketorolac 30 mg intravenously; induction — propofol 2–2.5 mg/kg fractionally until the onset of the clinical signs of anesthesia, fentanyl 0.005% 0.1 mg; relaxation on the background of atracurium besylate 0.3–0.6 mg/kg, tracheal intubation; maintenance of anesthesia: oxygen — sevoflurane mixture with FiO2 50–55 %, end-expired sevoflurane 1.4–1.8 vol.% (1–1.5 minimum alveolar concentration), use of low-flow technique. In the second group (db, n = 31), anesthesia was performed as in group d with the addition of pterygopalatine fossa blockade. Group d included 18 (60 %) men and 12 (40 %) women, mean age of 49.5 ± 2.5 years; db group — 16 (51.61 %) men and 15 (48.39 %) women (p = 0.583 according to the chi-square), mean age of 55.5 ± 3.2 years (p = 0.142 according to the t-test). Results. A comparative analysis of changes in cognitive status between db and d groups has shown no significant changes (p < 0.05) at different stages of neuropsychological testing. When considering the results of testing to assess short-term verbal memory in db and d groups, there was a 25 % decrease in the first 6 hours after surgery. After all, in d group, the indicators remained low compared to baseline until the 7th day of the postoperative period, while in the db group the recovery of short-term memory occurred one day after surgery. In both groups, the result of the Luria test on day 21 exceeded the baseline by 12.5 % in both groups. Examination using visual analogue scale has demonstrated that patients in db group felt better than those in d group. Conclusions. Thus, we see that the combination of dexmedetomidine with regional anesthesia in addition to less impact on the cognitive state improves the subjective well-being in the postoperative period in patients in ophthalmic surgery. Due to this, another link of influence on the etiological factors of postoperative cognitive dysfunction formation seems to appear.

2021 ◽  
Vol Volume 14 ◽  
pp. 133-138
Ronald Seidel ◽  
Andreas Wree ◽  
Marko Schulze

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Sahar Kamal Mohamed Abo Elela ◽  
Dalia Abd Elhamid Nasr ◽  
Maha Sadek Elderh ◽  
Karim Mohamed Salah Elgawish

Abstract Background Epidural anesthesia is one of the preferred modes of regional anesthesia for lower limb orthopedic surgeries. This technique provides not only peri-operative anesthesia but also post-operative analgesia. Bupivacaine is commonly used local anesthetic in epidural anesthesia, many adjuvants added to local anesthetics to enhance the quality and duration of surgical anesthesia, among them are opioids, alpha 2 agonists. Opioids like fentanyl have been a popular choice, it offers faster onset and prolongs the duration of analgesia. Recently, alpha 2 agonists like clonidine and dexmedetomidine have been also used in prolonging the duration of epidural analgesia. Aim of the Work To compare the efficacy of using fentanyl and dexmedetomidine with bupivacaine in epidural block for knee surgeries, the time of onset of sensory, motor blockade and the duration of this blockade. Patients and Methods After obtaining approval from the Research Ethical Committee of Ain Shams University, this study was conducted in the operating theatres of Ain Shams University Hospital. It was a prospective double-blind randomized clinical study. Study period was 6 months. Results A total of 50 patients out of 71 consecutive patients met the inclusion criteria and consented for study. These 50 patients were randomized into two groups of 25 each. Out of the total patients, 33 were male and 17 were female. Conclusion Dexmedetomidine as an adjuvant to epidural bupivacaine is a better alternative to fentanyl as it shows faster onset of sensory and motor block, lesser time to attain maximum sensory level and prolonged duration of anesthesia.

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Reem Hamdy Elkabarity ◽  
Heba Abdel Azim Labib ◽  
Marwa Mamdouh Elfar ◽  
Mostafa Mohamed Mohamed Ibrahim Sharaf

Abstract Background Intravenous regional anesthesia (IVRA) is a technically simple, reliable and costeffective method of regional anesthesia for short operative procedures of the extremities. It is easy to be administered, of lower cost compared with general anesthesia, no need for deep sedation and can be used for emergency operations on extremities for patients with full stomach. Objective Comparison between the anesthetic and analgesic parameters in local intravenous anesthesia by adding Paracetamol and Dexamethasone to xylocaine. Patients and methods This study was carried out in Ain Shams University hospitals for six months (from August 2018 to February 2019) on 45 patients of both sexes aged 20-50 years belonging to ASA I & II undergoing forearm and hand surgeries using IVRA. Results There was no significant difference between group (P), Group (C) as regard sensory, motor recovery times, both had a shorter sensory and motor block time need to an opioid dose as an analgesic dose. Group (D) had the fastest sensory and motor block time and more prolonged recovery time than group (P) and group (C) need less opioid dose as analgesia for controlling pain. As regard postoperative analgesic requirements. Group (D) and group (P) needed less analgesic doses than group (C) but there was no significant difference between group (P) and group (C). Conclusion Addition of 8 mg Dexamethasone as adjuvant to xylocaine for intravenous regional anesthesia led to: Reduction the dose of xylocaine used for IVRA, Shortening the sensory and motor block onset times, Prolong the sensory and motor block recovery times, and Reduction the postoperative analgesic requirement with satisfaction for patient and surgeon.

2021 ◽  
Vol 90 ◽  
pp. 306-307
J. Weichmann ◽  
A. Hogan ◽  
S. Hetjens ◽  
L.C. Siegwart ◽  
P.A. Grützner ◽  

Matthew J. Ritter ◽  
Jon M. Christensen ◽  
Suraj M. Yalamuri

Pain Medicine ◽  
2021 ◽  
Nantthasorn Zinboonyahgoon ◽  
Megan E Patton ◽  
Yun-Yun K Chen ◽  
Rob R Edwards ◽  
Kristin L Schreiber

2021 ◽  
pp. 112972982110454
Kaitlin Woods ◽  
Samantha D Minc ◽  
Dylan Thibault ◽  
Jacob Lambert ◽  
Amaris Jalil ◽  

Background: We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time. Methods: National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018. Results: A total of 144,392 patients met criteria; 90,741 (62.8%) received general anesthesia. The use of regional anesthesia and MAC decreased over time (8.0%–6.8%, 36.8%–27.8%, respectively; both p < 0.0001). Patients who underwent regional anesthesia were more likely to have ASA physical status >III and to reside in rural areas (52.3% and 12.9%, respectively; both p < 0.0001). Patients who underwent MAC were more likely to be older, male, receive care outside the South, and reside in urban areas (median age 65, 56.8%, 68.1%, and 70.8%, respectively; all p < 0.0001). Multivariate analysis revealed that being male, having an ASA physical status >III, and each 5-year increase in age resulted in increased odds of receiving alternatives to general anesthesia (regional anesthesia adjusted odds ratios (AORs) 1.06, 1.12, and 1.26, MAC AORs 1.09, 1.2, and 1.1, respectively; all p < 0.0001). Treatment in the Midwest, South, or West was associated with decreased odds of receiving alternatives to general anesthesia compared to the Northeast (regional anesthesia AORs 0.28, 0.38, and 0.03, all p < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all p < 0.05). Conclusions: Use of regional anesthesia and MAC with local anesthesia for arteriovenous access creation has decreased over time with general anesthesia remaining the primary anesthetic type. Anesthetic choice, however, varies with patient characteristics and geography.

A. M. Morozov ◽  
A. N. Pichugova ◽  
E. M. Askerov ◽  
S. V. Zhukov ◽  
Yu. E. Minakova ◽  

Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus. Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.

2021 ◽  
Vol 11 (4) ◽  
Chandra M. Kumar ◽  
Alfred W. Y. Chua ◽  
Farnad Imani ◽  
Saloome Sehat-Kashani

: Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.

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