Study Of Effect Of Intermittent Epidural Injection Of Normal Saline On Duration Of Motor And Sensory Blockade After Combined Spinal Epidural (cse) Anaesthesia. A Prospective, Rct

BACKGROUND: Prolonged motor and sensory block following Central Neuraxial Blockade (CNB) is associated with extended postoperative immobilization and its complications. Speedy recovery from motor blockade would improve the patients' acceptance of neuraxial anesthesia. Previous studies in patients undergoing epidural anaesthesia, demonstrated rapid motor recovery after administration of epidural crystalloids. We studied the effect of intermittent bolus injection of Normal saline (NS) on the duration of sensory and motor recovery after Combined spinal epidural anaesthesia (CSEA). METHODS:60 patients (ASA I-III) scheduled for surgeries under CSEA lasting for 1½ to 2 hrs were divided equally by systematic random sampling at the end of surgery. Control group - No bolus of NS flush was given through the epidural catheter. Intervention group -15 ml of NS flush through epidural catheter was given thrice. Sensory level, Motor blockade and vitals were noted at 5 min interval for 2 hours from end of surgery. RESULTS: 1. Sensory levels in two groups were significantly different (p-value < 0.001) at the end of two hours. In intervention group, T8 level was predominant, while in control group L1 level was predominant. 2. Difference in motor block in two groups was significant as (p-value < 0.001). In intervention group, 86.67% had Bromage score 0, while in control group 80% had score 1 at the end of 2 hrs. Conclusion: Postoperative epidural flush with 45 ml Normal saline hastened the motor recovery following CSEA without shortening of the duration of sensory blockade.

Persistent intraoperative sinus tachycardia: threat of thyroid storm? A case report.

Sinus tachycardia in a patient undergoing surgery under general anaesthesia is not an uncommon experience in anaesthesia practice. Causes of intraoperative sinus tachycardia can be multi-factorial. Operative causes are pain, surgical stimulation and light depth of anaesthesia. Pharmacological factors include administration of catecholamines, atropine, or ketamine. Medical factors such as sepsis, hypovolaemia, heart failure, anaemia, and thyrotoxicosis should also be considered. We report a case of inadequately controlled hyperthyroidism undergoing surgery for a spinal cord tumour under general anaesthesia who developed unexplained tachycardia intraoperatively.