ABSTRACT
Air can be introduced into the epidural space during the loss of resistance technique used to identify needle entry into the epidural space. Complications resulting from the injection of air into the epidural space include pneumocephalus, spinal cord and nerve root compression, retroperitoneal air collection, subcutaneous emphysema, venous air embolism, and possibly, incomplete analgesia and anesthesia. We experienced a case of a large epidural collection of air following epidural anesthesia attempted one month before. The CT scan revealed epidural air extending from L1-S1 with moderate compression of nerve root at L4-5.
Subject(s)
Anesthesia and Analgesia , Anesthesia, Epidural , Embolism, Air , Epidural Space , Needles , Pneumocephalus , Radiculopathy , Spinal Cord , Subcutaneous Emphysema , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The purpose of this study was to determine whether spinal or epidural anesthesia is more suitable in terms of sensory and motor blockade, cardiovascular stability, intraoperative blood loss, postoperative recovery and patient satisfaction in elderly patients undergoing TURP. METHODS: Fourty patients undergoing TURP were randomly allocated to either a spinal or an epidural anesthesia group. The spinal group (n = 20) received 10 12 mg of 0.5% tetracaine in 10% dextrose, while the epidural group (n = 20) received 20 25 ml of 2% lidocaine at L4-5 intervertebral space. After injection of the agent, changes in sensory and motor blockade, blood pressure and heart rate were measured in the two groups. We compared serum Hb, serum Na, foley removal, hospital stay, side effects, analgesic use, and patient satisfaction between the two groups. RESULTS: The two techniques were similar with regard to the level of blood pressure, heart rate, Hb and Na changes, foley removal and hospital stay. At 15 and 30 minutes after spinal and epidural anesthesia, the results for sensory blockade were T8 +/- 2.2 S5, T9 +/- 1.2 S5 (spinal) and T10 +/- 1.5 S3, T8 +/- 2.1 - S4 +/- 1.0 (epidural), and motor blockade was complete in the spinal group but incomplete in the epidural group. Patient satisfaction was better in the epidural group than in the spinal group, but analgesic use was more frequent in the spinal group than in the epidural group. CONCLUSIONS: Both spinal and epidural anesthesia are suitable for TURP. Spinal anesthesia was technically easier and produces a complete and more reliable block of the sacral segment, but was also an unnecessarily profound motor block of the lower extremity. Epidural anesthesia is less pronounced and gives a shorter duration of motor blockade with good patient satisfaction.
Subject(s)
Aged , Humans , Anesthesia, Epidural , Anesthesia, Spinal , Blood Pressure , Glucose , Heart Rate , Length of Stay , Lidocaine , Lower Extremity , Patient Satisfaction , Postoperative Hemorrhage , Tetracaine , Transurethral Resection of ProstateABSTRACT
BACKGROUND: Propofol is an intravenous anesthetic characterized by rapid induction and prompt recovery. Recently, its is used widely in clinical practice, especially when early discharge is advisable. We conducted this study for the evaluation of the effects of propofol as a sole intravenous anesthetic on the operation with minimal pain such as TUL(transurethral lithotripsy). METHODS: Patients were recruited for ASA class 1 and 2 from those who received TUL operation. Propofol was administered 2 mg/kg for induction and continuously infused at the rate of 1.2~1.4 mg/kg/hr after the loss of consciousness. With the stabilization of the vital signs, we reduced the dose of propofol to 1.0~1.2 mg/kg/hr. We checked the patients' movement, vital signs, recovery time and monitored the appearance of the symtoms such as nausea, vomiting postoperatively. RESULTS: 1) The average time of operation was 15+/-12 minutes. 2) The average recovery time was 15+/-9 minutes(range 2~30 min). 3) Blood pressure and peripheral oxygen saturation(SpO2) were declined during anesthesia, but SpO2 was normalized in the recovery room. 4) No significant complications were observed. 5) Mild movement of the patient was noticed in the begining of operation, but it did not affect the surgical procedure. CONCLUSIONS: Propofol was effective as a sole intravenous anesthetic to minimize postoperative complications such as nauea, vomiting for TUL with minimal pain.