ABSTRACT
BACKGROUND: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. METHODS: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. RESULTS: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. CONCLUSIONS: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Anesthetics, Local , Blood Pressure , Epinephrine , Heart Rate , Hemodynamics , Hypotension , Postural Balance , Prospective Studies , Retrospective StudiesABSTRACT
Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Subject(s)
Female , Humans , Anesthesia, Conduction , Anesthesia, General , Breast , Intercostal Nerves , Methods , Nerve Block , Pregnant Women , Thoracic Nerves , ThoraxABSTRACT
Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Subject(s)
Female , Humans , Anesthesia, Conduction , Anesthesia, General , Breast , Intercostal Nerves , Methods , Nerve Block , Pregnant Women , Thoracic Nerves , ThoraxABSTRACT
BACKGROUND: Remifentanil efficiently blunts the stress response during endotracheal intubation, but also causes hypotension, especially in geriatric patients. Hence, this study was designed to compare the hemodynamic changes during the induction with propofol or etomidate in geriatric patients. METHODS: Sixty ASA physical status class I or II geriatric patients, who were scheduled for elective surgery, were randomly assigned to two groups (n = 30 each). Induction was performed with either propofol (2 mg/kg mixed with lidocaine 40 mg, Group P) or etomidate (0.2 mg/kg, Group E). Both groups received a bolus dose of remifentanil (1 microg/kg), followed with continuous administration (0.1 microg/kg/min). An additional bolus dose (50 microg) was repeated, if needed. The systolic, diastolic, mean arterial blood pressure, heart rates and cardiac index were measured before induction (baseline vital signs), after propofol or etomidate administration, before intubation, immediately after intubation and at 1, 3, 5 and 10 minutes after intubation. RESULTS: Patient characteristics and baseline vital signs were similar in both groups. Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and cardiac output were significantly decreased in group P compared with those in group E (P < 0.05). Heart rates decreased after the injection of both propofol or etomidate, but were recovered after intubation. 5 patients in group P and 14 patients in group E needed an additional bolus dose of remifentanil (P < 0.05). CONCLUSIONS: Etomidate can be used safely with remifentanil for the stable induction of anesthesia in geriatric patients.