ABSTRACT
Estos son empleados con seguridad desde hace varias décadas; sin embargo, algunas complicaciones suelen presentarse. Una poco frecuente es su sección, la cual de no ser manejada adecuadamente genera importante morbilidad. Se presenta el caso de una paciente que recibe anestesia espinal epidural combinada. La técnica empleada, tanto para la colocación del catéter como para su retiro, aparentemente, fue correcta; sin embargo, este sufre una sección al retirarlo. En las imágenes posteriores se evidenciaría que el catéter se situó, accidentalmente, en el espacio paravertebral. Se teoriza un mecanismo de ruptura aun no descrito en la bibliografía. Se publica con el objetivo de mostrar la necesidad de la individualización en el manejo de este accidente, ya sea expectante o quirúrgico según las condiciones clínicas de cada paciente(AU)
The use of epidural catheters is a fundamental pillar of anesthesia. These have been safely employed for several decades; however, some complications usually occur. A rare one is its section, which if not properly managed generates significant morbidity. It is presented the case of a patient receiving combined epidural spinal anesthesia. The technique used, both for the placement of the catheter and for its removal, was apparently correct; however, it suffered a section when removed. In the subsequent images it was evident that the catheter was accidentally placed in the paravertebral space. A mechanism of rupture not yet described in the literature is theorized. It is published with the aim of showing the need for individualization in the management of this accident, whether expectant or surgical according to the clinical conditions of each patient(AU)
Subject(s)
Humans , Female , Adult , Anesthesia, Spinal/methodsABSTRACT
Objective To compare the effects of preload with intravenous infusion of 6％ hydroxyethyl starch combined with phenylephrine or dopamine to prevent the hypotension after combined epiduralspinal anesthesia in parturient undergoing caesarean section.Methods Eighty patients with ASA class Ⅰ or Ⅱ[,were randomly divided into Dopamine group and Phenylephrine group,40 cases in each group.The 6％hydroxyethyl starch 500 ml was infused at the tate of 20 ml/(kg · h) after the intravenous catheterization was established and after the finishing of the infusion of 250 ml,the dopamine 5 mg (Dopamine group) or 200 ug phenylephrine (Phenylephrine group) were added respectively in residual liquid.After the bupivacaine was injected into the subarachnoid space,the intravenous infusion was continued at the same rate until the fetus was taken out and the blood pressure and heart rate were measured at intervals of 1 min.The blood sample of fetal cord was taken to measure ther troponin Ⅰ concentration.Results The incidence of hypotension after combined epidural-spinal anesthesia anesthesia in dopamine group (2/40) and in phenylephrine group (3/40) was with no statistical difference (P ＞ 0.05) ;The incidence of bradycardia in dopamine group (0/40) was significantly lower than that in phenylephrine group (6/40)) (P ＜0.05) ; The incidence of tachycardia in dopamine group (8/40) was significantly higher than that in phenylephrine group (1/40) (P ＜0.05) ; The troponin Ⅰ concentration of fetal cord blood in dopamine group [(0.21 ±0.07) ng/ml] and in phenylephrine group [(0.18 ±0.09)ng/ml]was with no statistical difference (P ＞0.05).Conclusion Preload with intravenous infusion of 6％ hydroxyethyl starch combined with phenylephrine or dopamine can effectively prevent the hypotension after combined epidural-spinal anesthesia in parturient undergoing caesarean section with no significant effect on the fetus and both can be chosen in terms of the heart rate of parturient before anesthesia.
ABSTRACT
Objective To compare the effects of combined epidural-spinal anesthesia and different doses ropivacaine anesthesia for the lower limb operations. Methods One hundred and thirty-six patients for elected operations and 83 emergency operation patients receiving lower limbs operations were enrolled for the comparative study. Patients receiving spinal analgesia were divided into 3 groups with 0.1%, 0.15% and 0.2% ropivacaine, respectively. The dosage was increased from 3mg to 7mg with 1mg increase stepwise for each group, and a total of 15 groups and 219 cases were studied with this regime. For the patients undergoing epidural block anesthesia, 0.2% ropivacaine was used. Patients were placed in lateral recumbent position with the affected limb on the top. Puncture was done at the level of L2-3 interspace with a fine trocar, keeping the anesthetic level at T9-10. The anesthetic effect, BP, HR, SpO2 and Bromage score were then recorded. Results The effective rate was 95% in 6mg and 7mg group, 50%-55% in 5mg group, and 30% in 4mg group. The dosage of 3mg failed to achieve anesthesia. There was no failure in 7mg groups. During the operations the BP, HR and SpO2 were stable. No nausea and vomiting occurred, except 1 patient complaining of headache and 2 patients with urine retention. The intraoperation Bromage score of the affected limbs were 2-3, and for the unaffected limbs it was 0-1. Conclusions It is suggested that 0.1-0.2% ropivacaine in a dosage of 6-7mg for spinal anesthesia combined with 0.2% ropivacaine for epidual block can be used in the limb operation. It overcomes many side effects of traditional lumbar anesthesia. This method may be of great advantage to patients with complete analgesia, less anesthetic agent used, earlier ambulation, stable circulation and respiration, and fewer side-effects.