ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A raquianestesia unilateral pode apresentar vantagens em pacientes ambulatoriais. O objetivo deste trabalho foi comparar a raquianestesia unilateral com o bloqueio combinado femoral-isquiático em cirurgias ortopédicas unilaterais e ambulatoriais. MÉTODO: Sessenta pacientes foram aleatoriamente separados em dois grupos para receber 6 mg de bupivacaína hiperbárica ou hipobárica (grupo RQ) em decúbito lateral esquerdo ou 800 mg de lidocaína 1,6 por cento com epinefrina nos nervos femoral e isquiático (grupo CFI) em decúbito dorsal. O bloqueio dos nervos foi realizado com agulha de 150 mm conectada a um neuroestimulador e inserida no ponto médio entre as duas abordagens clássicas, sendo injetados 15 mL no nervo femoral e 35 mL no nervo isquiático. Avaliados o tempo para realização dos bloqueios e sua duração. Vinte minutos após, os pacientes foram avaliados em relação aos bloqueios sensitivo e motor. RESULTADOS: O tempo para a realização da raquianestesia foi significativamente menor do que o bloqueio combinado femoral-isquiático. O bloqueio unilateral foi obtido em 90 por cento dos pacientes no grupo RQ e 100 por cento no grupo CFI. O tempo para recuperação do bloqueio sensitivo e motor foi significativamente maior no grupo CFI. Não houve bradicardia ou hipotensão. CONCLUSÕES: Este estudo conclui que é tecnicamente fácil realizar bloqueio anterior combinado femoral-isquiático e pode ser uma alternativa para o bloqueio unilateral do membro inferior. A raquianestesia unilateral com baixas doses de bupivacaína resultou em menor tempo para realização, menor número de tentativas e recuperação mais precoce do bloqueio combinado femoral-isquiático, porém com mesma efetividade.
BACKGROUND AND OBJECTIVES: Unilateral spinal anesthesia has advantages when used in outpatient basis. The objective of the present study was to compare unilateral spinal anesthesia with combined sciatic-femoral nerve block in unilateral orthopedic surgeries in outpatients. METHODS: Sixty patients were randomly divided into two groups of 30 patients to receive 6 mg of hyperbaric or hypobaric bupivacaine (RQ group) in left lateral decubitus, or 800 mg of 1.6 percent lidocaine with epinephrine on sciatic and femoral nerves (CFI group) in dorsal decubitus. A 150-mm needle connected to a neurostimulator, inserted in the middle point between both classical approaches, was used for the nerve block, with the injection of 15 mL on the femoral nerve and 35 mL on the sciatic nerve. The time for the blockades and their duration were evaluated. After twenty minutes, patients were evaluated regarding the sensorial and motor blockades. RESULTS: Time for performance of spinal anesthesia was substantially lower than for combined sciatic-femoral nerve block. Unilateral blockade was achieved in 90 percent of the patients in the RQ group, and 100 percent in the CFI group. Bradycardia or hypotension was not observed. CONCLUSIONS: This study concluded that combined sciatic-femoral nerve block is technically easy to perform and it can be an alternative for unilateral blockade of the lower limbs. Unilateral spinal anesthesia with low doses of bupivacaine resulted in shorter time to perform it, lower number of attempts, and earlier recovery than combined sciatic-femoral nerve block, but with the same efficacy.
JUSTIFICATIVA Y OBJETIVOS: La raquianestesia unilateral puede presentar ventajas en pacientes ambulatoriales. El objetivo de este trabajo fue comparar la raquianestesia unilateral con el bloqueo combinado femoral-isquiático en cirugías ortopédicas unilaterales y ambulatoriales. MÉTODO: Sesenta pacientes fueron separados aleatoriamente en dos grupos de 30 para recibir 6 mg de bupivacaína hiperbárica o hipobárica (grupo RQ), en decúbito lateral izquierdo u 800 mg de lidocaína 1,6 por ciento con epinefrina en los nervios femoral e isquiático (grupo CFI), en decúbito dorsal. El bloqueo de los nervios fue realizado con una aguja de 150 mm conectada a un neuroestimulador e insertada en el punto medio entre las dos incisiones clásicas. Se inyectaron 15 mL en el nervio femoral y 35 mL en el nervio isquiático. Fue mensurado el tiempo para la realización de los bloqueos y su duración. Veinte minutos después, los pacientes fueron evaluados con relación a los bloqueos sensitivo y motor. RESULTADOS: El tiempo para la realización de la raquianestesia fue significativamente menor que el bloqueo combinado femoral-isquiático. El bloqueo unilateral se obtuvo en un 90 por ciento de los pacientes en el grupo RQ y en un 100 por ciento en el grupo CFI. El tiempo para la recuperación del bloqueo sensitivo y motor fue significativamente mayor en el grupo CFI. No hubo bradicardia o hipotensión. CONCLUSIONES: Por medio de este estudio, se llega a la conclusión de que es técnicamente fácil realizar el bloqueo anterior combinado femoral-isquiático y de que ese puede ser una alternativa para el bloqueo unilateral del miembro inferior. La raquianestesia unilateral con bajas dosis de bupivacaína, mostró un menor tiempo para la realización, un menor número de intentos y una recuperación más rápida del bloqueo combinado femoral-isquiático. Sin embargo, la efectividad fue la misma.
Subject(s)
Adult , Female , Humans , Male , Anesthesia, Spinal/methods , Leg/surgery , Nerve Block/methods , Sciatic Nerve , Anesthesia , Femoral Nerve , Injections, Intradermal , Prospective StudiesABSTRACT
Justificativa e objetivos: Apesar da eficácia da morfina intraarticular (IA) permanecer controversa, tem-se mostrado que doses maiores promovem melhores resultados e, consequentemente, menor consumo pós-operatório de analgésico, caracterizando, assim, efeito dose-dependente na ação periférica. Foi conduzido estudo controlado, aleatório e duplamente encoberto para avaliar a eficácia de 10 mg de morfina por via intra-articular em pacientes submetidos à artroplastia total de joelho. Método: Foram avaliados 50 pacientes submetidos à artroplastia total de joelho, distribuídos aleatoriamente em dois grupos: o grupotratamento recebeu 10 mg (1 mL) de morfina por via intra-articular diluído em 19 mL de solução fisiológica a 0,9 por cento (SF), enquanto o grupo-controle recebeu injeção intra-articular contendo 20 mL de SF, ambos após o fechamento da cápsula articular, ao final da operação. Morfina subcutânea sob demanda esteve disponível para dor residual. As seguintes variáveis foram avaliadas: intensidade da dor graduada na Escala Numérica (EN) às 2 h (M1), 6 h (M2), 12 h (M3) e 24 h (M4) após injeção IA; tempo para primeira solicitação de analgésico; consumo de analgésicos e efeitos adversos. Conclusões: O grupo-tratamento apresentou menores valores na EN que o grupo-controle em M1 e M2, enquanto que nos outros momentos não houve diferença significativa. O intervalo para primeira solicitação de analgésicos foi significativamente maior no grupo tratamento e o consumo de analgésicos nas primeiras 24 horas foi menor neste grupo. Não houve diferença entre incidência de efeitos adversos entre os grupos. Concluiu-se que 10 mg de morfina reduziram dor pós-operatória 2 e 6 horas após injeção IA, promoveram maior período sem analgésico de resgate e reduziram seu consumo nas primeiras 24 horas.
Background and objectives: Although the efficacy of intraarticular (IA) morphine is still controversial, it has been shown that higher doses promote better results and consequently decrease postoperative analgesic consumption, characterizing a dose-dependent peripheral action. A controlled, randomized, double-blind study was undertaken to evaluate the efficacy of the intra-articular administration of 10 mg of morphine in patients undergoing total knee arthroplasty. Methods: Fifty patients undergoing total knee arthroplasty were randomly divided into two groups: the treatment group received 10 mg (1 mL) of intra-articular morphine diluted in 19 mL of NS, while the control group received the intra-articular administration of 20 mL of NS, both after closure of the capsule at the end of the surgery. On demand subcutaneous morphine was available for residual pain. The following parameters were evaluated: pain severity according to the numeric scale (NS), 2 h (M1), 6 h (M2), 12 h (M3), and 24 h (M4) after the IA injection; time until the first request of analgesic; analgesic consumption, and side effects. Conclusions: The treatment group had lower NS than the control group in M1 and M2, while significant differences were not observed in the other moments. The time until the first request of analgesics was significantly higher in the treatment group, and analgesic consumption in the first 24 hours was also lower in this group. The incidence of side effects did not differ between both groups. We concluded that the postoperative IA administration of 10 mg of morphine promoted a longer period without rescue analgesics and reduced their consumption in the first 24 hours.
Justificativa y objetivos: A pesar de que la eficacia de la morfina intra-articular (IA), permanece como algo controvertido, ha quedado demostrado que las dosis mayores generan mejores resultados y consecuentemente, un menor consumo postoperatorio de analgésico, caracterizando así, el efecto dosis-dependiente en la acción periférica. Fue realizado un estudio controlado, aleatorio y doble ciego para evaluar la eficacia de 10 mg de morfina por vía intraarticular en pacientes sometidos a la artroplastia total de rodilla. Método: Se evaluaron 50 pacientes sometidos a la artroplastia total de rodilla, distribuidos aleatoriamente en dos grupos: el grupo tratamiento recibió 10 mg (1 mL) de morfina por vía intra-articular diluido en 19 mL de solución fisiológica al 0,9 por ciento (SF), mientras que el grupo control recibió una inyección intra-articular con 20 mL de SF, ambos después del cierre de la cápsula articular, al final de la operación. La morfina subcutánea bajo demanda, estuvo disponible para el dolor residual. Se evaluaron las siguientes variables: intensidad del dolor graduada en la Escala Numérica (EN) a las 2h (M1), 6h (M2), 12h (M3) y 24h (M4), después de la inyección IA; tiempo para la primera solicitación de analgésico; y consumo de analgésicos y efectos adversos. Conclusiones: El grupo tratamiento presentó menores valores en la EN que el grupo control en M1 y M2, mientras que en los otros momentos, no se registró ninguna diferencia significativa. El intervalo para la primera solicitación de analgésicos fue significantemente mayor en el grupo tratamiento y el consumo de analgésicos en las primeras 24 horas fue menor en ese grupo. No hubo diferencia entre la incidencia de efectos adversos entre los grupos. Llegamos a la conclusión, de que 10 mg de morfina redujeron el dolor del postoperatorio entre 2 y 6 horas después de aplicada la inyección IA, y se generó un periodo mayor sin analgésico de rescate reduciendo su consumo en las...
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Pain, Postoperative/drug therapy , Morphine/administration & dosage , Morphine/therapeutic useABSTRACT
Justificativa e objetivos: A anestesia para artroplastia total do quadril (ATQ) constitui desafio devido à idade avançada e às doenças associadas dos pacientes. O objetivo do estudo foi avaliar se o bloqueio do plexo lombar combinado à anestesia geral se equivale à anestesia peridural lombar quanto à eficácia do bloqueio nociceptivo, efeitos hemodinâmicos secundários, dificuldade na sua execução e influência no sangramento operatório...
Background and objectives: Anesthesia for total hip arthroplasty (THA) is a challenge due to the advanced age and associated diseases of patients. The objective of this study was to evaluate whether the efficacy of the nociceptive blockade, secondary hemodynamic effects, difficulty to execute the technique, and influence in intraoperative bleeding of lumbar plexus block combined with general anesthesia is equivalent to epidural lumbar...
Justificativa y objetivos: La anestesia para la artroplastia total de la cadera (ATC), constituye un reto a causa de la edad avanzada y de las enfermedades asociadas a los pacientes. El objetivo del estudio, fue evaluar si el bloqueo del plexo lumbar combinado con la anestesia general, equivale a la anestesia epidural lumbar en cuanto a la eficacia del bloqueo nociceptivo, efectos hemodinámicos secundarios, dificultad en su ejecución e influencia en el sangramiento operatorio...
Subject(s)
Humans , Anesthesia, Epidural/standards , Anesthesia, General/standards , Anesthetics, Combined/adverse effects , Anesthetics, Combined/standards , Hemodynamics , Arthroplasty, Replacement, Hip , Lumbosacral PlexusABSTRACT
Justificativa e objetivos: O procedimento de correção de pé torto congênito (PTC) cursa com dor pós-operatória intensa. A técnica mais utilizada em crianças é a peridural caudal associada à anestesia geral. Tem como limitação a curta duração da analgesia pós-operatória. Os bloqueios de nervos periféricos têm sido apontados como procedimentos com baixa incidência de complicações e tempo prolongado de analgesia. O objetivo do estudo foi comparar o tempo de analgesia dos bloqueios nervosos periféricos e bloqueio caudal e o consumo de morfina nas primeiras 24 horas após a correção de PTC em crianças...
Background and objetives: Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children...
Justificativa y objetivos: El procedimiento de corrección depie jorobado congénito (PJC), debuta con dolor postoperatorio intenso. La técnica más utilizada en niños es la epidural caudal asociada a la anestesia general. Posee la limitante de una corta duración de la analgesia postoperatoria. Los bloqueos de nervios periféricos han sido indicados como procedimientos con una baja incidencia de complicaciones y un tiempo prolongado de analgesia. El objetivo del estudio actual, fue comparar el tiempo de analgesia de los bloqueos nerviosos periféricos y del bloqueo caudal y el consumo de morfina, en las primeras 24 horas después de la corrección...
Subject(s)
Humans , Male , Female , Child , Anesthesia, Caudal , Morphine/therapeutic use , Nerve Block , Reaction Time , Postoperative Care , TalipesABSTRACT
JUSTIFICATIVA E OBJETIVOS: A dor após artroplastia total do quadril (ATQ) é intensa e agravada pelas mobilizações, o que demanda técnica analgésica eficaz e que permita mobilidade precoce, participação nas atividades de reabilitação e rápida recuperação funcional. O objetivo do estudo foi comparar os efeitos das técnicas de analgesia controlada pelo paciente (ACP) pelas vias peridural e perineural do plexo lombar sobre a reabilitação funcional em pacientes submetidos à ATQ. MÉTODO: Pacientes estado físico ASA I a III foram alocados aleatoriamente nos grupos Peridural e Lombar. Para a ATQ, foi realizada anestesia peridural lombar contínua com ropivacaína a 0,5 por cento (Peridural) ou bloqueio contínuo do plexo lombar com ropivacaína a 0,5 por cento (Lombar). Na sala de recuperação, iniciou-se ACP com infusão de ropivacaína a 0,2 por cento (Lombar) ou ropivacaína a 0,2 por cento + fentanil 3 µg.mL-1 (Peridural). A eficácia da analgesia nas primeiras 48 horas após a ATQ (escores de dor, consumo de morfina de resgate e de bolos da bomba de ACP) foi comparada entre os grupos. Diferentes parâmetros da reabilitação pós-operatória foram estudados. RESULTADOS: Quarenta e um pacientes foram submetidos à análise estatística. Os escores de dor em repouso foram semelhantes nos dois grupos. Apesar do controle mais efetivo da dor dinâmica no grupo Peridural e o uso de morfina ter sido maior, mais frequente e mais precoce no grupo Lombar, não houve diferença entre os grupos em nenhum dos parâmetros estudados de reabilitação. As técnicas de analgesia não influenciaram as falhas no processo de reabilitação. CONCLUSÕES: A maior efetividade da analgesia peridural não se traduziu em melhora no processo de reabilitação, nem reduziu o tempo necessário para alcançar os desfechos estudados.
BAKGROUND AND OBJECTIVES: Pain after total hip arthroplasty (THA) is severe and it is aggravated by movements, which requires an effective analgesic technique that allows early mobilization, participation in rehabilitation activities, and fast functional recovery. The objective of this study was to compare the effects of epidural and perineural patient-controlled analgesia (PCA) of the lumbar plexus on functional rehabilitation of patients undergoing THA. METHODS: Patients classified as physical status ASA I to III were randomly divided into two groups: Epidural and Lumbar. For THA, patients underwent continuous epidural lumbar block with 0.5 percent ropivacaine (Epidural) or continuous lumbar plexus block with 0.5 percent ropivacaine (Lumbar). In the recovery room, PCA with infusion of 0.2 percent ropivacaine (Lumbar) or 0.2 percent ropivacaine + fentanyl 3 µg.mL-1 (Epidural) was instituted. Analgesic efficacy in the first 48 hours after THA (pain scores, rescue morphine consumption, and bolus of the PCA pump) was compared between both groups. Different postoperative rehabilitation parameters were analyzed. RESULTS: Forty-one patients underwent statistical analysis. Resting pain scores were similar in both groups. Despite more effective control of dynamic pain in the Epidural group and the greater, more frequent, and earlier morphine consumption in the Lumbar group, rehabilitation parameters evaluated did not differ in both groups. Analgesia techniques did not affect rehabilitation failures. CONCLUSIONS: The greater effectivity of epidural analgesia did not translate in improvement of the rehabilitation process nor did it decrease the time necessary to achieve end goals.
JUSTIFICATIVA Y OBJETIVOS: El dolor después de la artroplastia total de la cadera (ATC) es intenso y se agrava por los movimientos, lo que demanda una técnica analgésica eficaz y que permita la movilidad precoz, la participación en las actividades de rehabilitación, y una rápida recuperación funcional. El objetivo de este estudio, fue comparar los efectos de las técnicas de analgesia controlada por el paciente (ACP), por las vías epidural y perineural del plexo lumbar sobre la rehabilitación funcional en pacientes sometidos a la ATC. MÉTODO: Pacientes en estado físico ASA I a III, que fueron ubicados aleatoriamente en los grupos Epidural y Lumbar. Para la ATC, se realizó la anestesia epidural lumbar continua con ropivacaína a 0,5 por ciento (Epidural) o bloqueo continuo del plexo lumbar con ropivacaína a 0,5 por ciento (Lumbar). En la sala de recuperación, se inició ACP con infusión de ropivacaína a 0,2 por ciento (Lumbar) o ropivacaína a 0,2 por ciento + fentanil 3 µg.mL-1 (Epidural). La eficacia de la analgesia en las primeras 48 horas después de la ATC (niveles de dolor, consumo de morfina de rescate y de bolos de la bomba de ACP), se comparó entre los grupos. Los diferentes parámetros de la rehabilitación postoperatoria también se estudiaron. RESULTADOS: Cuarenta y un pacientes se sometieron al análisis estadístico. Los niveles de dolor en reposo fueron similares en los dos grupos. A pesar de un control más efectivo del dolor dinámico en el grupo Epidural y de un uso más potente de la morfina, que se aplicó más a menudo y precozmente en el grupo Lumbar, no hubo diferencia entre los grupos en ninguno de los parámetros estudiados de rehabilitación. Las técnicas de analgesia no influyeron en las fallas en el proceso de rehabilitación. CONCLUSIONES: El más alto nivel de efectividad de la analgesia epidural, no se tradujo en una mejoría en el proceso de rehabilitación, ni tampoco redujo el tiempo necesario para alcanzar los resultados estudiados.
Subject(s)
Female , Humans , Male , Middle Aged , Analgesia, Epidural , Arthroplasty, Replacement, Hip/rehabilitation , Lumbosacral Plexus , Nerve Block , Nerve Block/methodsABSTRACT
JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO: Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5 por cento; Grupo 2: 20 mL de ropivacaína a 0,75 por cento; Grupo 3: 20 mL de ropivacaína a 1 por cento. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV) nas primeiras 48 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.
BACKGROUND AND OBJECTIVES: Arthroscopic shoulder surgeries are associated with severe postoperative pain. Among the analgesic techniques available, brachial plexus block has the best results. The objective of this study was to determine which concentration of local analgesic used in the posterior brachial plexus block provides longer postoperative analgesia. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided into three groups of 30 patients each. Group I: 20 mL of 0.5 percent ropivacaine; Group 2: 20 mL of 0.75 percent ropivacaine; and Group 3: 20 mL of 1 percent ropivacaine. The blockade was evaluated by assessing the thermal sensitivity using a cotton pad with alcohol and postoperative pain was evaluated according to a Verbal Numeric Scale (VNS) in the first 48 hours. RESULTS: Postoperative analgesia was similar in all three groups according to the parameters evaluated: mean VNS, time until the first complaint of pain, and postoperative opioid consumption. CONCLUSIONS: This study demonstrated that posterior brachial plexus block provides effective analgesia for shoulder surgeries. Twenty milliliters of ropivacaine in the different concentrations used in this study promoted similar analgesia.
JUSTIFICATIVA Y OBJETIVOS: Las intervenciones quirúrgicas por vía artroscópica en el hombro se relacionan con el dolor postoperatorio de gran intensidad. Entre las técnicas de analgesia, el bloqueo del plexo braquial es la que ofrece los mejores resultados. El objetivo de este estudio fue determinar cuál concentración de anestésico local en el bloqueo de plexo braquial por la vía posterior, propicia analgesia postoperatoria más prolongada para esas operaciones. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por la vía posterior se dividieron aleatoriamente en tres grupos de 30. Grupo 1: 20 mL de ropivacaina a 0,5 por ciento; Grupo 2: 20 mL de ropivacaina a 0,75 por ciento; Grupo 3: 20 mL de ropivacaina a 1 por ciento. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó según una escala numérico verbal (ENV) en las primeras 48 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor medio, tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve una analgesia eficaz para intervenciones quirúrgicas en el hombro. Utilizando 20 mL de ropivacaina, las tres diferentes concentraciones estudiadas promueven analgesia similar.
Subject(s)
Humans , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacology , Brachial Plexus , Pain, Postoperative/therapy , Arthroplasty , ShoulderABSTRACT
Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.
Subject(s)
Humans , Anesthesia, Spinal , Diagnosis , Femoral Neck Fractures , Hypovolemia , Mortality , Myocardial Infarction , Operating Rooms , Pneumothorax , Pulmonary Edema , Pulmonary Embolism , ShockABSTRACT
An Eighty-year-old female patient was transferred to the operating room for hip arthroplasty under the general anesthesia. Immediately after injection of two units of methylmethacrylate bone cement into the intramedullary canal, systolic blood pressure rapidly decreased and cardiac arrest occurred. The patient was turned to the supine position and was successfully resuscitated with intravenous administration of fluids, injection of epinephrine and external cardiac massage. In the intensive-care unit, she was treated for acute pulmonary edema. Three days later, postoperative delirium was developed. She spoke incoherently, was disoriented, and showed impairment of memory and attention. She was treated with haloperidol, lorazepam and sedative drug, five days later recovered. The patient was discharged to home without any sequelaes, but she died due to pneumonia two months later postoperatively at home.
Subject(s)
Aged , Female , Humans , Administration, Intravenous , Anesthesia, General , Arthroplasty , Blood Pressure , Delirium , Epinephrine , Haloperidol , Heart Arrest , Heart Massage , Hip , Lorazepam , Memory , Methylmethacrylate , Operating Rooms , Pneumonia , Pulmonary Edema , Supine PositionABSTRACT
An Eighty-year-old female patient was transferred to the operating room for hip arthroplasty under the general anesthesia. Immediately after injection of two units of methylmethacrylate bone cement into the intramedullary canal, systolic blood pressure rapidly decreased and cardiac arrest occurred. The patient was turned to the supine position and was successfully resuscitated with intravenous administration of fluids, injection of epinephrine and external cardiac massage. In the intensive-care unit, she was treated for acute pulmonary edema. Three days later, postoperative delirium was developed. She spoke incoherently, was disoriented, and showed impairment of memory and attention. She was treated with haloperidol, lorazepam and sedative drug, five days later recovered. The patient was discharged to home without any sequelaes, but she died due to pneumonia two months later postoperatively at home.
Subject(s)
Aged , Female , Humans , Administration, Intravenous , Anesthesia, General , Arthroplasty , Blood Pressure , Delirium , Epinephrine , Haloperidol , Heart Arrest , Heart Massage , Hip , Lorazepam , Memory , Methylmethacrylate , Operating Rooms , Pneumonia , Pulmonary Edema , Supine PositionABSTRACT
Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.
Subject(s)
Female , Humans , Middle Aged , Blood Pressure , Carbon Dioxide , Cardiotonic Agents , Catheters , Embolism, Air , Fractures, Compression , Heart Arrest , Heart Rate , Noise , Resuscitation , Spinal FusionABSTRACT
BACKGROUND: Methods to reduce the amount of blood transfusion include perioperative hemodilution, hypotensive anesthesia, the transfusion of previously deposited autologous blood, and intraoperative autotransfusion used the cell saver. The purpose of this study is to evaluate the effect of the use of the cell saver in orthopedic spinal surgery. METHODS: One hundred and one patients for orthopedic spinal surgery were involved in this study and divided into two groups: group 1 (no used cell saver, n=51) and group 2 (used cell saver, n=50). We checked transfusion amounts during operation and the changes of hematocrit after operation. RESULTS: The amount of blood obtained from cell saver apparatus was 1220 +/- 651 ml (mean SD). Hematocrit of the autologous blood from this apparatus was 48.5 +/- 2.5%. Amounts of blood transfusion during operation were 4.1 +/- 0.9 IU (400 ml/IU) in group 1 and 2.5 +/- 0.7 IU in group 2 (p<0.05). The hematocrit was markedly decreased at the postoperative 2 and 3 days in group 2 (p<0.05). CONCLUSIONS: This study suggested that intraoperative salvage technique with cell saver apparatus could decrease the use of bank blood by 40% in orthopedic spinal surgery. However, we should be prepare the blood for the decrease of the hematocrit at the postoperative 2 and 3 days.
Subject(s)
Humans , Anesthesia , Blood Transfusion , Blood Transfusion, Autologous , Hematocrit , Hemodilution , OrthopedicsABSTRACT
BACKGROUND: Esmolol is a short acting sympathetic beta receptor antagonist, and it was successfully applied to induced hypotension. Esmolol lowers blood pressure by decreasing cardiac output, and does not cause vasodilation. This property of esmolol may help to decrease bleeding during induced hypotension. In this study, we tried to elucidate the effect of esmolol on induced hypotension for total hip arthroplasty. METHOD: Twenty patients receiving total hip arthroplasty were randomly divided to two groups. Esmolol group (10 patients) received esmolol as a hypotensive agent, and sodium nitroprusside (SNP) group (10 patients) received SNP as a hypotensive agent. We measured arterial blood gas analysis, vital sign, amounts of bleeding, amounts of transfusion and administered fluid, and various laboratory findings. RESULTS: Induced hypotension was successfully performed in either esmolol and SNP group. Heart rate increased by SNP, and decreased by esmolol. There were no statistically significant differences between the two groups in amounts of bleeding, amounts of transfusion or administered fluid, and laboratory findings. Arterial oxygen tension was relatively constant in esmolol group, but decreased in SNP group. CONCLUSION: Esmolol can be used as a single hypotensive agent during induced hypotension without significant side effects during total hip arthroplasty.
Subject(s)
Humans , Arthroplasty, Replacement, Hip , Blood Gas Analysis , Blood Pressure , Cardiac Output , Heart Rate , Hemorrhage , Hypotension , Nitroprusside , Oxygen , Sodium , Vasodilation , Vital SignsABSTRACT
BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.