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Chinese Medical Journal ; (24): 1043-1051, 2021.
Article in English | WPRIM | ID: wpr-878147


BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Colloids , Female , Humans , Hypotension/etiology , Incidence , Infant, Newborn , Pregnancy , Vasoconstrictor Agents/therapeutic use
Chinese Medical Journal ; (24): 792-799, 2021.
Article in English | WPRIM | ID: wpr-878087


BACKGROUND@#Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.@*METHODS@#In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.@*RESULTS@#In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).@*CONCLUSION@#In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.@*TRIAL, NCT02542748;

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Double-Blind Method , Female , Humans , Hypotension/prevention & control , Infant, Newborn , Phenylephrine , Pregnancy , Randomized Controlled Trials as Topic , Vasoconstrictor Agents/therapeutic use
Rev. cuba. anestesiol. reanim ; 19(1): e576, ene.-abr. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093132


Introducción: El abordaje del espacio subaracnoideo fue descrito por Quincke en el 1891. En la actualidad es práctica común para la realización de la anestesia neuroaxial subaracnoidea en las pacientes obstétricas. Las complicaciones descritas, asociadas a esto, son varias. Dentro de estas, la parálisis del nervio abducens o VI par no es frecuente y en ocasiones, no está relacionada a la punción ya que se produce días después del evento. Objetivo: Revisar la información relacionada con la complicación de parálisis del VI par. Presentación del caso: Paciente de 33 años de edad, femenina, de profesión médico, con antecedentes personales de migraña, historia de anestesia neuroaxial epidural sin complicaciones, que para la realización de una cesárea de segmento arciforme y salpinguectomia parcial bilateral, recibió una anestesia combinada peridural-espinal. El transoperatorio transcurre con estabilidad hemodinámica, hizo cefalea al tercer día del posoperatorio, que la atribuyó al antecedente de migraña y fue tratada sin evaluación por anestesiología con dipirona. A los 10 días de operada hace desviación de la mirada y diplopia, se diagnostica parálisis del VI par. Fue tratada por Neurología y se plantean varios diagnósticos diferenciales. Los estudios imagenológicos resultan negativos, se trató con vitaminas y se produjo remisión a las 6 semanas. Conclusiones: El diagnóstico de esta complicación es necesario ya que puede pasar inadvertida la relación con la anestesia y, por tanto, ser mal conducido su tratamiento(AU)

Introduction: The approach to the subarachnoid space was described by Quincke in 1891. It is now a common practice to perform subarachnoid neuroaxial anesthesia in obstetric patients. The complications described, associated with this, are several. Within these, the paralysis of the abducens nerve or sixth pair is not frequent and sometimes is not related to the puncture, since it occurs days after the event. Objective: To review the information related to the complication of paralysis of the sixth pair. Case presentation: A 33-year-old female patient, a physician, with a personal history of migraine, a history of epidural neuroaxial anesthesia without complications, who underwent combined epidural-spinal anesthesia for performing a cranial segment cesarean section and bilateral partial salpingectomy. The transoperative period runs with hemodynamic stability. There was headache three days after surgery, which was attributed to the migraine history and the patient was treated, without evaluation by anesthesiology, with dipyrone. At 10 days after surgery, the eyes are diverted and diplopia is manifested, paralysis of the sixth pair is diagnosed. She was treated by neurology and several differential diagnoses were proposed. Imaging studies are negative. She was treated with vitamins and remission occurred at six weeks. Conclusions: The diagnosis of this complication is necessary, since the relationship with anesthesia may go unnoticed and, therefore, its treatment may be poorly conducted(AU)

Humans , Female , Pregnancy , Adult , Spinal Puncture/adverse effects , Abducens Nerve Diseases/complications , Anesthesia, Spinal/adverse effects , Diplopia/etiology
Rev. bras. anestesiol ; 69(6): 631-634, nov.-Dec. 2019.
Article in English | LILACS | ID: biblio-1057483


Abstract Loss of consciousness during spinal anesthesia is a rare but scary complication. This complication is generally related to severe hypotension and bradycardia, but in this case, the loss of consciousness occurred in a hemodynamically stable parturient patient. We present a 31 years-old patient who underwent an emergency cesarean section. She lost consciousness and had apnea that started 10 minutes after successful spinal anesthesia and repeated three times for a total of 25 minutes, despite the stable hemodynamics of the patient. The case was considered a subdural block, and the patient was provided with respiratory support. The subdural block is expected to start slowly (approximately 15-20 minutes), but in this case, after about 10 minutes of receiving anesthesia, the patient suddenly had a loss of consciousness. After the recovery of consciousness and return of spontaneous respiration, the level of a sensory block of the patient, who was cooperative and oriented, was T4. There were motor blocks in both lower extremities. Four hours after intrathecal injection, both the sensory and motor blocks ended, and she was discharged two days later with no complications. Hence, patients who receive spinal anesthesia should be closely observed for any such undesirable complications.

Resumo A perda de consciência durante a raquianestesia é uma complicação rara, mas assustadora. Essa complicação geralmente está relacionada à grave hipotensão e bradicardia, mas, neste caso, a perda de consciência ocorreu em uma paciente parturiente hemodinamicamente estável. Apresentamos o caso de uma paciente de 31 anos, submetida a uma cesariana de emergência. A paciente perdeu a consciência e apresentou apneia que teve início 10 minutos após a raquianestesia bem-sucedida e repetiu o episódio três vezes por 25 minutos, a despeito de sua hemodinâmica estável. O caso foi considerado como um bloqueio subdural e a paciente recebeu suporte respiratório. Espera-se que o bloqueio subdural inicie lentamente (aproximadamente 15-20 minutos), mas, neste caso, cerca de 10 minutos após a anestesia, a paciente repentinamente perdeu a consciência. Após a recuperação da consciência e o retorno da respiração espontânea, a paciente que estava orientada e cooperativa apresentou nível de bloqueio sensorial em T4. Havia bloqueio motor em ambas as extremidades inferiores. O bloqueio sensório-motor terminou quatro horas após a injeção intratecal e a paciente recebeu alta hospitalar dois dias depois, sem complicações. Considerando o exposto, os pacientes que recebem raquianestesia devem ser atentamente observados para quaisquer complicações indesejáveis.

Humans , Female , Pregnancy , Adult , Unconsciousness/etiology , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Hemodynamics/physiology , Anesthesia, Obstetrical/methods , Anesthesia, Spinal/methods
Rev. cuba. med. mil ; 48(2): e356, abr.-jun. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126617


Introducción: La historia de la raquianestesia, comenzó el 16 de agosto de 1898, la primera anestesia raquídea de la historia cimentó una de las piedras angulares de la Anestesiología. Más de cien años después y a pesar del desarrollo tecnológico que acompaña la especialidad, aún la anestesia regional es una técnica ampliamente utilizada a nivel mundial, no exenta de complicaciones, donde se destaca la cefalea pospunción dural. Objetivo: Describir la prevalencia y características de la cefalea pospunción dural en pacientes con deambulación, precoz o no, intervenidos bajo anestesia espinal subaracnoidea, para cirugía artroscópica de rodilla. Método: Se realizó un estudio observacional descriptivo en una serie de casos (100), atendidos en el Hospital Militar Central "Carlos J. Finlay", que fueron distribuidos en dos grupos. El grupo I formado por los que deambularon a las 4 horas de la intervención y el grupo II deambuló a las 14 horas. En ambos grupos se había utilizado anestesia raquídea con trocar 25 atraumático del tipo Whitacre. Resultados: En ambos grupos no se reportaron casos de cefalea pospunción dural. Conclusiones: No hubo casos de cefalea pospunción dural en pacientes con deambulación, precoz o no, intervenidos bajo anestesia espinal subaracnoidea para cirugía artroscópica de rodilla(AU)

Introduction: The history of spinal anesthesia, began on August 16, 1898, the first spinal anesthesia in history based one of the cornerstones of anesthesiology. More than a hundred years later and despite the technological development that accompanies the specialty, even regional anesthesia is a technique widely used worldwide, not free of complications, which highlights the dural post-puncture headache. Objective: To describe the prevalence and characteristics of dural post-puncture headache in patients with ambulation, early or not, undergoing subarachnoid spinal anesthesia, for arthroscopic knee surgery. Method: A descriptive observational study was conducted in a series of cases (100), attended at the Central Military Hospital "Carlos J. Finlay", which were divided into two groups. The group I formed by those who wandered at 4 hours after the intervention and group II wandered at 14 hours. In both groups, spinal anesthesia with atraumatic trocar of the Whitacre type was used. Results: In both groups there were no reported cases of dural post-puncture headache. Conclusions: There were no cases of dural post-puncture headache in patients with ambulation, early or not, undergoing subarachnoid spinal anesthesia for arthroscopic knee surgery(AU)

Humans , Male , Female , Adolescent , Adult , Middle Aged , General Surgery , Early Ambulation , Anesthesia, Spinal/adverse effects , Anesthesiology/methods , Epidemiology, Descriptive
Rev. bras. anestesiol ; 69(1): 7-12, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-977416


Abstract Introduction: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. Methods: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 cm, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII). Pain severity before the blockade, time to complete analgesia, degree of motor blockade, time to full cervical dilation, duration of the second stage of labor, pain severity during the 1st and 2nd stage of labor, type of delivery, use of oxytocin during labor, maternal cardiocirculatory and respiratory parameters and adverse events, and neonatal repercussions were recorded. Results: At the time of anesthesia, pain severity was similar in both groups. Pain relief was faster in GI (4.5 ± 1.5 min) when compared to GII (11.6 ± 4.6 min) p = 0.01; pain scores in the first and second stages of delivery were lower in GI (0.9 ± 0.3 and 1.8 ± 0.7, respectively) when compared to GII (1.9 ± 0.6 and 2.2 ± 0.5, respectively), with p = 0.01 only in the first stage of labor; there was need for local anesthetics supplementation in GII; there were more frequent spontaneous deliveries in GI (80% of patients) than in GII (50%) (p = 0.045) and more frequent use of instrumental (p = 0.03) in GII (12 patients) compared to GI (4 patients); the frequency of cesarean deliveries was significantly higher (p = 0.02) in Group II than in Group I, with 4 cases in GI and 8 cases in GII; absence of maternal cardiocirculatory and respiratory changes and neonatal repercussions; more frequent pruritus in GI (10 patients) and (0 patients in GII) (p = 0.02). Conclusion: The combined blockade proved to be effective with better quality of analgesia and greater comfort for pregnant women, constituting a good option for the practice of obstetric analgesia.

Resumo Introdução: O bloqueio peridural lombar constitui técnica eficaz e rotineiramente empregada para alívio da dor do parto e o bloqueio combinado raquiperidural tem como benefícios o emprego de doses menores de anestésicos locais e rápido início de analgesia. O objetivo do estudo foi avaliar comparativamente a eficácia e a segurança de duas técnicas anestésicas: bloqueio combinado raquiperidural e peridural contínua em grávidas submetidas à analgesia de parto. Método: Oitenta gestantes, ASA 2 e 3, apresentação cefálica e dilatação cervical entre cinco e seis centímetros, submetidas à analgesia de parto, distribuídas em dois grupos de acordo com a técnica anestésica: técnica combinada raquiperidural (GI) e peridural contínua (GII). Avaliaram-se: intensidade de dor antes do bloqueio; tempo para completa analgesia; grau do bloqueio motor; tempo para dilatação cervical total; duração do 2° estágio do trabalho de parto; intensidade de dor durante o 1° e o 2° estágio do trabalho de parto; tipo de parto; uso de ocitocina durante trabalho de parto; parâmetros cardiocirculatórios, respiratórios e eventos adversos maternos; repercussões neonatais. Resultados: No momento da anestesia a intensidade de dor era semelhante em ambos os grupos. O alívio da dor foi mais rápido no GI (4,5 ± 1,5 min) quando comparado com o GII (11,6 ± 4,6 min) p = 0,01; os escores de dor no primeiro e segundo estágios de parto foram menores no GI (0,9 ± 0,3) e (1,8 ± 0,7) quando comparados com o GII (1,9 ± 0,6) e (2,2 ± 0,5) com p = 0,01 somente no primeiro estágio de trabalho de parto; houve necessidade de complementação com anestésicos locais no GII; partos espontâneos mais frequentes em GI (80% das pacientes) do que em GII (50%) p = 0,045 e instrumentais mais frequentes (p = 0,03) em GII (12 pacientes) quando comparadas com o GI (quatro pacientes); a frequência de partos cesáreos foi significativamente maior (p = 0,02) no Grupo II do que no Grupo I, quatro casos no GI e oito no GII; ausência de alterações cardiocirculatórias e respiratórias maternas e repercussões neonatais; prurido mais frequente no GI (10 pacientes) e (0 paciente no GII) p = 0,02. Conclusão: O bloqueio combinado mostrou-se eficaz com melhor qualidade de analgesia e maior conforto às gestantes, constitui boa opção para a prática de analgesia obstétrica.

Humans , Female , Pregnancy , Young Adult , Analgesia, Epidural/adverse effects , Analgesia, Obstetrical/methods , Double-Blind Method , Analgesia, Obstetrical/adverse effects , Treatment Outcome , Combined Modality Therapy , Anesthesia, Spinal/adverse effects , Nerve Block/adverse effects , Nerve Block/methods
Rev. bras. anestesiol ; 69(1): 13-19, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-977430


Abstract Background and objectives: Hypothermia occurs in about 60% of patients under anesthesia and is generally not managed properly during short lasting surgical procedures. Hypothermia is associated with adverse clinical outcomes. The current study is designed to assess the effects of crystalloid warming on maternal and fetal outcomes in patients undergoing elective cesarean section with spinal anesthesia. Methods: In this prospective randomized controlled trial, sixty parturients scheduled for elective cesarean section with spinal anesthesia were randomly allocated to receive crystalloid at room temperature or warmed at 37 °C. Spinal anesthesia was performed at L3-L4 interspace with 10 mg of hyperbaric bupivacaine without adding opioids. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and 5-min intervals until the end of operation. The primary outcome was maternal core temperature at the end of cesarean section. Results: There was no difference for baseline tympanic temperature measurements but the difference was significant at the end of the operation (p = 0.004). Core temperature was 36.8 ± 0.5 °C at baseline and decreased to 36.3 ± 0.5 °C for isothermic warmed crystalloid group and baseline tympanic core temperature was 36.9 ± 0.4 °C and decreased to 35.8 ± 0.7 °C for room temperature group at the end of the operation. Shivering was observed in 43.3% in the control group. Hemodynamic parameter changes and demographic data were not significant between groups. Conclusions: Isothermic warming crystalloid prevents the decrease in core temperature during cesarean section with spinal anesthesia in full-term parturients. Fetal Apgar scores at first and fifth minute are higher with isothermic warming.

Resumo Justificativa e objetivos: A hipotermia ocorre em cerca de 60% dos pacientes sob anestesia e geralmente não é tratada adequadamente durante procedimentos cirúrgicos de curta duração. A hipotermia está associada a desfechos clínicos adversos. O presente estudo teve como objetivo avaliar os efeitos do aquecimento de cristaloides nas condições maternas e fetais em pacientes submetidas à cesariana eletiva com raquianestesia. Métodos: Neste estudo prospectivo, randômico e controlado, 60 parturientes agendadas para cesárea eletiva com raquianestesia foram distribuídas aleatoriamente para receber cristaloides à temperatura ambiente ou aquecidos a 37 °C. A raquianestesia foi realizada no interespaço L3-L4 com 10 mg de bupivacaína hiperbárica sem adição de opioides. Temperatura central, tremores e parâmetros hemodinâmicos foram medidos a cada minuto até o décimo minuto e em intervalos de 5 min até o fim da operação. O desfecho primário foi a temperatura central materna ao final da cesárea. Resultados: Não houve diferença nas mensurações basais da temperatura timpânica, mas a diferença foi significativa no fim da operação (p = 0,004). A temperatura central foi de 36,8 ± 0,5 °C na fase basal e diminuiu para 36,3 ± 0,5 °C no grupo com aquecimento isotérmico de cristaloides e a temperatura basal timpânica foi de 36,9 ± 0,4 °C e diminuiu para 35,8 ± 0,7 °C no grupo sem aquecimento das soluções no fim da operação. Tremores foram observados em 43,3% no grupo controle. Alterações nos parâmetros hemodinâmicos e dados demográficos não foram significantes entre os grupos. Conclusões: O aquecimento isotérmico de cristaloides previne a redução da temperatura central durante a cesariana com raquianestesia em parturientes a termo. Os escores de Apgar para os fetos no primeiro e quinto minutos são maiores com o aquecimento isotérmico.

Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Body Temperature/drug effects , Cesarean Section , Double-Blind Method , Fetus/drug effects , Crystalloid Solutions/therapeutic use , Hypothermia/therapy , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal/adverse effects , Prospective Studies , Crystalloid Solutions/pharmacology , Hyperthermia, Induced/methods , Middle Aged
Med. UIS ; 31(1): 31-38, ene.-abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-954900


Resumen Introducción: La anestesia subaracnoidea es la técnica más empleada para realización de cesáreas usando opioides neuroaxiales, cuyos principales eventos adversos son náusea y vómito. Objetivo: Establecer la eficacia de ondansetrón y dexametasona en la profilaxis de náuseas y vómitos en pacientes sometidos a cesárea. Materiales y métodos: Una muestra de 300 embarazadas llevadas a cesárea no emergente bajo anestesia subaracnoidea fueron asignadas aleatoriamente en tres grupos: DEX (dexametasona 4 mg), OND (ondansetrón 4 mg), PLB (placebo 5 mL de solución salina normal). La técnica anestésica se estandarizó con 9 mg de bupivacaína al 0.5%, 100 mcg de morfina y 25 mcg de fentanilo Intratecal. Se evaluó el resultado de interés durante el intraoperatorio, a las 2, 6 y 24 horas post-anestesia, con un nivel de significancia α de 0,05. Resultados: El RR en el grupo DEX para vómito fue 0,46 (IC95%: 0,28-0,76), y para náusea fue 0,79 (IC95%: 0,64-0,96). En el grupo OND el RR para vómito fue 0,41 (IC95%: 0,24-0,69) y para náusea 0,75 (IC95%: 0,67-0,84). La severidad de la náusea fue menor y significativa en el grupo OND durante todo el tiempo evaluado (p<0.001). Conclusiones: La dexametasona 4 mg y el ondansetrón 4 mg mostraron eficacia para disminuir el riesgo de náusea y vómito postoperatorio en pacientes sometidas a cesárea bajo anestesia subaracnoidea cuando se usan opioides neuroaxiales. Trial registration: (ISRCTN 57227250). MÉD.UIS. 2018;31(1):31-8.

Abstract Background: Subarachnoid anesthesia is the most common technique for cesarean section and coadjuvant opioids such as morphine and fentanyl have adverse events, predominantly nausea and vomit. A randomized, placebo-controlled trial was performed to evaluate the prophylactic effect of ondansetron and dexamethasone on these events. Objective: To establish the efficacy of ondansetron and dexamethasone in nausea and vomit prophylaxis in patients undergoing cesarean section. Method: A sample of 300 pregnant women was randomized in 3 groups: dexamethasone 4 mg, ondansetron 4 mg, and placebo. Standardized dose of 9 mg of bupivacaine at 0,5% 100 mcg of morphine and 25 mcg of intratechal fentanyl were administered to all patients. Both dexamethasone and ondansetron were compared against placebo. Emergency cesarean section, ASA III and allergic patients to any study drugs were excluded. Nausea and vomiting were evaluated intraoperative, 2, 6 and 24 hours after anesthesia, with a significance level α of 0,05. Results: On dexamethasone group the RR for vomit was 0,46 (CI 95% 0,28 to 0,76) and 0,79 (CI 95% 0, 64-0,96) for nausea. On the ondansetron group, it was 0.41 (CI 95% 0,24- 0,69) for vomit and 0,75 (CI 95% 0,67 a 0,84) for nausea. The severity of nausea was statistically lower on the ondansetron group through the entire follow-up. There was no nausea after 6 hours in the dexamethasone group. Conclusions: Both dexamethasone and ondansetron showed efficacy as a prophylactic treatment against the onset of nausea and vomit in patients undergoing cesarean section with subarachnoid anesthesia and neuroaxial opioids. Trial registration: (ISRCTN 57227250). MÉD.UIS. 2018;31(1):31-8.

Humans , Female , Pregnancy , Adult , Cesarean Section , Anesthesia, Spinal/adverse effects , Efficacy , Clinical Trial , Postoperative Nausea and Vomiting , Anti-Inflammatory Agents , Morphine , Antiemetics
Rev. bras. anestesiol ; 68(1): 42-48, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897799


Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1, Group C getting clonidine 1 and Group D patients receiving dexmedetomidine 0.5 The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable.

Resumo Introdução O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos Este estudo prospectivo, randômico, controlado e duplo-cego foi feito com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 de tramadol (Grupo T), 1 de clonidina (Grupo C) e 0,5 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) do que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor do que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão Dexmedetomidina foi melhor do que tramadol e clonidina para o controle de tremores devido ao seu início de ação mais rápido e à taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis.

Humans , Male , Female , Adult , Shivering/drug effects , Tramadol/therapeutic use , Clonidine/therapeutic use , Dexmedetomidine/therapeutic use , Hypnotics and Sedatives/therapeutic use , Intraoperative Complications/drug therapy , Anesthesia, Spinal/adverse effects , Narcotics/therapeutic use , Double-Blind Method , Prospective Studies
Rev. bras. cir. plást ; 32(4): 556-561, out.-dez. 2017. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-878776


Introdução: O controle da dor é essencial em qualquer evento cirúrgico. A lipoaspiração cursa, em geral, com queixas de dor pós-operatória, o que levanta a discussão acerca da melhor maneira de preveni-la e tratá-la. Dessa forma, estudos indicam que a analgesia deveria começar antes que qualquer estímulo doloroso seja deflagrado a fim de reduzir ou prevenir a dor preemptivamente. A abordagem nas diversas vias álgicas, com combinação de diferentes classes de fármacos ou associação dos bloqueios raquimedular ou epidural com anestesia geral, também pode contribuir para o manejo da dor. Métodos: Estudo descritivo, prospectivo, intervencionista, tipo Coorte, com pacientes submetidas à cirurgia plástica envolvendo lipoaspiração. O procedimento anestésico padrão consistiu na associação de anestesia geral e subaracnóidea. O escalonamento da dor, realizado 6 e 18 horas após o término da cirurgia, utilizou escalas unidimensionais. A ausência de dor ou a presença de dor leve foram consideradas como resultado satisfatório. Resultados: Foram avaliadas 50 pacientes do sexo feminino, com média de 35 anos de idade. Não foi encontrada dor severa em qualquer momento do estudo. Os resultados satisfatórios representaram 94% e 92% das pacientes na avaliação das 6 e 18 horas do pós-operatório, respectivamente (p < 0,001). Conclusões: A anestesia geral venosa combinada com raquianestesia, em cirurgia de contorno corporal, foi capaz de controlar satisfatoriamente a dor no pós-operatório imediato na maioria dos casos (>90%). A lipoaspiração mostrou ser cirurgia de dor controlável nesta casuística.

Introduction: Pain control is essential in any surgical event. Liposuction is, in general, accompanied by complaints of postoperative pain, which raises the discussion about the best way to prevent and treat it. Accordingly, studies indicate that the analgesia should begin before any painful stimulus is triggered in order to reduce or prevent the pain preemptively. The approach of the various pain pathways, with a combination of different classes of drugs or utilization of spinal block or epidural/general anesthesia can also contribute to pain management. Methods: A descriptive, prospective, interventional cohort type study was conducted with patients undergoing plastic surgery involving liposuction. The standard anesthetic procedure consisted of an association between general and spinal anesthesia. The assessment of pain, carried out 6 and 18 hours after the end of the surgery, used unidimensional scales. The absence of pain or the presence of mild pain was considered a satisfactory result. Results: Fifty female patients were evaluated, with an average of 35 years of age. No intense pain was found at any time during the study. Satisfactory results accounted for 94% and 92% of the patients in the assessment at 6 and 18 hours post-surgery, respectively (p < 0.001). Conclusions: Intravenous anesthesia combined with spinal anesthesia, in body contouring surgery, was able to satisfactorily control pain in the immediate postoperative period in most cases (>90%). In this study, liposuction was revealed to be a type of surgery with manageable pain.

Humans , Female , Adolescent , Adult , Middle Aged , History, 21st Century , Pain , Lipectomy , Analgesia , Anesthesia, General , Anesthesia, Spinal , Pain/complications , Pain/drug therapy , Pain, Postoperative/surgery , Pain, Postoperative/drug therapy , Pain, Postoperative/therapy , Lipectomy/methods , Analgesia/methods , Anesthesia, General/adverse effects , Anesthesia, General/methods , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methods
Rev. bras. anestesiol ; 67(4): 404-410, July-aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897742


Abstract Background and objectives: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. Methods: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. Results and conclusions: Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis.

Resumo Justificativa e objetivos: As diretrizes atuais para analgesia neuraxial em pacientes com esclerose múltipla (EM) são ambíguas e oferecem ao clínico apenas uma base limitada para a tomada de decisão. Esta revisão sistemática examina o número de casos nos quais a EM foi exacerbada após analgesia neuraxial central para avaliar racionalmente a segurança desses procedimentos. Métodos: Uma busca sistemática da literatura com as palavras-chave "anestesia ou analgesia" e "epidural, peridural, caudal, espinhal, subaracnóideo ou intratecal" em combinação com multiple sclerosis foi feita nas bases de dados PubMed e Embase à procura de dados clínicos sobre a efeito da analgesia neuraxial central sobre o curso da esclerose múltipla. Resultados e conclusões: Durante um período de 65 anos, nossa busca resultou em 37 relatos com um total de 231 pacientes. Em 10 pacientes, a esclerose múltipla foi agravada e, em nove, a esclerose múltipla ou neuromielite óptica foi diagnosticada pela primeira vez em momento concomitante com a analgesia neuraxial central. Nenhum dos casos apresentou uma clara relação entre causa e efeito. A evidência clínica atual não sustenta a teoria de que a analgesia neuraxial central afeta negativamente o curso da esclerose múltipla.

Humans , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/adverse effects , Multiple Sclerosis/etiology , Risk Factors , Disease Progression
Rev. bras. anestesiol ; 67(3): 305-310, Mar.-June 2017. graf
Article in English | LILACS | ID: biblio-843401


Abstract Introduction Cerebral venous thrombosis (CVT) is a rare but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia and had postoperative headache complicated with CVT. Case report Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged on the eighth day without sequelae. Discussion Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to CVT in some patients with prothrombotic conditions.

Resumo Introdução: A trombose venosa cerebral (TVC) é uma complicação rara, mas grave, após raquianestesia. Está frequentemente relacionada com a presença de fatores predisponentes, como gestação, puerpério, uso de contraceptivos orais e doenças malignas. O sintoma mais frequente é a cefaleia. Descrevemos um caso de um paciente submetido à raquianestesia que apresentou cefaleia no período pós-operatório complicada com TVC. Relato de caso: Paciente de 30 anos, ASA 1, submetido à cirurgia de artroscopia de joelho sob raquianestesia, sem intercorrências. Quarenta e oito horas após o procedimento apresentou cefaleia frontal, ortostática, que melhorava com o decúbito. Foi feito diagnóstico de sinusite em pronto socorro geral e recebeu medicação sintomática. Nos dias subsequentes teve pioria da cefaleia, que passou a ter localização holocraniana e mais intensa e com pequena melhora com o decúbito dorsal. Evoluiu com hemiplegia esquerda seguida de convulsões tônico-clônicas generalizadas. Foi submetido à ressonância magnética com venografia que fez o diagnóstico de TVC. A pesquisa para fatores pró-coagulantes identificou a presença de anticorpo lúpico. Recebeu como medicamentos anticonvulsivantes e anticoagulantes e teve alta hospitalar em oito dias, sem sequelas. Discussão: Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne muito prolongada, deve ser submetido a exames de imagem para excluir complicações mais sérias como a TVC. A perda de líquido cefalorraquidiano leva à dilatação e à estase venosa, que, associadas à tração provocada pela posição ereta, podem, em alguns pacientes com estados protrombóticos, levar à TVC.

Humans , Male , Adult , Venous Thrombosis/etiology , Intracranial Thrombosis/etiology , Post-Dural Puncture Headache/etiology , Anesthesia, Spinal/adverse effects , Venous Thrombosis/complications , Intracranial Thrombosis/complications , Post-Dural Puncture Headache/complications
Säo Paulo med. j ; 135(3): 247-252, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-904081


ABSTRACT BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: NCT02839538.

RESUMO CONTEXTO E OBJETIVO: A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti. MÉTODOS: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (LG) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (SG) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para LG e lidocaína para SG. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos. RESULTADOS: Onze (52,4%) pacientes em LG necessitaram de complementação, e nenhum em SG. A intensidade da dor foi maior para LG até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para SG. Os efeitos adversos foram náuseas, tonturas e retenção urinária. CONCLUSÕES: A intensidade da dor foi maior na LG que na SG nas primeiras 2 horas, porém sem diferenças após 150 e 180 minutos. O tempo para a primeira suplementação foi menor na LG; sem diferenças nas doses de paracetamol e tramadol e efeitos adversos. REGISTRO: NCT02839538.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Pain, Postoperative/prevention & control , Hemorrhoidectomy/methods , Analgesia/methods , Anesthesia, Local/methods , Anesthesia, Spinal/methods , Anal Canal , Postoperative Complications , Reference Values , Subarachnoid Space , Time Factors , Pain Measurement , Prospective Studies , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Hemorrhoidectomy/adverse effects , Analgesics/therapeutic use , Anesthesia, Local/adverse effects , Anesthesia, Spinal/adverse effects , Length of Stay
Rev. bras. anestesiol ; 67(2): 131-138, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-843375


Abstract Objectives: The increase in the prevalence of obesity presents a significant health and economic problem. Obesity has been reported to be a major contributor to variety of chronic diseases. Childhood obesity has been rising over the past decades leading to various complications in health. Millions of infants and children undergo surgery every year on various health grounds. The present investigation was undertaken to evaluate the effect of spinal anesthesia of equipotent doses of ropivacaine and bupivacaine on over-weight neonatal rats. Methods: The Sprague-Dawley rat pups were overfed on high fat diet to induce obesity. Behavioral assessments for sensory and motor blockade was made by evaluating thermal and mechanical withdrawal latencies at various time intervals following intrathecal injections of bupivacaine (5.0 mg·kg-1) and ropivacaine (7.5 mg·kg-1) in P14 rats. Spinal tissue was analyzed for apoptosis by determination of activated caspase-3 using monoclonal anti-activated caspase-3 and Fluoro-Jade C staining. Long-term spinal function in P30 rat pups was evaluated. Results: Exposure to intrathecal anesthesia in P14 increased thermal and mechanical latencies and was observed to increase apoptosis as presented by increase in activated caspase-3 and Fluro-Jade C positive cells. Significant alterations in spinal function were observed in high fat diet-fed pups as against non-obese control pups that were on standard diet. Bupivacaine produced more pronounced apoptotic effects on P14 pups; ropivacaine however produced long lasting effects as evidenced in motor function tests at P30. Conclusion: Ropivacaine and bupivacaine induced spinal toxicity that was more pronounced in over-fed rat pups as against normal controls.

Resumo Objetivos: O aumento da prevalência da obesidade é um problema sério de saúde e econômico. A obesidade tem sido relatada como um dos principais contribuintes para uma variedade de doenças crônicas. A obesidade infantil tem aumentado nas últimas décadas e levado a complicações de saúde. Milhões de bebês e crianças são submetidos a cirurgia todos os anos por diversos motivos de saúde. O presente estudo foi feito para avaliar o efeito da raquianestesia com doses equipotentes de ropivacaína e bupivacaína em ratos recém-nascidos com sobrepeso. Métodos: As crias de ratos Sprague-Dawley foram alimentadas em excesso com dieta rica em gordura para induzir obesidade. Avaliações comportamentais para bloqueio sensorial e motor foram feitas por meio da avaliação das latências de retirada térmicas e mecânicas em vários intervalos de tempo após injeções por via intratecal de bupivacaína (5,0 mg·kg-1) e ropivacaína (7,5 mg·kg-1) em ratos P14. Tecido medular foi analisado para apoptose por determinação da caspase-3 ativada, com o uso de anticorpo monoclonal anti-caspase 3 ativada e ecoloração com Fluoro-Jade C. A função da coluna vertebral em longo prazo em filhotes de ratos P30 foi avaliada. Resultados: A exposição à anestesia intratecal em P14 aumentou as latências térmicas e mecânicas e observamos aumento da apoptose, como apresentado pelo aumento da caspase-3 ativada e células positivas para Fluro-Jade C. Alterações significativas da função da coluna vertebral foram observadas em filhotes alimentados com dieta rica em gordura versus filhotes controles não obesos em dieta padrão. Bupivacaína produziu efeitos apoptóticos mais pronunciados sobre os filhotes P14; ropivacaína, entretanto, produziu efeitos duradouros, como evidenciado nos testes de função motora em P30. Conclusão: Ropivacaína e bupivacaína induziram toxicidade medular mais pronunciada nos filhotes de ratos sobrealimentados do que nos controles normais.

Animals , Male , Female , Rats , Bupivacaine/administration & dosage , Amides/administration & dosage , Anesthetics, Local/administration & dosage , Obesity/complications , Time Factors , Injections, Spinal , Bupivacaine/toxicity , Rats, Sprague-Dawley , Apoptosis/drug effects , Disease Models, Animal , Overweight/complications , Caspase 3/metabolism , Diet, High-Fat , Ropivacaine , Amides/toxicity , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methods , Anesthetics, Local/toxicity , Animals, Newborn
Rev. chil. anest ; 46(2): 80-85, 2017. tab
Article in Spanish | LILACS | ID: biblio-908247


Spinal anesthesia is the technique of choice for patients undergoing cesarean section. One of the most common adverse effects of this technique is arterial hypotension, which if severe, can result in serious maternal and fetal injury or death. Different alternatives exist to prevent and treat hypotension associated to spinal anesthesia; one of them is fluid therapy. The objective of this review is to evaluate the currently available evidence for different fluid therapy alternatives and assess their effectiveness. Nowadays, it does not seem advisable to use preload with crystalloids as evidence suggests its ineffectiveness. As for the other three alternatives (preload with colloids, coload with crystalloids and coload with colloids) there is no superiority among them and neither of them seems effective enough to be used as monotherapy. Due to its safety and ease of use, coload with crystalloids associated to alpha agonist vasopressor therapy seems to be the best management strategy. Further studies should aim at the best way to administer fluids in order to optimize vasopressor therapy.

La técnica anestésica de elección para operación cesárea es la anestesia subaracnoídea. Uno de los principales efectos adversos de esta técnica es la hipotensión arterial, que puede llegar a ocasionar graves complicaciones. Existen diversas alternativas para la prevención y manejo de la hipotensión arterial; una de ellas la fluidoterapia. El objetivo de esta revisión es evaluar la evidencia reciente disponible para las distintas alternativas de fluidoterapia y evaluar su efectividad. Actualmente no parece recomendable el utilizar precarga con cristaloides para la prevención de hipotensión arterial. En cuanto a las otras tres alternativas(precarga con coloides, cocarga con cristaloides o cocarga coloides) ninguna parece ser más efectiva que las otras previniendo hipotensión arterial y ninguna sería efectiva como monoterapia. Por su disponibilidad y seguridad de uso, al día de hoy la cocarga con cristaloides asociada a terapia vasopresora alfa agonista parece ser la mejor alternativa. Estudios futuros debieran apuntar a encontrar la forma de infusión que optimize la terapia con vasopresores.

Humans , Anesthesia, Spinal/adverse effects , Cesarean Section/methods , Fluid Therapy/methods , Hypotension/etiology , Hypotension/prevention & control , Isotonic Solutions
Anaesthesia, Pain and Intensive Care. 2017; 21 (1): 87-89
in English | IMEMR | ID: emr-187467


Opioids such as morphine and fentanyl have been used in neuraxial anesthesia to prolong the analgesic effects since long, but these have frequently been associated with few adverse effects e.g. nausea, vomiting, pruritus and rarely respiratory depression. Tramadol has also been used in epidural as well as spinal anesthesia, and respiratory depression has not been reported with its intrathecal use. We present a case in which 20 mg of intrathecal tramadol produced signs of opioid overdose including respiratory depression. The side effects were reversed with naloxone confirming our suspicion that these were caused by tramadol. We recommend adequate monitoring and vigilance for tramadol as is used for other intrathecal opioids

Adult , Humans , Male , Anesthesia, Spinal/methods , Injections, Spinal , Anesthesia, Spinal/adverse effects , Drug Overdose , Analgesics, Opioid , Narcotic Antagonists/therapeutic use , Respiratory Insufficiency
Rev. bras. anestesiol ; 66(5): 533-535, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: lil-794800


Abstract Subarachnoid haematoma after spinal anaesthesia is known to be very rare. In the majority of these cases, spinal anaesthesia was difficult to perform and/or unsuccessful; other risk factors included antiplatelet or anticoagulation therapy, and direct spinal cord trauma. We report a case of subarachnoid haematoma after spinal anaesthesia in a young patient without risk factors.

Resumo Hematoma subaracnoideo após anestesia espinal é conhecido por ser muito raro. Na maioria desses casos, a anestesia espinal foi difícil de executar e/ou malsucedida; outros fatores de risco incluem terapia anticoagulante ou antiplaquetária e trauma medular direto. Relatamos um caso de hematoma subaracnoideo após raquianestesia em paciente jovem sem fatores de risco.

Humans , Male , Adult , Spinal Diseases/etiology , Subarachnoid Hemorrhage/etiology , Anesthesia, Spinal/adverse effects , Postoperative Complications , Postoperative Complications/etiology , Spinal Diseases/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Magnetic Resonance Imaging
Int. braz. j. urol ; 42(3): 578-584, tab
Article in English | LILACS | ID: lil-785721


ABSTRACT Purpose Postoperative urinary retention (POUR) is one of the most common complications after surgical procedures under spinal anaesthesia. Recent studies have shown the beneficial effects of alpha-adrenergic blockers in preventing POUR. The aim of this prospective study was to investigate and compare the prophylactic effects of tamsulosin and alfuzosin on POUR after urologic surgical procedures under spinal anaesthesia. Materials and Methods A total of 180 males who underwent elective urologic surgery were included in this study. The patients were randomly allocated into three Groups. The Group I received placebo. Patients in Group II were given 0.4mg of tamsulosin orally 14 and 2 hours before surgery. Patients in Group III were given 10mg of alfuzosin ER orally 10 and 2 hours before surgery. All patients were closely followed for 24 hours postoperatively and their episodes of urinary retentions were recorded. Results There were 60 patients in each Group. Their mean age was 35.95±15.16 years. Fifteen patients in Group I (25%), 3 patients in Group II (5%) and 4 patients in Group III (6.7%) required catheterization because of urinary retention. In tamsulosin group and alfuzosin group, there were a significantly lower proportion of patients with POUR compared with the placebo Group (p=0.002 and p=0.006). The beneficial effects of tamsulosin and alfuzosin on POUR were similar between both Groups (p=0.697). Conclusion This study suggests that the use of prophylactic tamsulosin or alfuzosin can reduce the incidence of urinary retention and the need for catheterization after urologic surgical procedures under spinal anaesthesia.

Humans , Male , Adolescent , Adult , Aged , Young Adult , Quinazolines/therapeutic use , Sulfonamides/therapeutic use , Urologic Surgical Procedures, Male/adverse effects , Urinary Retention/prevention & control , Adrenergic alpha-1 Receptor Antagonists/therapeutic use , Pre-Exposure Prophylaxis/methods , Anesthesia, Spinal/adverse effects , Postoperative Complications/prevention & control , Time Factors , Urinary Catheterization , Prospective Studies , Reproducibility of Results , Analysis of Variance , Urinary Retention/etiology , Treatment Outcome , Tamsulosin , Middle Aged
Rev. bras. anestesiol ; 66(1): 86-93, Jan.-Feb. 2016. tab
Article in Portuguese | LILACS | ID: lil-773485


BACKGROUND AND OBJECTIVES: The manufacture of minimally traumatic needles and synthesis of pharmacological adjuncts with safe and effective action on inhibitory and neuromodulatory synapses distributed along the nociceptive pathways were crucial for a new expansion phase of spinal anesthesia. The objectives of this paper are present our clinical experience with 1330 lumbar spinal anesthesia performed with purposeful nociceptive blockade of the thoracic and cervical spinal nerves corresponding to dermatomes C4 or C3; warn about the method pathophysiological risks, and emphasize preventive standards for the safe application of the technique. CONTENT: Review of the historical background and anatomical spinal anesthesia with cervical levels of analgesia. Description of the technique used in our institution; population anesthetized; and surgery performed with the described method. Critical exposition of the physiological, pathophysiological, and clinical effects occurred and registered during anesthesia-surgery and postoperative period. CONCLUSION: Spinal anesthesia with nociceptive blockade to dermatome C4, or C3, is an effective option for surgery on somatic structures distal to the metamer of the third cervical spinal nerve, lasting no more than four or five hours. The method safety depends on the unrestricted respect for the essential rules of proper anesthesia.

JUSTIFICATIVA E OBJETIVOS: A fabricação de agulhas minimamente traumáticas e a síntese de coadjuvantes farmacológicos com ação efetiva e segura nas sinapses inibitórias e neuromoduladoras distribuídas ao longo das vias nociceptivas foram determinantes para uma nova fase de expansão da anestesia subaracnoidea. Os objetivos deste artigo são: apresentar a experiência clínica dos autores com a realização de 1.330 Raquianestesias lombares com bloqueio nociceptivo proposital dos nervos espinhais torácicos e cervicais até os dermátomos correspondentes a C4 ou C3; alertar sobre os riscos fisiopatológicos do método e enfatizar as normas preventivas para a realização da técnica com segurança. CONTEÚDO: Revisão dos fundamentos históricos e anatomofuncionais da anestesia subaracnoidea com níveis cervicais de analgesia. Descrição da técnica utilizada em nossa instituição; da população anestesiada e das cirurgias realizadas com o método descrito. Exposição crítica dos efeitos fisiológicos, clínicos e fisiopatológicos ocorridos e registrados durante o ato anestésico-cirúrgico e no período pós-operatório. CONCLUSÃO: A Raquianestesia com bloqueio nociceptivo até o dermátomo de C4, ou de C3 é uma opção efetiva para cirurgias sobre estruturas somáticas distais ao metâmero do terceiro nervo espinhal cervical com duração não superior a 4 ou 5 horas. A segurança do método depende do respeito irrestrito às regras essenciais da correta prática anestésica.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Anesthesia, Spinal/methods , Anesthetics, Local/administration & dosage , Nerve Block/methods , Thoracic Nerves , Cervical Plexus , Retrospective Studies , Anesthesia, Spinal/adverse effects , Lumbar Vertebrae , Middle Aged , Nerve Block/adverse effects