Continuous spinal anaesthesia using a standard epidural set for lower limb orthopedic procedures in high risk elderly patients

We studied 60 elderly Patients undergoing lower limb orthopedic procedures classified as ASA III or IV. Lumbar continuous spinal anaesthesia [CSA] was performed using a 20 G epidural catheter through an 18 G Tuohy needle. Small local anaesthetic boluses of isobaric bupivacaine [0.5%] was injected to achieve the desired sensory level of anaesthesia. Demographic data, anaesthetic duration, local anaesthetic doses, sensory level to pinprick, Arterial blood pressure, heart rate, use of systemic sympathomimetics and complications were recorded. Sensory level was between TB-T12, maximal decrease in systolic, diastolic BP and heart rate was 30 +/- 12.5%, 16.8 +/- 9.5% and 15.6 +/- 5.8% respectively. IV ephedrine used in 25% of our patients. While postdural puncture headache [PDPH] occurred in 1,66% of cases. No postanaesthetic neurological deficit was recorded. We conclude that CSA using a standard epidural set and isobaric bupivacaine is feasible for L.L. surgery in high-risk elderly patients

dose-response study of peribulbar anaesthesia using mixture of local anaesthetic and vecuronium in the eldery: evaluating oxygen saturation and akinesia of the globe

The aim of this double blind randomized study was to evaluate the effect of adding 1mg vecuronium bromide to the standard local anaesthetic solution compared to a dose of 0.5 mg vecuronium bromide added to the same local anaesthetic mixture used for peribulbor anaesthesia evaluating the akinesia of the globe and oxygen saturation in eldery people undergoing elective cataract surgery. 60 patients were included In the study, all received a mixture of 5m 12% lignocain with 1:200000 adrenaline. 5ml 0.5% bupivecaine and 150 international units hyaluronidase with either 1mg vecuronium [group I, n = 30] or 0.5 mg vecuronium group [n = 30]. Eye movement assessed at both 5 and 10 minutes were significantly reduced in group I compared to group II [p < 0.05]. There were no significant difference between the 2 groups with regards to the oxygen saturation measured throughout the procedure and the next postoperative 2 hours. We concluded that adding 1mg vecuronuim to local anaestbetic mixture was superior to 0.5 mg vecuroriuim as reginds the akinesia of the globe and without any harmful side effects on the respiratory function represented by the oxygen saturation