Effect of prolonged lateral position for 10-minutes following spinal anesthesia on hypotension and sensory blockade during cesarean delivery

BACKGROUND: During cesarean delivery, hypotension is a frequently occurring adverse effect following spinal anesthesia. Our hypothesis was that hypotension could be avoided or delayed with a lateral decubitus position for 10 minutes after intrathecal injection, by reducing the detrimental effects of the aortocaval compression. METHODS: Spinal anesthesia was performed in the lateral decubitus position with 8 mg of 0.5% hyperbaric bupivacaine and 15 µg of fentanyl. Forty-one patients undergoing elective cesarean delivery were randomly assigned to one of two groups. In the experimental group, patients were maintained in the lateral position for 10 minutes following intrathecal injection (group Decubitus). In the control group, patients were repositioned to supine immediately after the injection (group Supine). Incidence of hypotension, the required dose of ephedrine, and characteristics of the sensory blockade, were subsequently investigated. RESULTS: The incidence of hypotension, the incidence of nausea, and total amount of ephedrine, were not statistically different between the two groups. In group Decubitus, the onset of hypotension was delayed significantly (5.6 ± 1.7 min vs. 13.8 ± 1.7 min, P < 0.001), and the maximal blockade level was more cephalad (T3 [T1–T4] vs. T4 [T3–T5], P < 0.001) when compared to that of group Supine. Apgar scores were comparable in both groups. CONCLUSIONS: Maintaining the lateral position for 10 min following intrathecal injection during cesarean delivery did not influence the incidence of maternal hypotension. However, it caused delayed onset of hypotension and higher cephalad spread of sensory block.

Monitored anesthesia care in and outside the operating room / 대한마취과학회지

Monitored anesthesia care (MAC) is an anesthesia technique combining local anesthesia with parenteral drugs for sedation and analgesia. The use of MAC is increasing for a variety of diagnostic and therapeutic procedures in and outside of the operating room due to the rapid postoperative recovery with the use of relatively small amounts of sedatives and analgesics compared to general anesthesia. The purposes of MAC are providing patients with safe sedation, comfort, pain control and satisfaction. Preoperative evaluation for patients with MAC is similar to those of general or regional anesthesia in that patients should be comprehensively assessed. Additionally, patient cooperation with comprehension of the procedure is an essential component during MAC. In addition to local anesthesia by operators or anesthesiologists, systemic sedatives and analgesics are administered to provide patients with comfort during procedures performed with MAC. The discretion and judgment of an experienced anesthesiologist are required for the safety and efficacy profiles because the airway of the patients is not secured. The infusion of sedatives and analgesics should be individualized during MAC. Many procedures in and outside of the operating room, including eye surgery, otolaryngologic surgery, cardiovascular procedures, pain procedures, and endoscopy are performed with MAC to increase patient and operator satisfaction.

Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

The neuroprotective effect of combining sevoflurane and remote ischemic preconditioning in forebrain ischemia model

BACKGROUND: The aim of this study was to investigate the combining effects of sevoflurane and remote ischemic preconditioning (RIPC) on cell death of pyramidal neurons in the CA1 hippocampus induced by transient global cerebral ischemia in rats. METHODS: Twenty rats were assigned to one of two groups; sevoflurane group and combination of sevoflurane and RIPC group. RIPC was performed by occluding the bilateral femoral arteries for 10 min 3 times in an interval of 10 min. Ischemia was induced by a bilateral common carotid artery occlusion plus hemorrhagic hypotension (26-30 mmHg) and was maintained for 8 min. Histologic outcomes were measured at 7 days after ischemia in CA1 pyramidal cells of the rat hippocampus. RESULTS: The combination group contained significantly more viable cells in the hippocampal CA1 area than sevoflurane group (71% vs. 46%, P = 0.03). The mean percentage of apoptotic cells was significantly reduced in the combination group compared to sevoflurane group (11% vs. 41%, P = 0.014). CONCLUSIONS: A combination of sevoflurane and RIPC can offer additional neuroprotective effects after transient global cerebral ischemia in rats.

The neuroprotective effect of colloids in forebrain ischemia model

BACKGROUND: The aim of this study was to investigate the neuroprotective effects of colloids (albumin and pentastarch) after forebrain global ischemia in rats. METHODS: Thirty male Sprague-Dawley rats were randomly assigned to three groups; control, albumin and pentastarch group (each n = 10). Forebrain ischemia was induced by bilateral common carotid artery occlusion plus hemorrhagic hypotension. The control group received no treatment. The albumin group received 5 ml/kg of 20% albumin after ischemia. The pentastarch group received same volume of albumin after ischemia. Histologic outcomes were measured at 7 days after ischemia in CA1 pyramidal cells of the rat hippocampus. RESULTS: The mean percentage of viable cells in the hippocampal CA1 area was significantly higher in the albumin (47%) compared with the control group (33%) or pentastarch group (33%) (P = 0.001). The percentage of apoptotic cells was significantly lower in the albumin (30%) group than that in the pentastarch (44%) or control group (49%) (P = 0.006). CONCLUSIONS: This study shows that albumin can improve histologic outcomes after forebrain global ischemia compared with pentastarch.

Application of the continuous autotransfusion system (CATS) to prevent transfusion-related hyperkalemia following hyperkalemic cardiac arrest in an infant: A case report / 대한마취과학회지

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K+) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K+ concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.