RESUMO
AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or III, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg / kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg · kg
RESUMO
Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.
Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.
Assuntos
Humanos , Masculino , Idoso , Neoplasias Penianas , Neoplasias Penianas/cirurgia , Catéteres , Anestésicos , Dor Pós-Operatória , Psiquiatria , Qualidade de Vida , Transfusão de Sangue , Bupivacaína , Doença das Coronárias , Transtorno Depressivo , Manejo da Dor , Analgesia , Anestesia , Sulfato de MagnésioRESUMO
Objective: To observe the clinical effect of combined spinal epidural anesthesia(CSEA)by using orbital needle in patient-controlled epidural analgesia(PCEA)post cesarean delivery.Methods: 94 puerperas who received cesarean were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were narcotized by using CSEA combined with PCEA.And the observation group adopted a new type of lumbar vertebral combined puncture needle and the control group adopted the traditionally typical lumbar vertebral combined puncture needle.The score of visual analogue scale(VAS)and sedation score of Ramesay of two groups of postoperative 1h,4h,12h,24h and 48h were compared.And the number of times in 48h,the drug dosage and adverse reaction of using analgesia pump also were compared.Results: In postoperative 12 h,the VAS scores of the two groups showed an increasing trend.And the VAS scores of pain of two groups within postoperative 12-48 h decreased gradually.The differences of VAS scores of pain of two groups within postoperative 1-12h and 12-48h between observation group and control group were statistically significant(F=29.596,F=156.366,P＜0.05),respectively.And the VAS scores of pain post operative 4h and 12h of observation group [(2.01±0.51)and(3.49±0.74)]were significantly lower than that of control group [(2.32±0.47)and(3.85±0.69)](t=3.064,t=2.439,P＜0.05),respectively.Within postoperative 1-48h,there were no significant fluctuation in sedation score of Ramesay and the difference of sedation score between the two groups were no significant.And the number of times(11.35±3.04)and drug dosage(65.67± 7.98)mL of using analgesic pump of observation group were significantly lower than that of control group [(20.08±5.32)and(82.07 ± 9.05)mL],(t=9.768,t=9.318,P＜0.05),respectively.Besides,the incidences of postoperative nausea and skin pruritus of observation group(4.26％and 14.89％)were significantly lower than that of control group(17.02％and 34.04％)(x2=4.029,x2=4.663,P＜0.05),respectively.Conclusion: The analgesia effect of orbital needle external needle in implementing CSEA for cesarean delivery is better than that of traditional needle inner needle,and its adverse reactions are less and it is safety.
RESUMO
Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal epidural anesthesia shivering undergoing cesarean section.Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia,who developed shivering Wrench grade 3 or 4,aged 20-35 years,ASA physical status Ⅰ or Ⅱ,were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N,0.07 mg/kg) or tramadol (group T,1 mg/kg) as a slow intravenous bolus for treatment of shivering.Onset of shivering,time interval from treatment to cessation of shivering,success rate,recurrence rate after successon treatment outcome of shivering,OAA/S sedation scores,nausea and vomiting,bradycardia and hypotension were recorded.Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups.Compared with group C,there was statistically significant shorter time interval from treatment to cessation of shiveringin group N [(3.6±1.3) min vs (14.3±7.3) min] and group T [(4.2± 2.2) min vs (14.3±7.3) min],higher success ratein group N (93.3％ vs 16.7％) and group T (90％ vs 16.7％) and lower recurrance ratein group N (7.1％ vs 80.0％) and group T (11.1％ vs 80.0％)(P＜ 0.05).Higher sedation scores in group N were observed (P＜0.05).The incidence of nausea and vomiting was 60.0％ in group T,which was significantly higher than those in group C (20.0％) and group N (13.3％) (P＜0.05).There was no significant difference in the incidence of bradycardia and hypotension in three groups.Conclusion Nalbuphine can control the shivering of post combined spinal epidural anesthesia undergoing cesarean section safely and effectively,which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect.
RESUMO
Objective To observe the effects of general anesthesia and combined spinal epidural anesthesia in elderly patients with lower limb fracture surgery, and to evaluate the effect of postoperative cognitive function and pain score.Methods Retrospective analysis, screening of intraoperative anesthesia, postoperative change lost invalid cases, from November 2012 to October 2015 in our hospital accepted surgical treatment of 180 patients with lower limb fracture surgery were selected according to different patients with different anesthesia methods can be divided into treatment group and control group, 90 cases each group of patients.Patients in the treatment group were treated with combined spinal epidural anesthesia , while the control group received general anesthesia.The incidence of cognitive dysfunction and postoperative pain scores were compared between the two groups. Results the incidence of cognitive dysfunction after surgery in 90 cases of observation group was lower than that of the control group , and the difference was statistically significant (P<0.05).The evaluation of two groups of postoperative chronic pain for 3 days, 6 days, 10 days, 15 days, the incidence rate of VAS score and the character, whether the impact on the daily life and the rest, the patients in the treatment group pain scores were significantly lower than the control group, the difference was significant (P <0.05).Conclusion After lumbar epidural anesthesia in elderly lower limb fracture surgery effect on cognitive function in patients with small, and can reduce the pain of patients, in the actual work according to the actual situation of different specific problems in different specific analysis.
RESUMO
Objective To evaluate the efficacy of different concentrations and small dose of lidocaine of combined spinal epi-dural anesthesia(CSEA) in elderly patients with non-procedure for prolapse and haemorrhoids(PPH) anorectal surgery .Methods One hundred and twenty elderly patients undergoing non-PPH anorectal surgery were selected and randomly dividedin to 4 groups , the group A(1 .5% lidocaine) ,B(1 .0% lidocaine) ,C(0 .8% lidocaine) and D ,30cases in each group .The group A ,B and C adopted CSEA ,and the group D adopted the sacral anesthesia .The changes of mean arterial pressure(MAP) and heart rate(HR) at different time points ,stress reactions before and after operation ,anesthetic operating time ,effect onset time ,postoperative reactivating time , anesthetic grade ,success rate ,postoperative patient satisfaction ,postoperative surgeon satisfaction and urine retention were recor-ded .Results MAP and HR at different time points had no statistical difference among 4 groups(P>0 .05) .The anesthetic onset time and postoperative activity recovery time in the group A ,B and C were significantly less than those in the group D(P<0 .01) . The postoperative activity recovery time in the group A was longer than that in the group B and C .The urine retention time in the group A ,B and C was significantly less than that in the group D (P<0 .05) .The postoperative patient satisfaction and surgeon sat-isfaction in the group A and B were 100% .Conclusion 1% lidocaine CSEA is more suitable for the elderly patients with non-PPH anorectal operation .
RESUMO
Objective To compare the anesthetic effect of ultra-sound guided thoracic paravertebral nerve block and combined spinal-epidural anesthesia in percutaneous nephrolithotomy.Methods For 80 patients in our hospital scheduled for percutaneous nephrolithotomy were randomly divided into two groups with 40 cases each.The patients in group GT were given ultra-sound guided thoracic paravertebral nerve block.And the patients in group G were given combined spinal-epidural anesthesia.Observe and compare the aesthesia effects,the hemodynamic changes during body change in perioperative period,adverse reactions after surgery and complications of two groups.Results Anesthetic effects were not significantly different between two groups (P ＞ 0.05).During body change in perioperative period,the MAP and HR of G group were significantly lower than those of GT group.They had significantly difference (P ＜ 0.05).The adverse reactions after surgery and complications of two group were significantly different between two groups(P ＜0.05).The number of patients who have headache and urinary retention are apparently more group G than in group GT.Conclusion Ultra-sound guided thoracic paravertebral nerve block for percutaneous nephrolithotomy has significant anesthetic effect.Hemodynamics is stable during body change in perioperative period.And there is less complications after surgery.
RESUMO
Objective To study the application of dexmedetomidine in patients with combined spinal epidural anesthesia and its effects on hemodynamics and renin angiotensin aldosterone system (RAAS).Methods96 patients with open surgery under combined spinal epidural anesthesia from Oct.2013 to Oct.2016 in our hospital were selected.Divided into two groups by randomly, the dexmedetomidine group(46 cases) was given dexmedetomidine before anesthesia, the control group(46 cases) was given sodium chloride solution.The operation condition, and the changed of mean arterial pressure (MAP), heart rate, plasma renin activity (PRA), angiotensin II (ANG-II) and aldosterone (ALD) at before anesthesia (T1), post anesthesia 10min (T2), end of the operation (T3) and end of the operation 30 min (T4) were compared.ResultsThere was no significant difference in the operation time, blood loss, intraoperative transfusion, and wake up time between the two groups;there was no significant difference in MAP and heart rate between the two groups at T1, at T2, T3, T4 point, control group MAP, heart rate were significantly changed(P<0.05), and there was no significant change in dexmedetomidine group, at T2,T3,T4 point, the levels of MAP, heart rate in the dexmedetomidine group were lower than the control group(P<0.05);there was no significant difference between the two groups in PRA, ANG-Ⅱ and ALD at T1, at T2 and T3 point, the PRA, ANG-Ⅱ and ALD in the two groups were increased, at T4 point down, there were significant differences compared with the same group at T1(P<0.05);but at T2,T3,T4, the levels of PRA,ANG-Ⅱ,ALD were lower than the control group(P<0.05).ConclusionIn the combined spinal epidural anesthesia with dexmedetomidine before anesthesia, which can Maintain hemodynamic stability, And inhibit the activation of RAAS.
RESUMO
Objective To discuss nicardipin′s influence on post operation cognitive dysfunction (POCD) in senior patient after hip joint replacement operation.Methods 180 senior patient, who received selective unilateral hip joint replacement operation between October 2015 and October 2016 under the condition of combined spinal-epidural anesthesia (CSEA) were randomly divided into Group A (with nicardipine) and Group B (without nicardipine).Nicardipine was only appropriately pumped into vein in time in Group A.MAP was observed and recorded 30 minutes after starting the operation and at the end of the operation.Mini-mental state examination (MMSE) was applied to score the patient one day before, one day, three days and five days after operation, and the number of POCD was recorded.Results Compared with Group B, Group A was obviously lower in MAP level (P<0.05) after 30 minutes.MMSE score of Group A was obviously higher (P<0.01) one day after operation.The number of POCD in Group A was 8 (8.89%) significantly lower than than that of Group B (19, 21.11%).Conclusion Nicardipine could maintain hemodynamic stability of senior patients receiving selective unilateral hip joint replacement operation under the CSEA and prevent POCD to a certain extent.
RESUMO
Objective To study the influence of combined spinal-epidural anesthesia on perioperative coagulation function,RAAS activity and postoperative analgesia effect in parturients with cesarean section.Methods One hundred and eighteen parturients of cesarean section in our hospital from June 2013 to January 2016 were collected and divided into the observation group and control group according to the random number table method,59 cases in each group.The observation group received the combined spinal-epidural anesthesia and the control group received epidural anesthesia.The coagulation function indicators on preoperative 1 d (T0),at 10 min before operation end(T1) and postoperative 6 h (T2) were detected by adopting the automatic blood coagulation analyzer,the renin angiotensin aldosterone system (RAAS) function indices were detectd by radioimmunoassay.The pain indicators at postoperative 6 h(T2),12 h (T3) were detected by the pain threshold test instrument.Results The levels of prothrombin time(PT),activated partial thromboplastin time (APTT) and thrombin time (TT) at T1 and T2 in the observation group were significantly higher than those in the control group,while the PTA level was lower than that in the control group(P<0.05);serum RAAS indices such as (renin),angiotensin Ⅱ(ANG II) aldosterone(ALD) in the observation group were lower than those in the control group(P<0.05).The VAS score at T2,T3 in the observation group was lower than that in the control group,while the pain threshold and pain tolerance threshold levels in the observation group were higher than those in the control group(P<0.05).Conclusion Combined spinal-epidural anesthesia can reduce the blood coagulation and RAAS activation caused by cesarean section trauma,and the effect of postoperative analgesia is more significant.
RESUMO
Objective To analyze the effect of transvaginal total hysterectomy under combined spinal epidural anesthesia. Methods From December 2015 to December 2016, in Longde people's hospital 80 cases underwent transvaginal total hysterectomywere randomly divided into two groups, he observation group and the control group. The control group was treated with continuous epidural anesthesia, the observation group were given combined spinal epidural anesthesia. The anesthesia effect and VAS scores were observed and compared. Results The excellent rate of anesthesia in the observation group was 95%, which was significantly higher than 75% in the control group(P<0.05). 1h after anesthesia, there was no statistically significant difference in the cough and static state VAS scores between the 2 groups; 6 and 12 hours after anesthesia, the cough and static state VAS scores was significantly better than those in the control group(P<0.05). Conclusion Compared with epidural anesthesia, combined spinal epidural anesthesia for vaginal total hysterectomy has a better anesthetic and analgesic effect, anesthesia safety is high, it is worthy of clinical application.
RESUMO
A 30-year-old primigravida with gestational age of 25 weeks and 4 days was admitted for emergency cesarean section. She was diagnosed as pre-eclampsia with fetal distress. We anesthetized the patient through the combined spinal-epidural anesthetic technique, and there was no specific event throughout the surgical procedures and in post anesthetic care unit. Subsequently, she complained of unilateral hearing difficulty in the ward and an otolaryngology consultation was obtained. She was diagnosed with left sudden sensorineural hearing loss in full frequency range after an acoustic examination. She received intravenous and local steroid treatments for 4 weeks. She showed 32 dB on pure tone audiometry after 5 months. However, we could not continue follow-up testing on the patient because she stopped visiting the hospital since the last examination. We reported a case of uncommon unilateral sudden sensorineural hearing loss after a combined spinal-epidural anesthesia for emergency cesarean section.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Acústica , Anestesia , Audiometria , Cesárea , Emergências , Sofrimento Fetal , Seguimentos , Idade Gestacional , Audição , Perda Auditiva , Perda Auditiva Neurossensorial , Otolaringologia , Pré-EclâmpsiaRESUMO
Objective To compare the clinical effects of combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve versus spinal-epidural analgesia in total hip replacement. Methods Fifty cases of total hip replacement were randomly divided into two groups. Patients in group A received combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve,while patients in group B received spinal-epidural analgesia. Results There were no significant differences in preoperative HR, SBP,DBP and SpO2 between the groups(P > 0. 05). Compared with pre-anesthesia data,HR,SBP,DBP in group A were significantly lower during the anesthesia(P 0. 05). Patients′ heart rate in group A showed significant changes compared with that in group B. The differences in HR,SBP and DBP between group A and B at the same time points were significant(P < 0. 05). Superior rate of anesthesia in group B is higher than that in group A(P < 0. 05). Conclusion Combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve has limited influence on the circulatory and respiratory systems,which can be used for total hip replacement.
RESUMO
Objective To compare the effect of different puncture positions in the combined spinal epidural anesthesia (CSEA)in cesarean section.Methods Ninety uterogestation women under-going elective Caesarean section were randomly divided into two groups,45 in each group.L3-4 inter-vertebral space was selected as puncture point.Group R kept right lateral position for two minutes af-ter puncture and turned 30°left tilt supine position until ready for surgery.Group L was turned to su-pine position after left lateral punctured and then turned to 30 left tilt supine position until ready for surgery.1% ropivacaine 1.5 ml+ 10% glucose 0.5 ml was used for spinal anesthesia.The sensory block level and adverse reaction within 1 5 min after the spinal anesthesia were observed,and the neo-natal Apgar score and the pH value of umbilical artery blood were recorded.Results The final block level of the group R was significantly lower than group L,and the time achieving final block height was significantly shorter than that in group L(P <0.05 ).The ephedrine dosage of group R 0 (0-6) mg was significantly lower than that of group L6 (0-12)mg (P <0.05).The PH value of umbilical artery blood in group R was significantly higher than that in group L (P <0.05).There was no sig-nificant difference in neonatal Apgar score.Conclusion In Cesarean section,keeping right lateral puncture position for two minutes after infusion and then turning 30° left tilt supine position can a-chieve better effects than 30°left tilt supine position immediately after puncturing.
RESUMO
Objective To explore the anesthesia effect and influence of combined spinal epidural anesthesia (CSEA)with head -up of 10°on maternal hemodynamics during cesarean section.Methods 120 pregnant women undergoing cesarean section were selected,and were randomly divided into group A,B and C,40 cases in each group. Three groups were all given CSEA,yet pregnant women in group A were taken supine position,group B was taken head-up of 10°,and group C was taken head -up of 20°.Hemodynamic parameters of three groups of the following time points were compared,including before anesthesia(T0 ),5min after anesthesia(T1 ),skin incision(T2 ),fetal disen-gagement immediately(T3 ),and operation at the end(T4 ),also anesthesia effect was recorded,and usage of ephedrine and local anesthetic was noted,and adverse reactions were compared.Results Compared with T0 ,group A's hemody-namics in T1 decreased,including systolic blood pressure (SBP),diastolic blood pressure (DBP),and increased in T2 and T3 ,yet there were no statistical differences on hemodynamics in three groups in T4 .Compared with group B and C,there were statistical differences on hemodynamics in T1 ,T2 and T3 in group A(t =3.63 -7.25,P 0.05). Anesthesia block scores in group A,B and C were (2.0 ±0.3)points,(2.5 ±0.2)points,(2.6 ±0.2)points,and scores of B and C were higher than that in group A(t =3.92,4.01,all P <0.05).Cases and total usage of ephedrine in group A were higher than those of group B and C(χ2 =31.43,50.61,t =16.27,20.17,all P <0.01).Cases of adjusting surgical position,and addition of local anesthetic in group C were significantly higher than those of group B (χ2 =23.85,28.47,all P <0.01).Conclusion It has better anesthetic effect of taking CSEA by head -up of 10°, and maternal hemodynamics are more stable,can better meet operation's requirements,also with easier operation,so it is superior to supine position and head -up of 20°.
RESUMO
Objective To observe the efficacy ,safety and patient acceptance of the artificial airway with the oro‐pharyngo‐laryn‐gead airway cap(OPLAC) for hip replacement surgery in patients with intravenous‐inhalation combined anesthesia .Methods Sev‐enty eight cases of patients receiving the hip replacement surgery were included ,42 patients were to be adopted to establish artificial airway with the OPLAC for intravenous‐inhalation combined anesthesia ,another 36 patients treated with heath side‐lying position hypobaric spinal‐epidural anesthesia .There are two groups ,the oro‐pharyngo‐laryngead airway cap group(OPLAC ,n=42) and hy‐pobaric combined spinal‐epidural anesthesia group (CESA ,n=36) .Monitor the changes of respiratory and circulatory parameters of the two groups before the start of anesthesia ,anesthetic after 10 min ,30 min ,1 h ,and handling marrow ,observing occurrence of complications (delirium ,sore throat ,nausea ,vomiting ,deep vein thrombosis) ,following up the degree of satisfaction of patients and surgeons for anesthesia .Results The respiratory and circulatory parameters of the OPLAC group during anesthesia induction and maintenance were relatively stable ,on the other hand ,significant cyclic inhibition (blood pressure and heart rate decresing ) and re‐spiratory rate declining were observed in the CESA group after anesthesia ,cases with the use of atropine and dopamine significantly more than OPLAC group .The circulation and breath in the OPLAC group were relatively stable when handling marrow ,while cir‐culation fluctuating Significantly in the CESA group (blood pressure decreasing and heart rate increasing ) .The incidence of delirium in the CESA group was significantly higher than OPLAC group .The patient satisfaction of the OPLAC group was significantly bet‐ter than the CESA group .Conclusion The artificial airway with OPLAC for hip replacement surgery in patients with intravenous‐inhalation combined anesthesia is safe ,effective ,and satisfactory .
RESUMO
Objective:To compare the efficacy and safety of ropivacaine and bupivacaine in combined spinal epidural anesthesia in abdominal operation. Methods:Totally 86 abdominal operation patients with combined spinal epidural anesthesia were randomly divid-ed into group A and group B with 43 ones in each. Group A was with ropivacaine anesthesia, while group B was with levobupivacaine anesthesia. The anesthesia effect, hemodynamic changes at different time points and adverse drug reactions were compared between the two groups. Results:The duration of sensory block in the two groups was not statistically different (P>0. 05), while the patients in group A had shorter motor nerve recovery time than those in group B (P0. 05). During the operation, the parameters at different time points in group A had no significant difference from those in group B (P>0. 05). The incidence of adverse drug reaction was not statistically significant between the two groups as well (P>0. 05). Conclusion:Ropivacaine and levobupivacaine show similar blocking effect on the sensory nerve with the same effects on hemodynamics and adverse reactions, however, the blocking effect of ropivacaine on motor nerve is weaker, which is more beneficial to the early exercise of the patients after operation.
RESUMO
Dilated cardiomyopathy (DCM) is a multifactorial disease with enlargement and systolic dysfunction of one or both ventricles. Most of parturients having DCM would be advised to avoid or terminate her pregnancy owing to the high risk of cardiac overload that is likely associated with pregnancy. When maternal cardiac disease is observed, effective neuraxial analgesia may play an important role because a pain induced activation of the sympathetic nervous system during labor is associated with cardiovascular adverse effects, which may endanger the maternal and/or fetal well-being. Herein we report a case of a parturient with known DCM who received combined spinal-epidural anesthesia for labor and vaginal delivery. The maternal cardiac function and the effect of analgesia were evaluated by echocardiography during labor.
Assuntos
Humanos , Gravidez , Analgesia , Anestesia , Cardiomiopatia Dilatada , Ecocardiografia , Cardiopatias , Sistema Nervoso SimpáticoRESUMO
The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy.
Assuntos
Humanos , Anestesia , Anestesia por Condução , Anestesia Geral , Estenose da Valva Aórtica , Débito Cardíaco , Dexmedetomidina , Discotomia , Relaxamento Muscular , Respiração com Pressão Positiva , Decúbito VentralRESUMO
Objective To explore the narcotic effects of different puncture in combined spinal-epidural block anesthesia for urological Surgery.Methods 108 cases of urologic surgery were selected.The patients were randomly divided into the two groups according to digital meter (each group had 54 cases).Both groups were treated with combined spinal-epidural anesthesia.The anesthesia puncture of group A were in lumbar intervertebral 2-3,the anesthesia puncture of Group b were in lumbar intervertebral 3-4.The respects of the two groups were observed and compared such as blood pressure before and after anesthesia,initial anesthesia plane,the time the drug arrived to the sixth thoracic vertebrae,additional lidocaine dose during the operations anesthesia quality rate and anesthesia side effects.Resuits The blood pressures of the patients of group A were significantly lower than those of group B 5 minutes after anesthesia (t =2.73,2.29,2.29,all P ＜ 0.05),the incidence of adverse reactions of Group B such as nausea,vomiting,low blood pressure,difficulty in breathing (24.1％,14.8％),was significantly lower than incidence of group A (44.4％,and 13.0％,x2 =4.97,5.07,4.86,all P ＜ 0.05) the set of initial plane of anesthesia of group a was significantly higher than that of group B (t =2.91,P ＜ 0.05),the time the drug arriving to the sixth thoracic vertebrae,of group A was significantly shorter than group B (t =2.42,P ＜ 0.05) the amounts of additional lidocaine dose of Group A during the operations were significantly less than group A (t =2.61,P ＜ 0.05).There were no significant differences in the anesthesia quality rate (P ＞ 0.05).Conclusion Selecting L3-4 puncture points in combined spinalepidural anesthesia can significantly reduce incidence of adverse reactions such as nausea,vomiting,low blood pressure and difficulty in breathing compared with selecting L2-3 puncture during urology surgery procedure.It can also reduce pain during operations.Though there are significant differences in initial level of anesthesia,the time the drug arrive to the sixth thoracic vertebrae and additional lidocaine doses,leading no effects on superior rate of anesthesia.Thus the clinical significance is not very big.