Spinal phobia: survey results of patient attitudes and preferences regarding anesthesia.

STUDY OBJECTIVE: To determine unbiased patient preferences for either spinal or general anesthesia for upcoming surgeries. DESIGN: Prior to contact with anesthesia personnel, a simple questionnaire was completed by surgical patients to determine their demographic characteristics and previous anesthetic experiences. Their concerns regarding a list of complications of general and spinal anesthesia and their preferences for general or spinal anesthesia if either method could be used were also determined. SETTING: University-affiliated suburban community hospital. MEASUREMENTS AND MAIN RESULTS: The survey was completed by 254 patients. A preference for general over spinal anesthesia was expressed by 80.2% of the patients responding. They expressed significantly more concerns regarding nausea/vomiting, sore throat, feeling sleepy, and death with general anesthesia than with spinal anesthesia. Concerns of back pain, nerve damage and paralysis were statistically related to spinal anesthesia. CONCLUSIONS: This survey shows a strong patient preference for general anesthesia and a phobia for spinal anesthesia.

Ambulatory surgical patient priorities.

With the increasing numbers of ambulatory surgical patients, anesthetic and post anesthetic care priorities have been identified with the goal of providing safe care and a timely discharge. This article focuses on patient selection, anesthetic options, pain management, nausea and vomiting, and discharge priorities. Collaboration between nursing, anesthesia, and surgical personnel is emphasized throughout.

Beneficial impact of epidural anesthesia on recovery after outpatient arthroscopy.

The ideal outpatient anesthetic provides analgesia, is readily reversible, has minimal complications, and allows for a prompt hospital discharge. Iatrogenic side effects, such as nausea/vomiting and pain, however, may hamper patient recovery and delay discharge. The influence of anesthesia [general (G) versus epidural (E)] was assessed in 260 patients (G = 181, E = 79) undergoing ambulatory knee arthroscopic surgery. Patients were studied before discharge and on follow-up (24 h) to evaluate the effect of the anesthetic technique. Discharge times were shorter in the E group (159 +/- 6 min SEM E, compared with 208 +/- 8 min SEM G), as was the incidence of pain (24.1% versus 49.7%), and nausea/vomiting (8.9% versus 32%) before discharge. Patient satisfaction was equal in the two groups. Our study shows that in select patients, epidural anesthesia is a viable alternative to general anesthesia for knee arthroscopy, offering the advantages of fewer side effects and earlier discharge times.

Efficacy of ephedrine in the prevention of postoperative nausea and vomiting.

Although reported in the aerospace literature and anecdotally by anesthesiologists, the putative antiemetic effect of ephedrine remains unquantitated. We therefore prospectively studied ephedrine as an antiemetic agent in the perioperative setting in 97 patients undergoing general anesthesia for outpatient gynecologic laparoscopy. Patients were assigned in a double-blind randomized fashion to receive a standardized general anesthetic followed by an intramuscular dose of either ephedrine (0.5 mg/kg), droperidol (0.04 mg/kg), or saline before the conclusion of surgery. Nausea, retching, or vomiting, as well as the degree of sedation and discharge times, were assessed in the recovery room and for 24 h postoperatively. Ephedrine was found to have a significantly antiemetic effect (P less than 0.05) when compared with placebo and an antiemetic effect similar to that of droperidol. Sedation scores were also significantly less in the ephedrine group than in both placebo and droperidol groups. Finally, variations in mean arterial blood pressure among the three groups were not statistically significant. We conclude that ephedrine is an effective antiemetic agent with minimal sedative side effects in patients undergoing outpatient laparoscopy.

A single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension in an ambulatory surgery unit.

The efficacy of a single bolus dose of esmolol in the prevention of intubation-induced tachycardia and hypertension was studied in a double-blind manner. Thirty patients from the Ambulatory Surgery Unit at Rush-Presbyterian-St. Luke's Medical Center were prospectively randomized to receive a placebo, 100 mg of esmolol, or 200 mg of esmolol immediately prior to induction (2.5 to 3.0 minutes before intubation). The groups were similar in demographic characteristics and with regard to preoperative blood pressure (BP) and heart rate (HR). Anesthetic management was standardized for all patients. Esmolol 100 mg (1.4 +/- 0.3 mg/kg) and 200 mg (2.6 +/- 0.7 mg/kg) significantly (p less than 0.05) blunted the maximum increases in HR and BP following intubation. The average maximum HR increase in the placebo group was 40% as opposed to 16% in the esmolol 100 mg group and 14% in the esmolol 200 mg group. Both esmolol groups blunted the tachycardic response over a 4-minute postintubation time period. The average maximum BP increase was 47% in the placebo group versus 22% and 19% in the esmolol 100 mg and esmolol 200 mg groups, respectively. There were no significant differences between the two esmolol groups. This study demonstrates the efficacy of a single bolus dose of esmolol in blunting the tachycardic and hypertensive responses to laryngoscopy and intubation in an ambulatory surgery setting.

Adverse effects of spinal and epidural anaesthesia.

Spinal and epidural blockade are similar in many respects in the anaesthesia they produce, since they both cause major conduction blockade with local anaesthetic agents. Physiologically, the blockade involves the production of a sympathectomy with venous pooling and decreased venous return, causing decreased cardiac output and hypotension. Physiological complications include bradycardia, heart block and, rarely, cardiac arrest. Nonphysiological complications include high or total block from extensive spread of the local anaesthetic agent, and toxic reactions from inadvertent intravenous injection of local anaesthetic during epidural administration. Neurological complications include paraplegia from either haematoma or abscess, arachnoiditis or trauma. Post-dural puncture headache is a persistent problem that is more pronounced in younger patients. Cranial nerve lesions are rarely seen with spinal anaesthesia. This review covers the adverse effects of spinal and epidural blockade and what can be done to prevent and/or treat them. With attention to proper performance and patient selection, spinal and epidural anaesthesia are safe and efficacious options when choosing anaesthetic technique.

Incidence of hypotension associated with epidural anesthesia using alkalinized and nonalkalinized lidocaine for cesarean section.

The onset of epidural anesthesia is accelerated by alkalinization of lidocaine with added epinephrine (LE). The possibility that decreases in systolic blood pressure (SBP) are also enhanced was studied in 21 patients having elective cesarean sections. Ten patients given LE + NaHCO3 (0.1 mEq/ml anesthetic solution) compared with 11 given LE alone had significantly (P less than 0.05) greater decreases in SBP (32% vs 19% from baseline values), as well as a greater rate of SBP decline to those minimum values (9%/min vs 3%/min, respectively). These differences were noted despite the fact that patients given LE + HCO3 received no less ephedrine and no more additional anesthetic than controls. Possible adverse effects of SBP reduction on uteroplacental blood flow suggest that caution be used in the use of alkalinized LE in obstetrical patients.

Dural sinus thrombosis: a mechanism for pseudotumor cerebri in systemic lupus erythematosus.

We report a young woman with systemic lupus erythematosus complicated by pseudotumor cerebri which resolved with high dosage corticosteroid therapy. The cause of the raised intracranial pressure proved to be thrombosis of the torcular herophili and lateral sinuses. Despite laboratory evidence of a hypercoagulable state, the presence of a lupus anticoagulant could not be shown.