RESUMO
This study was designed to evaluate the anesthetic, analgesic and side effects of spinal, epidural and combined spinal-epidural anesthesia with the addition of morphine for lumbar laminectomy. A total of 66 patients undergoing lumbar laminectomy were included in the present study of whom 64 completed the study. Patients were randomly divided into three groups: (i) spinal anesthesia - the SA group; (ii) epidural anesthesia - the EA group; and (iii) combined spinal-epidural anesthesia - the CA group. Demographical data, surgical times and peak sensory levels of groups were similar. Heart rate, mean arterial pressure, and peripheral oxygen saturation did not differ between the three groups. No differences were observed intraoperatively in Ramsey sedation scale (RSS) scores between the groups, but postoperatively, although RSS scores were similar for the EA and CA groups, they were significantly lower for the SA group. The postoperative visual analogue scale pain scores were higher in the SA group compared to the EA and the CA groups except for the second postoperative hour. Time-to-use of the first patient controlled analgesia was similar for all groups. The total consumption of morphine over the 24-hour study period was significantly higher in the SA group compared to the EA and the CA groups. Postoperative nausea and vomiting frequencies were higher in SA group, but pruritus frequency was lower than the EA and the CA groups. In conclusion, although spinal, epidural, and combined spinal-epidural anesthesia are adequate and effective for lumbar laminectomies, epidural and combined spinal-epidural anesthesia techniques are more effective than spinal anesthesia for postoperative analgesia and sedation with lesser side effects.
Assuntos
Analgesia Epidural/métodos , Analgésicos Opioides , Anestesia Epidural/métodos , Raquianestesia/métodos , Laminectomia/métodos , Região Lombossacral/cirurgia , Morfina , Bloqueio Nervoso/métodos , Coluna Vertebral/cirurgia , Adolescente , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Controlada pelo Paciente , Analgésicos Opioides/efeitos adversos , Anestesia Epidural/efeitos adversos , Raquianestesia/efeitos adversos , Anestésicos Locais , Pressão Sanguínea/fisiologia , Bupivacaína , Sedação Consciente , Feminino , Frequência Cardíaca/fisiologia , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Morfina/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Consumo de Oxigênio/fisiologia , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/epidemiologia , Prurido/induzido quimicamente , Prurido/epidemiologia , Adulto JovemRESUMO
Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.
