Factors associated with urinary retention after vaginal delivery under intraspinal anesthesia: a path analysis model.

INTRODUCTION AND HYPOTHESIS: Women who have intraspinal anesthesia for delivery are more likely to experience postpartum urinary retention (PUR), which, if not recognized and treated promptly, can result in long-term urinary dysfunction. Many factors influencing PUR have been proposed, but no study has been conducted to investigate the relationship between them. This study is aimed at determining the influencing factors of PUR and to explore the relationship between them. METHODS: A prospective, cross-sectional survey using self-made questionnaires was conducted among 372 puerperae in a Grade A hospital in Guangzhou, China, from April to September 2022. SPSS25.0 and AMOS24.0 were used for data analysis, and a path analysis model was established to determine the relationship between the influencing factors. RESULTS: The incidence of PUR was 49.85%. Residence, the level of postpartum pain, and the change of postnatal urination position had a direct effect on PUR. Episiotomy and analgesic duration have both direct and indirect effects on PUR. Forceps delivery, perineal edema and oxytocin had an indirect effect on PUR. Variables could influence the occurrence of PUR by mediating the analgesic duration, episiotomy, postpartum pain level, and postnatal urination position changes. CONCLUSIONS: This study provides an empirical model to illustrate the relationship between PUR and related factors in women who delivered under intraspinal anesthesia. In future management, more attention should be paid to women who live in cities, have higher levels of postpartum pain, longer analgesic duration, higher grade of perineal edema, and received episiotomy, forceps delivery, and oxytocin during labor.

Effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient controlled analgesia in delivery analgesia and its influence on stress reaction and pregnancy outcome / 中国医师杂志

Objective:To investigate the effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient-controlled analgesia (PCA) in labor analgesia, and its influence on stress response and pregnancy outcome.Methods:The general data of 97 parturients who underwent intraspinal PCA delivery analgesia in Chengdu Seventh People′s Hospital from April 2019 to March 2021 were retrospectively analyzed. They were divided into the observation group (51 cases) and the control group (46 cases) according to different analgesia methods. The observation group parturients were given ropivacaine hydrochloride combined with sufentanil intraspinal PCA, and the control group parturients were given ropivacaine hydrochloride intraspinal PCA. The numerical scoring system (NRS) was used to evaluate the pain degree of the parturient before, 15 minutes after, 30 minutes after, 45 minutes after analgesia and when the uterine orifice was fully opened. The onset time of analgesia, the time of perfection of analgesia, the amount of ropivacaine hydrochloride, sufentanil and the total amount of analgesic drugs were counted. The levels of serum cortisol (COR), adrenocorticotropic hormone (ACTH) and Norepinephrine (NA) were detected by enzyme-linked immunosorbent assay (ELISA). The time of the first stage of labor, the active stage, the second stage of labor, and the third stage of labor, the amount of vaginal bleeding (during labor and within 2 hours after delivery), the proportion of oxytocin application, normal labor, forceps delivery, lateral perineum resection, and caesarean section, the occurrence of adverse reactions (itching, fever, nausea and vomiting, urinary retention, and fetal bradycardia), and the Apgar score of newborns (1 min and 5 min after birth) were counted.Results:There was no statistically significant difference in the onset time and improvement time of analgesia between the two groups of postpartum women, as well as the NRS scores before and after analgesia at 15, 30, and 45 minutes, as well as when the cervix was fully opened (all P>0.05). The dosage of Ropivacaine hydrochloride and the total amount of analgesics in the observation group were significantly less than those in the control group (all P<0.05). After analgesia, the serum levels of COR, ACTH, and NA in both groups decreased significantly compared to before analgesia (all P<0.05); After analgesia, there was no statistically significant difference in serum COR, ACTH, and NA levels between the two groups (all P>0.05). The second stage of labor in the observation group was shorter than that in the control group, the vaginal bleeding volume and the proportion of caesarean section were lower than those in the control group, the proportion of normal delivery and the Apgar score 1 min after birth of the fetus were higher than those in the control group, and the difference was statistically significant (all P<0.05). There was no statistically significant difference in the analgesic effect and total incidence of adverse reactions between the two groups of postpartum women (all P>0.05). Conclusions:Ropivacaine hydrochloride combined with sufentanil intraspinal PCA can effectively alleviate labor pain, reduce the amount of analgesics, and improve maternal and fetal pregnancy outcomes.

Potential epidural anesthesia risk of spinal dural arteriovenous fistula diagnosed and evaluated by indocyanine green fluorescence.

A patient was admitted to our hospital and scheduled to receive left knee arthroplasty and right knee arthroscopic debridement under epidural anesthesia. After anesthesia and surgery, the patient developed below T12 sensory perception lost, urinary retention and fecal incontinence. Magnetic resonance examination was conducted. Spinal hematoma, injury and other epidural anesthesia related complications were excluded. Spinal dural arteriovenous fistula (SDAVF) was diagnosed and removed under indocyanine green staining. Indocyanine green staining is a simple and accurate method for the differential diagnosis of spinal dural arteriovenous fistula with spinal complications. It can also be used to judge the accurate location of arteriovenous fistula and evaluate the effect of arteriovenous fistula resection.

Observation of Anesthetic Effect of Dexmedetomidine Combined With Intraspinal Anesthesia in Hip Arthroplasty and its Effect on Postoperative Delirium and Stress Response.

Objective: To observe the anesthetic effect of dexmedetomidine combined with spinal anesthesia in hip arthroplasty, and to analyze the effects of dexmedetomidine on postoperative stress response, incidence of delirium, immune function and inflammatory indicators. Methods: A total of 42 patients who underwent hip replacement in our hospital from March 2020 to June 2021 were selected as the research subjects and randomly divided into the control group and the observation group, 21 cases in each group. The control group was given intraspinal anesthesia, and the observation group was given dexmedetomidine on this basis. The onset time and maintenance time of sensory and motor nerve block were recorded. Stress response indexes [cortisol (Cor), blood glucose (Glu), adrenaline (E), noadrenaline (NE)], T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+), inflammatory indexes [tumor necrosis factor -α (TNF-α) and interleukin-6 (IL-6)] were detected before and after operation, and the incidence of postoperative delirium in both groups was recorded. Results: The onset time of sensory nerve block and motor block in the observation group were lower than those in the control group, and the retention time of sensory nerve block and motor nerve block were higher than those in the control group (P < 0.05). After surgery, the levels of Cor, Glu, E and NE in the observation group were lower than those in the control group (P < 0.05). After surgery, the incidence of postoperative delirium in the observation group (4.79%) was lower than that in the control group (28.57%) (P < 0.05). After surgery, the levels of CD3+, CD4+, CD8+, and CD4+/CD8+ in the observation group were higher than those in the control group (P < 0.05). After surgery, the levels of TNF-α and IL-6 in the observation group were lower than those in the control group (P < 0.05). Conclusion: The combined use of dexmedetomidine and intraspinal anesthesia has good anesthesia effect in hip joint replacement, which can greatly reduce the stress response of patients, reduce the incidence of postoperative delirium, and effectively restore the immune function of patients, reduce the level of inflammatory response, and has high clinical application value.

Comparison of clinical effects of general anesthesia and intraspinal anesthesia on total hip arthroplasty.

OBJECTIVE: To evaluate the clinical effects of general anesthesia and intraspinal anesthesia on total hip arthroplasty. METHODS: A total of 110 patients who underwent unilateral total hip arthroplasty in our hospital were randomly divided into the observation group and the control group, with 55 patients in each group. The observation group was given intraspinal anesthesia, while the control group was given general anesthesia. The excellent anesthesia rate, intraoperative blood pressure, intraoperative heart rate, observation time in the postoperative recovery room, the incidence of complications and hospitalization time were observed and compared between the two groups. RESULTS: Compared with the control group, the excellent anesthesia rate of the observation group increased (P<0.05). The observation time in the postoperative recovery room, intraoperative blood pressure, intraoperative heart rate and incidence of complications in the observation group were lower than those in the control group (all P<0.05). The hospitalization time of the observation group was significantly shorter than that of the control group (P<0.05). CONCLUSION: Intraspinal anesthesia in total hip arthroplasty can significantly improve the excellent anesthesia rate, help maintain the intraoperative blood pressure and heart rate and reduce the observation time in the postoperative recovery room, incidence of complications and hospitalization time of patients, which can be recommended in clinical application.

Remifentanil for Carboprost-Induced Adverse Reactions During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia.

PURPOSE: Carboprost may induce adverse reactions when used to treat postpartum hemorrhage. We aimed to explore the effects of intravenous infusion of low-dose remifentanil to prevent such reactions. METHODS: We enrolled parturient patients scheduled for elective cesarean section. Anesthesiologist administered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine subarachnoid space injections (1.5-2.5 ml). We randomly divided parturient patients, administered carboprost during surgery, into the remifentanil group (group R) and the control group (group C). Patients in group R received an intravenous target-controlled infusion of remifentanil (target effect-site concentration, 1.5 ng/ml) simultaneously with a carboprost tromethamine injection (250 µg). Patients in group C received a normal saline infusion with carboprost. We recorded and analyzed the incidence of carboprost-related adverse reactions (vomiting, nausea, chest congestion, flushing, hypertension, tachycardia, cough, and shivering), and assessed patient comfort using a numerical rating scale ([NRS], on which 0 was very uncomfortable and 10 was very comfortable). RESULTS: After applying inclusion and exclusion criteria, we conducted statistical analysis of the data from 70 women. The incidence of vomiting was significantly lower in group R than in group C (14.3 vs. 51.4%, p < 0.01); and the incidence of nausea, chest congestion, facial flushing, and hypertension were significantly lower in group R than in group C (all p < 0.01). Furthermore, the patients' comfort scores were significantly higher in group R than in group C (8.0 ± 1.8 vs. 3.6 ± 2.1, p < 0.01). CONCLUSION: Our results demonstrate that an intravenous low-dose remifentanil infusion can effectively prevent carboprost-related adverse reactions during cesarean delivery under combined spinal and epidural anesthesia. CLINICAL TRIAL REGISTRATION: We pre-registered this study at http://www.chictr.org.cn/showproj.aspx?proj=27707 (ChiCTR1800016292).

Sedative Effect of Dexmedetomidine in Elderly Patients Undergoing Spinal Anesthesia / 中国药师

Objective:To analyze the sedative effect of dexmedetomidine in the elderly patients with intraspinal anesthesia .Meth-ods:Totally 52 elderly patients with intraspinal anesthesia were randomly divided into the observation group (26 cases) and the control group (26 cases).After anesthetized successfully , the patients in the control group were given normal saline with intravenous pum-ping,while those in the observation group were given dexmedetomidine with intravenous pumping .The levels of blood pressure , RR, SpO2and HR, the Ramsay sedation score and the adverse reactions of the two groups before anesthesia (T0),10 min after anesthesia (T1),30 min after anesthesia (T2),60 min after anesthesia (T3) and at the end of operation (T4) were compared.Results:The lev-els of RR, SpO2 and HR in the two groups were maintained within the normal range , while the levels of SBP ,HR at T2 and T3 were sig-nificantly lower than those at T 0 in the observation group , and also lower than those at the same time point in the control group ( P<0.05).The Ramsay sedation score from T2 toT4 were significantly lower than that at T0 in the observation group, and also lower than that at the same time point in the control group (P<0.05).The incidence of adverse reactions in the observation group was obviously lower than that in the control group .Conclusion: Dexmedetomidine used in the elderly patients with intraspinal anesthesia can keep hemodynamic stability and exhibits adequate sedation with significantly reduced adverse reactions , which is worthy of clinical promo-tion.

The effects of preoperative education via WeChat video on surgery in patients with intraspinal anesthesia / 中国实用护理杂志

Objective To explore the effect of preoperative education via WeChat video on surgery in patients with intraspinal anesthesia. Methods Totally 160 patients with intraspinal anesthesia enrolled from February to November,2016 were divided into experimental group(80 patients)and control group(80 patients)by random digits table method.The control group was given routine preoperative care, while the experimental group was added preoperative animations education via WeChat. Postoperative satisfaction,anesthesia cooperation degrees,anxiety scores and operation stop/delay rates were recorded. Results The satisfaction rate was 96.3%(77/80)and 80.0%(64/80)in the experimental group and the control group, there was significant difference between the two groups(x2= 8.60, P <0.05). Anesthesia coordination degree was 94.9% (74/78) and 86.8% (66/76) in the experimental group and the control group, there was significant difference between the two groups (x2= 5.13, P<0.05). Surgical shutdown/extension rate was 2.5%(2/80)and 12.5%(10/80)in the experimental group and the control group,there was significant difference between the two groups (x2= 4.41, P<0.05). The postoperative anxiety scores before visit in the experimental group and the control group were(63.35±5.76)and(63.66±6.61)points, there was no significant difference between the two groups (P>0.05). After visit, the S-AI scores in the experimental group and the control group were(44.23±5.96)and(49.23±5.85)points,there was significant difference between the two groups(t=2.21, P<0.01). Conclusions Preoperative education via WeChat video can reduce patients' anxiety, lower operation stop rate, increase patient's anesthesia cooperation degree,improve the operation quality and ensure the operation smoothly.

Analysis of the risk factors of shivering after intraspinal anesthesia / 中国基层医药

Objective To explore the risk factors of shivering after intraspinal anesthesia.Methods 640 anesthesia recovery patients after intraspinal anesthesia from February 2011 to May 2015 were selected as the research subjects.According to whether patients appeared shivering,they were divided into research group and control group.The research group had 328 cases of appearing shivering,the control group had 312 cases without shivering. Basic clinical data of patients,operation time and blood loss,tympanic membrane temperature,anesthesia,anesthesia blocks plane indicators were compared to explore the risk factors of shivering after intraspinal anesthesia.Results This study included 640 cases,including 328 cases with chills reaction,the incidence rate was 51.25%.Single factor results showed that the low age,male,central cooler,surgery for a long time,the bleeding of more lumbar hemp,choice of anesthetic methods and anesthetic plane above T8 indicators, there were close relationship with shivering after intraspinal anesthesia,the differences between the two groups were statistically significant (χ2 =40.661,17.208, 32.369,32.931,36.624,14.844,26.84,all P<0.05).Multivariable logistic regression analysis results showed that age,gender,core body temperature,operation time,blood loss,spinal canal anesthesia methods and indexes of anes-thetic plane were important risk factors of chills reaction after anesthesia in patients with spinal canal anesthesia (OR=1.843,1.925,2.183,0.548,0.497,0.529,0.743,all P<0.05).Conclusion Male,younger age,operation for a long time,big intraoperative blood loss,tympanic membrane temperature low mode selection subarachnoid block anesthesia,and the anesthesia plane factor are the main risk factors of spinal canal anesthesia patients to appear chills response,the above factors are needed for close monitoring of patients with intraspinal anesthesia in the preoperative period.

Clinical observation of different ways of anesthesia in patients undergoing percutaneous nephrolithotomy / 中国医师进修杂志

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.