Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review.

Numerous advantages, including a quick start and consistent anesthesia, are provided by spinal anesthesia, a method often utilized in contemporary medicine for various surgical operations. However, it has some hazards, just like any medical procedure. With an emphasis on identifying and assessing the risk factors associated with administering spinal anesthesia, the review analyzes published literature and clinical investigations carried out in the field of anesthesia. Various key factors, including technique-related procedural and patient-related aspects, can influence the effectiveness of spinal anesthesia. Among these factors are age, sex, body mass index, concurrent conditions (such as cardiovascular disease, diabetes, and respiratory problems), pre-existing neurological issues, allergies, and a history of adverse responses to anesthesia drugs. Additionally, the chance of problems might be increased by physical abnormalities or malformations in the spinal canal and vertebral column. The safety and effectiveness of spinal anesthesia depend significantly on procedural factors, such as the type and dosage of anesthesia agents administered and the patient's position and alignment maintained during the entire surgical procedure and the injection rate. Increased risks can also be caused by inadequate monitoring and a slow response to unfavorable circumstances. Risk factors related to the technique include the expertise and competency of the anesthesiologist or medical professional carrying out the procedure. Inadequate post-procedure monitoring, inadvertent dural puncture, and improper needle placement might lead to complications during or after the spinal anesthesia administration. This review emphasizes the need for a complete preoperative assessment, suitable patient selection, and rigorous procedural planning to reduce the likelihood of problems during the administration of spinal anesthesia. It also emphasizes the significance of ongoing monitoring and timely management of adverse events to guarantee patient safety and the best results. Healthcare professionals may put preventative measures in place and follow best practices to limit possible consequences efficiently by recognizing the risk factors associated with spinal anesthesia. This review helps encourage safer anesthesia practices and improve patient care as medical knowledge and technology advance. However, further study and evidence-based recommendations are required to enhance patient outcomes and risk assessment.

Comparing Sequential vs Simultaneous Tourniquet Inflation in Bilateral Total Knee Arthroplasty.

BACKGROUND: There is little evidence on outcomes of tourniquet use during bilateral total knee arthroplasty (BTKA). Tourniquet use in BTKA effects postoperative outcomes and efficiency inside the operating room. This study evaluates the safety and efficacy of simultaneous tourniquet inflation in BTKA. MATERIALS AND METHODS: A retrospective review was performed on BTKA patients between March 2013 and May 2018. A total of 285 patients were divided into 2 cohorts. Patients in the simultaneous cohort had concomitant elevation of both tourniquets, but the sequential cohort did not. Perioperative variables were collected, and postoperative complications were tracked for a minimum of 90 days. Patients followed a uniform postoperative protocol. Complications were grouped by category to increase statistical power and compared using a noninferiority test. "Clinically noninferior" was defined as a margin ≤5%. RESULTS: The simultaneous cohort had significantly (P < .05) higher American Society of Anesthesiologists class and smokers. Tourniquet time, delta hemoglobin, and surgical time were significantly lower. For the complication categories of "Any Thrombotic Event", "Respiratory", and "Soft Tissue/Wound", the difference in occurrence rates was no more than 2.8%, 2.8%, and 5.2% between cohorts, respectively. The "Cardiovascular (non-MI)" group was no more than 9.3% different, that is, authors are 95% confident that 3 of 4 complication categories meet the clinically noninferior threshold. CONCLUSION: The study demonstrates the noninferiority of simultaneous as compared to sequential tourniquet inflation in BTKA. Patients with cardiac history may need sequential inflation or staged TKA. The information presented in the study assists surgeons in safely and efficiently performing BTKA.

Comparison between two mathematical methods to estimate arterial occlusion pressure and tourniquet effectiveness in lower limb surgery: a prospective, randomized, double blind, comparative study.

The effectiveness of two different methods for calculating the arterial occlusion pressure (AOP) to set tourniquet inflation pressures were assessed in patients underwent knee arthroscopy. Eighty patients were included in this study. Tourniquet inflation pressure was set by adding 20 mmHg of safety margin above the AOP value which was calculated by either the Tuncali et al. formula or Hong-yun Liu et al. formula. Primary outcome measures were the initial and maximum SBP, initial and maximum tourniquet inflation pressure, the secondary outcomes were the surgeon rating of the bloodlessness of the surgical field and tourniquet associated complications. There was significant difference in the initial tourniquet pressure (mmHg); it was 208 ± 12 and 262 ± 18 for group (A) and (B) respectively; also there was significant difference in the maximum tourniquet pressure (mmHg), it was 229 ± 14 and 283 ± 19 for group (A) and (B) respectively. There was no significant difference in the initial SBP-to- tourniquet inflation time, the initial SBP or the maximum SBP between the groups. Also, there was no significant difference in surgeon rating of the bloodlessness of the surgical field, at the start, middle and end of surgery. Hong-yun Liu et al. mathematical formula was found to be less effective than Tuncali et al. formula to estimate the least effective tourniquet pressure in lower limb surgery and we might consider it invalid to be used in the lower limb.Clinical trials registration number: NCT03706859 (Clinicaltrials.gov) and registration date: January, 2019. https://clinicaltrials.gov/ct2/show/NCT03706859.

Tourniquet application during anesthesia: "What we need to know?"

Tourniquets are routinely and safely used in limb surgeries throughout the world. Tourniquet application alters normal physiology. Healthy patients tolerate these physiological changes well, but the physiological changes may not be well-tolerated by patients with poor cardiac function. This review discusses the physiological changes associated with tourniquet use, safe practice and provides the latest updates regarding tourniquet use. A systematic literature search of PubMed, MEDLINE, ScienceDirect, and Google Scholar was done. The search results were limited to the randomized controlled trials and systemic reviews. The papers are summarized in this review.

Pulmonary thromboembolism after tourniquet inflation under spinal anesthesia -A case report-.

Pulmonary thromboembolism is one of the most important causes of morbidity and mortality in patients undergoing lower extremity orthopedic surgery. Early diagnosis and appropriate management are important clinical challenges. In this case, massive pulmonary embolism causing sudden cardiac arrest was attributed to use of tourniquet inflation during lower extremity orthopedic surgery. Resuscitation procedures were initiated and transesophageal echocardiography revealed pulmonary thromboembolism. Patients with high suspicion for the presence of deep vein thrombus must be monitored thoroughly during limb exsanguinations.

Pulmonary thromboembolism after tourniquet inflation under spinal anesthesia: A case report / 대한마취과학회지

Pulmonary thromboembolism is one of the most important causes of morbidity and mortality in patients undergoing lower extremity orthopedic surgery. Early diagnosis and appropriate management are important clinical challenges. In this case, massive pulmonary embolism causing sudden cardiac arrest was attributed to use of tourniquet inflation during lower extremity orthopedic surgery. Resuscitation procedures were initiated and transesophageal echocardiography revealed pulmonary thromboembolism. Patients with high suspicion for the presence of deep vein thrombus must be monitored thoroughly during limb exsanguinations.