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Coral G, Ayala M. Cervical Epidural Anesthesia Combined with Sedation for Neck Cancer Surgery: A Case Report. A A Pract 2024; 18:e01775. [PMID: 38572891 DOI: 10.1213/xaa.0000000000001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Cervical epidural anesthesia (CEA) is a well-established technique and is suitable for various surgeries, including carotid, thyroid, airway, neck cancer, breast, and upper limb procedures. We report the case of an elderly woman with a recurrent neck mass secondary to metastatic papillary thyroid carcinoma causing neurovascular compression, who underwent surgery under CEA. Five milliliters of 0.5% bupivacaine and 5 mL of 2% lidocaine (total 10 mL) were administered into the cervical epidural space. Combined with sedation, CEA in our case provided optimal anesthetic conditions, maintaining spontaneous ventilation, preventing airway collapse, ensuring patient comfort, and facilitating surgery.
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Affiliation(s)
- Gina Coral
- From the Department of Anesthesiology, Hospital Universitario San José Infantil, University Foundation Health Sciences, Bogotá, Colombia
| | - Marcela Ayala
- Department of Anesthesiology, University Foundation Health Sciences, Bogotá, Colombia
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Choi DY, Lee SE, Lee MW, Lee KH, Kang E, Kwon JY, Lee HS, Kim DC. Prediction of the Cervical Epidural Space Depth from the Skin Using Cervical X-Ray, During Cervical Epidural Block with Paramedian Approach. J Pain Res 2023; 16:2079-2090. [PMID: 37351196 PMCID: PMC10284158 DOI: 10.2147/jpr.s409347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
Objective The purpose of this study is to compare the actual needle depth measured during cervical epidural block (CEB) with the predicted needle depth measured through a cervical flexion x-ray image at the paramedian approach. Methods The study was conducted based on the medical records of patients who underwent CEB at the pain clinic of Haeundae Paik Hospital. The actual needle distance (AD) was recorded after each successful CEB. The distance from the spinolaminar line to the skin, predicted median depth (PMD), was measured using lateral x-ray images. The medial to lateral distance (MLD), which is the distance from the midline of the spine to the needle insertion point, was measured using anteroposterior (AP) x-rays. The predicted paramedian depth (PPD) was calculated using the Pythagorean formula. The PMD represents the expected depth of the median approach, while the PPD represents the expected depth of the paramedian approach. The PMD, PPD, and AD were compared with each other. Results Concordance correlation coefficient (CCC) and Bland-Altman analysis were obtained for PMD and PPD. The CCC value of PMD was measured as 0.829, and the CCC value of PPD was measured as 0.830. In the Bland-Altman analysis, PPD was measured at -0.13 ± 8.37 mm, and PMD was measured at 1.29 ± 8.38 mm. Conclusion When performing CEB through the paramedian approach, the depth can be predicted using a cervical flexion x-ray. At this time, the PMD can also be used to predict the depth during the paramedian approach.
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Affiliation(s)
- Dae Yun Choi
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Sang Eun Lee
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Min Woo Lee
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Ki Hwa Lee
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Eunsu Kang
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Ji Yeon Kwon
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Hyun-Seong Lee
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
| | - Dong-chun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, South Korea
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Zetlaoui PJ, Buchheit T, Benhamou D. Epidural blood patch: A narrative review. Anaesth Crit Care Pain Med 2022; 41:101138. [DOI: 10.1016/j.accpm.2022.101138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
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Shanthanna H, Mendis N, Goel A. Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations. Br J Anaesth 2016; 116:192-207. [PMID: 26787789 DOI: 10.1093/bja/aev453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cervical epidural analgesia (CEA) is an analgesic technique, potentially useful for surgeries involving the upper body. Despite the inherent technical risks and systemic changes, it has been used for various surgeries. There have been no previously published systematic reviews aimed at assessing its clinical utility. This systematic review was performed to explore the perioperative benefits of CEA. The review was also aimed at identifying the rationale of its use, reported surgical indications and the method of use. We performed a literature search involving PubMed and Embase databases, to identify studies using CEA for surgical indications. Out of 467 potentially relevant articles, 73 articles were selected. Two independent investigators extracted data involving 5 randomized controlled trials, 17 observational comparative trials, and 51 case reports (series). The outcomes studied in most comparative studies were on effects of local anaesthetics and other agents, systemic effects, and feasibility of CEA. In one randomized controlled study, CEA was observed to decrease the resting pain scores after pharyngo-laryngeal surgeries. In a retrospective study, CEA was shown to decrease the cancer recurrence after pharyngeal-hypopharyngeal surgeries. The limited evidence, small studies, and the chosen outcomes do not allow for any specific recommendations based on the relative benefit or harm of CEA. Considering the potential for significant harm, in the face of better alternatives, its use must have a strong rationale mostly supported by unique patient and surgical demands. Future studies must aim to assess analgesic comparator effectiveness for clinically relevant outcomes.
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Affiliation(s)
- H Shanthanna
- Department of Anaesthesiology, St Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - N Mendis
- Resident, Department of Anaesthesiology, University of Ottawa, Ottawa, ON, Canada
| | - A Goel
- Resident, Department of Anesthesiology, University of Toronto, Toronto, ON, Canada
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Menon M, Taha N, Purohit N, Kothari V, Singh S. Continuous Cervical Epidural Analgesia in Metastatic Spinal Cord Compression. Indian J Palliat Care 2016; 22:507-510. [PMID: 27803576 PMCID: PMC5072246 DOI: 10.4103/0973-1075.191860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Metastatic spinal cord compression is a devastating complication of cancer. Patients may often require high doses of opioids that may cause side effects, myoclonus being one such. A 63-year-old male suffering from malignant spinal cord compression was admitted to our institution. The primary team managed him conservatively with pharmacotherapy with no relief of pain, and he experienced myoclonus and sedation as adverse effects. A continuous cervical epidural catheter with local anesthetic infusion was inserted for 5 days to control his pain. This relieved his pain, which was sustained even after we removed the epidural catheter on day 5, for up to 64 days until the time of his death. Continuous cervical epidural local anesthetic infusions may help with refractory pain by deafferentation of noxious stimuli. Central neuraxial blocks may be a valuable rescue in selected patients.
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Affiliation(s)
- Mahesh Menon
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Nafisa Taha
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Navita Purohit
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Vatsal Kothari
- Department of Critical Care Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Shweta Singh
- Department of Critical Care Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Dionigi G, Bacuzzi A, Rovera F, Boni L, Piantanida E, Tanda ML, Castano P, Annoni M, Bartalena L, Dionigi R. Shortening hospital stay for thyroid surgery. Expert Rev Med Devices 2014; 5:85-96. [DOI: 10.1586/17434440.5.1.85] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yepes Temiño MJ, Lillo Cuevas M. [Anesthesia for carotid endarterectomy: a review]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:34-41. [PMID: 21348215 DOI: 10.1016/s0034-9356(11)70695-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cardiovascular diseases are associated with high rates of morbidity and mortality. Carotid artery stenosis causes between 20% and 25% of ischemic strokes, especially when an embolism is the underlying cause. Carotid endarterectomy is the treatment of choice when stenosis exceeds 60%. It is important to have an understanding of how to manage perioperative factors that can decrease the risk of stroke, infarction, and death. In contrast to the findings of earlier meta-analyses, the recent GALA trial of general versus local anesthesia concluded that the rates of stroke, myocardial infarction, and mortality during or soon after surgery are similar for both types of anesthesia.
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Affiliation(s)
- M J Yepes Temiño
- Departamento de Anestesiología y Reanimación de la Clínica Universidad de Navarra, Clínica Universidad de Navarra, Pamplona.
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Dionigi G, Bacuzzi A, Bertocchi V, Carrafiello G, Boni L, Rovera F, Dionigi R. Safe incorporation of new technologies in thyroid surgery. Expert Rev Med Devices 2009; 5:747-58. [PMID: 19025350 DOI: 10.1586/17434440.5.6.747] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between the years of 1873 and 1910. In general the essential objectives for thyroidectomy are: sparing the parathyroid glands, avoidance of injury to the laryngeal nerves, an accurate hemostasis and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery. These include mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia, intraoperative neuromonitoring, parathyroid hormone assay technology and genetic screening. This paper reviews the relevant medical literature published on the influence of these new technologies on the quality of thyroid surgery, as well as prevention of postoperative morbidity and mortality. Searches were last updated in April 2008.
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Affiliation(s)
- Gianlorenzo Dionigi
- Center of Endocrine Surgery, Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitario, Fondazione Macchi, Varese, Italy.
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Bacuzzi A, Dionigi G, Del Bosco A, Cantone G, Sansone T, Di Losa E, Cuffari S. Anaesthesia for thyroid surgery: perioperative management. Int J Surg 2008; 6 Suppl 1:S82-5. [PMID: 19195946 DOI: 10.1016/j.ijsu.2008.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this review is to analyse anaesthesiologic preoperative assessment, intraoperative management and postoperative complications of patients with thyroid disease. A special care is paid to difficult airway recognition and resolving this situation. Anaesthetist's and surgeon's point of view of perioperative and postoperative complications is both discussed with special interest on early surgical complications and the need for urgent anaesthetic treatment. Particularly total intravenous anaesthesia and recurrent laryngeal nerve monitoring actually are two end-points in the thyroid surgery.
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Affiliation(s)
- Alessandro Bacuzzi
- Department of Anaesthesia and Palliative Care, Azienda Ospedaliero-Universitaria, Fondazione Macchi, Varese, Italy.
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Nishi M, Usukaura A, Kidani Y, Tsubokawa T, Yamamoto K. Which Is a Better Position for Insertion of a High Thoracic Epidural Catheter: Sitting or Lateral Decubitus? J Cardiothorac Vasc Anesth 2006; 20:656-8. [DOI: 10.1053/j.jvca.2006.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Indexed: 11/11/2022]
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Dionigi G, Bacuzzi A, Boni L, Rovera F, Piantanida E, Tanda ML, Diurni M, Carcano G, Luigi B, Cuffari S, Dionigi R. Influence of new technologies on thyroid surgery: state of the art. Expert Rev Med Devices 2006; 2:547-57. [PMID: 16293066 DOI: 10.1586/17434440.2.5.547] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between 1873 and 1910. In general, the essential objectives for thyroidectomy are conservation of the parathyroid glands, avoidance of injury to the recurrent laryngeal nerve, an accurate hemostasis and an excellent cosmesis. In the last 20 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these are mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia and intraoperative neuro-monitoring.
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Affiliation(s)
- Gianlorenzo Dionigi
- University of Insubria, Department of Surgical Sciences, Azienda Ospedaliero-Universitario, Fondazione Macchi, Viale Borri, 57, 21100 Varese, Italy.
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Abstract
The primary result of this series is that each patient participated actively during his or her procedures. The concept of selective sensory block, therefore, which was the authors' overriding reason for using CEA in secondary tendon surgery, also may be beneficial to tetraplegic patients. Nystrom and Nystrom [2] also came to this conclusion. The use of CEA in tetraplegia is and must be used only in exceptional cases. If the usual surgical techniques seem to be inadequate for a given patient, and if the surgeon wishes to assess muscle tonicity and the effect of tenodesis in vivo, CEA may be used. The patients in the authors' series have been so satisfied with the technique that this dynamic approach to the tetraplegic upper leg may be as advantageous for the patient as it is for the surgeon.
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Affiliation(s)
- Jacques Deschodt
- Department of Anesthesia, Lapeyronie Hospital, 34295 Montpellier, France.
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Singelyn FJ. Continuous techniques of nerve conduction blockade. Best Pract Res Clin Anaesthesiol 2001. [DOI: 10.1053/bean.2000.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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