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Casas-Arroyave FD, Osorno-Upegui SC, Zamudio-Burbano MA. Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery. Response to Br J Anaesth 2023; 132: 625-6. Br J Anaesth 2024; 132:1171-1172. [PMID: 38453596 DOI: 10.1016/j.bja.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Fabian D Casas-Arroyave
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Surgery, University Hospital of San Vicente Foundation, Medellin, Colombia.
| | - Susana C Osorno-Upegui
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Anaesthesiology, Alma Mater of Antioquia Hospital, Medellin, Colombia
| | - Mario A Zamudio-Burbano
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Anaesthesiology, Alma Mater of Antioquia Hospital, Medellin, Colombia
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Banik RK, Tran BW, Belfar A, Akhtaruzzaman AKM, Nada E, Hanson N. Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: factors affecting successful thoracic epidural analgesia. Comment on Br J Anaesth 2023; 131: 947-54. Br J Anaesth 2024; 132:1169-1170. [PMID: 38336515 DOI: 10.1016/j.bja.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Affiliation(s)
- Ratan K Banik
- Department of Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Bryant W Tran
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alexandra Belfar
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - A K M Akhtaruzzaman
- Department of Anesthesiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Eman Nada
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University New York, Stony Brook, NY, USA
| | - Neil Hanson
- Department of Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, MN, USA
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Newman RB, Stevens DR, Hunt KJ, Grobman WA, Owen J, Sciscione A, Wapner RJ, Skupski D, Chien EK, Wing DA, Ranzini AC, Porto M, Grantz KL. Fetal Growth Biometry as Predictors of Shoulder Dystocia in a Low-Risk Obstetrical Population. Am J Perinatol 2024; 41:891-901. [PMID: 35240706 PMCID: PMC9627645 DOI: 10.1055/a-1787-6991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate fetal biometrics as predictors of shoulder dystocia (SD) in a low-risk obstetrical population. STUDY DESIGN Participants were enrolled as part of a U.S.-based prospective cohort study of fetal growth in low-risk singleton gestations (n = 2,802). Eligible women had liveborn singletons ≥2,500 g delivered vaginally. Sociodemographic, anthropometric, and pregnancy outcome data were abstracted by research staff. The diagnosis of SD was based on the recorded clinical impression of the delivering physician. Simple logistic regression models were used to examine associations between fetal biometrics and SD. Fetal biometric cut points, selected by Youden's J and clinical determination, were identified to optimize predictive capability. A final model for SD prediction was constructed using backward selection. Our dataset was randomly divided into training (60%) and test (40%) datasets for model building and internal validation. RESULTS A total of 1,691 women (98.7%) had an uncomplicated vaginal delivery, while 23 (1.3%) experienced SD. There were no differences in sociodemographic or maternal anthropometrics between groups. Epidural anesthesia use was significantly more common (100 vs. 82.4%; p = 0.03) among women who experienced SD compared with those who did not. Amniotic fluid maximal vertical pocket was also significantly greater among SD cases (5.8 ± 1.7 vs. 5.1 ± 1.5 cm; odds ratio = 1.32 [95% confidence interval: 1.03,1.69]). Several fetal biometric measures were significantly associated with SD when dichotomized based on clinically selected cut-off points. A final prediction model was internally valid with an area under the curve of 0.90 (95% confidence interval: 0.81, 0.99). At a model probability of 1%, sensitivity (71.4%), specificity (77.5%), positive (3.5%), and negative predictive values (99.6%) did not indicate the ability of the model to predict SD in a clinically meaningful way. CONCLUSION Other than epidural anesthesia use, neither sociodemographic nor maternal anthropometrics were significantly associated with SD in this low-risk population. Both individually and in combination, fetal biometrics had limited ability to predict SD and lack clinical usefulness. KEY POINTS · SD unpredictable in low-risk women.. · Fetal biometry does not reliably predict SD.. · Epidural use associated with increased SD risk.. · SD prediction models clinically inefficient..
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Affiliation(s)
- Roger B. Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - Danielle R. Stevens
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John Owen
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Health Care Center, Wilmington, Delaware
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York Presbyterian Queens, Flushing, New York
| | - Edward K. Chien
- Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
| | - Deborah A. Wing
- Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
- Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
| | - Angela C. Ranzini
- Department of Obstetrics and Gynecology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio
- Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, New Jersey
| | - Manuel Porto
- Department of Obstetrics and Gynecology, University of California, Irvine; Orange, California
| | - Katherine L. Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Ali TZ, Zil-E-Ali A, Lavanga E, Aziz F. Race-Based Variation in the Utilization of Epidural Analgesia in Addition to General Anesthesia for Open Abdominal Aortic Aneurysm Repair in the United States. Ann Vasc Surg 2024; 102:101-109. [PMID: 38307225 DOI: 10.1016/j.avsg.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Epidural analgesia (EA) is recommended along with general anesthesia (GA) for patients undergoing open abdominal aortic aneurysm repair (AAA) and is known to be associated with improved postoperative outcomes. This study evaluates inequities in using this superior analgesic approach and further assesses the disparities at patient and hospital levels. METHODS A retrospective analysis was performed using the Vascular Quality Initiative database of adult patients undergoing elective open AAA repair between 2003 and 2022. Patients were grouped and analyzed based on anesthesia utilization, that is, EA + GA (Group I) and GA only (Group II). Study groups were further stratified by race, and outcomes were studied. Univariate and multivariate analyses were performed to study the impact of race on the utilization of EA with GA. A subgroup analysis was also carried out to learn the EA analgesia utilization in hospitals performing open AAA with the least to most non-White patients. RESULTS A total of 8,940 patients were included in the study, of which EA + GA (Group I) comprised n = 4,247 (47.5%) patients, and GA (Group II) had n = 4,693 (52.5%) patients. Based on multivariate regression analysis, the odds ratio of non-White patients receiving both EA and GA for open AAA repair compared to White patients was 0.76 (95% confidence interval: 0.53-0.72, P < 0.001). Of the patients who received both EA + GA, non-White race was associated with increased length of intensive care unit stay and a longer total length of hospital stay compared to White patients. Hospitals with the lowest quintile of minorities had the highest utilization of EA + GA for all patients compared to the highest quintile. CONCLUSIONS Non-White patients are less likely to receive the EA + GA than White patients while undergoing elective open AAA repair, demonstrating a potential disparity. Also, this disparity persists at the hospital level, with hospitals with most non-White patients having the least EA utilization, pointing toward system-wide disparities.
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Affiliation(s)
- Tarik Z Ali
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Ahsan Zil-E-Ali
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Elizabeth Lavanga
- Office of Medical Education, Penn State University College of Medicine, Hershey, PA
| | - Faisal Aziz
- Division of Vascular Surgery, Heart & Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Tan HS, Fuller ME, Barney EZ, Diomede OI, Landreth RA, Pham T, Rubright SM, Ernst L, Habib AS. The 90% effective dose of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia in parturients with super obesity: an up-down sequential allocation study. Can J Anaesth 2024; 71:570-578. [PMID: 38438681 DOI: 10.1007/s12630-024-02705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/04/2023] [Accepted: 11/04/2023] [Indexed: 03/06/2024] Open
Abstract
PURPOSE To determine the 90% effective dose (ED90) of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal-epidural anesthesia (CSE) in parturients with super obesity (body mass index [BMI] ≥ 50 kg·m-2). METHODS We enrolled parturients with BMI ≥ 50 kg·m-2 with term, singleton vertex pregnancies undergoing elective Cesarean delivery under CSE. An independent statistician generated the 0.75% hyperbaric bupivacaine dosing regimen in increments of 0.75 mg using a biased-coin up-down sequential allocation technique. This was combined with 15 μg fentanyl, 150 μg morphine, and normal saline to a volume of 2.05 mL. The initial and maximum doses were 9.75 mg and 12 mg, respectively. Participants, clinical team, and outcome assessors were blinded to the dose. The primary outcome was block success, defined as T6 block to pinprick within ten minutes and no intraoperative analgesic supplementation within 90 min of spinal injection. We determined the ED90 using logistic regression. RESULTS We enrolled 45 parturients and included 42 in the analysis. All doses achieved a T6 level within ten minutes, and the primary outcome occurred in 0/1 (0%) of the 9.75-mg doses, 2/3 (67%) of the 10.5-mg doses, 21/27 (78%) of the 11.25-mg doses, and 11/11 (100%) of the 12-mg doses. The ED90 of hyperbaric bupivacaine was 11.56 mg (95% confidence interval, 11.16 to 11.99). Four parturients (9.5%) had sensory level higher than T2, but none was symptomatic or required general anesthesia. CONCLUSION The estimated ED90 of hyperbaric bupivacaine with fentanyl and morphine in parturients with super obesity undergoing Cesarean delivery under CSE was approximately 11.5 mg. STUDY REGISTRATION ClinicalTrials.gov (NCT03781388); first submitted 18 December 2018.
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Affiliation(s)
- Hon Sen Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - Matthew E Fuller
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Emily Z Barney
- Department of Anesthesiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Olga I Diomede
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, OR, USA
| | - Riley A Landreth
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Trung Pham
- Associated Anesthesiologists Inc., Tulsa, OK, USA
| | | | - Liliane Ernst
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Ashraf S Habib
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
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Yang M, Wang D, Xu X, Yu X, Xu H, Zeng Z, Dai J. Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report. Medicine (Baltimore) 2024; 103:e37662. [PMID: 38640318 PMCID: PMC11029979 DOI: 10.1097/md.0000000000037662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/29/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients. METHODS A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum. DIAGNOSES Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing. OUTCOMES At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up. CONCLUSION The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.
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Affiliation(s)
- Mengya Yang
- Department of Anesthesiology, People’s Hospital of Wanning, Wanning Hainan China
| | - Danmin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Xia Xu
- Department of Anesthesiology, Sanya Central Hospital, Sanya, Hainan China
| | - Xiaobo Yu
- Department of Neurosurgery, People’s Hospital of Wanning, Wanning Hainan China
| | - Hefei Xu
- Department of Thoracic surgery, People’s Hospital of Wanning, Wanning Hainan China
| | - Zhaoqiang Zeng
- Department of Anesthesiology, People’s Hospital of Wanning, Wanning Hainan China
| | - Jingwei Dai
- Department of Anesthesiology, People’s Hospital of Wanning, Wanning Hainan China
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Tran DQ, Booysen K, Botha HJ. Primary failure of thoracic epidural analgesia: revisited. Reg Anesth Pain Med 2024; 49:298-303. [PMID: 38124196 DOI: 10.1136/rapm-2023-105151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
Primary failure of thoracic epidural analgesia (TEA) remains an important clinical problem, whose incidence can exceed 20% in teaching centers. Since loss-of-resistance (LOR) constitutes the most popular method to identify the thoracic epidural space, the etiology of primary TEA failure can often be attributed to LOR's low specificity. Interspinous ligamentous cysts, non-fused ligamenta flava, paravertebral muscles, intermuscular planes, and thoracic paravertebral spaces can all result in non-epidural LORs. Fluoroscopy, epidural waveform analysis, electrical stimulation, and ultrasonography have been proposed as confirmatory modalities for LOR.The current evidence derived from randomized trials suggests that fluoroscopy, epidural waveform analysis, and possibly electrical stimulation, could decrease the primary TEA failure to 2%. In contrast, preprocedural ultrasound scanning provides no incremental benefit when compared with conventional LOR. In the hands of experienced operators, real-time ultrasound guidance of the epidural needle has been demonstrated to provide comparable efficacy and efficiency to fluoroscopy.Further research is required to determine the most cost-effective confirmatory modality as well as the best adjuncts for novice operators and for patients with challenging anatomy. Moreover, future trials should elucidate if fluoroscopy and electrical stimulation could potentially decrease the secondary failure rate of TEA, and if a combination of confirmatory modalities could outperform individual ones.
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Affiliation(s)
- De Q Tran
- Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Karin Booysen
- Private Anesthesiology Practice, Pretoria, Gauteng, South Africa
| | - Hendrik J Botha
- Private Anesthesiology Practice, Pretoria, Gauteng, South Africa
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El-Mallah JC, Greene AC, Clegg TJ, Shah SJ, El-Mallah SN, Vining CC, Dixon MEB, Peng JS. Comparison of epidural infusion versus intrathecal morphine block as part of enhanced recovery after open pancreatoduodenectomy. J Surg Oncol 2024; 129:869-875. [PMID: 38185838 DOI: 10.1002/jso.27574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVES The accepted approach to pain management following open pancreatoduodenectomy (PD) remains controversial, with the most recent enhanced recovery after surgery (ERAS) protocols recommending epidural anesthesia (EA). Few studies have investigated intrathecal (IT) morphine, combined with transversus abdominis plane (TAP) blocks. We aim to compare the different approaches to pain management for open PD. METHODS Patients who underwent open PD at our institution from 2020 to 2022 were included in the study. Patient characteristics, pain management, and postoperative outcomes between EA, IT morphine with TAP blocks, and TAP blocks only were compared using univariate analysis. RESULTS Fifty patients were included in the study (58% male, median age 66 years [interquartile range, IQR: 58-73]). Most patients received IT morphine (N = 24, 48%) or EA (N = 18, 36%). The TAP block-only group required higher doses of postoperative narcotics while hospitalized (p = 0.004) and at discharge (p = 0.017). The IT morphine patients had a shorter median time to Foley removal (p = 0.007). Postoperative pain scores, non-opioid administration, postoperative bolus requirements, postoperative outcomes, and length of stay were similar between pain modalities. CONCLUSIONS IT morphine and EA showed comparable efficacy with superior results compared to TAP blocks alone. Integration of IT morphine into PD ERAS protocols should be considered.
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Affiliation(s)
- Jessica C El-Mallah
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alicia C Greene
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Taylor J Clegg
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sejal J Shah
- Department of Anesthesia, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Saif N El-Mallah
- Department of Anesthesia, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Charles C Vining
- Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Matthew E B Dixon
- Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Surgery, Division of Surgical Oncology, RUSH University Medical Center, Chicago, IIllinois, USA
| | - June S Peng
- Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Thomas CL, Montes M, Malik T, Sandeep Ram B, Smith CL, Scavone BM, Cole NM. A Case Report of Fluoroscopically Guided Epidural Catheter Placement in a Parturient with History of Tethered Cord, Super-Morbid Obesity, and Risk for Difficult Airway. A A Pract 2024; 18:e01777. [PMID: 38587314 DOI: 10.1213/xaa.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Tethered cord syndrome results from adherence of the conus medullaris to the sacrum and may be associated with high complication rates from neuraxial anesthesia. We present the case of a 32-year-old gravida 2 para 0 patient with a history of lipomyelomeningocele (one of several types of spina bifida) and tethered cord status post repair, residual low-lying conus medullaris, supermorbid obesity (body mass index of 58), and Mallampati IV airway, who underwent successful fluoroscopically guided epidural catheter placement for vaginal delivery. Risks and benefits of epidural catheter utilization and methods of placement are reviewed.
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Affiliation(s)
- Caroline L Thomas
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Kristjansson VB, Gudmundsdottir EY, Skarphedinsdottir S, Gottfredsdottir H, Bjarnadottir RI. [Anaesthesia for Emergent Caesarean Section: A Population-based Study on Icelandic and Migrant Women during 2007-2018]. LAEKNABLADID 2024; 110:191-199. [PMID: 38517406 DOI: 10.17992/lbl.2024.04.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION General anaesthesia for emergent caesarean section, though uncommon, is vital in expediting deliveries. Studies indicate higher complication risks among pregnant migrant women. This research investigates if migrant women in Iceland are more likely to undergo general anaesthesia for emergent caesarean section compared to their Icelandic counterparts. MATERIALS AND METHODS This population-based cohort study analysed 4,415 emergency caesarean sections in Iceland between 2007 and 2018, sourced from the National Birth Registry. Participants were categorized by citizenship, with migrants further stratified by their country's Human Development Index (HDI). NCSP-IS and ICD-10 codes indexed diseases, interventions, and complications. The impact of variables was assessed through multiple logistic regression analysis. RESULTS Migrant women received general anaesthesia in 16.1% of cases, slightly surpassing Icelandic women's 14.6%. Adjusting for risk factors showed no increased risk for migrant women. However, they had a higher likelihood of urgent caesarean sections (OR 1.45, 95% CI 1.08-1.94, p=0.015), a known risk factor for general anaesthesia, despite fewer comorbidities. Adjusting for confounders revealed reduced odds with a history of previous caesarean section (aOR 0.73, 95% CI 0.59-0.89, p=0.003) and placement of epidural anaesthesia in the delivery room (aOR 0.49, 95% CI 0.40-0.60, p< 0.001). CONCLUSIONS Migrant women in Iceland do not face increased risks of general anaesthesia for emergent caesarean sections. However, their elevated risk of urgent caesarean sections suggests potential challenges, including language barriers or inadequate antenatal care. Early information dissemination and targeted interventions may mitigate these risks in this vulnerable community.
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Affiliation(s)
- Valdimar Bersi Kristjansson
- Department of Anesthesia and Intensive Care, Landspítali University Hospital, Faculty of Medicine, University of Iceland
| | | | | | - Helga Gottfredsdottir
- Faculty of Nursing and Midwifery, University of Iceland, Department of Obstetrics and Gynaecology, Landspítali University Hospital
| | - Ragnheidur I Bjarnadottir
- Faculty of Medicine, University of Iceland, Department of Obstetrics and Gynaecology, Landspítali University Hospital
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Ross SB, Christodoulou M, Ross N, Sucandy I, Lubrice K, Saravanan S, Rosemurgy A. Epidural versus general anesthesia for laparo-endoscopic single-site cholecystectomy: a randomized controlled trial. Surg Endosc 2024; 38:1414-1421. [PMID: 38172336 DOI: 10.1007/s00464-023-10628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION This study compares outcomes after LESS cholecystectomy utilizing epidural versus general anesthesia. METHODS Patients undergoing LESS Cholecystectomy were randomized into receiving epidural or general anesthesia by protocol. Patients used a Visual Analog Scale to rate pain from 0 (no pain) to 10 (severe pain). Data presented as median (mean ± standard deviation). RESULTS 75 patients underwent LESS cholecystectomy with general anesthesia [32 patients (22% men) after five patients withdrew consent] or epidural anesthesia [23 patients (22% men) after 15 patients withdrew consent]. Respectively, they were of age 38 years (41 ± 15.1) and 47 years (48 ± 13.9), BMI 29 (28 ± 4.9) kg/m2 and 28 (28 ± 3.8) kg/m2, and ASA 2 (2 ± 0.5) and 2 (2 ± 0.3) (p > 0.05 for all). LOS for patients receiving general vs. epidural anesthesia was 72 min (122 ± 104.4) vs. 95 min (113 ± 77.5) (p = 0.25). On POD 0, patients receiving general anesthesia rated pain as 4 (4 ± 2.9) vs. 0 (1 ± 2.2) for epidural anesthesia (p = 0.02). On POD 1, they rated pain as 6 (5 ± 2.3) vs. 6 (6 ± 2.9) (p = 0.68). On POD 6, patients rated pain as 3 (3 ± 2.7) vs. 4 (3 ± 2.2) (p = 1.00). For patient satisfaction with incisional scars for those receiving general vs. epidural anesthesia, patients rated their scars to be 10 (8 ± 3.6) vs. 10 (9 ± 1.2) (p = 0.21). Total costs for the hospital using general vs. epidural anesthesia were found $6,909 (7,167 ± 2,083.8) vs. $6,225 (5,848 ± 1530.1) (p = 0.014), respectively. Patients self-assessed satisfaction on a scale of 1 (worst) to 5 (best) as a 5 (5 ± 0). CONCLUSIONS Patients undergoing LESS cholecystectomy with general vs. epidural anesthesia had similar demographics, LOS, and pain scores. Patients that received epidural anesthesia reported less pain and incurred less cost. Utilization of epidural anesthesia in lieu of general anesthesia for LESS cholecystectomy is safe, reduces pain, and offers potential cost savings.
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Affiliation(s)
- Sharona B Ross
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA.
| | | | - Nicole Ross
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
| | - Iswanto Sucandy
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
| | - Kenneth Lubrice
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
| | - Sneha Saravanan
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
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12
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Coppens S, Uppal V, Hoogma DF, Merjavy P, Rex S. Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery. Comment on Br J Anaesth 2023; 131: 947-54. Br J Anaesth 2024; 132:625-626. [PMID: 38228421 DOI: 10.1016/j.bja.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/20/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Steve Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Biomedical Sciences Group, KU Leuven, Leuven, Belgium.
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Nova Scotia Health Authority and IWK Health Centre, Halifax, NS, Canada
| | - Danny F Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Peter Merjavy
- Craigavon Area University Teaching Hospital, Portadown, UK; School of Medicine, University of East Anglia, Norwich, UK
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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13
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Ganesh A, Maher J, Record S, Welsby I, Lidsky ME. Thoracic Epidural Analgesia for Hepatic Arterial Infusion Pump Implantation. Anesth Analg 2024; 138:692-693. [PMID: 38109846 DOI: 10.1213/ane.0000000000006800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Arun Ganesh
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - James Maher
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Sydney Record
- Duke University School of Medicine, Durham, North Carolina
| | - Ian Welsby
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael E Lidsky
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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14
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Chen Y, Cai Y, Yu G, Zhang X, Hu T, Xue R. Safety and effcacy of remimazolam tosilate for sedation during combined spinal-epidural anesthesia for orthopedic procedures: a randomized controlled trial. BMC Anesthesiol 2024; 24:75. [PMID: 38408901 PMCID: PMC10895730 DOI: 10.1186/s12871-024-02451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE The objective of this study was to assess the efficacy and safety of Remimazolam in the context of combined spinal-epidural anesthesia for sedation during orthopedic surgery. METHODS This randomized controlled trial enrolled patients scheduled for orthopedic surgery under combined spinal-epidural anesthesia (N = 80), who were randomly allocated to receive either dexmedetomidine (Group-D) or remimazolam (Group-R). The target sedation range aimed for a Ramsay score of 2-5 or a BIS value of 60-80 to evaluate the effectiveness and safety of remimazolam during sedation. RESULTS The time taken to achieve the desired level of sedation was significantly shorter in the remimazolam group compared to the dexmedetomidine group (3.69 ± 0.75 vs. 9.59 ± 1.03; P < 0.0001). Patients in the remimazolam group exhibited quicker recovery, fewer intraoperative adverse events, more consistent vital signs, and greater satisfaction at various time points throughout the surgery. CONCLUSION This preliminary study demonstrates that remimazolam tosilate serves as a safe and effective sedative for orthopedic surgery performed under combined spinal-epidural anesthesia, in comparison with dexmedetomidine.
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Affiliation(s)
- Yufei Chen
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Yimeng Cai
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Guoqing Yu
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Xi Zhang
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Tian Hu
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Rui Xue
- Department of Anesthesiology, Renmin Hospital,Hubei University of Medicine, Shiyan City, Hubei Province, China.
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15
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Wang C, Liu Y, Calle P, Li X, Liu R, Zhang Q, Yan F, Fung KM, Conner AK, Chen S, Pan C, Tang Q. Enhancing epidural needle guidance using a polarization-sensitive optical coherence tomography probe with convolutional neural networks. J Biophotonics 2024; 17:e202300330. [PMID: 37833242 PMCID: PMC10922538 DOI: 10.1002/jbio.202300330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
Epidural anesthesia helps manage pain during different surgeries. Nonetheless, the precise placement of the epidural needle remains a challenge. In this study, we developed a probe based on polarization-sensitive optical coherence tomography (PS-OCT) to enhance the epidural anesthesia needle placement. The probe was tested on six porcine spinal samples. The multimodal imaging guidance used the OCT intensity mode and three distinct PS-OCT modes: (1) phase retardation, (2) optic axis, and (3) degree of polarization uniformity (DOPU). Each mode enabled the classification of different epidural tissues through distinct imaging characteristics. To further streamline the tissue recognition procedure, convolutional neural network (CNN) were used to autonomously identify the tissue types within the probe's field of view. ResNet50 models were developed for all four imaging modes. DOPU imaging was found to provide the highest cross-testing accuracy of 91.53%. These results showed the improved precision by PS-OCT in guiding epidural anesthesia needle placement.
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Affiliation(s)
- Chen Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Yunlong Liu
- School of Computer Science, University of Oklahoma, Norman, OK 73019, USA
| | - Paul Calle
- School of Computer Science, University of Oklahoma, Norman, OK 73019, USA
| | - Xinwei Li
- Department of Electrical and Electronic Engineering, University of Nottingham, Nottingham, United Kingdom, NG7 2RD
| | - Ronghao Liu
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, 250100, China
| | - Qinghao Zhang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Feng Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Kar-ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Andrew K. Conner
- Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Chongle Pan
- School of Computer Science, University of Oklahoma, Norman, OK 73019, USA
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
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16
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Chau A, Markley JC. Re-attempting the procedure after an accidental dural puncture during an epidural blood patch: is there a hole in the plan? Int J Obstet Anesth 2024; 57:103953. [PMID: 37989614 DOI: 10.1016/j.ijoa.2023.103953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/21/2023] [Indexed: 11/23/2023]
Affiliation(s)
- A Chau
- University of British Columbia, Vancouver, BC, Canada.
| | - J C Markley
- University of California San Francisco, San Francisco, CA, USA
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17
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Shi X, Xu C, Wen Y, Jiang M, Yu H, Wang X, Yuan H, Feng S. Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis. BMC Anesthesiol 2024; 24:33. [PMID: 38243205 PMCID: PMC10797910 DOI: 10.1186/s12871-024-02412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE An emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes. METHOD This was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured. RESULTS Of the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed. CONCLUSION Compared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.
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Affiliation(s)
- Xueduo Shi
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Chenyang Xu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Yazhou Wen
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Ming Jiang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Huiling Yu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Xian Wang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Hongmei Yuan
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
| | - Shanwu Feng
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
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18
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Kim JY, Lee JS, Kim JY, Baek JW, Kim HS, Kim DH. Comparison of the incidence of intravascular injection using the Tuohy and Quincke needles during ultrasound-guided caudal epidural block: a prospective randomized controlled study. Reg Anesth Pain Med 2024; 49:17-22. [PMID: 37169489 DOI: 10.1136/rapm-2023-104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Intravascular injection of a local anesthetic can lead to life-threatening complications, such as deficits in neurological function after caudal epidural block. This study aimed to determine whether the intravascular injection rate of the Tuohy needle is lower than that of the Quincke needle during an ultrasound-guided caudal block. METHODS Two-hundred and thirty patients were randomized into the Quincke (n=115) and the Tuohy (n=115) needle groups. The randomly selected needle was introduced at a 45° angle until it penetrated the sacrococcygeal ligament under ultrasound guidance, and intravenous injections were analyzed using contrast-dyed digital subtraction angiography. The relationship between the incidence of intravascular injection and independent variables, including needle type, patient demographics, history of lumbosacral surgery, use of anticoagulants, anatomic variables of the sacrum, presence of bony contact during the procedure, and the number of needle repositioning under ultrasound guidance, were examined. RESULTS Intravascular uptake of contrast medium was surveyed in 25/230 (10.9%) caudal blocks using digital subtraction angiography (DSA). The incidence of intravascular uptake was 13.9% (16/115) using the Quincke needle and 7.8% (9/115) using the Tuohy needle (p=0.14). Although the needle tip type was not associated with the rate of intravascular injection, the occurrence of bony contact during the procedure demonstrated a relationship with the intravenous injection (p<0.01). CONCLUSIONS The overall incidence of inadvertent intravascular injections during ultrasound-guided caudal block confirmed using DSA was 10.9%. Tuohy needles did not reduce intravascular injection rates during the ultrasound-guided caudal block. TRIAL REGISTRATION NUMBER NCT05504590.
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Affiliation(s)
- Ji Yeong Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Jong Seok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Ji Won Baek
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Hye Su Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Do-Hyeong Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
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Kaufmann M, Orth V, Dorwarth TJ, Benrath J, Gerber B, Ghezel-Ahmadi D, Reißfelder C, Herrle F. Two-stage laparoscopic transversus abdominis plane block as an equivalent alternative to thoracic epidural anaesthesia in bowel resection-an explorative cohort study. Int J Colorectal Dis 2024; 39:18. [PMID: 38206380 PMCID: PMC10784341 DOI: 10.1007/s00384-023-04592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE We evaluated the effect of the two-stage laparoscopic transversus abdominis plane block (TS-L-TAPB) in comparison to thoracic epidural anaesthesia (TEA) and a one-stage L-TAPB (OS-L-TAPB) in patients who underwent elective laparoscopic bowel resection. METHODS We compared a TS-L-TAPB (266 mg bupivacaine), which was performed bilaterally at the beginning and end of surgery, with two retrospective cohorts. These were patients who had undergone a TEA (ropivacaine/sufentanil) or an OS-L-TAPB (200 mg ropivacaine) at the beginning of surgery. Oral and i.v. opiate requirements were documented over the first 3 postoperative days (POD). RESULTS Patients were divided into three groups TEA (n = 23), OS-L-TAPB (n = 75), and TS-L-TAPB (n = 49). By the evening of the third POD, patients with a TEA had a higher cumulative opiate requirement with a median of 45.625 mg [0; 202.5] than patients in the OS-L-TAPB group at 10 mg [0; 245.625] and the TS-L-TAPB group at 5.625 mg [0; 215.625] (p = 0.1438). One hour after arrival in the recovery room, significantly more patients in the TEA group (100%) did not need oral and i.v. opioids than in the TS-L-TAPB (78%) and OS-L-TAPB groups (68%) (p = 0.0067).This was without clinical relevance however as the median in all groups was 0 mg. On the third POD, patients in the TEA group had a significantly higher median oral and i.v. opioid dose at 40 mg [0; 80] than the TS-L-TAPB and OS-L-TAPB groups, both at 0 mg [0; 80] (p = 0.0009). CONCLUSION The TS-L-TAP showed statistically significant and clinically meaningful benefits over TEA and OS-L-TAP in reducing postoperative opiate requirements.
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Affiliation(s)
- M Kaufmann
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - V Orth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - T-J Dorwarth
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - J Benrath
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - B Gerber
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - D Ghezel-Ahmadi
- Department of Anesthesiology, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany
| | - F Herrle
- Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
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Xie S, Li L, Meng F, Wang H. Regional anesthesia might reduce recurrence and metastasis rates in adult patients with cancers after surgery: a meta-analysis. BMC Anesthesiol 2024; 24:19. [PMID: 38200414 PMCID: PMC10777509 DOI: 10.1186/s12871-023-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The influence of anesthesia techniques on cancer recurrence and metastasis following oncological surgery is a topic of growing interest. This meta-analysis investigates the potential effects of regional anesthesia (RA), either independently or combined with general anesthesia (GA), on these outcomes. METHODS We performed an extensive search across PubMed, Embase, and the Cochrane Library databases. The primary outcome was cancer recurrence, while the secondary outcomes were local recurrence and distant metastasis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by utilizing random-effects models. The Newcastle-Ottawa Scale (NOS) was used for quality assessment of observational studies, the Cochrane Risk of Bias Tool for Randomized Trials (Rob 2.0) was used for randomized controlled trials, and all the outcomes were assessed by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS This study included 32 studies comprising 24,724 cancer patients. RA, either alone or in combination with GA, was significantly associated with reduced cancer recurrence compared to GA alone (OR = 0.82; 95% CI = 0.72 to 0.94; p < 0.01). This association remained significant for prostate cancer patients in subgroup analyses (OR = 0.71; 95% CI = 0.51 to 0.98; p = 0.04) and in the context of epidural anesthesia combined with GA. However, there were no significant associations noted for local recurrence or distant metastasis. CONCLUSIONS This meta-analysis provides evidence that RA, used alone or adjunctively with GA, is associated with a lower risk of cancer recurrence, particularly in patients with prostate cancer. However, no significant effects were observed on local recurrence or distant metastasis. Further prospective studies should be conducted to clarify this important issue.
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Affiliation(s)
- Shuang Xie
- Department of Anesthesiology, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Liang Li
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fanqing Meng
- Department of Anesthesiology, Jinan Maternity and Child Health Care Hospital, Shandong First medical university, Jinan, China
| | - Huanliang Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.
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Chen J, Li T, Pan Z, Ke Y, Ding J. The impact of sufentanil versus remifentanil on surgical site wound healing in caesarean section primiparas undergoing epidural anaesthesia: A systematic meta-analysis. Int Wound J 2024; 21:e14377. [PMID: 37697689 PMCID: PMC10784625 DOI: 10.1111/iwj.14377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
Caesarean section (C-section) is a prevalent obstetric surgical procedure, with the choice of analgesic agents playing a pivotal role in postoperative recovery. This systematic meta-analysis aimed to compare the effects of sufentanil (ST) and remifentanil (RT) on postoperative wound healing in caesarean section primiparas undergoing epidural anaesthesia. A comprehensive search was conducted across multiple databases, adhering to PRISMA guidelines, yielding eight randomized controlled trials (RCTs) for inclusion. The primary outcome was wound healing assessment using the REEDA (redness, edema, ecchymosis, discharge, approximation) scale on the third, fifth and tenth postoperative days. The meta-analysis encompassed 691 primiparas. A significant difference in wound healing was observed between ST and RT on the third (I2 = 99%; Random: SMD: 6.75, 95% CIs: 3.11-10.39, p < 0.01) and fifth days (I2 = 99%; Random: SMD: 3.63, 95% CIs: 1.56-5.70, p < 0.01) postcaesarean section. However, no significant difference was noted on the tenth day (I2 = 5%; Random: SMD: 0.00, 95% CIs: -0.45-0.45, p = 0.35). Sufentanil and remifentanil exhibit differential effects on early postoperative wound healing in caesarean section primiparas undergoing epidural anaesthesia. While both opioids are effective analgesics, sufentanil demonstrates a more pronounced impact on wound healing during the immediate postoperative days. Clinicians should consider these findings when selecting an opioid for pain management in this patient population.
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Affiliation(s)
- Jiefeng Chen
- Department of AnesthesiaShaoxing Maternity and Child Health Care HospitalShaoxingZhejiangChina
| | - Ting Li
- Department of AnesthesiaShaoxing Maternity and Child Health Care HospitalShaoxingZhejiangChina
| | - Zhengbin Pan
- Department of AnesthesiaShaoxing Maternity and Child Health Care HospitalShaoxingZhejiangChina
| | - Yanjun Ke
- Department of AnesthesiaShaoxing Maternity and Child Health Care HospitalShaoxingZhejiangChina
| | - Jielan Ding
- Department of AnesthesiaShaoxing Maternity and Child Health Care HospitalShaoxingZhejiangChina
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Schäfer M, Kopf A, Treskatsch S. Replacement of Opioid-Based Anesthesia by Epidural Esketamine: Is It a Real Alternative? Anesth Analg 2024; 138:e5-e6. [PMID: 38100813 DOI: 10.1213/ane.0000000000006781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Michael Schäfer
- Department of Anesthesiology and Operative Intensive Care Medicine, Berlin Institute of Health, Humboldt Universität zu Berlin, Berlin, Germany,
| | - Andreas Kopf
- Department of Anesthesiology and Operative Intensive Care Medicine, Berlin Institute of Health, Humboldt Universität zu Berlin, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Operative Intensive Care Medicine, Berlin Institute of Health, Humboldt Universität zu Berlin, Berlin, Germany
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23
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Yang H, Zhang Q, Zhong Z, Sun Y, Gong H, Liu Y, Dai X, Lin L, Luo J, Gong G, Yang Y. Administration of combined spinal epidural anesthesia with ultrasound-assisted positioning in obese patients undergoing open hysterectomy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36695. [PMID: 38206749 PMCID: PMC10754612 DOI: 10.1097/md.0000000000036695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Administration of combined spinal epidural anesthesia (CSEA) with traditional landmark-guided positioning can be challenging in patients with high body mass index (BMI). The popularization of ultrasound technology may effectively solve these problems. However, reports on the administration of CSEA ultrasound-assisted positioning in obese populations are relatively limited and have made inconsistent conclusions. We aimed to investigate the ability of ultrasound-assisted positioning to improve the success rate of CSEA in obese patients. METHODS Overall, 118 adult women with a BMI ≥ 30 kg/m2 who scheduled to undergo open hysterectomy and received CSEA were recruited. Finally, 108 patients were enrolled and randomly assigned to 2 groups: the ultrasound-assisted positioning group (group A) and traditional landmark-guided positioning group (group B). Ultrasound-assisted or landmark-guided positioning was employed to locate the puncture interspace before anesthesia. The primary outcomes were the success rate of first attempt and number of attempts. The secondary outcomes were the patient positioning accuracy, positioning time, CSEA operation time, patient-satisfaction scores, anesthesia characteristics, and complications of CSEA. RESULTS The success rate of patient first puncture attempt in group A was significantly higher than that in group B (78.4% vs 52.9%, P = .007). The total number of punctures was lower in group A than that in groups B (average rank 44.54 vs 58.46, P = .005). Using ultrasound positioning as the gold standard, the accuracy of landmark-guided location was only 67%. Positioning time in croup A was longer in group A than that in group B (P = .004), while CSEA operation time spent in Group A was less than that in Group B (P < .001). Patient satisfaction score in group A was significantly higher than that in group B (P = .002). The successful puncture interspace in group A were more likely at L3-4 than that in group B (P = .02). CONCLUSION The success rate of first puncture attempt and positioning accuracy in CSEA with ultrasound-assisted is significantly higher than those based on landmark-guided location in obese patients.
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Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- Department of Anesthesiology, No.950 Hospital, Yecheng, Xinjiang, China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Qin Zhang
- Outpatient department, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Zuling Zhong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yangyang Sun
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Huaqu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yinghai Liu
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Xuemei Dai
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Lu Lin
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Jingya Luo
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Gu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yongjian Yang
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
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Takahata K, Horiuchi S, Miyauchi A, Tadokoro Y, Shuo T. A longitudinal study of the association of epidural anesthesia and low-dose synthetic oxytocin regimens with breast milk supply and breastfeeding rates. Sci Rep 2023; 13:21146. [PMID: 38036700 PMCID: PMC10689802 DOI: 10.1038/s41598-023-48584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
Breastfeeding is known to improve maternal and child health. However, epidural anesthesia (EDA) and synthetic oxytocin (synOT) are suggested to have negative effects on breastfeeding. In this study, we aimed to determine the effects of intrapartum synOT and EDA on breast milk supply, breastfeeding rates, and maternal salivary oxytocin levels. Women were recruited during pregnancy or after birth at a single hospital. Data were collected at 3 days postpartum (T1), 1 month postpartum (T2), and 4 months postpartum (T3) on 83 low-risk primiparous women who planned to breastfeed for at least 12 weeks postpartum to avoid dropouts from early discontinuance of breastfeeding. Women with cesarean section, twin pregnancy, premature neonates, and an Apgar score of < 7 at 5 min were excluded. Participants recorded their 24-h milk supply by test weights at 3 days and 1 month postpartum. Additionally, they filled out questionnaires assessing their breastfeeding level and lactogenesis stage II initiation. Salivary oxytocin levels were obtained at 3 days postpartum. Women who delivered using EDA had lower salivary oxytocin levels (P = .055, d = .442), breast milk supply in early postpartum (P = .025, d = .520) and at 1 month postpartum (P = .036, d = .483), and breastfeeding rates at 4 months postpartum (P = .037, V = .236) than women who did not deliver using EDA. There was no association between breastfeeding and the use of intrapartum synOT. In conclusion, this study showed that women who delivered using EDA had lower breast milk supply in the early postpartum period and breastfeeding rates at 4 months postpartum. It also revealed that using synOT at low doses during labor did not affect breastfeeding. Thus, women who deliver using EDA need support for increased breast milk supply in the early postpartum period.Trial registration: UMIN000037783 (Clinical Trials Registry of University Hospital Information Network).
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Affiliation(s)
- Kaori Takahata
- Department of Nursing, Shonan Kamakura University of Medical Sciences, Yamasaki 1195-3, Kamakura, Kanagawa, 247-0066, Japan.
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Ai Miyauchi
- Department of Maternal Health, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Yuriko Tadokoro
- Department of Chiba Faculty of Nursing, Tokyo Healthcare University, Chiba, Japan
| | - Takuya Shuo
- Faculty of Health and Medical Sciences, Hokuriku University, Ishikawa, Japan
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Shen H, Pang Q, Gao Y, Liu H. Effects of epidural anesthesia on the prognosis of ovarian cancer-a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:390. [PMID: 38030996 PMCID: PMC10685604 DOI: 10.1186/s12871-023-02352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION The global low survival rate among ovarian cancer patients has resulted in significant social and economic burdens. Nevertheless, previous studies have produced mixed results when exploring the link between anesthetic techniques and the prognosis of ovarian cancer. The study aims to compare the effect of epidural anesthesia with general anesthesia on survival time after cytoreductive surgery in patients with ovarian cancer. METHODS The PubMed (National Library of Medicine), Cochrane library, Web of science, Embase, CNKI (China National Knowledge Internet), Wanfang Med Online (China database), were systematically searched from inception to May, 2023, using the Medical Subject Headings [MeSH] of "Ovarian Neoplasm" and "Anesthesia, Epidural" and free words to identify systematic reviews or meta-analyses. The research methodology involved analyzing randomized controlled trials (RCTs), as well as prospective or retrospective cohort studies, which compared the long-term prognosis of patients with ovarian cancer under general anesthesia combined with epidural anesthesia (GEA) versus general anesthesia alone (GA). The Newcastle Ottawa Scale (NOS) was used to assess methodological quality and bias. Data extraction and assessment of study quality were conducted by two independent reviewers. A meta-analysis was then performed to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Overall survival (OS) was defined as the primary outcome, time to tumor recurrence (TTR) was the secondary outcome. Epidural anesthesia could be used intraoperatively and immediately postoperatively (EIP), or postoperatively only (EP). GEA includes EIP and EP. RESULTS In total, 8 retrospective cohort studies with 2036 participants met the inclusion criteria. The pooled results demonstrated that GEA could extend OS (HR 0.75, 95% CI 0.67-0.84, I2 = 0%, P < 0.05, fixed-effect model) when compared with GA in ovarian cancer patients undergoing cytoreductive surgery, but not TTR (sensitivity analysis revealed substantial heterogeneity among the included studies). The result of analyzing a total of 1490 patients in 4 studies was that EIP had a better prognosis on OS than GA (HR 0.68, 95%CI 0.55-0.85, I2 = 61%, P < 0.05, random-effect model). However, EP had no advantage in TTR (sensitivity analysis revealed it was unstable outcome). Ovarian cancer FIGO(International Federation of Gynecology and Obstetrics) stage III, stage IV compared to stage I on OS was statistically significant, HRs respectively are 3.67 (95%CI 2.25-5.98), I2 = 0%, fixed-effect model, P < 0.05, and 7.43 (95%CI 3.67-15.03), I2 = 31%, fixed-effect model, P < 0.05, but there was no statistically significant difference between stage II and stage I, HR 2.00, 95%CI0.98-4.09, I2 = 0%, fixed-effect model, P > 0.05. 1-10 mm tumor residuals shorten TTR compared with 0 residuals, HR 1.75, 95% CI1.50-2.04, I2 = 0%, fixed-effect model, P < 0.05. CONCLUSIONS It is hard to conclude that postoperative epidural analgesia offers greater benefits than GA. However, general anesthesia combined with epidural anesthesia (EIP) can improve overall survival in ovarian cancer patients, allowing the anesthesiologist to use anesthesia techniques to provide a favorable prognosis for the ovarian cancer patient. Tumor staging and the extent of cell reduction are also critical factors that significantly influence the long-prognosis of ovarian cancer patients.
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Affiliation(s)
- Haijian Shen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qianyun Pang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Youzhu Gao
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Hongliang Liu
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China.
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Acil F, Dedeoğlu A, Andıç O, Kaya S, Kaçar CK. Application of Cervical Epidural Anesthesia and Analgesia to the Patient With 90% Burnt Surface Area. J Burn Care Res 2023; 44:1519-1522. [PMID: 37607108 DOI: 10.1093/jbcr/irad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Indexed: 08/24/2023]
Abstract
Patients with an extremely large, burnt surface area have a high mortality rate. The follow-up, treatment, and intraoperative anesthesia practices of these patients in the ICU pose serious challenges. In this case, the experience of anesthesia and analgesia using cervical epidural anesthesia, which is not frequently used in anesthesia routine, applied to a patient with a 90% burnt surface area is shared. It was aimed to evaluate the contribution of effective non-opioid analgesia, early mobilization, and nutrition applied to the patient's recovery.
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Affiliation(s)
- Fatma Acil
- Department of Anesthesiology, Health Science University, Diyarbakır Gazi Yaşargil Research and Education Hospital, Diyarbakır, Republic of Türkiye
| | - Andaç Dedeoğlu
- Department of Anesthesiology, Health Science University, Diyarbakır Gazi Yaşargil Research and Education Hospital, Diyarbakır, Republic of Türkiye
| | - Okan Andıç
- Department of Anesthesiology, Health Science University, Diyarbakır Gazi Yaşargil Research and Education Hospital, Diyarbakır, Republic of Türkiye
| | - Sedat Kaya
- Department of Anesthesiology, Health Science University, Diyarbakır Gazi Yaşargil Research and Education Hospital, Diyarbakır, Republic of Türkiye
| | - Cem Kıvılcım Kaçar
- Department of Anesthesiology, Health Science University, Diyarbakır Gazi Yaşargil Research and Education Hospital, Diyarbakır, Republic of Türkiye
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Bruhn J, Mühling J, van Geffen GJ. The use of an epidural catheter for "spray-as-you-go" with the C-MAC video stylet. J Clin Anesth 2023; 90:111214. [PMID: 37490797 DOI: 10.1016/j.jclinane.2023.111214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Jörgen Bruhn
- Department of Anesthesiology, Radboud UMC, Route 714, PO Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Jörg Mühling
- Department of Anesthesiology, Radboud UMC, Route 714, PO Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Geert-Jan van Geffen
- Department of Anesthesiology, Radboud UMC, Route 714, PO Box 9101, 6500HB Nijmegen, the Netherlands.
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Jaconia G, Naus C, Lee A. Anesthesiology resident preferences regarding learning to perform epidural anesthesia procedures in obstetrics: a qualitative phenomenological study. Int J Obstet Anesth 2023; 56:103923. [PMID: 37708742 DOI: 10.1016/j.ijoa.2023.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Learning to perform neuraxial techniques in obstetrics is considered one of the most difficult skills for anesthesiology trainees to acquire and no consensus exists regarding the best practices for teaching these procedures. Utilizing a qualitative, phenomenological approach, we aimed to explore what trainees perceive as the best approaches to teaching epidural anesthesia techniques; identify how these perceptions align or differ from those of faculty anesthesiologists; and examine how these approaches fit into the cognitive apprenticeship framework, which describes a process of reflection on how learning occurs in the authentic environment. METHODS Semi-scripted interviews were conducted with 10 residents and three faculty members from the division of obstetric anesthesiology at an academic center. Interviews were transcribed, de-identified, fragmented, and coded. A thematic analysis was conducted, and codes re-organized into the cognitive apprenticeship framework of (1) content, (2) method (including subcategories modeling, coaching, scaffolding, articulation, reflection, and exploration), (3) sequence, and (4) sociology (including situated learning and culture of expert practice). RESULTS Trainees valued a staged approach to learning epidural techniques, independent trouble-shooting, graded independence, focused feedback, and a calm instructor. The challenges of learning and teaching epidural techniques identified by trainees and instructors included the tactile nature of the procedure, teaching on awake, non-sedated patients, limited teaching time, and creating an environment of psychological safety. CONCLUSION Trainee and instructor preferences for teaching epidural procedures in obstetrics aligned with the cognitive apprenticeship framework. These concepts may be applied to curriculum design, evaluation, feedback, self-assessment and faculty development.
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Affiliation(s)
- G Jaconia
- Columbia University Irving Medical Center, New York, NY, USA
| | - C Naus
- Columbia University Irving Medical Center, New York, NY, USA
| | - A Lee
- Columbia University Irving Medical Center, New York, NY, USA.
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Dong Y, Han J, Tan W, Yu J. Improved method of locating thoracic epidural puncture points prior to thoracic surgery. J Clin Anesth 2023; 90:111209. [PMID: 37433249 DOI: 10.1016/j.jclinane.2023.111209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Yan Dong
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, Liaoning province, China
| | - Jie Han
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, Liaoning province, China
| | - Wenfei Tan
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, Liaoning province, China
| | - Jiangang Yu
- Department of Anesthesiology, the First Hospital of China Medical University, Shenyang, Liaoning province, China.
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Pombo A, Cardoso TM, Araújo AM, Frada R, Nunes CS, Órfão J, Lemos P. Airway approach for caesarean section under general anaesthesia: a national survey. Int J Obstet Anesth 2023; 56:103920. [PMID: 37625984 DOI: 10.1016/j.ijoa.2023.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Affiliation(s)
- A Pombo
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
| | - T M Cardoso
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - A M Araújo
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Frada
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - C S Nunes
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Universidade Aberta, Department of Science and Technology, Porto, Portugal
| | - J Órfão
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - P Lemos
- Serviço de Anestesiologia - Departamento de Anestesiologia, Cuidados Intensivos e Emergência, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Hierro F, Nunes J, Fontão L. Teaching NeuroImage: Pneumorrhachis and Paraplegia After Spinal Anesthesia. Neurology 2023; 101:e1833-e1834. [PMID: 37596044 PMCID: PMC10634640 DOI: 10.1212/wnl.0000000000207824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023] Open
Affiliation(s)
- Fátima Hierro
- From the Neuroradiology Department (F.H.), Hospital Pedro Hispano, Senhora da Hora; Imagiology Department (J.N.), Centro Hospitalar de Vila Nova de Gaia/Espinho; and Neurology Department (L.F.), Centro Hospitalar de entre Douro e Vouga, Santa Maria da Feira, Portugal.
| | - Joana Nunes
- From the Neuroradiology Department (F.H.), Hospital Pedro Hispano, Senhora da Hora; Imagiology Department (J.N.), Centro Hospitalar de Vila Nova de Gaia/Espinho; and Neurology Department (L.F.), Centro Hospitalar de entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Luis Fontão
- From the Neuroradiology Department (F.H.), Hospital Pedro Hispano, Senhora da Hora; Imagiology Department (J.N.), Centro Hospitalar de Vila Nova de Gaia/Espinho; and Neurology Department (L.F.), Centro Hospitalar de entre Douro e Vouga, Santa Maria da Feira, Portugal
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Zheng T, Xie H, Gao F, Gong C, Lin W, Ye P, Liu Y, He B, Zheng X. Research and application of a teaching platform for combined spinal-epidural anesthesia based on virtual reality and haptic feedback technology. BMC Med Educ 2023; 23:794. [PMID: 37880665 PMCID: PMC10601272 DOI: 10.1186/s12909-023-04758-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Intraspinal anesthesia poses significant teaching challenges and inadequate teaching resources, which ultimately limit students' opportunities for practice. To address this issue, we aimed to develop a virtual platform for combined spinal-epidural anesthesia that merges virtual reality technology with haptic feedback technology, while assessing its educational impact and learning outcomes. METHODS We utilized MIMICS, 3Ds MAX, and UNITY 3D software to perform 3D reconstruction based on lumbar CT/MRI data from a standard male volunteer. The haptic coefficients were configured on each layer by 20 experienced anesthesiologists in accordance with the Geomagic Touch X force feedback device. A total of 20 anesthesiology interns completed 30 virtual puncture training sessions. Two experienced anesthetists evaluated the efficacy of the platform and the level of mastery achieved using the Global Rating Scale (GRS) and a Checklist score, respectively. Finally, a questionnaire survey was conducted to gather feedback on the virtual platform. RESULTS After the 10th session, the puncture time stabilized at 2.4 min. As the number of sessions increased, the Global Rating Scale (GRS) score stabilized by the 8th session, and the Checklist scores tended to stabilize by the 10th session. Results from questionnaires indicated that over half of the anesthesiology interns (70%) believed that the platform, which exhibited strong repeatability, improved their anatomical recognition and provided a strong sense of breakthrough in identifying the ligamentum flavum. The majority of them (80%) expressed satisfaction with the virtual platform. CONCLUSIONS The platform effectively facilitated the acquisition of basic and accurate puncture skills on a virtual patient.
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Affiliation(s)
- Ting Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
| | - Huihong Xie
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Fei Gao
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Emergency Medical Center, Fuzhou, China
| | - Cansheng Gong
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
| | - Wei Lin
- College of Mechanical Engineering, Fuzhou University, Fuzhou, China
| | - Peng Ye
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
| | - Yuqing Liu
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
- Department of Neurosurgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Bingwei He
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China
- College of Mechanical Engineering, Fuzhou University, Fuzhou, China
| | - Xiaochun Zheng
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
- Fujian Provincial Co-Constructed Laboratory of "Belt and Road", Fujian Emergency Medical Center, Fuzhou, China.
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Emergency Medical Center, Fuzhou, China.
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Emergency Medical Center, Fuzhou, China.
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Wingert TEA, Hekmat D, Ayad I. Regional Anesthesia for Neonates. Neoreviews 2023; 24:e626-e641. [PMID: 37777613 DOI: 10.1542/neo.24-10-e626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Pain management in neonates and infants has many unique and important facets, particularly in former preterm infants. Untreated pain and surgical stress in neonates are associated with myriad negative sequelae, including deleterious inflammatory, autonomic, hormonal, metabolic, and neurologic effects. Meanwhile, opioid side effects are also very impactful and affect multiple systems and pathways, particularly in the neonatal and infant population. Regional anesthesia presents a unique opportunity to provide highly effective analgesia; prevent deleterious signaling cascade pathways within the endocrine, immune, and nervous systems from occurring; and create conditions to facilitate reduced reliance on opioids and other analgesics. In some cases, clinicians can completely avoid general anesthesia and systemic anesthetics. This review will discuss some of the unique aspects of pain management in neonates and infants and provide an overview of the different regional anesthetic options available, namely, spinal anesthesia, epidural anesthesia, and peripheral nerve blocks.
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Affiliation(s)
- Theodora E A Wingert
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Diana Hekmat
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Ihab Ayad
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles, Los Angeles, CA
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Selvamani BJ, Sondekoppam RV. Pulsatile fluid column-a simple bedside test to confirm optimal placement of thoracic epidural catheter. Can J Anaesth 2023; 70:1709-1710. [PMID: 37442902 DOI: 10.1007/s12630-023-02551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Liang T, Wu F. The "Hand as Foot" teaching method in epidural anesthesia. Asian J Surg 2023; 46:4612-4613. [PMID: 37244826 DOI: 10.1016/j.asjsur.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/12/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Tao Liang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Fan Wu
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China.
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Yoshida K, Tokimura S. To prevent accidental administration of disinfectants used for skin disinfection in epidural anesthesia. Reg Anesth Pain Med 2023; 48:533. [PMID: 37094992 DOI: 10.1136/rapm-2023-104599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University, Fukushima, Japan
| | - Satoko Tokimura
- Department of Anesthesiology, The Cancer Institute Hospital of JFCR, Koto-ku, Japan
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Broom MA. Intrathecal catheterisation after accidental dural puncture: real-world data, real-world benefits and real-world barriers. Anaesthesia 2023; 78:1195-1198. [PMID: 37553790 DOI: 10.1111/anae.16116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Affiliation(s)
- M A Broom
- Department of Anaesthesia, Glasgow Royal Infirmary and Princess Royal Maternity Hospital, Glasgow, UK
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Ayerle GM, Mattern E, Striebich S, Oganowski T, Ocker R, Haastert B, Schäfers R, Seliger G. Effect of alternatively designed hospital birthing rooms on the rate of vaginal births: Multicentre randomised controlled trial Be-Up. Women Birth 2023; 36:429-438. [PMID: 36935270 DOI: 10.1016/j.wombi.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND There is limited research into the effects of the birth environment on birth outcomes. AIM To investigate the effect of a hospital birthing room designed to encourage mobility, self-determination and uptake of upright maternal positions in labour on the rate of vaginal births. METHODS The multicentre randomised controlled trial Be-Up, conducted from April 2018 to May 2021 in 22 hospitals in Germany, included 3719 pregnant women with a singleton pregnancy in cephalic position at term. In the intervention birthing room, the bed was removed or covered in a corner of the room and materials were provided to promote upright maternal positions, physical mobility and self-determination. No changes were made in the control birthing room. The primary outcome was probability of vaginal births; secondary outcomes were episiotomy, perineal tears degree 3 and 4, epidural anaesthesia, "critical outcome of newborns at term", and maternal self-determination (LAS). ANALYSIS intention-to-treat. FINDINGS The rate of vaginal births was 89.1 % (95 % CI 87.5-90.4%; n = 1836) in the intervention group and 88.5 % (95 % CI 87.0-89.9 %; n = 1863) in the control group. The risk difference in the probability of vaginal birth was + 0.54 % (95 % CI - 1.49 % to 2.57 %), the odds ratio was 1.06 (95 % CI 0.86-1.30). Neither the secondary endpoints nor serious adverse events showed significant differences. Regardless of group assignment, there was a significant association between upright maternal body position and maternal self-determination. CONCLUSION The increased vaginal birth rates in both comparison groups can be explained by the high motivation of the women and the staff.
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Affiliation(s)
- Gertrud M Ayerle
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
| | - Elke Mattern
- Study Programme Midwifery Science, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Gesundheitscampus 6 - 8, 44801 Bochum, Germany
| | - Sabine Striebich
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Theresa Oganowski
- Study Programme Midwifery Science, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Gesundheitscampus 6 - 8, 44801 Bochum, Germany
| | - Ronja Ocker
- Clinic and Polyclinic for Obstetrics and Prenatal Medicine, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Saale, Germany
| | | | - Rainhild Schäfers
- Study Programme Midwifery Science, Department of Applied Health Sciences, Hochschule für Gesundheit, University of Applied Sciences, Gesundheitscampus 6 - 8, 44801 Bochum, Germany
| | - Gregor Seliger
- Clinic and Polyclinic for Obstetrics and Prenatal Medicine, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Saale, Germany
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Koehler A, Koch F, El-Ahmar M, Ristig M, Lehmann K, Ritz JP. Necessity of routine perioperative epidural catheter placement in laparoscopic colorectal resections: a retrospective data analysis. Langenbecks Arch Surg 2023; 408:335. [PMID: 37624426 DOI: 10.1007/s00423-023-03074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Whether epidural anesthesia leads to further improvement in the postoperative course of colorectal procedures is under discussion. The aim of this study was to evaluate the effects of minimally invasive colorectal oncological interventions without epidural anesthesia (EDA). METHODS This retrospective data analysis included the clinical data of all patients who underwent minimally invasive oncological colorectal resection at our clinic between January 2013 and April 2019. Of 385 patients who met the inclusion criteria, 183 (group I; 47.5% of 385) received EDA, and 202 (group II; 52.5% of 385) received transversus abdominis plane block instead. The relevant target parameters were evaluated and compared between the groups. The postoperative complications were graded according to the Clavien-Dindo classification. RESULTS The patients in group I (n=183; women, 77; men, 106; age 66.8 years) were younger (p=0.0035), received a urinary catheter more often (99.5% versus [vs.] 28.2% p<0.001), required longer, more frequent arterenol treatment (1.1 vs. 0.6 days; p<0.001), and had a longer intermediate care unit stay than those in group II (2.8 vs. 1.1 days; p<0.001). Postoperative pain levels were not significantly different between the groups (p=0.078). The patients in group I were able to ambulate later than those in group II (4 vs. 2 days; p<0.001). The difference in the postoperative day of the first defecation was not significant between the groups (p=0.236). The incidence of postoperative complications such as bleeding (p=0.396), anastomotic leaks (p=0.113), and wound infections (p=0.641) did not differ between the groups. The patients in group I had significantly longer hospital stays than those in group II (12.2 vs. 9.4 days; p<0.001). CONCLUSION EDA can be safely omitted from elective minimally invasive colorectal resections, and its omission is not accompanied by any relevant disadvantages to the patient.
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Affiliation(s)
- A Koehler
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany.
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - F Koch
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - M El-Ahmar
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - M Ristig
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
| | - K Lehmann
- Department of General and Visceral Surgery, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - J-P Ritz
- Clinic for General and Visceral Surgery, Helios Clinics in Schwerin, University Campus of the MSH Medical School Hamburg, Wismarsche Strasse 393-397, Schwerin, 19055, Germany
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Chen LJ, Chen SH, Hsieh YL, Yu PC. Continuous nerve block versus thoracic epidural analgesia for post-operative pain of pectus excavatum repair: a systematic review and meta-analysis. BMC Anesthesiol 2023; 23:266. [PMID: 37559029 PMCID: PMC10410789 DOI: 10.1186/s12871-023-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Surgery to repair pectus excavatum (PE) is often associated with severe postoperative pain, which can impact the length of hospital stay (LOS). While thoracic epidural analgesia (TEA) has traditionally been used for pain management in PE, its placement can sometimes result in severe neurological complications. Recently, paravertebral block (PVB) and erector spinae plane block (ESPB) have been recommended for many other chest and abdominal surgeries. However, due to the more severe and prolonged pain associated with PE repair, it is still unclear whether continuous administration of these blocks is as effective as TEA. Therefore, we conducted this systematic review and meta-analysis to demonstrate the equivalence of continuous PVB and ESPB to TEA.
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Affiliation(s)
- Li-Jung Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Shih-Hong Chen
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Yung-Lin Hsieh
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan
| | - Po-Chuan Yu
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist, 231405, New Taipei City, Taiwan.
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Esmaeeli S, Binda DD, Mejias Garcia J, Vaynberg E. Caudal epidural steroid injections with paracoccygeal injections for management of postpartum coccydynia: a case series. Int J Obstet Anesth 2023; 55:103897. [PMID: 37270858 DOI: 10.1016/j.ijoa.2023.103897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Affiliation(s)
- S Esmaeeli
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, USA
| | - D D Binda
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, USA.
| | - J Mejias Garcia
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, USA
| | - E Vaynberg
- Department of Anesthesiology, Boston University Chobanian and Avedisian School of Medicine, USA
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Mesa Suárez P, Pulido Barba M, Portilla Huerta D. Epidural analgesia and lumbar tattoos: 20 years of uncertainty. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:422-423. [PMID: 37549829 DOI: 10.1016/j.redare.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 08/09/2023]
Affiliation(s)
- P Mesa Suárez
- Área en Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain.
| | - M Pulido Barba
- Área en Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - D Portilla Huerta
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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Song Y, Zou XJ. Remimazolam dosing for intraoperative sedation in elderly patients undergoing hip replacement with combined spinal-epidural anesthesia. Eur Rev Med Pharmacol Sci 2023; 27:7485-7491. [PMID: 37667924 DOI: 10.26355/eurrev_202308_33399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the 50% and 95% effective doses (ED50 and ED95) of remimazolam for intraoperative sedation in elderly patients undergoing hip replacement with combined spinal-epidural anesthesia (CSEA). PATIENTS AND METHODS We retrospectively analyzed the clinical data of 50 patients who underwent hip replacement with CSEA in our hospital from October 2021 to June 2022. There were 29 males and 21 females, aged 60-80 years old, with body mass indexes (BMI) ranging from 18 to 24 kg/m2, and American Society of Anesthesiologists (ASA) classifications of I or II. The modified Dixon sequential method was used to determine the dose of remimazolam for each patient. Each patient's initial dose was 0.1 mg/kg/h, and the dose gradient was 0.01 mg/kg/h. The bispectral index (BIS) and the modified observer's assessment of alertness/sedation score (MOAA/S) were used to evaluate the sedation of the patient. An MOAA/S score ≤3 and a BIS <85 at three or more time points during surgery indicated the sedation was satisfactory. The induction dose of the next patient was adjusted by 0.01 mg/kg/h based on the level of sedation achieved, and the study was terminated after eight crossovers. RESULTS The ED50 and ED95 of remimazolam for sedation of elderly patients undergoing hip replacement with CSEA are 0.212 mg/kg/h (95% CI: 0.121-0.231 mg/kg/h) and 0.288 mg/kg/h (95% CI: 0.254-0.884 mg/kg/h), respectively. Two patients experienced transient bradycardia, five experienced hypoxemia, three experienced postoperative nausea, and three experienced postoperative delirium. No patients experienced adverse reactions such as injection pain, hypotension, vomiting, delayed awakening, or emergence agitation. CONCLUSIONS The ED50 and ED95 of remimazolam for sedation of elderly patients undergoing hip replacement with CSEA are 0.212 mg/kg/h and 0.288 mg/kg/h, respectively.
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Affiliation(s)
- Y Song
- Department of Anesthesiology, Renhe Hospital Affiliated to Three Gorges University, Yichang City, Hubei Province, China.
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Bhattacharya D, Latus S, Behrendt F, Thimm F, Eggert D, Betz C, Schlaefer A. Tissue Classification During Needle Insertion Using Self-Supervised Contrastive Learning and Optical Coherence Tomography. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082740 DOI: 10.1109/embc40787.2023.10340648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Needle positioning is essential for various medical applications such as epidural anaesthesia. Physicians rely on their instincts while navigating the needle in epidural spaces. Thereby, identifying the tissue structures may be helpful to the physician as they can provide additional feedback in the needle insertion process. To this end, we propose a deep neural network that classifies the tissues from the phase and intensity data of complex OCT signals acquired at the needle tip. We investigate the performance of the deep neural network in a limited labelled dataset scenario and propose a novel contrastive pretraining strategy that learns invariant representation for phase and intensity data. We show that with 10% of the training set, our proposed pretraining strategy helps the model achieve an F1 score of 0.84±0.10 whereas the model achieves an F1 score of 0.60±0.07 without it. Further, we analyse the importance of phase and intensity individually towards tissue classification.
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Skrifvars MB, Meyhoff CS. Optimal oxygen targets in patients undergoing general anesthesia for major non-cardiac surgery-How to handle the conflict between observational and randomized trials? Acta Anaesthesiol Scand 2023; 67:686-687. [PMID: 36973884 DOI: 10.1111/aas.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Ammitzbøll ILA, Andersen BR, Lange KHW, Clausen T, Løkkegaard ECL. Response to the commentary "Anaesthesia for caesarean section and the miscredit of top-up epidurals". Eur J Obstet Gynecol Reprod Biol 2023; 286:147-148. [PMID: 37253648 DOI: 10.1016/j.ejogrb.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023]
Affiliation(s)
- I L A Ammitzbøll
- Department of Obstetrics and Gynecology, North Zealand Hospital, Denmark; Department of Anesthesiology, Copenhagen University Hospital, North Zealand, Denmark; Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Denmark.
| | - B R Andersen
- Department of Obstetrics and Gynecology, North Zealand Hospital, Denmark; Department of Anesthesiology, Copenhagen University Hospital, North Zealand, Denmark; Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Denmark
| | - K H W Lange
- Department of Obstetrics and Gynecology, North Zealand Hospital, Denmark; Department of Anesthesiology, Copenhagen University Hospital, North Zealand, Denmark; Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Denmark
| | - T Clausen
- Department of Obstetrics and Gynecology, North Zealand Hospital, Denmark; Department of Anesthesiology, Copenhagen University Hospital, North Zealand, Denmark; Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Denmark
| | - E C L Løkkegaard
- Department of Obstetrics and Gynecology, North Zealand Hospital, Denmark; Department of Anesthesiology, Copenhagen University Hospital, North Zealand, Denmark; Department of Clinical Medicine, Health and Medical Sciences, University of Copenhagen, Denmark
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Li S, Zhan Y, Bu S, Tian Y, Xiong C, Shen J, Liu K. Effect of ropivacaine combined with sufentanil epidural anesthesia in abdominal surgery. Pak J Pharm Sci 2023; 36:1355-1360. [PMID: 37606028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
To explore and analyze the effect of ropivacaine plus sufentanil for epidural anesthesia during abdominal surgery, a total of 120 patients who underwent abdominal surgery at our institution between May 2019 and November 2020 were recruited and randomly assigned at a 1:1 ratio to receive either ropivacaine alone for epidural anesthesia (control group) or ropivacaine plus sufentanil (observation group). The total anesthesia effect in the observation group was significantly higher than that in the control group (96.66% vs 78.33%) (P<0.05). The combined anesthesia resulted in significantly lower visual analogue scale (VAS) scores (1.51±0.84, 1.63±0.56, 1.69±0.63, 1.54±0.42) in patients at 4h, 8h, 16h and 24h postoperatively versus ropivacaine alone (2.35±0.88, 2.49±0. 69, 2.47±0.78, 2.39±0.58) (P<0.05). The Ramsay sedation score (RSS) scores (1.98±0.81, 2.44±0.62, 2.18±0.62, 2.51±0.37) of the observation group at 4h, 8h, 16h and 24h after operation were significantly lower than those of the control group (1.42±0.52, 1.73±0.71, 1.47±0.66, 1.68±0.62) (P<0.05). Patients receiving ropivacaine plus sufentanil were associated with a lower incidence of adverse reactions than those given ropivacaine only (5.00% vs 30.00%) (P<0.05). In abdominal surgery, ropivacaine plus sufentanil epidural anesthesia resulted in reduced postoperative pain, enhanced sedative effects and a lower risk of adverse reactions versus ropivacaine alone.
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Affiliation(s)
- Songfeng Li
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Yong Zhan
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Shaojin Bu
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Yalin Tian
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Chunyan Xiong
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Jintao Shen
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
| | - Ke Liu
- Department of Anesthesiology, Fengdu People's Hospital, Chongqing, China
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Lee T, Shinn HK, Kim NE, Kim D. Application of high-flow nasal cannula oxygen therapy in patient with pulmonary edema following cesarean-section under combined spinal-epidural anesthesia: A case report. Medicine (Baltimore) 2023; 102:e34140. [PMID: 37390235 PMCID: PMC10313262 DOI: 10.1097/md.0000000000034140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC), which overcomes the disadvantages of the existing low flow mask, is an efficient method that can immediately provide a high volume of heated oxygen to the patient.[1] Therefore, this case reports a case in which HFNC was applied to a pregnant with acute respiratory failure. CASE A 37-year-old woman pregnant (GA 30 + 5 weeks) with twin was diagnosed with preeclampsia. It was decided to perform an emergency Cesarean-section under combined spinal-epidural technique worsening respiratory failure. After delivery, maternal dyspnea was not alleviated applying of O28 L/min via facial mask. Thus, high-flow nasal cannula (HFNC) oxygen therapy was applied (60 L/min, partial pressure of oxygen (FiO2) 80%) and SpO2 subsequently rose to 98% and the patient's dyspnea was resolved. CONCLUSIONS HFNC is a safe device that can effectively provide oxygen to pregnant with acute respiratory failure.
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Affiliation(s)
- Taeil Lee
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Helen Ki Shinn
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Na Eun Kim
- Department of Anesthesiology and Pain Medicine, Inha University, Incheon, South Korea
| | - Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
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Chapek M, Kessler A, Poon S, Cho R, Nguyen C, Kessler J. The Effect of Adolescent Idiopathic Scoliosis on Natural Delivery and Epidural Use in Pregnant Females: A Matched Cohort Study. Spine (Phila Pa 1976) 2023; 48:E188-E195. [PMID: 36745423 DOI: 10.1097/brs.0000000000004592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective matched cohort study. OBJECTIVE The aim of this study was to determine whether females with idiopathic scoliosis (IS), both with and without spine fusion, experience different rates of cesarean section (CS) and epidural anesthesia (EA) than females without scoliosis. SUMMARY OF BACKGROUND DATA IS is a common spine condition with a higher prevalence in females. It is unclear whether females with scoliosis, treated nonoperatively or operatively, have different rates of cesarean delivery or EA. MATERIALS AND METHODS Patients with IS who delivered in our integrated health care system during a 6-year period were identified (N = 1810). They were matched with a group without scoliosis who delivered during the same period (N = 1810). Rates and relative risk (RR) of CS and EA between cohorts and subgroups were calculated. RESULTS The scoliosis cohort had significantly higher rates and RR of EA ( P = 0.002 and P = 0.004, respectively). Scoliosis patients treated nonoperatively had an 8% greater RR of EA ( P = 0.004) and had a significantly lower rate of CS (23.2% vs . 26%, P = 0.048) compared with the control group. Among only scoliosis patients, those treated with spine fusion had a 38% decreased RR of EA ( P < 0.001). Distal fusion level did not seem to influence the RR of EA or CS. CONCLUSIONS Females with scoliosis were significantly more likely to receive EA at delivery compared with females without scoliosis. Rates and RR of cesarean delivery were not significantly lower among women with scoliosis, but females treated nonoperatively for scoliosis had a significantly lower CS rate than those without scoliosis. Females treated with spine fusion for scoliosis were far less likely to receive EA than both females without scoliosis and females with scoliosis treated nonoperatively.
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Affiliation(s)
- Michael Chapek
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
| | - Adam Kessler
- Kaiser Los Angeles Medical Center, Department of Orthopedics, Los Angeles, CA
| | - Selina Poon
- Shriners Hospital for Children, Pasadena, CA
| | - Robert Cho
- Shriners Hospital for Children, Pasadena, CA
| | | | - Jeffrey Kessler
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA
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Younger JD, Faryami A, Prasad M, Viar D, Menkara A, Tang A, Harris CA. Direct Comparison of Peak Bulk Flow Rate of Programmable Intermittent Epidural Bolus and Manual Epidural Bolus Using a Closed-End Multiorifice Catheter: An Experimental Study. Anesth Analg 2023; 136:1198-1205. [PMID: 36730916 DOI: 10.1213/ane.0000000000006268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The programmable intermittent epidural bolus (PIEB) has been popularized as the optimal delivery technique for labor analgesia. Suggested advantages of this method are less local anesthetic consumption, improved maternal satisfaction, potentially shorter duration of labor, and decreased workload requirements for the anesthesia providers. However, a manual bolus is still routinely used for breakthrough pain when the PIEB is underperforming. METHODS We conducted a laboratory-based study to quantify the flow through a multiorifice epidural catheter using the PIEB setting on an epidural pump compared to the manual epidural bolus. Four syringe volumes, 3, 5, 10, and 20 mL, were selected for this experiment. The flow in a manual bolus was also studied with and without the presence of an epidural catheter filter. A generalized estimating equation analysis was done to compare data between the groups. RESULTS Regardless of the syringe size, there was a several-fold increase in flow when a manual bolus was used compared to a pump-administered dose, with the highest difference in the peak flow rate observed in 3-mL boluses with up to a 12-fold difference, while the difference was, at most, 7-fold in 5-mL and 10-mL boluses. Manual boluses without a filter achieve a mean peak flow rate higher than manual boluses with a filter. CONCLUSIONS Our study found that manual boluses produced a higher flow rate compared to the CADD-Solis epidural pump (Smiths Medical). This study also found that the placement of a particulate filter reduces the flow rates generated while bolusing. Bulk flow rate is directly correlated with induced pressure and solution spread. Because higher bolus pressure has been shown to provide a more efficient distribution of local anesthetic and more efficient pain relief, these results may have impactful clinical significance and will pave the way for future studies.
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Affiliation(s)
- Joshua D Younger
- From the Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, Michigan
| | - Ahmad Faryami
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Monica Prasad
- Department of Medical Education, Wayne State University School of Medicine, Detroit, Michigan
| | - Daniel Viar
- Department of Computer Science and Engineering, University of Toledo, Toledo, Ohio
| | - Adam Menkara
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Amy Tang
- Department of Public Health Science, Henry Ford Health, Detroit, Michigan
| | - Carolyn A Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
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