Search

Introduction. Spinal anesthesia is one of the oldest and most commonly used regional anesthesia techniques. It is based on the injection of a local anesthetic into the subarachnoid space, during which there is a transient interruption of impulse conduction in the spinal nerve roots. Application of spinal anesthesia. The use of spinal anesthesia depends on the following factors: the site of the surgical procedure, the type and duration of the surgical procedure, the degree of necessary surgical relaxation, and presence of accompanying diseases. Local anesthetics used in spinal anesthesia. There are two types local anesthetics used in spinal anesthesia. These are local anesthetics of the ester and amide type. Most frequently applied local anesthetics are those of the amide type. Orthopedic procedures under spinal anesthesia. The most common surgical procedures in orthopedic surgery performed under spinal anesthesia are hip, knee and ankle surgeries. Complications of spinal anesthesia. The most common complications of spinal anesthesia are hypotension, bradycardia, urinary retention, and postpuncture headache. Conclusion. The advantages of spinal over general anesthesia in orthopedic surgery include lower incidence of respiratory and myocardial depression, better peripheral tissue perfusion, minimal coagulation system disorders and prolonged postoperative analgesia. [ABSTRACT FROM AUTHOR]

Spinal anesthesia is a frequently applied technique for lower limb orthopedic surgery. Hypotension is the most frequent side effect of conventional bilateral spinal anesthesia. An exclusively unilateral block only affects the sensory, motor and sympathetic functions on one side of the body without the typical adverse side effects seen with a bilateral block. The aim of this prospective, randomized study was to compare unilateral anesthesia versus conventional bilateral spinal anesthesia in lower limb orthopedic surgery according to the quality of sensory and motor blockade, analgesia, hemodynamic stability and side effects. Forty ASA I - II patients scheduled for lower limb orthopedic surgery were randomly allocated into two groups. Group BS patients received bilateral spinal anesthesia with 3ml isobaric 0.5% levobupivacaine (conventional dose) and group US patients received unilateral low dose spinal anesthesia with hyperbaric spinal solution (7.5mg of 0.5% levobupivacaine and 40mg of 10% glucose) over a period of 120 seconds and the patients were kept in the lateral position for 15 minutes. In both groups, the quality of the sensory and motor block was adequate for the surgical procedure. The time to two segment regression of sensory blockade, recovery time of motor blockade, as well as the time of complete recovery was significantly shorter in US group as compared to the BS group. Seven patients in the bilateral, and one patient in the unilateral group developed hypotension that required treatment with ephedrine (Chi-square test 7.02; p < 0.05). Unilateral low dose spinal anesthesia achieves stable hemodynamics. It also results in rapid recovery compared to a bilateral conventional dose spinal anesthesia. [ABSTRACT FROM AUTHOR]

Introduction. Femoral fractures are the most common cause of morbidity and mortality in the elderly. The aim of this study was to establish the predictors of hypotension in the elderly patients with femoral fractures during surgery in spinal anesthesia. Material and Methods. This retrospective study included 454 patients and investigated the relationship between hypotension and predictive factors for the development of hypotension using binary logistic regression. A paired sample T-test for dependent variables was used to compare the mean arterial pressure before and after the surgical procedure. Three mean arterial pressure values were compared between subjects receiving bupivacaine and subjects who received levobupivacaine: preoperative, the lowest value during the surgery, and the mean arterial pressure at the end of the surgery. Results. The age of the subjects ranged from 20 to 93 years (mean = 71.56; standard deviation = 13.26, median = 74). The mean arterial pressure values during the preoperative evaluation (103.2 ± 14.7) were higher than the last mean arterial pressure during surgery (84.8 ± 13.6) and these differences were statistically significant (p < 0.001). The group of subjects who received levobupivacaine presented with higher values of median arterial pressure (73.99) than the group receiving bupivacaine (70.76). Conclusion. The predictors of hypotension during surgery of patients with femoral fractures in spinal anesthesia are elderly age and preoperative use of beta blockers. [ABSTRACT FROM AUTHOR]

Introduction: Spinal anesthesia (synonyms: subarachnoidal nerve block, subdural nerve block, subdural anesthesia, lumbar anesthesia, subarachnoid anesthesia) occurs by injection of local anesthetics within the subarachnoid space in the lumbal interspace.1 It is also called a neuroaxial blockade that represents the primary anesthetic technique in one-third of surgical procedures.2 A local anesthetic, given in this way, transits blocking the transmission of sensory, motor and autonomic nerve impulses transiently, resulting in the desired effects, sensory and motor blockade, as well as the side effects due to blocking autonomic nerve fibers, when unwanted effects of spinal anesthesia, hyopotension, bradycaria, nausea, vomiting and retention of urine occur. In this paper we examined the effect of spinal anesthesia on cardiovascular functions in patients whose sympathetic tonus is partly suppressed due to the chronic use of |3-blockers due to essential hypertension. We wanted to know whether spinal anesthesia is a safe anesthetics technique in this group of patients or their effects are summed up, which would lead to cardiovascular instability that would result in greater use of pharmacological agents for the treatment of hypotension and bradycardia. Aim of the Study: To examine cardiovascular stability during spinal anesthesia in patients on p-blocker therapy and determine the safety of its use in this group of patients. Patients and Methods: After approval by the Ethics Committee of UCC Banja Luka, a prospective, observation study was conducted on 70 patients divided into two groups, aged 35-65 years, and it lasted from June 1st, 2013. until May 31st, 2016. Group N1, a working group, consisted of 35 patients who used beta-blocker, Metoprolol, in chronic therapy due to essential hypertension. The second group was a control group, N2, and it consisted of 35 healthy patients of the same age limit. Patients underwent spinal anesthesia for “bloodless” surgery on the inguines, perineum, urinary bladder, prostate, urethrae and lower extremities. No pregnant women, diabetic patients, kidney, liver and heart disease were involved in the work. Results: The results showed that there were a significantly higher number of patients with a critical drop in blood pressure, in the group of patients undergoing therapy with beta-blockers, ž30%, and alone with this more frequent use of vasopressor. Likewise, in the group of patients on beta-blocker therapy, significantly more patients developed bradycardia, i.e. a pulse of 50/min, which required the use of Atropine. Conclusion: Spinal anesthesia is not a safe anesthetic technique in patients on beta-blocking therapy [ABSTRACT FROM AUTHOR]

The aim of the present study was to compare the anaesthesia quality, patient comfort and complications during spinal anaesthesia in patients who received less volume of the local anaesthetic (1.5ml and 2.0 ml) and patients with higher volumes intrathecally injected local anaesthetic (3.5ml and 4.0 ml) 0.5 % solution levobupivacaine. Materials and methods: The study involved 40 patients, ASA I to IV who were scheduled to have elective surgery with spinal anaesthesia. The patients were divided in two groups: Group A (the group received higher volume) and Group B (the group received less volume). The heart rate, non-invasive blood pressure and SpO2 were recorded before spinal anaesthesia and on 5 minutes during the surgery. Results: There were no significant differences between the two groups with respect to age and ASA patient status. The onset and progress of Bradycardia was in a significant statistical correlation with the dose of the local anaesthetic (p<0,001). The complications and side effects of spinal anaesthesia techniques, such as nausea, vomiting, headache were frequentl in the group with higher dose of local anaesthetic. Conclusion: There were no statistically significant discrepancies related to the success of the spinal block with respect to the dose of the applied anaesthetic. The incidence of sideeffects was proportional to the dose of the applied anaesthetic. [ABSTRACT FROM AUTHOR]

Spinal anesthesia is generally accepted as the first choice for hip surgery due to the deep nerve block affecting a large part of the body achieved through a relatively simple procedure of injecting a small amount of local anesthetic. By controlling the factors that influence the widening of the blocked area, the desired type of block can be achieved, the variability of which can be attributed to factors such as cerebrospinal fluid density, lumbar lordosis or volume of lumbosacral cerebrospinal fluid, namely, its dilution through the injection of isobaric anesthetic solution. However, it is important to know that in certain indications surgical anesthesia needs to be accomplished by a general endotracheal anesthesia. Spinal anesthesia of acceptable height and solidity is achieved through adequate intrathecal distribution of the local anesthetic solution, therefore the difference between the density of liquor and the injected solution of local anesthetic provides the main effect on the intrathecal spread of anesthetics. Anticipated spinal anesthesia is achieved by a hyperbaric or hypobaric solution of local anesthetic; in other words, hyperbaric solutions "sink" while the hypobaric solutions "swim" in such a way that the level of caudal or cranial spread of local anesthetic will depend on the mutual interaction of the density of the solution and the patient's body posture. [ABSTRACT FROM AUTHOR]

Uvod: Aortna stenoza je najčešće valvularno oboljenje gerijatrijske populacije sa učestalošću od 3%, i uzrok je iznenadnih srčanih smrti u 20% slučajeva. Uprkos napretku anestezioloških i hirurških tehnika, morbiditet i mortalitet kod pacijenata sa teškom aortnom stenozom ostaje visok. Teška aortna stenoza je prediktor za perioperativne komplikacije, jer se tokom anestezije hemodinamski parametri mogu rapidno pogoršati, što je riziko faktor za perioperativni mortalitet i morbiditet. Anesteziološka tehnika i vođenje moraju biti pažljivo planirani, sa ciljem da se izbegne sistemska hipotenzija, koja bi dovela do miokardne ishemije i smanjenja kontraktilnosti, i da se održi sinus ritam i spreči tahikardija, koja bi skratila vreme dijastolnog punjenja i ugrozila miokardnu perfuziju. Cilj: Prikazati da spinalna anestezija izvedena kombinacijom minimalnih efektivnih doza lokalnog anestetika levobupivakaina i opioidnog analgetika fentanila obezbeđuje hemodinamsku stabilnost pacijenta za sigurno izvođenje operativnog zahvata implantacije endoparcijalne proteze kuka. Materijal i metodi rada: Deskriptivnimetod - prikaz slučaja. Rezultati: Pacijentkinja stara 81 godinu biva hospitalizovana na Odeljenje ortopedske hirurgije i traumatologije Zdravstvenog centra Negotin, radi operativnog zbrinjavanja preloma zgloba kuka. Dijagnoze na prijemu: Fractura colli femoris dextri. Stenosis ostii aortae gravis (ehokardiografski se nad sklerotičnom valvulom registruje gradijent od 62 mm Hg). Myocardiopathia chronica ishaemica compensata. Hypertensio arterialis. Anaemia secundaria. Status post perforatio ulcus ventriculi al IV. Tabletirana terapija na prijemu: Tritace comp 1×1, ujutro, Tritace 5mg 1×1, uveče, Binevol 5 mg ujutro, Monizol 20 mg 1+1+0, Controloc 20 mg 2×1, Oriblete Fomela pp. Operacije: Totalna histerektomija, pre 35 godina. Negira alergije na lekove i hranu, kao i druge bolesti od značaja. Dobro toleriše fizički napor po MET klasifikaciji. ASA 3. Nakon inicijalne resuscitacije, nadoknade volumena kristaloidima, analgezije, tromboprofilakse, korekcije anemije derivatima krvi, i izvršenih laboratorijskih pretraga i konsultativnih specijalističkih pregleda, pristupa se planiranju tehnike anestezije i operacije. Anesteziološki izbor je spinalna anestezija u kombinaciji 2,5 ml 0.5% lokalnog anestetika Levobupivakaina (12,5mg) i 25 μg Fentanyla, sa ciljem da se obezbedi stabilna hemodinamika; vrednosti arterijske tenzije do 10% niže od inicijalne, sinus ritam i srčana frekvenca u rasponu od 60-80 otkucaja u minti. Ortopedski izbor je implantacija bescementne endoparcijalne proteze, gde hirurška manipulacija traje kratko-1h, gubici krvi su minimalni, a sama tehnika ne utiče na hemodinamiku pacijenta. Anestezija i operativni zahvat se odvijaju u skladu sa projektovanim ciljevima. Nakon popuštanja spinalnog bloka, dodavanjem opioidnog analgetika fentanila (100 μg u ifuziji), i multimodalnom trojnom analgetskom terapijom, postiže se zadovoljavajući analgetski efekat, sa minimalnim uticajem na hemodinamske parametre. Nakon skidanja drenova, pacijentkinja se trećeg postoperativnog dana vertikalizuje. Postoperativni tok protiče bez komplikacija, započinje se rani fizikalni tretman i rehabilitacija, te se 21. dana otpušta sa bolničkog lečenja u dobrom opštem stanju, sa preporukom za nastavak rehabilitacionog banjskog tretmana. Zaključak: Dodatak 25 μg fentanila intratekalno na 12.5 mg levobupivakaina daje zadovoljavajući blok tokom operacije i višečasovnu postoperativnu analgeziju, a nije udružen sa hemodinamskom nestabilnošću i hipotenzivnim epizodama, ili drugim komplikacijama u visoko rizičnih gerijatrijskih pacijenata koji se podvrgavaju ortopedskoj hirurgiji. [ABSTRACT FROM AUTHOR]