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Background: Intravenous fluid administration and prophylactic vasopressor infusion are the primary methods for preventing spinal anesthesia-induced hypotension during cesarean delivery. However, evidence regarding the impact of different volumes of crystalloid solution on the phenylephrine infusion dosage for preventing this hypotension remains inconclusive. This study aimed to determine the effect of two IV fluid infusion rates (10 or 20 mL/kg/h) on phenylephrine requirement for preventing spinal anesthesia-induced hypotension. Methods: Eighty healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. Participants were randomly assigned to receive either 10 mL/kg/h (group 10) or 20 mL/kg/h (group 20) of lactated Ringer's solution. The first patient in each group received 0.5 µg/kg/min of phenylephrine infusion immediately after intrathecal injection. The phenylephrine dose in subsequent patients was adjusted by increments or decrements of 0.05 µg/kg/min based on the previous patient's response. The ED50 of phenylephrine infusion for preventing spinal-induced hypotension for cesarean delivery was estimated using a modified up-down sequential analysis, with probit analysis applied as a backup sensitivity analysis. Results: The ED50 values for preventing spinal anesthesia-induced hypotension were 0.30 µg/kg/min (95% CI, 0.29–0.32 µg/kg/min) for group 10, and 0.19 µg/kg/min (95% CI, 0.16–0.22 µg/kg/min) for group 20, respectively. The estimated relative potency for phenylephrine in group 10 compared to group 20 was 1.52 (95%CI, 1.24–1.97), showing a significant difference in the ED50 values between the two groups. Conclusion: This study found that a higher crystalloid co-loading rate significantly reduces prophylactic phenylephrine requirement for preventing spinal anesthesia induced hypotension. Trials registration: https://www.chictr.org.cn/showproj.html?proj=125918 (Trial number: ChiCTR2100048002). [ABSTRACT FROM AUTHOR]

Background: Worldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital. Methods: This cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis. Results: A total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36–37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%). Conclusion: The present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: High spinal block is a serious complication of spinal anesthesia. However, findings regarding its associated risk factors are inconsistent, and no studies have reported a relevant risk prediction score. We aimed to determine the risk prediction score for high spinal block in patients who were induced spinal anesthesia for cesarean delivery. Methods: This retrospective cohort study was conducted at a hospital in Southern Thailand between 2019 and 2020. We recorded demographic characteristics, gestational age (GA), hyperbaric bupivacaine dose, sensory block level, pre- and post-procedure blood pressure, and birth weight. High spinal block was defined as a decrease in pinprick sensation > T4. Risk scores, adjusted odds ratios (OR), and 95% confidence intervals (CI) were determined. Risk scores were derived from the coefficients of the final multivariate logistic regression model. Results: The incidence of high spinal block was 22.4% among the 1003 parturients. Our risk prediction tool for high spinal block had a sensitivity and specificity of 76% and 49%, respectively, and was classified into high (> 21), intermediate (15–21), and low (≤ 14) risk groups. The patient-related predictors were a GA < 35 weeks (OR [95% CI]: 2.31 [1.13, 4.71], score of 8), height < 150 cm (2.21 [1.11, 4.38], score of 8), and post-pregnancy body mass index > 27.5 kg/m2 (2.68 [1.33, 5.41], score of 10). The anesthesia-related predictors were a hyperbaric bupivacaine dose > 11 mg (2.56 [1.34, 4.87], score of 9) and induction by a first-year resident (1.48 [1.05, 2.09], score of 4). The surgery-related predictors were previous cesarean delivery in labor (1.83 [1.2, 2.78], score of 6) and elective cesarean delivery (2.53 [1.57, 4.07], score of 9) compared to indication by cephalopelvic disproportion. The incidence of intraoperative hypotension was significantly higher in the high-block group than in the control group (46% vs. 25%, p < 0.001). Conclusion: The combination of patient- and anesthesia-related predictors played an important role in the intermediate- and high-risk groups for high sensory spinal block. Addressing the modifiable risk factors—a GA < 35 weeks, an optimal dose of bupivacaine, and the experience level of the spinal block performer—could minimize the risk of high spinal block during cesarean delivery. [ABSTRACT FROM AUTHOR]

Purpose: Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless). Methods: Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group. Results: No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004). Conclusion: Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups. [ABSTRACT FROM AUTHOR]

Background/Objectives: Spinal conditions, such as fractures and herniated intervertebral discs (HIVDs), are often challenging to diagnose due to overlapping clinical symptoms and the difficulty in assessing their functional impact. Accurate differentiation between these conditions is crucial for effective treatment, particularly in the context of preoperative anesthesia evaluation, where understanding the underlying condition can influence anesthesia planning and pain management. Methods and Materials: This study presents a Support Vector Machine (SVM) model designed to distinguish between spinal fractures and HIVDs using key clinical predictors, including age, gender, preoperative Visual Analog Scale (VAS) pain scores, and the number of spinal fractures. A retrospective analysis was conducted on a dataset of 199 patients diagnosed with these conditions. The SVM model, using a radial basis function (RBF) kernel, classified the conditions based on the selected predictors. Model performance was evaluated using precision, recall, accuracy, and the Kappa index, with Leave-One-Out (LOO) cross-validation applied to ensure robust results. Results: The SVM model achieved a precision of 92.1% for fracture cases and 91.2% for HIVDs, with recall rates of 98.1% for fractures and 70.5% for HIVDs. The overall accuracy was 92%, and the Kappa index was 0.76, indicating substantial agreement. The analysis revealed that age and VAS pain scores were the most critical predictors for accurately diagnosing these conditions. Conclusions: These results highlight the potential of the SVM model with an RBF kernel to reliably differentiate between spinal fractures and HIVDs using routine clinical data. Future work could enhance model performance by incorporating additional clinical parameters relevant to preoperative anesthesia evaluation. [ABSTRACT FROM AUTHOR]

Purpose: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. Methods: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. Results: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33–3.509)] and movement [2.40 (1.20–4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100–300); Group 2: 37.5 (0–200); p < 0.001]. Conclusion: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Method: A total of 200 patients (50–75 years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, a nomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. Results: In total, 175 patients were analyzed and 79 (45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090–1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043–1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had a better predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. Conclusion: Elevated preoperative systolic arterial blood pressure and a higher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment. [ABSTRACT FROM AUTHOR]

Introduction: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. Materials and methods: In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. Results: In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Conclusion: Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate. [ABSTRACT FROM AUTHOR]

Background: The primary aim of our study was to determine which patient characteristics were associated with opioid consumption following cesarean delivery. Methods: The Baylor Scott & White Research Institute institutional review board approved this study (024-178). Patients who underwent cesarean delivery at Baylor Scott & White Medical Center – Temple with single injection or combined spinal epidural anesthesia in 2023 were eligible for inclusion. We examined the medical records of 300 patients, calculated the 24-hour opioid consumption for each, and compared the top third to the low group in a bivariate analysis and then performed a multivariate logistic regression. Results: One hundred thirty-one patients had no opioid consumption in the first 24 postoperative hours, and 100 patients had a morphine milligram consumption of 30 to 117.5 mg. A multivariate logistic regression determined that patients in the higher opioid consumption cohort were more likely to have received combined spinal epidural anesthesia (odds ratio 2.079; 95% confidence interval 1.149, 3.762; P = 0.02) and administration of intravenous dexmedetomidine in the intraoperative period (odds ratio 2.542; 95% confidence interval 1.038, 6.224; P = 0.04). Conclusion: Intraoperative administration of intravenous dexmedetomidine and combined spinal epidural anesthesia was associated with increased postoperative opioid consumption following cesarean delivery. [ABSTRACT FROM AUTHOR]

Spinal anesthesia (SA) is the preferred anesthesia modality for total joint arthroplasty (TJA). However, studies establishing SA as preferential may be subject to selection bias given that general anesthesia (GA) is often selectively utilized on more difficult, higher-risk operations. The optimal comparison group, therefore, is the patient converted to GA due to a failed attempt at SA. The purpose of this study was to determine risk factors and outcomes following failed SA with conversion to GA during primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). A consecutive cohort of 4,483 patients who underwent primary TJA at our institution was identified (2,004 THA and 2,479 TKA). Of these patients, 3,307 underwent GA (73.8%), 1,056 underwent SA (23.3%), and 130 patients failed SA with conversion to GA (2.90%). Primary outcomes included rescue analgesia requirement in the postanesthesia care unit (PACU), time to ambulation, pain scores in the PACU, estimated blood loss, and 90-day complications. Risk factors for SA failure included older age and a higher comorbidity burden. Failure of SA was associated with increased estimated blood loss, rescue intravenous opioid use, and time to ambulation when compared to the successful SA group in both THA and TKA patients (P <.001). The anesthesia modality was not associated with significant differences in PACU pain scores. The 90-day complication rate was similar between the failed SA and GA groups. There was a higher incidence of postoperative pain prompting unplanned visits and thromboembolism when comparing failed SA to successful SA in both THA and TKA patients (P <.05). In our series, patients who had failed SA demonstrated inferior outcomes to patients receiving successful SA and similar outcomes to patients receiving GA who did not have an SA attempt. This emphasizes the importance of success in the initial attempt at SA for optimizing outcomes following TJA. [ABSTRACT FROM AUTHOR]

Existing evidence of the effect of spinal anesthesia (SA) on cardiac systolic function is scarce and inconclusive. This study aimed to evaluate the effects induced by a single injection of SA for elective vascular surgery on left (LV) and right (RV) ventricular systolic performance using transthoracic echocardiography (TTE). A prospective study. Single-center study, university hospital. Adult patients undergoing elective vascular surgery with SA. During patients' evaluations fluid administration was targeted using arterial waveform monitoring. All patients underwent TTE studies before and after SA induction for the assessment of indices reflective of LV and RV systolic function. Blood samples were drawn to measure troponin and brain natriuretic peptide (BNP) levels. A total of 62 patients (88.7% males, 71.00 ± 9.42 years) were included in the study. The primary outcome was the difference before and after SA in LV ejection fraction (LVEF) and tricuspid annular plane systolic excursion (TAPSE). In total population, LVEF significantly increased after SA 53.07% [16.51]vs 53.86% [13.28]; p < 0.001). End-systolic volume (ESV, 69.50 [51.50] vs. 65.00 [29.50] ml; p < 0.001) decreased while stroke volume (SV) insignificantly increased (70.51 ± 16.70 vs. 73.00 ± 18.76 ml; p = 0.131) during SA. TAPSE remained unchanged (2.23 [0.56] vs. 2.25 [0.69] mm; p = 0.558). In patients with impaired compared to those with preserved LV systolic function, the changes evidenced in LVEF (7.49 ± 4.15 vs. 0.59 ± 2.79; p < 0.001), ESV (-18.13 ± 18.20 vs-1.53 ± 9.09; p < 0.001) and SV (8.71 ± 11.96 vs-1.43 ± 11.89; p = 0.002) were greater. This study provides evidence that SA in patients undergoing elective vascular surgery improved LV systolic function, while changes in RV systolic function are minimal. [ABSTRACT FROM AUTHOR]

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People all around the world suffer from low back pain (LBP), which frequently results in disability and a lower quality of life. Myths and misconceptions around LBP are still prevalent in both the general public and hospital settings, despite its ubiquitous prevalence. Through dispelling these myths and advocating for evidence-based knowledge, medical professionals can enhance patient education, lessen stigma, and anxiety related to life with post-traumatic stress disorder and enable more successful management techniques. Furthermore, dispelling myths regarding low back pain in the broader public can enable people to actively participate in their own care and support improved outcomes for those who have this crippling illness. The purpose of this evaluation of the literature is to identify and dispel prevalent misconceptions about LBP by examining the available data. [ABSTRACT FROM AUTHOR]

Background: Anaphylactic cardiovascular collapse is complicated by aortocaval compression during pregnancy, exacerbated by neuraxial anesthesia. Despite recommendations to administer perioperative antibiotics before anesthesia, common practice in Japan involves administering them after anesthesia induction. We report a case of possible antibiotics-induced anaphylaxis just before anesthesia for cesarean delivery. Case presentation: A 24-year-old woman at 37 weeks of gestation presented for a scheduled repeat cesarean under spinal anesthesia. After starting administration of cefazolin prior to anesthesia, she developed anaphylactic symptoms. Hypotension refractory to adrenaline necessitated conversion to an emergency cesarean section under general anesthesia. A neonate was delivered with favorable Apgar scores. Post-delivery, the mother's hemodynamics stabilized significantly. Elevated plasma tryptase confirmed anaphylaxis. Both mother and infant were discharged without further complications. Conclusions: This case emphasizes the importance of administering prophylactic antibiotic before anesthesia in mitigating severity of shock induced by anaphylaxis and the crucial role of prompt emergency cesarean in achieving successful outcomes. [ABSTRACT FROM AUTHOR]

Background: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section. Methods: In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. Results: Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15–6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14–4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72–10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06–1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49–0.57) and 0.56 (95%CI 0.51–0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively. Conclusion: In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability. Trial registration: Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

To prospectively investigate the effect of music therapy on patient's anxiety and pain level during retrograde intrarenal surgery under spinal anesthesia. 286 patients aged above 18 years, who underwent Retrograde Intrarenal Surgery (RIRS) under spinal anesthesia for renal or ureteral calculi were evaluated between January 2023 and June 2023 by a prospective, randomized, controlled clinical protocol. Patients were randomized into 2 groups. Group 1 included patients, who listened to music, and Group 2 was comprised of patients, who were not allowed to listen to music. Visual Analog Scale (VAS) results and pain sensation, anxiety level, together with the results of State-Trait Anxiety Inventory (STAI), a self-reported anxiety inventory, were captured. The number of patients, who were randomized to the music group (Group 1) and non-music group (Group 2) was 144 and 142, respectively. Mean heart rate in Group 1 and Group 2 was 60 ± 4.19 and 70 ± 8.36, respectively (p = 0.02), indicative of the fact that mean heart rate was significantly lower in the music group. Heart rate measured post-operatively within the first hour subsequent to the procedure was similar in both groups (p < 0.05). The VAS score was significantly lower in Group 1. STAI score in Group 1 and Group 2 was 45.51 ± 2.968 and 49.16 ± 1.88, respectively. Therefore, there was a statistically significant difference (p < 0.001). Music therapy during the RIRS procedure under spinal anesthesia was associated with a significantly decrease in pain and anxiety scores in patients. [ABSTRACT FROM AUTHOR]

Spinal anesthesia is a widely practiced anesthetic technique during cesarean section but is associated with the risk of postdural puncture headache (PDPH). This article reports a case of refractory PDPH following a cesarean section that achieved immediate pain relief after a sphenopalatine ganglion block (SPGB). SPGB has been proposed as a non‐invasive alternative to the traditional epidural blood patch for nonobstetrical PDPH, nonetheless, it is a procedure not commonly performed by obstetricians. By targeting the sphenopalatine ganglion, SPGB offers a viable treatment option for PDPH and provides immediate relief to patients. This case report and literature review suggest that SPGB is a promising, effective, and safe approach for managing PDPH after cesarean section. Considering SPGB as an alternative to epidural blood patch, obstetricians can offer noninvasive treatment options for patients with PDPH. [ABSTRACT FROM AUTHOR]

Background: Although subdural hematoma is a rare complication after spinal anesthesia, there have been no reports of an intracranial epidural hematoma after cesarean section with spinal anesthesia. Case presentation: A 32-year-old nulliparous woman at the 35th week of a twin pregnancy underwent an emergency cesarean section due to her first contraction. She had no preoperative complications and the spinal anesthesia was uneventful, with 0.5% bupivacaine 12 mg and fentanyl 15 µg from the L3/4 intervertebral space. She complained of headache and nausea 15 min after spinal anesthesia, demonstrating a consciousness disturbance after surgery. Computed tomography 2 h after the cesarean section revealed an intracranial epidural hematoma. She underwent decompressive craniotomy 1 h later. Conclusion: This case highlights the possible development of an intracranial epidural hematoma in low-risk obstetric patients. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic created a massive shift in how health care systems interact with COVID testing for patients. To avoid delay in accessing second trimester surgical abortion at our hospital (St. Paul's Hospital Millennium Medical College) during this pandemic, dilation and evacuation (D&E) procedures were attended as emergency cases, instead of as elective surgical procedures, which then required adherence to the universal preoperative COVID-19 testing protocol. This study aimed at documenting the experience of this unique abortion service adjustment in response to the COVID-19 pandemic. Methods: This was a retrospective descriptive study conducted at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, from April 1, 2021 to July 31, 2021. We reviewed second trimester surgical abortion cases managed with D& E procedures, performed under spinal anesthesia using the emergency COVID-19 pre-operative testing protocol. Data were analyzed using SPSS version 23 and simple descriptive statistics were applied. Percentages and proportions were used to present the results. Results: Nineteen cases of second trimester D&E cases were reviewed. The median gestational age of the abortion clients was 21.57 weeks. Eight of 19 cases had cervical preparation with overnight intra-cervical Foley catheter placement while the rest 11 (57.9%) cases had their cervical preparation with Laminaria. The median time interval from initial evaluation of the abortion client to time of doing D& E procedure was 21.83 h. Conclusion: Surgical abortion service reorganization enabled abortion clients to access dilation and evacuation procedures within 24 h of their initial presentation. This prevented significant delays in accessing abortion care that could otherwise have occurred as a result of adhering to the preoperative COVID-19 testing protocols applied to elective surgeries. [ABSTRACT FROM AUTHOR]

Background: Maintaining hemodynamic stability during spinal anesthesia for caesarean sections is crucial for optimal maternal and fetal outcomes. Norepinephrine and phenylephrine are commonly used vasopressors to manage hypotension in this setting, but their comparative efficacy and safety are not well-established. Objective: The study was planned with overall objective to compare the efficacy of Norepinephrine and Phenylephrine infusions required to manage hypotension during spinal anaesthesia for caesarean section and to compare the maternal adverse effects. Methods: This is an institution based Comparative Prospective study, it’s conducted from One and half year (February 2023 – May 2024) after getting permission from Institute Ethics Committee (IEC) and approval of The West Bengal University of Health Sciences (WBUHS) at Operation theatre of Department of Gynaecology & Obstetrics, Murshidabad Medical College & Hospital, Berhampore, West Bengal. Results: Requirement infusions was higher for the Phenylephrine infusions group subjects than the Norepinephrine infusions group subjects, and which was not statistically significant. The mean (SD) infusions required for Norepinephrine group subjects was 3.033(0.7063) and for Phenylephrine infusions group subjects was 3.267(0.6798). Conclusion: Norepinephrine infusion is more effective than phenylephrine in maintaining hemodynamic stability during spinal anesthesia for caesarean section, with fewer adverse effects. These findings suggest that norepinephrine may be a preferable option for managing hypotension in this clinical setting. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is widely used for various surgical procedures, but it can be associated with adverse events. Understanding these adverse events and their frequency can guide clinicians in selecting the most appropriate anesthesia technique for different patient populations. Objective: This study aimed to compare the incidence and types of adverse events associated with different spinal anesthesia techniques used during surgery at SRM Medical College Hospital, Bhawani Patna, Odisha, India. Methods: A prospective, observational study was conducted with a sample size of 180 patients undergoing elective surgeries under spinal anesthesia. Patients were randomly assigned to receive one of three types of spinal anesthesia: bupivacaine, ropivacaine, or levobupivacaine. Adverse events were monitored and recorded intraoperatively and postoperatively for up to 48 hours. Data were analyzed using descriptive statistics, chisquare tests, and logistic regression to identify factors associated with adverse events. Results: The overall incidence of adverse events was 32.8%, with the highest frequency observed in the bupivacaine group (38.3%), followed by ropivacaine (30.0%) and levobupivacaine (27.8%). The most common adverse events were hypotension (15.0%), bradycardia (10.6%), and postoperative nausea and vomiting (PONV) (7.2%). Significant differences were found between the groups regarding the incidence of hypotension (p=0.021) and bradycardia (p=0.034). Multivariate analysis identified age, baseline hypertension, and type of spinal anesthesia as significant predictors of adverse events. Conclusion: This study provides comparative data on the adverse events associated with different spinal anesthesia techniques. The findings suggest that levobupivacaine may be associated with a lower incidence of adverse events compared to bupivacaine and ropivacaine. These insights can aid anesthesiologists in selecting the most appropriate spinal anesthesia technique, enhancing patient safety and outcomes. [ABSTRACT FROM AUTHOR]

Background, Aims and Objectives: Shivering is a common problem in obstetric patients undergoing cesarean section under spinal anaesthesia and its incidence is approximately 30% to 55%. Aim of our study was to compare the efficacy of intravenous Dexmedetomidine, intravenous Tramadol with placebo in prevention of post-spinal anaesthesia shivering in obstetric patients undergoing caesarean section. Secondary objective was to observe any side effects like nausea, vomiting, hypotension, bradycardia and sedation. Materials and methods: This prospective, randomized, and double-blinded study was conducted in the department of Anaesthesia, PGIMS, Rohtak . 126 Healthy pregnant women, 20-40 years of age, without any comorbid conditions requiring caesarean section under spinal anaesthesia were enrolled for the study and randomly allocated into one of the three groups according to computer generated randomisation . Group A (n=41) received 0.5 mcg/kg Dexmedetomidine, Group B (n=43) 0.5 mg/kg Tramadol and Group C (n=42) plain 100 mL normal saline IV infusion after spinal anaesthesia and delivery of baby. Shivering, sedation, blood pressure, heart rate was measured intraoperatively. Result: All data were summarised as mean ± SD for continuous variables, numbers and percentages for categorical variables. There was a significant difference between the various groups in terms of distribution of Incidence of Shivering (χ2 = 48.199, p-value < 0.001) . 9.8% (n=4) of the participants in the Group A, 53.5% (n=23) of the participants in the Group B, and 85.7% (n=36) of the participants in the Group C had shivering. Conclusion: This study showed dexmedetomidine as a better drug for the prevention of shivering after spinal anaesthesia as compared to tramadol as it has a low incidence of shivering, benefits of awake sedation and not associated with nausea and vomiting. [ABSTRACT FROM AUTHOR]

Background: The incidence of hypotension in parturients with coronavirus disease (COVID-19) undergoing regional anesthesia remains controversial. This study aimed to investigate the incidence of hypotension during spinal anesthesia in parturients infected with COVID-19, as well as to identify associated risk factors. Methods: This retrospective study compared COVID-19-positive parturients who underwent cesarean section under spinal anesthesia (COVID-19 group) with a control group between January 2017 and June 2022. We reviewed the medical records and collected the following information: basic patient characteristics, spinal anesthesia, and newborn-related data. Results: Compared with the control group, the COVID-19 group did not show any significant differences in terms of hypotension occurrence and vasopressor usage. A positive correlation was noted in the COVID-19 group between heart rate and duration of hospital stay (P < 0.001, Spearman’s rho = 0.422). In subgroup analysis of the COVID-19 group, group with a baseline heart rate ≥ 100 (group H) had lower Apgar scores at 1 min, longer hospital stays, and more severe COVID-19 symptoms than the with a baseline heart rate < 100 (group L). Moreover, in group H, there was a positive correlation between the heart rate and the lowest systolic blood pressure after spinal anesthesia (P = 0.012, Spearman’s rho = 0.528). Conclusions: Parturients with COVID-19 do not appear to have a higher risk of hypotension during cesarean section under spinal anesthesia than those without COVID-19. Given the close association between preoperative heart rate and extent of hypotension in parturients with COVID-19 undergoing spinal anesthesia, vigilant monitoring of vital signs by anesthesiologists is crucial during the perioperative period. [ABSTRACT FROM AUTHOR]

Background: Inadequate pain relief with moderate to severe pain remains a challenge after cesarean section and may significantly impair postoperative recovery. However, detailed assessment on the timing of severe pain, opioid consumption, influence on activities such as mobilization, breastfeeding, and caring for the infant are difficult to conduct, especially after discharge. Short message services (SMS)‐based questionnaires may offer a low‐cost way of providing such data but with the risk of insufficient response rates. We assessed the feasibility of collecting detailed, prospective data on postoperative pain and recovery during the initial hours and days following cesarean section using SMS‐based questionnaires. Methods: Prospective Danish single‐center cohort study involving elective cesarean sections under spinal anesthesia with fentanyl and bupivacaine. The postoperative pain regimen consisted of paracetamol, NSAID and oral morphine by request. Patients received an SMS‐based questionnaire at 6, 12, 18, 24, and 48 h postoperatively, as well as on days 7 and 30. Primary outcome: Response rate and time from receiving the SMS to completion of the questionnaires. Secondary outcomes: Opioid consumption and Patient Reported Outcomes Measures on pain and recovery. Results: From December 2022 to June 2023; 100 patients were included. The response rate was 78% at 6 h postoperatively, decreasing to 63% at 24 h. The median response time from receiving to answering the SMS‐based questionnaire at 6 h after cesarean section was 23 min (IQR 2–72), decreasing to 20 min (IQR 2–78) after 24 h. Severe pain, corresponding to a Numeric Rating Scale (NRS) score >6, was reported by 57% (95% CI 65–84) at 6 h, decreasing to 28% (95% CI 34–58) at 24 h. Median opioid consumption within the first 24 h was 30 mg (IQR 20–50). Conclusion: SMS‐based questionnaires on Patient Reported Outcome Measures are a feasible and cost‐effective way of prospectively collecting frequent data with acceptable response rates, even shortly after cesarean section. Secondarily 66% of patients reported severe pain during the first 24 h following cesarean section, with the highest pain scores within the initial 12 h. Future studies should focus on optimizing pain‐management within this timeframe. [ABSTRACT FROM AUTHOR]

Background & Objectives: Placental perfusion is not autoregulated and is susceptible to effects of spinal anesthesia (SA) induced hypotension. The perfusion index (PI) is a non-invasive marker of peripheral vascular tone, and a higher PI indicates increased risk of hypotension following SA. This study aims to establish preoperative baseline PI in our local population and its correlation with incidence of intraoperative hypotension. Methods: This prospective observational study recruited 35 parturients who underwent elective lower segment cesarean section (LSCS). Preoperatively, baseline heart rate (HR), systolic blood pressure (SBP), mean arterial pressure (MAP) and PI were documented. SA was performed with 8 to 10 mg of injection bupivacaine 0.5% (hyperbaric) at L3--L4 interspace followed by co-loading with 1 L Hartmann solution. Hypotension was defined as SBP less than 80% of baseline or less than 90 mmHg. A bolus of phenylephrine 50 µg was given as rescue medication to treat the hypotension. Intraoperatively, degree of decrease in SBP, MAP and HR, as well as the amount of phenylephrine required was recorded every minute until delivery of the baby and 3 min thereafter. Results: The correlations between parturients' baseline PI with the degree of decreases in systolic and mean arterial pressure (r = 0.81, P < 0.001 and r = 0.76, P < 0.001, respectively) and phenylephrine requirement (r = 0.761, p < 0.005) were recorded. This study identified that the patients with cut-off PI value of 3.2 were at higher risk for SA induced hypotension with a sensitivity of 85.9% and a specificity of 87.5% (P = 0.001). Conclusion: The patients with baseline cut-off perfusion index value of more than 3.2 were at higher risk for spinal anesthesia induced hypotension in elective cesarean section. [ABSTRACT FROM AUTHOR]

Background & Objective: Shivering after general as well as spinal anesthesia is a common phenomenon. Unmanaged post-anesthetic shivering can worsen postoperative pain and patient's metabolism. Various techniques including inj. tramadol, body warming, and covering have been evaluated to treat this common complication. We aimed to compare the effectiveness of tramadol administration with patient coverage as therapeutic methods for managing post-anesthesia shivering. Methodology: The study enrolled 60 patients who underwent spinal anesthesia. Patients were divided into two groups: Group A received blanket coverage as treatment for shivering, while Group B received intravenous tramadol. Shivering onset time and duration after treatment were measured. Descriptive statistics and chi-square test/independent t-test determined significance, with P < 0.05 considered statistically significant. Results: The findings of this study revealed no significant difference in the onset of shivering between patients who received intravenous tramadol and those who were covered by blankets (39.83 ± 13.21 min vs 38.60 ± 13.48 min). However, the duration of shivering after treatment was significantly shorter in patients who received intravenous tramadol compared to those who received blanket, e.g., 20.30 ± 9.62 vs. 34.83 ± 12.53; P < 0.000). Conclusion: In conclusion, intravenous tramadol is more effective than non-pharmacological methods (blankets) in managing shivering. Tramadol treatment resulted in a significantly shorter duration of shivering. [ABSTRACT FROM AUTHOR]

Background & Objective: This study examined the use of dexmedetomidine 5 μg as an adjuvant to 10 mg of intrathecal hyperbaric 0.5% bupivacaine in elective cesarean sections and aimed to assess dexmedetomidine's impact on block characteristics and post-operative pain management. As spinal anesthesia is commonly employed for cesarean deliveries, the study seeks to determine whether the addition of dexmedetomidine as an adjuvant can prolong the duration and enhance the quality of the block, leading to improved post-operative pain relief. Methodology: This randomized controlled trial included 100 parturients undergoing elective cesarean section over a period of six months. Participants were allocated to either Group B or Group D using a non-random consecutive sampling technique. In Group D, 2 mL of 0.5% bupivacaine mixed with 0.05 mL of dexmedetomidine (5µg) was injected intrathecally, while Group B received 2 mL of 0.5% hyperbaric bupivacaine along with an equivalent volume of saline. Sensory and motor block assessments were conducted prior to the start of surgery. Post-operatively, the duration of motor block and post-operative pain relief were assessed. Results: The addition of dexmedetomidine as an adjuvant to intrathecal bupivacaine resulted in significant reductions in the onset time of sensory block (4.22 ± 0.79 min vs 5.66 ± 1.21 min) and motor block (4.20 ± 0.81min vs 6.32 ± 1.20 min) (P < 0.001). Furthermore, the duration of motor block was longer in the dexmedetomidine + bupivacaine group compared to the bupivacaine alone group (7.32 ± 0.95 h vs 4.38 ± 1.27 h). Additionally, patients who received intrathecal dexmedetomidine as an adjuvant to bupivacaine experienced significantly longer durations of post-operative analgesia (7.32 ± 0.95 h) as compared to the bupivacaine alone group (4.38 ± 1.27 h) (P < 0.001). Conclusion: Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine extends the duration of analgesia and motor block, providing prolonged pain relief. Additionally, it exhibits an early onset of sensory and motor block, ensuring prompt pain relief and rapid anesthesia onset. [ABSTRACT FROM AUTHOR]

Background: Cancer treatment that is commonly used is surgical resection. Anesthesia is necessary for surgery to take place, but the anesthetic methods used can have an impact on the cancer's ability to spread and return following the procedure. The present study was conducted to assess role of Anesthesia with multiple comorbidities in oncology patients. Materials & Methods: The study was carried out on 56 patients who underwent any type of cancer resection surgery of both genders. Parameters such as type of cancer, recurrence etc. was recorded. Results: Out of 56 patients, males were 36 and females were 20. Type of cancer was bladder cancer in 3, breast cancer in 14, colorectal cancer in 6, esophageal cancer in 3, gastric cancer in 1, hepatocellular carcinoma in 5, ovarian cancer in 3, and prostate cancer in 21 patients. The difference was significant (P< 0.05). Type of anesthesia used was epidural anesthesia in 10, general anesthesia in 5, both EA+GA in 34 and spinal anesthesia in 7 patients. The difference was significant (P< 0.05). Local recurrence was seen in 2, cancer recurrence in 3 and distant recurrence in 2 cases. The difference was significant (P< 0.05). Conclusion: RA, used alone or adjunctively with GA, is associated with a lower risk of cancer recurrence. [ABSTRACT FROM AUTHOR]

We present the case of a successful application of combined adductor canal block (ACB) and sacral erector spinae plane (S‑ESP) block for the management of a patient suffering from severe hemophilia A with an end‑stage arthropathy who underwent total knee replacement. The implementation of a tailored protocol, not incorporating neuraxial techniques, such as spinal anesthesia, facilitated optimal intra‑ and postoperative pain management and expedited postoperative recovery and rehab without motor weakness and side effects, highlighting the potential benefit of such strategy in selected cases. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the clinical practice of physicians working in obstetric setting toward postoperative nausea and vomiting (PONV) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia. Methods: We conducted this online survey to all active members of the Japan Society of Obstetric Anesthesiology and Perinatology (JSOAP), where leads academic society in obstetric anesthesia in Japan. The questionnaire was developed using the Delphi method. The survey included questions about routine practices for PONV prevention, the use of neuraxial opioids, optimal practices, and perceived obstacles. The email sent three times every 2 weeks as a reminder. Results: A total of 1046 e‐mails were sent, and 307 JSOAP members responded to the survey (29.3%). More than half of responders (62.7%) used neuraxial opioids with intrathecal morphine being the most frequent. They had a higher rate of multimodal PONV prophylaxis compared with who did not use neuraxial opioids for postoperative analgesia (19.9% vs 6.7%). Metoclopramide was the commonest medication for PONV prevention, and there was a significant difference in the use of 5‐hydroxytryptamine receptor antagonists (19.9% vs. 8.6%, p = 0.012). We observed that 80% of physicians reported the routine administration of prophylaxis for PONV for CD. Among these, 20% indicated the use of two or more agents. Conversely, in the cohort not administering neuraxial opioids, only 6.7% reported the use of two or more agents. Conclusion: The online survey showed that the physicians using neuraxial opioids for CD had a higher proportion of multimodal PONV management involving two or more agents. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the effects of caffeine consumption and sleep on post-spinal headache after spinal anesthesia. Background: Post-spinal headache is among the most well-known and common complications of spinal anesthesia. Although caffeine consumption is recommended to prevent headache after spinal anesthesia, caffeine does not prevent headache and causes sleep-related problems. No study in the literature found a correlation between sleep and caffeine consumption after spinal anesthesia and post-spinal headache. Methods: The research is a descriptive and cross-sectional study. The study sample comprised 425 patients who underwent elective surgery in a research hospital. The research data were collected by face-to-face interviews between April 2021 and December 2023. The "Sociodemographic and Clinical Characteristics Form," "Richard-Campbell Sleep Scale," "Insomnia Severity Index," and "Visual Analog Scale" were used in data collection. Factors affecting post-spinal headache were determined using binary logistic regression analysis. Results: According to the binary logistic regression, the insomnia severity score (OR = 1.234; p <.001), sleep quality score (OR =.992; p <.01), postoperative sleep duration (OR =.619; p <.05), and not consuming coffee (OR =.035; p <.001) are statistically significant predictors of post-spinal headache and explain 57.7% of the variance. A one-unit increase in patients' insomnia severity increased the probability of experiencing a post-spinal headache by 23.4%. With a one-unit increase in sleep quality, there was an 8% decrease in the probability of experiencing spinal headache, and a 3.81% decrease in the probability of experiencing post-spinal headache with an increase in sleep duration after surgery. The probability of experiencing post-spinal headache was 0.35 times higher in individuals who did not consume caffeine after surgery than in those who consumed it. Conclusion: The present study demonstrated that insomnia severity and sleep quality were more effective than caffeine consumption in preventing post-spinal headache. Insomnia and decreased sleep quality may cause a significant burden in developing post-spinal headache in patients and may cause post-spinal headache to be observed more frequently. Therefore, the use of caffeine in preventing or reducing post-spinal headache may adversely affect the duration and quality of sleep and increase the severity of insomnia. [ABSTRACT FROM AUTHOR]

Background: Post-operative shivering after spinal anesthesia is a common issue in women undergoing cesarean section, then its management is necessary to increase patients’ satisfaction. Therefore, the current study aimed to compare the prophylactic effect of Granisetron and meperidine on post-spinal shivering in elective cesarean section. Methods: In this double-blinded clinical trial study, 100 women under elective cesarean section using block randomization were divided into two groups. The spinal anesthesia was performed in all women with 10 mg hyperbaric bupivacaine 0.5 %. Then, after the birth of the baby, the patients received 0.04 mg/kg Granisetron or 0.4 mg/kg meperidine intravenously. Mean Arterial Pressure (MAP), Heart Rate (HR), and percentage of arterial blood oxygen saturation (SpO2 ) were measured before intervention and 60 minutes after surgery using a standard monitoring device. Shivering was evaluated 30 minutes after the surgery in the recovery room according to the clinical examinations. Results: The changes in hemodynamics parameters were similar between the two groups. There was a statistically significant difference in the rate of shivering between the two groups. The rate of shivering in the Granisetron group was higher than in the meperidine group. Thus, 13 patients (26%) and 5 patients (10%) had shivering in the Granisetron and meperidine groups, respectively (p=0.037). Conclusion: Granisetron was not more effective than meperidine as routine treatment in preventing shivering after spinal anesthesia in women under elective cesarean section. [ABSTRACT FROM AUTHOR]

Background: Data on the association between the plain ropivacaine dose and maternal hypotension during cesarean delivery are limited. Thus, this study aimed to explore this association. Methods: This retrospective study included patients undergoing cesarean sections under spinal or combined spinal-epidural anesthesia with plain ropivacaine at The First Hospital of Fuyang, Hangzhou, China, between 2018 and 2022. Data were obtained from the anesthesia information management system. Liner trend tests were used to distinguish the linear relationship between spinal hypotension and the plain ropivacaine dose, and receiver operating characteristic curves were used to calculate the dose threshold. Logistic regression was used to adjust for confounders. Sensitivity analyses were performed to evaluate the stability of the results. The secondary outcome was vasopressor use (metaraminol and ephedrine). Results: In total, 1,219 women were included. The incidence of hypotension linearly correlated with the plain ropivacaine dose (adjusted P-value for trend, P < 0.001). Thus, we used a dose threshold of 17.5 mg to compare the dose as a binary variable (≥17.5 mg vs. < 17.5 mg). Plain ropivacaine doses of ≥17.5 mg were associated with a higher incidence of spinal hypotension (adjusted odds ratio: 2.71; 95% confidence interval [1.85–3.95]; P < 0.001). The sensitivity analyses yielded similar results. The plain ropivacaine dose also correlated with metaraminol use but not ephedrine use. Conclusions: The incidence of spinal-induced hypotension in women undergoing cesarean section linearly correlated with the plain ropivacaine dose. The dose threshold for hypotension risk was 17.5 mg. [ABSTRACT FROM AUTHOR]

Background and Aims: Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods: A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1% < 10% and ∆FEV1% ≥ 10%) based on reductions (∆) in FEV1% predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV1% and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI. Results: The mean FEV1% predicted following SA was lower than the mean FEV1% predicted before SA (83.42 vs. 95.31, p = 0.001). In a fully adjusted model, ∆FEV1% ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07–171.24, p = 0.044]. The positive associations between ∆FEV1% ≥ 10% and hypotension [2.02 (0.33–12.46), 0.449], bradycardia [1.10 (0.28–4.25), 0.895] and nausea/vomiting [9.74 (0.52–183.94), 0.129] were not statistically significant. Conclusion: Reduction in FEV1% predicted following SA was associated with adverse intraoperative outcomes. FEV1 may play an important role in the association between SA and cardiopulmonary complications. [ABSTRACT FROM AUTHOR]

Background: Spinal anesthesia is one of the most commonly used regional anesthesia techniques. Post-dural puncture headache (PDPH) is a well-known iatrogenic consequence of spinal anesthetic and diagnostic lumbar puncture, primarily caused by loss of cerebral spinal fluid. To reduce complications, spinal needles have undergone modifications. The two most important modifiable risk variables for PDPH were needle shape and size. In young expecting mothers, post-cesarean sections are associated with an increased incidence of PDPH. Aims and Objectives: The aims and objectives of the study are to compare the incidence of PDPH in obstetric patients using cutting and pencil-point spinal needles following spinal anesthesia. Materials and Methods: This 1-year double-blind study was carried out in the Department of Anaesthesia from August 2021 to July 2022. The study comprised obstetric patients who were scheduled for elective-segment cesarean section. The subarachnoid block needle was divided into Groups A and B at random: Group A 25-gauge Whitacre spinal needle with a pencil point, whereas Group B 25-gauge Quincke spinal needle with a cutting bevel. Records were kept on age, height, weight, and gestational age. A follow-up was conducted up until the discharge date. The incidence and severity of PDPH after spinal anesthesia were examined in both groups. The results were analyzed with SPSS 20.0, and the Fischer exact and Chi-square tests were used to look for statistical significance. Results: The current study included 120 patients in total, 60 patients in each of Groups A and B. When a pencil point Whitacre was used, the incidence of PDPH was 2 (3.3%), however, when a cutting Quincke needle was used, the incidence was 7 (10.8%). With a P < 0.05, the relationship between the two was considered statistically significant. The pain severity was mild in both patients of Group A. Of the seven patients in Group B, four had mild pain, two had moderate pain, and one had severe pain. Conclusion: The pencil-point 25-G Whitacre spinal needle has a lower incidence of PDPH than the traditional 25-G Quincke needle and was suggested for patients at risk of PDPH. In light of this, the current study suggested using pencil-point spinal needles for lumbar punctures and spinal anesthesia in obstetric patients. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Dural ectasia is a common manifestation of neurofibromatosis type 1. Although there have been reports of unsuccessful spinal anesthesia due to dual ectasia in Marfan syndrome, reports describing similar unsuccessful spinal anesthesia in neurofibromatosis type 1 are lacking. Case presentation: A parturient with neurofibromatosis type 1 was scheduled for a repeat cesarean section. During a previous cesarean section, she had experienced a failed spinal anesthesia, which resulted in a conversion to general anesthesia. Preoperative lumbar magnetic resonance imaging revealed dural ectasia, which was speculated to be the cause of the previous spinal anesthesia failure. Therefore, combined spinal-epidural anesthesia was implemented. Because the block level of spinal anesthesia was insufficient as predicted, supplemental administration of epidural anesthesia successfully provided adequate analgesia for the surgery. Conclusions: Combined spinal-epidural anesthesia can be useful for the management of cesarean sections in patients with neurofibromatosis type 1-associated dural ectasia. [ABSTRACT FROM AUTHOR]

Background Cerebrospinal fluid (CSF)-venous fistulas (CVFs) are increasingly identified as a cause of spontaneous intracranial hypotension (SIH). Lateral decubitus digital subtraction myelography (LD-DSM) and CT myelography (LD-CTM) are mainly used for detection, but the most sensitive method is yet unknown. Objective To compare LD-DSM with LD-CTM for diagnostic yield of CVFs. Methods Patients with SIH diagnosed with a CVF between January 2021 and December 2022 in which the area of CVF(s) was covered by both diagnostic modalities were included. LD-CTM immediately followed LD-DSM without repositioning the spinal needle, and the second half of the contrast agent was injected at the CT scanner. Patients were awake or mildly sedated. Retrospectively, two neuroradiologists evaluated data independently and blinded for the presence of CVF. Results Twenty patients underwent a total of 27 combined LD-DSM/LD-CTM examinations (4/20 with follow-up and 3/20 with bilateral examinations). Both raters identified significantly more CVFs with LD-CTM than with LD-DSM (rater 1: 39 vs 9, P<0.001; rater 2: 42 vs 12, P<0.001). Inter-rater agreement was substantial for LD-DSM (κ=0.732) and LD-CTM (κ=0.655). The results remained significant after considering the senior rating for cases of disagreement (39 vs 10; P<0.001), and no CVF detected on LD-DSM was missed on LD-CTM. Conclusion In this study, LD-CTM has a higher diagnostic yield for the detection of CVFs than LD-DSM and should supplement LD-DSM, but further studies are needed. LD-CTM can be easily acquired in awake or mildly sedated patients with the second half of contrast injected just before CT scanning, or it may be considered as a stand-alone investigation. [ABSTRACT FROM AUTHOR]

Background: Hip fracture surgery under general or spinal anesthesia is a common procedure for older adults in the United States (US). Although spinal or general anesthesia can be appropriate for many patients, and the choice between anesthesia types is preference-sensitive, shared decision-making is not consistently used by anesthesiologists counseling patients on anesthesia for this procedure. We designed an Option Grid™-style conversation aid, My Anesthesia Choice─Hip Fracture, to promote shared decision making in this interaction. This study will refine the aid and evaluate its implementation and effectiveness in clinical practice. Methods: The study will be conducted over 2 phases: qualitative interviews with relevant clinicians and patients to refine the aid, followed by a stepped wedge cluster randomized trial of the intervention at 6 settings in the US. Primary outcomes will include the percentage of eligible patients who receive the intervention (intervention reach) and the change in quality of patient/clinician communication (intervention effectiveness). Secondary outcomes addressing other RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) domains will also be collected. Outcomes will be compared between baseline data and an active implementation period and then compared between the active implementation period and a sustainment period. Implementation strategies are guided by three constructs from the Practical, Robust Implementation and Sustainability Model (PRISM): intervention, recipients, and implementation and sustainability infrastructure. Discussion: This is a novel, large-scale trial evaluating and implementing a shared decision-making conversation aid for anesthesia choices. Strong buy-in from site leads and expert advisors will support both the success of implementation and the future dissemination of results and the intervention. Results from this study will inform the broader implementation of this aid for patients with hip fractures and can lead to the development and implementation of similar conversation aids for other anesthesia choices. Trial registration: ClinicalTrials.gov, NCT06438640 [ABSTRACT FROM AUTHOR]

The 7th cervical vertebra (C7) is described as having the most prominent spinous process (SP) and is characterized as the "vertebra prominens" (VP) of the cervical spine in anatomy textbooks. The VP is an important anatomical landmark of the neck for clinical examination and therapeutic intervention. The present study identifies the level of the most prominent SP of the cervical and uppermost thoracic vertebrae in a cadaveric cohort. Thirty-nine (23 female and 16 male) cadavers of a mean age of 77.5 years were investigated in a prone position and a certain cervical kyphotic bending. The most prominent SP, at the base of the neck, was palpated and marked with a wedging nail into the SP of the vertebra. The cervical region was dissected, and a blind investigator examined whether the nail was placed into the SP of C7 or the SP of another upper or lower vertebra. In 19 out of 39 cadavers (48.7%), the C7 was identified as the VP (typical anatomy), followed by the C6 (in 14 cadavers, 35.9%), C5 (in 4 cadavers, 10.3%). In 2 cadavers (5.1%) the first thoracic vertebra was identified as having the most prominent SP. Although C7 is described as the VP, in the present study the SP of C7 was the most prominent in less than 50%. The high variable projection level of the most prominent SP of the cervical vertebra holds great clinical significance for spine examination, neck surgery, and spinal anesthesia. [ABSTRACT FROM AUTHOR]

Objective To determine the median effective dose (ED50) of ropivacaine for spinal anesthesia in sub-high altitude cesarean sections. Methods A total of 30 parturients from sub-high altitudes received initial 14 mg (1.4 mL) of 1% ropivacaine intrathecally. Effectiveness was defined by sensory block to T6 within 15 minutes without additional epidural anesthesia. Doses were adjusted by ±1 mg based on response. ED50 and 95% CI were estimated using Dixon’s method and isotonic regression. Adverse reactions were noted. Results Thirty parturients with an average age of (30.88±5.56）years, gestational weeks of (40±1.41) weeks，height of (156.69±5.80) cm，and weight of（ 67.44±10.48) kg were studied. The ED50 was 10.68 mg (95%CI：9.65-12.58 mg) by Dixon’s method and 10.33 mg (95%CI: 9.41-12.07 mg) by isotonic regression. Intraoperatively, 8 cases of hypotension, 1 case of bradycardia, and 7 cases of nausea and vomiting were observed, no hypertension or shivering occurred among the parturients. Conclusion The ED50 for ropivacaine in sub-high altitude cesarean sections is 10.68 mg, which is higher than the currently known ED50 required for patients in plain areas. [ABSTRACT FROM AUTHOR]

Introduction: The use of push-dose vasopressors to treat anesthesia-induced hypotension is a common evidence-based practice among anesthesiologists. In more recent years, the use of push-dose vasopressors has transitioned to the emergency department (ED) and critical care setting. There is debate on the best choice of a push-dose vasopressor, with push-dose epinephrine or phenylephrine being more commonly used. This scoping review evaluated publications regarding the clinical use of push-dose norepinephrine. Methods: We queried research studies in both PubMed and Google Scholar on the use of push-dose norepinephrine in human subjects, with numerous randomized controlled trials that compare norepinephrine to other vasopressors including phenylephrine, ephedrine, and epinephrine. Results: A large majority of the studies were performed in the setting of spinal anesthesia prior to cesarean section, while several involved the administration of general anesthesia, with limited-to-no literature in the emergency and critical care setting. Of the 27 studies that we included in the review, 17 were randomized controlled trials. These studies demonstrated that norepinephrine was safe and effective. Conclusion: Prior research has demonstrated the superiority of norepinephrine as a pressor of choice for various shock states. In this review, the safety and efficacy of push-dose norepinephrine is demonstrated, and favorable hemodynamic markers are shown in comparison to other agents. In addition, there are some safety and efficiency benefits to using push-dose norepinephrine from an administration standpoint, as well as clinically in decreased need for repeat doses. Further high-quality studies in the emergency and critical care realm would be beneficial to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. Methods: This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant. Results: Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported. Conclusion: Prophylactic administration of acetaminophen+ caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section. Trial registration number: IRCT20141009019470N98. [ABSTRACT FROM AUTHOR]

Introduction: Shivering is a common complication during neuraxial anesthesia, leading to metabolic and cardiovascular challenges. Existing treatments vary in effectiveness, and this study compares intravenous tramadol and nalbuphine, both administered with midazolam, for shivering control. Objectives: To evaluate and compare the efficacy of IV tramadol and IV nalbuphine, alongside midazolam, in controlling post-spinal anesthesia shivering. Materials and Methods: A prospective, randomized comparative clinical study involving 100 patients undergoing various surgical procedures under spinal anesthesia. Patients were divided into two groups to receive either IV Tramadol or IV Nalbuphine with midazolam. Parameters like shivering severity, time to cessation, recurrence, and side effects were recorded and analyzed. Results: Both tramadol and nalbuphine effectively controlled shivering with comparable response times and side effect profiles. There was no significant difference in the incidence of nausea, vomiting, and sedation between the groups. Hemodynamic stability was maintained throughout the study. Conclusion: IV tramadol and IV nalbuphine, in conjunction with midazolam, are effective in controlling post-spinal anesthesia shivering, with similar efficacy and safety profiles. They provide valuable options for clinicians in managing this common anesthetic complication. Further research is encouraged for more refined application in diverse patient populations. [ABSTRACT FROM AUTHOR]

Nephrolithiasis, or kidney stone disease, is a significant global health issue in urology, requiring effective management strategies. The management of nephrolithiasis through flexible ureteroscopy (fURS) is increasingly gaining acceptance; however, it is associated with significant costs related to consumables, pharmacotherapy, specialized equipment, and general anesthesia (GA). Limited resources and the need to optimize the cost effectiveness ratio have driven the shift to day-case procedures, offering financial and operational benefits and improving patient satisfaction. This outpatient care approach addresses clinical and economic challenges. For same-day discharge, spinal anesthesia (SA) is essential for fURS, as GA does not permit safe immediate discharge. This retrospective study investigates the feasibility of same-day discharge following fURS procedures performed under SA. Analyzing data from 401 patients who underwent 414 fURS procedures between January 2020 and December 2023, this study aims to evaluate whether same-day discharge is a viable option compared to conventional fURS under GA. The primary objectives are to assess the outcomes, including efficacy, stone-free rate (SFR), pain management, and complication rates, in the context of same-day discharge. Additionally, this study seeks to identify patient and kidney stone characteristics that may influence the suitability of one-day fURS under SA. Outcomes will be measured using the Dindo–Clavien (D-C) classification and Visual Analog Scale (VAS) scores post-procedure. [ABSTRACT FROM AUTHOR]

Introduction Inguinal hernia most frequent problem in human being adult as well as children suffer with it. Inguinal hernia repair done under “anesthesia” {such as local anesthesia, spinal anesthesia, nerve block, epidural anesthesia, & general anesthesia}, depending upon number of variables i.e. patient’s acceptance, surgeon’s preference, safety, practicality and cost effectiveness. Objectives To compare nerve block versus spinal Anesthesia in Lichtenstein tension-free mesh inguinal hernia repair Methods The Present study, conducted as a hospital-based comparative prospective study at the Department of General Surgery, Muzaffarnagar Medical College & Hospital, Muzaffarnagar, U.P., aimed to investigate the efficacy of two different anesthesia techniques in inguinal hernia repair. Over an 18-month period, 100 patients meeting the inclusion criteria. The study utilized a combination of ilioinguinal and iliohypogastric nerve blocks alongside field blocks for anesthesia administration, ensuring proper analgesia and relaxation. Cases were grouped based upon fitness for spinal anesthesia, comorbidities, and patient preference. Group A underwent mesh repair under spinal anesthesia, while Group B received nerve block via inguinal field block technique. Results In the <40 year group, Nerve Block accounts for 2.0% of cases while Spinal Anaesthesia accounts for 10.0%. In the 41-50year group, Nerve Block represents 64.0% of cases, whereas Spinal Anaesthesia represents 60.0%. In the >50 age group, Nerve Block represents 34.0% of cases, and Spinal Anesthesia represents 30.0%. On comparison of seroma occurrence between Group A and Group B revealed interesting insights. In Group A, comprising 50 cases, 45 cases (90.0%) exhibited seroma, while 5 cases (10.0%) did not. Similarly, in Group B, consisting of another 50 cases, 47 cases (94.0%) showed seroma, with 3 cases (6.0%) without it. When considering both groups collectively, out of 100 cases, 92 cases (92.0%) had seroma, while 8 cases (8.0%) did not. Conclusion We came to the conclusion that all patients with primary inguinal hernias benefit from Lichtenstein mesh repair performed under local anesthesia for a number of reasons. Simpleness, dependability, efficacy, safety, a smooth recovery period marked by easily managed pain, a prompt return to full range of activities, and high patient satisfaction are a few of these. [ABSTRACT FROM AUTHOR]

Introduction: Subarachnoid block is the most commonly used anaesthetic technique for caesarean sections. Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anaesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. The aim of this study is to assess the incidence of postdural puncture headache in the median and paramedian approach using 25G Whitacre spinal needle in pregnant females undergoing caesarean section. Materials and methods: After obtaining institutional ethical committee approval,100 patients of ASA I and ASAII of pregnant women undergoing caesarean section belonging to age group of 18-35 years randomized by computer generated numbers into two groups (50 each) after fulfilling inclusion criteria. The patients were randomized to receive spinal anaesthesia by either a median (n=50) approach or paramedian approach (n=50). After informed written consent, all patients were premedicated with Inj.Metoclopromide 10mg and all patients received 500ml of Normal saline intravenously over 30minutes before the procedure. Each patient received 9-12mg of hyperbaric bupivacaine with 25G Whitacre spinal needle either through median approach(group M, n=50) or paramedian approach(group PM, n=50).The patients were followed for 48 hours for PDPH, presence of PDPH was assessed by visual numerical analogue scale. Results: Out of total 100 caesarean section patients, six patients developed PDPH. 4/50(8%) had PDPH in median approach and 2/50(4%) had PDPH in paramedian approach. However the difference in incidence of PDPH in both median and paramedian approaches is not statistically significant (p value=0.4000) and the severity of PDPH in both groups was of mild degree. Conclusion: Even though we noticed the incidence of PDPH is less with 25G Whitacre spinal needle in paramedian approach compared to median approach, but there was no significant statistical difference on incidence of PDPH using 25 G Whitacre spinal needle between median and paramedian approach in caesarean section patients. [ABSTRACT FROM AUTHOR]

Aims: We aimed to compare the analgesic efficacy of oral clonidine vs intrathecal clonidine added as an adjuvant to 0.5% hyperbaric bupivacaine spinal anesthesia in cesarean section Materials and Methods: A prospective randomized double blind controlled studyenrolled 50 patients for elective caesarean sections under spinal anesthesia and were allocated into 2 groups (25 each) after fulfilling the inclusion and exclusion criteria. Group O received 0.5% hyperbaric bupivacaine 2cc(10mg) plus 0.5 cc NS intrathecally and 200µg oral clonidine was given 90 mins before spinal anesthesia and group I received 0.5 % Hyperbaric bupivacaine 2cc(10mg) + 45 µg (0.5cc) of clonidine intrathecally with oral vitamin c tablets 90 mins before spinal anesthesia. Results: Both the groups had comparable demographics in age, height,weight, BMI. There was a statistically significant difference in terms of duration of analgesia between the two groups. Duration of analgesia was prolonged more in Group I than in Group O with a p value 0.0001.There was a statistically significant difference in terms of onset of sensory and motor blockade which was faster in Group I than in Group O. (P=0.0001). There was a statistically significant difference in terms of duration of sensory and motor blockade which was prolonged in Group I than in Group O. (P=0.0001). There was a significant reduction in pulse rate and hypotensive episodes encountered with Group O than Group I which was statistically significant. The sedation, fetal well being and adverse effects were all comparable between the two groups. Conclusion: Intrathecal clonidine when added as an adjuvant to hyperbaric bupivacaine prolongs the duration of analgesia, sensory and motor block than oral clonidine without significant adverse effects. [ABSTRACT FROM AUTHOR]