BACKGROUND AND OBJECTIVE:Epidural volume extension via a combined spinal-epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. We ...evaluated the effect of epidural volume extension on the combined spinal-epidural technique of providing spinal anaesthesia for Caesarean section with hyperbaric or plain 0.5% bupivacaine.
METHODS:Patients (n = 240) with height >163 cm received 9 mg and patients <163 cm received 8 mg of bupivacaine. Each study drug was combined with 20 μg fentanyl. Using the combined spinal-epidural technique, Group A (n = 60) received hyperbaric bupivacaine, and Group B (n = 60) received hyperbaric bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. Group C (n = 60) received plain bupivacaine and Group D (n = 60) received plain bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. An anaesthetist blinded to the anaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min for 135 min during the recovery period.
RESULTS:Time to reach a sensory block at T4 was significantly shorter in Groups C and D than in Groups A (P = 0.003 and 0.017) and B (P = 0.006 and 0.048), respectively. During the intraoperative period, sensory block levels were significantly higher in Group C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D.
CONCLUSION:There was no effect of epidural volume extension on the profile of spinal anaesthesia with the combined spinal-epidural technique for Caesarean section using hyperbaric or plain bupivacaine.
Epidural volume extension and role of baricity Kucukguclu, S; Gunenc, F; Kuvaki, B ...
European journal of anaesthesiology,
2008-July, 2008-07-00, Letnik:
25, Številka:
7
Journal Article
Background: The aim of this study was to investigate the effects of sevoflurane anesthesia in day/night cycles on melatonin levels in rats. Methods: Fifteen-day-old 24 rats were included in the study ...and randomized into four groups according to anesthetic (sevoflurane or control) and the timing of administration (night phase or day phase). 2.6 % sevoflurane and 6 L.min-1 of oxygen were delivered to rats, between 07:00 pm-01:00 am (night group) and 07:00 am-01:00 pm (day group). After the sacrification of the rats, blood samples were taken and samples were centrifuged and plasma melatonin levels were measured by radioimmunoassay. Results: When Group night sevoflurane (GN-S) was compared with Group night control (GN-C), significant difference was found on melatonin levels (p=0,002). When plasma melatonin levels were compared between Group day sevoflurane (GD-S) and Group day control (GD-C), melatonin level of Group Day sevoflurane was found significantly higher (p=0.002). Similarly, when plasma melatonin levels were compared between GN-C and GD-C groups, melatonin level of GN-C was found significantly higher (p=0.002). Conclusions: In this study, it has been ascertained that 2.6% sevoflurane administered for six hours during the day and night periods increased melatonin levels significantly in 15 days old rats.
Abstract Cerebral ischemia may cause permanent brain damage and behavioral dysfunction. The efficacy and mechanisms of pharmacological treatments administered immediately after cerebral damage are ...not fully known. Sugammadex is a licensed medication. As other cyclodextrins have not passed the necessary phase tests, trade preparations are not available, whereas sugammadex is frequently used in clinical anesthetic practice. Previous studies have not clearly described the effects of the cyclodextrin family on cerebral ischemia/reperfusion (I/R) damage. The aim of this study was to determine whether sugammadex had a neuroprotective effect against transient global cerebral ischemia. Animals were assigned to control, sham-operated, S 16 and S 100 groups. Transient global cerebral ischemia was induced by 10-minute occlusion of the bilateral common carotid artery, followed by 24-hour reperfusion. At the end of the experiment, neurological behavior scoring was performed on the rats, followed by evaluation of histomorphological and biochemical measurements. Sugammadex 16 mg/kg and 100 mg/kg improved neurological outcome, which was associated with reductions in both histological and neurological scores. The hippocampus TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) and caspase results in the S 16 and S 100 treatment groups were significantly lower than those of the I/R group. Neurological scores in the treated groups were significantly higher than those of the I/R group. The study showed that treatment with 16 mg/kg and 100 mg/kg sugammadex had a neuroprotective effect in a transient global cerebral I/R rat model. However, 100 mg/kg sugammadex was more neuroprotective in rats.
Background: Retrobulbar injection can be associated with significant pain, due to both needle insertion and deposition of the local anaesthetic solution. The local anaesthetic cream EMLA® (eutectic ...mixture of local anaesthetics) which contains a mixture of lignocaine and prilocaine has been shown to reduce the pain associated with skin puncture. The efficacy of EMLA® in alleviating the pain of retrobulbar injection for cataract surgery was assessed in this study.
Methods: In this, randomised double‐blind study, EMLA® (n = 53) or lignocaine 5% ointment (n = 50) was administered to the inferior orbital margin at least 45 min before retrobulbar block in 103 patients. Pain assessed during retrobulbar block was marked subjectively by the patient on a 10‐point numerical rating scale.
Results: Median verbal pain scores were 3.0 with an interquartile range of 1.5–6.5 in the control group and 3.50 with an interquartile range of 2.0–6.0 in the EMLA® group (P = 0.67).
There was no significant difference between the EMLA® group and the lignocaine ointment group according to this pain assessment.
Conclusion: EMLA® does not permit pain‐free retrobulbar injection.
Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye ...movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia.
In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 microg) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display.
Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94+/-0.92 in the topical group and 2.92+/-0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05).
Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia.
PDF
