<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-oper...<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.展开更多
Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial ...Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.展开更多
Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chr...Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.展开更多
目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润...目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。展开更多
Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly...Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly the use of an anti-inflammatory medication or steroid, given epidurally or as part of the intradermal injectate. The purpose of this study is to determine the effect of topical Nonsteroidal Anti-inflammatory drugs (NSAIDS) patch on decreasing the incidence of post-operative backache following spinal anaesthesia for caesarean section. Patients and methods: One hundred thirty parturients aged 19 - 40 years, American society of Anaesthesiology class I & II scheduled for elective caesarean section with spinal anaesthesia were divided randomly into two equal Groups (65 patients each): ketoprofen group (TDK) received 30 mg ketoprofen transdermal patch at site of puncture for 24 hours and control group (TDC) received a placebo transdermal patch at site of puncture for 24 hours. In the Postoperative period 24 hours after the spinal procedure, the transdermal patch was removed in both groups then symptoms of back pain have been determined by visual numerical scale (VNS). Results: regard incidence of occurrence and severity of back pain (VNS > 3) the results showed that the back pain was less in the TDK group than in the TDC group at 24 hours post spinal interval (4.6% vs 15.4%) respectively. On the other hand there was no statistical significant difference at 48 hours and 2 weeks post spinal interval. Conclusion: Prophylactic application of topical NSAIDS patch may reduce the incidence and the severity of short term backache after spinal anaesthesia in CS with negligible complications.展开更多
目的回顾性分析妊高症产妇剖宫产术腰麻后低血压发生率及母婴结局。方法回顾性分析年龄≥18岁单胎在腰麻下行剖宫产术的妊高症产妇353例。根据妊娠期高血压不同特征分为妊娠期高血压组(113例)、轻度子痫前期组(91例)及重度子痫前期组(14...目的回顾性分析妊高症产妇剖宫产术腰麻后低血压发生率及母婴结局。方法回顾性分析年龄≥18岁单胎在腰麻下行剖宫产术的妊高症产妇353例。根据妊娠期高血压不同特征分为妊娠期高血压组(113例)、轻度子痫前期组(91例)及重度子痫前期组(149例)。分别记录产妇一般资料及腰麻后低血压、腰麻后严重低血压、心动过缓发生率、新生儿1 min及5 min Apgar评分、新生儿转科率。结果重度及轻度子痫前期组产妇较妊娠期高血压组产妇孕周更小(P<0.05)、基础收缩压更高(P<0.05)、腰麻后低血压发生率更低(P<0.05)、新生儿1 min和5 min Apgar评分较低(P<0.05),新生儿转科率较高(P<0.05)。结论轻度及重度子痫前期产妇较妊娠期高血压产妇腰麻后低血压发生率更低,但新生儿Apgar评分更低、转科率更高。展开更多
文摘<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
文摘Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.
文摘Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.
文摘目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。
文摘Background: Women who had caesarean section (CS) with spinal anaesthesia had more chances to develop low back pain. Controlled studies evaluating the prevention of back pain after neuraxial anaesthesia involved mostly the use of an anti-inflammatory medication or steroid, given epidurally or as part of the intradermal injectate. The purpose of this study is to determine the effect of topical Nonsteroidal Anti-inflammatory drugs (NSAIDS) patch on decreasing the incidence of post-operative backache following spinal anaesthesia for caesarean section. Patients and methods: One hundred thirty parturients aged 19 - 40 years, American society of Anaesthesiology class I & II scheduled for elective caesarean section with spinal anaesthesia were divided randomly into two equal Groups (65 patients each): ketoprofen group (TDK) received 30 mg ketoprofen transdermal patch at site of puncture for 24 hours and control group (TDC) received a placebo transdermal patch at site of puncture for 24 hours. In the Postoperative period 24 hours after the spinal procedure, the transdermal patch was removed in both groups then symptoms of back pain have been determined by visual numerical scale (VNS). Results: regard incidence of occurrence and severity of back pain (VNS > 3) the results showed that the back pain was less in the TDK group than in the TDC group at 24 hours post spinal interval (4.6% vs 15.4%) respectively. On the other hand there was no statistical significant difference at 48 hours and 2 weeks post spinal interval. Conclusion: Prophylactic application of topical NSAIDS patch may reduce the incidence and the severity of short term backache after spinal anaesthesia in CS with negligible complications.
文摘目的回顾性分析妊高症产妇剖宫产术腰麻后低血压发生率及母婴结局。方法回顾性分析年龄≥18岁单胎在腰麻下行剖宫产术的妊高症产妇353例。根据妊娠期高血压不同特征分为妊娠期高血压组(113例)、轻度子痫前期组(91例)及重度子痫前期组(149例)。分别记录产妇一般资料及腰麻后低血压、腰麻后严重低血压、心动过缓发生率、新生儿1 min及5 min Apgar评分、新生儿转科率。结果重度及轻度子痫前期组产妇较妊娠期高血压组产妇孕周更小(P<0.05)、基础收缩压更高(P<0.05)、腰麻后低血压发生率更低(P<0.05)、新生儿1 min和5 min Apgar评分较低(P<0.05),新生儿转科率较高(P<0.05)。结论轻度及重度子痫前期产妇较妊娠期高血压产妇腰麻后低血压发生率更低,但新生儿Apgar评分更低、转科率更高。
