جستجوی مقالات مرتبط با کلیدواژه "epidural anesthesia" در نشریات گروه "پزشکی"

Anesthesia techniques significantly impact the long-term and short-term outcomes after cancer surgery such as cancer recurrence, post-discharge hospitalizations, and duration of hospitalization, probably by decreasing the neuroendocrine stress response during surgery, reducing opioid requirement, reducing post-operation nausea vomiting, and pain, and interacting with the immune system. Research in recent years has provided ample evidence that epidural anesthesia produces better post-operation outcomes compared to general anesthesia. The purpose of this study was to evaluate the effects of epidural anesthesia on cancer recurrence after surgery in gastrointestinal cancer patients.

To perform this study medical records from the archive of gastrointestinal cancer patients who have undergone surgery at Imam Khomeini Hospital Complex (IKHC) from the years 1390 to 1400 were used. The variables required for the study were obtained from the records. The data obtained were analyzed by the SPSS software and the significance value of < 0.05 was considered.

Our study included 8987 patients out of which 1673 patients received epidural anesthesia. Cancer recurrence was reported after 90 days and 180 days and for the type of surgery (using or not using epidural anesthesia) B value for 90 days and 180 days was 0.079 and 0.018 respectively. Thus causality was not established for the type of surgery with recurrence of cancer.

The findings of our study indicate that the rate of gastrointestinal cancer recurrence after surgery is not influenced by having or not having epidural anesthesia.

 This study compared dexmedetomidine to fentanyl as an adjunct to ropivacaine for epidural anesthesia in patients undergoing femoral neck fracture surgery.

 A total of 56 patients in two different groups with dexmedetomidine and fentanyl underwent the epidural anesthesia method by ropivacaine. This study compared the onset and duration of sensory block, duration of motor block, visual analog scale (VAS) analgesia, and sedation score. The VAS and hemodynamics (e.g., heart rate and mean arterial pressure) were measured every 5 to 15 minutes, then every 15 minutes to the end of the surgery, and then in the 1st, 2nd, 4th, 6th, 12th, and 24th hours after surgery.

 In the fentanyl group, the onset time of the sensory block was longer (P < 0.001), and the duration of the block was shorter than in the dexmedetomidine group (P = 0.045). In the fentanyl group, the onset time of motor block was longer than in the dexmedetomidine group (P < 0.001). The mean highest VAS score for each patient in the dexmedetomidine group was 4.9 ± 0.6, compared to the fentanyl group (5.8 ± 0.9), with a significant difference between the two groups (P < 0.001). The sedation score was higher from the 30th minute (P = 0.01) to the 120th minute (P = 0.04) in the patients of the dexmedetomidine group than in the fentanyl group. Side effects, such as dry mouth, hypotension, and bradycardia, were more common in the dexmedetomidine group, and nausea and vomiting were more common in the fentanyl group; however, there were no differences between the groups. There was no respiratory depression in both groups.

 This study presented that dexmedetomidine as an adjuvant in epidural anesthesia for orthopedic femoral fracture surgery shortens the onset time of sensory and motor block, increases analgesia length, and prolongs anesthesia. Sedation with dexmedetomidine is better than fentanyl, with fewer side effects, and more effective as preemptive analgesia.

The aim of this study is to evaluate the effects of anesthesia methods on the success of urethral access and stone access achievement in endoscopic treatment of urolithiasis.

In this prospective randomized study, 105 patients who underwent primary ureterorenos-copy (URS) procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia

General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared.

There was no statistically significant difference among the three groups in terms of the demographic val-ues and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group.

In patients who decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.

Epidural block approach and drugs are common options for improving the sensory and motor block duration and postoperative pain management.

The study aimed to compare the analgesic effects of dexmedetomidine and morphine as adjuvants to bupivacaine for epidural anesthesia in leg fracture surgery.

This prospective clinical trial was conducted on patients (n = 80, age range: 18 - 60 years) categorized as ASA class I or II. After a clinical examination, the patients were allocated to receive either lumbar epidural bupivacaine + morphine (BM) (12 mL bupivacaine 0.5% + morphine 2 mg) or bupivacaine + dexmedetomidine (BD) (12mLbupivacaine 0.5% + dexmedetomidine 1g/kg). After drug administration, the sensory block level was assessed at 2-min intervals using the Cold Swab method until it reached the T12 level. At the T12 level of sensory block, the surgery began when motor block reached grade 3 of the modified Bromage scale.

The BD group had a significantly shorter time to reach the sensory and motor block than the BM group (P < 0.001). The duration of sensory and motor block was significantly longer in the group BD than in the BM group (P < 0.001). Moreover, the BD group showed lower VAS scores (P < 0.0001) and longer time to first analgesia demand than the BM group.

Combined bupivacaine + dexmedetomidine prolongs the sensory and motor block duration and controls postoperative pain more effectively, indicating that it is an appropriate combination for epidural anesthesia.

To evaluate the evolution pattern of epidural block after rotating the needle tip 45° to the operative side and evaluate its effects on patients’ hemodynamics and recovery profile in those undergoing arthroscopic knee surgery. Forty participants were randomly subdivided into control and rotation group (n=20). An 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L4-5 and pushed forward into the epidural space through parasagittal approach, in control group, the needle was pushed forward to the epidural space in cephaldad 90 degrees. For the rotation group, the needle was pushed forward to the epidural space and the tip was rotated 45 degrees to the surgical side.15 mL of bupivacaine 0.5% was injected and evolution of sensory and motor blocks until 2-segment regression of the sensory level below to T10 as well as total duration of motor block and surgery were recorded. Hemodynamic parameters (HR, MAP, and SPO2), hypotension, fluid intake, vasopressors, first ambulation and spontaneous urination were recorded. Statistical analysis was performed using SPSS and P≤0.5 considered significant. Sensory block up to T10 level, Complete motor block and time for 2-segment regression of sensory level were earlier in the 45°-rotation than in the control group (p<0.001).Total duration of motor block in control group was lower than rotation group (p<0.001).Hypotension, N&V, vasopressors and fluid intake showed no statistically difference between the two groups (p=0.219). First spontaneous urination and ambulation were significantly lower in rotation group (p<0.001). 45 degrees’ needle rotation to the surgical side provides a faster block evolution and hastened recovery profile with no significant difference in hemodynamic fluctuations.

Epidural anesthesia (EA) today has been used extensively in surgical procedures and the management of pain associated with midwifery and chronic pain. This type of anesthesia can be done in different technical, physiological, and pharmacological ways. The aim of this study was to compare the effects of thoracic EA with general anesthesia (GA) on hemodynamic changes and its complications in patients underwent laparoscopic colonoscopy.

This clinical trial study was conducted on 80 patients undergoing laparoscopic cholecystectomy with EA or GA based on inclusion and exclusion criteria. The patients were randomly divided into two groups of 40 and changes in blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and arterial blood oxygen saturation were measured. The incidence of nausea, vomiting, chills, and itching in the two groups was recorded. The analysis was performed descriptively and also using t-test and Chi-square tests.

The results showed that the mean of SBP and DBP, HR, and arterial blood oxygen saturation and the incidence of nausea and vomiting was statistically significant (P < 0.05) between the two groups at 4, 6, and 12 h after anesthesia and it was higher in a group of GA. There was no significant difference in shivering and itching between the two groups (P > 0.05).

The results of this study indicated that thoracic EA in patients with laparoscopic cholecystectomy has significant effects on factors such as SBP and DBP and arterial blood oxygen saturation. Furthermore, EA has fewer complications than GA, and it is the preferable approach.

Thalassemia is an inherited defect in the production of globulin chains transmitted by autosomal recessive inheritance. Anaesthetic management of these patients is challenging, being associated with hypersplenism, unanticipated difficult airway and vertebral malformations, perioperative high blood pressure, systemic features of iron overload, cardiac and hepatic failure and anaemia.   In this case, we highlight the anaesthetic concerns in a child of beta thalassemia intermedia with high levels of Hemoglobin F posted for splenectomy along with cholecystectomy. To avoid need of postoperative mechanical ventilation due to low oxygen carrying capacity of blood and anaerobic metabolism during the period of surgical stress, epidural catheter inserted despite possibility of epidural hematoma or bleed because of thrombocytopenia. Patient had an enhanced recovery in term of decrease oxygen demand, decrease postoperative nausea and vomiting, early ambulation and patient satisfaction. Intraoperative epidural also decreases need of neuromuscular blocking agent and intravenous analgesia. This lead to faster awakening from anaesthesia even in the presence of decrease oxygen carrying capacity due to anaemia and acidosis (anaerobic metabolism). Use of regional anesthesia should be considered in similar cases after assessing risk and benefits for individual cases.

Both neuraxial anesthesia and general anesthesia are used for lower limb surgery. And because of the complications that occur with this type of surgery, we searched in this narrative review the effectiveness and safety of neuraxial anesthesia versus general anesthesia for lower limb surgery. We included randomized controlled trials comparing neuroaxial anesthesia (spinal or epidural anesthesia) versus general anesthesia in adults (35 years or older) with lower-limb surgery.

General anesthesia (GA) is associated with serious concerns in advanced cases of Charcot-Marie-Tooth (CMT). Despite several benefits of applying regional anesthesia (RA), recommendation for RA is controversial in CMT due to insufficient supporting documents and trials. We report combined epidural/general anesthesia for a 12-year-old boy with CMT disease undergoing major spine corrective surgery. This manuscript is presented not only to evaluate the costs and benefits of RA, but also to highlight the safety of neuraxial anesthesia and emphasis on the broad potential role of RA to reduce risks of GA in CMT patients.

Context: Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction.Evidence Acquisition: We searched MEDLINE (Pub Med, OVID, MD Consult), SCOPUS and the Cochrane database for the following keywords: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013. Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs. Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient’s condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above mentioned rules a safe anesthesia could be achievable in these patients.