Incidence of Paresthesia, Neurological Complications and Cardiocirculatory Changes after Thoracic Spinal Anesthesia: A Multicentric Retrospective Study | Chapter 15 | Medicine and Medical Research: New Perspectives Vol. 5

Introduction: Various analgesic management strategies have evolved, often the regional analgesic techniques being favored over the systemic administration of opioids. Most anesthesiologists use thoracic epidural, which has a 0.75% incidence of accidental perforation. However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury.

 

Aim: The main objective of this retrospective study was to evaluate the incidence of paresthesia and neurological complications, as well as cardiocirculatory changes after thoracic spinal anesthesia.

 

Methods: This retrospective study of patients undergoing thoracic spinal anesthesia evaluated the following parameters: needle types, needle insertion, puncture position (sitting or lateral decubitus), thoracic puncture level, presence of cerebrospinal fluid (CSF) in the needle hub, type of anesthetic, latency, motor block, incidence of bradycardia and hypotension, paresthesia (duration) and neurological complications. This study conducted a retrospective audit, between January 2007 and December 2019. This study reviewed the record sheets of patients who experienced paresthesia for thoracic spinal anesthesia with two types of needles of the same gauge, isobaric and hyperbaric 0.5% bupivacaine and puncture in the sitting or left lateral position, and median and paramedian insertion.

 

Results: Paresthesias occurred in 5.9% of patients. In this observation, 41 patients experienced a paresthesia with cut needle compared with 43 patients with a pencil point, without statistical difference. All paresthesias were transient and lasted a maximum of three days. No sequelae neurologic were observed in all patients during this study. Bradycardia occurred in 3.1% of the patients and hypotension in 13.2% of the patients, easily corrected by the use of atropine and vasopressor.

 

Conclusion: All 84 paresthesias observed in this study were associated with free flow of CSF when the stylet was removed from the needles. No association was found between the type of spinal needle and the incidence of paresthesias. This study with 1,406 patients showed that thoracic spinal anesthesia is safe and without neurological sequelae, with a puncture between T8 and T11. If the anesthetist has an adequate knowledge of the relevant modern anatomy, physiology and pharmacology, safe and satisfactory anesthesia can easily be obtained to the mutual satisfaction of the patient, surgeon and anesthetist.

 

 

Author (s) Details

Luiz Eduardo Imbelloni
CET-SBA Hospital Clínicas Municipal de São Bernardo do Campo, SP, Senior Researcher of INCA, Rio de Janeiro (RJ), Brazil.

 

Marcos Fornasari
Hospital Rio Laranjeiras, Rio de Janeiro (RJ), Brazil.

 

Raphael Sant’Anna
Unimed Hospital, Porto Velho, RO, Brazil.

 

Geraldo Borges de Morais Filho
UFPB, João Pessoa-PB, Statistician of the Complexo Hospitalar Mangabeira, João Pessoa- PB, Brazil.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/361

Simple, Reliable, and Safe Technique for Endotracheal Tube Cuff Inflation: A Comparative Evaluation of the Three Common Methods | Chapter 11 | Medical Research and Its Applications Vol. 3

 

The aim of this study is to compare the three common (Sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications. Tracheal arterial capillary pressure decreases when the cuff exerts pressure greater than 30 cm H2O, causing tracheal ischemia proportional to the pressure exerted by the cuff and to the duration of exposure. There is a strong relationship between endotracheal cuff pressure and airway complication, therefore, the methods of endotracheal tube cuff inflation are of great importance to maintaining safe and effective cuff pressure. Seventy-five adult patients scheduled for N2O-free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for females and 8.0 mm for males were used. Patients were randomly assigned into one of three groups. Control group (n=25), the cuff was inflated to a pressure of 25 cm H2O, sealing group (n=25), the cuff was inflated to prevent air leaks at an airway pressure of 20 cm H2O and finger group (n=25), the cuff was inflated using finger estimation. Tracheal leaks, the incidence of sore throat, hoarseness and dysphagia were tested.  Although cuff pressure was significantly low in the sealing group compared to the control group (P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat was significantly higher in the finger group compared to both the control and the sealing group (P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leaks around the endotracheal tube cuff. The incidence of sore throat was significantly higher in the finger group compared to both the sealing and control groups, whereas the incidence of both hoarseness and dysphagia was similar in the three groups.

Conclusions: When it comes to efficient sealing and a low rate of sore throat, sealing cuff pressure in N2O-free anesthesia is a simple, undemanding, and safe substitute for the conventional method.

 

Author(s)details:-

 

Roshdi R. Al-Metwalli|
Department of Anesthesia, Imam Abdulrahman Bin Faisal University [Dammam University (Previously)], Saudi Arabia.

 

Abdulmohsen A. Al-Ghamdi
Department of Anesthesia, Imam Abdulrahman Bin Faisal University [Dammam University (Previously)], Saudi Arabia.

 

Hany A. Mowafi
Department of Anesthesia, Imam Abdulrahman Bin Faisal University [Dammam University (Previously)], Saudi Arabia.

Sayed Sadek
Department of Anesthesia, Imam Abdulrahman Bin Faisal University [Dammam University (Previously)], Saudi Arabia.

 

Wesam F. Mousa
Qatif Central Hospital, Saudi Arabia.

 

Please See the book here :-  https://doi.org/10.9734/bpi/mria/v3/230

A Rare Presentation on Epstein-Barr Virus Infection Mimicking Acute Appendicitis | Chapter 13 | Advancement and New Understanding in Medical Science Vol. 3

This case report describes about a young patient with right lower quadrant pain initially considered acute appendicitis by imaging scans, which was finally diagnosed as EBV infection. Appendicitis is the most common surgical emergency and is typically accompanied by pain in the right lower quadrant of the abdomen and localized tenderness at McBurney’s point. A 21-year-old male patient was admitted to the hospital with fever and stomach ac he for 2 days. The patient had a high value of infection index, but there was no obvious tenderness in the appendix; therefore, appendicitis could not be diagnosed. Surgical investigation was inevitable, but lesions could not be detected during the procedure; nevertheless, the patient’s family consented to the surgical procedure. Hence, laparoscopic examination and appendectomy were performed under general anesthesia.

Author(s) Details:

Li Wang,
Department of Emergency Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou-310009, China.

Wei-Hua Gong,
Department of Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou-310052, China.

Please see the link here: https://stm.bookpi.org/ANUMS-V3/article/view/13185

An Evidence-based Assessment of Local Anesthesia Versus Spinal Anesthesia during Inguinal Hernia Surgery | Chapter 3 | Novel Research Aspects in Medicine and Medical Science Vol. 1

 To determine the best, the most prudent anesthesia mix (local vs. sleep-inducing or numbing drug) for inguinal hernia processes, with the goal of lowering discomfort, hospital stay, and improvement time. This article outlines approximate analytical dossier obtained by inguinal surgeries performed under local and sleep-inducing or numbing drug anaesthesia to evolve a precise opinion concerning both methods. This prospective analytical study was administered on 140 patients of easy unilateral inguinal hernia that were operated subsequently dividing them in two groups on the footing of type of anaesthesia (Local induced absence of feeling or Spinal anaesthesia) received. Outcome of study was assembled and statistically analysed for cost benefit, patient satisfaction levels, following and postoperative complications. The mean age of the research players was 40.44 years traditional for group B and 44.36 years traditional for group A. There was no statistically significant difference in the middle surgery opportunity between the two groups (70.26 vs. 72.46 brief time period; p-value > 0.05). Except for questions linked to spinal sleep, postoperative confusions were comparable across the two groups. In the first 24 hours, the group taking local anesthesia knowledgeable more pain reduction. The median ward stay following surgery was smaller (2.36 days as opposed to 3.56 days) in the local anesthesia group. When distinguished to group B, group A's median opportunity to resume employment was smaller (8 days as opposed to 11 days). Under local sleep, inguinal hernia repair is a dependable, secure, and careful procedure. Use concerning this method will boost surgical performance two together in quantity and kind in India, where patients exceed resources and ability.

Author(s) Details:

Anurag Jain,
Department of General Surgery, Government Medical College, Satna, Madhya Pradesh, India.

Rajiv Jain,
Department of General Surgery, SAIMS, Indore, Madhya Pradesh, India.

Ashish Choudhrie,
Padhar Hospital, Betul, Madhya Pradesh, India.

Please see the link here: https://stm.bookpi.org/NRAMMS-V1/article/view/11781

New Method of Classic Laryngeal Mask Air Way Insertion | Chapter 14 | New Advances in Medicine and Medical Science Vol. 6

 The present study was completed activity to validate the new system for correct anatomic installation of the LMA and to compare it accompanying the standard technique. Laryngeal mask ventilating pipe (LMA) is a supraglottic airway device used to control the ventilating pipe during the presidency of anesthesia in the room for surgery and for emergency ventilating pipe management.This study was exhausted Basrah University Medical Center from 1st January 2019 to 31st December 2019. Patients were randomly appointed and categorized into two groups; Group I – the students that study together, and Group II – the standard (control) group. Results were expressed as repetitions or means ± standard departures. Frequencies or means were compared utilizing X2 and t-test, respectively.Study transported a new technique at which point the device is introduced easily outside digital guidance during insert. It will be appropriate for the anesthesiologists and healing personnel the one use LMA as there is less risk of contamination or injury to their fingers. Three hundred and ninety-seven (397) participants were registered in this study accompanying a mean age of 35.7 ± 14 y. Of those, 154 (38.8%) were males. The new plan showed larger sensitivity and veracity rate (97.4%, 95.9%, respectively) distinguished to the standard method.In comparison to the normal method of insert, the new method is a suitable method that improved the ease of LMA insert and successfully inserted the device in a smaller amount of time outside complications. The study approves this technique expected used in sleep-inducer practice as a sole method, or a suggestion of choice technique, at any time there is a trouble.

Author(s) Details:

Jasim M. Salman,
Department of Anesthesiology, University of Basrah, College of Medicine, Basrah, Iraq.

Please see the link here: https://stm.bookpi.org/NAMMS-V6/article/view/10995

Physiological and Anatomical Changes of Pregnancy Implications for Anaesthesia | Chapter 2 | Perspective of Recent Advances in Medical Research Vol. 9

 The purpose of this chapter is to provide detailed information about the physiological and anatomical changes that occur during pregnancy. During pregnancy, the body goes through various anatomical and physiological changes to provide suitable environment for foetal development, to cater to the increased metabolic demands and to prepare for the childbirth. These changes have notable anaesthetic implications in determining the optimal anaesthetic technique, while also keeping in mind the gestational age, type of procedure and any coexisting medical condition. A randomized controlled trial was done among 200 pregnant women in Department of Obstetrics and Gynaecology at Tertiary care institute and hospital for the period of 6 months (November 2021 to April 2022). The physiology of the respiratory system changes continuously during pregnancy. Due to the effects of progesterone on bronchial smooth muscle, airway resistance is reduced by 50%. The Minute ventilation, RR, Tidal volume, and Alveolar ventilation are increased. Anatomically, diaphragm moves up with cephalad pressure of the growing gravid uterus, and the chest wall diameter increases in both anteroposterior and transverse diameters. This leads to unchanged Total Lung Capacity, Vital Capacity, and CC, while Expiratory Reserve Volume, Residual volume, and Functional residual capacity seen a decrease in 20% in all patients. Blood volume increases rapidly early in pregnancy (around 12 weeks), then gradually increases during the second trimester and then more slowly throughout the pregnancy. Cardiac output rises early in pregnancy, with changes detectable by 8 weeks. Increased minute ventilation, RR, tidal volume, and alveolar ventilation. Cardiac output rises early in pregnancy, with changes detectable by 8 weeks. Cardiac output rises most rapidly (to approximately 35% above baseline) during the second trimester and then stays relatively constant until term. With labour contractions, output increases significantly; each contraction increases cardiac output by 10-25%.

Author(s) Details:

Sarmistha Panigrahi,
Department of Anaesthesiology, Apollo Hospital, Kakinada, Andhra Pradesh, India.

Sandhya Peethani,
Department of Obstetrician and Gynaecologist, Apollo Hospital, Kakinada, Andhra Pradesh, India.

Please see the link here: https://stm.bookpi.org/PRAMR-V9/article/view/9589

Anesthesia Protocol Procedures for Hemodynamic Diagnostic and Interventional Cardiology: Our Experience Ultimate Revision | Chapter 3 | Current Practice in Medical Science Vol. 3

Hemodynamic diagnostic and interventional cardiology techniques often call for general anaesthesia, extubation, and patient waking after the operation. This anaesthetic protocol is utilised on patients who are scheduled for normal or emergency operations; nevertheless, dedicated anaesthetic procedural approaches are required for particular situations and hemodynamic treatments.

Author(s) Details:

L. Milella,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

M. T. Ficarella,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

M. Sisto,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

P. Moliterni,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

R. L. Grieco,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

F. Cito,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

M. L. Lasorella,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

F. Lenoci,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

G. Calabrese,

General Neonatal and Pediatric Anesthesia and ICU - Neonatal and Pediatric Cardiac Anesthesia and ICU - Pediatric Hospital 'John XXIII'- Bari-Italy.

Please see the link here: https://stm.bookpi.org/CPMS-V3/article/view/7381

Critical Study on Subtotal Thyroidectomy for Giant Goiters under Local Anesthesia: Experience with 15 Nigerians | Chapter 5 | Challenges in Disease and Health Research Vol. 1

Thyroid surgery is performed by majority of surgeons using general anesthesia with endotracheal intubation. In resource poor countries, the paucity of equipment and Anesthetists limit such procedure needing endotracheal intubation. We describe our experiences with 15 Nigerians who presented with giant goiters and were operated using local anesthesia. We conclude that subtotal thyroidectomy under local anesthesia is safe and cost effective. It should be encouraged in resource- poor countries and save the patients from living with the stigmata of goiters when they are not able to pay their ways to centers that use general anesthesia with endotacheal intubation for such procedure.

Author(s) Details

Dr. B. A. Eke
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. B. A. Ojo
Department of Histopathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. W. T. Yongu
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. C. Ahachi
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.

Dr. P. Abayol
College of Health Sciences, Benue State University, Makurdi, Nigeria.

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