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Background Early initiation of breastfeeding (EIBF) within 1 h of birth is crucial in preventing newborn deaths and plays a vital role in early infant nutrition. Promoting and supporting breastfeeding is an integral part of midwifery. The objective of the study was to improve the EIBF rate in neonates born through a Cesarean Section (CS) from 0% to 50% within six months through a quality improvement (QI) process and to assess the maternal experience of EIBF in operation theatre (OT). Methods Six Plan-Do-Study-Act (PDSA) cycles were conducted to test the change ideas proposed by the team members for a month to improve EIBF. Participants of the study were the stable term newborns delivered by CS under spinal anesthesia. Results The EIBF rate improved from 0% to 88% after the sixth PDSA cycle. The effect was sustained for six months. Mothers of 51 neonates (98%) who received EIBF reported that their newborns were breastfed successfully, and it was not physically tiring to feed immediately in the OT. Conclusions A quality improvement (QI) initiative was able to improve and sustain the improved EIBF rate after CS. Early skin-to-skin contact to be initiated with EIBF for better neonatal outcomes.

Spinal anesthesia and peripheral nerve block anesthesia are used in total knee replacement. The aim of the study was to examine whether peripheral nerve block anesthesia would provide a more stable hemodynamic profile and analgesic effect in elderly patients undergoing total knee replacement, as compared to spinal anesthesia. This is a single-center case-control trial, with patients from our prospectively followed registry. The patients were divided into two groups, those with peripheral nerve block anesthesia and spinal anesthesia. Propensity score analysis was performed in 1:1 ratio. The primary outcome was analgesia with total analgesic effect and the secondary outcome was intraoperative hemodynamic status. The patients in peripheral nerve block anesthesia group had a longer length of analgesia (606.19±219.35 vs 359.48±106.82, P

To assess the efficacy of knee-chest position in shortening the time of spinal induction in pregnant women undergoing elective cesarean section. We also assessed for any untoward adverse events that might limit their usefulness in real-life clinical scenarios.Prospective, randomized controlled study was done in maternity operating room of tertiary care institution in 45 ASA II pregnant women undergoing elective cesarean section under spinal anaesthesia. Patients were randomly assigned to groups S (supine) and K (kneechest position). After performing subarachnoid block (9 mg of 0.5% hyperbaric bupivacaine and 25 µg fentanyl) in the sitting position, women in group K were maintained in the knee-chest position for 60 seconds. Time to attain block height of T6 and maximum sensory blockade, intraoperative hemodynamics, Bromage score, intraoperative fluid, vasopressor requirement, and respiratory parameters were recorded. The newborn was evaluated using Apgar scores at 1 and 5 minutes.Data of 45 patients were analyzed. Time to attain T6 block height (group K=2.1 ± 0.65 minutes, 95% CI: 1.83-2.39; group S=6.4 ± 0.77 minutes, 95% CI: 6.10-6.78) and time to achieve maximum sensory block height were significantly lower in group K (group K=3.2 ± 1.35 minutes, 95% CI: 2.61-3.78; group S=6.6 ± 0.89 min, CI: 6.19-6.98). The degree of motor block was higher in group K than that of group S at 2 minutes (P=.0002), 4 minutes (P.0001), and 6 minutes (P.0001), with no difference at 8 minutes. No statistically significant difference was observed in fluids and vasopressors requirement intraoperatively.This study provides evidence that the onset of adequate surgical anaesthesia for the cesarean section can be hastened by placing the patient in the knee-chest position for a minute after performing the subarachnoid block in the sitting position.

Purpose: This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.Methods: This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.Results: Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with

Современные неинвазивные способы лечения постпункционной головной боли: постельный режим, нагрузка жидкостью, кофеин, суматриптан — малоэффективны. Хирургическое закрытие разрыва твердой оболочки является крайней мерой. Эпидуральная пломбировка кровью остается инвазивным методом выбора с примерно 70% длительным успехом после первой инъекции. Старинная внутривенная акватерапия менее инвазивна и довольно популярна среди украинских акушерских анестезиологов. Блокада крылонебного узла является наименее инвазивным методом, требующим исследования.

Спінальну анестезію (СА) виконано в 93 жінок при кесаревому розтині. Показаннями до операції слугували: хвороба оперованої матки, неспроможність рубця на матці, клінічно вузький таз, міопія високого ступеня, вторинна родова слабкість. Як місцевий анестетик для СА використовували 0,5% Лонгокаїн Хеві. Преінфузію виконували Гекотоном — 3–4 мл/кг. З метою оцінки впливу СА на показники центральної гемодинаміки і преінфузію вивчали центральну гемодинаміку, об’єм циркулюючої плазми, об’єм позаклітинної рідини, новонароджених оцінювали за шкалою Апгар. Було встановлено, що внутрішньовенна преінфузія Гекотоном за рахунок поєднання переваг колоїдно-гіперосмолярного компонента швидко викликає перерозподіл рідини з міжклітинного простору у внутрішньосудинний, надійно підтримує волемічний ефект, що дозволяє використовувати менший об’єм розчину для передопераційної підготовки при нейроаксiальнiй анестезії. Застосування Гекотону як преінфузії (3–4 мл/кг) стабілізує гемодинамiчний профіль після виконання СА. У 81 (87,1 %) випадку відзначалася відносно стабільна гемодинаміка, що не потребувала адреноміметичної підтримки, і тільки в 12 (12,9 %) — розвивалася виражена артеріальна гіпотензія, корекцію якої проводили фракційним введенням мезатону.

Досліджено 206 пацієнтів (вік — 55,5 ± 3,3 року; маса тіла — 84,8 ± 2,9 кг; I–III клас за ASA), яким виконувалися лапароскопічні холецистектомія, герніопластика, кістектомія. Спінальну анестезію проводили гіпербаричним бупівакаїном (0,5%; 10–20 мг) у поєднанні з 0,06 мг бупренорфіну. Для профілактики больового плечолопаткового синдрому виконували правобічну поверхневу блокаду шийного сплетіння ізобаричним бупівакаїном (0,125%, 10 мл) і термінальну анестезію діафрагми ізобаричним бупівакаїном (0,25%, 15 мл; спрей; через лапароскопічний троакар). Місця інтервенції лапароскопічних портів інфільтрували 0,25% ізобаричним бупівакаїном. Для створення пневмоперитонеума використовували закис азоту з тиском 9–10 мм рт.ст. Пацієнти отримували перорально по 6 мг мелатоніну перед сном, за 1 год до лапароскопії та в перший післяопераційний день перед сном. Перед операцією: перорально/внутрішньовенно — 1 г парацетамолу, внутрішньом’язово — 20 мг нефопаму, внутрішньовенно — 8 мг дексаметазону, внутрішньовенно — 8 мг ондансетрону, внутрішньовенно — 50 мг декскетопрофену. Після операції протягом 1–1,5 доби: перорально/внутрішньовенно — 1 г парацетамолу кожні 8 год, внутрішньом’язово — 50 мг декскетопрофену кожні 8 год. Корекцію гіпотензії забезпечували інфузією адреналіну, змінюючи швидкість введення препарату залежно від рівня артеріального тиску та частоти серцевих скорочень, у межах 0,09–0,18–0,27 мг/год. Післяопераційний біль оцінювали за числовою рейтинговою шкалою болю від 0 до 10 балів через 3, 10, 24, 48 год та отримали відповідно такий результат: 0; 0,27 ± 0,02; 0,41 ± 0,07; 0,45 ± 0,06 бала. Ускладнення: затримка сечі — 1 (0,49 %) випадок; післяопераційна нудота й блювання — 31 (15,1 %) хворий; свербіж — 25 (12,1 %) пацієнтів (ефективно був купований внутрішньовенним введенням 0,4 мг налоксону). Період госпіталізації становив 31,0 ± 1,6 год. Висновки: спінальна анестезія бупівакаїном із бупренорфіном — ефективний метод знеболювання лапароскопії, що характеризується тривалим позитивним післяопераційним аналгетичним профілем; поліпшення якості аналгезії дозволяло проводити ранні активізацію й ентеральне харчування пацієнтів, тому скорочувався період післяопераційного відновлення, що повністю відповідає концепції Fast track surgery; поєднане інтратекальне застосування бупренорфіну та бупівакаїну характеризувалося значно меншою кількістю негативних побічних ефектів порівняно з іншими опіоїдами.

A 44-year-old woman underwent a total laparoscopic hysterectomy for adenomyosis under spinal anaesthesia and general anaesthesia. Postoperatively, she recovered uneventfully and was discharged the following day. Three days after the surgery, she developed severe orthostatic headache associated with

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH). Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care. Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

Background. General anesthesia and spinal anesthesia in cesarean section both have advantages and disadvantages. The scoring system of APGAR is a standardized tool that can inform the condition of newborn infants, which might be influenced by gestational age, medication, resuscitation, cardiorespiratory and neurological conditions of the mother. This study aimed to compare the effect of general and spinal anesthesia usage to the APGAR score of newborn infants at Haji Adam Malik General Hospital Medan. Methode. This study uses an observational-analytic design with a cross-sectional approach, conducted using secondary data through the medical records of mothers who gave birth through cesarean section and obtained at the Medical Record Installation at the Haji Adam Malik Hospital Medan from 2018 to 2019. Result. In spinal anesthesia, there are 52 samples for a score of 8-10. Whereas in general anesthesia, there are 52 samples to score 8-10. The APGAR score of 1 minute in infants born through cesarean section under spinal anesthesia had an average of 8.63, with general anesthesia of 8.00 (p=0.001). The 5-minute APGAR score in infants born through cesarean section under spinal anesthesia had an average of 9.85, and with general anesthesia of 8.67 (p=1.000). Conclusion: The 1-minute APGAR score for infants using spinal anesthesia showed a statistically better effect than the 1-minute APGAR score for infants using general anesthesia.

Objective. This study aims to compare two different methods of regional anesthesia applied for knee arthroscopy in terms of patient and surgeon satisfaction. Materials and Methods. Eighty patients who underwent knee arthroscopy either with spinal anesthesia (SA) or unilateral sciatic and femoral nerve block (SFNB) were included in the study. A nurse conducted a blind study questionnaire to assess the surgeon and patient satisfaction from anesthesia performed at the end of the surgery. Pain score, demographical data, duration of surgery, motor and sensory block duration, time of first rescue analgesia were recorded and analyzed statistically. Results. A statistically significant difference was found between the patient (p = 0.001; p

Background The effect of epidural/spinal anesthesia during labor on breastfeeding is unclear. Few studies had assessed whether or how medically assisted delivery (operative vaginal delivery or unscheduled cesarean birth) plays a mediating role. We aimed to examine whether the relationship between using epidural/spinal anesthesia and breastfeeding is mediated by increased medically assisted delivery among healthy nulliparous women. Methods A secondary, cross-sectional analysis was conducted using US birth certificate data from 2016 (n = 381 199). Logistic regression was used to examine associations between factors. Structural equation modeling (SEM) was used to analyze the model fit of the path models and to quantify the direct, indirect, and total effect of anesthesia on breastfeeding at discharge, considering medically assisted delivery as a mediator. Results Women who were administered epidural/spinal anesthesia were more likely to experience medically assisted delivery (adjusted odds ratio [AOR]: 95% confidence interval [CI] 3.01 (2.91-3.12)) and less likely to be breastfeeding at discharge (0.95 [0.92-0.98]). Operative vaginal and unscheduled cesarean deliveries were significantly associated with nonbreastfeeding at discharge (0.81 [0.77-0.84] and 0.81 [0.79-0.84], respectively). SEM revealed excellent model fit for our model. The indirect effect was significant (β = -0.038; 95% CI, -0.043 to -0.033), as was the total effect (β = -0.038; 95% CI, -0.043 to -0.033). Conclusions Epidural/spinal anesthesia is associated with nonbreastfeeding at discharge, mediated through medically assisted delivery. Health care providers should consider these risks and provide adequate support to help all parents attain their breastfeeding goals.

Objectives: Hip Fractures (HF) affect the elderly in particular, and are associated with high mortality rates. Most geriatric patients are admitted to Intensive Care Unit (ICU) after HF surgery. In this study, the purpose was to investigate the prognostic value of preoperative NLR (Neutrophil-to-Lymphocyte Ratio) on postoperative ICU admission and mortality in elderly patients with HF. Methods: In the present study, the data of 188 geriatric patients who underwent surgery because of isolated HF (i.e. femur neck and intertrochanteric fracture) were examined retrospectively. The patients over 65 years of age, ASA score 3/4, whose preoperative duration was less than 72 hours, and who underwent spinal anesthesia were included in the study. The patients were divided into two groups as ICU admission (ICU, n = 58), and Non-ICU (Non-ICU, n = 130). The patients were also grouped as Survival (n = 168) and Non-survival (n = 20) according to postoperative mortality rates. NLR values were statistically compared between the groups. Results: The preoperative NLR values of the patients in the ICU Group were significantly higher than those in the Non-ICU Group (p < 0.001). The cut-off value of NLR for ICU admission was found to be 9.65 with 89% sensitivity and 67% specificity in the ROC analysis. The median NLR value was 6.42 (3.55-9.44) in the Survivor Group, and 9.5 (7.23-11.02) in the Non-Survivor Groups (p = 0.015). Conclusions: It was shown in the study that high NLR values in elderly patients may be a risk factor for ICU admission, and for postoperative mortality after HF.

Background: Spinal anesthesia is a reliable and safe technique for infraumbilical surgeries. Nevertheless, some of its characteristics may limit its use for day care surgery. Use of long-acting anesthetic drugs like bupivacaine in spinal anesthesia may lead to side effects such as delayed ambulation and risk of urinary retention. Chloroprocaine is an amino-ester local anesthetic with a very short half-life now being extensively evaluated in volunteer studies and clinical practice with a favorable safety profile and efficacy, suggesting that it may be a suitable alternative to long-acting local anesthetics like bupivacaine in day care surgeries. Aims and Objective: This study aims at evaluating the duration and efficacy of chloroprocaine in spinal anesthesia for infraumbilical surgeries. The primary outcome of the study was to evaluate the duration and efficacy of chloroprocaine 1% in spinal anesthesia for infraumbilical surgeries and the secondary outcome was to find out the incidence of adverse effects if any. Materials and Methods: In this randomized single-blinded clinical evaluation, after institutional ethical committee approval, 30 adult patients (18–70 years, ASA physical Status I-III, BMI < 36 kg/m2) scheduled for infraumbilical surgeries received chloroprocaine 40 mg intrathecally. Patients were evaluated for onset and regression of sensory and motor blockade, peak level of sensory blockade, and time of ambulation postoperatively. Results: The average duration of the surgeries was 46.87±15.24 min. Anesthesia was sufficient for the planned surgery. Only three patients required sedation intraoperatively. The median peak sensory block height was T8. The mean time for peak height sensory block was 6.6±1.673 min and complete motor block was 2±1.05 min. Mean time for complete sensory block regression was 95.37±20.79 min and complete motor block regression was 81.43±20.33 min. Four patients required inj. atropine following bradycardia and three patients required vasopressors following hypotension. Conclusion: Spinal anesthesia with chloroprocaine provides reliable sensory and motor block for short duration infraumbilical surgeries with fewer intraoperative and post-operative complications.

Margaretha B Breebaart,1,2 Lies Saerens,3 Jordi Branders,2 Sari Casaer,3 Luc Sermeus,4 Patrick Van Houwe3 1Department of Medicine and Healthcare Sciences, University of Antwerp, Wilrijk, Belgium; 2Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium; 3Department of Anesthesia, GZA Hospitals, Wilrijk, Belgium; 4Department of Anesthesia, Université Catholique de Louvain, Brussel, BelgiumCorrespondence: Margaretha B Breebaart Email margaretha.breebaart@uza.bePurpose: Chloroprocaine provides spinal anesthesia for day-case surgery lasting up to 40 minutes. Intravenous and spinal dexmedetomidine can prolong spinal anesthesia, but no data are available for the combination with chloroprocaine. This double-blind randomized controlled trial compares chloroprocaine with spinal or intravenous dexmedetomidine regarding block characteristics, micturition, and discharge times.Patients and Methods: After ethical approval and informed consent, 135 patients scheduled for knee arthroscopy were randomized to receive either 40mg spinal chloroprocaine (Chloro-group), 40mg chloroprocaine with 5 mcg spinal dexmedetomidine (Spinal Dex-group) or 40mg chloroprocaine with 0.5 mcg/kg IV dexmedetomidine (IV DEXgroup). Block characteristics, hemodynamic variables and the use of analgesics were registered. Voiding and discharge times were noted. A scoring system was used for micturition problems and sedation. Transient neurological symptoms (TNS) and other late side effects were evaluated after one week.Results: Demographic data were similar between groups. Block onset times and intensity of motor block were comparable between groups. The time to L2 and Bromage 1 regression was prolonged in the SpinalDEx-group by approximately 30 minutes compared to the other groups (p < 0.01). First voiding as well as discharge from the hospital was prolonged in the Spinal Dex-group by approximately 40 minutes p < 0.01. There was no significant difference between groups regarding treatment of hypotension, sedation, micturition problems or the use of postoperative analgesics (P > 0.8). One patient experienced TNS.Conclusion: Intrathecal but not intravenous (0.5 mcg/kg) dexmedetomidine can prolong chloroprocaine (40mg) spinal anesthesia when surgery is expected to last over 40 minutes. Despite a similar incidence of adverse effects, this also led to a postponed hospital discharge time.Keywords: ambulatory surgery, bladder function, chloroprocaine, dexmedetomidine, knee arthroscopy, spinal anesthesia

Background: Supine hypotensive syndrome is a pathophysiologic state in a parturient after 20 weeks’ gestation when put in the supine position during cesarian section under spinal anesthesia. Spinal anesthesia produces rapid, effective, reliable and safe anesthesia making it the preferred technique for cesarian section. Maternal hypotension is a known common side effect of spinal anesthesia and is generally managed pharmacologically and/or non Pharmacologically. The aim of this study was to assess the management of supine hypotension during cesarean section under spinal anesthesia among CRAs at Tamale Teaching Hospital (TTH). Methods: A cross-sectional study with both quantitative and descriptive approaches were employed. Thirty-eight (38) CRAs were conveniently sampled and a structured self-administered questionnaire was used for data collection after pretesting for validity and reliability. Data was analyzed with Stata I/C. Results: Non-Pharmacological interventions: 19(50%) of CRAs placed parturient in the supine position n after spinal anesthesia with head up, 15 (39.5%) in Supine position alone, 4 (10.5%), used lateral position alone. Pharmacological interventions (Use of Intravenous fluids): Lactated Ringers solution 6(15.8%), Normal saline solution 24(63.2%), Crystalloid and colloid combination 8(21%). Vasopressor of choice: Ephephrine alone 36(94.8%), Phenylephrine alone 1 (2.6%), Multiple agents 1 (2.6%). Preferred intervention: non-Pharmacological 21(55.3%), Pharmacological 17(44.7%). Determinants of choice of intervention: Severity of hypotension 29(76.3%), availability of intervention 7(18.5%), diagnosis of the patient 1(2.6%), frequency of hypotension 1(2.6%). Conclusions: Most CRAs placed parturient in the supine position with head up as a non-pharmacological approach to managing supine hypotension after spinal anesthesia. Normal saline solution and ephedrine were widely used as pharmacological agents. Majority of the CRAs preferred using the non-pharmacological techniques as compared with the pharmacological approaches and their choice of intervention was significantly influenced by the severity of the intervention.

Aims and Objectives: To evaluate salivary alpha-amylase (sAA) levels for determining stress variations in patients undergoing spinal anesthesia for infra-umbilical surgery. Materials and Methods: One hundred and twenty subjects (age 18–65 years) planned for infra-umbilical surgery under spinal anesthesia were included and allocated to Groups A and B ensuring age and sex matching. In both groups, sAA levels (S1 to S4) were assessed sequentially at different times (E1 to E4). S1 and S2 were collected on the evening before surgery (E1) and in the preoperative room on the day of surgery (E2), respectively. Thereafter, in Group A, S3 and S4 were collected before (E3) and 15 min after spinal anesthesia (E4), following which intravenous Midazolam was given. In Group B, intravenous Midazolam was administered first, S3 was collected 5 min later (E3), spinal anesthesia was administered and S4 was collected after15 min (E4). Results: In both groups, sAA levels showed a mild increase from E1 to E2 (not significant). Thereafter from E2 to E3 and E3 to E4, a significant sharp rise in sAA levels in Group A and a significantly acute decline in Group B was noted. Mean sAA levels in Group A were higher as compared to group B (P < 0.005) in E3 and E4. Conclusion: Sequential documentation of increase in sAA levels in our study, starting with the baseline levels, presents a comprehensive report of the stress that the patients experience during preoperative period and reinforces the need of anxiolytic before spinal anesthesia.

Background: Hydroxyethyl starch solutions which have been introduced some three decades ago, have been extensively used for treatment of intraoperative hypovolaemia. Aims and Objectives: The present prospective study was conducted to study changes in post-operative renal function and coagulation profile in patients undergoing orthopedic hip surgery under spinal anesthesia after coloading with 6% HES 130/0.4. Materials and Methods: Seventy patients, aged between 50 and 80 years, of either sex, belonging to ASA physical Status I and II, scheduled for orthopedic hip surgery under spinal anesthesia were included in the study. As per the group allocation, coloading was done with 7.5 mlkg-1 of either Group RL or 6% 130/0.4 Group HES during the 1st h of surgery. Venous samples were withdrawn before the day of surgery, on the day of surgery, and on the 3rd day of surgery. Results: No statistically significant difference between renal and coagulation profile was found among groups. Conclusion: Thus, we recommend using tetrastarch (6% HES 130/0.4) for intraoperative hypovolemia in elderly patients with normal renal function and coagulation profile undergoing orthopedic hip surgery.

Objective: To compare levobupivacaine based caudal epidural anesthesia and spinal anesthesia in terms of Intraoperative hemodynamic changes and postoperative pain and patient comfort in subjects undergoing perianal surgery in outpatient setting. Material and methods: All consecutive patients who were scheduled for perianal surgery. The difference in intraoperative hemodynamic changes, sensory and motor block level, postoperative pain and patient comfort was the primary outcome measure of this study. Results: There were no significant differences between the groups in terms of mean arterial pressure and heart rate recorded. Subjects randomized to spinal anesthesia had a significantl extensive motor and sensory block compared to those randomized to caudal epidural anesthesia. Visual analogue scale scores for surgical pain at postoperative 12 hours was significantly higher in subjects receiving spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.05). Time to first analgesic administration was significantly lower in subjects randomized to spinal anesthesia compared to those receiving caudal epidural anesthesia (p< 0.01). Conclusion: Spinal anesthesia is associated with more extensive sensory and motor block compared to caudal epidural anesthesia in patients undergoing perianal surgery. Both techniques lead to similar hemodynamic changes. Postoperative pain control is more favorable with caudal block than the spinal anesthesia.

Objective: To discuss problems faced in the management of emergency and elective cesarean sections with known or unknown abnormal placental placement and their management. Study Design: Retrospective observational study. Place and Duration of Study: Different Hospitals for the last 7 years from 2013 to 2020. Methodology: This retrospective observational study of 120 cases was selected for data collections that underwent anesthesia. Variables under study were age, weight, type of abnormal placenta, fluid, blood/blood products given during surgery, hysterectomy done, general surgeon help required, anesthesia type, and redo of operations. Results: A total of 120 patients were operated having abnormal placentation. The frequency of placenta previa 90 (75%), and accreta was 30 (25%). Primigravida patients were 19 (15.8%) and multigravida patients were 101 (84.1%). hysterectomy was done in 28 (23.3%) patients. Spinal anesthesia was given in 50 (41%) patients while 70 (58.3%) patients have general anesthesia. The spinal anesthesia was later on converted to general anesthesia in 32 (26.6%) patients out of 50 (41%). Only 12 (10%) patients were reopened for uncontrolled bleeding and 4 (3.3%) patients were sent to tertiary care hospital for further management. The general surgeon was called for help in 24 (20%) of patients and bladder injury occurred in 25 (20.8%) patients. No mortality was found during this period. Conclusion: Abnormal placental placement is a threat to mother life as well fetus and team of dedicated doctor is required to deal with this emergency. Use of inotropes can help to save the precious lives.

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol. Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups. Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

В статье представлен опыт применения односторонней спинальной анестезии в ургентной хирургии. Продемонстрировано, что односторонняя спинальная анестезия снижает степень операционно-наркозного риска и не несет рисков развития осложнений, связанных с видом обезболивания, существенно ограничивает влияние сопутствующей патологии на течение и исход оперативного вмешательства, а также является безопасной, в связи с чем в условиях ургентной хирургии может рассматриваться как преимущественный метод обезболивания у пациентов пожилого и старческого возраста, особенно с высокой степенью операционно-наркозного риска.

Background: Spinal Anesthesia (SA) as a safe, reliable, and cost-effective method is widely used for Cesarean Section (CS). However, it is sometimes complicated by Post-Dural Puncture Headache (PDPH). Objectives: We investigated the frequency of PDPH in CS under SA and related risk factors in an academic referral hospital in the north of Iran. Materials & Methods: This descriptive cross-sectional prospective study was conducted at Alzahra hospital as an academic referral center affiliated with the Guilan University of Medical Sciences on 147 eligible cases During from May 2019 to October 2019. Then questionnaires containing questions about patients’ demographic data and some PDPH-related factors were filled out via face-to-face interviews. The collected data were analyzed by SPSS v. 21 using Chi-squared and and Fisher’s exact test. Results: The incidence of PDPH was 6.1%. Early ambulation, the number of attempts, and having a history of headache were significantly associated with a higher incidence of PDPH (P=0.001), while body mass index (P=0.106), age (P=0.093), and residents’ experience (P=0.384) had no significant association. None of our cases experienced a severe or persistent headache. Conclusion: The main predisposing factors for PDPH were found to be the history of HA, early ambulation, and the number of dura punctures. Women at risk for PDPH should be objectively screened before CS under SA.

Objective. To increase the effciency of spinal anesthesia (SA) in operative delivery of pregnant women with type 1 diabetes mellitus (DM).Materials and methods. A dynamic assessment of the clinical effciency of spinal anesthesia in cesarean sections was performed in 123 pregnant women with DM. The level of the sensor and motor block was determined depending on the dose of a 0.5% hyperbaric solution of bupivacaine calculated according to the original method.Results. The SA method in cesarean sections in pregnant women with diabetes mellitus has been proposed taking into account the dosage of a hyperbaric solution of bupivacaine depending on the patient`s height and gestational age. The application of this method provided the development of the necessary degree of the sensory and motor block by the eight minute and created the requisite conditions for a cesarean section.Conclusion. The proposed method of the calculation of the hyperbaric solution dosage for subarachnoid anesthesia taking into account the patients` height and gestational age makes it possible to ensure the necessary degree of the sensor block at the level of 4-5 thoracic segments and suffcient relaxation in the surgical area during a cesarean section.

Актуальність. Останнім часом питанням періопераційного знеболювання при травмах нижніх кінцівок приділяється багато уваги. Остаточно не встановлено найбільш ефективного та безпечного методу анестезії при цих операціях. Більшість науковців та практикуючих лікарів вважає, що провідникові та нейроаксіальні методи анестезії найбільш відповідають цим вимогам, однак для остаточного рішення цього питання потребуються додаткові дослідження. Мета: дослідити клінічну ефективність методик спинномозкової анестезії та при її поєднанні із седацією при оперативних втручаннях на нижніх кінцівках у травматології за даними показників адекватності анестезії, інтенсивності болю та вивчення тривожності пацієнтів. Матеріали та методи. У дослідження були включені 35 хворих віком від 18 до 59 років, яким проводились операції металоостеосинтезу на нижніх кінцівках. Хворі були розподілені на групи: І (n = 17) — хворі, які прооперовані в умовах спинномозкової анестезії, ІІ — пацієнти (n = 18), які прооперовані в умовах спинномозкової анестезії з подальшою седацією 1% пропофолом. Хворі обох груп не відрізнялися за віком та антропометричними даними. Інтенсивність болю оцінювали за візуально-аналоговою шкалою (ВАШ) до та на 1-шу добу після операції, рівень особистісної та ситуативної тривожності за Спілбергером — Ханіним визначали також на цих етапах. Критерій Спірмена використовувався для виявлення взаємозв’язків між ВАШ та тривожністю. Результати. Установлено, що при поєднанні спинномозкової анестезії з внутрішньовенною седацією пропофолом у хворих зменшується інтенсивність больового синдрому після операції. У пацієнтів обох груп до операції був виявлений кореляційний зв’язок між показником ВАШ та ситуаційною тривожністю (r = 0,50; p

Актуальность. Односторонняя спинальная анестезия с использованием малых доз местных анестетиков является недорогой, эффективной и быстро проводимой методикой. Особое значение при одностороннем блоке придается предотвращению гипотензии, контролю уровня и продолжительности блока, что может быть достигнуто применением малой дозы местного анестетика. Продолжается поиск эффективной и безопасной малой дозы гипербарического бупивакаина при проведении артроскопических операций на коленном суставе с возможностью быстрой и надежной выписки. Цель: оценка эффективности и безопасности односторонней спинальной анестезии малой дозой (5 мг) гипербарического бупивакаина при артроскопических операциях на коленном суставе с возможностью быстрой и надежной выписки. Материалы и методы. Тридцать пациентов, запланированных на проведение артроскопических операций на коленном суставе, были распределены на 2 группы по 15 человек. В группе 1 применялась спинальная анестезия с использованием стандартной дозы (7,5 мг) гипербарического бупивакаина, в группе 2 — односторонняя спинальная анестезия с использованием малой дозы (5 мг) гипербарического бупивакаина. Проводилось изучение характеристики блока, частоты развития побочных явлений и возможности выписки. Результаты. Увеличивалась частота получения сенсорного блока на уровне T12 в группе 2. При этом не отмечалось получение сенсорного блока на уровне Т10–T8 на оперируемой стороне, также не было обнаружено развитие двустороннего сенсорного и моторного блока в группе 2. Не было выявлено развития гипотензии и брадикардии в обеих группах. Более быстрое восстановление возможности ходьбы (145,6 ± 21,7 в сравнении с 180,3 ± 24,7 мин, p

Background: TURP is the most common surgical intervention for patients with benign prostatic hyperplasia. Aims and Objectives: This prospective randomized study was planned to evaluate spinal anaesthesia (SA) versus saddle block with regard to haemodynamic parameters, ephedrine consumption, patient and surgeon satisfaction, perioperative complications in patients undergoing TURP. Materials and Methods: Eighty patients between the ages of 50-80 years with BPH, belonging to ASA grade I- III, prostatic volume between 50 - 80 cc were included in our study. Patients were randomly divided into two groups of 40 patients each. Patients in group SA (n=40) received spinal anaesthesia and the patients in group SBBI (n=40) were given saddle block with bladder instillation of local anaesthetic jelly for undergoing TURP. Results: There was more statistically significant fall in MAP in Group SA as compared to Group SBBI (p

Актуальность. Ежегодный рост количества хирургических вмешательств и широта физиологических воздействий нарушения сна в послеоперационном периоде делают проблему инсомнии актуальной для современной анестезиологии. Цель исследования: анализ распространенности послеоперационной инсомнии и факторов риска ее развития, связанных с методом анестезиологического обеспечения. Материалы и методы. Двести пациентов, перенесших ортопедическое или хирургическое вмешательство, были распределены на группы в зависимости от вида анестезии. Проводилась оценка качества сна, уровней боли, тревоги, депрессии, потребности в анальгетиках. Результаты. Общая частота развития послеоперационных нарушений составила 72,08 %, среди которых легкая инсомния достигала 42,64 %, инсомния средней тяжести — 18,78 % и тяжелая инсомния — 10,66 %. Распределение по группам составило: в группе общей анестезии (ОА) легкой инсомнии — 44,44 %, инсомнии средней тяжести — 19,75 % и тяжелой инсомнии — 12,35 %; в группе спинномозговой анестезии (СМА) легкой инсомнии — 40,34 %, инсомнии средней тяжести — 17,65 % и тяжелой инсомнии — 11,76 %. Разница между группами не достигла уровня статистической достоверности. В обеих группах выявлена связь инсомнии с выраженностью послеоперационной боли. В группе ОА — r = 0,437; в группе СМА — r = 0,513. Также в обеих группах наблюдалась положительная корреляция уровня тревожности (rОА = 0,341; rСМА = 0,312) и депрессии (rОА = 0,342; rСМА = 0,301). В группе CМА наблюдалась отрицательная корреляция развития инсомнии с послеоперационным использованием наркотических анальгетиков (r = –0,218), в группе ОА корреляция не достигла статистически значимого уровня (r = –0,165). Выводы. Инсомния является частым послеоперационным осложнением. Основными факторами, провоцирующими ее развитие, являются высокий уровень боли, тревожности и депрессии в послеоперационном периоде, использование опиоидных анальгетиков в схеме послеоперационного обезболивания. Региональные социокультурные особенности не имеют существенного влияния на факторы риска и тождественны для других исследованных популяций.

On the basis of revealed circulatory disorders in the extremity nonunion, the optimal type of preoperative pain management is long-term analgesia in the perioperative period. The quantitative indices of the rheovasography showed a significant decrease in the pulse blood filling of the affected lower extremity, which were caused by an increased tone of the vessels — arteries and veins of medium and small size. The expressed pain syndrome in the preoperative period could aggravate the vascular disorders, which is not a favorable factor in bone fusion. Therefore, the best option is to perform spinal anesthesia in combination with the introduction of dexketoprofen. There were no complications of treatment. Dynamics of indicators on the visual analogue scale testify to the high efficiency of anesthesia performed., С учетом выявленных нарушений кровообращения в конечности при несращении оптимальным видом пери­операционного обезболивания является долгосрочное обез­боливание в периоперационном периоде. Количественные показатели реовазограммы свидетельствовали о достоверном снижении пульсового кровенаполнения пораженной нижней конечности, которое было вызвано повышением тонуса сосудов — артерий и вен среднего и малого калибра. Выраженный болевой синдром в периоперационном периоде мог усугубить сосудистые нарушения, что является неблагоприятным фактором при сращивании костей. Поэтому оптимальным вариантом является проведение спинномозговой анестезии в комбинации с введением декскетопрофена. Осложнений лечения не выявлено. Динамика показателей визуально-аналоговой шкалы свидетельствует о высокой эффективности проведенного обезболивания., З огляду на виявлені порушення кровообігу в кінцівці при незрощенні оптимальним видом періопераційного знеболювання є довготривале знеболювання в періопераційному періоді. Кількісні показники реовазограми свідчили про вірогідне зниження пульсового кровонаповнення ураженої нижньої кінцівки, що було викликане підвищенням тонусу судин — артерій і вен середнього й малого калібру. Виражений больовий синдром у періопераційному періоді міг посилити судинні порушення, що є несприятливим фактором при зрощенні кісток. Тому оптимальним варіантом є проведення спинномозкової анестезії в комбінації з введенням декскетопрофену. Ускладнень лікування не виявлено. Динаміка показників візуально-аналогової шкали свідчить про високу ефективність проведеного знеболювання.

Objective: There is a relationship between ABO blood groups, which are part of the genetic phenotype, and various psychiatric diseases. Our primer aim in this study is to examine the relationship between ABO blood groups and preoperative anxiety (POA) levels in patients undergoing elective cesarean section. The secondary aim is to determine the relationship between POA levels and birth outcomes in pregnant women. Material and Method: A total of 132 patients with different ABO blood groups who were scheduled for elective cesarean section under spinal anesthesia between August 2020 and July 2021 at the Medical Faculty Hospital were included in this prospective observational study. State Anxiety Inventory scores (SAI) were used to assess preoperative anxiety in groups A, B, AB, and O. Birth outcomes (fetal birth weight, birth sex and APGAR scores at the 1st and 5th minutes) were recorded. Results: There were 55 people (41.7%) in the A blood group, 43 people (32.6%) in the O blood group, 25 people (18.9%) in the B blood group, 9 people (6.8%) in the AB blood group. A total of 73/132 (55.3%) patients with SAI score >40 were identified. There was no significant difference in mean SAI scores in A, B, AB and O blood groups (p=0.531). Fetal birth weight was found to be lower in patients with high SAI scores (p=0.044). Conclusion: There was no relationship between ABO blood groups and preoperative anxiety and birth outcomes in elective cesarean sections under spinal anesthesia, but low fetal birth weight was found in pregnant women with high anxiety. More studies with larger sample sizes in the future are needed to confirm the results of our study.

For 40 years, spinal anesthesia has made significant strides and is now a great rival to general anesthesia.

OBJECTIVE To correlate the measurements of pelvic organ quantification (POP-Q) score obtained preoperatively with Valsalva maneuver with POP-Q score obtained intraoperatively under anesthesia in the assessment of pelvic organ prolapse. METHODS A prospective observational study included 25 women attending gynecology outpatient department with symptomatic pelvic organ prolapse in Midnapore Medical College, India and planned for vaginal operative treatment between March 2019 and February 2020. The preoperative examination was performed in the outpatient department using the POP-Q system with Valsalva maneuver and final examination was performed under spinal anesthesia with mechanical traction. The correlation was performed using the preoperative and intraoperative measurements. RESULTS All intraoperative POP-Q measurements showed a significantly higher descent compared with preoperative measurements (mean difference Aa 0.72 cm, Ba 1.08 cm, C 1.66 cm, Ap 0.26 cm, Bp 1.6 cm, D 1.6 cm, Gh 0.6 cm,) except for Pb and Tvl. Among all nine measurements, the greatest difference between the preoperative and intraoperative values was observed for points C, D, and Bp. CONCLUSION Preoperative POP-Q scores significantly differed when assessed intraoperatively under spinal anesthesia with traction. The patient should be informed that the surgical plan may change depending on the intraoperative findings. Our study is an alert for both surgeons and patients.

The current pandemic has highlighted the need to protect both patients and medical staff. The increased use of regional anaesthesia as a primary anaesthetic modality for operations and other invasive procedures has limited the number of aerosol-generating procedures performed during general anaesthesia. Its use is further characterized by decreases in postoperative pain and length of hospitalization. This article provides an overview of regional anaesthetic techniques (peripheral nerve locks, epidural and spinal anaesthesia) and their uses during the COVID pandemic.

Introduction: Complications of surgery may lead the patient to experience ill and even death. One of the complications in the patient after surgery with spinal anesthesia is the incidence of hypothermia. Hypothermia can occur as a result of a combination of anesthesia and surgery that causes disturbance in body temperature regulation that can make decreasing body temperature. Method: This research uses a descriptive correlational method with a retrospective approach, with total sampling technique amount of 106 respondents, using a checklist sheet research instrument.Data analysis techniques spearman rank. Results: The characteristics of surgery patients with spinal anesthesia in the operating room of Yogyakarta "JIH" Hospital were mostly female, 87.9%, most of whom were adults 74.1%, the highest frequency of surgery with spinal anesthesia duration >2 hours 55.7% and had an incidence of hypothermia 54.7%. Correlational statistical analysis obtained a Cramer's value of 0.371, a correlation coefficient value of 0.348 with a probability value (p-value) of 0.000. Conclusion: There is a relationship between spinal anesthesia and hypothermia incidence among postoperative patients in the operating recovery room "JIH" Hospital Yogyakarta. The direction of the correlation is positive and closeness is sufficient.

the aim of current study: was Comparison of 1-and 2- minute sitting position versus immediately lying down on hemodynamic variables after spinal anesthesia with hyperbaric bupivacaine in elective cesarean section. Patients and methods: This study was performed after the approval of the Iraqi Council for Medical Specialization in anesthesia and intensive care, and after obtaining the consents from 90 pregnant women (at term) who were candidate for cesarean section with spinal anesthesia were recruited in this study. They were collected from “AL-Imamain AL-Kademain Medical City Teaching Hospital” (July 2017 – January 2018) , All patients were premedicated with 10mg IV metoclopramide and 50mg IV ranitidine , Base line blood pressure and the pulse rate were recorded initially before intervention , the Lumbar puncture was performed in the sitting position under full aseptic teqnique , For assessment of blood pressure and pulse rate, ten readings were taken at (3, 5, 10, 15, 20, 25, 30, 35,40and 60 min) using an automated noninvasive blood pressure. Pulse rate monitored by electrocardiogram and oximetry (SPO2). Results: Current study showed higher means of pulse rate than the other two groups especially at early times after anesthesia induction. On the other hand, both group A1 and A2 showed higher mean of systolic, diastolic and mean blood pressure than group B especially 3, 5, 10 and 15 minutes after anesthesia induction, so the variation of pulse rate over the time in the three groups. Group B had higher pulse rate Journal of University of Shanghai for Science and Technology ISSN: 1007-6735 Volume 23, Issue 9, September – 2021 Page-7882 than the other two groups at 3,5,10, 25 and 40 minutes with significant difference (P8 in all groups. Conclusions: This study revealed that the patient’s position is an important factor, which affects the frequency of Hypotension and the onset of sensory block , as well as Administration of spinal anesthesia for cesarean section. Based on the findings, keeping the parturient seated for 1 Or 2 minutes after spinal anesthesia, compared to immediately lying down, could decrease the frequency of hypotension.

Background: The best technique for transurethral resection of prostate (TURP) is regional anesthesia. The hypotension is the major complication following spinal anesthesia. The hemodynamic changes is less with saddle block than spinal block. Aim and Objective: To compare hemodynamic effect between the spinal block and saddle block in TURP. Patients and methods: 50 patients between 50-70 years old ASA I – II prepared for TURP, divided randomly in two groups 25 pt. in each group. Group A received spinal 10 mg of hyperbaric bupivacaine (2 ml of 0.5%), were group B received saddle block 10 mg of hyperbaric bupivacaine (2 ml of 0.5%). The blood pressure, oxygen saturation, heart rate measured and recorded subsequently. The hypotension treated by 100 mcg bolus of phenylephrine. Results: In our study there was statically significant difference (p < 0.05) between group A which received spinal anesthesia and group B which received saddle block in hemodynamic effect. In which the incidence of hypotension and vasopressor requirement more in group A. Conclusion: Under saddle block the TURP can safely performed with low risk of hypotension and less requirement of vasopressor.

Objective: Pentraxin-3 (PTX3) is a biomarker shown to correlate with the severity of infections. It is a good indicator of mortality and is useful in monitoring treatment success. However, there is inadequate information about the factors affecting PTX3 levels. This study aimed to investigate the effects of different anaesthesia types on serum PTX3 levels. Materials/Patients and Methods: Serum PTX3 levels were obtained from patients who were under general anaesthesia (GA) and spinal anaesthesia (SA) for a caesarean section (C-section). Blood Samples were collected preoperatively at 6 h and 24 h postoperatively. Biomarkers such as C-reactive protein, white blood cells, neutrophils and lymphocytes were also assessed as biomarkers. Results: No difference was found in the preoperative serum PTX3 levels among the participants (p > 0.05). A significant increase was observed when the preoperative PTX3 levels (0.16 ng/mL) were compared with the postoperative levels at 6 h (0.25 ng/mL) and 24 h (0.54 ng/mL) in the GA group. No significant change was found in the PTX3 levels at 0–6–24 h measurements in the SA group. Nevertheless, the GA group was found to be significantly higher than the SA group at 6 h and 24 h postoperatively (p < 0.05). Additionally, No correlation was observed between PTX3 levels and other biomarkers. Conclusions: This study showed that when coupled with C-section, GA increased the PTX3 levels postoperatively compared with the PTX3 levels during the preoperative period. No significant change was observed with SA. The PTX-3 levels should be considered to increase in association with GA in suspected infectious and inflammatory cases. Therefore, regional anaesthesia should be preferred.

BACKGROUND Spinal anesthesia is commonly used for various surgeries. While many complications occur after induction of spinal anesthesia, involuntary movement is an extremely rare complication. CASE SUMMARY Herein, we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics. This patient had undergone metal implant removal surgery in both the lower extremities; 7 h after intrathecal hyperbaric bupivacaine administration, involuntary raising of the left leg began to occur every 2 min. When the movement disorder appeared, the patient was conscious and cooperative. No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started; moreover, the patient's motor and sensory assessments were normal. The symptom gradually subsided. Twelve hours after the symptom first occurred, its frequency decreased to approximately once every three hours. Two days postoperatively, the symptoms had completely disappeared without intervention. CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause, such as electrolyte imbalance or epilepsy, since immediate action may be required for treatment. Furthermore, it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.

Background and objectives: Abdominal Hysterectomy (AH) is associated with significant inflammatory response and can result in moderate to severe postoperative pain. This study aimed to evaluate the efficacy of magnesium infusion in reducing postoperative pain and analgesic consumption after AH under spinal anesthesia with Intrathecal Morphine (ITM). Method: Eighty-six patients were included in this clinical, controlled, randomized, double-blind study. Patients received in Group Mg, MgSO4 50 mg kg−1 for 15 minutes followed by 15 mg kg−1 h−1 until the end of the surgery; and in Group C, (control) the same volume of isotonic saline. Both groups received 100 µg of ITM. All patients received dipyrone + ketoprofen intraoperatively and postoperatively, and dexamethasone intraoperatively only. We evaluated the intensity of pain, tramadol consumption, and adverse events 24 hours postoperatively. Results: Serum magnesium concentrations were higher in Group Mg at the end, and one hour after the operation (p = 0.000). Postoperative pain scores were reduced in Group Mg at 6 hours at rest and on movement (p < 0.05). Tramadol consumption did not show a statistically significant difference between Group Mg and Group C (15.5 ± 36.6 mg and 29.2 ± 67.8 mg respectively, p = 0.53). Hemodynamic variables, the incidence of pruritus, nausea, and vomiting were similar in the two groups. Conclusion: Infusion of MgSO4 during AH undergoing spinal anesthesia with ITM reduced at 6 hours at rest and on movement. More studies should be performed to evaluate the potential antinociceptive effect of MgSO4 in scenarios where a multimodal analgesia approach was employed.

To describe the clinical characteristics and the frequency of maternal, fetal and neonatal complications in accordance with the neuraxial anesthesia (NA) technique in women with twin-totwin transfusion syndrome (TTTS) treated with laser photocoagulation.Descriptive retrospective cohort study of pregnant patients with TTTS treated with laser photocoagulation under NA at Fundación Valle del Lili, Cali (Colombia), between 2013-2017. Patients with Quintero stage V TTTS were excluded. The protocol was approved by the institutional ethics committee.Of the participants, 32 met the inclusion and exclusion criteria. The study population consisted of young, multiparous women. Urgent interventions were performed in 87.5% of cases; 43.7% were Quintero stage III and epidural anesthesia was used in 56.2% of the women. Maternal hemodynamic variables were similar, in accordance with the timing of surgery and the neuraxial technique used. Sustained hypotension occurred in 65.6% of the pregnant women and 9.3% developed pulmonary edema. Pre-term delivery occurred in 65.6% of the patients and 18.7% had premature rupture of membranes. There were 14 fetal demises and five neonatal deaths. There were no cases of maternal mortality.In patients with TTTS requiring laser photocoagulation, the use of epidural, spinal or combined anesthesia is likely associated with similar maternal hemodynamic variables at the time of surgery. Practitioners providing care to these pregnant women must be aware of the frequent occurrence of maternal, fetal and neonatal complications. Prospective studies to assess the safety and effectiveness of the different neuraxial anesthesia techniques in patients with TTTS are required.describir las características clínicas y la frecuencia de complicaciones maternas, fetales y neonatales, según técnica de anestesia neuroaxial (AN) en mujeres con síndrome de transfusión feto-fetal (STFF) tratadas con fotocoagulación láser (FL).estudio de cohorte retrospectiva descriptivo. Se incluyeron gestantes con STFF tratadas con FL y AN en la Fundación Valle del Lili, Cali (Colombia) entre 2013-2017. Se excluyeron pacientes con STFF estadio-V de Quintero. Se usó estadística descriptiva. El protocolo fue aprobado por el Comité de Ética de la institución.32 participantes cumplieron con los criterios de inclusión y de exclusión. La población estuvo constituida por mujeres jóvenes, multíparas. En el 87,5% de los casos se realizó intervención de urgencia. El 43,7% presentaba el estadio-III de Quintero y en el 56,2 % de las gestantes se utilizó anestesia epidural. Las variables hemodinámicas maternas exhibieron un comportamiento similar, acorde al momento de la cirugía y la técnica neuoraxial implementada. El 65,6 % de las gestantes presentó hipotensión sostenida y el 9,3 % desarrolló edema pulmonar. El 65,6 % de las pacientes experimentó parto pretérmino y el 18,7 % ruptura prematura de membranas. Se registraron 14 muertes fetales y cinco neonatales. No se registraron casos de mortalidad materna.en pacientes con STFF que requieren FL, el uso de la anestesia epidural, espinal o combinada probablemente se asocia con un comportamiento similar al de las variables hemodinámicas maternas, durante los momentos de la cirugía. Los profesionales que brindan atención a estas gestantes deben estar alerta ante la frecuente aparición de complicaciones maternas, fetales y neonatales. Se requieren estudios prospectivos que evalúen la seguridad y la efectividad de las diferentes técnicas de anestesia neuroaxial en pacientes con STFF.

Aim: It is a known fact that the prone position has curative effects on respiratory parameters. To evaluate the effect of prone position on respiratory status in lumbar discectomy operations with spinal anesthesia using integrated pulmonary index (IPI), which is a novel tool that incorporates different respiratory parameters. Methods: A total of 40 patients were enrolled in this prospective, observational study between December 2020 and February 2021. The IPI parameters included end-tidal carbon dioxide, respiratory rate, pulse rate and oxygen saturation recorded at the time of admission to the operating room, at ten minutes after spinal anesthesia administration, at ten minutes following prone positioning and ten minutes after the end of the operation. Results: The mean end-tidal carbon dioxide value significantly increased after prone positioning and at the end of the operation. The mean oxygen saturation similarly increased at the end of the operation. There was a moderately significant correlation between the mean IPI scores after prone positioning and ten minutes after the administration of spinal anesthesia. Conclusion: Prone position did not show any negative effect on respiratory mechanics as obtained from IPI, while it increased oxygenation. IPI may be a valuable tool in clinical practice to monitor respiratory mechanics in the prone position in patients undergoing lumbar disc surgeries.

Background Midazolam is frequently used for sedation during spinal anesthesia. However, external environmental factors, such as bright surgical lights, may hamper patient relaxation, which may lead to an increase in the dose of midazolam required and the likelihood of adverse drug effects. We investigated whether using an eye mask to block the external environment could reduce midazolam requirements during spinal anesthesia. Methods Participants aged 18–‒80 years, scheduled for elective surgery under spinal anesthesia, were randomly divided into a masked group (wearing eye masks during surgery, n = 20) and a control group (no mask, n = 18). The sedation level was assessed using a modified Observer Assessment of Alertness and Sedation (MOAA/S) scale. Midazolam (1 mg) was incrementally administered every 5 min until moderate sedation (MOAA/S score of 3) was achieved. The bispectral index (BIS) was monitored, and the onset and maintenance times of a BIS Results The two groups had similar demographic characteristics. The midazolam requirements were significantly lower in the masked group than in the control group (2.8 mg vs. 3.7 mg, P = 0.024). However, the onset and maintenance times for a BIS Conclusions Blocking the external environment with an eye mask during spinal anesthesia can reduce the requirement for sedatives, such as midazolam. Trial registration The trial was retrospectively registered with the Clinical Research Information Service (No. KCT0005528, 15/10/2020) entitled “Can we reduce an amount of sleeping pills just by blocking light?”.

Purpose: Post-anesthesia shivering is one of the most common problems after surgery and may lead to multiple complications such as hypoxemia, lactate acidosis and catecholamine release. The purpose of this study was to compare the effects of intravenous meperidine and ondansetron on postoperative shivering in patients having an elective cesarean section under spinal anesthesia. Design: Cross-sectional study Methods: In this cross-sectional study, 105 patients with the age of 18-45 years and ASA class I-II undergoing elective cesarean section were randomly assigned into three groups. Group O was administered 8mg ondansetron, group M patients were given 0.4mg/kg meperidine and group P was placebo that was administered with 2cc of saline intravenously after the delivery. The incidence and intensity of shivering and postoperative nausea was monitored and recorded by the trained nurse. The data obtained was analyzed using SPSS v18. Results: All three groups (n=35) had no significant difference in terms of age, weight and time of spinal anesthesia. Postoperative shivering was reported in 4 patients (11.4%) in group A and 3 patients (8.6%) in group B and in 14 patients (40%) in group C. The incidence of postoperative shivering was significantly less in groups A and B as compared to the placebo, p=0.03. The intensity of shivering was greater in group C as compared to groups A and B, p=0.01. The incidence and intensity of postoperative nausea was significantly less in group A, p=0.03, p Conclusion: 8mg ondansetron and 0.4 mg/kg of meperidine are equally effective in managing postoperative shivering; however, ondansetron has an additional effect of reducing the incidence of postoperative nausea among patients undergoing caesarean section with spinal anesthesia.