A general anesthetic for Cesarean delivery should be based on the following principles: preventing aspiration, anticipating a difficult intubation, maintaining oxygenation, insuring materno-feto-placental perfusion and maintaining a deep level of anesthesia to avoid intraoperative awareness while minimizing neonatal effects.
Purpose We investigated the effects of a combination of low-dose fentanyl-midazolam premedication on the speed of inhaled induction with sevoflurane and ProSeal TM laryngeal mask airway (PLMA) insertion conditions. Methods Eighty adult patients undergoing elective surgery were randomized in a double-blind fashion to receive either a normal saline placebo (Group PLAC) or a fentanyl 0.6 lg Á kg -1 and midazolam 9 lg Á kg -1 premedication (Group FM) 5 min before tidal volume sevoflurane 8%/O 2 induction. Anxiety levels, times to loss of eyelash reflex (LER) and PLMA insertion, and cardiorespiratory data were recorded. Results Times to LER (Group PLAC: 66 ± 34 sec vs Group FM: 47 ± 18 sec, P = 0.0027, difference = 19 sec: 95% confidence interval [CI] 7-31 sec) and to PLMA insertion (Group PLAC: 186 ± 80 sec vs Group FM: 119 ± 44 sec, P \ 0.0001, difference = 68 sec: 95% CI 39-97 sec) were shorter following FM. After PLMA insertion, end-tidal sevoflurane concentration (EtSevo) was lower and end-tidal CO 2 (EtCO 2 ) was higher following FM. Respiratory rate (RR) was lower with FM, but there was no difference regarding tidal volume. Adverse events, such as movements and apnea, occurred more often in Group PLAC. Systolic blood pressure (SBP) and heart rate (HR) during induction were both lower with FM. Anxiety level after premedication was lower following FM administration. All participants remembered the face mask being applied in Group PLAC vs 69% in Group FM, P \ 0.0001. Conclusion Administration of a low-dose fentanylmidazolam combination prior to sevoflurane induction decreases time to LER and allows for more rapid and less eventful PLMA insertion. Both SBP and HR were lower when premedication was administered. Patients receiving premedication were less anxious and less likely to remember the face mask. However, premedication was associated with a lower RR and increased EtCO 2 values following PLMA insertion, in spite of lower EtSevo concentrations. (ClinicalTrials.gov ID NCT00723164).
RésuméObjectif Nous avons examine´les effets d'une combinaison de fentanyl -midazolam a`faible dose en pre´me´dication sur la vitesse d'une induction par inhalation de se´voflurane et sur les conditions d'insertion du masque larynge´Pro-Seal TM (PLMA). Méthode Quatre-vingts patients adultes subissant une chirurgie non urgente ont e´te´randomise´s en double aveugle a`recevoir soit un placebo de solution sale´e (groupe PLAC) ou une pre´me´dication compose´e de fentanyl 0,6 lgÁkg -1 et midazolam 9 lgÁkg -1 (groupe FM) cinq minutes avant l'induction avec du se´voflurane 8 %/O 2 av olume courant. Les niveaux d'anxie´te´, le temps jusqu'a`la perte du re´flexe ciliaire (PRC) et l'insertion du PLMA ainsi que les donne´es cardiorespiratoires ont e´te´enregistre´es. Résultats Les temps jusqu'a`PRC (groupe PLAC : 66 ± 34 secondes vs groupe FM : 47 ± 18 secondes, P = 0,0027, diffe´rence = 19 secondes : intervalle de confiance [IC] 95 % 7-31 secondes) et jusqu'a`insertion du PLMA (groupe PLAC : 186 ± 80 secondes vs groupe FM : 119 ± 44 s...
(Can J Anesth/J Can Anesth. 2019;66:762–771)
Neuraxial anesthesia is preferable for cesarean deliveries (CDs), as it allows mothers to be awake and avoids the associated risks of general anesthesia. However, an estimated 53% of patients under neuraxial anesthesia suffer from shivering. Uncontrolled shivering intervenes with vital sign monitoring, causes physiological stress, and affects a patient’s satisfaction and comfort. The most common pharmacological treatment for shivering is meperidine (a synthetic opioid). However, as this drug becomes increasingly scarce in North American hospitals, an effective alternative agent is desired. Dexmedetomidine is an alternative treatment for shivering and can alleviate shivering while avoiding side effects associated with opioids. The aim of this study was to test whether a single bolus of 30 μg intravenous (IV) dexmedetomidine, administered 5 minutes after childbirth, could reduce shivering during CD under neuraxial anesthesia.
Post-Dural Puncture Headache is a common complication for patients with dural puncture and if untreated, it can result in complications such as subdural hematoma and seizures. The aim of this case report is to present a case of headache after corrective spinal surgery for idiopathic scoliosis resolved with a BGON block.
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