Cerebrospinal Fluid Cytology in Patients Undergoing Combined Spinal Epidural versus Spinal Anaesthesia without an Introducer

Sharma, Bimla; Gupta, Suresh; Jain, Neeraj; Handoo, Anil; Sood, Jayashree

doi:10.1177/0310057x1103900518

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…A tissue coring phenomenon may also be responsible for spreading cancer cells from extramedullary blast infiltrates (skin, ligaments, or muscles) to the epidural or dural spaces when advancing the needle ( Table 1 ) [ 8 , 9 , 18 , 20 , 21 ]. This last issue persists whether or not an introducer is used [ 22 ]. Hence, many authors believe that, in the presence of ≥5% of circulating blasts, general anesthesia is the safer choice for cesarean delivery [ 11 , 18 ].…”

Section: Commentsmentioning

confidence: 99%

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Rebahi

Sliman

Adib

2018

Case Reports in Obstetrics and Gynecology

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Background Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes. Case Report A 37-year-old pregnant woman, gravida 2, para 2, with a previous cesarean section in 2011, presented to the obstetric unit. Her medical past revealed that she is a newly diagnosed patient with CML managed by TKI during her preconception period. Due to the perilous use of TKI during her pregnancy, a switch to interferon-α administration was adopted. But after the completion of 36 weeks of gestation, disease progression (relapse with blast crisis), attested by biological worsening, a white blood cell count = 245000/mm3 with 32% blasts in the peripheral blood, urged the medical team to opt for cesarean delivery. She underwent general endotracheal anesthesia without any perioperative incidents and gave birth to a healthy newborn. Ten days later, the patient was started on TKI. Discussion Although data on this specific and challenging situation are limited, this case highlights the difficulties encountered by the anesthesiologists when choosing the accurate anesthetic strategy and how important it is to weigh the risks and benefits inherent to each technique. Above all, taking into consideration the possible central nervous system (CNS) contamination by circulating blast cells when performing spinal or epidural approach is primordial. This potential adverse event (CNS blast crisis) is extremely scarce but it is responsible for high rates of morbidity and mortality.

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Section: Commentsmentioning

confidence: 99%

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Rebahi

Sliman

Adib

2018

Case Reports in Obstetrics and Gynecology

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“…As a result, it can increase the patient's acceptance of regional anaesthetic technique. 6 Ketofol, a combination of the drugs ketamine and propofol has good analgesic and sedative properties in addition to fast onset of action. Sedation with Ketofol decreases the side effects of both ketamine and propofol as they potentiate each other and thus smaller doses are used.…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Effects of Ketofol and Fenofol as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

et al. 2023

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Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: This study compares Ketofol (Ketamine+Propofol) and Fenofol (Fentanyl+ Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period of January 2022 to June 2022. Patients were randomly allocated to one of two groups: Ketofol group (Group KP, n=30), who received Ketofol in a single dose of 0.5mg/kg (Ketamine- 0.5mg/kg+Propofol-0.5mg/kg) and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Ketofol or Fenofol to closure of eye lids and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups (P>0.05). Time of onset of sedation was comparable between the two groups (P>0.05). Duration of sedation was significantly less in Fenofol group (p value=<0.001). Significant percentage of patients required oxygen supplementation after sedation with Fenofol due to hypoventilation (66.66% vs 10%, p value <0.001). Incidence of nausea and vomiting was significantly more with Fenofol (46.66% vs 10%, p value >0.001). Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly more with Ketofol than Fenofol which is beneficial for the patient in single dose technique for sedation. Fenofol was associated with significantly high incidence of nausea, vomiting. Moreover, significantly higher percentage of patients required O2 supplementation due to hypoventilation during sedation with Fenofol. Thus it is recommended that Ketofol is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section. J Rang Med Col. March 2023; Vol. 8, No. 2:20-26

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“…As a result, it can increase the patient's acceptance of regional anaesthetic technique. 6 Fentanyl is a potent narcotic analgesic with rapid onset and short duration of effect following a single intravenous dose. It provides analgesia with sedation but it has the propensity of respiratory depression when used in higher doses.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Effects of Fentanyl and Fenofol as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Karim¹,

Akram²,

Rashid³

et al. 2023

Khwaja Yunus Ali Medical College Journal

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Background: Regional anaesthesia has become an important anaesthetic technique now a days. Pharmacologically induced tranquility improves acceptance of regional technique. Objective: To compare Fentanyl and Fenofol (Fentanyl+Propofol) in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal(subarachnoid) anaesthesia. Materials and Methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I or II patients between age 20-40 years undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Fenofol group (Group FP, n=30), who received Fenofol in a single dose of Fentanyl-0.5mcg/kg+Propofol-0.5mg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (intravenous) injection of Fentanyl or Fenofol to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 ( patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’ Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P>0.05). Time of onset of sedation and the arousal time i.e. duration of sedation was comparable between the two groups (P>0.05). Significant percentage of patients required O2 supplementation in Fenofol group due to hypoventilation (66.66% vs 10%, P<0.001). Pain in arm during drug administration was significantly more with Fenofol (46.66% vs 6.66%, P<0.001). Conclusion: As a significantly higher percentage of patients required O2 supplementation during sedation with Fenofol and pain in arm during drug administration was significantly more in Fenofol group, it is recommended that Fentanyl is a better choice than Fenofol for sedation in single dose technique during subarachnoid block for Caesarean section. KYAMC Journal Vol. 13, No. 04, January 2023: 234-239

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Cerebrospinal Fluid Cytology in Patients Undergoing Combined Spinal Epidural versus Spinal Anaesthesia without an Introducer

Cited by 6 publications

References 20 publications

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Comparison Between Effects of Ketofol and Fenofol as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Comparison between Effects of Fentanyl and Fenofol as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

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