Spinal Anesthesia From the Surgeon's Standpoint

Scarborough, Robert A.

doi:10.1001/jama.1958.03000100026005

Cited by 13 publications

(3 citation statements)

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“…Spinal anesthesia provides uniform muscle relaxation, allowing the surgeon to perform laparoscopic procedures with lower intraabdominal pressure, typically 8-10 mm Hg, in non-obese patients [20]. The level of muscle relaxation achieved with spinal anesthesia cannot be attained in general anesthesia, even with the use of relaxant drugs, without undesirable depression of respiratory and circulatory functions [21]. Spinal anesthesia also gives good analgesia, reduces the need for muscle relaxants, and minimizes opioid requirements.…”

Section: Case Descriptionmentioning

confidence: 99%

Untitled

2024

J. Med. Chem. Sci.

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Introduction: Quick and smooth recovery after bariatric surgery for morbidly obese patients may pose a challenge to anesthesiologists, especially if there is any cardiac comorbidity. The addition of spinal anesthesia besides general anesthesia is a strategy that can be considered in this procedure. Case description: The 27 y.o. woman with a BMI of 53,8 kg/m 2 , atrial septal defect, and arrhythmogenic right ventricular dysplasia planned for bariatric surgery. The patient received preoxygenation for 24 hours before the day of surgery. After standard bedside monitoring for surgery had been applied, spinal anesthesia was administered at lumbal level L1-L2. General anesthesia was conducted after confirmation of a successful neuraxial block. Modifications of the surgical technique include low-flow CO2 insufflation. An episode of hypotension occurred once during the procedure and has been treated successfully with a 10 mg ephedrine bolus. Ventricle extrasystole appeared several times, but resolved with increasing oxygen fraction. Before extubation, infiltration of bupivacaine was done on a surgical wound. Paracetamol was intravenously administered for analgesia post-surgery. The patient was content with the anesthesia management and returned home without any complications. Discussion: A combination of anesthetic modalities may provide good abdominal relaxation, reduce the intraabdominal pressure during pneumoperitoneum, and reduce the use of muscle relaxants and opioids, which is important to gain optimal results in morbidly obese patients. Conclusions: General anesthesia is widely used for laparoscopic bariatric surgery. The addition of spinal anesthesia in morbidly obese simple left-toright atrial septal defect patients is still safe and may be a good alternative technique in selected cases.

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Section: Case Descriptionmentioning

confidence: 99%

Untitled

2024

J. Med. Chem. Sci.

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“…Spinal anaesthesia offers the advantage of targeted pain relief, a lower incidence of respiratory complications, and a reduced risk of confusion or cognitive dysfunction, which can be particularly advantageous in older patients with pre-existing medical conditions [4]. Furthermore, it allows for early postoperative mobilization, promoting faster recovery and shorter hospital stays [4].…”

Section: Of 12mentioning

confidence: 99%

Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study

Al-Husinat,

Al Sharie,

Araydah

et al. 2023

JPM

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Background: The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality. Methods: This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management. Results: Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer’s (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5–4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1–5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2–12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0–6.3; p < 0.001) were all significant predictors of mortality. Conclusions: This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.

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“…Refinements in the solutions themselves and in the techniques of administration have been responsible for a reduced frequency of complications (Swerdlow 1980). The incidence of major complications ranges from none in 78 000 cases (Scarborough 1958) to 0.16% in 65677 cases (Sadove et al 1961). No permanent neurologic sequela was reported in a series of over 500000 spinal anesthetics reviewed by Lund and Cwik (1968).…”

Section: Etiology and Frequency Modem Usage Of Localmentioning

confidence: 99%