Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria

Etta, Otu; Umeh, Kingsley U; Akpan, S

doi:10.1080/22201181.2016.1168612

Cited by 5 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 Similar observations have been reported by other researchers. 2,3,4 The infrequent use of thoracic epidural anaesthesia for oncologic breast surgeries in our environment may be attributed to fear of potential complications of thoracic epidural, which include spinal injury, epidural haemetoma and abscess, as well as postdural puncture headache. However, with experience and due precautions, these complications are extremely rare.…”

Section: Discussionmentioning

confidence: 99%

Thoracic epidural for modified radical mastectomy in a high-risk patient

Etta¹,

Udeme²

2017

Mal. Med. J

View full text Add to dashboard Cite

A 52-year-old woman was scheduled for modified radical mastectomy on account of advanced carcinoma of the right breast. The patient was a known hypertensive and diabetic, diagnosed 3 years prior to presentation and also a known asthmatic, diagnosed at childhood. She was being managed with lisinopril, amlodipine, and Mixtard insulin injection. However, she was not compliant on her medications. Three days before the scheduled surgery, her blood pressure (BP) was 170/110 mmHg, and fasting blood sugar was 10.8 mmol/L. Additionally, she suffered an asthmatic attack 2 days prior to surgery. Her regular doses of antihypertensive drugs and insulin(42 IU/day) were increased, while salbutamol inhaler at 2 puffs as required, along with aminophylline and prednisolone tablets were used to manage the mild asthmatic attack. On the evening prior to surgery her vital signs were as follows: pulse rate (PR) 88/minute, BP 130/70 mmHg, respiratory rate (RR) 20/minute and temperature 36.8°C. Her chest was clinically clear and other examination findings were normal. Her packed cell volume (PCV) was 36%. Electrocardiogram (ECG) and chest x-ray findings were suggestive of left ventricular hypertrophy. Other investigation results, including electrolyte, urea, and creatinine were within normal limits. Based on the comorbid conditions, she was assigned class to III of the American Society of Anesthesiologists (ASA) classification scheme. She was counselled for thoracic epidural anaesthesia, as general anaesthesia was considered a more risky alternative, and consent for the procedure was obtained. On the morning of surgery her fasting blood sugar was 8.9 mmol/L and 500 mL of 5% dextrose water infusion, into which 5 mmol of potassium and 5 IU of soluble insulin were added, was set up to run at 100 mL/hour. Additionally, the morning doses of her regular antihypertensive medications were given. In theatre, a multiparameter monitor was attached to the patient, measuring peripheral capillary oxygen saturation and noninvasive BP. Baseline values were as follows: PR 84/ minute, BP 110/70 mmHg, and SpO 2 96%. In the sitting position, a midline thoracic epidural was performed at the T4/T5 interspinous space using a size 18G Tuohy epidural needle and loss of resistance to air technique. The skin epidural depth was 5 cm, and 4 cm of the epidural catheter was left in situ in the epidural space in the cephalad direction, and the catheter adhered to the back with adhesive tape. After a test dose of 3 mL of 1% lidocaine with adrenaline, a loading dose of 7 mL of 2% lidocaine with adrenaline 1:200,000 was given in 4 mL and 3 mL aliquots at 5-minute intervals. The epidural catheter was connected to a syringe pump for continuous infusion of 2% lidocaine-adrenaline at 4 mL/hour. Five minutes later, a sensory block height of T1 to T10 was achieved bilaterally, and the surgery commenced. The breast tissues and tumour were excised en bloc, including fibrofatty tissues of the medial aspect of the right axilla. Oxygen was given via face mask at 4 L/minute througho...

show abstract

Section: Discussionmentioning

confidence: 99%

Thoracic epidural for modified radical mastectomy in a high-risk patient

Etta¹,

Udeme²

2017

Mal. Med. J

View full text Add to dashboard Cite

show abstract

“…Further data derived from randomized controlled trials including a larger number of patients are needed to examine this approach in depth (e.g., to compare potential advantages, in terms of ICU admissions and anesthesiological complications to laparoscopy under general anesthesia). Unfortunately, only a few case reports and even fewer case series deepening the influence of RA on the outcomes after acute care surgery are available [ 15 – 18 ]. As known, RA techniques slightly differ from institution to institution [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Awake Major Abdominal Surgeries in the COVID-19 Era

Romanzi

Boleso

Palma

et al. 2021

Pain Research and Management

View full text Add to dashboard Cite

Background. During the outbreak of coronavirus disease 2019 (COVID-19), allocating intensive care beds to patients needing acute care surgery became a very difficult task. Moreover, since general anesthesia is an aerosol-generating procedure, its use became controversial. This strongly restricted therapeutic strategies. Here, we report a series of undeferrable surgical cases treated with awake surgery under neuraxial anesthesia. Contextual benefits of this approach are deepened. Methods. During the first pandemic surge, thirteen patients (5 men and 8 women) with a mean age of 80 years, needing undelayable surgery due to abdominal emergencies, underwent awake open surgery at our Hospital. Prior to surgery, all patients underwent nasopharyngeal swab tests for COVID-19 diagnosis. In all cases, regional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain intensities have been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. Postoperative course has been examined. Results. The mean operative time was 87 minutes (minimum 60 minutes; maximum 165 minutes). In one case, conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien–Dindo ≥3) occurred. Early readmission after surgery never occurred. All nasopharyngeal swabs resulted negative. Conclusions. In our experience, awake laparotomy under regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. This approach allowed prevention of the need of postoperative intensive monitoring during the COVID-19 era. In such a peculiar time, we believe it could become part of an ICU-preserving strategy and could limit viral transmission inside theatres.

show abstract

“…Unfortunately, only a few case reports and even fewer case series deepening the influence of RA on the outcomes after acute care surgery were available. [16][17][18]…”

Section: Discussionmentioning

confidence: 99%

Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective

2021

View full text Add to dashboard Cite

In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.

show abstract

Thoracic epidural anaesthesia for major abdominal surgeries: experience in private hospital setting in Uyo, South-South Nigeria

Cited by 5 publications

References 13 publications

Thoracic epidural for modified radical mastectomy in a high-risk patient

Thoracic epidural for modified radical mastectomy in a high-risk patient

Awake Major Abdominal Surgeries in the COVID-19 Era

Outcome of major abdominal surgeries in COVID-19 positive patients with awake anaesthesia: surgeons’ perspective

Contact Info

Product

Resources

About