Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2002
Case ReportsDissociative mental state in a patient with an intrathecal drug administration system.
We describe a patient with acute mental status changes, which resolved on removal of medication from the reservoir of a Synchromed intrathecal pump. This report highlights the potential adverse mental affects of chronic spinal infusions for pain therapy and discusses pitfalls in toxicology analysis using immunoassay.
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Anesthesia and analgesia · Oct 2002
Randomized Controlled Trial Clinical TrialThe median approach to transsacral epidural block.
Transsacral epidural block may be useful for surgery or cancer pain affecting the rectal, anal, or urethral region. The procedure through the dorsal sacral foramen is difficult because of the long insertion route. We investigated whether the transsacral epidural block could be simplified by using a median approach instead of a lateral approach through the foramen. Thirty patients for transurethral resection of bladder tumor had a catheter placed 5 cm cephalad at S2-3 (15 patients) or caudal (15 patients) epidural space using a 19-gauge Tuohy needle by the median approach. Lidocaine 2% 15 mL was administered for anesthesia. Anesthesia level (sensory block to cold), hemodynamics, and side effects were compared between the two approaches. The success rate of anesthesia was 87% for transurethral resection of bladder tumor (proximal anesthesia level higher than T10) and 100% for the sacral region (S1-5) in both groups. The highest level of anesthesia (median, T8 in the S2-3 group and T9 in the caudal group) was obtained in 20 min in both groups. No side effects were observed. We conclude that the median transsacral epidural approach is technically feasible in adults and presents an alternative to caudal block. ⋯ The median approach to transsacral epidural block has been described in children. We found that it is technically feasible in adults and presents an alternative to caudal block for procedures on the rectal, anal, or urethral region.
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Anesthesia and analgesia · Oct 2002
Randomized Controlled Trial Clinical TrialCapsicum plaster at the korean hand acupuncture point reduces postoperative nausea and vomiting after abdominal hysterectomy.
Postoperative nausea and vomiting (PONV) are still common and distressing problems after general anesthesia, especially in patients undergoing abdominal hysterectomy. We studied a nonpharmacological therapy of PONV-capsicum plaster (PAS)-at either the Korean hand acupuncture point K-D2 or the Chinese acupuncture point Pericardium 6 (P6) of both hands. One-hundred-sixty healthy patients were included in a randomized, double-blinded study: 60 patients were in the control group, 50 patients were in the K-D2 group, and 50 patients were in the P6 group. PAS was applied at the K-D2 point in the K-D2 group and at the P6 point in the P6 group, whereas in the control group, an inactive tape was fixed at the K-D2 point of both hands. The PAS was applied before the induction of anesthesia and removed at 8 h after surgery. The incidence of PONV and the need for rescue medication were evaluated at predetermined time intervals. In the treatment group, the incidence of vomiting was significantly less (22% for the K-D2 group and 26% for the P6 group) than in the control group (56.7%) at 24 h after surgery (P < 0.001). The need for rescue antiemetics was significantly less in the treatment groups compared with the control group (P < 0.001). We conclude that PAS at the Korean hand acupuncture point K-D2 was an effective method for reducing PONV, as was PAS at the P6 acupoint, after abdominal hysterectomy. ⋯ Capsicum plaster at either the Korean hand acupuncture point K-D2 or the Pericardium 6 acupoint reduces postoperative nausea and vomiting in patients undergoing abdominal hysterectomy.
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Anesthesia and analgesia · Oct 2002
Case ReportsThe breaking of an intrathecally-placed epidural catheter during extraction.
Misplacement of an epidural catheter into the subarachnoid space is a recognized complication. However, breakage of an intrathecal epidural catheter during removal presents a dilemma. Appropriate imaging, a neurosurgical consultation, and aggressive surgical exploration and extraction of the retained piece are warranted, even in the asymptomatic patient.