MyMedR

Whittle ED

Malaya Medical Journal, 1911;9:15-20.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Low dose unilateral spinal anaesthesia for lower limb amputation in critically ill patients

Chuah KH, Thong CL, Krshnan H, Chan L

Med J Malaysia, 2007 Mar;62(1):81-2.

Patients with poorly controlled diabetes mellitus have an increased risk of lower limb infection and gangrene. In Malaysia, they frequently present late and are often in septic shock with multi-organ dysfunction. We report on two patients who presented for lower limb amputation in a desperate attempt to control sepsis and save their lives. Both patients were classified as ASA 5. Both patients had successfully undergone surgery under low dose unilateral spinal anaesthesia. The anaesthetic management of these critically ill patients in view of limited resources is discussed.

Matched MeSH terms: Anesthesia, Spinal/methods*

Fulltext Spinal analgesia and headache at Penang General Hospital

Inbasegaram K, Yong BH

Med J Malaysia, 1985 Sep;40(3):233-8.

PMID: 3842718

One hundred (100) consecutive patients who underwent spinal analgesia for surgical and orthopaedic operations were studied. Postural headache occurred in 9% of patients, the majority in those cases where large bore (l8G to 21G) needless were used. No other neurological complications were encountered. Conservative measures provided some relief of the headache. Epidural blood patch was found to be effective.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Temporary cardiopulmonary bypass and isolated lung ventilation for tracheal stenosis and reconstruction

Chiu CL, Teh BT, Wang CY

Br J Anaesth, 2003 Nov;91(5):742-4.

PMID: 14570801

A 27-yr-old lady with a past history of prolonged ventilation presented with worsening respiratory distress caused by tracheal stenosis. She required urgent tracheal resection and reconstruction. Because of the risk of an acute respiratory obstruction, spinal anaesthesia was used to establish cardiopulmonary bypass by cannulating the femoral artery and femoral vein. Adequate gas exchange was possible with full flow rate. Thoracotomy was then carried out to mobilize the left main bronchus. After successfully securing an airway by intubation of the left main bronchus, cardiopulmonary bypass was discontinued and tracheal resection and anastomosis was done under conventional one lung anaesthesia.

Matched MeSH terms: Anesthesia, Spinal/methods

Fulltext Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass

Chong SE, Mohd Nikman A, Saedah A, Wan Mohd Nazaruddin WH, Kueh YC, Lim JA, et al.

Br J Anaesth, 2017 05 01;118(5):799-801.

PMID: 28510752 DOI: 10.1093/bja/aex108

Matched MeSH terms: Anesthesia, Spinal/methods*

Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study

Chen CK, Lau FC, Lee WG, Phui VE

J Clin Anesth, 2016 Sep;33:75-80.

PMID: 27555137 DOI: 10.1016/j.jclinane.2016.03.007

STUDY OBJECTIVES: To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).

DESIGN: Retrospective cohort study.

SETTING: Operation theater with postoperative inpatient follow-up.

PATIENTS: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.

INTERVENTIONS: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.

MEASUREMENTS: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.

MAIN RESULTS: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.

CONCLUSION: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

Matched MeSH terms: Anesthesia, Spinal/adverse effects; Anesthesia, Spinal/methods*

Anaesthesia for emergency operations

Hopkin DAB

Journal of the Malaya Branch of the British Medical Association, 1939;3:315-25.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Survey on maternal satisfaction in receiving spinal anaesthesia for caesarean section

Dharmalingam TK, Ahmad Zainuddin NA

Malays J Med Sci, 2013 May;20(3):51-4.

PMID: 23966825 MyJurnal

This study was undertaken to evaluate patient satisfaction after spinal anaesthesia, which is the most frequently administered anaesthesia in obstetric patients.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Comparison between preloading with 10 ml/kg and 20 ml/kg of Ringer's lactate in preventing hypotension during spinal anaesthesia for caesarean section

Muzlifah KB, Choy YC

Med J Malaysia, 2009 Jun;64(2):114-7.

PMID: 20058569 MyJurnal

This prospective, randomized, study was designed to compare the effect of two different preloading volumes of Ringer's lactate for prevention of maternal hypotension induced by spinal anaesthesia for Caesarean section. Eighty ASA I or II obstetric patients were randomized to two groups. Group 1 (n = 40) received 20 ml/kg of Ringer's lactate and Group 2 (n = 40) 10 ml/kg of Ringer's lactate over 20 minutes before spinal anaesthesia. The lowest mean arterial pressure (MAP) for both groups were recorded at 15 minutes after giving spinal anaesthesia, This difference in the drop of MAP from base-line at 15 minutes (mean decrease of 12.5 mmHg from baseline), between preloading with 10 ml/kg and 20 ml/kg of Ringer's was statistically significant. Twelve patients from Group 1 required bolus doses of ephedrine and 15% of these needed additional crystalloid whereas two patients from Group 2 needed ephedrine boluses and 22% of these required additional crystalloid. The difference in frequency of requirement for treatment of hypotension was not statistically significant. There were five patients in Group 1 and six patients in Group 2 who experienced nausea and vomiting, the frequency of occurrence did not show any statistically significant difference between the two groups. In conclusion, for prevention of hypotension during spinal anaesthesia for Caesarean section, infusing 20 ml/kg or 10 ml/kg of Ringer's Lactate gave similar results and we do not recommend the use of a larger volume of crystalloid for preloading before spinal anaesthesia.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Loss of consciousness following spinal anaesthesia for caesarean section

Chan YK, Gopinathan R, Rajendram R

Br J Anaesth, 2000 Sep;85(3):474-6.

PMID: 11103195

A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Fulltext Spread of spinal anaesthesia with 0.5% bupivacaine: influence of the vertebral interspace and speed of injection

Chin KW, Chin NM, Chin MK

Med J Malaysia, 1994 Jun;49(2):142-8.

PMID: 8090093

Three millilitres of plain 0.5% bupivacaine were injected intrathecally at two different spinal interspaces (L2/3 and L4/5) and at two different speeds (15 and 30 sec) in four groups of ten patients. Injection at L2/3 over 15 sec produced a significantly higher mean maximum spread of analgesia (T6.4) when compared to injection at L4-5 over 15 sec (T10.3) (P < 0.05). Over the same interspace L2/3, injection over 15 sec also produced a higher level of spread as compared to the 30 sec group (p < 0.05). At 15 min there was a greater fall in blood pressure in the L2/3 15 sec group when compared to the other groups (p < 0.01). There was a further decrease in the blood pressure in L2/3 15 sec and L4/5 30 sec groups after 30 minutes of blockade (p < 0.01). Therefore close monitoring of cardiovascular parameters must be continued for at least 30 min in spinal anaesthesia with bupivacaine.

Matched MeSH terms: Anesthesia, Spinal*

Fulltext Incidence of postdural puncture headache. A prospective study of 101 spinal anaesthetics in orthopaedic patients

Chan L, Delilkan AE

Med J Malaysia, 1992 Mar;47(1):20-6.

PMID: 1387444

Spinal anaesthesia was performed on 101 patients with a 25-Gauge (0.52 mm) needle. We found a 13.9% overall incidence of postdural puncture headache (PDPH) in an orthopaedic population whose mean age was 33.6 years. This incidence is too high and an alternative technique may be needed.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Fulltext Inadvertent injection of adrenaline into subarachnoid space--a case report

Mustafa WNA, Mohandas K

Med J Malaysia, 1982 Jun;37(2):108-9.

PMID: 7132830

A local anaesthetic agent with adrenalin meant for infiltration block was inadvertently given into spinal canal without any serious sequelae. The consequences of adrenalin in the subarachnoid space are discussed. Measures to prevent such accidents are suggested.

Matched MeSH terms: Anesthesia, Spinal/adverse effects*

Fulltext Combined spinal-epidural analgesia in labour: its effects on delivery outcome

Singh SK, Yahya N, Misiran K, Masdar A, Nor NM, Yee LC

Braz J Anesthesiol, 2016 May-Jun;66(3):259-64.

PMID: 27108822 DOI: 10.1016/j.bjane.2014.09.006

BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome.

METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared.

RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups.

CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Matched MeSH terms: Anesthesia, Spinal/methods*

Injection speed of spinal anaesthesia for Caesarean delivery in Asian women and the incidence of hypotension: A randomised controlled trial

Chiang CF, Hasan MS, Tham SW, Sundaraj S, Faris A, Ganason N

J Clin Anesth, 2017 Jun;39:82-86.

PMID: 28494915 DOI: 10.1016/j.jclinane.2017.03.025

STUDY OBJECTIVE: The purpose of this investigation was to determine if a slower speed of spinal anaesthesia injection would reduce the incidence of hypotension.

STUDY DESIGN: Randomised controlled trial.

SETTING: Tertiary level hospital in Malaysia.

PATIENTS: 77 patients undergoing elective Caesarean delivery.

INTERVENTION: Differing speeds of spinal injection.

MEASUREMENTS: Systolic blood pressure was assessed every minute for the first 10min and incidence of hypotension (reduction in blood pressure of >30% of baseline) was recorded. The use of vasopressor and occurrence of nausea/vomiting were also recorded.

MAIN RESULTS: 36 patients in SLOW group and 41 patients in FAST group were recruited into the study. There was no significant difference in blood pressure drop of >30% (p=0.497) between the two groups. There was no difference in the amount of vasopressor used and incidence of nausea/vomiting in both groups.

CONCLUSION: In our study population, there was no difference in incidence of hypotension and nausea/vomiting when spinal injection time is prolonged beyond 15s to 60s.

TRIAL REGISTRATION: ClinicalTrials.govNCT02275897. Registered on 15 October 2014.

Matched MeSH terms: Anesthesia, Spinal/adverse effects; Anesthesia, Spinal/methods*

Fulltext Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

Hamed Y, Ramesh A, Taylor R, Michaud R

Malays Orthop J, 2020 Nov;14(3):110-113.

PMID: 33403070 DOI: 10.5704/MOJ.2011.017

Introduction: Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation.

Materials and Methods: One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017.

Results: Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17).

Conclusion: There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Lumbar tinea versicolor and spinal anaesthesia

Mazlan MZ, Chong SE, Salmuna Ayub ZN, Mohamad NAN

IDCases, 2019;16:e00520.

PMID: 31024798 DOI: 10.1016/j.idcr.2019.e00520

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Post spinal meningitis with subdural collection:an uncommon complication after spinal anaesthesia for caesarean section

Seng, Wee Cheo, Qin, Jian Low, Yee, Ann Tan, Yuen, Kang Chia

Neuroscience Research Notes, 2018;1(2):1-5.

MyJurnal

Abstract: Meningitis after spinal anaesthesia is a rare yet devastating complication of spinal anaesthesia. The exact incidence is unknown. Our patient developed signs and symptoms of meningitis 48 hours after spinal anaesthesia and required intensive care unit admission. Her cerebrospinal fluid was sterile. Computed tomography of brain showed left subdural collection. She recovered well after 6 weeks of intravenous antibiotics. No neurological sequela noted from subsequent follow-upexaminations. Our case provides an important insight of meningitis with subdural collection after spinal anaesthesia for emergency caesarean section.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Ultrasound guided transversus abdominis plane block versus intrathecal morphine for analgesia post caesarean section: which is better?

Aizatul Isla, A.L., Wan Rahiza, W.M., Azrin, M.A., Thohiroh, A.R., Nurlia, Y., Nadia, M.N.

Journal of Surgical Academia, 2013;3(2):39-45.

MyJurnal

The tranversus abdominis plane (TAP) block for postoperative analgesia after caesarean section may confer potential benefits comparable to that of intrathecal opioids. We compared postoperative analgesia, and the incidence of nausea, vomiting, pruritus and sedation between the TAP block and intrathecal morphine (ITM) in patients undergoing Caesarean section. This was a prospective, randomised clinical study. Fifty American Society of Anaesthesiologists physical status I or II patients, planned for elective caesarean section under spinal anaesthesia, were randomly allocated to the TAP group (patients receiving spinal anaesthesia with bilateral TAP block without ITM) or ITM group (patients receiving spinal anaesthesia with ITM without a TAP block). Assessment for pain, postoperative nausea and vomiting, pruritus and sedation was done upon arrival and discharge from recovery, and at 6, 12 and 24 hours, postoperatively in the post natal ward. Results were analysed using analysis of variance (ANOVA). There was no pain at rest in either groups. Both groups experienced pain on movement at the 12th (p = 0.6) and 24th hour (p = 0.4). None of the patients in the TAP group experienced nausea, vomiting, pruritus or sedation. However, these incidences were found to be significantly higher in the ITM group. Ultrasound guided TAP block provided comparable postoperative analgesia to ITM without the side effects of the latter.

Matched MeSH terms: Anesthesia, Spinal

Fulltext Spinal anaesthesia with bupivacaine and intrathecal morphine versus combined spinal-epidural anaesthesia using Bupivacaine and Epidural infusion of bupivacaine plus fentanyl for postoperative analgesia after hip and knee arthroplasty

Mohd Azizan, G., Karis, M., Noordin, Y.

Journal of Surgical Academia, 2013;3(2):46-53.

MyJurnal

This randomised single-blinded study was conducted to evaluate if there was any difference between spinal anaesthesia with hyperbaric bupivacaine 0.5% and intrathecal morphine 0.2mg and combined-spinal epidural using hyperbaric bupivacaine 0.5% with epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml for 24 hours, postoperative analgesia following hip and knee arthroplasty, in terms of pain score and side effects (nausea, vomiting, pruritus and respiratory depression). Eighty patients ASA I or ASA II, aged between 18 to 75 years who underwent knee and hip arthroplasty of approximately 3-4 hours, duration were recruited. They were randomly allocated to one of two groups by using computer generated randomised numbers. The pain score during the postoperative period was evaluated using Visual Analogue Score (VAS pain score) and the side effects were documented and treated accordingly. Results showed that patients in Group 1 and Group 2 were comparable in terms of age, gender, height, weight and race. There was no statistical difference in VAS pain score between the two groups at all times intervals. However, patients in Group 1 had a higher incidence of nausea and pruritus than patients in Group 2. None of the patients in either group, experienced respiratory depression. Thus, it was concluded that both intrathecal morphine 0.2mg and epidural infusion of bupivacaine 0.1% plus fentanyl 2.0μg/ml were comparable in providing postoperative analgesia up to 24 hours following hip and knee arthroplasty. Nevertheless, the use of spinal morphine led to a higher incidence of side effects namely nausea and pruritus.

Matched MeSH terms: Anesthesia, Spinal

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