Continuous spinal anaesthesia for laparotomy

Jaitly, Vanya; Kumar, Chandra M.

doi:10.1016/j.cacc.2008.12.002

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…20 High volume centers certainly have better outcomes, but CSA has also demonstrated excellent perioperative outcomes in high-risk patients undergoing cardiac, vascular, orthopedic, pelvic, and abdominal surgery. 11,21–23 Open abdominal surgeries are usually done under GA, but many elderly patients presented to this type of surgery have several major medical problems. Among the drawbacks of GA are the negative side effects of the drugs, and longer recovery times, all contraindications for elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Castellani

Starnari

Faloia

et al. 2018

Therapeutic Advances in Urology

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Background: Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscleinvasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients. Methods: We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours. Results: Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up. Conclusions: Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.

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Section: Discussionmentioning

confidence: 99%

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Castellani

Starnari

Faloia

et al. 2018

Therapeutic Advances in Urology

View full text Add to dashboard Cite

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“…CSA was originally documented in surgical patients some 100 years ago [ 3 , 4 ]. Although underutilized, CSA is a well-established neuraxial blockade method due to the rapid onset of sensory blockade onset and hemodynamic stability CSA is an alternate anesthetic approach to a single-shot spinal anesthetics and epidural anesthesia [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Continuous Spinal Anesthesia Technique After Accidental Dural Puncture

Matturu¹,

Singam²,

Madavi³

et al. 2022

Cureus

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Continuous spinal anesthesia (CSA) is a mode of anesthesia and analgesia that has various therapeutic advantages. CSA allows the anesthesiologist to titrate tiny doses of a local anesthetic to achieve the desired degree of spinal anesthesia. The duration can be extended to accommodate the demands of the protracted operation. Due to a lack of equipment and financial restraints, particularly in resource-constrained areas, and worries of neurologic consequences such as cauda equina syndrome, CSA is yet to acquire general acceptability among anesthesiologists. In terms of postoperative pain management, CSA can be comparable to epidural analgesia and is considered far superior to abdominal wall blocks when correctly applied. Here we discuss a case wherein a standard epidural catheter in subarachnoid space was used to successfully perform an emergency exploratory laparotomy.

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“…Also, Jaitly et al suggests that, CSA can be used as a sole anesthetic technique for laparotomy especially in patients with severe cardio-respiratory disease who would otherwise be considered unlikely to tolerate general anesthesia or where general anesthesia could result in a prolonged stay in the intensive care unit [22].…”

Section: Discussionmentioning

confidence: 99%

Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

Amin

Sadek

2016

Egyptian Journal of Anaesthesia

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Background: Anesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Continuous epidural anesthesia (CEA) is generally accepted as the routine method of regional anesthesia for vascular surgery of the lower limb. Continuous spinal anesthesia (CSA) has been reported to be more rapid in action, with good sensory and motor block, fewer hemodynamic disturbance and side effects when compared to continuous epidural anesthesia (CEA), and single dose spinal anesthesia (SDSA). Patients and methods: Forty adult patients with depressed systolic function (EF 45% or less) scheduled for lower abdominal surgeries were subjected to our study. Under full aseptic precautions subarachnoid space was accessed in the setting position by an epidural needle at L3-4 and 2 ml of hyperbaric bupivacaine (10 mg) was injected into subarachnoid space, then an epidural catheter was inserted in the subarachnoid space for 3 cm. Anesthesia was maintained by Top up doses of plain bupivacaine 0.5% 1.2 ml. Result: There were no differences in demographic characteristics of patients, procedure's duration, and ASA physical status classification. There were no significant changes in hemodynamics throughout the procedure. Hypotension occurred in 5% of patients, bradycardia occurred in 10% of patients and arrhythmia occurred in 2.5% of patients. There were no postoperative ECG changes and postoperative Troponin was negative. There was no postoperative Neurological deficit or Post dural puncture headache. Conclusion: We can conclude that, CSA was effective and safe technique for patients with cardiomyopathy undergoing lower abdominal surgeries.

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Continuous spinal anaesthesia for laparotomy

Cited by 11 publications

References 28 publications

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Continuous Spinal Anesthesia Technique After Accidental Dural Puncture

Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

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