Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease

Zundert, André van; Stultiëns, G.N.; Jakimowicz, Jack J.; Borne, Ben E. E. M. van den; Ham, W.G.J.M. van der; Wildsmith, J.A.W.

doi:10.1093/bja/ael036

Cited by 108 publications

(95 citation statements)

References 2 publications

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“…Thoracic epidural anaesthesia (TEA) has been consistently shown to provide excellent pain relief, to facilitate early ambulation. Many used regional anaesthesia alone for laparoscopic cholecystectomy in patients with chronic obstructive airway disease [4,8,9]. It has been also used in other studies, alone for laparoscopic cholecystectomy in healthy patients [4,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Many used regional anaesthesia alone for laparoscopic cholecystectomy in patients with chronic obstructive airway disease [4,8,9]. It has been also used in other studies, alone for laparoscopic cholecystectomy in healthy patients [4,10,11]. Different regional techniques have been attempted during breast surgery; including thoracic epidural [1] and thoracic paravertebral block [3].…”

Section: Discussionmentioning

confidence: 99%

“…Recently segmental thoracic spinal anesthesia has been used for laparoscopic cholecystectomy was practiced by (Zundert et al) who inject (7.5 mg bupvacin and 25 μg fentanyle) at lower thoracic region (T9-T10) [4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Ahmed¹,

Ali²,

Helal³

et al. 2017

J Pain Relief

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Ahmed¹,

Ali²,

Helal³

et al. 2017

J Pain Relief

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“…It is evident from the case study and feasibility study from VAN ZUNDERT et al (1,2), that there may be benefits to the practice of spinal blockades at higher levels. A pertinent question arising from this technique of VAN ZUNDERT et al (1), mentioned in the introduction, is that of the safety of performing thoracic spinal blockade.…”

Section: Discussionmentioning

confidence: 99%

385: The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI)

Lee

Zundert

Wieringa

2007

Regional Anesthesia and Pain Medicine

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: Background and Objectives : Anesthesiologists are reluctant to consider higher levels for spinal anesthesia, largely due to direct threats to the spinal cord. The goal of this study is to investigate, with magnetic resonance imaging (MRI), the distances between the relevant structures of the spinal canal (spinal cord, thecal tissue, etc.) to determine modal anatomical positions for neuraxial anesthesia. Method : A group of 19 patients were imaged with an MRI scanner in supine position. Medial sagittal slices of the thoracic and lumbar spine were measured for the relative distances between anatomical structures, including epidural space, dura, and spinal cord. Results : The posterior dura -spinal cord distance is significantly greater in the middle thoracic region than at upper and lower thoracic levels (e.g. T6 9.5 ± 1.8 mm, T12 3.7 ± 1.2 mm, p < 0.001, T1 4.7 ± 1.7 mm, p < 0.001). There is variation in modal distances between the structures important for neuraxial anesthesia, at different levels of the spinal canal. Conclusions :The spinal cord tends to follow the straightest line through the imposed geometry of the spine. Considering the necessary angle of entry of the needle at mid-thoracic levels, there is relatively (more than at upper thoracic and lumbar levels) substantial separation of cord and surrounding thecal tissue. Anesthesiologists perform spinal blockades up to the L2-L3 interspace, but avoid higher levels for fear of neurological damage. The information that there is substantially more space in the dorsal subarachnoid space at thoracic level, might lead to potential applications in regional anesthesia. In contrast, the cauda equina sits more dorsally in the lumbar region.

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“…The studies of the thoracic column with MRI [18][19][20] show that exist a space between the dura-mater and the spinal cord (medula). Van Zundert [38,39] and Imbelloni [40] have placed segmental spinal anesthesia through a combined spinal-epidural technique in a combined spinalepidural block via a thoracic approach and produced segmental spinal anesthesia using a set of combined spinal epidural block and a thoracic approach without any complication.…”

Section: Toracic Spinalmentioning

confidence: 99%

Thoracic Spinal Anesthesia

2016

JACCOA

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In 1909 Thomas Jonnesco published his interesting paper under the title General spinal anesthesia through an approach of the subarachnoid space at a thoracic level, providing condition for surgery on the skull, head, neck and thorax. Etherington-Wilson proposed explaining the various possibilities for the spinal anesthesia. Leonardo da Vinci was considered the discoverer of Human and animal Anatomy. Image techniques have opened a gret new field for the study of anatomy in the living man. The modern means of image, associated to computed means have facilitated the evaluation of the CSF volume, through antero-posterior and height measures of the subarachnoid space based on bi-dimentional studies of MRI. The studies of the thoracic column with MRI show that exist a space between the dura-mater and the spinal cord (medula). Thoracic ouncture performed with needles proved safe and without neurological injury. Thoracic spinal anesthesia is a viable procedure, with a low incidence of hypotension and did not present any neurologic problem.

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Segmental spinal anaesthesia for cholecystectomy in a patient with severe lung disease

Cited by 108 publications

References 2 publications

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

385: The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI)

Thoracic Spinal Anesthesia

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