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Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients' recovery.
During a 6-month period, 500...
Context in source publication
Context 1
... prospective, single-centre observational trial was per- formed according to the guidelines of the local institutional re- view board (Ethic Commission II, Faculty of Clinical Medicine Mannheim, Germany, vote: 2007-236N-MA). From February un- til July 2007, 674 patients received several in-house perianal pro- cedures in the University Hospital Mannheim ( table 1 ). Prior to the scheduled operation, all patients were interviewed by an an- aesthesiologist and informed verbally and in writing about the study before consenting to participate. ...
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Citations
... Propofol sedation on demand has been proposed to improve the comfort of patients during surgery with SB however, an increase in the incidence of nausea and a longer delay for mobilization and spontaneous urination were noted. 11 Saddle block induces few hemodynamic changes requiring fluid resuscitation, and in such case, use of a vasoconstrictor is preferred. The risk of urinary retention is related to surgery (proctology), age (> 70 years), urological history, sex (male) and the use of intrathecal morphine. ...
SummarySaddle block is a spinal anaesthetic restricted to the perineal area, or that part of the body in touch with a saddle. It is achieved by using a small dose of hyperbaric solution of local anaesthetic and maintaining the patient in a seated position after injection. One of the major advantages is avoiding hypotension. It also allows rapid mobilization of the patient for the surgical procedure. Certain surgical procedures have an increased risk of urinary retention when performed under saddle block
... In earlier studies of our group, we found rates between 2% and 2.8%. 7, 25 Kazak et al. found a rate of 0%. 18 The missing oral premedication may explain this phenomenon. ...
... In earlier studies of our group, we found rates between 2% and 2.8%. 7, 25 Kazak et al. found a rate of 0%. 18 The missing oral premedication may explain this phenomenon. ...
Background:
Hyperbaric prilocaine 20 mg/ml may be preferable for perianal outpatient surgery. The aim of this prospective, single-centre, randomised, single-blinded, controlled clinical trial was to determine the optimal dosage of hyperbaric prilocaine 20 mg/ml for a spinal anaesthesia (SPA) in patients undergoing perianal outpatient surgery.
Methods:
One hundred and twenty patients (18-80 years/American Society of Anesthesiologists grade I-III) were enrolled in this study. The patients were randomised to receive 10, 20 or 30 mg of prilocaine for SPA. We measured expansion of the sensory and motor block, evaluated times to walk, void and being eligible for discharge, and determined the demand of analgesics.
Results:
116/120 patients were available for analysis. The expansion of the sensory block gained with an increasing dosage: 10 mg: 3(1-6) dermatomes; 20 mg: 4(2-6) dermatomes; 30 mg: 5(3-7) dermatomes (P < 0.0001). Dermatomes were counted upwards beginning with S(5). Also, the motor block gained with an increased dosage (Bromage score 1-3: 10 mg: n = 3, 20 mg: n = 8 and 30 mg: n = 18, P = 0.0002). Patients receiving 10 mg were ready for discharge earlier compared with both other groups (10 mg: 199 ± 39 min; 20 mg: 219 ± 47 min; 30 mg: 229 ± 32 min, P = 0.0039). Pain occurred earlier in the 10 mg group than in the 30 mg group (10 mg: 168 ± 36 min; 30 mg: 205 ± 33 min, P = 0.0427). The demand of additional analgesics was comparable in all dosage groups.
Conclusion:
Hyperbaric prilocaine 20 mg/ml can be applied in dosages of 10, 20 and 30 mg for SPA in perianal surgery. Because of sufficient analgesia, missing motor block and shorter recovery times, 10 mg of hyperbaric prilocaine 20 mg/ml can be recommended for perianal outpatient surgery.
... Son installation et les appuis correspondants s'en trouvent facilités, que ce soit en position gynécologique, ventrale ou même en position genu-pectorale. Une sédation par propofol à la demande a été proposée pour améliorer le confort des patients avec cependant une majoration de l'incidence des nausées et un délai plus long pour la mobilisation et la miction spontanée [10]. ...
Saddle block is a spinal anaesthesia restricted to the perineal site. Saddle block is achieved using small dose of hyperbaric solution of local anaesthetic and maintaining the patient seated after spinal injection. The major advantage is to avoid hypotension and to allow a rapid mobilization of the patient. According to surgical procedure, one may consider the risk of urinary retention to which the block may contribute.
Objective:
The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure.
Methods:
After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction.
Results:
In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D.
Conclusion:
It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.
