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Nathan L Pace - One of the best experts on this subject based on the ideXlab platform.
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transient neurologic symptoms tns following Spinal Anaesthesia with lidocaine versus other local anaesthetics
Cochrane Database of Systematic Reviews, 2009Co-Authors: Dusanka Zaric, Nathan L PaceAbstract:Background Spinal Anaesthesia has been in use since 1898. During the last decade there has been an increase in the number of reports implicating lidocaine as a possible cause of temporary and permanent neurologic complications after Spinal Anaesthesia. Follow up of patients who received uncomplicated Spinal Anaesthesia revealed that some of them developed pain in the lower extremities after an initial full recovery. This painful condition that occurs in the immediate postoperative period was named 'transient neurologic symptoms' (TNS). Objectives To study the frequency of TNS and neurologic complications after Spinal Anaesthesia with lidocaine compared to other local anaesthetics. Search methods We searched the Cochrane Central Register of Controlled Trials Register (CENTRAL) (The Cochrane Library, Issue 4, 2008); MEDLINE (1966 to August 2008); EMBASE (1980 to week 35, 2008); LILACS (August 2008); and handsearched the reference lists of trials and review articles. Selection criteria We included all randomized and quasi-randomized studies comparing the frequency of TNS and neurologic complications after Spinal Anaesthesia with lidocaine as compared to other local anaesthetics. Data collection and analysis Two authors independently evaluated the quality of the relevant studies and extracted the data from the included studies. Main results Sixteen trials reporting on 1467 patients, 125 of whom developed TNS, were included in the analysis. The use of lidocaine for Spinal Anaesthesia increased the risk of developing TNS. There was no evidence that this painful condition was associated with any neurologic pathology; the symptoms disappeared spontaneously by the fifth postoperative day. The relative risk (RR) for developing TNS after Spinal Anaesthesia with lidocaine as compared to other local anaesthetics (bupivacaine, prilocaine, procaine, levobupivacaine, ropivacaine, and 2-chloroprocaine) was 7.31 (95% confidence interval (CI) 4.16 to 12.86). Mepivacaine was found to give similar results as lidocaine and was therefor omitted from the overall comparison to diminish the heterogeneity. Authors' conclusions The risk of developing TNS after Spinal Anaesthesia with lidocaine was significantly higher than when bupivacaine, prilocaine, or procaine were used. The term 'transient neurological symptoms' implies neurologic pathology. Failing identification of the pathogenesis of TNS, consideration should be given to choosing a neutral descriptive term which does not imply a particular causation. One study about the impact of TNS on patient satisfaction and functional impairment demonstrated that non-TNS patients were more satisfied and had less functional impairment after surgery than TNS patients, but this did not influence their willingness to recommend Spinal Anaesthesia.
Torben Baek Hansen - One of the best experts on this subject based on the ideXlab platform.
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incidence and related factors for intraoperative failed Spinal Anaesthesia for lower limb arthroplasty
Acta Anaesthesiologica Scandinavica, 2018Co-Authors: Eske Kvanner Aasvang, Mogens Berg Laursen, Jacob Madsen, Mogens Kroigaard, Soren Solgaard, Per Kjaersgaardandersen, Hans Mandoe, Torben Baek HansenAbstract:BACKGROUND Spinal Anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about Spinal Anaesthesia should also include the risk for intraoperative failed Spinal Anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed Spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential Anaesthesia stratification. METHODS In a sub-analysis, data from a prospective study on Spinal Anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general Anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from Spinal administration until end of surgery) were analysed with logistic regression for relation to failed Spinal Anaesthesia. RESULTS In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed Spinal Anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed Spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. CONCLUSION Failed Spinal Anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing Anaesthesia and included in the information to patients.
Jacob Madsen - One of the best experts on this subject based on the ideXlab platform.
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incidence and related factors for intraoperative failed Spinal Anaesthesia for lower limb arthroplasty
Acta Anaesthesiologica Scandinavica, 2018Co-Authors: Eske Kvanner Aasvang, Mogens Berg Laursen, Jacob Madsen, Mogens Kroigaard, Soren Solgaard, Per Kjaersgaardandersen, Hans Mandoe, Torben Baek HansenAbstract:BACKGROUND Spinal Anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about Spinal Anaesthesia should also include the risk for intraoperative failed Spinal Anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed Spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential Anaesthesia stratification. METHODS In a sub-analysis, data from a prospective study on Spinal Anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general Anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from Spinal administration until end of surgery) were analysed with logistic regression for relation to failed Spinal Anaesthesia. RESULTS In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed Spinal Anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed Spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. CONCLUSION Failed Spinal Anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing Anaesthesia and included in the information to patients.
Mogens Berg Laursen - One of the best experts on this subject based on the ideXlab platform.
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incidence and related factors for intraoperative failed Spinal Anaesthesia for lower limb arthroplasty
Acta Anaesthesiologica Scandinavica, 2018Co-Authors: Eske Kvanner Aasvang, Mogens Berg Laursen, Jacob Madsen, Mogens Kroigaard, Soren Solgaard, Per Kjaersgaardandersen, Hans Mandoe, Torben Baek HansenAbstract:BACKGROUND Spinal Anaesthesia is the preferred choice for total hip- and knee arthroplasty (THA/TKA), due to the claimed superior outcome profile, relative simple technique and without the need for advanced airway support. However, choosing and informing about Spinal Anaesthesia should also include the risk for intraoperative failed Spinal Anaesthesia with associated pain, discomfort and suboptimal settings for airway management. Small-scale studies suggest incidences from 1 to 17%; however, no multi-institutional large data exists on failed Spinal incidence and related factors during THA/TKA, hindering evidence-based information and potential Anaesthesia stratification. METHODS In a sub-analysis, data from a prospective study on Spinal Anaesthesia for THA/TKA were examined for incidence of intraoperative conversion to general Anaesthesia. Potential perioperative factors (age, gender, American Society of Anaesthesiologist (ASA) score, height, weight, BMI, procedure, bupivacaine dosage and duration of time from Spinal administration until end of surgery) were analysed with logistic regression for relation to failed Spinal Anaesthesia. RESULTS In all, 1451 patients were included for analysis, whereof 57 (3.9%) had failed Spinal Anaesthesia. Spinal failure patients were significantly younger (61 vs. 67 years, P = 0.003), and operation time longer in the failed Spinal group vs no-failure, respectively (133 vs. 89 min, P < 0.001). No significant differences were found with regard to bupivacaine volume, gender, ASA-score, height, weight, BMI or THA vs. TKA. CONCLUSION Failed Spinal Anaesthesia for THA and TKA is a relatively frequent occurrence and identification of risk patients is not feasible. These results should be considered when choosing Anaesthesia and included in the information to patients.
Hannu Kokki - One of the best experts on this subject based on the ideXlab platform.
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Spinal Anaesthesia in paediatric patients.
Current Opinion in Anaesthesiology, 2005Co-Authors: Franco Puncuh, Elisabetta Lampugnani, Hannu KokkiAbstract:Purpose of review Spinal Anaesthesia has seldom been employed in paediatric patients. Its use has been suggested mainly in former preterm newborns and infants who are known to be exposed to high perioperative apnoea risk. There is currently some evidence that Spinal Anaesthesia could be considered as an equal alternative to general Anaesthesia as it is in adults. Recent findings New drugs and adjuvants recently introduced in clinical practice, more-detailed knowledge of spread anaesthetic modalities and larger databases, now available, could today make paediatric Spinal Anaesthesia a more suitable technique for many anaesthetists. Summary We will review recent literature focusing the latest techniques, drugs, dosages, and complications in order to define the limits and advantages of employing Spinal Anaesthesia in all paediatric ages, in routine and emergency surgery.
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Spinal Anaesthesia in infants and children
Best Practice & Research Clinical Anaesthesiology, 2000Co-Authors: Hannu KokkiAbstract:Abstract Every anaesthetist who deals with paediatric patients should have the expertise to perform Spinal Anaesthesia. Often, children undergoing surgery in the lower part of the body have contraindications for general Anaesthesia; in these children Spinal Anaesthesia is a convenient option. The aim of Anaesthesia is to provide good operating conditions for the surgeon while avoiding any harmful psychological sequelae for the child. In addition, the anaesthetist's goal is to lessen the physiological stress response to surgery and to prevent post-operative morbidity. In children, Spinal Anaesthesia produces a dense intra-operative analgesia and, when combined with general Anaesthesia, it reduces the requirements for anaesthetic agents and opioids intra-operatively. Spinal Anaesthesia allows a fast return to a bright and alert status, and a rapid return of normal appetite. Following Spinal Anaesthesia, analgesia continues into the early post-operative period, and nausea and vomiting are uncommon. Consequently, ambulation and discharge are not delayed. Some children develop complications following Spinal Anaesthesia—for example, a post-lumbar puncture headache and transient neurological symptoms. In young children these symptoms may be difficult to perceive if parents are not informed. When long-lasting, these symptoms may surpass the benefits of Spinal Anaesthesia and should therefore be identified and treated appropriately.