<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-oper...<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.展开更多
目的比较腰硬联合麻醉(CSEA)与硬膜外麻醉在分娩镇痛中的应用效果。方法选取2019年1月至2022年3月于上饶东信第五医院分娩的40名产妇作为研究对象,按照随机数字表法分为对照组与观察组,每组20例。对照组实施硬膜外麻醉,观察组实施腰硬...目的比较腰硬联合麻醉(CSEA)与硬膜外麻醉在分娩镇痛中的应用效果。方法选取2019年1月至2022年3月于上饶东信第五医院分娩的40名产妇作为研究对象,按照随机数字表法分为对照组与观察组,每组20例。对照组实施硬膜外麻醉,观察组实施腰硬联合麻醉,比较两组镇痛起效时间、产程(第一产程、第二产程)、应激指标[白细胞介素-6(IL-6)、肾上腺素(ADR)与皮质醇(Cor)、一氧化氮(NO)]、疼痛数字分级法(NRS)评分及镇痛药物用量及自控镇痛次数、产后泌乳指标[泌乳始动时间、产后12h催乳素(PRL)]和泌乳情况及不良反应发生情况。结果观察组镇痛起效时间、第一产程、第二产程均短于对照组,差异有统计学意义(P<0.05)。镇痛5、30min,观察组NRS评分均低于对照组,差异有统计学意义(P<0.05);两组镇痛前后其他时间点NRS评分比较差异无统计学意义。分娩后24h,两组Cor、ADR、IL-6、NO水平均高于产前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组芬太尼用量、罗哌卡因用量、自控镇痛次数均少于对照组,差异有统计学意义(P<0.05)。观察组泌乳始动时间短于对照组,产后12 h PRL水平、泌乳有效率均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论与硬膜外麻醉相比,CSEA用于分娩镇痛中效果良好,可有效缩短产程,缓解患者疼痛感,控制机体应激水平,促进产妇产后泌乳,减少不良反应的发生。展开更多
Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be as...Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.展开更多
目的观察剖宫产手术中EA和CSEA麻醉方式的效果,探讨剖宫产手术的较佳麻醉方法。方法回顾性分析比较我院2007年单纯硬膜外麻醉(EA,对照组)剖宫产270例与选择腰麻-硬膜外联合麻醉(CSEA,观察组)610产妇的临床资料。结果两组产妇均无呼吸抑...目的观察剖宫产手术中EA和CSEA麻醉方式的效果,探讨剖宫产手术的较佳麻醉方法。方法回顾性分析比较我院2007年单纯硬膜外麻醉(EA,对照组)剖宫产270例与选择腰麻-硬膜外联合麻醉(CSEA,观察组)610产妇的临床资料。结果两组产妇均无呼吸抑制,血氧饱和度均大于95%,顺利完成手术,新生儿结局l min和5 min Apgar评分均大于8.5,比较无差异(P>0.05);观察组Bromage高、麻醉显效时间短于、不良反应及PDPH发生率低于对照组,肌松程度好,但低血压高于观察组(P<0.05),对通过补充血容量,加大手术床左侧的倾斜度,应用升压药均可以纠正。结论CSE和EA均能够满足剖宫产手术的要求顺利完成手术,但CSEA具起效快、麻醉平面易于控制、肌松完全、术后并发症少等优点,可作为剖宫产术的首选麻醉方法,特别适合于急症胎儿宫内窘迫的产妇。展开更多
文摘<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
文摘目的比较腰硬联合麻醉(CSEA)与硬膜外麻醉在分娩镇痛中的应用效果。方法选取2019年1月至2022年3月于上饶东信第五医院分娩的40名产妇作为研究对象,按照随机数字表法分为对照组与观察组,每组20例。对照组实施硬膜外麻醉,观察组实施腰硬联合麻醉,比较两组镇痛起效时间、产程(第一产程、第二产程)、应激指标[白细胞介素-6(IL-6)、肾上腺素(ADR)与皮质醇(Cor)、一氧化氮(NO)]、疼痛数字分级法(NRS)评分及镇痛药物用量及自控镇痛次数、产后泌乳指标[泌乳始动时间、产后12h催乳素(PRL)]和泌乳情况及不良反应发生情况。结果观察组镇痛起效时间、第一产程、第二产程均短于对照组,差异有统计学意义(P<0.05)。镇痛5、30min,观察组NRS评分均低于对照组,差异有统计学意义(P<0.05);两组镇痛前后其他时间点NRS评分比较差异无统计学意义。分娩后24h,两组Cor、ADR、IL-6、NO水平均高于产前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组芬太尼用量、罗哌卡因用量、自控镇痛次数均少于对照组,差异有统计学意义(P<0.05)。观察组泌乳始动时间短于对照组,产后12 h PRL水平、泌乳有效率均高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论与硬膜外麻醉相比,CSEA用于分娩镇痛中效果良好,可有效缩短产程,缓解患者疼痛感,控制机体应激水平,促进产妇产后泌乳,减少不良反应的发生。
文摘Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.
文摘目的观察剖宫产手术中EA和CSEA麻醉方式的效果,探讨剖宫产手术的较佳麻醉方法。方法回顾性分析比较我院2007年单纯硬膜外麻醉(EA,对照组)剖宫产270例与选择腰麻-硬膜外联合麻醉(CSEA,观察组)610产妇的临床资料。结果两组产妇均无呼吸抑制,血氧饱和度均大于95%,顺利完成手术,新生儿结局l min和5 min Apgar评分均大于8.5,比较无差异(P>0.05);观察组Bromage高、麻醉显效时间短于、不良反应及PDPH发生率低于对照组,肌松程度好,但低血压高于观察组(P<0.05),对通过补充血容量,加大手术床左侧的倾斜度,应用升压药均可以纠正。结论CSE和EA均能够满足剖宫产手术的要求顺利完成手术,但CSEA具起效快、麻醉平面易于控制、肌松完全、术后并发症少等优点,可作为剖宫产术的首选麻醉方法,特别适合于急症胎儿宫内窘迫的产妇。
