Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have redu...Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.展开更多
BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesi...BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.展开更多
Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesi...Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.展开更多
BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system ...BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.展开更多
Achondroplasia is a genetic condition characterized by skeletal dysplasia that results in characteristic craniofacial and spinal abnormalities.It is the most common form of short-limbed skeletal dysplasia.A morbidly o...Achondroplasia is a genetic condition characterized by skeletal dysplasia that results in characteristic craniofacial and spinal abnormalities.It is the most common form of short-limbed skeletal dysplasia.A morbidly obese pregnant patient warrants specific anatomical and physiological considerations,such as a difficult airway with potential hypoxia,full stomach precautions,and a reduced functional residual capacity.Achondroplasia increases the risks of maternal and fetal complications.Although neuraxial techniques are generally preferred for cesarean sections,there is no consensus among patients with achondroplasia.We aimed to discuss the anesthetic challenges in an achondroplastic patient and report our regional anesthesia approach for an elective cesarean section.展开更多
Background:Intravertebral and general anesthesia(GA)are two main anesthesia approaches but both have defects.This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-control...Background:Intravertebral and general anesthesia(GA)are two main anesthesia approaches but both have defects.This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion(TCI)on blood loss and transfusion for total hip arthroplasty(THA)in elderly patients in comparison with combined spinal-epidural anesthesia(CSEA)or GA.Methods:Totally,240 patients(aged>65 years,American Society of Anesthesiologists[ASA]I-III)scheduled for posterior THA were enrolled from September 1st,2017 to March 1st,2018.All cases were randomly divided into three groups to receive CSEA(group C,w=80),GA(group G,n=80),or subarachnoid anesthesia and propofol TCI(group T,w=80),respectively.Primary outcomes measured were intra-operative blood loss,autologous and allogeneic blood transfusion,mean arterial pressure at different time points,length of stay in post-anesthesia care unit(PACU),length of hospital stay,and patient satisfaction degree.Furthermore,post-operative pain scores and complications were also observed.The difference of quantitative index between groups were analyzed by one-way analysis of variance,repeated measurement generalized linear model,Student-Newman-Keuls test or rank-sum test,while ratio index was analyzed by Chi-square test or Fisher exact test.Results:Basic characteristics were comparable among the three groups.Intra-operative blood loss in group T(331.53±64.33 mL)and group G(308.03±64.90 mL)were significantly less than group C(455.40±120.48 mL,F=65.80,P<0.001).Similarly,the autologous transfusion of group T(130.99±30.36 mL)and group G(124.09±24.34 mL)were also markedly less than group C(178.31±48.68 mL,F=52.99,P<0.001).The allogenetic blood transfusion of group C(0[0,100.00])was also significantly larger than group T(0)and group G(0)(Z=2.47,P=0.047).Except for the baseline,there were significant differences in mean arterial blood pressures before operation(F=496.84,P<0.001),10-min after the beginning of operation(F=351.43,P<0.001),30-min after the beginning of operation(F=559.89,P<0.001),50-min after the beginning of operation(F=374.74,P<0.001),and at the end of operation(F=26.14,P<0.001)among the three groups.Length of stay in PACU of group T(9.41±1.19 min)was comparable with group C(8.83±1.26 min),and both were significantly shorter than group G(16.55±3.10 min,F=352.50,P<0.001).There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores.Patient satisfaction degree of group T(77/80)was significantly higher than group C(66/80,%=7.96,P=0.004)and G(69/80,/2=5.01,P=0.025).One patient complained of post-dural puncture headache and two complained of low back pain in group C,while none in group T.Incidence of post-operative nausea and vomiting in group G(10/80)was significantly higher than group T(3/80,/2=4.10,P=0.043)and group C(2/80,x2=5.76,P=0.016).No deep vein thrombosis or delayed post-operative functional exercise was detected.Conclusions:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients,with less blood loss and peri-operative transfusion,higher patient satisfaction degree and fewer complications.Trial registration:chictr.org.cn:ChiCTR-IPR-17013461;http://www.chictr.org.cn/showproj.aspx?proj=23024.展开更多
文摘Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.
基金Changning District Health Commission Medical Key(Characteristic)Specialized Program,No.20192003.
文摘BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block.
文摘Objective: To study the efficacy of low-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia. Methods: Puerperae who underwent vaginal delivery under combined spinal-epidural anesthesia for labor analgesia in Lincheng People's Hospital between June 2014 and March 2017 were selected and randomly divided into three groups, group A received 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, group B received 25 μg large-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia, and group C received ropivacaine epidural anesthesia alone for labor analgesia. During delivery, the serum in the second stage of labor was collected to determine the contents of pain transmitters, inflammatory cytokines and stress response indexes. Results: During delivery, serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A and group B were lower than those of group C and serum SP, 5-HT, DA, NE, DYN, TNF-α, IL-1β, IL-6, IL-10, PGE2, Cor, C-P, MDA and AOPP contents of group A were not significantly different from those of group B. Conclusion: 15 μg small-dose fentanyl and ropivacaine combined spinal-epidural anesthesia for labor analgesia is with exact efficacy and good safety.
文摘BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.
基金supported in part by the University of California Davis Health Department of Anesthesiology and Pain Medicine and an NIH grant(No.UL1 TR000002)from the University of California Davis Health.
文摘Achondroplasia is a genetic condition characterized by skeletal dysplasia that results in characteristic craniofacial and spinal abnormalities.It is the most common form of short-limbed skeletal dysplasia.A morbidly obese pregnant patient warrants specific anatomical and physiological considerations,such as a difficult airway with potential hypoxia,full stomach precautions,and a reduced functional residual capacity.Achondroplasia increases the risks of maternal and fetal complications.Although neuraxial techniques are generally preferred for cesarean sections,there is no consensus among patients with achondroplasia.We aimed to discuss the anesthetic challenges in an achondroplastic patient and report our regional anesthesia approach for an elective cesarean section.
文摘Background:Intravertebral and general anesthesia(GA)are two main anesthesia approaches but both have defects.This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion(TCI)on blood loss and transfusion for total hip arthroplasty(THA)in elderly patients in comparison with combined spinal-epidural anesthesia(CSEA)or GA.Methods:Totally,240 patients(aged>65 years,American Society of Anesthesiologists[ASA]I-III)scheduled for posterior THA were enrolled from September 1st,2017 to March 1st,2018.All cases were randomly divided into three groups to receive CSEA(group C,w=80),GA(group G,n=80),or subarachnoid anesthesia and propofol TCI(group T,w=80),respectively.Primary outcomes measured were intra-operative blood loss,autologous and allogeneic blood transfusion,mean arterial pressure at different time points,length of stay in post-anesthesia care unit(PACU),length of hospital stay,and patient satisfaction degree.Furthermore,post-operative pain scores and complications were also observed.The difference of quantitative index between groups were analyzed by one-way analysis of variance,repeated measurement generalized linear model,Student-Newman-Keuls test or rank-sum test,while ratio index was analyzed by Chi-square test or Fisher exact test.Results:Basic characteristics were comparable among the three groups.Intra-operative blood loss in group T(331.53±64.33 mL)and group G(308.03±64.90 mL)were significantly less than group C(455.40±120.48 mL,F=65.80,P<0.001).Similarly,the autologous transfusion of group T(130.99±30.36 mL)and group G(124.09±24.34 mL)were also markedly less than group C(178.31±48.68 mL,F=52.99,P<0.001).The allogenetic blood transfusion of group C(0[0,100.00])was also significantly larger than group T(0)and group G(0)(Z=2.47,P=0.047).Except for the baseline,there were significant differences in mean arterial blood pressures before operation(F=496.84,P<0.001),10-min after the beginning of operation(F=351.43,P<0.001),30-min after the beginning of operation(F=559.89,P<0.001),50-min after the beginning of operation(F=374.74,P<0.001),and at the end of operation(F=26.14,P<0.001)among the three groups.Length of stay in PACU of group T(9.41±1.19 min)was comparable with group C(8.83±1.26 min),and both were significantly shorter than group G(16.55±3.10 min,F=352.50,P<0.001).There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores.Patient satisfaction degree of group T(77/80)was significantly higher than group C(66/80,%=7.96,P=0.004)and G(69/80,/2=5.01,P=0.025).One patient complained of post-dural puncture headache and two complained of low back pain in group C,while none in group T.Incidence of post-operative nausea and vomiting in group G(10/80)was significantly higher than group T(3/80,/2=4.10,P=0.043)and group C(2/80,x2=5.76,P=0.016).No deep vein thrombosis or delayed post-operative functional exercise was detected.Conclusions:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients,with less blood loss and peri-operative transfusion,higher patient satisfaction degree and fewer complications.Trial registration:chictr.org.cn:ChiCTR-IPR-17013461;http://www.chictr.org.cn/showproj.aspx?proj=23024.
