Factors resulting in underutilization of pediatric spinal anesthesia in South Punjab (Pakistan)

Background & objectives: Spinal anesthesia in children a useful alternative to general anesthesia, is not usually practiced in most of the hospitals of South Punjab. We aimed to evaluate the utilization of spinal anesthesia in children in South Punjab (Pakistan) and to discover the elements preventing its use in children. Methodology: A questionnaire was delivered to all 47 FCPS qualified anesthesiologists working in South Punjab vide e-mail and whatsapp messages to them. Out of 47 anesthesiologists, 38 (80.85%) responded. Questionnaire consisted of 3 components. All participants were asked to fill the first component regarding demographic data, but only those who did not administer spinal in children, needed to fill second and third components. In the second component, structured questions with scale 1 to 5 (strongly disagree to strongly agree). In the third component, the participant had open choice to write three most important factors (most important, second most and third most) prohibiting the practice of spinal anesthesia in children. Results: All of the 47 senior anesthesiologists working in South Punjab were included in this survey. The response rate was 80.85%. Demographic data showed 33/38 (87%) males and 05/38 (13%) females, mean age 44.34 ± 11.06 yrs, mean of total experience in anesthesia 17.03 ± 9.12 yrs and mean experience after postgraduation 8.01 ± 6.85 yrs. The number of respondents administering spinal anesthesia in children was just 3 (7.88%) and 35 (92%) never used spinal in children. Lack of expertise/training/guidance (4.69 ± 0.83) is the most common cause prohibiting the use of pediatric spinal anesthesia followed by risk of high/total spinal (4.14 ± 1.31), lack of cooperation of child (3.83 ± 1.34), risk of spinal cord injury (3.71 ± 1.51), difficulty in assessment of block (3.34 ± 1.64). Less common factors avoiding pediatric spinal include objection by family, objection by surgeon and lack of proper recommendations. The number of participants considering lack of expertise/training/guidance most important factors for avoiding spinal anesthesia in children was 9 (25.71%), followed by uncooperative children 8 (22.86%), risk of spinal cord damage 5 (14.28%), risk of high/total spinal 3 (8.57%) and objection by family 3 (8.57%). Other factors quoted were objection by the surgeon, risk of postdural puncture headache, risk of neurological complications, being short duration, not recommended and not acceptable by society. Conclusion: Pediatric spinal anesthesia is practiced by only three consultants (7.88%) in South Punjab out of a total of 47. There is a need to enhance the expertise level of the anesthesiologists during postgraduate training and to remove the fears / phobias attached with this particular practice. Key words: Pediatric; Anesthesia, Spinal; Barriers; South Punjab Citation: Durrani HD, Sadaf S, Naqvi SAA, Siddique A, Bajwa MH. Factors resulting in underutilization of pediatric spinal anesthesia in South Punjab (Pakistan). Anaesth. pain intensive care 2020;24(6):--- Received: 20 August 2020, Reviewed: 17 October 2020, Revised: 25 October 2020, Accepted: 6 October 2020

Awake Endospine Disektomi pada Pasien Lumbar Spinal Stenosis karena Hernia Nucleus Pulposus

Lumbar spinal stenosis (LSS) are symptoms from degradation canalis spinalis vertebrae’s size which pressured nerve inside it. Based on its cause, there are two types of LSS, congenital and degenerative. The patient can experience an unpredictable pain phase as well as a stable phase without pain. Bulging of intervertebralis disc or HNP is one of degenerative LSS. HNP disease is one of the causes of low back pain and is a major health problem. HNP prevalention is 1-2 % from population. One of therapy use to medicate LSS is endospine discectomy. This operation done with general anesthesia (GA) or neuroaxial anesthesia (spinal, epidural). GA preferably used because it caused less side effect like airway obstruction or neural injury. Dexmedetomidine has a sedative effect without the risk of respiratory depression and has an analgesic effect. It can be used to awake endospine methods in dissectomy. In this case report, the writer did awake endospine method to accommodate operator so they could know level of pain and motoric function of patient durante operation.

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

SPECIFIC ASPECTS OF ANESTHESIA IN PROCTOLOGY

Proctology, as a domain of abdominal surgery, deals with the treatment of diseases affecting the end part of the large bowel, it’s terminal 20 cm, to which anus anatomically belongs as well. In view of the physiological role of this part of the digestive tract (stool control), all the diseases and disorders in the region cause patient discomfort and produce significant problems in everyday life. On account of that, diagnostic management should be performed promptly in order that effective treatments could be introduced as soon as possible. The most commonly used techniques of anesthesia in proctology are local anesthesia, independent or in combination with intravenous analgosedation, regional anesthesia (spinal and epidural), and general anesthesia. Local anesthesia combined with analgosedation has been the preferred approach in recent studies, since it is able to provide adequate settings for the planned surgery, patient comfort and minimization of side effects. An adequate anesthesia technique reduces metabolic response to surgical stress and length of hospitalization, which markedly affects cost-effectiveness of the treatment.

The Difference Duration between Analgesia Bupivacaine Hyperbaric Morphine and Bupivacaine Hyperbaric Epinephrine Intrathecal toward Post Surgery of Sectio Caesaria Patient in Bhayangkara Mataram Hospital

Background and Objectives: The most used of regional anesthesia technic is spinal anesthesia. Spinal anesthesia is an easier technic to get the depth and speed of nerve blockade. Some medicine can be used as an adjuvant of local anesthesia to increase the effect of analgesia bupivacaine. This research is aimed to compare the effectiveness of administration of 0.1 mg intrathecal morphine and 0.1 mg intrathecal epinephrine to prolong 0.5% 12.5 mg hyperbaric analgesia bupivacaine toward caesarean section postoperative period. Method: This research is an experimental clinical trial randomized double-blind phase II. Subject of this study is the elective surgery patients (ASA I and II) with spinal anesthesia who are 18–40 years old and having weight around 50–70 kgs. There are 48 patients that is divided into 2 groups; 24 patients of group M (morphine 0.1 mg) and 24 patients of group E (epinephrine 0.1 mg). Result: The result of this study revealed the duration of analgesia is longer in group M (morphine 0.1 mg) than group T (tramadol 25 mg) (309.08±5.55 vs 221.66±6.43). Conclusion: adjuvant of 0.1 mg morphine and 0.5% 12.5 mg intrathecal hyperbaric bupivacaine can make the work period of analgesia longer while post caesaria section surgery rather than 0.5% 12.5 mg bupivacaine and 0.1 intrathecal epinephrine.

Total Hip Arthroplasty

This chapter discusses the goals, procedure, and potential outcomes of total hip arthroplasty (THA). Patients may be candidates for a THA when they have severe arthritis of their hip(s) (degeneration of cartilage covering the ends of the bones creating the hip joint). Arthritic hip pain is often progressive and gets worse as the cartilage continues to deteriorate. Typically, at the time a patient seeks hip arthroplasty, his or her quality of life has become very compromised. In a total hip arthroplasty, damaged bone and cartilage of the hip joint are removed and replaced with prosthetic components. THA can be performed under neuraxial anesthesia (spinal or epidural) or general anesthesia or a combination of both.

Kateter Epidural Terputus Saat Dipasang

Latar belakang: Anestesia epidural adalah satu bentuk dari anestesia regional dan merupakan salah satu bentuk teknik blok neuroaksial, dimana penggunaannya lebih luas daripada anesthesia spinal. Teknik epidural sangat luas penggunaanya pada anestesia operatif, analgesia untuk kasus obstetri, analgesia post operatif dan untuk nyeri kronis. Morbiditas dan bahkan mortalitas pascaoperasi dapat dikurangi ketika blokade neuraksial digunakan, baik sebagai agen tunggal maupun sebagai kombinasi dengan anestesi umum. Kasus: Seorang wanita usia 45th, ASA II dengan Adenokarsinoma Lambung yang akan menjalani operasi Gastrektomi Parsial. Penilaian preoperasi pasien sudah dalam kondisi yang optimal. Direncanakan akan dilakukan anestesi dengan teknik Epidural, insersi pada ruang intervertebra lumbal 3-4 dengan pemasangan kateter epidural tetapi gagal dipasang dan terputus 1cm saat pencabutan. Kemudian teknik anestesi dikonversi menjadi anestesi umum.Pembahasan: Kerusakan kateter adalah komplikasi yang dapat dikenali pada anestesi epidural, sering dikaitkan dengan trauma pada penusukan jarum epidural atau kekuatan yang berlebihan saat penarikan kateter. Pemeriksaan CT scan lebih sensitif daripada MRI dalam mendeteksi fragmen kateter dalam ruang epidural dan lebih sensitif dengan radiografi polos, terutama untuk fragmen kecil. Pengelolaan post operasi, potongan kateter epidural yang dianggap benda asing umumnya dianggap sebagai tidak aktif dan seharusnya tidak menghasilkan reaksi tubuh.Kesimpulan: Meskipun dikatakan potongan kateter epidural yang dianggap benda asing umumnya tidak menghasilkan reaksi tubuh. Pada kebanyakan kasus, standard penanganan terputusnya segmen kateter epidural, adalah dengan membiarkan dengan pengawasan sampai muncul gejala simptomatik. Namun, ada situasi di mana operasi pengangkatan harus dilakukan.

Transient Neurologic Symptoms following Spinal Anesthesia with Isobaric Mepivacaine: A Decade of Experience at Toronto Western Hospital

Background. Transient neurologic symptoms (TNSs) can be distressing for patients and providers following uneventful spinal anesthesia. Spinal mepivacaine may be less commonly associated with TNS than lidocaine; however, reported rates of TNS with intrathecal mepivacaine vary considerably. Materials and Methods. We conducted a retrospective cohort study reviewing the internal medical records of surgical patients who underwent mepivacaine spinal anesthesia at Toronto Western Hospital over the last decade to determine the rate of TNS. We defined TNS as new onset back pain that radiated to the buttocks or legs bilaterally. Results. We found one documented occurrence of TNS among a total of 679 mepivacaine spinal anesthetics (0.14%; CI: 0.02–1.04%) that were performed in 654 patients. Conclusion. Our retrospective data suggest that the rate of TNS associated with mepivacaine spinal anesthesia is lower than that previously reported in the literature.

PERBANDINGAN NYERI YANG TERJADI 24 JAM PASCA OPERASI PADA PENDERITA YANG DIBERIKAN ANESTESIA UMUM DAN ANESTESIA SPINAL

Pain can be described as an unpleasant sensory and emotional experience associated with tissue damage which has already occured or potentially will be occurred. General anesthesia is oftenly perfomed on a wide range of surgical procedures. There are two techniques of general anesthesia: inhalation anesthesia and intravenous anesthesia. Spinal anesthesia is one of the simplest and most reliable of regional anesthesia technique. This study aimed to compare the pain between general anesthesia and spinal anesthesia 24 hours post operative. This was an analytical prospective study. Samples were 24 patients consisting of 12 patients with general anesthesia and 12 patients with spinal anesthesia. The inclusion criteria were patients aged 20-60 years old, duration of operation 1-4 hours, and the operations were caesarean section and hysterectomy. The pain assessment used VAS score as well as blood pressure, pulse, and respiration. Data were statistically analyzed by using the Mann-Whitney test and showed a p-value 0.876. Conclusion: There was no significant difference in 24-hour-post-operative pain using VAS score among patients with general anesthesia and with spinal anesthesia.Keywords: VAS scores, general anesthesia, spinal anesthesia.Abstrak: Nyeri dapat digambarkan sebagai suatu pengalaman sensorik dan emosional yang tidak menyenangkan yang berkaitan dengan kerusakan jaringan yang sudah atau berpotensi terjadi. Anestesia umum sering dilalukan pada berbagai macam prosedur pembedahan dan terbagi atas anestesia inhalasi dan anestesia intravena. Anestesia spinal merupakan salah satu anestesia yang paling sederhana dan paling dapat diandalkan dari tehnik anestesia regional. Penelitian ini bertujuan untuk mengetahui perbandingan nyeri pada pemberian anestesia umum dan anestesia spinal 24 jam pasca operasi. Penelitian ini menggunakan metode analitik prospektif. Terdapat 24 sampel yang terbagi atas 12 penggunaan anestesia umum dan 12 penggunaan anestesia spinal, dengan kriteria rentang umur pasien 20-60 tahun, lama operasi 1-4 jam serta jenis pembedahan seksio sesarea dan histerektomi. Penilaian nyeri menggunakan skor VAS serta tekanan darah, nadi dan respirasi. Data diolah dengan menggunakan program SPSS versi 20. Hasil uji statistik Mann-Whitney mendapatkan nilai p= 0,876 yang menunjukkan tidak terdapat perbedaan bermakna dari skor VAS. 24 jam pasca operasi dengan anestesia umum dan anestesia spinal. Simpulan: Tidak terdapat perbedaan bermakna nyeri 24 jam pasca operaasi dinilai dengan skor VAS pada pemberian anestesia umum dan anestesia spinal.Kata kunci: Skor VAS, anestesia general, anestesia spinal