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Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter

Year 2018, Volume: 4 Issue: 3, 123 - 131, 14.10.2018

Abstract

Amaç: Bu çalışmada femur kırığı nedeniyle total kalça protezi planlanan ve Amerikan Anesteziyoloji Derneği (ASA) Sınıf ≥III olan 65 yaş üzeri hastalarda iki santral blok yöntemi olan sürekli spinal anestezi ile kombine spinal-epidural anestezi kıyaslandı.

Hastalar ve yöntemler: Çalışmaya toplam 40 ardışık hasta dahil edildi. Hastalar sürekli spinal anestezi grubu (Grup 1; n=20) ve kombine spinal-epidural anestezi grubu (Grup 2; n=20) olarak iki gruba ayrıldı. Santral blok girişimleri L3-4 aralığından yapıldı. Grup 1’e spinal kateterden 2.5 µg %0.5 izobarik bupivakain verildi. Grup 2’ye 7.5 µg %0.5 izobarik bupivakain ile spinal anestezisi yapılarak epidural kateter takıldı. Blok etkinliği, Bromage ve pinprick testleri ile değerlendirildi ve pik süreleri kaydedildi. Ameliyat sırasında ve sonrasında vital bulgular ve motor ve duyusal blok seviyeleri ölçüldü ve Görsel Analog Ölçeği (GAÖ) ve Ramsey Sedasyon Ölçeği (RSS) skorları kaydedildi.

Bulgular: Çalışma grupları arasında demografik özellikler açısından istatistiksel olarak anlamlı bir fark yoktu. Grup 2’nin ameliyat öncesi ve sonrası kalp atım hızında istatistiksel olarak anlamlı bir fark saptandı. Gruplar arasında motor ve duyusal blok pik süreleri, duyusal blok seviyesi ve motor blok dereceleri arasında istatistiksel olarak anlamlı bir fark izlendi. Grupların ameliyat sırası ve sonrası GAÖ ve RSS skorları arasında istatistiksel olarak anlamlı bir fark bulundu.

Sonuç: Sürekli spinal anestezi, geriatrik hastalarda, yüksek sempatik blok ile gelişen hemodinamik bozuklukların azaltılmasında güvenli bir anestezi tekniği olup, derlenme dönemi daha kısa ve komplikasyonsuz olmaktadır.

References

  • 1. Atkinson RS, Rushman GB, Davies NJH. Lee’s Synopsis of Anaesthesia. 11th ed. Boston: Butterwarth-Heinemann Ltd.; 1993. 2. White PF. Outpatient anaesthesia. Miller RD, editor. Anesthesia. 3rd ed. NewYork: Churchill- Livingstone; 1990. p. 2025-9. 3. Shenkman Z, Eidelman LA, Cotev S. Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy. Can J Anaesth 1997;44:1042-6. 4. Schnider TW, Mueller-Duysing S, Jöhr M, Gerber H. Incremental dosing versus single-dose spinal anesthesia and hemodynamic stability. Anesth Analg 1993;77:1174-8. 5. Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoïpe M, Lassié P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus single dose versus titration through a catheter. Anaesthesia & Analgesia 1996;82:312-7. 6. Shenkman Z, Eidelman LA, Cotev S. Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy. Can J Anaesth 1997;44:1042-6. 7. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906-16. 8. Morton CPJ, Armstrong PJ, McClure JH. Continuous subarachnoid infusion of local anaesthesic. BJA 1992;69:533. 9. Collard CD, Eappen S, Lynch EP, Concepcion M. Continuous spinal anesthesia with invasive hemodynamic monitoring for surgical repair of the hip in two patients with severe aortic stenosis. Anesth Analg 1995;81:195-8. 10. Wilhelm S, Standl T, Burmeister M, Kessler G, Schulte am Esch J. Comparison of continuous spinal with combined spinal-epidural anesthesia using plain bupivacaine 0.5% in trauma patients. Anesth Analg 1997;85:69-74. 11. Bernard CM. Epidural and spinal anaesthesia., In: Barash PG, editor. Anaesthesia. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 645-68. 12. Barnard MJ, Drasner K. Continuous spinal anaesthesia with 28 G catheter. BJA 1991:66:411-2. 13. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin 1989;27:31-9. 14. Gratadour P, Viale JP, Parlow J, Sagnard P, Counioux H, Bagou G, et al. Sympathovagal effects of spinal anesthesia assessed by the spontaneous cardiac baroreflex. Anesthesiology 1997;87:1359-67. 15. McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993;70:672-80. 16. Rigler ML, Drasner K. Distribution of catheter-injected local anesthetic in a model of the subarachnoid space. Anesthesiology 1991;75:684-92. 17. Klimscha W, Weinstabl C, Ilias W, Mayer N, Kashanipour A, Schneider B, et al. Continuous spinal anesthesia with a microcatheter and low-dose bupivacaine decreases the hemodynamic effects of centroneuraxis blocks in elderly patients. Anesth Analg 1993;77:275-80. 18. King H, Wooten DJ, Liao BS. Continuous spinal anaesthesia with hyperbaric and isobaric bupivacaine. Anaesthesia & Analgesia 1991;73:647-76. 19. Van Gessel EF, Praplan J, Fuchs T, Forster A, Gamulin Z. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg 1993;77:483-7. 20. Petros AJ, Barnard M, Smith D, Ronzoni G, Carli F. Continuous spinal anesthesia: dose requirements and characteristics of the block. Reg Anesth 1993;18:52-4. 21. Lowson SM, Brown J, Wilkins CJ. Influence of the lumbar interspace chosen for injection on the spread of hyperbaric 0.5% bupivacaine. Br J Anaesth 1991;66:465-8. 22. Morrison LM, McClure JH, Wildsmith JA. Clinical evaluation of a spinal catheter technique in femoro-popliteal graft surgery. Anaesthesia 1991;46:576-8. 23. Standl T, Beck H. Influence of the subarachnoid position of microcatheters on onset of analgesia and dose of plain bupivacaine 0.5% in continuous spinal anesthesia. Reg Anesth 1994;19:231-6. 24. Standl T, Eckert S, Rundshagen I, Schulte am Esch J. A directional needle improves effectiveness and reduces complications of microcatheter continuous spinal anaesthesia. Can J Anaesth 1995;42:701-5. 25. Marette A, Richardson JM, Ramlal T, Balon TW, Vranic M, Pessin JE, et al. Abundance, localization, and insulin-induced translocation of glucose transporters in red and white muscle. Am J Physiol 1992;263:443-52. 26. Pappa X, Pouliou K, Nastou H, Dovinou K, Kyriakidis A. The potential for contamination of continuous spinal catheters. Acta Anaesthesiol Belg 1994;45:107-12. 27. Drasner K, Sakura S, Chan VW, Bollen AW, Ciriales R. Persistent sacral sensory deficit induced by intrathecal local anesthetic infusion in the rat. Anesthesiology 1994;80:847-52. 28. Barnard MJ, Drasner K. Continuous spinal anaesthesia with 28 G catheter. BJA;66:411-2.
Year 2018, Volume: 4 Issue: 3, 123 - 131, 14.10.2018

Abstract

References

  • 1. Atkinson RS, Rushman GB, Davies NJH. Lee’s Synopsis of Anaesthesia. 11th ed. Boston: Butterwarth-Heinemann Ltd.; 1993. 2. White PF. Outpatient anaesthesia. Miller RD, editor. Anesthesia. 3rd ed. NewYork: Churchill- Livingstone; 1990. p. 2025-9. 3. Shenkman Z, Eidelman LA, Cotev S. Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy. Can J Anaesth 1997;44:1042-6. 4. Schnider TW, Mueller-Duysing S, Jöhr M, Gerber H. Incremental dosing versus single-dose spinal anesthesia and hemodynamic stability. Anesth Analg 1993;77:1174-8. 5. Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoïpe M, Lassié P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus single dose versus titration through a catheter. Anaesthesia & Analgesia 1996;82:312-7. 6. Shenkman Z, Eidelman LA, Cotev S. Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy. Can J Anaesth 1997;44:1042-6. 7. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906-16. 8. Morton CPJ, Armstrong PJ, McClure JH. Continuous subarachnoid infusion of local anaesthesic. BJA 1992;69:533. 9. Collard CD, Eappen S, Lynch EP, Concepcion M. Continuous spinal anesthesia with invasive hemodynamic monitoring for surgical repair of the hip in two patients with severe aortic stenosis. Anesth Analg 1995;81:195-8. 10. Wilhelm S, Standl T, Burmeister M, Kessler G, Schulte am Esch J. Comparison of continuous spinal with combined spinal-epidural anesthesia using plain bupivacaine 0.5% in trauma patients. Anesth Analg 1997;85:69-74. 11. Bernard CM. Epidural and spinal anaesthesia., In: Barash PG, editor. Anaesthesia. 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1996. p. 645-68. 12. Barnard MJ, Drasner K. Continuous spinal anaesthesia with 28 G catheter. BJA 1991:66:411-2. 13. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin 1989;27:31-9. 14. Gratadour P, Viale JP, Parlow J, Sagnard P, Counioux H, Bagou G, et al. Sympathovagal effects of spinal anesthesia assessed by the spontaneous cardiac baroreflex. Anesthesiology 1997;87:1359-67. 15. McCrae AF, Wildsmith JA. Prevention and treatment of hypotension during central neural block. Br J Anaesth 1993;70:672-80. 16. Rigler ML, Drasner K. Distribution of catheter-injected local anesthetic in a model of the subarachnoid space. Anesthesiology 1991;75:684-92. 17. Klimscha W, Weinstabl C, Ilias W, Mayer N, Kashanipour A, Schneider B, et al. Continuous spinal anesthesia with a microcatheter and low-dose bupivacaine decreases the hemodynamic effects of centroneuraxis blocks in elderly patients. Anesth Analg 1993;77:275-80. 18. King H, Wooten DJ, Liao BS. Continuous spinal anaesthesia with hyperbaric and isobaric bupivacaine. Anaesthesia & Analgesia 1991;73:647-76. 19. Van Gessel EF, Praplan J, Fuchs T, Forster A, Gamulin Z. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg 1993;77:483-7. 20. Petros AJ, Barnard M, Smith D, Ronzoni G, Carli F. Continuous spinal anesthesia: dose requirements and characteristics of the block. Reg Anesth 1993;18:52-4. 21. Lowson SM, Brown J, Wilkins CJ. Influence of the lumbar interspace chosen for injection on the spread of hyperbaric 0.5% bupivacaine. Br J Anaesth 1991;66:465-8. 22. Morrison LM, McClure JH, Wildsmith JA. Clinical evaluation of a spinal catheter technique in femoro-popliteal graft surgery. Anaesthesia 1991;46:576-8. 23. Standl T, Beck H. Influence of the subarachnoid position of microcatheters on onset of analgesia and dose of plain bupivacaine 0.5% in continuous spinal anesthesia. Reg Anesth 1994;19:231-6. 24. Standl T, Eckert S, Rundshagen I, Schulte am Esch J. A directional needle improves effectiveness and reduces complications of microcatheter continuous spinal anaesthesia. Can J Anaesth 1995;42:701-5. 25. Marette A, Richardson JM, Ramlal T, Balon TW, Vranic M, Pessin JE, et al. Abundance, localization, and insulin-induced translocation of glucose transporters in red and white muscle. Am J Physiol 1992;263:443-52. 26. Pappa X, Pouliou K, Nastou H, Dovinou K, Kyriakidis A. The potential for contamination of continuous spinal catheters. Acta Anaesthesiol Belg 1994;45:107-12. 27. Drasner K, Sakura S, Chan VW, Bollen AW, Ciriales R. Persistent sacral sensory deficit induced by intrathecal local anesthetic infusion in the rat. Anesthesiology 1994;80:847-52. 28. Barnard MJ, Drasner K. Continuous spinal anaesthesia with 28 G catheter. BJA;66:411-2.
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Details

Primary Language Turkish
Journal Section Articles
Authors

Gülay Eren This is me

Oya Hergünsel This is me

Yasemin Tekdoş Şeker

Publication Date October 14, 2018
Published in Issue Year 2018 Volume: 4 Issue: 3

Cite

APA Eren, G., Hergünsel, O., & Tekdoş Şeker, Y. (2018). Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, 4(3), 123-131.
AMA Eren G, Hergünsel O, Tekdoş Şeker Y. Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. October 2018;4(3):123-131.
Chicago Eren, Gülay, Oya Hergünsel, and Yasemin Tekdoş Şeker. “Geriatrik Total kalça Protezi ameliyatlarında sürekli Santral Blok: Eski Dost Spinal Kateter”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4, no. 3 (October 2018): 123-31.
EndNote Eren G, Hergünsel O, Tekdoş Şeker Y (October 1, 2018) Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4 3 123–131.
IEEE G. Eren, O. Hergünsel, and Y. Tekdoş Şeker, “Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter”, İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, vol. 4, no. 3, pp. 123–131, 2018.
ISNAD Eren, Gülay et al. “Geriatrik Total kalça Protezi ameliyatlarında sürekli Santral Blok: Eski Dost Spinal Kateter”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4/3 (October 2018), 123-131.
JAMA Eren G, Hergünsel O, Tekdoş Şeker Y. Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2018;4:123–131.
MLA Eren, Gülay et al. “Geriatrik Total kalça Protezi ameliyatlarında sürekli Santral Blok: Eski Dost Spinal Kateter”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, vol. 4, no. 3, 2018, pp. 123-31.
Vancouver Eren G, Hergünsel O, Tekdoş Şeker Y. Geriatrik total kalça protezi ameliyatlarında sürekli santral blok: Eski dost spinal kateter. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2018;4(3):123-31.