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Continuous spinal anaesthesia using a standard epidural set for extracorporeal shockwave lithotripsy

  • Ze’ev Shenkman
  • Leonid A. Eidelman
  • Shamay Cotev
Reports of Investigation

Abstract

Purpose

Continuous spinal anaesthesia (CSA) offers considerable advantages over “single shot” spinal or epidural anaesthesia since it allows titration of anaesthesia using small doses of local anaesthetics (LA). We evaluated the feasibility of CSA using a standard epidural set for extracorporeal shockwave lithotnpsy (ESWL).

Methods

Charts of 100 consecutive CSAs for ESWL were retrospectively reviewed. Lumbar CSA was performed using a 20G epidural catheter through an 18G Tuohy needle. The CSA was preplanned, or followed inadvertent dural puncture. Small LA boluses were injected to achieve the desired sensory level of anaesthesia. Demographic data, anaesthetic duration, LA doses, the most cephalad sensory level to pinprick, arterial blood pressure, heart rate, use of systemic sympathomimetics and complications were recorded.

Results

Mean age was 66.2 ± 9.9 (SD). The ASA status was III–IV in 54.1 % and 5.5% of the preplanned and inadvertent patients, respectively. In 85 anaesthetics, hyperbanc bupivacaine 0.1% (9.7 ± 7.5 mg) was used as the sole anaesthetic. Sensory level was T4-T8. Maximal decrease in systolic and diastolic blood pressures and heart rate was 19.0 ± 9.8%, 13.4 ± 13.3%, and 7.2 ± 11.7 respectively. Intravenous sympathomimetics were used in nine of 82 (11.0%) preplanned, and in six of 18 (33.3%) inadvertent anaesthetics. Post dural puncture headache appeared following two of 82 (2.5%) preplanned, and four of 18 (22.2%) inadvertent anaesthetics. No postanaesthetic neurological deficit was detected.

Conclusion

Continuous spinal anaesthesia, using a standard epidural set and hyperbaric bupivacaine is feasible for ESWL in high risk patients. Inadvertent dural puncture does not preclude CSA under these circumstances.

Keywords

Bupivacaine Subarachnoid Space Extracorporeal Shockwave Lithotripsy Single Shot Sensory Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Parce qu’elle permet de trtrer l’anesthesie avec des doses minimes d’anésthesique local (AL), la rachianesthésie continue (RAC) offre des avantages considérables sur la rachianesthésie et l’épidurale à injection unique. Nous avons recherché s’il était possible d’administrer la RAC avec un plateau épidural standard pour la lithotnpsie extracorporelle par ondes de choc (LEOC).

Méthodes

L’étude a consiste à revoir rétrospectivement les dossiers de 100 interventions de LEOC consécutives. La rachianesthésie lombaire était réalisée avec un cathéter épidural 20G introduit à travers une Tuohy 18G. La RAC faisart partie de la planification originale ou suivait une ponction accidentelle de la dure-mère. Le niveau sensoriel d’anesthésie désiré étart atteint par l’injection de petits bolus d’AL. Les données démographiques, la durée de l’anesthésie, les doses d’AL, le niveau céphalique maximal déterminé par piqûre. la pression artérielle, la fréquence cardiaque, l’utilisation de sympathicomimétiques et les complications ont été enregistrées.

Resultats

L’âge moyen était 66,2 ± 9,9 (ÉT). Le pourcentage d’état physique ASA III-IV representart 54, 1% des patients prévus et de 5,5% chez les patients imprévus. Quatre-vingt-dnq patients n’ont reçu que de la bupivacaïne hyperbare à 0,1 % (9,7 ± 7,5 mg). Le niveau sensoriel atteint se situait entre T4 et T8. Les chutes maximales des pressions systolique et diastolique et de la fréquence cardiaque étaient de 19 ± 9,8%, 13,4 ± 13,3% et 7,2 ± 11,7 bpm. Il a fallu administrer des sympathicomimétiques intraveineux à 9 des 82 (11,0%) des patients prévus et à six des 18 (33,3%) des imprévus. Une céphalée postrachianesthésie s’est manifestée après 2 des 82 (2,5%) RAC prévues et quatre de 18 (22,2%) imprévues. Il n’y a pas eu de déficit neurologique.

Conclusion

Il est possible d’administrer une rachianesthésie continue avec un plateau épidural standard et de la bupivacaïne hyperbare pour la LEOC chez des patients à haut risque. Une ponction accidentelle de la duremère n’exclut pas la RAC dans ces circonstances.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Ze’ev Shenkman
    • 1
  • Leonid A. Eidelman
    • 1
  • Shamay Cotev
    • 1
  1. 1.Department of Anesthcsiology and CCMHadassah University Hospital and Hebrew University Hadassah School of MedicineJerusalemIsrael

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