Journal of anesthesia
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Journal of anesthesia · Feb 2019
ReviewSpinal myoclonus following neuraxial anesthesia: a literature review.
Spinal myoclonus (SM) is a rare neurologic movement disorder following neuraxial anesthesia (NA). SM following NA (SM-NA) has insufficient clinical information and its pathogenesis remains to be elucidated. The aim of this review article was to summarize the past cases and consider SM-NA pathophysiology. ⋯ In the LA elimination process, the large concentration differences in intrathecal LA may induce the partially functioning spinal neurons, resulting in myoclonus generation. The morphological features of the lumbar spine in women can predispose to a higher LA concentration difference. SM-NA is an unpredictable and rare neural complication following NA and should be confirmed by basic experiments and large-scale researches.
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Journal of anesthesia · Feb 2019
Comment LetterIn reply: Use of low-molecular weight dextran as an LA adjuvant to extend LA action.
Abstract
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Journal of anesthesia · Feb 2019
Randomized Controlled Trial Comparative StudyLocal anesthetic spread into the paravertebral space with two types of quadratus lumborum blocks: a crossover volunteer study.
Previous work showed that 20 mL of local anesthetic (LA) did not spread into the paravertebral space (PVS) via the intramuscular quadratus lumborum block (QLBi). If spread of LA into the PVS can be achieved by increasing the total LA volume, QLBi can be more effective. We hypothesized that a larger volume of LA for the QLBi would spread into the PVS. ⋯ LA administered by the QLB2 spreads into the PVS of T10-T12, resulting in lower and lateral abdominal sensory loss. In contrast, LA administered by the QLBi does not spread into the PVS and results in only lateral abdominal sensory loss.
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Journal of anesthesia · Feb 2019
Multicenter Study Comparative Study Observational StudyCrystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial.
Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading. ⋯ Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid.
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Journal of anesthesia · Feb 2019
Surface contamination in the operating room: use of adenosine triphosphate monitoring.
We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. ⋯ Apart from the OR floors, laryngoscope handles emerged as a key OR site where improved cleaning practices may reduce cross-contamination risk. While some sites showed increased contamination over the course of the day, none of these met statistical significance thereby offering tentative evidence that current cleaning practices during case turnover are effective for most sites.