INTRODUCTION: Postoperative urinary retention (POUR) frequently complicates the course of patients following hip and knee arthroplasty. Intrathecal morphine (ITM) was identified as a significant risk factor for POUR. The objective of this study was to investigate the incidence and risk factors for POUR in fast-track total joint arthroplasty (TJA) under spinal anaesthesia (SA) with ITM. METHODS: We conducted a retrospective study of our institutional joint registry of patients who underwent primary TJA under SA with ITM between October 2017 and May 2021. Preoperative (baseline demographics) and perioperative data were collected. The primary outcome was the incidence of POUR after 8 h or earlier, either due to lack of voiding or according to patient's complaints of bladder distension. Univariate and adjusted analyses were performed to identify predictors of POUR. RESULTS: Sixty-nine patients who underwent total knee arthroplasty (TKA) and 36 patients who underwent total hip arthroplasty (THA) under SA with ITM were included in the study. POUR requiring bladder catheterisation was diagnosed in 21% of patients. Independent predictors of POUR were age over 65 years and male gender. CONCLUSIONS SA with ITM for TJA is associated with high rates of POUR in males older than 65 years of age. Other previously identified risk factors such as intraoperative fluid administration or comorbidities may not be as influential.
Humans ; Retrospective Studies ; Male ; Urinary Retention/epidemiology* ; Arthroplasty, Replacement, Knee/adverse effects* ; Anesthesia, Spinal/adverse effects* ; Female ; Arthroplasty, Replacement, Hip/adverse effects* ; Morphine/adverse effects* ; Aged ; Middle Aged ; Risk Factors ; Postoperative Complications/epidemiology* ; Injections, Spinal ; Incidence ; Analgesics, Opioid/adverse effects* ; Aged, 80 and over

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Achondroplasia is a rare genetic disorder that affects endochondral ossification resulting in decreased linear bone growth. It is a form of primary skeletal dysplasia that accounts for more than 90% of disproportionate short stature in humans with an incidence of approximately 1 in 15,000–1 in 40,000 live births. These patients present with a characteristic craniofacial appearance along with musculoskeletal, respiratory, and cardiac abnormalities that, when superimposed with the physiological changes of pregnancy, may complicate anesthetic management. The paucity of evidence-based recommendations and protocols for the anesthetic management of parturients with achondroplasia for cesarean delivery poses a challenge in the choice of anesthesia and warrant special anesthetic considerations. Knowing the intricate relationship between the existing anatomical and physiological changes in achondroplasia and pregnancy is crucial for favorable patient outcomes. This is a case report of a 26-year-old primipara with achondroplasia who had a cesarean delivery for malpresentation under spinal anesthesia.

Background and Objective: Brachytherapy is the only demonstrated technique of delivering the high radiation dose required to control cervical cancer (>80 Gray [Gy]) without causing unwanted side effects. There is still limited data available in the Philippines regarding the anesthetic management of patients receiving intracavitary brachytherapy for cervical cancer. It is the aim of this study to present the anesthetic management of these procedures performed in a non-operating site remote from the main hospital during the first 1 ½ years of the COVID-19 pandemic. Methods: A retrospective review of 446 eligible charts was made. Data collected included demographic variables, ASA physical status classification, anesthetic technique, anesthetic agents used, oxygen supplementation device, duration of procedure, intra-procedure complication, intra-procedure pain medications, post-procedure pain medications, recovery room (RR) rescue medications, time to fulfill discharge criteria, and patient disposition. Results: Four hundred forty-six (446) anesthetic encounters involving 117 patients is presented. Charts from 46 patients were excluded as it cannot be located. Mean age of the patients was 49 years with majority having normal BMI. Spinal anesthesia (SA) was more frequently (75%) used compared to total intravenous anesthesia (TIVA). Less than 5% immediate anesthesia-related complications were recorded and all patients were discharged on the same day. Conclusion Spinal anesthesia and TIVA are safe and effective anesthetic techniques in patients with cervical cancer undergoing high dose intracavitary brachytherapy. Prospective studies to assess other aspects of their care as well as anesthesia-related long-term effects from repetitive anesthetic exposure is recommended.
brachytherapy ; uterine cervical neoplasm ; anesthesia, spinal ; anesthesia, intravenous

Ruptured Sinus of Valsalva (RSOV) is a rarely encountered cardiac anomaly that can potentially lead to adverse clinical outcomes. RSOV increases the risk of morbidity during pregnancy due to the physiological changes associated with gestation, that can exacerbate the underlying cardiac pathology. We present the case of a 29-year-old female with an uncorrected RSOV who required an emergency cesarean section for abruptio placenta. The patient underwent the procedure under spinal anesthesia, with careful titration of norepinephrine infusion and close monitoring of hemodynamic parameters using an invasive intra-arterial line. Given the absence of established anesthetic protocols for parturients with RSOV undergoing cesarean delivery, a comprehensive understanding of the complex interaction between the hemodynamic effects of RSOV, pregnancy, and anesthesia is essential. This understanding enables the safe use of spinal anesthesia in urgent situations, leading to favorable patient outcomes.
Sinus of Valsalva ; Aortic Rupture ; Cesarean Section ; Anesthesia, Spinal

Humans ; Joint Dislocations/surgery* ; Spinal Fractures/surgery* ; Anesthesia, General ; Cervical Vertebrae/injuries* ; Spinal Fusion

Introduction: Shivering is defined as an involuntary, repetitive activity of skeletal muscles. Mechanisms of shivering for patients undergoing surgical operation include intraoperative heat loss, increase sympathetic tone, pain, and systemic release of pyrogens. Regional anesthesia, particularly spinal anesthesia causes redistribution of core heat to the peripheral tissues this in turn predisposes patient to shivering and hypothermia. The median incidence of shivering related to regional anesthesia observed in a review of 21 studies is 55%. Paracetamol is one of the most commonly used analgesic and antipyretic drugs around the world, available without a prescription, it has analgesic and antipyretic property similar to NSAIDs it also affects core body temperature through the hypothalamus. Though different modalities have been established for shivering prevention, the search for a cost-effective drug with lesser side effects and improvement of patient satisfaction still continues. Objective: The aim of this study was to evaluate the effect of prophylactic dose of Paracetamol on postanesthesia shivering on patients undergoing, gynecological procedures under spinal anesthesia as compared to patients not given Paracetamol. Methodology This is a Double blind, Randomized, Placebo Controlled conducted in patients scheduled for benign gynecological procedures such as Hysterectomy with or without adnexectomy. Using simple random sampling through fishbowl method and a sample size of 42, all patients who consented to participate in the study was randomly assigned to receive Paracetamol 900 mg IV or Placebo 0.9% Saline intravenously 30 minutes prior to induction of spinal anesthesia. Incidence and severity of Shivering was documented using shivering five point scale outlined by Crossley and Mahajan, while patient satisfaction was also evaluated using the Likert Scale, possible side effects was also assessed.
Acetaminophen ; Anesthesia, Spinal

BACKGROUND: Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients. METHODS: In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth. RESULTS: In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008). CONCLUSION: In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits. TRIAL REGISTRATION ClinicalTrials.gov, NCT02542748; https://clinicaltrials.gov/ct2/show/record/NCT02542748.
Anesthesia, Spinal/adverse effects* ; Cesarean Section/adverse effects* ; Double-Blind Method ; Female ; Humans ; Hypotension/prevention & control* ; Infant, Newborn ; Phenylephrine ; Pregnancy ; Randomized Controlled Trials as Topic ; Vasoconstrictor Agents/therapeutic use*

BACKGROUND: Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section. METHODS: Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis. RESULTS: Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH. CONCLUSION This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.
Anesthesia, Spinal/adverse effects* ; Cesarean Section/adverse effects* ; Colloids ; Female ; Humans ; Hypotension/etiology* ; Incidence ; Infant, Newborn ; Pregnancy ; Vasoconstrictor Agents/therapeutic use*