Hemodynamic changes during spinal anesthesia in premature infants with congenital heart disease undergoing inguinal hernia correction

Introduction: There are conflicting reports on the effects of spinal anesthesia (SA) on hemodynamics. Data on the hemodynamic effects of SA in infants with congenital heart disease (CHD) are limited. Methods: We reviewed our experience with 44 unsupplemented SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine in premature and former premature infants with noncyanotic CHD. Hemodynamics and oxyhemoglobin saturation (SpO₂) were assessed. Neither preoperative fluid boluses nor atropine was administered to any of the infants. Results: There was no significant change in systolic, diastolic, or mean blood pressures from pre‐SA induction compared with end of surgery. Heart rate showed a small but systematic decline (mean change of 10 beats per minute, P < 0.01) but was within the normative range values for age. There was a small, but clinically insignificant increase in SpO₂ across the time course. Intraoperatively, two infants developed transient apneic spells. No infant developed postoperative apnea, oxygen desaturation, or bradycardia. Conclusions: The data suggest that SA with 1 mg·kg^?1 of either hyperbaric tetracaine or bupivacaine can be used safely as the sole anesthetic for inguinal hernia repair in infants with noncyanotic CHD even when fluid restricted and apparently causes minimal respiratory complications in these infants.     

A prospective comparison of local and spinal anesthesia for inguinal hernia repair

Aim Today, in inguinal hernia repair, postoperative pain and costs are regarded as equally important issues as technique and recurrence rates. Postoperative pain is thought to vary according to the applied anesthesia method. As local anesthesia is reported to inflict less pain, its effects on early period post-operative complications should also be evaluated. Methods Two hundred patients, on whom Lichtenstein tension free hernia repair had been performed due to unilateral inguinal hernia between March 2004 and July 2005, were prospectively examined. The patients were randomized according to the anesthesia applied. They were divided into two groups: local anesthesia (LA) and spinal anesthesia (SA). The early post-operative complications, post-operative pain scores, and operation durations of the patients, were evaluated. Results Local anesthesia was found not to increase the post-operative complications; on the contrary, it was shown to prevent the complications of spinal anesthesia. Although visual analogue pain score (VAS) values at 4, 8, 12, and 24 h post-operation were found to be lower than the SA group, the difference between was not significant. Also, it was discovered that LA did not retard the operation duration. Conclusion Local anesthesia reduces post-operative pain and facilitates patients’ mobilization and discharge along with decreasing the early post-operative complications. Thus, LA is a safe and advantageous method to be applied in inguinal hernia repair.     

Laparoscopic transabdominal preperitoneal repair of inguinal hernia under spinal anesthesia: a pilot study

Background

The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with the well-known advantages of a minimally invasive approach. However, general anesthesia is routinely required for the procedure. Based on our previous experience in regional anesthesia for laparoscopic procedures, we designed a pilot study to assess the feasibility and safety of performing laparoscopic TAPP repair under spinal anesthesia.

Methods

Forty-five American Society of Anesthesiologists I or II patients with a total of 50 inguinal hernias underwent TAPP repair under spinal anesthesia, using a low-pressure CO₂ pneumoperitoneum. Five patients had bilateral hernias, and 4 patients had recurrent hernias. Thirty hernias were indirect and the remaining direct. Intraoperative incidents, postoperative pain complications, and recovery in general as well as patient satisfaction at the follow-up examination were prospectively recorded.

Results

There was 1 conversion from spinal to general anesthesia and 2 conversions from laparoscopic to the open procedure at a median operative time of 50 minutes (range 30-130). Ten patients complained of shoulder pain during the procedure, and 6 patients suffered hypotension intraoperatively. The median pain score (visual analog scale) was 1 (0-5) at 4 hours after the completion of the procedure, 1.5 (0-6) at 8 hours, and 1.5 (0-5) at 24 hours, and the median hospital stay was 1 day (range 1-2). Sixteen patients had urinary retention requiring instant catheterization. At a median follow-up of 20 months (range 10 months-28 months), no recurrence was detected.

Conclusions

TAPP repair is feasible and safe under spinal anesthesia. However, it seems to be associated with a high incidence of urinary retention. Further studies are required to validate this technique.     

Laparoscopic bilateral inguinal hernia repair under local anesthesia

A case report of the laparoscopic repair of bilateral inguinal hernias performed under local anesthesia with intravenous sedation is presented. The combination of nitrous oxide for peritoneal insufflation and an ultrasonically activated scalpel for dissection made the procedure feasible. It is hoped that this technique can extend laparoscopic surgery to patients who are poor candidates for general anesthesia.     

Clinical assessment of spinal and epidural anesthesia in inguinal hernia repair

Purpose. The current study was done to compare the effect of spinal and epidural anesthesia on surgical outcome measures of inguinal herniorrhaphy. Methods. Ninety-eight male patients undergoing inguinal hernia repair were randomized to either spinal (SA; n = 39) or epidural (EA; n = 59) anesthesia groups anesthetized with either glycosylated bupivacaine (20 mg) or 0.5 % bupivacaine (100 mg). Anesthesia onset time (AOT), postoperative stand-up time (SUT), first pain sensation time (FPT), operation time (OT), analgesic requirement (AR), hospital stay (HS), visual analogue scores of pain (VAS), per- and postoperative complications, and postanesthesia complications were recorded and compared with each other. Results. FPT was 6.6 ± 0.6 h and 3.1 ± 0.4 h and OT was 40 ± 2 min and 33.1 ± 1 min in the EA and SA groups, respectively (p < 0.05). SUT was also longer in EA group. VAS scores at 12 and 24 h were significantly higher in the EA group (28 ± 4 mm and 24 ± 5 mm in EA and 16 ± 4 and 5 ± 1 mm in SA; P < 0.05). No statistically significant difference was found between the SA and EA groups with respect to the other outcome measures that were considered. Conclusion. Spinal and epidural anesthesia show some differences from each other with respect to outcome measures such as OT, SUT, FPT, and 12- and 24-h VAS scores. Received: October 10, 2000 / Accepted: November 30, 2001     

中老年腹股沟疝局麻与硬膜外麻醉手术的比较

目的比较中老年人在局麻与硬膜外麻醉下行腹股沟疝修补术的疗效、住院时间、平均费用、恢复正常生活的时间及手术并发症等.方法采用随机对照方法,将223例病人分为局麻组(男,113人)和硬膜外阻滞麻组(男110人).结果局麻组病人平均手术时间(44min)、住院时间(2.1d)、恢复正常生活时间(5.4d)和手术并发症等均明显小于硬膜外阻滞组(P＜0.01～0.05).结论中老年人局麻下进行疝修补,可明显减少手术费用,术后并发症的发生率,是一安全而有效的方法,值得推广.     

七氟烷吸入麻醉对行腹腔镜疝修补术患儿呼吸、应激及不良反应的影响

目的探讨七氟烷吸入麻醉对行腹腔镜疝修补术患儿呼吸参数、补体水平、躁动及恶心呕吐的影响。方法选取2016年7月至2019年6月在海南省妇女儿童医学中心行腹腔镜疝修补术患儿118例作为研究对象。按照随机数表法,将所有患者分为研究组和对照组,各59例。对照组患者给予氯胺酮麻醉,研究组患者给予七氟烷吸入麻醉,比较麻醉前(T0)。麻醉结束时(T1)、手术开始时(T2)、手术结束时(T3)的呼吸参数,并比较手术前后的补体水平和术中躁动及术后恶心呕吐情况。结果2组患者在T1、T2、T3时的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO₂)明显降低T0时。2组患者在T1、T2、T3时的舒张压(DBP)明显升高T0时。研究组患者在T2、T3时的收缩压(SBP)明显高于T0时,对照组患者T1、T2、T3时的SBP明显高于T0时,且差异有统计学意义(P<0.05);研究组患者在T1、T2、T3时的HR、MAP明显高于对照组,研究组患者在T1、T2、T3时的DBP、SBP明显低于对照组,研究组患者T2时的SpO₂明显高于对照组,差异均有统计学意义(P<0.05)。术后2组患者的补体C3、补体C4水平均降低,研究组的补体C3、补体C4水平明显高于对照组,差异有统计学意义(P<0.05)。研究组患者的躁动、恶心呕吐发生率分别为1.69%、3.39%,高于对照组(3.39%、8.47%),差异均无统计学意义(P>0.05)。结论对行腹腔镜疝修补术患儿采用七氟烷吸入麻醉,可降低对呼吸循环的影响,减少对机体脏器的损伤,具有较高的安全性。     

局麻下前入路改良Kugel腹股沟疝无张力修补术的临床应用

目的探讨在局麻下应用前入路改良Kugel施行腹股沟疝无张力修补术的可行性及优越性。方法回顾性分析并随访我院近2年来在局麻下施行的改良Kugel的无张力腹股沟疝修补术22例(25侧),对患者手术前合并症、手术时间、手术方式、术后镇痛药应用、术后并发症、术后住院天数以及平均总住院费用进行综合分析。结果本组患者手术过程顺利,麻醉效果好,术后疼痛耐受好,不需应用镇痛药物,并发症少,平均手术时间55min(35~110min),术后住院天数3~8d,术后随访无疼痛发生。结论局麻下应用改良Kugel实施微创腹股沟疝无张力修补术是可行的,该方式具有简便、安全、快捷、患者耐受性好、并发症少、费用低廉、术后恢复快、学习曲线短等优点,尤其适合于合并多种慢性疾病的老年患者。     

不同麻醉方式在腹股沟疝修补术后并发症及疼痛感受

目的探讨全身麻醉和局部麻醉对腹股沟疝修补术后的影响。 方法选取2017年1月至2018年11月,中国医科大学附属盛京医院进行腹股沟疝修补术的患者70例为研究对象。按照麻醉方法不同分为全麻组和局麻组,每组患者35例。观察2组患者的围手术期临床指标和并发症发生情况。 结果局麻组患者的手术、下床活动以及住院时间更短,但是疼痛程度更高;全麻组患者的感染、尿潴留、恶心及切口积液的发生率更低,差异均有统计学意义（P<0.05）。 结论局部麻醉患者的手术时间、下床活动时间和住院时间更短;并发症更少,全身麻醉术后减轻患者疼痛效果更好。     

Laparoscopic extraperitoneal inguinal hernia repair with spinal anesthesia and nitrous oxide insufflation

Background: Laparoscopic repair of inguinal hernia is traditionally performed under general anesthesia mainly because of the adverse effects that carbon dioxide pneumoperitoneum has on awake patients. Since a mandatory use of general anesthesia for all hernia repairs is questionable, the feasibility of laparoscopic extraperitoneal herniorraphy using spinal anesthesia combined with nitrous oxide insufflation was investigated. Methods: Over a 4-month period, February to May 1998, we performed 35 consecutive total extraperitoneal inguinal hernia procedures (24 unilateral, 11 bilateral) using spinal anesthesia and nitrous oxide extraperitoneal gas. Data on operative findings, self-reported operative and postoperative pain and discomfort (visual analog pain scale), procedure-related hemodynamics, and complications were collected prospectively. Results: All 35 procedures were completed laparoscopically without the need to convert to general anesthesia. Mean operative time was 39 ± 7 min for unilateral hernia and 65 ± 10 min for bilateral hernia. Incidental peritoneal tears occurred in 22 patients (63%) resulting in nitrous oxide pneumoperitoneum, which was well tolerated. The patients remained hemodynamically stable throughout the procedure, and operative conditions and visibility were excellent. Complications at a mean of 4 months after the procedure included seven uninfected seromas (20%), three patients with transient testicular pain, and one (3%) recurrence. Conclusions: Laparoscopic total extraperitoneal hernia repair can be safely and comfortably performed using spinal anesthesia with extraperitoneal nitrous oxide insufflation gas. This method provides a good alternative to general anesthesia. Received: 17 February 1999/Accepted: 1 July 1999     

腰硬联合麻醉复合丙泊酚用于腔镜下腹股沟斜疝手术的临床观察

目的探讨腰硬联合麻醉复合丙泊酚用于腹股沟斜疝手术的可行性。方法抽取80例于2011年10月-2013年10月在我院行腔镜下腹股沟斜疝手术的患者,美国麻醉师协会（ASA）分级Ⅰ-Ⅱ级,随机分成两组：腰硬联合麻醉复合丙泊酚组,40例（治疗组）,腰硬联合麻醉复合芬太尼、氟哌利多组,40例（对照组）,对比分析两组的治疗效果和不良反应的发生率。结果治疗组的术中MAP、HR、SpO2较术前有明显下降,与同期的对照组数据比较差异有统计学意义（P〈0.01）,从不良反应来看,治疗组的不良反应发生率明显低于对照组,组间比较差异有统计学意义（P〈0.05）。结论腰硬联合麻醉复合丙泊酚可以安全有效地用于腔镜下腹股沟斜疝手术,同时优于芬太尼、氟哌利多,值得在临床上推广。     

Total extraperitoneal preperitoneal laparoscopic hernia repair using spinal anesthesia.

BACKGROUND: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP). METHODS: We prospectively reviewed 30 patients undergoing TEP while under spinal anesthesia. Methods of anesthesia, surgical procedure, operative and anesthesia delivery times, as well as outcomes were reviewed. Patients were followed up over a 2-year period. Short- and long-term results of the surgical procedure and anesthesia delivered were noted. RESULTS: All patients underwent successful laparoscopic hernia repair while under spinal anesthesia without conversion to general anesthesia. Forty-four hernias were repaired in 30 patients. Short- and long-term follow-up (2 years) revealed no significant untoward affects from the spinal anesthesia in this series of patients. Aside from inguinodynia in 3 patients in the short-term, no other short-term or long-term untoward sequelae occurred. CONCLUSIONS: Spinal anesthesia is a feasible, and in our experience, the preferable method of anesthesia for total extraperitoneal laparoscopic hernia repair.     

局麻下开放腹膜前复发性腹股沟疝修补术的临床疗效

目的总结局部麻醉下,开放腹膜前复发性腹股沟疝修补术的临床疗效。 方法回顾性分析自2016年6月至2018年1月,陕西省第四人民医院普外科收治的36例成人复发性直疝患者。行局部麻醉下单纯腹膜前修补术,观察其手术时间、术后住院时间、术后疼痛、术后复发等数据。 结果本组患者平均手术时间为单侧26 min（19～36 min）,双侧46 min（39～65 min）。术后回病房即可饮食,术后局部腹带加压12～24 h,手术当天下床活动,住院期间伤口轻度疼痛,一般不用处理,平均住院2.8 d。术后1周内,脂肪液化者2例,血清肿者1例,无切口感染,无补片感染,无复发。 结论局部麻醉下,单纯腹膜前无张力修补复发性性直疝,安全可靠。     

七氟醚面罩吸入复合氯胺酮麻醉对疝手术患儿苏醒质量、血流动力学的影响

目的探究小儿疝手术中应用七氟醚面罩吸入复合氯胺酮麻醉效果。方法研究对象为海口市妇幼保健院2018年10月至2019年10月102例进行疝手术患儿,依据随机数字表分组标准以及患儿情况分为复合组与对照组,分别为51例,复合组采用七氟醚面罩吸入复合氯胺酮麻醉,对照组采用氯胺酮麻醉。比较2组患儿麻醉效果,苏醒质量,麻醉前后生命体征指标,麻醉前后应激指标水平,不良反应发生。结果复合组患儿麻醉优良率(96.08%)高于对照组(80.39%),差异有统计学意义(P<0.05);复合组患儿麻醉诱导时间显著高于对照组(P<0.05),苏醒时间、睁眼时间、即时躁动时间、30 min躁动时间显著短于对照组(P<0.05);麻醉前后,2组患儿生命体征指标血氧饱和度、心率、呼吸频率以及平均动脉压比较差异无统计学意义(P>0.05);2组患儿手术后应激指标去甲状腺素、皮质醇以及肾上腺素水平明显改善(P<0.05),手术后复合组患儿去甲状腺素、肾上腺素显著高于对照组(P<0.05),皮质醇显著低于对照组(P<0.05);复合组患儿不良反应发生率4例(7.84%)低于对照组5例(9.80%),差异无统计学意义(P>0.05)。结论疝手术患儿采用七氟醚面罩吸入复合氯胺酮麻醉可以维持血流动力学稳定,有效提高麻醉效果,改善患儿苏醒质量,减轻患儿应激反应。     

腹腔镜腹股沟斜疝手术患儿麻醉诱导前应用右美托咪定的影响

目的探究麻醉诱导前应用右美托咪定（DEX）对腹腔镜腹股沟斜疝手术患儿应激反应、血流动力学及苏醒质量的影响。 方法选取2017年2月至2018年12月,临高县人民医院84例腹腔镜腹股沟斜疝手术患儿为研究对象,采用随机数字表法分为DEX组及对照组,每组42例。DEX组麻醉诱导前给予DEX滴鼻,对照组麻醉诱导前则给予生理盐水滴鼻。比较2组入室时（T0）、麻醉诱导前（T1）、建立气腹时（T2）、手术结束时（T3）血流动力学[平均动脉压（MAP）、心率（HR）]和T0、T3时应激反应[去甲肾上腺素（NE）、肾上腺素（E）]与T0、T1时焦虑状态[改良耶鲁手术前焦虑量表（mYPAS）],并记录2组麻醉诱导配合度[麻醉诱导期合作量表（ICC）]、麻醉苏醒情况（呼吸恢复时间、拔管时间、苏醒时间）、不良反应发生情况。 结果2组T0、T1时组内及组间MAP、HR比较,差异无统计学意义（P>0.05）;2组T2、T3时MAP、HR均低于T0、T1（P<0.05）,T3则低于T2（P<0.05）;且T2、T3时,DEX组MAP、HR均低于对照组（P<0.05）。T3时,2组血清NE、E均较T0时升高（P<0.05）,且对照组高于DEX组（P<0.05）。对照组T0、T1时mYPAS评分比较,差异无统计学意义（P>0.05）;T1时,DEX组mYPAS评分较T0时降低（P<0.05）,且低于对照组（P<0.05）。DEX组ICC评分及呼吸恢复时间、拔管时间、苏醒时间、术后躁动发生率均低于对照组（P<0.05）。2组不自主运动、恶心呕吐、分泌物增多发生情况比较,差异无统计学意义（P>0.05）。 结论麻醉诱导前应用DEX能提高腹腔镜腹股沟斜疝手术麻醉苏醒质量,减少术后躁动,还能降低患儿术中血流动力学波动及应激反应,在减轻术前焦虑、提高患儿配合度方面也有重要作用。     

Laparoscopic inguinal hernia repair in children

Childhood inguinal hernia is a result of a congenital patent processus vaginalis. In order to prevent strangulation of viscera trapped in the defect, surgery is necessary. Conventional operation for childhood inguinal hernia involves the use of a skin incision over the groin to dissect out the sac, taking care not to injure the adjacent important structures, namely the vas deferens and testicular vessels. The sac is then divided and the proximal end transfixed. With the advance in minimally invasive surgery, laparoscopic repair of childhood inguinal hernia has been attempted. Modification of the technique by injecting normal saline extraperitoneally before the purse‐string closure of the neck of the processus vaginalis has made the procedure safer. An advantage of the laparoscopic procedure is that it allows detection and repair of the contralateral hernia. Randomised controlled trials are still required to verify the suggested advantages of better cosmesis outcome and more efficient pain control. Long‐term follow up in a large‐scale study is also desirable, to evaluate the cost‐effectiveness and possible complications of this mode of treatment.      

咪唑安定对布比卡因蛛网膜下腔麻醉效果的影响

目的观察咪唑安定加入布比卡因对蛛网膜下腔麻醉维持时间和麻醉效果的影响。方法40例ASAⅠ级子宫切除病人随机分为咪唑安定组（试验组，11=20）和对照组（n=20）。咪唑安定组蛛网膜下腔注入0．5％重比重布比卡因2．5ml加咪唑安定1mg（0．2m1），对照组注入0．5％重比重布比卡因2．5ml加生理盐水0．2ml。观察运动神经阻滞（改良Bromage）、感觉神经阻滞（针刺法）、镇痛时间（VAS）、术者和患者对麻醉的满意率。结果咪唑安定组感觉和运动神经阻滞时间显著延长（P〈0．01），术者和患者对麻醉的满意率提高（P〈0．05）。咪唑安定组有效镇痛时间也显著延长（P〈0．001）。两组血流动力学、不良反应情况差别无显著性。结论咪哗安定加入布比卡因能显著延长麻醉作用时间，麻醉效应增强，而不良反应未见增加。     

Lichtenstein疝修补术治疗长期使用抗凝药物的老年腹股沟疝病人的临床观察

目的 研究李金斯坦无张力疝修补术治疗长期使用抗凝药物的老年腹股沟疝病人的临床疗效。方法 回顾性分析2015年1月至2017年12月间，中山大学附属第八医院胃肠外科使用Lichtenstein无张力疝修补术在局部浸润麻醉下治疗108例长期使用抗凝药物的老年男性病人的临床资料。结果 本组病人围手术期无死亡，无严重并发症出现，手术时间50~105 min，术中出血5~20 mL，血氧饱和度均正常，术后病人给予普食，未出现尿潴留。有8例患者出现血清肿，其中5例予以抽吸后好转，无切口感染。术中血压上升有12例，心率增快有10例。术中出现疼痛共16例。术后 6 h、12 h、24 h的疼痛评分（视觉模拟评分法）分在3分以下。术后慢性疼痛、感觉异常有2例。结论 长期使用抗凝药物的老年腹股沟病人局麻下行李金斯坦无张力疝修补术，安全有效，并发症少，病人术后恢复快。     

Lichtenstein疝修补术治疗长期使用抗凝药物的老年腹股沟疝病人的临床观察

目的 研究李金斯坦无张力疝修补术治疗长期使用抗凝药物的老年腹股沟疝病人的临床疗效。方法 回顾性分析2015年1月至2017年12月间,中山大学附属第八医院胃肠外科使用Lichtenstein无张力疝修补术在局部浸润麻醉下治疗108例长期使用抗凝药物的老年男性病人的临床资料。结果 本组病人围手术期无死亡,无严重并发症出现,手术时间50~105 min,术中出血5~20 mL,血氧饱和度均正常,术后病人给予普食,未出现尿潴留。有8例患者出现血清肿,其中5例予以抽吸后好转,无切口感染。术中血压上升有12例,心率增快有10例。术中出现疼痛共16例。术后 6 h、12 h、24 h的疼痛评分（视觉模拟评分法）分在3分以下。术后慢性疼痛、感觉异常有2例。结论 长期使用抗凝药物的老年腹股沟病人局麻下行李金斯坦无张力疝修补术,安全有效,并发症少,病人术后恢复快。     

Laparoscopic ventral hernia repair under spinal anesthesia: a feasibility study

BACKGROUND: Regional anesthesia has not been used as the sole anesthetic procedure in laparoscopic ventral hernia repair due to the fear of potential adverse effects of the pneumoperitoneum. However, there are recent reports on the feasibility of performing laparoscopic procedures, such as cholecystectomy, in fit patients, under spinal anesthesia alone. The current study aimed to detect the feasibility of performing laparoscopic ventral hernia repair under spinal anesthesia. METHODS: Twenty-five American Society of Anesthesiologists (ASA) I or II patients underwent laparoscopic ventral hernia repair with low-pressure CO2 pneumoperitoneum under spinal anesthesia. In 9 cases the hernia was umbilical/para-umbilical, in 5 cases epigastric, and in 11 cases incisional. Intraoperative incidents, complications, postoperative pain, and recovery in general, as well as patient satisfaction at follow-up examination, were prospectively recorded. RESULTS: All operations were completed laparoscopically and conversion from spinal to general anesthesia was not required in any of the cases. Median pain score at 4 hours postoperatively was .5 (range 0-5), at 8 hours 1.5 (range 0-6), and at 24 hours 1.5 (range 0-4). Most patients were discharged 24 hours after the operation; the median hospital stay was 1 day (range 1-3 days). At 2-weeks follow-up, no late complications were detected and all patients reported being satisfied with the anesthetic procedure. CONCLUSION: Laparoscopic ventral hernia repair with low-pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and smooth recovery.