Method for prevention of spinal headache in bone marrow donors in spinal and combined spinal epidural anaesthesia

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthetics, and can be used for the prevention of spinal headache during spinal or combined spinal epidural anaesthesia in bone marrow exfusion. That is ensured by an intravenous infusion of 6% hydroxyethylstarch 500 ml 30 minutes before the subarachnoid puncture and the spinal and combined spinal epidural puncture or for the first 30 minutes of the anaesthesia.

EFFECT: invention provides preventing postoperative spinal headache in this group of patients.

1 dwg, 1 tbl, 4 ex

 

The invention relates to medicine, namely to anesthesiology and critical care medicine.

There are ways to prevent postfunctional headache with a puncture subarachnoid space, based on the use of needles of small diameter with a blunt end with a cut parallel to the fibers of the Dura and more acute (15 degrees) angle of the needle relative to the dural sack (Gelfand B. R., Kiriyenko P. A., Grinenko, T. F., reference No. 1, E. Shifman M, reference number 2, Morgan J. Ed., Michael M. C. reference No. 3, Arendt K, Demaerschalk BM, Wingerchuk DM, Camann W. Neurologist, reference No. 4, Schmittner MD, Urban N, Janke A, Weiss C, Bussen DG, Burmeister MA, Beck GC., reference No. 5).

However, these methods of prevention postfunctional headache does not allow, in practice, individually and guaranteed to perform prevention postfunctional headache.

The known method has significant drawbacks, as it is not always possible to prevent this complication. Described cases where, despite the use of needles of small diameter with a blunt end, there were complications in the form of postfunctional headache (Schmittner MD, Terboven Τ, Dluzak Μ, Janke A, Limmer ME, Weiss C, Bussen DG, Burmeister MA, Beck GC, reference No. 6).

As the prototype accepted method of prevention postfunctional headache, requires the use of a needle of small diameter, the tra with a blunt end and cut, the parallel fibers of the Dura, because previously it was found that postfunctional headache occurs mainly when using the puncture needle large diameter (less than 25 G).

The purpose of the invention is to provide a method for prevention postfunctional headache, can prevent the development of this complication as during spinal spinal-epidural anesthesia, and after its completion.

The essence of the invention lies in the fact that in the proposed method of prevention postfunctional headache when performing spinal or spinal-epidural anesthesia when exposee bone marrow 30 minutes prior to puncture of the subarachnoid space and the beginning of the spinal cord, spinal-epidural anesthesia or during the first 30 minutes after the start of anesthesia carry out intravenous infusion of 6% hydroxyethylamine in a volume of 500 ml, which is an increase of circulating blood volume, profilaktirujut arterial hypotension, which is a risk factor postfunctional headache.

The use of the invention allows to obtain the following technical result, the way in spinal spinal-epidural anesthesia to perform early prevention, preventing the development of postfunctional headache

The technical effect is achieved due to the fact that during the 30 minutes prior to lumbar puncture to conduct spinal anesthesia with the donation of bone marrow in an adult patient (donor) is the infusion of 500 ml of 6% solution of hydroxyethylamine.

The method is as follows: within 30 minutes before spinal puncture for conducting spinal anesthesia with the donation of bone marrow in an adult patient (donor) or within 30 minutes after spinal puncture is intravenous infusion of 500 ml of 6% solution of hydroxyethylamine.

Example 1: the Donor bone marrow D., 53 years. Were expose bone marrow in terms of spinal-epidural anesthesia. After one hour from the onset of anesthesia, there was a decrease in mean arterial pressure 65 mm RT.article and diastolic blood pressure by up to 38 mm RT.art., and reduced vegetative index to -1, which corresponds to parasympathicotonia. In connection with the developed arterial hypotension was introduced 500 ml of a colloidal solution. In total during General anesthesia infusion volume was 3000 ml, of these colloids is 20%, the rest - crystalloid solutions. After 20 hours after spinal anesthesia from the donor appeared headache, worse when moving in a vertical position, nausea, vomiting. This rigidness the cervical muscles were absent. Within 7 days were symptomatic therapy, which helped to arrest postfunctional headache.

Example 2: the Donor bone marrow N., 42 years. Expose bone marrow in terms of spinal anesthesia. 30 minutes before spinal anesthesia was introduced 500 ml of 6% solution of hydroxyethylamine. During the intraoperative period smooth. During anesthesia, ventilation and hemodynamic disturbances were noted. The organs and systems without features. In the postoperative period postfunctional headache not occurred.

Example 3:. Donor bone marrow C., 35 years. Were expose bone marrow in terms of spinal anesthesia. 30 minutes prior to lumbar puncture and injection of anesthetic was performed by infusion of 500 ml of 6% solution of hydroxyethylamine. During the intraoperative period smooth. During anesthesia, ventilation and hemodynamic disturbances were noted. HELL within 95-80/70-50 mm RT.art., the heart rate of 90-100 beats per minute. The organs and systems without features. The postoperative period without complications postfunctional headache not occurred.

Example 4: a bone marrow Donor that is, 27 years. Expose bone marrow in terms of spinal anesthesia. 10 minutes after the beginning of anesthesia introduced 500 ml of 6% solution of hydroxyethylamine. For intra who personnage period smooth, ventilation and hemodynamic disturbances were noted. HELL within 100-90/70-60 mm RT.art., pulse 55-85 beats per minute. The organs and systems without features. The postoperative period without complications, postfunctional headache not occurred.

The examples illustrate the results summarized in the table. 1 and in Fig. 1. Previously intravenous injection of colloidal solution in 500 ml completely prevents the development postfunctional headache.

Figure 1 in the main group of 50 people (hatched bars) were conducted intravenous colloidal solution 30 minutes before the start of anesthesia or during the first 30 minutes after it started. In the control group (white bars) introduction colloidal solutions was carried out urgently in 40 minutes after the start of anesthesia in connection with a fall in blood pressure due to symptoms of parasympathetic tone of the nervous system. As a result of application of the proposed technology 50 donors were not observed postfunctional headache, whereas in 9 donors, which was not applied this technology has been registered postfunctional headache, sometimes lasting up to 7 days.

References

1. Gelfand B. R., Kiriyenko P. A., Grinenko, T. F. Digger. Anesthesiology and intensive therapy. Practical is the resource guide for physicians. 2006

2. Shifman Ε. M. Spinal anesthesia in obstetrics. 2005

3. Morgan J. Ed., Michael M. C. Clinical anesthesiology. Book 1. 2001

4. Rathmell D. P. Regional anesthesia. 2007

5. Arendt, Demaerschalk BM, Wingerchuk DM, Camann W. Neurologist. Atraumatic lumbar puncture needles: after all these years, are we still missing the point. 2009:15(l):17-20.

6. Schmittner MD, Urban N, Janke A, Weiss C, Bussen DG, Burmeister MA, Beck GC. Int J Colorectal Dis. Influence of the pre-operative time in upright sitting position and the needle type on the incidence of post-dural puncture headache (PDPH) in patients receiving a spinal saddle block for anorectal surgery. 2011: 26(1):97-102.

7. Schmittner MD, Terboven T, Dluzak M, Janke A, Limmer ME, Weiss C, Bussen DG, Burmeister MA, Beck GC. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. 2010: 25 (6): 775-81.

The way to prevent postfunctional headache when performing spinal or spinal-epidural anesthesia when exposee bone marrow, which consists in the fact that 30 minutes prior to puncture of the subarachnoid space and the beginning of the spinal cord, spinal-epidural anesthesia or during the first 30 minutes after the start of anesthesia carry out intravenous infusion of 6% hydroxyethylamine in the volume of 500 ml



 

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15 cl, 11 tbl, 45 ex

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