Anesthetic care for kyphoscoliosis patient undergoing TURP.
Journal name: World Journal of Pharmaceutical Research
Original article title: Anaesthetic management of a patient with severe kyphoscoliosis posted for transurethral resection of prostate (turp)
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Original source:
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Dr. Kirti Kamal, Dr. Hemant Kamal, Dr. Sumedha Vashishth, Dr. Geeta Ahlawat, Dr. Rajmala Jaiswal and Dr. Parul Jain
World Journal of Pharmaceutical Research:
(An ISO 9001:2015 Certified International Journal)
Full text available for: Anaesthetic management of a patient with severe kyphoscoliosis posted for transurethral resection of prostate (turp)
Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research
Doi: 10.20959/wjpr20173-8047
Copyright (license): WJPR: All rights reserved
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Summary of article contents:
1. Introduction
The case report discusses the anesthetic management of a 72-year-old male patient with severe kyphoscoliosis undergoing Transurethral Resection of Prostate (TURP). While spinal anesthesia is typically the preferred method for TURP, patients with kyphoscoliosis may pose significant challenges due to the spinal deformities, which can lead to insufficient or failed anesthesia. This report presents the use of a saddle block technique in such a patient, highlighting its advantages in managing anesthesia effectively despite the anatomical difficulties.
2. Importance of Saddle Block in Kyphoscoliosis
Saddle block anesthesia was chosen for the patient due to its ability to effectively paralyze the pelvic muscles and sacral nerve roots while minimizing the height of the block. This approach is particularly beneficial in patients with spinal deformities, as it reduces the risk of hypotension and the need for vasopressors during the procedure. The technique allows for quick onset and reliable anesthesia in the regions required for TURP, making it a suitable alternative to spinal anesthesia, which may be difficult or inadequate in such complex cases.
3. Challenges of Spinal Anesthesia
The report details the specific challenges faced in administering spinal anesthesia to individuals with severe kyphoscoliosis. This condition results in the distortion of spinal anatomy, making identification of intervertebral spaces for lumbar puncture difficult. Additionally, the rotation of the vertebral column significantly increases the risk of failed or unilateral blocks, especially when utilizing hyperbaric bupivacaine. These obstacles highlight the necessity for alternative anesthetic techniques when standard approaches may not suffice.
4. Advantages of Regional Anesthesia
The discussion emphasizes the benefits of regional anesthesia over general anesthesia in TURP procedures. Regional techniques, particularly spinal and saddle block, reduce blood loss, offer earlier detection of complications, and mitigate risks associated with circulatory overload, especially in elderly patients who may have comorbid conditions. The case illustrates that by selecting an appropriate anesthetic approach tailored to the patient's specific needs, surgeons can enhance patient safety and procedural success.
5. Conclusion
In summary, the case report underscores the significance of employing saddle block anesthesia in patients with severe spinal deformities undergoing TURP. It demonstrates how tailored anesthetic strategies can effectively address anatomical challenges while ensuring patient comfort and safety during surgery. By recognizing the advantages and limitations of various techniques, anesthesiologists can optimize care for diverse patient populations, particularly those with complex medical histories.
FAQ section (important questions/answers):
What is the focus of the case report in this study?
The case report focuses on the anaesthetic management of a 72-year-old male patient with severe kyphoscoliosis undergoing Transurethral Resection of Prostate (TURP), specifically using saddle block as an alternative to traditional spinal anaesthesia.
What are the advantages of using saddle block for TURP?
Saddle block offers several advantages, including quicker setup, paralysis of pelvic muscles, less risk of hypotension, and reduced vasopressor requirements compared to spinal anaesthesia in patients with spinal deformities.
What challenges did the patient present due to kyphoscoliosis?
The patient had severe kyphoscoliosis leading to rotation and tilting of the pelvis, making it difficult to lie supine, which complicated traditional lumbar puncture and anaesthesia administration.
How was anaesthesia administered to the patient?
The anaesthesia was administered using saddle block with 1.4ml of 0.5% hyperbaric bupivacaine injected into the subarachnoid space at the L3-L4 intervertebral space.
What condition was noted in the patient's pulmonary function tests?
The pulmonary function tests indicated restrictive lung disease, with reduced values such as FVC at 43% and FEV1 at 56%, highlighting the patient's compromised respiratory status.
What ethical considerations were addressed in this case report?
Ethical approval was obtained from the university ethical committee, and the authors disclosed no conflicts of interest regarding the publication of this case report.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Anesthetic care for kyphoscoliosis patient undergoing TURP.”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Sharman (Sarma, Sarman, Sharma):
Sharma refers to Pt. B. D. Sharma PGIMS, a medical institution in Rohtak, Haryana, India, which is notable in this context for its Departments of Anaesthesia and Urology. The hospital is highlighted as the academic and clinical setting where the presented case study and surgical procedure occurred, showcasing its contributions to medical education and practice.
2) India:
India is the country where the case study took place, specifically in Rohtak, Haryana. Its healthcare system, including medical education, surgical practices, and anaesthetic management, is pertinent to the case presented in this document, illustrating the challenges faced in treating patients with specific conditions like severe kyphoscoliosis.
3) Disease:
Disease is a prominent term in this context, referring to benign prostatic hyperplasia (BHP), the condition that necessitated surgical intervention for the patient. Understanding the disease is crucial for the surgical process and anaesthetic management since it affects the patient's overall health and treatment approach, including considerations for anaesthesia.
4) Blood:
Blood is significant in the context of the TURP procedure as it relates to the patient’s medical condition, the surgical risks, and intraoperative management. Effective anaesthesia can minimize blood loss and help manage complications such as volume overload, particularly crucial due to the patient's age and health status.
5) Pain:
Pain is a critical aspect addressed by the anaesthesia technique chosen for the procedure. In the context of TURP and the patient's kyphoscoliosis, effective pain management is essential for patient comfort, awareness, and cooperation during surgery, as well as for postoperative recovery and satisfaction.
6) Tuberculosis:
Tuberculosis is mentioned in the case history as a condition that the patient does not have, which is relevant in assessing his overall health status. The absence of such chronic infections is significant for patient management, especially considering respiratory function is essential given the patient's restrictive lung disease.
7) Discussion:
Discussion refers to the section of the study where the authors analyze and interpret the implications of their case report. It highlights the challenges and considerations in anaesthetizing patients with kyphoscoliosis, providing insights into best practices, potential complications, and the rationale for choosing a saddle block over other techniques.
8) Writing:
Writing signifies the process of documenting the case report and disseminating findings to the medical community. Effective writing is essential in sharing clinical experiences, contributing to medical literature, and enhancing knowledge about specific medical conditions and their management, ultimately improving patient care practices.
9) Pulse:
Pulse is a vital sign monitored during the surgical procedure and anaesthesia management. It reflects the patient’s cardiovascular status and overall wellbeing, helping in the assessment of hemodynamic stability during and after surgery. Close monitoring of the pulse is crucial for early detection of potential complications.
10) Birth:
Birth in this context refers to the patient's history, indicating that his severe kyphoscoliosis is a condition he has had since birth. Understanding the congenital nature of his spinal deformity provides insight into the long-term management needs and potential complications he may face due to his anatomical challenges.
11) Kirti (Kirtti):
Kirti refers to Dr. Kirti Kamal, one of the authors and an anaesthesiologist involved in the case report. His expertise and role in the study underscore the collaboration between medical professionals required to manage complex cases. It highlights the importance of skilled practitioners in ensuring patient safety during surgical procedures.
12) Study (Studying):
Study here refers to the case report presented in the paper, encapsulating clinical findings, procedural details, surgical outcomes, and the significance of using a saddle block in a patient with severe kyphoscoliosis. This study contributes to the broader understanding of anaesthetic techniques in challenging clinical scenarios.
13) Sign:
Sign, in a medical context, often relates to observable indicators of a patient's health status. In this case, it emphasizes the importance of monitoring vital signs during anesthesia and surgery, ensuring that any changes are promptly addressed to minimize risks and ensure patient safety throughout the procedure.
14) Post:
Post refers to the postoperative period, highlighting the importance of monitoring and assessing the patient after the TURP procedure. This phase is critical for ensuring the patient's recovery, managing any complications, and evaluating the effectiveness of the anaesthesia technique used during surgery.
15) Male:
Male identifies the gender of the patient discussed in the case report. Gender can influence medical conditions, treatment responses, and healthcare needs. Recognizing the patient's male gender is relevant in the context of TURP, which is a common surgical procedure specifically performed for male patients with prostatic conditions.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Anesthetic care for kyphoscoliosis patient undergoing TURP.’. Further sources in the context of Science might help you critically compare this page with similair documents:
Laboratory investigation, General anesthesia, Pulmonary function test, Volume overload, Informed written consent, Ethical approval, Spinal anaesthesia, Anaesthetic management, Transurethral Resection of Prostate (TURP), Saddle Block, Thoracolumbar Spine, Intervertebral Space, Elderly Age Group, Circulatory Overload.