Abstract:
:Although rare, spinal haematoma and abscess after central neuraxial blocks may cause severe permanent neurological injury. Optimal treatment and outcome remain unclear. In order to identify possible predisposing patient characteristics and describe the ensuing clinical course, we searched Medline, Embase, and the Cochrane Library for reports of spinal haematomas and abscesses associated with central neuraxial blocks. Extracted data included patient characteristics, symptoms, treatment, and outcome. We analysed 409 reports, including 647 patients (387 patients with spinal haematoma and 260 patients with spinal abscess). Spinal haematoma and abscess occurred predominantly after epidural anaesthesia (58% and 83%, respectively). Neurological recovery was correlated with the severity of initial neurological deficit. When decompression of spinal haematoma was delayed for >12 h after clinical diagnosis, neurological outcome was worse compared with earlier decompression (odds ratio 4.5, 95% confidence interval 2.1-9.9, P<0.001, n=163). After spinal haematoma, 47% of published patients had full recovery, 28% had partial recovery, and in 25% no recovery was observed. Good outcome after conservative management was observed in patients with mild symptoms or with spontaneous recovery during the diagnostic and therapeutic workup. After spinal abscess, 68% of reported patients recovered fully, 21% showed partial recovery, and no recovery was reported in 11%. Persistent neurological symptoms after spinal haematoma and abscess are common and correlate with the severity of initial neurological deficit. Neurological outcome seems worse when decompressive surgery of haematoma is delayed. Notwithstanding the considerable risk of selection bias and publication bias, conservative management may be feasible in patients with mild symptoms or spontaneous recovery.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Bos EME,Haumann J,de Quelerij M,Vandertop WP,Kalkman CJ,Hollmann MW,Lirk Pdoi
10.1016/j.bja.2017.11.105subject
Has Abstractpub_date
2018-04-01 00:00:00pages
693-704issue
4eissn
0007-0912issn
1471-6771pii
S0007-0912(17)54212-9journal_volume
120pub_type
杂志文章,评审abstract::We have measured in a double-blind study the changes in intraocular pressure (IOP) in 40 consecutive patients (pretreated with fentanyl or alfentanil) who received suxamethonium and tracheal intubation. Although IOP increased significantly following administration of suxamethonium, mean IOP in both groups remained sig...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/63.6.688
更新日期:1989-12-01 00:00:00
abstract::Patients with metastatic carcinoid tumours often undergo surgical procedures to reduce the tumour burden and associated debilitating symptoms. These procedures and anaesthesia can precipitate a life-threatening carcinoid crisis. To assess perioperative outcomes, we studied retrospectively the medical records of adult ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/87.3.447
更新日期:2001-09-01 00:00:00
abstract::We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/87.6.935
更新日期:2001-12-01 00:00:00
abstract::We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 micrograms kg-1 (approximately one-fifth of the normal ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/73.4.494
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:Pain on injection of propofol is unpleasant. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target-controlled infusions (TCI) of both drugs were used. A prospective, randomized, double-blind, placebo-co...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aem293
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:During normothermic cardiopulmonary bypass (CPB), the effect on propofol pharmacokinetics of changes in its binding to plasma proteins is consistent with the predictions of the well-stirred model of hepatic elimination for nonrestrictively cleared drug. However, whether changes in binding lead to clinically ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aei293
更新日期:2006-02-01 00:00:00
abstract::The time course of the plasma lignocaine concentration, following caudal anaesthesia, was studied in 11 healthy children (3.5-9 yr). Plasma lignocaine concentrations were measured for up to 6 h after administration (5 mg kg-1). Peak plasma concentration was 2.05 +/- 0.08 micrograms ml-1 and occurred at 28.2 +/- 2.9 mi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/56.12.1399
更新日期:1984-12-01 00:00:00
abstract::Zomepirac 100 mg and dihydrocodeine 30 mg were compared with placebo in a controlled randomized, double-blind, single-dose postoperative study. Patients continued to receive either zomepirac or dihydrocodeine for pain relief for 5 days at home in a double-blind study, being allowed to titrate the consumption of tablet...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/57.4.412
更新日期:1985-04-01 00:00:00
abstract::Nociceptin/orphanin FQ, N/OFQ, and its receptor NOP represent a non-opioid branch of the opioid superfamily that were first studied for their effects on pain responses. Both N/OFQ and NOP are involved in a wide range of 'non-pain' responses including immunomodulation and cardiovascular control. There is now growing in...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,评审
doi:10.1093/bja/aeq337
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Isoflurane has been reported to induce caspase-3 activation, which may induce neurotoxicity and contribute to the pathogenesis of Alzheimer's disease. However, the underlying mechanism is largely unknown, especially whether or not isoflurane can induce ryanodine receptors (RyRs)-associated endoplasmic reticu...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeu053
更新日期:2014-10-01 00:00:00
abstract::Experiments were performed on rats using two analgesimetric tests (tail-flick; hot-plate) before and after injection i.v. of graded doses of aprotinin (12.5, 25.0 and 50 KIU g-1). A dose-related analgesic effect was noted with both tests. Prior administration of naloxone 0.001 mg g-1 i.p. inhibited the analgesic actio...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/52.11.1107
更新日期:1980-11-01 00:00:00
abstract::Alveolar type II (ATII) cells perform many important functions within the lung, including surfactant metabolism. We have investigated the effects of isoflurane and different i.v. anaesthetics on cell metabolism in primary cultures of rat ATII cells. Biosynthesis of phosphatidylcholine, the main phospholipid component ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/82.5.767
更新日期:1999-05-01 00:00:00
abstract::We describe a 25 mg intrathecal morphine overdose during a combined spinal-epidural block for a Caesarean delivery. Naloxone infusion (5.24 mg over 24 h) was started prior to the patient becoming symptomatic and almost immediately after the overdose. Invasive therapeutics such as mechanical ventilation were avoided. ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aef286
更新日期:2002-12-01 00:00:00
abstract:BACKGROUND:The use of lipid emulsions to reduce cardiac toxicity of local anaesthetics (LAs) has shown success in experimental studies and some clinical cases, and thus has been implemented in clinical practice. However, lipid treatment is usually given after the occurrence of neurological or cardiovascular symptoms of...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aet353
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:The therapeutic potential of cardiac μ-opioid receptors in ischaemia-reperfusion (I/R) injury during opioid-modulating diseases, such as heart failure, is unknown. We aimed to explore the changes of cardiac μ-opioid receptor expression during heart failure, and its role in opioid-induced cardioprotection. M...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2017.11.110
更新日期:2018-07-01 00:00:00
abstract::Thirty patients for elective lower segment Caesarean section were randomly divided into two groups. One group received 50 mulitre/kg of Althesin for induction of anaesthesia and the other, 100 mulitre/kg. The two maternal groups were similar. There was no significant difference in the clinical or biochemical status of...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/47.11.1213
更新日期:1975-11-01 00:00:00
abstract:Background:Cognitive aids improve the technical performance of individuals and teams dealing with high-stakes crises. Hand-held electronic cognitive aids have rarely been investigated. A randomized controlled trial was conducted to investigate the effects of a smartphone application, named MAX (for Medical Assistance e...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/aex256
更新日期:2017-11-01 00:00:00
abstract::We have measured in 38 patients the plasma concentration profile of atracurium and its effect on the electromyographic first response of the train-of-four. One of three techniques was used to supplement anaesthesia with 66% nitrous oxide in oxygen, 0.9% isoflurane (end-tidal), 0.5% halothane (end-tidal) or midazolam 3...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章
doi:10.1093/bja/70.1.38
更新日期:1993-01-01 00:00:00
abstract::The use of di-isopropyl phenol (Diprivan) for induction of anaesthesia was assessed in doses ranging from 1 to 3 mg kg-1. With less than 1.75mg kg-1 not all patients were anaesthetized; 2.0 mg kg-1 appeared to be a satisfactory induction dose. Involuntary muscle movement, cough and hiccup at induction were rare with a...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/53.11.1197
更新日期:1981-11-01 00:00:00
abstract:BACKGROUND:The perioperative management of two-stage oesophagectomy has not been standardized and the prevailing practice regarding the timing of extubation after the procedure varies. This audit has evaluated the outcome, in particular the respiratory morbidity and mortality, after immediate extubation in patients who...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aeg091
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Propofol and sevoflurane are suitable agents for maintenance of anaesthesia during neurosurgical procedures. We have prospectively compared these agents in combination with the short-acting opioid, remifentanil. METHODS:Fifty unpremedicated patients undergoing elective craniotomy received remifentanil 1 mic...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/aei141
更新日期:2005-06-01 00:00:00
abstract::A method for the assessment and management of factors both causing and maintaining a primary metabolic alkalosis is presented. During a 2-year period 65 patients with metabolic alkalosis were treated with saline and potassium chloride infusions. In four patients the alkalosis was refractory and required additional the...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/49.8.811
更新日期:1977-08-01 00:00:00
abstract:BACKGROUND:The objective of the present study was to investigate sublingual microvascular blood flow and microcirculatory haemoglobin oxygen saturation (Smc(O(2))) during cardiopulmonary bypass (CPB) using constant systemic blood flow but different perfusion pressures achieved by phenylephrine administration. METHODS:...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/aep018
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:There is growing interest in the effect of postoperative analgesics on oncological outcomes after cancer surgery. We investigated the impact of tramadol after breast cancer surgery on recurrence and mortality and explored the mechanism by which tramadol affects cultured breast cancer cells in vitro. METHODS...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1016/j.bja.2019.09.004
更新日期:2019-12-01 00:00:00
abstract::Using in vivo microdialysis, we have investigated the effects of propofol on acetylcholine (ACh) release from various regions of the rat brain. Propofol 25 and 50 mg kg-1 i.p. decreased basal ACh release from the frontal cortex by 70% and 85%, respectively. Propofol 25 and 50 mg kg-1 i.p. decreased basal ACh release f...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/80.5.644
更新日期:1998-05-01 00:00:00
abstract::We have assessed neuromuscular block electromyographically at the gastrocnemius muscle and compared it with that at the abductor digiti minimi muscle in 60 adult patients undergoing cervical spine surgery under general anaesthesia. All patients were in the prone position. After vecuronium 0.2 mg kg-1, times to onset o...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,收录出版
doi:10.1093/bja/82.3.329
更新日期:1999-03-01 00:00:00
abstract::A retrospective study was carried out to determine analgesic requirements in a group of orthopaedic outpatients (n = 145) and oral surgery inpatients (n = 172). The orthopaedic patients received a codeine-paracetamol premedication, an opioid during operation, or no analgesic. Less than 50% of the orthopaedic patients ...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/64.5.617
更新日期:1990-05-01 00:00:00
abstract::In a randomized study of patients undergoing Caesarean section, either enflurane (mean 0.24 MAC-h) or halothane (mean 0.23 MAC-h) and 50% nitrous oxide in oxygen were administered to women (n = 12) with severe pre-eclampsia-eclampsia and to 16 healthy pregnant patients with normal renal and hepatic function. No eviden...
journal_title:British journal of anaesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/bja/56.6.587
更新日期:1984-06-01 00:00:00
abstract:BACKGROUND:The aim of this study is to test the hypothesis that a standard 30-min break in a routine 7.5 h period of work makes a difference in cognitive function. METHODS:In a double-blinded, cross-over trial 30 residents in anaesthesia were randomized to receive or not to receive a 30-min break between the assessmen...
journal_title:British journal of anaesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1093/bja/ael151
更新日期:2006-09-01 00:00:00
abstract::The rate of liquid-phase gastric emptying was determined in seven smokers from the rate of paracetamol absorption after abstaining overnight from cigarettes, and again after smoking two cigarettes within 30 min. There were no significant differences between the maximum paracetamol concentration, the time to reach maxi...
journal_title:British journal of anaesthesia
pub_type: 杂志文章
doi:10.1093/bja/57.11.1104
更新日期:1985-11-01 00:00:00