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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Continuous spinal anesthesia (CSA) fell into disuse because of a presumed high incidence of post dural puncture headache (PDPH). A careful retrospective study of 226 continuous spinal anesthetics administered for a variety of surgical (not obstetric) procedures was carried out and indicated that none of the patients developed PDPH. While 62% of the patients were older than 60 years of age, a group with a low incidence of PDPH, it was expected that some of the younger patients would develop this complication, especially since 94% of the dural punctures were carried out with 17- and 18-gauge needles. This study also revealed only a 12% incidence of hypotension, an impressive finding because 64% of the patients were considered ASA III or IV. There were no other intraoperative or postoperative complications or deaths due to CSA. This retrospective study indicates that CSA, properly carried out with 17- and 18-gauge needles, is not necessarily associated with a high incidence of PDPH; and in view of its low morbidity and mortality, CSA is particularly useful and safe in the poor-risk elderly patient. This study also raises the question as to whether there is a need for the recently developed (and expensive) microcatheters that fit through very small-bore needles.
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PMID:Continuous spinal anesthesia and post dural puncture headache: a retrospective study. 204 23

To evaluate dural puncture headache (DPH) after intradural anesthesia (IA) carried out by residents of anesthesiology and reanimation, and its relation with the degree of difficulty of the puncture, a sample of 81 patients with ages ranging between 48 and 88 years was evaluated. The incidence of DPH was 12.35%, and it was not statistically associated with age, sex, anesthetic approach, local anesthetic, or degree of difficulty of lumbar puncture.
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PMID:[Incidence of dural puncture headache after intradural anesthesia carried out by residents]. 207 91

Signs of a fistula of the C.S.F. may be deceiving and difficult to relate to the cause: posterior secretions of the cavum, whooping cough, headache on swallowing, fever, and asthenia, meningitis. The seat of the fistula is sometimes difficult to determine, necessitating multiple investigations with a high performance scanner, magnetic resonance imaging, scintigraphy. The increased pressure of the C.S.F. caused by general anaesthesia may be an aid in the radiological discovery of the fistula. Sealing is preferably performed by the low approach with the help of a lumbar drain for a few days in the case of major C.S.F. leakage. The graft material used to seal the fistula is either dermo-fatty tissue, or, if the fistula is narrow, an osseous wedge forming a kind of stopper.
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PMID:[Surgical technical note: apropos of cerebrospinal fluid fistula of the skull base]. 208 15

High thoracic epidural anesthesia was administered by anesthetists in 20 patients undergoing submuscular breast augmentation. An average of 12 ml of 2% lidocaine was instilled after sedation with midazolam, 2-6 mg. The augmentation procedure averaged 90 minutes. In 3 patients, the block developed more rapidly on one side than the other, but soon became symmetrical in all; additional subcutaneous infiltration of lidocaine was necessary in 1 patient because of infraclavicular pain; ephedrine, 10 mg was needed in 2 patients to treat hypotension (greater than 20% decrease in blood pressure). Three patients felt infraclavicular pressure; 1 had a brief sensation of breathlessness; 3 had nasal stuffiness from Horner's syndrome associated with the block; none developed headache, back pain, or paresthesias; and 3 had postoperative nausea. The average time from the end of the procedure to patient discharge was 96 minutes. In this limited series, high thoracic epidural anesthesia for submuscular breast augmentation was extremely satisfactory.
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PMID:Early experience with high thoracic epidural anesthesia in outpatient submuscular breast augmentation. 202 43

An 18-year old patient bearing a subcutaneous Norplant implant in the left upper arm for 2 years visited a gynecological clinic. The implant rods were removed under local anesthesia because of the increasing pigmentation of the skin, and she switched to oral contraceptive use. Norplant contains a total of 216 mg of levonorgestrel (LNG) in 6 silastic rods, each 3.4 cm long. Norplant-2 consists of 3 rods with a length of 4.4 cm providing a total of 140 mg of LNG. It has been in use since 1974 in Chile, and subsequently in Brazil, Indonesia, Thailand, Africa, and to a lesser extent in Scandinavia. It works via the continuous release of 30-50 mcg doses of progesterone daily that induces cervical mucous changes whereby sperm penetration is thwarted; nidation does not occur, and ovulation is also often inhibited. The Pearl-Index reaches .1-1.1 in the first 5 years of use. The most important side effects are menstruation changes (oligo- and amenorrhea), weight gain, and headache. The continuation rate is similar to that of the IUD: 95% through the 1st year of use, and 75% through 3 years reported from Chile and China. Reversibility is a major advantage: 50% of women become pregnant within 3 months after removal, 86% within 1 year, and 93% within 2 years. In the Netherlands sits acceptance is clearly distinct from prevalence in Chile and China, and it has only a minor role in applicability when other contraceptives fail.
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PMID:[Norplant in The Netherlands]. 210 35

One hundred patients aged 18-49 yr, undergoing elective arthroscopy of the knee joint, were allocated randomly to either spinal anaesthesia using a 29-gauge spinal needle or general anaesthesia. Dural puncture was considered difficult in 18% of the patients receiving spinal anaesthesia. In three patients (6%) it was necessary to supplement the spinal anaesthetic with general anaesthesia. Spinal and general anaesthesia were otherwise uneventful in all patients. The incidence of postoperative headache was similar in the two groups. One patient developed post dural puncture headache following spinal anaesthesia. This headache was of short duration and disappeared without treatment. Spinal anaesthesia caused more backache than general anaesthesia, otherwise the frequency of postoperative complaints was the same or lower. Ninety-six percent of the patients receiving spinal anaesthesia would prefer the same anaesthetic for a similar procedure in the future.
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PMID:Spinal anaesthesia in young patients using a 29-gauge needle: technical considerations and an evaluation of postoperative complaints compared with general anaesthesia. 222 55

In a prospective study of 80 patients under 40 years of age, given spinal anaesthesia through either a 0.52 mm (25-gauge) needle or a 0.33 mm (29-gauge) needle, the incidence of post-dural puncture headache and backache was compared. There were no headaches in the 0.33 mm needle group, while in the 0.52 mm needle group an incidence of 25% was found. The incidence of backache was the same in both groups. The technique of performing spinal anaesthesia was evaluated and concluded to be slightly more difficult with a 0.33 mm needle, as estimated by the number of redirections of the needle needed to obtain cerebrospinal fluid. There were no differences between the two needles with respect to obtaining adequate spinal anaesthesia and spread of blockade.
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PMID:Post-dural puncture headache in young patients. A comparative study between the use of 0.52 mm (25-gauge) and 0.33 mm (29-gauge) spinal needles. 214 82

We studied 106 day-care surgical patients (52 male) aged 18-70 yr (mean 49.6 yr) who received spinal anaesthesia with a 26-gauge spinal needle. The incidence of headache, back pain and patient acceptability were investigated after operation using a questionnaire. The incidence of postspinal headache was 7.5%, and 11.3% of patients developed back pain. One patient remained in hospital because of hypotension and dizziness. There were no major complications and patient acceptability was almost 100%. We conclude that spinal anaesthesia for day-care surgery is easy to perform and cost effective.
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PMID:Spinal anaesthesia in day-care surgery with a 26-gauge needle. 214 64

The authors carried out a study on patients in whom spinal anaesthesia was performed for various surgical procedures. In a first group of patients neither ephedrine nor other sympathicomimetic drugs were administered before spinal anaesthesia, while in the second group ephedrine was given on a systematic basis as premedication, with the exception of patients who had an absolute contraindication for this drug. In the first group headache following spinal anaesthesia was much more frequent and it was inferred that hypotension with consecutive hypoxia could be considered as a pathophysiological mechanism of headache, beside the already known and accepted mechanisms.
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PMID:[Post-spinal anesthesia headache--some other physiopathological mechanism?]. 214 95

A 40-year-old white female was seen with the chief complaint of recurrent episodes of severe pulsating occipital headache. The headache was temporarily controlled with the treatment of antibiotics only to recur. Sinus X-ray revealed an increased radio-opacity in the left sphenoidal sinus. The sinus walls showed sclerotic reaction. X-Ray CT demonstrated a small piece of metallic density within the soft-tissue density. Intranasal sphenoidotomy was performed under general anesthesia. A small piece of stone, measuring 3 X 2 X 1.5mm, was found in the sphenoidal sinus, with purulent discharge and caseous concrements. Histopathologic examination of the caseous concrements demonstrated fungal hyphae with branching and septate suggesting Aspergillus sp. Chemical analysis of the stone (3mg dried weight) was done and it consisted of calcium phosphate (88%) and calcium carbonate (12%). Postoperative course for five years was uneventful, and postop. CT confirmed the aerated sphenoidal sinus.
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PMID:[A case of mycotic sphenoidal sinusitis with stone formation]. 218 Oct 92


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