Management of intra operative priapism after spinal anesthesia with intravenous glycopyrrolate and intracorporeal injection of ultra low dose of phenylephrine- A case report

2021 ◽  
Vol 8 (2) ◽  
pp. 348-350
Author(s):  
Tshering P Bhutia ◽  
Neelima Pradhan ◽  
Tsewang D Bhutia ◽  
Rajni ◽  
Sonam D Bhutia
Keyword(s):  
Case Report ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Ureteric Stone ◽  
Successful Management ◽  
Ureteroscopic Lithotripsy ◽  
The Past ◽  
Dorsal Penile Nerve Block ◽  
Dorsal Penile Nerve ◽  
Intravenous Ketamine

Priapism following neuraxial anesthesia or general anesthesia is a rare but problematic event which may result in delay, complication or even cancellation of scheduled operations in urological endoscopic procedures. We present a case of successful management of intra operative priapism in a 32 years old male under spinal anesthesia posted for Ureteroscopic Lithotripsy (URSL) of bilateral ureteric stone.Different therapies for management of intra operative priapism have been quoted in the past like intracorporeal injection of vasopressors, dorsal penile nerve block, intravenous glycopyrrolate, intravenous ketamine/dexmedetomidine etc. In this case we treated with intravenous glycopyrrolate and intracorporeal injection of ultra low dose phenylephrine.

scholarly journals CASE REPORT - -Combined General and Spinal Anesthesia for Lumbar decompression in an Opioid-intolerant Patient: Intra-operative Administration of Intrathecal Bupivacaine via the Surgical Incision

2012 ◽  
Vol 6 (1) ◽  
pp. 9-11
Author(s):  
Stephen D. Wilkins ◽  
Theodore A. Alston ◽  
Jingping Wang
Keyword(s):  
Case Report ◽  
Spinal Anesthesia ◽  
Postoperative Nausea ◽  
Surgical Procedure ◽  
Postoperative Nausea And Vomiting ◽  
Lumbar Surgery ◽  
Surgical Incision ◽  
History Of ◽  
Fluid Leak ◽  
Intravenous Ketamine

We illustrate repeat dosing of spinal anesthesia as a means to avoid opioids during lumbar surgery for a patient intolerant of opioids. A patient required redo lumbar surgery but had a marked history of nausea, vomiting and retching in response to opioids. A propofol-based anesthetic was supplemented with intravenous ketamine and intrathecal bupivacaine. The first dose of bupivacaine receded during the lengthy surgical procedure but was supplemented by means of a 25-gauge pencil-point needle passed through the exposed dura. Postoperatively, there was no spinal fluid leak, no headache, and no nausea. Supplementation of intrathecal anesthesia under direct dural vision during lengthy lumbar surgery is facile, can help to obviate a need for opioids, and can aid in avoidance of postoperative nausea and vomiting.

scholarly journals Successful treatment of paroxysmal tonic upgaze with low dose Gravol ®

2015 ◽  
Vol 42 (S1) ◽  
pp. S24-S24
Author(s):  
K Sawicka ◽  
R Huntsman
Keyword(s):  
Case Report ◽  
Neurological Examination ◽  
Low Dose ◽  
Therapeutic Option ◽  
Brain Mri ◽  
Blood Analysis ◽  
Anticholinergic Effects ◽  
The Past ◽  
One Year ◽  
Novel Therapeutic

Background: We present a case of paroxysmal tonic upgaze (PTU) of infancy treated with a daily low dose of Gravol ® to improve symptoms. Method: Case report Results: A one year-old boy presented with episodes of sustained conjugate upgaze that persisted for 30 to 45 minutes, varied in severity, and occurred with increasing frequency over the past two months. The episodes were worse when fatigued and were relieved by sleep. Pregnancy, delivery, and development were normal. Neurological examination between episodes was normal, as were EEG, brain MRI, and blood analysis. CSF neurotransmitter analysis showed serotonin and dopamine metabolites at lower levels of normal. The patient was diagnosed with paroxysmal tonic upgaze of infancy and was treated with 12.5 mg of Gravol ® daily with complete cessation of episodes. Conclusions: Paroxysmal tonic upgaze (PTU) of infancy is a disorder seen in infants where the eyes are forcibly deviated upwards for minutes to hours at a time. PTU often resolves spontaneously over several months, however episodes are extremely debilitating. Currently, treatments with levodopa have been tried with some success. Via its anticholinergic effects, Gravol may be a novel therapeutic option for PTU, negating the need to use serotonergic medications.

scholarly journals Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia

2016 ◽  
Vol Volume 9 ◽  
pp. 689-692 ◽  
Author(s):  
AA Gde Putra Semara Jaya ◽  
I Made Gede Widnyana ◽  
Made Wiryana ◽  
I Gusti Ngurah Mahaalit Aribawa ◽  
I Wayan Aryabiantara ◽  
...  
Keyword(s):  
Stress Response ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Intravenous Ketamine

scholarly journals Intravenous Ketamine for the Prevention of Post Anesthetic Shivering in Spinal Anesthesia: A Randomized Double-Blind Placebo-Controlled Trial

2020 ◽  
Author(s):  
Farzad Sarshivi ◽  
Ebrahim Ghaderi ◽  
Arman Sarshivi ◽  
Shoaleh Shami ◽  
Karim Nasseri
Keyword(s):  
Spinal Anesthesia ◽  
Low Dose ◽  
Controlled Trial ◽  
Saline Group ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
To Receive ◽  
Intravenous Ketamine

Spinal anesthesia (SA) may impair thermoregulatory control, which may result in shivering, which is a potentially harassing complication. The aim of the current study was to evaluate the prophylactic effects of intravenous ketamine on the prevention of shivering in patients who underwent elective cesarean section (CSs) under SA. In this double-blind, randomized placebo controlled trial, a total of 90 parturients under SA using hyperbaric bupivacaine 12.5 mg were allocated in two groups to receive ketamine 0.3 mg/kg or 0.9% saline following delivery. After induction of SA, patients were observed for the incidence and intensity of shivering using a four-point scale. Shivering was observed in 24 patients (53.3%) in the saline group and 15 patients (33.3%) in the ketamine group. Median (quartiles 1 and 3) of the intensity of shivering was 1 (0-2) and 0 (0-2) in saline and ketamine groups, respectively. Time from spinal anesthesia to the beginning of shivering was 33.1±11.7 min in saline versus 41.6±20.7 min in the ketamine group. The incidence of nausea, vomiting, hypotension, and bradycardia was not different between the groups. A significantly higher incidence of nystagmus and sedation was observed in the ketamine group when compared with the saline group administration of low dose i.v. Ketamine (0.3 mg/kg) was effective in lowering shivering intensity during CSS under spinal anesthesia, though side effects such as nystagmus and sedation may restrict its effectiveness.

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