Epidural injection of lidocaine reduces the response to dural puncture accompanying spinal needle insertion when performing combined spinal-epidural anesthesia.

During placement of needles for combined spinal-epidural anesthesia (CSEA), patients may experience pain, pressure, paresthesia, or discomfort during skin and deeper injection of local anesthetic, needle impingement on periosteum, dural puncture by the spinal needle, and insertion of the epidural catheter. We investigated the incidence of perception of and spontaneous verbal and motor responses to insertion of a spinal needle through the dura mater and pia mater and the effect of injecting lidocaine into the epidural space through the epidural needle before inserting the spinal needle through the meninges. Forty-three patients presenting for elective cesarean delivery under CSEA were studied.

Intravenous or inhaled induction of anesthesia in adults? An audit of preoperative patient preferences.

If given a choice, would patients prefer an inhaled or IV method of inducing anesthesia? We investigated the choice between inhaled and IV induction of anesthesia of adult patients presenting to an academic institution for ambulatory surgery. Of 240 patients audited at the preoperative visit, 212 (88%) reported anesthetic histories in which anesthesia had been induced IV and by inhalation in 203 (96%) and 5 (2%) patients, respectively, with the remaining 4 (2%) having no recall of route of the induction of anesthesia. Seventy-eight (33%) patients selected IV induction, 120 (50%) chose inhaled induction, and 42 (17%) patients were undecided.

Premedications and peribulbar analgesia--a prospective audit.

Purpose: After peribulbar block analgesia (PBA) instituted in the preoperative anesthetic room, patients are often anxious, developing increased heart rate (HR) and blood pressure (BP) upon their arrival to the operating room and during subsequent surgery. The efficacy of premedication in attenuating these stress responses has not been examined. A prospective audit was undertaken to examine the relationship between the premedication schedules most commonly prescribed at the King Khaled Eye Specialist Hospital and increases in HR and BP during surgery in response to the stress of surgery, and the requirements for intravenous (IV) benzodiazepine, opioid or NSAID medication to treat these increases, or any complaint of pain or positional discomfort on the operating table, respectively.