The technique of continuous spinal (subarachnoid)anesthesia (CSA) for administration of intermittentdoses of local anesthetic is well established (1-7). Itwas first mentioned in 1907 by Dean (l), a British surgeon, who wrote of placing a needle in the subarachnoid space and leaving it in situ to facilitate reinjection.In 1944 Tuohy (2) reported placement of a
ureteral catheter in the subarachnoid space using a
Huber point needle.This technique has two main advantages. The first is that the duration of anesthesia can be tailored to lengthy surgical procedures without the risk of the local anesthetic wearing off, as might be the case with single-injection spinal anesthesia. The other advantage is that small doses of local anesthetic can be administered intermittently until an adequate level of
anesthesia is obtained, thus minimizing the risk of cardiovascular or respiratory disturbances, which is important, particularly in elderly or high-risk patients.
In recent years, continuous spinal anesthesia has fallen into disuse as reflected by the paucity of references to it in the recent literature (6) and in the
current textbooks (3-5). Some of the reasons voiced for this disuse is fear that the large-bore needle used, 16-18-gauge, would result in an unacceptably high
incidence of postdural puncture headache (PDPH) (5,8), and that there may be some risk of neurological sequelae or infection associated with a catheter in the
subarachnoid space (9).Since its introduction in this hospital 3 yr ago, continuous spinal anesthesia has been routinely used for patients in whom spinal anesthesia is indicated when the duration of surgery is anticipated to exceed
2-3 hr.There is a slight risk of PDPH after single-injection spinal anesthesia. The incidence decreases, however,with increasing age of the patient and with decreasing needle size. The overall frequency varies from 0.24 to 37% (10-15). However, little is known about the incidence of PDPH after CSA. No prospective studies have been performed, but the few retrospective ones
that have been published suggest that the incidence is low (6,7).
The purpose of this prospective study was to investigate the incidence of PDPH in patients after CSA.
Patients and Methods
One hundred and seventeen patients who underwent surgery of the leg or lower abdomen in whom continuous spinal anesthesia was indicated were studied.The type of surgery performed is shown in Table 1.Informed consent was obtained, and approval from the local ethical committee was granted. In addition to the usual contraindications to spinal anesthesia, patients with a history of migraine or senile dementia were excluded from the study. The study data were stored and analyzed on an IBM PC computer using the SYSTAT Data Program.
Anesthetic Technique
The patients were prernedicated as deemed appropriate by the anesthesiologist supervising the case. Lumbar puncture was performed with the patient either
sitting or in the lateral decubitus position, after an intravenous infusion of 200-500 ml of crystalloid solution.Through a suitable interspace (L2-3, L3-4, or
LA-5) under aseptic conditions, the subarachnoid space was entered using an 18-gauge Hustead needle, with the needle bevel parallel to the direction of the dural
fibers. A 20-gauge, 90-cm nylon epidural
Senin, 23 Mei 2011
Jumat, 06 Mei 2011
Continuous Headache a comprehensive view
There is a very rare minority who will not (for reasons not worth entering into), but the sad reality is that the headaches are just part of life for many of us. While most people can handle short occasional headache, continuous headache is much more difficult to pass. Continuous headache just means it lasts for a term, and long periods vary from person to person. Here are three proven ways to eliminate these headaches:
1. Stay Hydrated - About 80% of Americans are not getting enough water. Although you may be drinking something throughout the day, if there is already caffeine really make you dehydrated. Your goal must have at least eight glasses of water a day, or at least 1 / 2 cup for every caffeinated beverage you drink. This is a very simple and easy, and it will make a huge difference in continuous headaches not only how many you get, but how long they last. So, start drinking more water now if you want less headaches later!
2. Avoid Sugar and Caffeine - Because of how your body processes the sugar is simple, very easy to get a headache when you get what is called a sugar crash. A sugar crash is caused by excess production of insulin in the body. Basically, when you eat something like candy, the pancreas produces insulin to process sugar. After the sugar is lost, sometimes the pancreas continues to produce too much insulin, which makes you want more sugar and often cause headaches and fatigue. Caffeine is a powerful diuretic, and so will hinder your efforts to stay hydrated (as described above). Basically the only limit the amount of water your body can absorb, so try and avoid caffeine as much as possible. Although sugar crashes usually do not cause constant headaches, withdrawal from not getting enough caffeine (if you've become addicted to it) or because dehydration can and WILL cause them.
3. Relax - constant headache is called tension headache lot, because they were caused by excessive tension in the muscles of the head, neck, and upper back. The muscles become tense from stress or more congested and basically pull the top of the head, causing headaches are usually felt in the front of your head. These headaches can be very difficult constantly to get rid of, because there is no quick way to completely relax your muscles. However, there are several ways to prevent this type of continuous headaches from affecting you. First, do some neck and shoulder rolls loose shrug when you wake up every morning and then again in the afternoon. This will help to keep the muscles loose and relaxed. Do this exercise again at night right before you go to bed too. Second, try to get the neck or shoulder massage once a week if you can. If you can not buy a professional massage performed by a trained specialist, offers a trade-off with your partner.
This is an easy way to treat and prevent headaches constantly. If you are bothered by these annoying headaches, start using this method directly - you'll be glad you did!
1. Stay Hydrated - About 80% of Americans are not getting enough water. Although you may be drinking something throughout the day, if there is already caffeine really make you dehydrated. Your goal must have at least eight glasses of water a day, or at least 1 / 2 cup for every caffeinated beverage you drink. This is a very simple and easy, and it will make a huge difference in continuous headaches not only how many you get, but how long they last. So, start drinking more water now if you want less headaches later!
2. Avoid Sugar and Caffeine - Because of how your body processes the sugar is simple, very easy to get a headache when you get what is called a sugar crash. A sugar crash is caused by excess production of insulin in the body. Basically, when you eat something like candy, the pancreas produces insulin to process sugar. After the sugar is lost, sometimes the pancreas continues to produce too much insulin, which makes you want more sugar and often cause headaches and fatigue. Caffeine is a powerful diuretic, and so will hinder your efforts to stay hydrated (as described above). Basically the only limit the amount of water your body can absorb, so try and avoid caffeine as much as possible. Although sugar crashes usually do not cause constant headaches, withdrawal from not getting enough caffeine (if you've become addicted to it) or because dehydration can and WILL cause them.
3. Relax - constant headache is called tension headache lot, because they were caused by excessive tension in the muscles of the head, neck, and upper back. The muscles become tense from stress or more congested and basically pull the top of the head, causing headaches are usually felt in the front of your head. These headaches can be very difficult constantly to get rid of, because there is no quick way to completely relax your muscles. However, there are several ways to prevent this type of continuous headaches from affecting you. First, do some neck and shoulder rolls loose shrug when you wake up every morning and then again in the afternoon. This will help to keep the muscles loose and relaxed. Do this exercise again at night right before you go to bed too. Second, try to get the neck or shoulder massage once a week if you can. If you can not buy a professional massage performed by a trained specialist, offers a trade-off with your partner.
This is an easy way to treat and prevent headaches constantly. If you are bothered by these annoying headaches, start using this method directly - you'll be glad you did!
Headache Treatments
Often keeping food diary can help you determine whether a particular food can cause your headaches. Maintain a regular sleep schedule is helpful in avoiding the headaches. Too much or too little sleep may contribute to headaches.
OTC medications such as aspirin, acetominophen, ibuprofen, or naproxen sodium is the treatment of choice for most tension headaches. You must follow the proper dosage instructions when using pain medication so it is not too often taken. OTC drug overdose some permanent damage to the liver and overuse of these drugs can cause rebound headaches.
Biofeedback therapy is several times helps to reduce headaches and stress by helping you learn to relax. Exercise and avoid stressful situations and anxiety will often reduce the number of headaches you experience. Walking is a simple exercise that everyone who is running to do and is a major symptom reducer as a whole which has additional benefits to reduce your risk for many diseases including heart disease.
If you experience a migraine, your doctor will prescribe medication to take before you become an intense headache. You can discuss these medications with your doctor to determine whether they are suitable for you.
When to seek professional care
It is important that all headaches were diagnosed correctly. If you have never consult with your doctor about your headaches, talk to him to ensure that your chronic headaches are not serious.
The doctor will take a detailed medical history and ask pertinent questions. There is no test to diagnose migraine, so your answer is important. This will help your doctor diagnose your headache if you would keep a headache diary or journal before your appointment.
If you are over 50 and you suddenly started having headaches when you never had before, this is very important to see your physician. Migraine headaches may occur in early childhood. But most often, the onset occurs between ages 5 to 50, a sudden onset of headache after age 50, may indicate serious disease.
OTC medications such as aspirin, acetominophen, ibuprofen, or naproxen sodium is the treatment of choice for most tension headaches. You must follow the proper dosage instructions when using pain medication so it is not too often taken. OTC drug overdose some permanent damage to the liver and overuse of these drugs can cause rebound headaches.
Biofeedback therapy is several times helps to reduce headaches and stress by helping you learn to relax. Exercise and avoid stressful situations and anxiety will often reduce the number of headaches you experience. Walking is a simple exercise that everyone who is running to do and is a major symptom reducer as a whole which has additional benefits to reduce your risk for many diseases including heart disease.
If you experience a migraine, your doctor will prescribe medication to take before you become an intense headache. You can discuss these medications with your doctor to determine whether they are suitable for you.
When to seek professional care
It is important that all headaches were diagnosed correctly. If you have never consult with your doctor about your headaches, talk to him to ensure that your chronic headaches are not serious.
The doctor will take a detailed medical history and ask pertinent questions. There is no test to diagnose migraine, so your answer is important. This will help your doctor diagnose your headache if you would keep a headache diary or journal before your appointment.
If you are over 50 and you suddenly started having headaches when you never had before, this is very important to see your physician. Migraine headaches may occur in early childhood. But most often, the onset occurs between ages 5 to 50, a sudden onset of headache after age 50, may indicate serious disease.
A Continuous headache may not be chronic in nature
It may appear episodic assessment but caution will reveal that the continuous (constant, persistent, non-stop, Neverending). The intensity of the pain may subside, though not complete, for a period of time (hours or days) and then returned with full intensity.
These headaches may respond to analgesics (pain relievers partial or complete), but this does not change the nature of the headache - constant, continuous, persistent.
Does chronic daily headache?
Constant headache is not always chronic in nature. Each headache, episodic or persistent, lasting for 3 months or more may be considered chronic.
The term chronic daily headache is technically used for this type of headache and pain will usually be present for a minimum of 15 days or more in a month. In order to convince diagnose cases of chronic daily headache, it is advisable to keep a headache diary (note frequency, trigger factors may be, the day of the menstrual cycle, pain intensity from 1 to 10 and duration) for a period of 3 to 6 months.
Clinical Significance of Constant Headache
Any person who suffers constant headaches for a period of time can be frustrating. Continuous pain, various tests and investigations and regular changes in medication or dosage can be exhausting. The question arises whether the diagnosis is missed or focus on one cause is to lead the clinician astray. Many medical practitioners will attribute constant headache to psychological causes (depression, anxiety or imaginary) that leave many patients are dissatisfied with the diagnoses.
Persistent headache without neurological symptoms, no signs and symptoms or other obvious lack of significant clinical findings from other disorders is not likely to be associated with serious health disorders. Repeat testing, investigation and clinical evaluation by more than one medical practitioner is always recommended. This ensures that the condition develops missed both as a result of negative or inconclusive findings initially or because the skills of a practitioner, or lack thereof.
diagnostics may be required to work with general practitioners and specialists (neurologist, physician, psychiatrist) to find the cause of constant headache. Long Long pain management may be your only option in dealing with constant headache in some cases.
These headaches may respond to analgesics (pain relievers partial or complete), but this does not change the nature of the headache - constant, continuous, persistent.
Does chronic daily headache?
Constant headache is not always chronic in nature. Each headache, episodic or persistent, lasting for 3 months or more may be considered chronic.
The term chronic daily headache is technically used for this type of headache and pain will usually be present for a minimum of 15 days or more in a month. In order to convince diagnose cases of chronic daily headache, it is advisable to keep a headache diary (note frequency, trigger factors may be, the day of the menstrual cycle, pain intensity from 1 to 10 and duration) for a period of 3 to 6 months.
Clinical Significance of Constant Headache
Any person who suffers constant headaches for a period of time can be frustrating. Continuous pain, various tests and investigations and regular changes in medication or dosage can be exhausting. The question arises whether the diagnosis is missed or focus on one cause is to lead the clinician astray. Many medical practitioners will attribute constant headache to psychological causes (depression, anxiety or imaginary) that leave many patients are dissatisfied with the diagnoses.
Persistent headache without neurological symptoms, no signs and symptoms or other obvious lack of significant clinical findings from other disorders is not likely to be associated with serious health disorders. Repeat testing, investigation and clinical evaluation by more than one medical practitioner is always recommended. This ensures that the condition develops missed both as a result of negative or inconclusive findings initially or because the skills of a practitioner, or lack thereof.
diagnostics may be required to work with general practitioners and specialists (neurologist, physician, psychiatrist) to find the cause of constant headache. Long Long pain management may be your only option in dealing with constant headache in some cases.
solution to these constant headaches ?
Over the last four years I had constant headaches, usually wake up with one in the morning or sometimes the one developed after I was awake for an hour or more.
It hurts around my eyes and they feel depressed and tense, which is usually aggravated by bright sunlight or bright indoor lights.
The area around the brow I felt tense and nervous, like my temples on both sides, and my forehead felt tense and depressed, too.
It hurts the eyes and forehead to look at the top surface of the head.
I had the eye test that shows my eye pressure and so the views of all fine.
I've been to many doctors over four times the previous year, but with no success whatsoever. I have taken courses amytripyline on three separate occasions (such as doctors thought the cause may be muscle tension in my forehead.)
It made no difference at all to the occurrence or severity of headaches.
I've been taking a course Paramax, again with no effect. I've stopped taking paracetemol for two months to see if taking up so much every day cause headaches to continue, but again no effect, and this would not explain the original cause of the headaches as well.
I've stopped taking the pill for more than six months, again to no effect. I have a headache, the same every day continuously for 4 years before and I really felt at the end of my tether.
I eat a balanced diet, exercise one or two times a week doing aerobics, and I have at least eight hours of sleep most nights.
I get these headaches if I'm stressed (during my exams) or not (relax on the beach outside the country) and always the same severity and feeling depressed.
I have seen two different doctors but they failed to explain or cure this headache and I'm constantly on the edge of my patience.
My blood pressure is fine and the X-ray doctor sent me to take my head also found no indication either the cause or the answer to the headaches.
I'm in my final year at university and I will do almost anything to just feel 'normal' again. It's been so long I can not remember how it felt to not have constant headaches and functioning properly.
Surely there must be something wrong to get a headache so long and so continuously?
It hurts around my eyes and they feel depressed and tense, which is usually aggravated by bright sunlight or bright indoor lights.
The area around the brow I felt tense and nervous, like my temples on both sides, and my forehead felt tense and depressed, too.
It hurts the eyes and forehead to look at the top surface of the head.
I had the eye test that shows my eye pressure and so the views of all fine.
I've been to many doctors over four times the previous year, but with no success whatsoever. I have taken courses amytripyline on three separate occasions (such as doctors thought the cause may be muscle tension in my forehead.)
It made no difference at all to the occurrence or severity of headaches.
I've been taking a course Paramax, again with no effect. I've stopped taking paracetemol for two months to see if taking up so much every day cause headaches to continue, but again no effect, and this would not explain the original cause of the headaches as well.
I've stopped taking the pill for more than six months, again to no effect. I have a headache, the same every day continuously for 4 years before and I really felt at the end of my tether.
I eat a balanced diet, exercise one or two times a week doing aerobics, and I have at least eight hours of sleep most nights.
I get these headaches if I'm stressed (during my exams) or not (relax on the beach outside the country) and always the same severity and feeling depressed.
I have seen two different doctors but they failed to explain or cure this headache and I'm constantly on the edge of my patience.
My blood pressure is fine and the X-ray doctor sent me to take my head also found no indication either the cause or the answer to the headaches.
I'm in my final year at university and I will do almost anything to just feel 'normal' again. It's been so long I can not remember how it felt to not have constant headaches and functioning properly.
Surely there must be something wrong to get a headache so long and so continuously?
List of 9 causes of Constant headache (Continuous headache)
more than 45 million Americans who suffer from chronic headaches each year, at least 16 million suffer from migraines. Migraine headaches occur in women three times more often in men and affects approximately 18% of women in the United States, while only 6% of men experience migraine.
Research has found clear evidence that 60% of women who experienced headaches can trace the roots of their headaches to their menstrual cycle. Several studies have shown an increased risk of stroke with use of oral contraceptives. So talk with your doctor to determine whether it is appropriate treatment for you.
What causes headaches?
Many people have experienced various types of headaches at different times and is very important to obtain the correct diagnosis of your headache. Various causes of headaches there. But they are usually a symptom of a disease such as sinus infections, cold, flu or other benign diseases. But the possibility of potentially life-threatening diseases such as hemorage brain anuerysm, tumor, or brain infection remains.
Some factors that can trigger headaches, including diseases, nutrition, and your environment. Foods like chocolate, what pickles, beans, sourdough, banana, pizza, sausage or bologna are among the few foods that often trigger a migraine. Excess amount of coffee, tea, soda and caffeine can also trigger migraine headaches.
Many migraine patients feel they are the result of allergies, although the scientific community can not clearly verify this theory. Common household chemicals like bleach and ammonia headache trigger for many people. Others report headaches triggered by things such as perfume and hair products.
Headaches can also be a symptom of more serious illness or infection. So if you have a headache accompanied by fever or stiff neck, you should seek immediate medical attention because these are symptoms of meningitis or other serious infections. Any headache accompanied by fever require your doctor's advice.
If your headache is a result of head injury and lasted more than a few days, call your doctor. Or if there are neurological symptoms accompany your headaches, such as disruption in your speech or vision, any numbness or weakness in your body, or problems concentrating, thinking or remembering, it is important that you seek your doctor's advice immediately.
Research has found clear evidence that 60% of women who experienced headaches can trace the roots of their headaches to their menstrual cycle. Several studies have shown an increased risk of stroke with use of oral contraceptives. So talk with your doctor to determine whether it is appropriate treatment for you.
What causes headaches?
Many people have experienced various types of headaches at different times and is very important to obtain the correct diagnosis of your headache. Various causes of headaches there. But they are usually a symptom of a disease such as sinus infections, cold, flu or other benign diseases. But the possibility of potentially life-threatening diseases such as hemorage brain anuerysm, tumor, or brain infection remains.
Some factors that can trigger headaches, including diseases, nutrition, and your environment. Foods like chocolate, what pickles, beans, sourdough, banana, pizza, sausage or bologna are among the few foods that often trigger a migraine. Excess amount of coffee, tea, soda and caffeine can also trigger migraine headaches.
Many migraine patients feel they are the result of allergies, although the scientific community can not clearly verify this theory. Common household chemicals like bleach and ammonia headache trigger for many people. Others report headaches triggered by things such as perfume and hair products.
Headaches can also be a symptom of more serious illness or infection. So if you have a headache accompanied by fever or stiff neck, you should seek immediate medical attention because these are symptoms of meningitis or other serious infections. Any headache accompanied by fever require your doctor's advice.
If your headache is a result of head injury and lasted more than a few days, call your doctor. Or if there are neurological symptoms accompany your headaches, such as disruption in your speech or vision, any numbness or weakness in your body, or problems concentrating, thinking or remembering, it is important that you seek your doctor's advice immediately.
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