Regional anesthesia最新文献

Not everything that can be done should be done 不是所有能做的事都应该做

Regional anesthesia Pub Date : 2016-02-24 DOI: 10.2147/LRA.S102366

C. Slagt

{"title":"Not everything that can be done should be done","authors":"C. Slagt","doi":"10.2147/LRA.S102366","DOIUrl":"https://doi.org/10.2147/LRA.S102366","url":null,"abstract":"Dear editor \u0000 \u0000After reading the article, “Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency” by Mehta et al,1 I have the following considerations. Laparoscopic cholecystectomy was performed under spinal anesthesia in healthy patients.2 Perioperative hemodynamic instability (59%) and discomfort (43%) were noticed in this group of 49 patients. From the gastroenterology literature, we know that a combination of lumbar spinal and thoracic epidural anesthesia can be used as a monotherapy for high-risk patients undergoing gastrointestinal and colorectal surgery.3 Perioperative hemodynamics and discomfort were not observed in 12 patients. Is this a stress-free environment? Preventing general anesthesia should not be a goal on its own. From an oxygen delivery-consumption point of view, general anesthesia reduces oxygen consumption and can promote oxygen delivery, theoretically preventing organ failure, especially in high-risk surgical patients with diseases that involve multiple organs.4 Our body has protected the delicate spinal cord by the vertebral column. Damaging the spinal cord during anesthesia, for instance, during epidural procedures, is one of the greatest fears of our patients and anesthesiologists.5,6 New techniques should be thoroughly tested on healthy patients before they are used on high-risk surgical patients. A combined thoracic spinal epidural anesthesia is, in the light of the above, an undesirable technique, especially combined with pneumoperitoneum when hemodynamic and respiratory homeostasis and patient comfort can be compromised. Although there is the possibility to place a thoracic combined spinal epidural anesthesia, I strongly like to emphasize that especially in the view of patient safety, this procedure is undesirable. A thoracic epidural combined with general anesthesia is in the most cases (if not all cases) a safe alternative.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"9 1","pages":"13 - 15"},"PeriodicalIF":0.0,"publicationDate":"2016-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S102366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68394519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency 胸椎联合硬膜外麻醉在老年缺血性心脏病伴肾功能不全的腹腔镜胆囊切除术中的应用

Regional anesthesia Pub Date : 2015-12-02 DOI: 10.2147/LRA.S86390

N. Mehta, Sunana Gupta, A. Sharma, M. Dar

{"title":"Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency","authors":"N. Mehta, Sunana Gupta, A. Sharma, M. Dar","doi":"10.2147/LRA.S86390","DOIUrl":"https://doi.org/10.2147/LRA.S86390","url":null,"abstract":"Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"8 1","pages":"101 - 104"},"PeriodicalIF":0.0,"publicationDate":"2015-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S86390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68394933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review 连续肋间神经阻滞或硬膜外镇痛对外伤性肋骨骨折后呼吸并发症发生率、重症监护病房和住院时间的比较评价:回顾性回顾

Regional anesthesia Pub Date : 2015-10-27 DOI: 10.2147/LRA.S80498

T. Britt, Ryan Sturm, R. Ricardi, V. LaBond

{"title":"Comparative evaluation of continuous intercostal nerve block or epidural analgesia on the rate of respiratory complications, intensive care unit, and hospital stay following traumatic rib fractures: a retrospective review","authors":"T. Britt, Ryan Sturm, R. Ricardi, V. LaBond","doi":"10.2147/LRA.S80498","DOIUrl":"https://doi.org/10.2147/LRA.S80498","url":null,"abstract":"Background Thoracic trauma accounts for 10%–15% of all trauma admissions. Rib fractures are the most common injury following blunt thoracic trauma. Epidural analgesia improves patient outcomes but is not without problems. The use of continuous intercostal nerve blockade (CINB) may offer superior pain control with fewer side effects. This study’s objective was to compare the rate of pulmonary complications when traumatic rib fractures were treated with CINB vs epidurals. Methods A hospital trauma registry provided retrospective data from 2008 to 2013 for patients with 2 or more traumatic rib fractures. All subjects were admitted and were treated with either an epidural or a subcutaneously placed catheter for continuous intercostal nerve blockade. Our primary outcome was a composite of either pneumonia or respiratory failure. Secondary outcomes included total hospital days, total ICU days, and days on the ventilator. Results 12.5% (N=8) of the CINB group developed pneumonia or had respiratory failure compared to 16.3% (N=7) in the epidural group. No statistical difference (P=0.58) in the incidence of pneumonia or vent dependent respiratory failure was observed. There was a significant reduction (P=0.05) in hospital days from 9.72 (SD 9.98) in the epidural compared to 6.98 (SD 4.67) in the CINB group. The rest of our secondary outcomes showed no significant difference. Conclusion This study did not show a difference in the rate of pneumonia or ventilator-dependent respiratory failure in the CINB vs epidural groups. It was not sufficiently powered. Our data supports a reduction in hospital days when CINB is used vs epidural. CINB may have advantages over epidurals such as fewer complications, fewer contraindications, and a shorter time to placement. Further studies are needed to confirm these statements.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"8 1","pages":"79 - 84"},"PeriodicalIF":0.0,"publicationDate":"2015-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S80498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68394860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 32

External ventilation monitoring system in nonintubated subjects: the noninvasive apnea monitor. 非插管受试者体外通气监测系统:无创呼吸暂停监测。

Regional anesthesia Pub Date : 1997-11-01

E Zarzur

引用次数: 0

Response to Dr. Neal's comments and to paper by Dr. Rathmell et al. 对Neal博士的评论和Rathmell博士等人的论文的回应。

Regional anesthesia Pub Date : 1997-11-01

E I Abouleish

引用次数: 0

Asystole during trigger point injections in a patient with panic disorder. 恐慌症患者在触发点注射时心脏骤停。

Regional anesthesia Pub Date : 1997-11-01

C Spevak

引用次数: 0

A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. 低剂量低压布比卡因脊柱麻醉用于膝关节镜检查。

Regional anesthesia Pub Date : 1997-11-01

K S Kuusniemi, K K Pihlajamäki, M T Pitkänen, J E Korkeila

{"title":"A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies.","authors":"K S Kuusniemi, K K Pihlajamäki, M T Pitkänen, J E Korkeila","doi":"","DOIUrl":"","url":null,"abstract":"Background and objectives: Ambulatory surgery requires anesthesia methods that allow rapid recovery and safe discharge of the patient. Spinal anesthesia is easy and quick to perform, and the use of noncutting small gauge needles reduces the occurrence of postdural puncture headache. For minimal hemodynamic consequences and faster recovery and discharge it would be optimal to limit the spread of spinal anesthesia only to the area which is necessary for surgery. In this study, the possibility in achieving unilateral spinal anesthesia with 0.18% hypobaric bupivacaine was studied.Methods: Spinal anesthesia with 3.4 mL of hypobaric 0.18% bupivacaine (6.12 mg), without any intravenous infusion or prophylactic vasopressors, was administered with 27-gauge Whitacre unidirectional needle to 70 ASA I and II patients undergoing knee arthroscopies. The patients were allocated randomly to be kept either 20 (group I) or 30 (group II) minutes in the lateral position operation side uppermost. Sensory and motor block (pinprick/modified Bromage scale) were compared between the operation and the contralateral side.Results: The motor and sensory block between operation and contralateral sides were significantly different at all testing times in both groups (P < .001, Mann-Whitney U test). The motor block was completely unilateral in 14 patients (39%) in group I and in 22 patients (65%) in group II. The hemodynamics were stable in all 70 patients.Conclusions: Approximately three and a half milliliters hypobaric 0.18% bupivacaine (6.12 mg) provides a predominantly unilateral spinal block. Thirty minutes spent in the lateral position does not provide benefits over 20 minutes. The main advantages of our method are the hemodynamic stability and the patient satisfaction.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"22 6","pages":"534-8"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20353488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Failed axillary brachial plexus block techniques result in high plasma concentrations of mepivacaine. 失败的腋窝臂丛阻滞技术导致高血浆浓度的甲哌卡因。

Regional anesthesia Pub Date : 1997-11-01

K Yamamoto, T Nomura, K Shibata, S Ohmura

{"title":"Failed axillary brachial plexus block techniques result in high plasma concentrations of mepivacaine.","authors":"K Yamamoto, T Nomura, K Shibata, S Ohmura","doi":"","DOIUrl":"","url":null,"abstract":"Background and objectives: Unintentional extrasheath injection causes failed axillary brachial plexus block. We wanted to find out if extrasheath injections produce higher plasma concentrations of local anesthetics compared to intrasheath injections. We also studied the incidence of extrasheath injection with radiographs.Methods: Axillary brachial plexus blocks were established using a catheter technique. Fifty milliliters of 1.5% mepivacaine without epinephrine mixed with contrast medium was injected through the catheter. An anteroposterior radiograph was used to determine the distribution of contrast medium. Mepivacaine concentrations in arterial plasma were compared when local anesthetic solution was injected unintentionally outside of the axillary neurovascular sheath (n = 6) and when it was injected correctly into the sheath (n = 6). The incidence of extrasheath injection was studied in a different series of 109 patients.Results: Arterial plasma mepivacaine concentrations were higher after extrasheath injection [8.0 (6.3-9.7) vs 5.8 (4.5-7.0), microg/mL, means (95% confidence intervals), P < .05]. Pharmacokinetic parameters such as mean residence time and total clearance did not differ between intra- and extrasheath injections. Extrasheath injection was observed in 3.7% (4/109) of cases.Conclusion: Failed extrasheath injection of 50 mL 1.5% plain mepivacaine produces higher arterial plasma concentration in axillary brachial plexus block.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"22 6","pages":"557-61"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20353493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comments on articles by Carpenter et al. and Bromage. 对Carpenter等人和Bromage的文章的评论。

Regional anesthesia Pub Date : 1997-11-01 DOI: 10.1136/RAPM-00115550-199722060-00019

Schweitzer Tw

引用次数: 1

Does epidural analgesia during labor affect the incidence of cesarean delivery? 分娩时硬膜外镇痛是否影响剖宫产的发生率?

Regional anesthesia Pub Date : 1997-11-01

D H Chestnut

{"title":"Does epidural analgesia during labor affect the incidence of cesarean delivery?","authors":"D H Chestnut","doi":"","DOIUrl":"","url":null,"abstract":"There is substantial evidence that there is an increased incidence of cesarean delivery among patients who receive epidural analgesia during labor. The controversy as to whether there is a causal relationship between epidural analgesia and cesarean delivery. Two prospective, randomized studies suggest that epidural analgesia may increase the incidence of operative delivery in laboring women. However, retrospective population-based studies suggest that the introduction of an epidural analgesia service, or the increased use of epidural analgesia, does not increase the cesarean delivery rate. It is possible that epidural analgesia during labor may increase the risk of cesarean delivery in selected patients. Such an effect--if it exists at all--appears to be small in contemporary practice. Furthermore, the availability and use of epidural analgesia may encourage other patients to undergo an adequate trial of labor or attempt vaginal birth after cesarean delivery. It is important to consider the impact of epidural analgesia on the total population of obstetric patients. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate. Finally, physicians should remember that pain relief is itself a worthy goal.","PeriodicalId":77347,"journal":{"name":"Regional anesthesia","volume":"22 6","pages":"495-9"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20352881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0