Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2010
Case ReportsPerioperative analgesia for forequarter amputation in a child: a dual paravertebral approach.
We describe the management of postoperative pain for a 10-year-old girl who underwent forequarter amputation for osteosarcoma of the left humerus. Because the brachial plexus itself was divided and resected during surgery, and the main body part innervated by the nerves from this plexus (the entire upper limb including the scapula and clavicle) was removed, providing analgesia via a brachial plexus block alone would probably not have provided adequate coverage. Because the tissue not resected with this surgery was innervated via the cervical and brachial plexuses and some upper thoracic nerve roots, we elected to combine a perioperative high continuous cervical paravertebral block at the C5 level with a continuous thoracic paravertebral block at the T2 level for postoperative analgesia. Our patient experienced excellent postoperative analgesia and required no narcotics during the immediate postoperative period.
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Anesthesia and analgesia · Mar 2010
The ability of pleth variability index to predict the hemodynamic effects of positive end-expiratory pressure in mechanically ventilated patients under general anesthesia.
Pleth variability index (PVI) is a new algorithm allowing automated and continuous monitoring of respiratory variations in the pulse oximetry plethysmographic waveform amplitude. PVI can predict fluid responsiveness noninvasively in mechanically ventilated patients during general anesthesia. We hypothesized that PVI could predict the hemodynamic effects of 10 cm H2O positive end-expiratory pressure (PEEP). ⋯ PVI may be useful in automatically and noninvasively detecting the hemodynamic effects of PEEP when V(T) is >8 mL/kg in ventilated and sedated patients with acceptable sensitivity and specificity.