Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
Clinical TrialMultiple injection axillary brachial plexus block: influence of obesity on failure rate and incidence of acute complications.
Obesity has been associated with an increased failure rate in regional anesthesia, but specific block techniques have not been evaluated. We hypothesized that obesity decreases the success rate of axillary brachial plexus block. ⋯ Obesity increased the failure rate and immediate complications of axillary brachial plexus block. Furthermore, more obese patients were dissatisfied with their anesthesia.
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Anesthesia and analgesia · Jul 2010
Ropivacaine-induced peripheral nerve injection injury in the rodent model.
Intraneural administration of local anesthetics has been associated with nerve damage. We undertook the present study to investigate histological changes induced by ropivacaine injection into rat sciatic nerve. ⋯ This study demonstrates that, in the rat model, ropivacaine is associated with marked histological abnormality, including edema of the perineurium and axonal destruction with wallerian degeneration, when injected into or extraneurally placed onto a nerve. Extrafascicular injection and extraneural placement were associated with similar, although milder, histological damage than intrafascicular injection. Further work is needed to investigate the functional implications, if any, of the histological abnormalities observed in this study.
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Anesthesia and analgesia · Jul 2010
Control chart monitoring of the numbers of cases waiting when anesthesiologists do not bring in members of call team.
An anesthesia group staffing agreement with a hospital often specifies the minimum number of operating rooms (ORs) to be covered during evening or weekend hours. Frequently, 1 anesthesiologist works in-house and others take call from home, coming in if multiple cases are waiting to be done. The anesthesiologist in-house sometimes does not bring in colleagues from home when the number of ORs he can supervise is less than the number specified in the agreement with the hospital (i.e., assignment is less than staffing). Queuing occurs even if managers have selected an appropriate number of ORs to be run during evenings and weekends (i.e., the number of cases [jobs] exceeds the number of ORs [identical machines] that are actually run). ⋯ Anesthesiologists sometimes do not notify call team members when cases are waiting and the number of ORs running is less than allocated. The number of cases waiting, rather than the amount of waiting, is more appropriate for monitoring trends over time. Simple Shewhart charts can be used for monitoring contractually specified staffing.
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Anesthesia and analgesia · Jul 2010
Blockade of the sinuvertebral nerve for the diagnosis of lumbar diskogenic pain: an exploratory study.
In this exploratory study we evaluated sensitivity and target specificity of sinuvertebral nerve block (SVNB) for the diagnosis of lumbar diskogenic pain. Diskography has been the diagnostic gold standard. Fifteen patients with positive diskography underwent SVNB via interlaminar approach to the posterior aspect of the disk. ⋯ The sensitivity was 73.3% (95% CI: 50.9%-95.7%). The target specificity was 40% (15.2%-64.8%). The results indicate that SVNB cannot yet replace diskography but encourage future studies to improve its target specificity.
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Anesthesia and analgesia · Jul 2010
Editorial CommentPRO: accumulating evidence for an outrageous claim.