Anesthesia and analgesia
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There is growing interest in the use of regional anesthesia worldwide. With this survey, we determined the use of regional techniques among anesthesiologists in Nigeria using a cross-sectional study design. A self-administered questionnaire was mailed to a randomly generated list of anesthesiologists in Nigeria. ⋯ Regular use of spinal, epidural, and peripheral nerve blocks was 92.9%, 15%, and 2.9%, respectively. A high percentage of respondents (47.1%) had never performed a nerve block and only 31.4% had used a nerve stimulator technique. Limited exposure to equipment and techniques accounted for their lack of use.
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Anesthesia and analgesia · Jan 2010
Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia.
The use of local anesthetic test doses is standard practice when performing regional anesthesia. When an intravascular test dose is administered during inhaled anesthesia, the heart rate does not increase in about 25% of children; altered T-wave amplitude is a better indicator. No studies have examined the criteria for a positive result during total i.v. anesthesia (TIVA) in children. ⋯ A positive test dose during TIVA is best detected by increased arterial blood pressure. Twenty-seven percent of intravascular injections were missed using heart rate criteria. T-wave amplitude is not a reliable indicator of intravascular injection during TIVA. This is in marked distinction to what is seen during inhaled anesthesia.
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Anesthesia and analgesia · Jan 2010
Development and validation of predictors of respiratory insufficiency and mortality scores: simple bedside additive scores for prediction of ventilation and in-hospital mortality in acute cervical spine injury.
Numerous studies have developed a "severity score" or "risk index" for mechanical ventilation and mortality, but there are few to predict outcomes for cervical spine injury (CSI) patients. Our objective in this study was to develop a simple bedside additive predictive score for requirement for ventilation and early in-hospital mortality for patients with CSI. ⋯ PRIM scores enable accurate prediction of individual patient risk of need for mechanical ventilation and in-hospital mortality in association with acute CSI.
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Anesthesia and analgesia · Jan 2010
Case ReportsSpinal cord stimulation for severe degenerative joint disease of the shoulder in a patient with severe chronic obstructive pulmonary disease: a new indication?
Approximately 70% of the United States population older than 65 yr has osteoarthritis. Chronic obstructive pulmonary disease (COPD) is also more prevalent in the elderly, and thus, the likelihood of having elderly patients with osteoarthritis and COPD in clinical settings is significant. COPD may preclude the optimum use of opioids, thus the potential to provide pain control with nonpharmacological treatment modalities becomes a valuable option. We present the case of an elderly woman with severe degenerative joint disease of the shoulder and severe COPD in whom spinal cord stimulation was used to provide pain control.
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Anesthesia and analgesia · Jan 2010
The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.
Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. ⋯ No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.