Anesthesia and analgesia
-
Anesthesia and analgesia · Dec 2012
Case ReportsCase report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies.
The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesia. Possible mechanisms of injury and implications for practice are discussed.
-
Anesthesia and analgesia · Dec 2012
Case ReportsCase report: an unforeseen peril of parental presence during induction of anesthesia.
Parental presence during induction of anesthesia is a common practice to allay perioperative anxiety in the pediatric population. We present the first documented case in the anesthesia literature of parental interruption of induction of anesthesia. The report is to inform practitioners of the need for perioperative screening, education, and contingency planning to prepare for the possibility of familial disruption during pediatric inductions, cesarean deliveries, and other practice settings that may have lay people present.
-
Anesthesia and analgesia · Dec 2012
The local peripheral antihyperalgesic effect of levetiracetam and its mechanism of action in an inflammatory pain model.
We have recently shown that levetiracetam, administered systemically, exerts an antihyperalgesic effect in a rat inflammatory pain model. In this study, we examined whether levetiracetam has local peripheral antihyperalgesic/anti-edematous effects in the same model of localized inflammation and whether opioidergic, adrenergic, purinergic, 5-HTergic, and GABAergic receptors are involved in its antihyperalgesic action. ⋯ Our results show that levetiracetam produces local peripheral antihyperalgesic and anti-edematous effects in a rat model of localized inflammation. Antihyperalgesia is at least in part mediated by peripheral μ-opioid, α2A,C-adrenergic, A1 adenosine, and 5-HT1B/1D receptors, but not by GABAA receptors. These findings could contribute toward a better understanding of the analgesic effects of levetiracetam, and improved treatments of inflammatory pain with a lower incidence of systemic side effects and drug interactions of levetiracetam.
-
Anesthesia and analgesia · Dec 2012
Technical communication: anatomy and clinical implications of ultrasound-guided selective femoral nerve block.
In this study we evaluated the anatomic basis and clinical findings of ultrasound-guided femoral nerve block performed close to the distal apex of the femoral triangle. Cadaver studies were conducted in 9 thighs of fresh bodies within 24 hours postmortem. In all cases, during injection of 10 mL of blue dye, the skin proximal to the injection site was compressed to prevent the proximal flow. ⋯ The femoral nerve was successfully dyed in all cases of the cadaver study, whereas the muscular branch to the sartorius muscle and quadriceps muscle, with the exception of the vastus medialis muscle, evaded dyeing. All 20 patients with varus knee deformities reported analgesia; none of them experienced motor block. We conclude that local anesthetic injection at the site where the superficial femoral artery has passed beneath the medial border of the sartorius muscle (8 to 12 cm distal to the inguinal crease), combined with efforts taken to prevent proximal flow may anesthetize the sensation of the anterior-to medial aspect of the knee and motor branch of the vastus medialis muscle, without blocking the sartorius or quadriceps muscles.
-
Anesthesia and analgesia · Dec 2012
Editorial Historical ArticleAnesthesia & analgesia by the numbers: then & now.