Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Clinical Trial
Somatosensory evoked potentials as an objective assessment of the sensory median nerve blockade after infraclavicular block.
Median nerve somatosensory evoked responses (MnSSER) alterations were compared to clinical tests (cold and pinprick) variations, in 20 ASA I adult patients following infraclavicular block obtained with 40 mL ropivacaine 0.5% to assess first, the difference of time course of the respective electrophysiological and clinical signs, and second, the objectivity and the reproducibility of MnSSER changes. ⋯ Selected MnSSER amplitude reduction indicates objectively the onset of median nerve anesthesia following infraclavicular brachial plexus block before the appearance of clinical signs.
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The significance of intraoperative somatosensory evoked potentials (SSEP) monitoring is well known during spinal surgery. This technology could be beneficial during peripheral nerve surgery as well. In order to illustrate potential applications, two cases of successful peripheral nerve release demonstrated by on-line, intraoperative, SSEP are reported. Clinical and technical features: The first case presents a complex brachial plexus lesion involving two mixed sensory-motor nerves: median and ulnar. The second case involved an entrapment neuropathy of the lateral femoral cutaneous nerve, a pure sensory nerve (meralgia paresthetica). For each patient we elicited specific peripheral nerve SSEP (recorded using bipolar cephalic montage) by stimulating each nerve independently. In each case, during difficult nerve dissection and after having excluded other possible factors of intraoperative SSEP variations, an increase of the SSEP amplitude was observed, and later correlated with favourable patient clinical outcome. ⋯ Two cases demonstrate that intraoperative SSEP monitoring may provide an effective tool to guide surgical dissection during peripheral nerve release. This technique has potentially beneficial clinical applications and warrants further investigation.
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Comparative Study
Audio spectrum and sound pressure levels vary between pulse oximeters.
The variable-pitch pulse oximeter is an important intraoperative patient monitor. Our ability to hear its auditory signal depends on its acoustical properties and our hearing. This study quantitatively describes the audio spectrum and sound pressure levels of the monitoring tones produced by five variable-pitch pulse oximeters. ⋯ There is considerable variance in the sound pressure and audio spectrum of commercially-available pulse oximeters. Further studies are warranted in order to establish standards.
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To describe innovative airway management in an adult with a peritonsillar abscess (quinsy) located atypically in the inferior pole of the palatine tonsil. ⋯ We present an innovative technique of fibreoptic intubation in an awake patient with an inferior pole peritonsillar abscess.
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Case Reports
Management of acute respiratory distress syndrome using pumpless extracorporeal lung assist.
To describe the use of a pumpless extracorporeal lung assist device in the treatment of severe acute respiratory distress syndrome (ARDS). ⋯ In this case of a severely damaged lung, an arteriovenous pumpless extracorporeal lung assist was a helpful device to remove elevated CO(2) and reduce mechanical stress by applying minimal ventilation. This device is simple to operate and has the potential of being used routinely in the treatment of severe ARDS.