Journal of anesthesia
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Journal of anesthesia · Aug 2014
Case ReportsAltered responses to vasopressors of a patient medicated with carvedilol, pilsicainide and enalapril.
A patient scheduled for laparoscopic rectal surgery was medicated with carvedilol, an antagonist of beta 1-, beta 2- and alpha 1-adrenergic receptors, pilsicainide, a class Ic antiarrhythmic drug and enalapril, an angiotensin-converting enzyme inhibitor. Because the patient experienced attacks of atrial fibrillation with rapid ventricular response almost weekly, carvedilol and pilsicainide were continued up to the day of surgery, while enalapril was discontinued for 24 h prior to surgery. During the operation, he showed prolonged hypotension that did not respond to usual doses of vasopressors such as ephedrine, phenylephrine and dopamine but responded to higher doses of norepinephrine. Postoperatively, he was given dopamine but exhibited tachyarrhythmia until the dopamine infusion was discontinued.
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Journal of anesthesia · Aug 2014
Application of quinidine on rat sciatic nerve decreases the amplitude and increases the latency of evoked responses.
Multi-modality electrophysiological techniques were performed to assess the effects of quinidine on peripheral nerve conduction. ⋯ Quinidine decreases amplitude and prolongs latency in the sciatic nerve in a dose-related manner without local neural toxicity.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialDifferential axillary nerve block for hand or forearm soft-tissue surgery.
This study determined the effective concentration of ropivacaine required to produce the type of differential block known as sensory block with mobilization, for adequate analgesia after forearm or hand soft tissue surgery by axillary brachial plexus block. ⋯ This analysis showed that 16 ml of 0.1285 % ropivacaine is suitable for achieving differential block in ultrasound-guided axillary nerve block for hand and forearm surgery.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialLateral Trendelenburg with the injected side down after the block improves the efficacy of the axillary approach to brachial plexus block.
We hypothesized that, after axillary block, positioning the patient in a lateral position with the injected side down and simultaneously in a 20° Trendelenburg position will increase the success rate and quality of the block. ⋯ We conclude that, for patients undergoing an axillary block, positioning the patient laterally with the injected side down and in a 20° Trendelenburg position increases the success rate and quality of the block.
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Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyUltrasound-guided sciatic nerve block: a comparison between four different infragluteal probe and needle alignment approaches.
Our aim was compare onset time of sciatic nerve blockade (SNB) performed distal to the subgluteal fold using four different ultrasound (US)-guided approaches in patients undergoing foot or ankle surgery. ⋯ The LA-IP approach resulted in a rapid onset of SNB and was associated with the best satisfaction for postoperative analgesia in comparison with LA-OP, SA-IP, and SA-OP approaches for patients undergoing foot and ankle surgery.