Paediatric anaesthesia
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Paediatric anaesthesia · Jan 2012
Review Historical ArticleHistory of pediatric regional anesthesia.
The history of local and regional anesthesia began with the discovery of the local anesthetic properties of cocaine in 1884. Shortly afterwards nerve blocks were being attempted for surgical anesthesia. Bier introduced spinal anesthesia in 1898, two of his first six patients being children. ⋯ Spinals and other local techniques had periods of greater and lesser use and have not been universally employed. Initial loss of popularity seemed to relate to improvements in general anaesthesia. The advent of lignocaine (1943) and longer acting bupivacaine (1963) and increasing concern about postoperative analgesia in the 1970-1980s, contributed to the increased use of blocks.
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Local anesthetics (LA) block propagation of impulses along nerve fibers by inactivation of voltage-gated sodium channels, which initiate action potentials (1). They act on the cytosolic side of phospholipid membranes. ⋯ Amino amides are metabolized exclusively by the liver. Only amide LAs will be considered in this article.
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Paediatric anaesthesia · Jan 2012
ReviewUltrasound-guided upper extremity blocks - tips and tricks to improve the clinical practice.
Brachial plexus blockade in children can be used for a broad spectrum of clinical indications. Nevertheless, these regional anesthetic techniques are still underused in pediatric anesthesia that is mainly because of insufficient descriptions of the particular techniques. ⋯ The most important issue in this context is theoretical background knowledge and intensive training of hand skills. The following review article discusses all relevant aspects of ultrasound-guided brachial plexus blockade.