International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2012
ReviewOutpatient regional anesthesia for upper extremity surgery update (2005 to present) distal to shoulder.
Multiple different approaches to the brachial plexus are available for the regional anesthesiologist to provide successful anesthesia and analgesia for ambulatory surgery of the upper extremity. Although supraclavicular and infraclavicular blocks are faster to perform than axillary blocks, the operator needs to keep in mind that blocks performed around the clavicle carry the risk for specific side effects and complications, no matter whether ultrasound or nerve stimulation is the chosen modality for neurolocation. ⋯ Smaller interventions such as carpal tunnel release or trigger finger release can be performed under elbow, wrist, or digital blocks. The regional anesthesiologist should strive to develop a tailored plan for each individual case to provide the most effective and safest nerve block technique for their patients.
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Int Anesthesiol Clin · Jan 2012
Forecast for perineural analgesia procedures for ambulatory surgery of the knee, foot, and ankle: applying patient-centered paradigm shifts.
Although much of the current clinical research is directed toward practitioner-centered refinement of RA techniques and technology, it is important to consider pharmacologic advances in perineural analgesia as the next major patient-centered advancement of our specialty. With all due respect to excellent bench science work with novel drugs and toxins that may not gain approval of the Food and Drug Administration for many years, it is useful to know that four Food and Drug Administration-approved drugs are commercially available for potentially ground-breaking off-label use, pending ongoing research. ⋯ Research is also needed to determine the extent to which these four drugs may reduce the needed local anesthetic concentration to achieve a surgical nerve block (on bolus injection). Ongoing research in this direction seems to represent the next major advancement in the subspecialty, being distinguished from refinement research involving strictly techniques and technology.
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Int Anesthesiol Clin · Jan 2012
ReviewRegional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.
This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. ⋯ Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined perineural analgesic adjuvants prolong low-concentration LA nerve blocks sufficiently to render brachial plexus catheters as unnecessary would certainly represent another quantum leap.
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Int Anesthesiol Clin · Jan 2012
ReviewThe role of extracorporeal membrane oxygenation (ECMO) therapy in acute heart failure.
ECMO is a reliable and useful treatment for patient with acute cardiac failure. However, outcomes of cardiac ECMO are not yet as successful as case of ECMO support for respiratory failure. ⋯ Other options, including LVADs and heart transplant, should be considered when patients do not show any improvements under ECMO therapy. A multidisciplinary approach is required to provide the maximum chance of survival after ECMO treatment.
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PVB remains an underused block. It is easy to perform reliable and effective blocks for a wide variety of applications both for acute or chronic pain. As evidence continues to be published showing the advantages of PVB versus traditional methods of pain control, it is hoped that PVB will become part of the standard repertoire of blocks used in teaching hospitals and in private practice.