Regional anesthesia and pain medicine
-
Reg Anesth Pain Med · Nov 1999
The incidence of tissue coring during the performance of caudal injection in children.
The performance of caudal injection (CI) has become a routine part of pediatric anesthesia. The intraoperative and immediate postoperative complications of CIs have been reported extensively. Although the long-term consequences of CI are unknown, they may include the development of epidermoid tumors in the spinal canal. Such tumors have been attributed to tissue coring (the process by which pieces of tissue are removed by a needle as it passes through the tissue) and the subdural deposition of such tissue. ⋯ These findings suggest that technical modifications may improve patient safety. The results also have implications for long-term follow-up of caudal anesthetics. Techniques for reducing the incidence of tissue coring during the performance of CI are discussed.
-
Reg Anesth Pain Med · Nov 1999
Cerebrospinal fluid cytokine levels after surgery with spinal or general anesthesia.
Studies show that pain may cause neuroinflammatory changes in the spinal cord. These inflammatory changes could be caused by circulating factors such as plasma cytokines or could be a primary neuroimmune response of the central nervous system following peripheral nerve injury. To identify the possible effects of peripheral trauma and pain on the cytokine environment of the spinal cord, interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations in plasma and cerebrospinal fluid (CSF) were measured before and after hip replacement surgery. ⋯ Major orthopedic surgery leads to elevated CSF levels of the proinflammatory cytokine, IL-6. The origin of increased CSF IL-6 may be central because there was no significant correlation with plasma levels.