Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jan 2009
Comparative StudyElectrocardiographic and hemodynamic effects of intravenous infusion of bupivacaine, ropivacaine, levobupivacaine, and lidocaine in anesthetized ewes.
Neural blockade techniques are associated with a risk of acute cardiac toxicity after accidental intravenous (IV) injection of local anesthetics. The aim of this study was to compare electrocardiographic (ECG) and hemodynamic (HEM) effects induced by IV infusion of local anesthetics in an anesthetized ewe model. ⋯ In our anesthetized ewe model, high dose IV infusion of BUPI induced the most marked changes in RR, PR, QRS, QT, QTc intervals, DeltaSAP, and DeltadP/dt. ROPI altered ECG variables less than BUPI but more than S-BUPI. LIDO was associated with the smallest changes.
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Reg Anesth Pain Med · Jan 2009
Comparative StudyDiagnosis of unintentional subdural anesthesia/analgesia: analyzing radiographically proven cases to define the clinical entity and to develop a diagnostic algorithm.
: Subdural injection is a well-known but often poorly recognized complication of neuraxial anesthesia/analgesia. This report aims to further describe the clinical presentation of subdural injection by analyzing radiographically proven cases. A new diagnostic algorithm is then proposed. ⋯ : Radiographically proven subdural injections were used to further define the clinical presentation of subdural analgesia/analgesia and a new diagnostic algorithm is proposed.
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Reg Anesth Pain Med · Jan 2009
Case ReportsNeuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection.
This case report describes the anesthetic management of a patient with severe chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) who underwent elective sigmoid resection under combined spinal-epidural anesthesia and bilevel positive airway pressure (BiPAP). ⋯ Combined spinal-epidural anesthesia was successfully used in a patient with COPD and OSA undergoing sigmoid resection. Perioperative administration of BiPAP, excellent pain control by continuous epidural infusion of local anesthetic, and the avoidance of endotracheal intubation may have contributed to this patient's uncomplicated postoperative course.
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Reg Anesth Pain Med · Jan 2009
Does a paresthesia during spinal needle insertion indicate intrathecal needle placement?
Paresthesias are relatively common during spinal needle insertion, however, the clinical significance of the paresthesia is unknown. A paresthesia may result from needle-to-nerve contact with a spinal nerve in the epidural space, or, with far lateral needle placement, may result from contact with a spinal nerve within the intervertebral foramen. However, it is also possible and perhaps more likely, that paresthesias occur when the spinal needle contacts a spinal nerve root within the subarachnoid space. This study was designed to test this latter hypothesis. ⋯ Our data suggest that the majority of transient paresthesias occur when the spinal needle enters the subarachnoid space and contacts a spinal nerve root. Therefore, when transient paresthesias occur during spinal needle placement it is appropriate to stop and assess for the presence of CSF in the needle hub, rather than withdraw and redirect the spinal needle away from the side of the paresthesia as some authors have suggested.
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Reg Anesth Pain Med · Jan 2009
Practice GuidelineThe American Society of Regional Anesthesia and Pain Medicine and the European Society Of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. ⋯ The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.