Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2013
Randomized Controlled TrialEffect of Chronic β-Blockade on the Utility of an Epinephrine-Containing Test Dose to Detect Intravascular Injection in Nonsedated Patients.
A test dose containing epinephrine is routinely used during epidural blockade to detect accidental intravenous needle or catheter placement before the administration of local anesthetics to avert local anesthetic systemic toxicity. β-Blocker therapy may interfere with the expected hemodynamic response from an intravascular injection. This study describes a cohort of 24 patients and their response to an epinephrine test dose (ie, if expected increased heart rates during test-dose administration are valid in this population.) ⋯ Epinephrine test-dose administration in nonsedated, chronically β-blocked patients cannot distinguish intravenous injection at the classic threshold increase of 20 bpm. The response in individuals is varied, and thresholds for a positive test need revising for this population of patients on therapeutic β-blockers.
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Reg Anesth Pain Med · Sep 2013
Review Case ReportsManagement of thyroid incidentalomas encountered by anesthesiologists and pain physicians.
Unexpected, asymptomatic thyroid lesions incidentally discovered during unrelated diagnostic or therapeutic interventions are called thyroid incidentalomas (TIs). These lesions are extremely common, creating a clinical problem that most anesthesiologists and pain specialists are unfamiliar with. Ultrasonography (US), which allows high-quality real-time visualization of tissues during brachial plexus block, stellate ganglion block, central vascular access, and other interventions, is the imaging modality of choice of many anesthesiologists and pain medicine specialists for therapeutic interventions on the neck. ⋯ Interventionalists are responsible for acquiring optimal images, accurate needle positioning during interventions, and storage and appropriate labeling of the obtained images. Ignoring the TI or disclosing the presence of a "tumor" can substantially affect the patient's well-being. In this literature review, we discuss 2 clinical cases of incidentalomas, summarize the current evidence-based strategies, and provide readers with practical guidelines-possibly applicable to other abnormal findings-for the management of incidentally found thyroid lesions.
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Reg Anesth Pain Med · Sep 2013
Historical ArticleThe European society of regional anaesthesia and pain therapy (1982-2012): 30 years strong.
Inspired by the earlier establishment of the American Society of Regional Anesthesia, but with a structure to accommodate the diverse languages and health care systems of Europe, the European Society of Regional Anaesthesia (ESRA) held its first scientific meeting in 1982. During the following 30 years, ESRA grew from strength to strength and implemented a number of important educational initiatives, the story of these developments being the subject of this review. ⋯ Educationally, activities grew from a single annual congress to include zonal meetings, cadaver workshops, a major online program, and collaborations (guidelines and conferences) with other societies. Finally, the introduction of a Diploma qualification in regional anesthesia was an entirely novel project.