Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Sep 2013
Case ReportsSupraclavicular block as a sole anesthetic technique in craniopagus twins.
This is the first report in the literature of a sole regional anesthetic for adult craniopagus twins using a supraclavicular block for an elbow incision and drainage/bursa excision procedure. It demonstrates that for these complex medical patients, a total regional anesthesia technique is preferable when possible. There are several known general anesthetic complications in these patients. ⋯ However, with regional anesthesia, the twins can position themselves and report any discomfort, which could go unnoticed under general anesthesia, leading to other complications. Craniopagus twins have a high likelihood of a difficult airway due to anatomy or positioning difficulties, which is avoided by regional anesthesia. This case emphasizes the unique challenges that these patients pose and the ability of regional anesthesia to help avoid the pitfalls of general anesthesia in these patients.
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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
Compound imaging technology and echogenic needle design: effects on needle visibility and tissue imaging.
Needle visualization in ultrasound-guided regional anesthesia can be improved by using needles of echogenic design with higher rate of reflection of ultrasound waves. Imaging solutions such as compound imaging might further improve imaging of both needle and tissue; these effects have not yet been studied. We hypothesized that compound imaging would significantly improve needle visibility, regardless of the insertion angle or needle type used. The effects of compound imaging on needle artifacts and tissue imaging were also investigated. ⋯ Compound imaging technology enhances needle imaging with both echogenic and conventional needles. Tissue imaging and speckle artifacts are also optimized. Echogenic needle design results in better needle visibility scores in both B-mode and compound imaging.
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Reg Anesth Pain Med · Sep 2013
Cervical epidural anesthesia is associated with increased cancer-free survival in laryngeal and hypopharyngeal cancer surgery: a retrospective propensity-matched analysis.
Regional anesthesia preserves perioperative immune competence and may reduce the risk of recurrence and metastasis after cancer surgery. Cervical epidural anesthesia provides adequate analgesia for head and neck cancer surgery, but its impact on cancer recurrence is unknown. ⋯ The association between cervical epidural anesthesia and increased cancer-free survival found in this retrospective study should be an important hypothesis to further investigate in head and neck cancer surgery.