Regional anesthesia and pain medicine
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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
Promising effects of intravenous lipid emulsion as an antidote in acute tramadol poisoning.
In recent years, research has provided experimental and subjective evidence that intravenous lipid emulsions (ILEs) reverse some hemodynamically considerable poisonings with various drugs. The aim of this study was to investigate the possible antidotal effect of ILE on acute tramadol poisoning. ⋯ Intravenous lipid emulsion significantly reduced mortality due to acute toxicity with tramadol in rabbits, although increasing the ILE dose may cause reverse effects.
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Reg Anesth Pain Med · Sep 2013
Sonoanatomy Relevant for Lumbar Plexus Block in Volunteers Correlated With Cross-sectional Anatomic and Magnetic Resonance Images.
Ultrasound imaging of the anatomy relevant for lumbar plexus block (LPB) is challenging because of its deep anatomic location and the "acoustic shadow" of the overlying transverse processes. A paramedian transverse scan (PMTS) of the lumbar paravertebral region with the ultrasound beam being insonated through the intertransverse space (ITS) and directed medially toward the intervertebral foramen (PMTS-ITS) may overcome the problem of the "acoustic shadow" and allow clear visualization of the anatomy relevant for LPB. This study assessed the feasibility of using PMTS-ITS for imaging the anatomy relevant for LPB in healthy volunteers. ⋯ A PMTS-ITS can be used to image the sonoanatomy relevant for LPB including the lumbar nerve root, lumbar paravertebral space, lumbar plexus, and the psoas compartment.