Minerva anestesiologica
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Minerva anestesiologica · Sep 2005
Biography Historical ArticleObstetric anesthesia - then and now.
In 1947 John Bonica as new Chief of Anesthesiology at Tacoma General Hospital organized one of the first around-the-clock labor anesthesia services and when became the first chairman of the new Department of Anesthesiology at the University of Washington (1960), caudal anesthesia was the primary technique used for providing labor analgesia. In 1967 the first volume of Bonica's classic textbook ''Principles and practice of obstetric analgesia and anesthesia'' was published. The text was a comprehensive treatise that pulled together virtually everything that was known in that field. ⋯ Current obstetric anesthetic practice, though quite different from what it was 30 or 40 years ago, has its roots in the priorities, techniques and teachings of Dr. John J. Bonica.
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Spinal cord stimulation (SCS) is a neuromodulation technique using electricity, proposed for the first time by Shealy in 1967, as an alternative to neuroablation. Technological improvements in the last 20 years (percutaneous electrodes, single and dual leads, octopolar electrodes, high energy internal pulse generators) have allowed to obtain good results with SCS in various clinical situations of chronic pain. The main clinical indications to SCS are: vascular pain--refractory angina and peripheral vascular diseases (PVD); rachidian pain--failed back surgery syndrome (FBSS), degenerative low back leg pain (LBLP), nerve root lesions, incomplete spine lesions, spinal stenosis; neuropathic pain; chronic regional pain syndrome (CRPS) type 1 and type 2; perineal pain and urological diseases (urge-incontinence, interstitial cystitis). ⋯ All of this is going to change the attitude towards SCS in USA, where the amputation incidence for critical ischaemia is considerably higher than in Europe. An indication to SCS not very mentioned in literature and that seems to have good results is LBLP due to acquired or mixed (constitutional-acquired) spinal stenosis. In this situation SCS seems to improve notably pain control and quality of life index of patients.