Journal of anaesthesiology, clinical pharmacology
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J Anaesthesiol Clin Pharmacol · Oct 2018
Transcoccygeal neurolytic ganglion impar block for perineal pain: A case series.
Chronic perineal pain (CPP) is a poorly localized pain. Its etiology may be benign or malignant. The ganglion impar is a solitary retroperitoneal structure at sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. CPP has been effectively managed by ganglion impar block. Here, we describe a case series of neurolytic ganglion impar block by transcoccygeal approach, analyzing its safety and efficacy. ⋯ Transcoccygeal ganglion impar block may offer a safe and effective treatment option for CPP as compared to opioids. This approach for neurolysis of the ganglion impar may be recommended in view of the direct course, appreciable end point, and smaller volume of neurolytic requirement.
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J Anaesthesiol Clin Pharmacol · Oct 2018
ReviewA comparative analysis of femoral nerve block with adductor canal block following total knee arthroplasty: A systematic literature review.
Patients undergoing total knee arthroplasty suffer from moderate-to-severe postoperative pain resulting in immobility-related complications and prolonged hospitalization. Femoral nerve block is associated with reduction in the quadriceps strength and increasing incidence of falls. Adductor canal block has been shown to be as effective as femoral nerve block without causing quadriceps weakness. ⋯ Mobilization and ambulation, which are both important for recovery after total knee arthroplasty are both inhibited less by adductor canal block.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Assessment of awake i-gel™ insertion for fiberoptic-guided intubation in patients with predicted difficult airway: A prospective, observational study.
Orotracheal intubation (OTI) with fiberoptic bronchoscope (FOB) in spontaneous ventilation is one of the main techniques for patients with predicted difficult airway. Latest generation supraglottic airway devices have been designed to allow OTI through them. We assessed the safety and effectiveness of FOB-guided OTI through i-gel™ device which was inserted in spontaneously breathing patients with predicted difficult airway. ⋯ I-gel insertion in spontaneous ventilation secures the airway before achieving fiberoptic intubation without the occurrence of adverse events. More studies might be necessary in order to confirm the results presented, but we consider that the technique described is a safe and effective alternative to classic OTI with FOB in spontaneously breathing patients with predicted difficult airway.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Effect of adjunctive dexmedetomidine on anesthesia and analgesia requirement and recovery characteristics during Bispectral Index-guided anesthesia for cerebello-pontine angle surgeries: A randomized clinical trial.
The study was conceived to elucidate the effects of dexmedetomidine as an anesthetic adjunct to propofol (total intravenous anesthesia) on anesthetic dose reduction and anesthesia recovery parameters in cerebello-pontine angle (CPA) surgeries. ⋯ Dexmedetomidine-fentanyl-propofol anesthesia compares favorably with fentanyl-propofol anesthesia during CPA neurosurgical procedures with regard to anesthesia recovery times, but with lower intraoperative opioid and hypnotic utilization rates.
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J Anaesthesiol Clin Pharmacol · Oct 2018
Effect of spinal flexion and extension in the lateral decubitus position on the unilaterality of spinal anesthesia using hyperbaric bupivacaine.
Many unilateral lower limb orthopedic surgeries are conducted under unilateral spinal anesthesia with full flexion of spine and immediate extension after local anesthetic administration into the subarachnoid space. Studies have shown that extension of the spine in lateral decubitous position makes cauda equina to sink to the dependent side due to gravity. Continuous flexion of the spine causes sunken cauda equina to be suspended in the middle of the subarachnoid space increasing the possibility of unilateralization of the block. Hence, this study was carried out to assess the effect of flexion and extension in lateral decubitus position in unilateral spinal anesthesia. ⋯ Maintaining flexion of the spinal column for 15 min increases the likelihood of unilateral spinal block compared with extension of the spinal column during lateral decubitus positioning.