Regional anesthesia
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During performance of epidural injection, entry into the epidural space has traditionally been determined by identification of negative pressure to the advancing needle by indirect means such as hanging drop; loss of resistance to air, saline, or water; or use of a MacIntosh balloon. Confusion in the literature regarding entry pressures versus postentry (baseline) pressures and zero reference pressure was noted. ⋯ Lumbar epidural pressure is greater than atmospheric pressure when referenced to zero at the dorsal spine level.
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Regional anesthesia · Jul 1992
Randomized Controlled Trial Clinical TrialThe addition of epinephrine to subarachnoid administered hyperbaric bupivacaine with fentanyl for cesarean delivery: the effect on onset time.
This study examines the effect of epinephrine on the time to achieve a T4 sensory level when added to a hyperbaric bupivacaine-fentanyl mixture for spinal anesthesia. ⋯ The onset time to T4 is related inversely to patient weight, and epinephrine (100 micrograms and 200 micrograms) delays the onset of sensory block to T4 when administered with subarachnoid hyperbaric bupivacaine-fentanyl.
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Regional anesthesia · Jul 1992
Comparative StudyFentanyl and lidocaine versus lidocaine for Bier block.
The present study was designed to assess the efficacy of fentanyl combined with dilute lidocaine solution for intravenous regional anesthesia of the arm. ⋯ Results of this and other studies indicate there is no value in adding fentanyl to local anesthetics for intravenous regional anesthesia.
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Regional anesthesia · Jul 1992
Hemodynamic changes associated with tourniquet use under epidural anesthesia for total knee arthroplasty.
Epidural anesthesia is administered commonly for total knee arthroplasty, a procedure using a thigh tourniquet. Tourniquet use has been associated with intraoperative hypertension and with occasional circulatory collapse after deflation. The purpose of this study was to define the hemodynamic changes in this setting. ⋯ In this setting, tourniquet-induced hypertension is rare. However, hypotension after deflation is common, occurs rapidly, and correlates poorly with clinical parameters.
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Regional anesthesia · Jul 1992
Indirect sonographic guidance for epidural anesthesia in obese pregnant patients.
Obesity and edema frequently obscure anatomic landmarks and result in technical difficulties during epidural anesthesia administration. However, the method of indirect sonographic guidance permits identification of the midline by sagittal scan of the laminae of lumbar vertebrae 2, 3, and 4. ⋯ Needle depth was measured by marker and measure, and epidural anesthesia was successfully administered to all patients. Simple linear regression analysis was performed with strong positive results. Indirect and continuous sonographic guidance studies designed to determine whether sonography reduces complications are planned.