Regional anesthesia
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Regional anesthesia · Nov 1993
Continuous spinal anesthesia: mechanical and technical problems of catheter placement.
Although continuous spinal anesthesia with microcatheters has a number of advantages, there are also some drawbacks: technical problems in advancing the catheter, the possibility of traumatizing neural structures, the development of cauda equina syndrome, and maldistribution of the local anesthetic. ⋯ To take advantage of continuous spinal anesthesia, a meticulous technique is required.
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To extract experimental data of importance for the understanding of neurotoxicity of local anesthetics, with special reference to continuous spinal anesthesia. ⋯ Correctly administered LAs of clinical concentration are safe, but animal data indicate that all LAs are potentially neurotoxic. The neurotoxicity seems to be a function of the concentration of the LA and the time of exposure of the nervous tissue to the LA. Concomitant neural trauma, ischemia, or both, may potentiate the neurotoxic effect of the LA.
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Regional anesthesia · Nov 1993
Case Reports Randomized Controlled Trial Clinical TrialDirection of catheter insertion and incidence of paresthesias and failure rate in continuous epidural anesthesia: a comparison of cephalad and caudad catheter insertion.
Paresthesias and unblocked segments during continuous epidural anesthesia--sometimes leading to higher doses of local anesthetics--can increase the risk of this technique. A cephalad insertion of the epidural catheter might decrease the incidence of these problems, but this has not been evaluated before in a controlled study. ⋯ Our results support the contention that the catheter should be directed cephalad during insertion for continuous epidural anesthesia.
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Regional anesthesia · Nov 1993
ReviewPhysiologic mechanisms by which local anesthetics may cause injury to nerve and spinal cord.
Review evidence for possible physiologic mechanisms by which local anesthetics cause nerve injury was reviewed. ⋯ In rare instances, the clinical use of local anesthetics is associated with neurologic morbidity. The physiologic mechanisms of toxicity for which there is the best evidence are inhibition of fast axonal transport, disruption of the axonal cytoskeleton, axonal degeneration, and ischemic nerve injury. The effects of local anesthetics on nerve blood flow may be related to inhibition of endothelium-dependent vasodilation or interruption of the synthesis of vasodilating prostaglandins. Both the prevention and the treatment of nerve injury caused by local anesthetics requires information that is not yet available about the physiologic and molecular mechanisms for direct neural toxicity of local anesthetics.