Regional anesthesia
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Regional anesthesia · May 1989
Precordial Doppler monitoring and pulse oximetry during cesarean delivery: detection of venous air embolism.
Venous air embolism (VAE) is a potential but rare complication of cesarean delivery that can be associated with morbidity and death. Uterine sinuses are susceptible to the entrance of air during cesarean delivery. To define the incidence of VAE and its relation to arterial oxygen saturation (SaO2) and consequent electrocardiographic (ECG) changes, a prospective study was undertaken in which precordial Doppler monitoring was conducted during cesarean delivery. ⋯ Although all ECG changes resolved spontaneously without sequelae, the potential clearly existed for life threatening embolic events. Thus, precordial Doppler monitoring of cesarean delivery patients demonstrated a surprisingly high incidence of Doppler changes consistent with VAE. Some episodes were associated with a significant reduction in SaO2 and rarely with ECG changes.
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Regional anesthesia · Mar 1989
A retrospective analysis of neurolytic celiac plexus block for nonpancreatic intra-abdominal cancer pain.
Neurolytic celiac plexus block (NCPB) has been reported to be an effective method for pain relief for a variety of intra-abdominal malignancies, especially pancreatic. In spite of this, few data exist concerning efficacy of the block for pain related to other intraabdominal tumors. ⋯ The incidence of neurologic injury (footdrop) was less than 0.5%. This therapy deserves more widespread use in patients with abdominal pain secondary to a variety of other malignancies, in addition to that of the pancreas.
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Regional anesthesia · Mar 1989
Contractility effects of local anesthetics in the presence of sodium channel blockade.
The effects of lidocaine (25, 50 and 100 micrograms/ml) and bupivacaine (5, 10, and 20 micrograms/ml) on amplitude, velocity, and contraction frequency were studied in monolayer cultures of spontaneously beating chick embryo ventricular cells. The physiologic parameters of contraction frequency, amplitude, and velocity of shortening were measured with an optical-video system. Studies were also carried out in the presence of 1 microM tetrodotoxin (TTX) to isolate effects caused by TTX-sensitive ion channel blockade from other possible mechanisms of action of local anesthetics. ⋯ In the presence of TTX, lidocaine (50 micrograms/ml) produced a further decrease in amplitude of contraction, but no significant change in contraction frequency or velocity of contraction. It is well known that local anesthetics block Na+ channels of excitable membranes. The authors observations suggest that both lidocaine and bupivacaine have at least one locus of action at a site other than a TTX blockade site.