CRNA : the clinical forum for nurse anesthetists
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As with any regional technique, practice will improve the success rate as well as ability of the practitioner to provide the blocks. Despite the simplicity of the techniques, one must always keep in mind that such anesthesia blunts or eliminates sophisticated and highly effective airway protection reflexes, potentially leaving the patient at risk for aspiration or obstruction. As with other forms of regional anesthesia, airway blocks will provide the anesthetist with additional tools with which to better treat his/her patients. These tools will prove to be useful not only in the operating room setting, but also in emergency room and intensive care areas as well, and will add to the confidence and abilities of the practitioner.
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The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. ⋯ The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.
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Although the use of peripheral nerve stimulators and unsheathed needles in performing nerve blocks has been previously described, there has been a growing emphasis on the use of specific, expensive equipment to ensure success. The availability of equipment designed for use in peripheral nerve blocks, insulated needles and nerve stimulators, will help promote the use of these techniques, but the expense of purchasing this specialized equipment may contribute to a decline in performance of certain types of blocks. This article reviews the use of standard equipment, available in most anesthesia departments, for performing peripheral nerve blocks successfully.