Articles: nerve-block.
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Acta Anaesthesiol. Sin. · Jun 1997
Case ReportsDyspnea resulting from phrenic nerve paralysis after interscalene brachial plexus block in an obese male--a case report.
Phrenic nerve paralysis is a common complication in interscalene brachial plexus block. This complication is often ignored by most anesthesiologists because no clinical symptoms occur in patients who have no underlying lung disease. ⋯ The decreased respiratory reserve and direct compressing effect of the abdominal organs on the diaphragm in the supine position are thought to be the risk factors in this obese patient. Also discussed are the incidence, diagnostic methods, clinical presentation and treatments of phrenic nerve paralysis during interscalene brachial plexus block.
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Changes in plasma cortisol concentrations during the first 4 hours after castration of 6-week-old lambs by one of four methods were measured. The methods were application of a rubber ring above the testes, application of a ring to shorten the scrotum below the testes, use of a castration clamp plus a ring, and use of a castration clamp alone. The efficacy of local anaesthetic in reducing or abolishing the cortisol responses to castration by all these methods except short scrotum was assessed. ⋯ Local anaesthetic injected into the scrotal neck or spermatic cords did not affect significantly the cortisol response to the IO-second clamp application. The following conclusions were drawn from this work: the testes as well as the scrotum were sources of noxious sensory input after ring application; the clamp plus ring method used here was ineffective in reducing the pain-induced distress (as indicated by cortisol concentrations) caused by ring-only castration; injection of local anaesthetic into the scrotal neck or into the testes prior to ring application blocked most noxious sensory input from both the scrotum and the testes; and on the basis of the present cortisol responses the 10-second clamp applications method could not be recommended in reference to the ring-only method, but the l-second clamp application method might be equally acceptable for castrating 6-week-old-lambs. Of the methods examined, injections of local anaesthetic into the scrotal neck or both testes were the most effective in reducing the pain-induced distress caused by ring-only castration.
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Klin Monbl Augenheilkd · Jun 1997
Case Reports[Endophthalmitis after intra-oral block of the infraorbital nerve].
Most penetrating needle puncture injuries occur in retro- or peribulbar anesthesia. Hereby only a small percentage of patients develop endophthalmitis. Ocular penetration after enoral infraorbital nerve block has not yet been reported in literature. ⋯ Careful anamnesis would have prevented this accidental globe penetration. Right upper palate is absent presumably due to congenital cleft malformation or surgery. This allowed needle penetration through smooth tissue into the right globe. Fortunately, endophthalmitis develops only in a small percentage after needle puncture. We recommend immediate pars-plana-vitrectomy and intravitreal antibiotics in case of endophthalmitis after ocular penetration.
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Anesthesia and analgesia · Jun 1997
Case Reports Randomized Controlled Trial Clinical TrialGlossopharyngeal nerve block for pain relief after pediatric tonsillectomy: retrospective analysis and two cases of life-threatening upper airway obstruction from an interrupted trial.
A regional anesthetic technique formerly used in adults for tonsillectomy was adapted to provide posttonsillectomy pain relief in children. Injection of 3-10 mL of 0.25%-0.5% bupivacaine into each lateral pharyngeal space appeared to provide good postsurgical analgesia. A retrospective chart review failed to link the technique to airway-related complications. ⋯ We conclude that the volume and concentration of bupivacaine were sufficient to block the vagus nerves proximal to the take off of the recurrent laryngeal nerves and/or the hypoglossal nerves, resulting in severe UAO. The short distance between the hyoid and jugular foramen would predispose children and adults with a short neck to the development of this complication. In conclusion, bilateral local anesthetic injection into the lateral pharyngeal space may result in severe UAO and loss of protective reflexes.
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Anesthesia and analgesia · Jun 1997
Randomized Controlled Trial Clinical TrialEvaluation of residual neuromuscular block using train-of-four and double burst stimulation at the index finger.
We examined the percentage of tactile detection of fade in response to train-of-four (TOF), double burst stimulation3,3 (DBS3,3), or DBS3,2 at the index finger compared with that at the thumb during continuous infusion of vecuronium. One hundred five adult patients were studied. At TOF ratios (T4/T1) of 0.41-0.70, fades in response to TOF were more frequently identified by tactile means at the index finger than at the thumb (58% vs 26%, P < 0.05). ⋯ The baseline displacement of the index finger was significantly less than that of the thumb (P < 0.05). In summary, the percentage of tactile detection of fade in response to neurostimulation at the index finger is higher than at the thumb, and the absence of fade in response to DBS3,3 at the index finger is a good indicator of adequate recovery from neuromuscular block. This is probably because of the smaller baseline displacement of the index finger.