Articles: nerve-block.
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Maxillary nerve blockade is not commonly used by general practitioners due to a lack of experience with the techniques involved and the fear of iatrogenic damage. Nevertheless, it represents an excellent method of producing profound anesthesia in the maxilla, with definite indications in selected instances. The anatomy and techniques associated with the maxillary block, as well as the indications, contraindications and complications are reviewed, and the use of the greater palatine foramen approach to treat a patient with a facial abscess is described.
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We have studied the effect of renal function on the pharmacodynamics of mivacurium. Sixty patients were allocated to three groups according to creatinine clearance: group C (control), creatinine clearance > 50 ml min-1; group P (preterminal renal failure), creatinine clearance < 50 ml min-1 > 20 ml min-1; group T(terminal renal failure), creatinine clearance < 20 ml min-1. Neuromuscular transmission (train-of-four) was monitored using electromyography from the hypothenar muscle with stimulation of the ulnar nerve. ⋯ The dose of mivacurium necessary to maintain 95% neuromuscular block was similar in patients with normal renal function and patients with different levels of renal impairment. Recovery from neuromuscular block after ceasing mivacurium infusion was significantly prolonged in patients with preterminal renal impairment. There was a close correlation between mivacurium pharmacodynamics and pseudocholinesterase activity, but not creatinine clearance.
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Clinical Trial
The maximum depth of an atracurium neuromuscular block antagonized by edrophonium to effect adequate recovery.
The inability of edrophonium to rapidly reverse a deep nondepolarizing neuromuscular block may be due to inadequate dosage or a ceiling effect to antagonism of neuromuscular block by edrophonium. A ceiling effect means that only a certain level of neuromuscular block could be antagonized by edrophonium. Neuromuscular block greater than this could not be completely antagonized irrespective of the dose of edrophonium administered. The purpose of this study was to determine whether a ceiling effect occurred for antagonism of an atracurium-induced neuromuscular block by edrophonium and, if so, the maximum level of block that could be antagonized by edrophonium. ⋯ There is a maximum level of neuromuscular block that can be antagonized by edrophonium to effect adequate recovery. The level corresponds approximately to the reappearance of the fourth response to TOF stimulation. It is probably safest to wait until this level of block occurs before edrophonium is given for reversal. Earlier administration will not hasten recovery.
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Anaesth Intensive Care · Apr 1995
Inguinal field block for adult inguinal hernia repair using a short-bevel needle. Description and clinical experience in Solomon Islands and an Australian teaching hospital.
One of the limitations of an inguinal field block is that it does not reliably produce complete anaesthesia. The purpose of this study was to describe a modified short-bevel needle technique, facilitating correct needle placement, for inguinal hernia repair. Anaesthetists from two different institutions performed the described infiltration blocks. ⋯ Results of the modified inguinal field block showed a 97% ability to achieve a "fair" block or better. Intraoperative and postoperative data showed high surgeon and patient satisfaction for the block. The described block using a short-bevel needle is recommended as a suitable method for adult patients undergoing inguinal hernia repair.
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Percutaneous radiofrequency neurotomy has been used in the treatment of pain from the cervical zygapophysial joints, but the results have been modest and not compelling. Several factors might account for its apparent poor success rate, including inadequate patient selection, inaccurate surgical anatomy, and technical errors. In an effort to overcome these confounders, we used comparative local anesthetic blocks to preoperatively, definitively diagnose cervical zygapophysial joint pain and developed an amended operative technique based on formal anatomical studies. ⋯ After procedures at all levels, a brief period of postoperative pain was experienced by the patients and ataxia was a side effect of third occipital neurotomy. There were no cases of postoperative infection or anesthesia dolorosa. Given the high technical failure rate of third occipital neurotomy, we recommend that this procedure be abandoned until the technical problems can be overcome.(ABSTRACT TRUNCATED AT 250 WORDS)