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https://www.readbyqxmd.com/read/27887785/thromboelastography-teg%C3%A2-demonstrates-that-tinzaparin-4500-international-units-has-no-detectable-anticoagulant-activity-after-caesarean-section
#1
S Griffiths, C Woo, V Mansoubi, A Riccoboni, A Sabharwal, S Napier, M Columb, M Laffan, G Stocks
BACKGROUND: Low molecular weight heparin is routinely used for thromboprophylaxis in pregnancy and the puerperium. Consensus guidelines recommend waiting 10-12h after administration of a thromboprophylactic dose of low molecular weight heparin before performing a neuraxial block or removing an epidural catheter. Thromboelastography (TEG®) has been reported to be sensitive to the effects of enoxaparin 4h after administration. The purpose of this study was to use TEG to examine coagulation changes in the first 10h after a thromboprophylactic dose of tinzaparin in an attempt to ratify the current consensus guidelines about timing of neuraxial blockade and epidural catheter removal...
October 8, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27871587/peripheral-nerve-blocks-in-the-management-of-postoperative-pain-challenges-and-opportunities
#2
REVIEW
Girish Joshi, Kishor Gandhi, Nishant Shah, Jeff Gadsden, Shelby L Corman
Peripheral nerve blocks (PNBs) are increasingly used as a component of multimodal analgesia and may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). We undertook a qualitative review focusing on sPNB and cPNB with regard to benefits, risks, and opportunities for optimizing patient care. Meta-analyses of randomized controlled trials have shown superior pain control and reductions in opioid consumption in patients receiving PNB compared with those receiving intravenous opioids in a variety of upper and lower extremity surgical procedures...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27843773/effect-of-position-during-spinal-anesthesia-on-postdural-puncture-headache-after-cesarean-section-a-prospective-single-blind-randomized-clinical-trial
#3
Maryam Davoudi, Masoud Tarbiat, Mohammad Reza Ebadian, Puran Hajian
BACKGROUND: The most common method of anesthesia for cesarean section is spinal anesthesia, and postdural puncture headache (PDPH) remains a major complication of this procedure. Nowadays, PDPH is a major cause of morbidity in parturients after spinal anesthesia. This headache is the third most popular reason for claims against anesthesiologists in obstetrics. The position after spinal anesthesia has been evaluated as a contributory factor in the occurrence of PDPH, but the position before spinal anesthesia has not yet been evaluated...
August 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27833488/vibration-sensation-as-an-indicator-of-surgical-anesthesia-following-brachial-plexus-block
#4
Seema Jindal, Gurkaran Kaur Sidhu, Dinesh Sood, Anju Grewal
BACKGROUND: Local anesthetic instillation in close vicinity to nerves anywhere in body blocks sensations in the same order as in central neuraxial blockade. The main purpose of this study was to evaluate the efficacy of vibration sense as criteria to determine the onset of surgical anesthesia following brachial plexus block and its correlation with loss of sensory and motor power. MATERIALS AND METHODS: This prospective study included fifty patients of American Society of Anaesthesiologist physical status I and II, aged between 18 and 45 years, undergoing elective upper limb surgery under brachial plexus block by supraclavicular approach...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27828783/transversus-abdominis-plane-block-for-inguinal-hernia-repair-in-a-premature-infant-a-low-risk-high-benefit-technique
#5
Rashmi Ramachandran, Sumit Bansal, Preeti Yadav, Vimi Rewari
In this report, we describe the case of a premature infant (36 weeks' postgestational age) who underwent left inguinal hernia repair under general anesthesia without the use of any airway device. Anesthesia was induced and maintained with sevoflurane in oxygen and nitrous oxide. An ultrasound-guided transversus abdominis plane block was performed that provided effective analgesia, obviating the need for opioids in the intraoperative period. The infant's hemodynamics remained stable throughout the surgery. This report also briefly explains the advantages of using a transversus abdominis plane block, compared with neuraxial blockade, for hernia repair surgery...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27746553/prevention-of-hypotension-induced-by-combined-spinal-epidural-anesthesia-using-continuous-infusion-of-vasopressin-a-randomized-trial
#6
Chetna Shamshery, Ashish Kannaujia, Rajashree Madabushi, Dinesh Singh, Divya Srivastava, Shobhana Jafa
BACKGROUND: Central neuraxial blockade (CNB) is an established technique of providing anesthesia for surgeries of the lower limb and abdomen. Hypotension is the most common side effect of CNB. It was hypothesized that by supplementing the initial burst of vasopressin following hypovolemia, hypotension following combined spinal epidural anesthesia (CSEA) could be avoided. MATERIALS AND METHODS: A total of 122 patients undergoing lower limb and abdomen surgeries were included in the study, with 61 patients randomized into two groups - I and II...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27746531/effect-of-adding-clonidine-to-intrathecal-bupivacaine-on-the-quality-of-subarachnoid-block-a-prospective-randomized-double-blind-study
#7
Srivishnu Vardhan Yallapragada, Nagendra Nath Vemuri, Mastan Saheb Shaik
CONTEXT: The purpose of adding an adjuvant to local anesthetic in a central neuraxial blockade is to augment the desirable pharmacological actions of the agent and/or to minimize its undesirable pharmacological effects. Clonidine is an alfa-2 receptor agonist which has gained popularity in recent times as an adjuvant in spinal anesthesia. AIMS: To evaluate the influence of clonidine on the hemodynamic stability and the duration of anesthesia when added to intrathecal hyperbaric bupivacaine...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27746528/lower-limb-surgeries-under-combined-femoral-and-sciatic-nerve-block
#8
Lipsy Bansal, Joginder Pal Attri, Pawan Verma
INTRODUCTION: Peripheral nerve blocks are gaining popularity for many infraumblical surgeries with the development of new techniques such as ultrasound and peripheral nerve stimulator. It provides stable hemodynamic, better, and prolonged postoperative analgesia. This study was carried out to see the effectiveness of combined femoral and sciatic nerve block with ropivacaine alone and by adding fentanyl. MATERIALS AND METHODS: The study was carried out on 100 patients scheduled for lower limb surgeries and were randomly divided into two groups of 50 each...
September 2016: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/27687460/survey-of-external-cephalic-version-for-breech-presentation-and-neuraxial-blockade-use
#9
Carolyn F Weiniger, Pervez Sultan, Ashley Dunn, Brendan Carvalho
STUDY OBJECTIVE: Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. SETTING AND DESIGN: We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice using a 15-item survey developed by 3 obstetric anesthesiologists and tested for face validity. The survey was e-mailed in January 2015 and again in February 2015 to the 1056 Society of Obstetric Anesthesiology and Perinatology members...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27650294/clinical-usefulness-of-pectoral-nerve-block-for-the-management-of-zoster-associated-pain-case-reports-and-technical-description
#10
Yeon-Dong Kim, Seon-Jeong Park, Junho Shim, Hyungtae Kim
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. In the thoracic region, a neuraxial blockade is often used to manage zoster-associated pain. However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy...
September 20, 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/27641088/ultrasound-to-identify-the-lumbar-space-in-women-with-impalpable-bony-landmarks-presenting-for-elective-caesarean-delivery-under-spinal-anaesthesia-a-randomised-trial
#11
M Creaney, D Mullane, C Casby, T Tan
BACKGROUND: Ultrasound can facilitate neuraxial blockade in patients with poorly defined anatomical surface landmarks, but there are no studies comparing an ultrasound-guided technique with landmark palpation for spinal anaesthesia. The objective of this study was to compare pre-procedural lumbar ultrasonography with landmark palpation to locate the needle insertion point in women with impalpable lumbar spinous processes presenting for caesarean delivery. METHODS: After institutional ethics committee approval, 20 women with impalpable lumbar spinous processes presenting for elective caesarean delivery were recruited...
December 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27570462/optimal-point-of-insertion-of-the-needle-in-neuraxial-blockade-using-a-midline-approach-study-in-a-geometrical-model
#12
Mark Vogt, Dennis J van Gerwen, John J van den Dobbelsteen, Martin Hagenaars
Performance of neuraxial blockade using a midline approach can be technically difficult. It is therefore important to optimize factors that are under the influence of the clinician performing the procedure. One of these factors might be the chosen point of insertion of the needle. Surprisingly few data exist on where between the tips of two adjacent spinous processes the needle should be introduced. A geometrical model was adopted to gain more insight into this issue. Spinous processes were represented by parallelograms...
2016: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/27559484/a-rare-case-of-c2-sensory-blockade-with-preserved-phrenic-nerve-function-in-an-obstetric-patient
#13
John C Coffman, Kasey Fiorini, Meghan Cook, Robert H Small
High neuraxial blockade is a serious complication in obstetric patients and requires prompt recognition and management in order to optimize patient outcomes. In cases of high neuroblockade, patients may present with significant hypotension, dyspnea, agitation, difficulty speaking or inability to speak, or even loss of consciousness. We report the unusual presentation of an obstetric patient that remained hemodynamically stable and had the preserved ability to initiate breaths despite sensory blockade up to C2...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27460467/-sectio-and-brugada-syndrome
#14
Henriette Berg Ammundsen, Kim Ekelund, Arash Afshari, Charlotte Krebs Albrechtsen
Brugada syndrome (BS) is an inherited cardiac disease with increased risk of ventricular tachyarrythmias, cardiac arrest and sudden death. BS is diagnosed on various criteria including specific electrocardiographic abnormalities in a structurally normal heart. Many drugs have been reported to induce fatal arrhythmias in patients with BS and in particular sodium channel blockers i.e. local anaesthetics such as bupivacaine. We report the anaesthetic management of two women with BS during caesarean section and provide a general discussion on the use of bupivacain for neuraxial blockade for patients with BS...
July 18, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27436450/comparison-of-a-gps-needle-tracking-system-multiplanar-imaging-and-2d-imaging-for-real-time-ultrasound-guided-epidural-anaesthesia-a-randomized-comparative-observer-blinded-study-on-phantoms
#15
Cécilia Menacé, Olivier Choquet, Bertrand Abbal, Sophie Bringuier, Xavier Capdevila
BACKGROUND: The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. METHODS: Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach...
July 17, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27433072/epidural-anesthesia-a-safe-option-for-cesarean-section-in-parturient-with-severe-pulmonary-hypertension
#16
Sreyashi Sen, Sourav Chatterjee, Pinaki Mazumder, Sudakshina Mukherji
Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic...
July 2016: Journal of Natural Science, Biology, and Medicine
https://www.readbyqxmd.com/read/27385940/the-effect-of-regional-analgesia-on-vascular-tone-in-hip-arthroplasty-patients
#17
Enrique A Goytizolo, Ottokar Stundner, Sandra Hurtado Rúa, Dorothy Marcello, Valeria Buschiazzo, Ansara M Vaz, Stavros G Memtsoudis
BACKGROUND: While it is assumed that neuraxial analgesia and pain management may beneficially influence perioperative hemodynamics, few studies provided data quantifying such effects and none have assessed the potential contribution of the addition of a nerve block. QUESTIONS/PURPOSES: This clinical trial compared the visual analog scale (VAS) scores and measurement of arterial tone using augmentation index of patients who received combined spinal-epidural (CSE) only to patients who received both CSE and lumbar plexus block...
July 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/27382821/anesthetic-management-of-femoral-fracture-repair-in-a-patient-with-cervical-myelopathy-autonomic-dysfunction-and-difficult-airway
#18
Ajay R Vellore, Christopher B Robards, Steven R Clendenen
Spinal stenosis is a potentially serious condition that can lead to myelopathies and autonomic instability, both of which, as a result, may complicate anesthetic management. Additionally, neuraxial anesthesia appears to increase the risk of worsened neurological outcomes in this population. A 56-year-old female with spinal stenosis, autonomic dysfunction, and known difficult airway who required anesthesia for repair of a femur fracture is presented. After pre-operative arterial line and femoral block placement, an ultrasound guided subarachnoid block was safely placed...
February 2016: Middle East Journal of Anesthesiology
https://www.readbyqxmd.com/read/27358643/a-randomised-controlled-trial-comparing-the-effect-of-adjuvant-intrathecal-2-mg-midazolam-to-20-micrograms-fentanyl-on-postoperative-pain-for-patients-undergoing-lower-limb-orthopaedic-surgery-under-spinal-anaesthesia
#19
Francis Codero, Mung'ayi Vitalis, Sharif Thikra
BACKGROUND: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post-operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia...
March 2016: African Health Sciences
https://www.readbyqxmd.com/read/27308952/the-use-of-ultrasound-guidance-for-perioperative-neuraxial-and-peripheral-nerve-blocks-in-children-a-cochrane-review
#20
Joanne Guay, Santhanam Suresh, Sandra Kopp
BACKGROUND: Objectives were to determine whether the use of ultrasound guidance offers any clinical advantage in the performance of neuraxial or peripheral nerve blocks in children in terms of increasing the success rate or decreasing the rate of complications. METHODS: We searched the following databases to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), EMBASE (OvidSP), and Scopus (to January 2015). We included all parallel randomized controlled trials that evaluated the effect of ultrasound guidance to perform a regional blockade technique in children...
June 15, 2016: Anesthesia and Analgesia
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