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thoracic epidural

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https://www.readbyqxmd.com/read/28444433/boundaries-of-the-thoracic-paravertebral-space-potential-risks-and-benefits-of-the-thoracic-paravertebral-block-from-an-anatomical-perspective
#1
Esther A C Bouman, Judith M Sieben, Andrea J R Balthasar, Elbert A Joosten, Hans-Fritz Gramke, Maarten van Kleef, Arno Lataster
PURPOSE: Thoracic paravertebral block (TPVB) may be an alternative to thoracic epidural analgesia. A detailed knowledge of the anatomy of the TPV-space (TPVS), content and adnexa is essential in understanding the clinical consequences of TPVB. The exploration of the posterior TPVS accessibility in this study allows (1) determination of the anatomical boundaries, content and adnexa, (2) description of an ultrasound-guided spread of low and high viscous liquid. METHODS: In two formalin-fixed specimens, stratification of the several layers and the 3D-architecture of the TPVS were dissected, observed and photographed...
April 25, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/28442931/postoperative-pain-and-patient-controlled-epidural-analgesia-related-adverse-effects-in-young-and-elderly-patients-a-retrospective-analysis-of-2-435-patients
#2
Jae Chul Koh, Young Song, So Yeon Kim, Sooyeun Park, Seo Hee Ko, Dong Woo Han
In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20-39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6-48 hours postsurgery...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28442930/thoracic-epidural-analgesia-reduces-myocardial-injury-in-ischemic-patients-undergoing-major-abdominal-cancer-surgery
#3
Mohamad Farouk Mohamad, Montaser A Mohammad, Diab F Hetta, Eman Hasan Ahmed, Ahmed A Obiedallah, Alaa Ali M Elzohry
BACKGROUND AND OBJECTIVES: Major abdominal cancer surgeries are associated with significant perioperative mortality and morbidity due to myocardial ischemia and infarction. This study examined the effect of perioperative patient controlled epidural analgesia (PCEA) on occurrence of ischemic cardiac injury in ischemic patients undergoing major abdominal cancer surgery. PATIENTS AND METHODS: One hundred and twenty patients (American Society of Anesthesiologists grade II and III) of either sex were scheduled for elective upper gastrointestinal cancer surgeries...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28434767/extrarenal-rhabdoid-tumor-presented-with-an-immobile-arm-in-a-one-year-old-boy
#4
Chi-Ting Chung, Yen-Lin Liu, Chien-Jui Cheng, Kevin Li-Chun Hsieh, Min-Lan Tsai, Tai-Tong Wong
Infants with an immobile arm may be easily overlooked in primary care settings. Differential diagnoses include injuries, infections, neuropathies, ischemia and rarely, neoplasms. We report the case of a one-year-old boy with weakness in his left arm after minor trauma with a diagnosis of brachial plexus palsy initially. After rehabilitation for 2months, his weakness progressed to unsteady gait and quadriparesis. MRI revealed a huge solid tumor in the left supraclavicular fossa, which also involved the left brachial plexus, upper thoracic cavity, and left paravertebral space with invasion into the spinal canal...
April 20, 2017: Brain & Development
https://www.readbyqxmd.com/read/28430048/a-spinal-epidural-abscess-due-to-streptobacillus-moniliformis-infection-following-a-rat-bite-case-report
#5
Alexander Hammer, Dorit Wolff, Walter Geißdörfer, Michael Schrey, Renate Ziegler, Hans-Herbert Steiner, Christian Bogdan
The authors describe the case of a 40-year-old man suffering from an epidural abscess in the thoracic spine due to a rarely isolated pathogen, Streptobacillus moniliformis, the causative agent of rat bite fever. Besides diffuse abdominal pain, ataxia, paresthesia, hypesthesia, and enhanced reflexes of the lower extremities, the patient suffered from a decreased sensation of bladder filling. His history was also positive for a rat bite 6 weeks earlier. Magnetic resonance imaging showed an epidural, space-occupying lesion compressing the spinal cord at the vertebral levels of T6-8...
April 21, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28419420/reliability-of-pressure-waveform-analysis-to-determine-correct-epidural-needle-placement-in-labouring-women
#6
I Al-Aamri, S H Derzi, A Moore, M F Elgueta, M Moustafa, T Schricker, D Q Tran
Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance)...
April 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28417614/spinal-epidural-abscess-caused-by-brucella-species-a-review-of-17-cases
#7
Qin Zhang, Xiaohui Yang, Honglin Yu, Benrang Jia, Bin Meng
BACKGROUND: Spinal epidural abscess (SEA) is a rarely encountered clinical entity during the course of Brucella infection. METHODS: We reported 17 patients diagnosed with Brucellar SEA for a mean follow-up of 15 months. Spinal epidural abscess was detected by magnetic resonance imaging in all cases. Brucella diagnosis was established by serological tests. Patients were administered antibiotics for duration of 6 to 16 weeks. RESULTS: SEA was localized in lumbar region in 9 patients, thoracic in 4 patients, cervical in 3 patients, both thoracic and lumbar in 1 patient...
June 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28407704/delayed-epidural-mucin-collection-after-surgery-for-spinal-metastatic-pancreatic-adenocarcinoma
#8
Dong Ha Kim, Dong Hwan Kim, Hwan Soo Kim, Kyoung Hyup Nam, Byung Kwan Choi, In Ho Han
A rare case of delayed large epidural mucin collection causing neurologic deficit after surgery for metastatic pancreatic cancer is reported. A 65-year-old man presented with intractable upper-thoracic back pain radiating to the chest and gait disturbance. He had a history of subtotal pancreatectomy due to intraductal papillary mucinous neoplasm (IPMN) of the pancreas and concurrent chemotherapy. Eight months after pancreatectomy, multiple thoracic spinal metastasis was diagnosed with routine up positron emission tomography-computed tomography...
March 2017: Korean Journal of Spine
https://www.readbyqxmd.com/read/28405771/sacral-epidural-arteriovenous-fistulas-imitators-of-spinal-dural-arteriovenous-fistulas-with-different-pathologic-anatomy-report-of-three-cases-and-review-of-the-literature
#9
Jan-Karl Burkhardt, Michael M Safaee, Aaron J Clark, Michael T Lawton
BACKGROUND: Sacral epidural arteriovenous fistulas (eAVFs) are rare and often misdiagnosed because of the incongruence between the thoracic level of clinical deficits and the sacral location of the offending pathology. Failure to diagnose this lesion delays treatment, resulting in prolonged venous hypertension in the cord, progressive neurological deterioration, and decreased chances of recovery. METHODS: A single-institution case series and the published literature were reviewed...
April 12, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28405171/estimation-of-the-depth-of-the-thoracic-epidural-space-in-children-using-magnetic-resonance-imaging
#10
Tariq M Wani, Mahmood Rafiq, Arif Nazir, Hatem A Azzam, Usama Al Zuraigi, Joseph D Tobias
BACKGROUND: The estimation of the distance from the skin to the thoracic epidural space or skin to epidural depth (SED) may increase the success rate and decrease the incidence of complications during placement of a thoracic epidural catheter. Magnetic resonance imaging (MRI) is the most comprehensive imaging modality of the spine, allowing for the accurate determination of tissue spaces and distances. The present study uses MRI-derived measurements to measure the SED and define the ratio between the straight and inclined SEDs at two thoracic levels (T6-7 and T9-10) in children...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28400726/review-of-epidural-spinal-cord-stimulation-for-augmenting-cough-after-spinal-cord-injury
#11
REVIEW
Jan T Hachmann, Jonathan S Calvert, Peter J Grahn, Dina I Drubach, Kendall H Lee, Igor A Lavrov
Spinal cord injury (SCI) remains a debilitating condition for which there is no cure. In addition to loss of somatic sensorimotor functions, SCI is also commonly associated with impairment of autonomic function. Importantly, cough dysfunction due to paralysis of expiratory muscles in combination with respiratory insufficiency can render affected individuals vulnerable to respiratory morbidity. Failure to clear sputum can aggravate both risk for and severity of respiratory infections, accounting for frequent hospitalizations and even mortality...
2017: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/28400498/effect-of-thoracic-epidural-anesthesia-on-heart-rate-variability-in-a-porcine-model
#12
Arjun Mahajan, Tatsuo Takamiya, Peyman Benharash, Wei Zhou
Heart rate variability (HRV) is increasingly recognized as a means of evaluating autonomic tone. Thoracic epidural anesthesia (TEA) has been previously demonstrated to suppress the electrical storms in patients. However, the effect of TEA on HRV during sympathoexcitation remains unknown. In this study, we aimed to determine the effects of TEA on HRV response to left stellate ganglion stimulation (LSS) in a porcine model. In 12 anesthetized pigs after insertion of an epidural catheter to T1 level, a median sternotomy was performed to expose the heart and the left stellate ganglion...
April 2017: Physiological Reports
https://www.readbyqxmd.com/read/28396950/giant-cell-tumor-of-the-thoracic-spine-completely-removed-by-total-spondylectomy-after-neoadjuvant-denosumab-therapy
#13
Noritaka Yonezawa, Hideki Murakami, Satoshi Kato, Akihiko Takeuchi, Hiroyuki Tsuchiya
PURPOSE: Denosumab, a novel monoclonal antibody that targets the receptor activator of nuclear factor-κB (RANK) ligand (RANKL), has recently been used to treat patients with giant cell tumor of bone (GCTB). However, few reports have described the clinical results of denosumab therapy for spinal GCTB and evaluated treatment efficacy with respect to the entirety of the resected vertebra after denosumab therapy. METHODS: We present the case of a 51-year-old man with T12 GCTB that was completely removed by a total spondylectomy following 10 courses of neoadjuvant denosumab therapy...
April 10, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28384375/risk-factors-for-anastomotic-leakage-following-esophagectomy-impact-of-thoracic-epidural-analgesia
#14
Wen Wang, Gefei Zhao, Linxin Wu, Yanpeng Dong, Chaobin Zhang, Li Sun
BACKGROUND AND OBJECTIVES: Anastomotic leakage (AL) is one of common complications after esophageal cancer surgery. Thoracic epidural analgesia (TEA) is often recommended in patients undergoing esophagectomy. However, the impact of TEA on AL is still controversial. Thus, we conducted this study to evaluate the effect of TEA on the occurrence of AL and identify risk factors for the development of AL following esophagectomy. METHODS: Our retrospective study identified patients who underwent elective esophagectomy between July 2013 and July 2016...
April 6, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28377250/acute-spinal-epidural-hematoma-after-acupuncture-personal-case-and-literature-review
#15
Maurizio Domenicucci, Daniele Marruzzo, Alessandro Pesce, Antonino Raco, Paolo Missori
BACKGROUND: Spinal acupuncture is a relatively safe and common analgesic treatment, but it may be complicated by serious adverse effects such as direct spinal cord and nerve root injury, subdural empyema and epidural abscesses. In this report we are comparing our case of an extremely uncommon spinal epidural hematoma which appeared following treatment by acupuncture with other similar documented cases. CASE DESCRIPTION: This is the case of a 64-year-old man who presented a left hemiparesis associated with paraesthesias...
April 1, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28367291/learning-curves-for-three-specific-procedures-by-anesthesiology-residents-using-the-learning-curve-cumulative-sum-lc-cusum-test
#16
Gregoire Weil, Cyrus Motamed, David J Biau, Marie Laurence Guye
BACKGROUND: The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures. METHODS: The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation...
April 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28367195/the-effect-of-bilateral-intrapleural-infusion-of-lidocaine-with-fentanyl-versus-only-lidocaine-in-relieving-pain-after-coronary-artery-bypasses-surgery
#17
Kamran Shadvar, Sarvin Sanaie, Ata Mahmoodpoor, Mitra Safarpoor, Bahman Nagipour
BACKGROUND AND OBJECTIVE: Pain control during surgery in order to cause analgesia and reduce the somatic and autonomic response may decrease the morbidity. Intrapleural catheter embedding during surgery under direct vision of surgeon is safe and easy and without potential risk of thoracic epidural block. The aim of this study was to investigate the effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypass surgery...
January 2017: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/28358748/effect-of-thoracic-epidural-anesthesia-on-ventricular-excitability-in-a-porcine-model
#18
Kimberly Howard-Quijano, Tatsuo Takamiya, Erica A Dale, Kentaro Yamakawa, Wei Zhou, Una Buckley, Aman Mahajan
BACKGROUND: Imbalances in the autonomic nervous system, namely, excessive sympathoexcitation, contribute to ventricular tachyarrhythmias. While thoracic epidural anesthesia clinically suppresses ventricular tachyarrhythmias, its effects on global and regional ventricular electrophysiology and electrical wave stability have not been fully characterized. The authors hypothesized that thoracic epidural anesthesia attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity...
March 30, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28341230/intraoperative-cryoanalgesia-for-managing-pain-after-the-nuss-procedure
#19
Claire Graves, Olajire Idowu, Sang Lee, Benjamin Padilla, Sunghoon Kim
BACKGROUND: Cryoanalgesia prevents pain by freezing the affected peripheral nerve. We report the use of intraoperative cryoanalgesia during the Nuss procedure for pectus excavatum and describe our initial experience, modifications of technique, and lessons learned. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who received cryoanalgesia during the Nuss procedure between June 1, 2015, and April 30, 2016, at our institutions and analyzed modifications in surgical technique during this early adoption period...
March 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28340013/implications-of-thoracic-epidural-analgesia-on-hospital-charges-in-rib-fracture-patients
#20
Courtney D Jensen, Jamie T Stark, Lewis E Jacobson, Jan M Powers, Kathy L Leslie, Jeffrey M Kinsella-Shaw, Michael F Joseph, Craig R Denegar
Objective.:  Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not...
March 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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