Anesthesia and analgesia
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Anesthesia and analgesia · Jul 1984
Continuous axillary brachial plexus block--a clinical and anatomical study.
In order to decrease both the failure rate and inadvertent arterial puncture rate that may be associated with continuous axillary brachial plexus block, a new technique of insertion of the catheter in the axilla was studied in 52 patients and in 12 fresh cadavers. With the arm abducted, externally rotated, and flexed at the elbow, an 80-mm long catheter was inserted under the skin at a site located 40-mm below the axilla and medial to the biceps muscle. Injection of lidocaine and bupivacaine produced sensory and motor blockades of the median, radial, ulnar, and musculocutaneous nerves in 98% of the patients. ⋯ In the anatomical study, injection of dye and molding solutions showed that the tip of the catheter lay not in the perivascular sheath, but in a virtual cavity that was very superficial, under the skin, and surrounding the perivascular space. The technique used was safe and had a high success rate. It is particularly useful in patients undergoing long operations and in patients in whom pain would otherwise prevent postoperative physiotherapy of the upper arm.
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In order to evaluate the possible physiologic significance of intra- and postoperative hypotension, we monitored arterial blood pressure and heart rate continuously for 36 hr starting the night before and ending the morning after operation in 34 gynecologic patients. The lowest pressures that occurred during physiologic sleep were compared with the lowest arterial pressures that occurred during anesthesia without deliberate hypotension. ⋯ These physiologic nadirs in blood pressure are assumed to be tolerated well by the patient. Intraoperative pressures in elderly patients frequently drifted below sleep-associated levels of blood pressure and may, therefore, constitute physiologically significant hypotension.
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Anesthesia and analgesia · Jul 1984
A controlled comparison of techniques for locating the internal jugular vein using ultrasonography.
Fifteen techniques for localization of the internal jugular vein ( IJV ) were evaluated in each of 25 subjects using ultrasonography to simulate actual cannulation. Ultrasound images were used to determine puncture of the IJV , puncture of the carotid artery (CA), the distance from the skin to the center of the IJV , the width of the IJV lumen, the relationship of the CA to the IJV , and the lateral distance of the IJV from the axis of the sound beam. No technique proved best in successful IJV puncture. ⋯ Rotation of the head, extension of the neck, and breathholding had no influence on IJV cannulation rates. It is concluded that no one technique is clearly superior to the others. Facility with one technique may be more critical to successful cannulation than the technique itself.