Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Clinical TrialUltrasound-guided obturator nerve block: a sonoanatomic study of a new methodologic approach.
Obturator nerve block is one of the most technically challenging regional anesthesia techniques. Recently, the characteristics of the nerve have been described using ultrasound. However, clinical application of proximal ultrasound-guided obturator nerve block on patients has not been reported. In this study, we used ultrasound to describe the anatomical localization of the obturator nerve and its two branches in cadavers, volunteers, and also patients. ⋯ Landmarks defined in this clinical trial can be used in patients for obturator nerve block with ultrasound guidance.
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Anesthesia and analgesia · Mar 2009
The efficacy of skin temperature for block assessment after infraclavicular brachial plexus block.
Although it has been reported that an increase in skin temperature indicates block success with higher specificity and sensibility than skin sensitivity to pinprick and cold, the methodology previously used computer-assisted infrared thermography, a technique that is expensive and requires substantial personnel training. In this prospective observational study, we evaluated whether a simple infrared thermometer can reliably predict block effectiveness after infraclavicular brachial plexus blockade. ⋯ Skin temperature assessment with an infrared thermometer is a reliable, simple and early indicator of a successful nerve block.
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Anesthesia and analgesia · Mar 2009
Case ReportsTreatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer.
Calcium channel blocker (CCB) overdose is often lethal. Conventional medical treatment includes i.v. calcium, high doses of catecholamines, insulin, and glucagon. A new inotropic drug, levosimendan, should be considered in severe CCB poisoning. ⋯ We describe two patients with serious CCB overdose. Despite intensive medical and mechanical cardiovascular support, both patients remained in shock. Hemodynamics gradually improved after administration of levosimendan.
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Anesthesia and analgesia · Mar 2009
Proprioceptive function is more sensitive than motor function to desflurane anesthesia.
Evaluating the effects of sub-immobilizing anesthetic doses on movement will identify target neural circuits for investigation as sites of action for anesthetic-induced immobility. ⋯ Proprioceptive function is more sensitive to anesthetic-induced depression than motor function in frogs. This suggests that the most anesthetic-sensitive component of the spinal neural circuitry underlying movement generation in response to noxious stimulus is prior to the level of the motoneuron.
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Anesthesia and analgesia · Mar 2009
Case ReportsSevere methemoglobinemia detected by pulse oximetry.
An elderly surgical patient acquired a life-threatening methemoglobinemia as a result of topical benzocaine spray to the oropharynx in preparation for awake endotracheal intubation. A new multiwavelength pulse oximeter, the Masimo Rad-57, detected this methemoglobinemia an hour before it was confirmed by laboratory CO-oximetry. ⋯ The new pulse oximeter gave continuous readings of methemoglobin level at the bedside, whereas the laboratory values were delayed by up to an hour. This case demonstrates the clinical application of a multiwavelength pulse oximeter in the diagnosis and treatment of a life-threatening dyshemoglobinemia.