Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2013
Randomized Controlled Trial Comparative StudyA Comparison of Quincke and Whitacre Needles with Respect to Risk of Intravascular Uptake in S1 Transforaminal Epidural Steroid Injections: A Randomized Trial of 1376 Cases.
Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. ⋯ To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.
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Anesthesia and analgesia · Nov 2013
ReviewSelection of Obese Patients Undergoing Ambulatory Surgery: A Systematic Review of the Literature.
The incidence of obesity has increased over the past 2 decades. In recent years, several studies have assessed perioperative outcomes in obese patients undergoing ambulatory surgery. However, this evidence has not been reviewed and evaluated systematically. ⋯ The literature lacks adequate information to make strong recommendations regarding appropriate selection of the obese patients scheduled for ambulatory surgery. The literature does indicate that the super obese (BMI >50 kg/ m) do present an increased risk for perioperative complications, while patient with lower BMIs do not seem to present any increased risk as long as any comorbidities are minimal or optimized before surgery. This review also identifies knowledge gaps and recommends future research required to guide optimal selection of obese patients scheduled for ambulatory surgery.