Anesthesia and analgesia
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Two adult patients suffered postoperative delirium following administration of lorazepam, a new benzodiazepine sedative. Physostigmine was found effective in reversing all untoward central nervous system effects.
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During the period November 1972 through October 1974, 118 epidural blood patch procedures were performed for severe postlumbar-puncture cephalgia. Subsequently, in a period varying from 105 to 380 days, three patients, two of whom had twice undergone epidural blood patch, were readmitted for either surgical operation or delivery. Either epidural, caudal, or spinal block was successfully accomplished. ⋯ During the spinal block, ligmentum flavum was distinctly felt from the dura. The extent of the blocks, the onset and duration of action ofpivacaine, mepivacaine, and lidocaine were within normal limits. It is, therefore, concluded that epidural blood patch does not obliterate the epidural space and should not preclude the use of regional block for later surgical or obstetric procedures.
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A modified low-dose paratracheal approach to stellate ganglion block at the C6 level prevents the possible complications of subarachnoid introduction of large quantities of local anesthetic, brachial plexus block, and toxic reaction to local anesthetics. It is a technically simple procedure with readily identifiable landmarks and can be performed on an outpatient basis with short recovery periods. Successful block can be readily evaluated. It is emphasized that a series of blocks is required to "disorganize" the reflex activity triggered in the internuncial pools of the spinal cord as well as in the sympathetic ganglia themselves.
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Anesthesia and analgesia · Jul 1975
A new single-position supine approach to sciatic-femoral nerve block.
To overcome the disadvantages of other methods, the authors have devised a procedure for below-the-knee operations, involving a new technic of sciatic-femoral nerve block. The technic has so far been successful without use of adjuvant agents in 90 percent of over 100 patients so handled.
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Epidural blood patch (EBP) was performed for the treatment of severe postlumbar puncture cephalalgia in 118 young patients. Following the first EBP, 105 patients had relief of headache. Eleven of the 13 in whom it failed had a second EBP, with adequate relief in 10, giving an overall success of 97.5 percent. ⋯ Residual complications included backache and/or back stiffness in 22 patients and paresthesia in two. Two-year follow-up revealed 95 percent patient acceptance of the procedure. EBP was found to be a safe, effective method for treating severe postlumbar puncture cephalalgia, provided a proper diagnosis is made and there is no contraindication.