Regional anesthesia and pain medicine
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Dura-arachnoid puncture for spinal anesthesia is associated with several complications. Postdural puncture headache (PDPH) and needle bending are significant among these. The incidence of PDPH has been reduced significantly with the advent of pencil-point needles. ⋯ Braun, Melsungen, Germany) has been modified manually. The new tip-holed design seems to be sound both from theoretical and practical point of view. Searching Medline Plus through their Internet Web site (www.nlm.nih.com) did not reveal the existence of any such spinal needle.
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Reg Anesth Pain Med · Jul 2000
Neurotoxicity of intrathecally administered tetracaine commences at the posterior roots near entry into the spinal cord.
Neurotoxicity of intrathecally administered local anesthetics is generating increased interest. This study was designed to examine the histopathologic effects of intrathecally administered tetracaine. ⋯ Our results suggest that the initial target of intrathecal tetracaine neurotoxicity may be the posterior roots at their entry into the spinal cord, where the axons are devoid of myelin sheath and thus representing a sensitive area for neurotoxic change.
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Reg Anesth Pain Med · Jul 2000
Clinical Trial Controlled Clinical TrialRespiratory gas exchange and hemodynamics during lumbar epidural anesthesia: effects of lidocaine with and without epinephrine.
Epinephrine modifies the hemodynamic response to epidural local anesthetic; effects on respiratory gas exchange are not known. We hypothesized that epidural epinephrine would increase oxygen consumption and carbon dioxide production. ⋯ The addition of epinephrine, 5 microg x mL(-1), to the epidural injection of 2% lidocaine is associated with changes not only in hemodynamics, but also in respiratory gas exchange.
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Reg Anesth Pain Med · Jul 2000
Generating a learning curve for pediatric caudal epidural blocks: an empirical evaluation of technical skills in novice and experienced anesthetists.
Learning curves for anesthesia procedures in adult patients have been determined, but no data are available on procedures in pediatric anesthesia. The aim of this study was to assess the number of caudal blocks needed to guarantee a high success rate in performing caudal epidural analgesia in children. ⋯ High success rates in performing caudal anesthesia in pediatric patients can be acquired after a limited number of cases. Success rates of residents learning this procedure are comparable to the results of staff anesthesiologists.