Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Nov 2016
Case ReportsDelayed Neuraxial Hematoma in Parturient With Fontan Circulation Following Neuraxial Anesthesia for Cesarean Section.
Neuraxial hematoma is a rare complication of spinal or epidural anesthesia. However, variable coagulation factor defects are relatively common in patients with Fontan circulation, and may predispose such patients to either increased risk of thrombosis or coagulopathy. These defects may indirectly increase their risk of neuraxial hematoma. ⋯ Parturients with single ventricle physiology present numerous challenges to balance, including pregnancy-related physiologic alterations in blood volume, cardiac output, systemic vascular resistance, oxygen consumption, and coagulation. Although neuraxial anesthesia is common in this population, it is not without risks. We report the circumstances surrounding a parturient with single ventricle physiology who experienced neuraxial hematoma 4 days after continuous spinal anesthesia despite adherence to accepted guidelines. Eighteen months after undergoing a cesarean section, she had a full recovery and returned to her baseline medical status.
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled Trial Comparative StudyA Randomized Controlled Trial of Ultrasound Versus Nerve Stimulator Guidance for Axillary Brachial Plexus Block.
Ultrasound-guided techniques improve outcomes in regional anesthesia when compared with traditional techniques; however, this assertion has not been studied with novices. The primary objective of this study was to compare sensory and motor block after axillary brachial plexus block when performed by novice trainees allocated to an ultrasound- or nerve-stimulator-guided group. A secondary objective was to compare the rates of skill acquisition between the 2 groups. ⋯ We were unable to demonstrate a difference in the efficacy of axillary brachial plexus block performed by novices when ultrasound guidance was compared with a nerve stimulator technique. There was evidence of similarly improved clinical performance of novices in both groups.
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Reg Anesth Pain Med · Nov 2016
Randomized Controlled Trial Comparative StudyDetermining the Learning Curve for Acquiring Core Sonographic Skills for Ultrasound-Guided Axillary Brachial Plexus Block.
The objectives of this study were to determine the learning curve for capturing sonograms and identifying anatomical structures relevant to ultrasound-guided axillary brachial plexus block and to determine if massed was superior to distributed practice for this core sonographic skill. ⋯ The proficiency of participants in capturing sonograms and identifying anatomical structures improved significantly over 8 to 10 learning sessions. Because of sample size issues, we cannot make a firm conclusion regarding massed versus distributed practice for this core sonographic skill.
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Reg Anesth Pain Med · Nov 2016
The Use of Epinephrine in Caudal Anesthesia Increases Stroke Volume and Cardiac Output in Children.
Caudal anesthesia is a common and effective regional anesthesia technique in pediatric patients. The addition of epinephrine to local anesthetics in caudal anesthesia is a frequent practice; however, changes in hemodynamic and cardiac parameters produced by epinephrine in caudal anesthesia are not well studied. Using data collected with the ICON noninvasive cardiac output monitor, we examined the hemodynamic changes associated with the administration of epinephrine containing local anesthetics during caudal anesthesia in children. ⋯ Epinephrine added to local anesthetic injected for caudal anesthesia produces significant increases in SV, CO, and CI in children. Stroke volume and CI changes from epinephrine added to local anesthetic for caudal anesthesia seem to take place only in children 6 months or older.