Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Dec 2024
ReviewPerioperative considerations for patients exposed to hallucinogens.
Hallucinogen exposure in patients in the perioperative period presents challenges for anesthesiologists and other anesthesia providers. Acute and chronic exposure to these substances can cause physiological impacts that can affect the function of anesthetic and analgesic medications used during perioperative care. The objective of this narrative review is to educate readers on the wide array of hallucinogens and psychedelics that may influence the perioperative management of patients exposed to these substances. ⋯ Many of these substances increase serotonin levels or act directly at serotonergic receptors. However, there are other relevant actions that may include varied mechanisms from N-methyl-D-aspartate receptor antagonism to stimulation of muscarinic receptors. With hallucinogen exposure rates on the rise, understanding the effects of hallucinogens is important for optimizing management and reducing risks perioperatively for patients with acute or chronic exposure.
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Reg Anesth Pain Med · Dec 2024
Randomized Controlled TrialRandomized control trial of a holographic needle guidance technique for thoracic epidural placement.
The Microsoft HoloLens is a head-mounted mixed reality device, which allows for overlaying hologram-like computer-generated elements onto the real world. This technology can be combined with preprocedural ultrasound during thoracic epidural placement to create a visual of the ideal needle angulation and trajectory in the users' field of view. This could result in a technically easier and potentially safer alternative to traditional blind landmark techniques. ⋯ This study shows that thoracic epidural placement may be facilitated by using a guidance hologram and may be more technically efficient.
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Reg Anesth Pain Med · Dec 2024
Cost of sterility: probe covers should not be mandated for single-shot peripheral nerve blocks.
Ultrasound guidance has become ubiquitous with regional anesthesia, but little consistency exists on necessary ultrasound probe hygiene and sterility barriers. Fear of possible infection has led to calls for universal use of sterile ultrasound probe covers. ⋯ While various parties have labeled single-shot nerve blocks as a sterile procedure, in practice, it is a clean technique. In this article, we argue that mandating the use of probe covers is unnecessary and that it should be left to the anesthesiologist to determine what type of anti-infection equipment is necessary for single-shot nerve blocks based on their practice situation and expertize.
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Reg Anesth Pain Med · Dec 2024
Changes in needle maneuver space and optimal insertion site for midline neuraxial puncture with progressive age: an analysis in computed tomography scans.
We systematically describe the morphology and accessibility of interspinous spaces across age groups of patients. Our primary goal was to objectively estimate if the maneuver space for a virtual spinal needle changes with age. Our secondary goal was to estimate if the optimal site and angle for midline neuraxial puncture change with age. ⋯ Needle maneuver space in midline neuraxial puncture significantly decreases with progressive age at all levels of the spine. Optimal puncture points and angles are similar between age groups.