Regional anesthesia and pain medicine
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Eisenmenger's syndrome is characterized by right-to-left or bidirectional shunting and pulmonary hypertension. Perioperative risk is high for noncardiac surgery, and many clinicians avoid regional anesthesia because of the potential deleterious hemodynamic effects. We determined perioperative mortality based on published reports describing anesthetic management in patients with Eisenmenger's syndrome. ⋯ This review of anesthesia and surgery in patients with Eisenmenger's syndrome reveals that most deaths probably occurred as a result of the surgical procedure and disease and not anesthesia. Although perioperative and peripartum mortalities are high, many anesthetic agents and techniques have been used with success.
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Reg Anesth Pain Med · Sep 2002
Case ReportsRepeated failure of epidural analgesia: an association with epidural fat?
To report the case of a patient who experienced repeated failed epidural analgesia associated with an unusual amount of fat in the epidural space (epidural lipomatosis). ⋯ We have described a case of repeated failure of epidural analgesia in a patient with epidural lipomatosis.
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Reg Anesth Pain Med · Sep 2002
Does local anesthetic stereoselectivity or structure predict myocardial depression in anesthetized canines?
It is unclear whether the susceptibility to myocardial depression from an accidental intravascular local anesthetic (LA) administration is associated with LA stereoselectivity or structure. By using direct left ventricular pressure monitoring and echocardiographic indices of contractile function in anesthetized, ventilated dogs, we compared the cardiac depressant effects of bupivacaine, ropivacaine, levobupivacaine, and lidocaine. ⋯ This study suggests that smaller molecular size and possibly a piperidine-free structure as opposed to stereoselectivity may be the more important factor in reducing the risk of LA-induced myocardial depression.
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Reg Anesth Pain Med · Sep 2002
Successful interscalene block with a nerve stimulator may also result after a pectoralis major motor response.
Interscalene block of the brachial plexus is a well-established anesthetic and analgesia technique for shoulder surgery. The endpoint for successful block using the nerve stimulator has been described by previous authors as a bicep motor response (twitch) and recently by a deltoid motor response. This retrospective observational case study of regular clinical practice examined the efficacy of using the pectoralis major motor response as an endpoint for a successful block. ⋯ This retrospective observational case study of regular clinical practice suggests that a pectoralis major motor response can be a satisfactory endpoint for interscalene block.