Minerva anestesiologica
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Minerva anestesiologica · Apr 2015
Enhanced visual acuity with echogenic needles in ultrasound-guided axillary brachial plexus block : A randomized, comparative, observer-blinded study.
We prospectively evaluated the effect of insertion angle on the visibility of echogenic and nonechogenic needles in phantoms and in axillary nerve blocks in patients. ⋯ Needles with enhanced echogenicity improved physician comfort, image quality, needle visibility, and visualization time of the needle during ultrasound-guided procedures in phantoms and axillary nerve blocks using insertion angles of 30-45° and ≥ 45°.
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Minerva anestesiologica · Apr 2015
ReviewThe use of cisatracurium in critical care: A review of the literature.
Cisatracurium is currently one of the most commonly used neuromuscular blocking agent (NMBA) in intensive care units. Cisatracurium was developed primarily for anaesthetic purposes in order to attempt to resolve some of the problems associated with earlier NMBAs, such as histamine release and laudanosine accumulation. Cisatracurium, the the R-cis-R-cis isomer of atracurium, is up to 5 times more potent than atracurium and so is administered in smaller quantities and produces a lesser degree of laudanosine accumulation in the plasma. ⋯ Its use has been associated with better outcomes in therapeutic hypothermia and in traumatic brain injury. Although it has many favorable pharmacological properties, it is more expensive than comparable agents and some safety concerns persist regarding adverse events associated with the drug. The aim of the present study was to perform the first comprehensive review to date of all literature relating to the use of cisatracurium in critically ill patients.
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Topical analgesics may play an important role in the management of chronic pain and have good tolerability. Systemic ketamine has limited usage as an anesthetic and along with its potential for addiction and dependence has not gained popularity as an analgesic compound. Topical ketamine however, is devoid of serious side effects, and thus can be used in the management of various pain states such as neuropathic pain and complex regional pain syndrome. ⋯ Its efficacy may depend on the choice of vehicle, the concentration and the pain state. Suboptimal concentration of ketamine and suboptimal pharmaceutical properties of the cream base might have contributed to the negative results of some studies. In this article we will review clinical studies involving the use of topical ketamine for pain.