Minerva anestesiologica
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Minerva anestesiologica · Oct 2001
Case Reports[Intubating laryngeal mask airway (ILMA) in otorhinolaryngology surgery. A case of failure].
Intubating laryngeal mask airway (ILMA) is a very useful device for difficult airway management. The use of this device has not yet been studied in otorhinolaryngology surgery. The case of a 52-year-old man, weighing 104 kg, anesthetized for microlaryngoscopy due to aphonia occurred 6 months before, is reported. ⋯ Blind intubation with ILMA is not, probably, the first alternative in these cases. Fiberoptic equipment intubation or use of ILMA with fiberoptic bronchoscope must be considered in these situations for possible better RESULTS. The use of ILMA in otorhinolarynogology surgery must be investigated with a specific study because there are only few experiences on this subject.
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Lumbar plexus and sacral plexus are responsible for sensory and motor innervation of the whole inferior limb and their blockade can be used as a single technique or integrated with general anaesthesia for hip-, femur-, knee-, lower leg-, ankle- and foot surgery. For the performance of the blocks, knowledge of peripheral and central percourse of the nerves and their anatomical relationships to bone-, muscle-, vessel and skin structures is important. In case of the sciatic nerve, a cutaneous projection of the percourse of the nerve is possible (the so-called sciatic line) formed by a virtual line from the midpoint of the line between great trochanter and ischial tuberosity to the apex of the popliteal fossa. ⋯ Regarding the last one, the following approaches are possible, depending on the anatomical site of performance: classic proximal posterior block, parasacral proximal block, lithotomic posterior proximal block, subgluteal posterior proximal block, anterior proximal block, lateral medio femoral popliteal proximal block, block distal from the poplitea, subcalcaneal block. The terms distal and proximal are in relation to the small trochanter. All blocks have to be performed using a nerve stimulator, teflon insulated needles of various measures depending on the kind of block, variable stimulation from 1,5 mA (when evoking muscle contraction) to 0,5-0,3 mA (injection of local anaesthetic) with frequencies of 2 Hz/0,1 ms.
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The rational approach to acute pain management is to use the highest quality evidence available. Acute pain management is more than a collection of interventions. It is a package of care that needs to be examined as a whole as well as in its parts. ⋯ Existing tools can do the job if doctors and nurses are educated, both to dispel the myths and misconceptions and to take responsibility for providing pain control. It is much easier to dispel myths when you have the evidence. In 1846, the first anaesthetic provided pain-free surgery - 150 years later patients should not have to endure unrelieved pain anywhere in the hospital.
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Minerva anestesiologica · Sep 2001
Randomized Controlled Trial Comparative Study Clinical Trial[Cervical plexus block and continuous cervical peridural block with ropivacaine for carotid surgery: a comparison between the 2 methods].
To evaluate the efficacy and security of the cervical plexus block and the continuous cervical peridural anaesthesia in carotid surgery, using ropivacaine as local anaesthetic. ⋯ cervical plexus block and continuous cervical peridural anaesthesia performed with ropivacaine are both effective for anaesthesia in carotid surgery. Ropivacaine, for its minor cardiotoxicity, yields eventual complications related to the two methods, less severe.
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Caudal block is the single most popular regional anesthetic technique used in infants and children. A review of the literature concerning complications related to this technique reveals that it is safe and it has a low failure rate. Probably the incidence of complications of caudal block is 7/10.000, the lowest of all the central blocks. ⋯ Caudal morphine has been used successfully for postoperative analgesia in children of all ages, including neonates after open-heart surgery. Possible complications of this technique are: local anesthetics overdose, vascular penetration and intravascular injection of local anesthetics, dural puncture and total spinal anaesthesia, intraosseous injection, infections, meningitis, respiratory depression (when morphine is used). Authors analyze all these complications and the safety rules for their prevention.