Revista española de anestesiología y reanimación
-
Rev Esp Anestesiol Reanim · Dec 2000
Review[Morphology of peripheral nerves, their sheaths, and their vascularization].
This review aims to update our understanding of peripheral nerves, including the nature and function of their sheaths and, finally, their vascularization. The peripheral nervous system is made up of nerves whose function is to gather stimuli from the periphery as well as to transport the motor, secretory or vegetative responses that are triggered to the periphery. The connective tissue surrounding peripheral nerves all along their extension is made up of endoneurial, perineurial and epineurial. ⋯ Regarding the blood-nerve barrier and the existence of capillary permeability: endoneural capillaries have junctions that are stronger than those of the endothelial cells of vessels in the epineurium and perineurium. Two distinct lymph channels networks are present in the peripheral nerve stems and are separated by the perineural barrier. The nervi-nervorum are special nerves of a sympathetic and sensory nature that arise from the nerve itself and the perivascular plexuses.
-
The laryngeal mask for intubation (MLI), or "Fastrach", is a new device designed by Brain for airway management. The MLI, a modified version of the conventional laryngeal mask, allows for blind intubation through the device using endotracheal tubes up to 8 mm in diameter. ⋯ The MLI has been used with high rates of success in combination with other techniques such as fiberoptic bronchoscopy (success rate 99 to 100%) and transillumination (95 to 100% success rate) in patients whose airways have been considered difficult to manage. Given such high rates of success for MLI placement (95 to 100%) and for blind orotracheal intubation (81 to 100%), the Fastrach may offer an alternative to the conventional laryngeal mask in algorithms for airway management.
-
Rev Esp Anestesiol Reanim · Jun 2000
Review[Failure of obstetric epidural analgesia and its causes].
The frequency of failure to establish and maintain an epidural block is low in Spain for surgery but higher in obstetrics. The reasons are many, but noteworthy factors are the prior experience of the anesthesiologist, the anatomical features of the patient and the type of material used. However, we lack clinical and anatomical studies of the epidural space that would allow us to come to definitive conclusions. ⋯ The anesthesiologist should avoid inserting too much of the epidural catheter and should assure firm support, checking it periodically and taking into account the patient's position. Finally the anesthetic dose should be adjusted to the progress of labor. The risk of incomplete analgesia and the possible need to insert a second epidural catheter must be discussed with the patient during preanesthetic evaluation.
-
Rev Esp Anestesiol Reanim · May 2000
Review Historical Article[Subarachnoid anesthesia: 100 years of an established technique].
Over the 100 years since the introduction of spinal anesthesia into clinical practice, this technique, like most others, has enjoyed varying degrees of popularity. The attraction of spinal anesthesia is easy to identify: a relatively simple technique is used to inject a very small amount of drug into a readily identifiable body compartment to provide deep anesthesia. ⋯ In addition to reviewing the history of spinal anesthesia and the local anesthetics and adjuvant drugs administered by this route, we discuss single-dose and continuous spinal injection, combined spinal-epidural technique, and spinal anesthesia for outpatient settings. The problems typical of dural puncture and placement of local anesthetics and adjuvant drugs into the intrathecal space are also reviewed.
-
Rev Esp Anestesiol Reanim · May 2000
Review[Combined subarachnoid-epidural technique for obstetric analgesia].
Combined spinal-epidural blockade for labor pain has enjoyed increasing popularity in obstetric anesthesia. The usual procedure is to use a single space and a single needle for dural puncture, inserting a spinal needle through an epidural needle followed by insertion of a catheter. A small dose of one or several substances (usually a lipophilic opioid and a local anesthetic) is first injected in the intrathecal space to provide rapid, effective analgesia with minimal muscle blockade. ⋯ The most widely-recognized advantage of the technique is high maternal satisfaction with rapid and effective analgesia. Mobility of the lower extremities is preserved and the mother is often able to walk. Because opioids are injected into the intrathecal space and because the technique is more invasive than standard epidural analgesia, the potential risk to mother and fetus increases.