AANA journal
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Randomized Controlled Trial Comparative Study
Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.
We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure. ⋯ No differences in demographics, block success rate, pain scale scores, and analgesia duration were noted between groups. The ISCM group required less time to complete the block (7.08 +/- 2.9 min) compared with the IS group (9.62 +/- 5.31 min) (P = .039), achieved a significantly higher rate of complete motor and sensory block at 30 minutes (P = .032), and had fewer side effects (P = .049). Based on our results, we found that using the ISCM approach to the brachial plexus resulted in a faster onset of anesthesia and a higher ratio of complete block at 30 minutes compared with the IS approach.
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Review Case Reports
Unintended subdural injection: a complication of epidural anesthesia--a case report.
Epidural anesthesia is practiced in virtually every clinical setting. Its safety and versatility have supported increasing use for more and varied therapies. In a healthy patient in whom near-complete left hemiparesis developed following a routine continuous epidural anesthetic for labor, subdural deposit of the local anesthetic was suspected. The following case and discussion may help illustrate the mechanism behind this complication and how it can be detected, treated, and, possibly, avoided.
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The popularity of regional anesthesia blocks for both intraoperative anesthesia and postoperative pain management supports the inclusion of the administration of regional anesthesia into discussions about operating room (OR) efficiency. This article reviews the literature on OR efficiency with a focus on day-of-surgery decision making. ⋯ Regional anesthetic block placement can affect surgical schedules, and thus OR efficiency. When patient safety is unaffected, rearranging OR schedules on the day of surgery to place regional blocks, meet surgeon requests, or move up incision times should generally not be done if doing so results in otherwise unnecessary increases in overutilized OR time.
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Eisenmenger syndrome is an insidious disease entity. This disease is characterized by an unrepaired congenital heart defect and left-to-right cardiac shunting. After many years of increased blood flow through the pulmonary system as a result of the shunting, damage to the pulmonary vessels occurs, culminating in severe pulmonary hypertension. ⋯ Because of the great strides in medical care, more patients with Eisenmenger syndrome require anesthesia. Maintaining the patient's systemic vascular resistance at the preoperative level is of paramount importance. Choosing the best anesthesia technique is difficult, at best.
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Randomized Controlled Trial
The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron.
Specific risk factors place patients at greater risk for postoperative nausea and vomiting (PONV). Routinely, these patients are treated prophylactically with intravenous (IV) ondansetron or transdermal (TD) scopolamine. No study has examined what effect using a combination of these prophylactic treatments would have on the incidence of PONV in a group of high-risk patients. ⋯ No difference in demographics or the incidence of side effects was noted between groups. Patients in the scopolamine group had a lower incidence of PONV (P = .043), longer time to first reported nausea (P = .044), longer time to first episode of emesis (P = .031), and decreased supplemental antiemetic requirements (P = .016) compared with the placebo group. Based on this study, we recommend using a combination of TD scopolamine and IV ondansetron to prevent PONV in patients identified as high risk for PONV.