Regional anesthesia
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Smooth emergence from general endotracheal anesthesia is frequently complicated by coughing induced by stimulation from an endotracheal tube. Lidocaine and other local anesthetics have been shown to anesthetize important rapidly adpating stretch receptors in the dog trachea. With the aim of providing a reservoir for continuous lidocaine release to adjacent tracheal tissue, we examined the ability of clinically used concentrations of lidocaine to diffuse across a commonly used endotracheal tube cuff. ⋯ The highest concentration obtained was 17.49 +/- 2.03 micrograms/mL after 360 minutes. We conclude lidocaine diffuses across endotracheal tube cuffs in a fashion that may enable the cuff to serve a potentially useful role as a reservoir for local anesthetic. This in turn appears to have the potential to smooth emergence from general endotracheal anesthesia in those patients in whom tracheal stimulation may be a complicating factor.
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Regional anesthesia · Jan 1990
A prospective study on reproducibility of the spread of spinal anesthesia using plain 0.5% bupivacaine.
This prospective study was carried out to determine whether a spinal block with plain 0.5% bupivacaine spreads similarly when repeated in the same patient. During a 14-month period, 50 patients underwent from two to five spinal anesthesias using identical anesthetic technique, including the same premedication, the same volume of injected plain 0.5% bupivacaine, the same site of injection and the same position of the patient. Plain 0.5% bupivacaine was injected with the patient lying in the lateral horizontal position. ⋯ Regression analysis showed that the reproducibility of the maximal analgesic segmental spread of the second anesthesia on the basis of the initial anesthesia was highly significant (p less than 0.0001). The blocking results of the patients who underwent from three to five anesthesias within the study period were in accordance with the spread of the first anesthesia. If a higher or lower spread of anesthesia is desirable, a modification or another local anesthetic for the spinal anesthesia may be preferred.
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Regional anesthesia · Jan 1990
Review Biography Historical ArticleThe Bier block after 80 years: a historical review.
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Regional anesthesia · Jan 1990
Case ReportsAnesthetic management of a parturient with myotonia dystrophica: a case report.
We report the case of a 22-year-old parturient with myotonia dystrophica. She underwent two separate intraabdominal surgical procedures in one day, both under lumbar epidural anaesthesia. Management was directed toward prevention of shivering, a known trigger of myotonic crises. Measures used included warm ambient atmosphere, warmed IV fluids, warming blankets and administration of epidural sufentanil, an opioid recently ascribed as an inhibitor of shivering in parturients.