Regional anesthesia
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Regional anesthesia · Sep 1990
Biography Historical ArticlePersonal reflections on 50 years of obstetric anesthesia.
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Regional anesthesia · Sep 1990
Anesthesia for cesarean delivery in patients with herpes simplex virus type-2 infections.
Some concerns exist regarding the use of regional anesthesia for patients with active genital herpes simplex virus type-2 (HSV) infections undergoing cesarean delivery. Previous studies have reported the safe use of epidural anesthesia in these patients; there are no reports of the use of spinal anesthesia in this setting. We performed a 6-year retrospective survey of 169 patients delivered by cesarean delivery because of HSV infection. ⋯ One patient who was diagnosed with primary herpes and who received spinal anesthesia had a transient postpartum neurologic deficit; the etiology of this deficit was not clearly related to the anesthetic technique. No patients with secondary infection had septic or neurologic complications related to the anesthetic. Both spinal and epidural anesthesia appear to be safe alternatives for patients with secondary HSV infections undergoing cesarean delivery.
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Regional anesthesia · Sep 1990
Plasma concentrations after high doses of mepivacaine with epinephrine in the combined psoas compartment/sciatic nerve block.
A combination of psoas compartment block and sciatic nerve block was performed with a total dose of 731.5 mg mepivacaine (55 ml, 1.33%) with epinephrine (1:600,000) in patients scheduled for orthopedic surgery on one leg. In 20 patients, arterial blood samples were collected at timed intervals over a 6-hour period to determine the mepivacaine plasma concentration. ⋯ Despite the high dose of mepivacaine, the plasma concentrations stayed below 6.0 micrograms/ml, with one exception, although no clinical signs of local anesthetic toxicity were observed. Plasma pharmacokinetic variables of mepivacaine were as follows: Cmax: 4.22 mg.l-1 (SD, 1.28); Tmax: 0.99 hours (SD, 0.76); T1/2: 3.25 hours (SD, 1.12); CL 0.55 1.hour-1.kg-1.