Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Sep 2002
[Tomographic identification of popliteal nerves epineural sheath during foot intermittent regional anesthesia: case report.].
Lower limb regional nervous blocks are common procedures for surgery and postoperative analgesia. This study aimed at describing a rare and casual tomographic image of a catheter in the popliteal fossa, which was originally directed to the sciatic nerve, and of anesthetic solution spread during intermittent analgesia for foot trauma. ⋯ Relevant enhanced tomographic findings of the popliteal region have proven a recent anatomic study on the individualization of the neural sheath involving popliteal nerves with implications in blockade outcome. Anesthesia obtained by a catheter in the popliteal fossa was effective only in the superficial fibular nerve dermatome (medial dorsum of foot and hallux).
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Rev Bras Anestesiol · Sep 2002
[Association of fentanyl or sufentanil an 0.5% isobaric bupivacaine in spinal anesthesia: a comparative study.].
Since the discovery of opioid receptors and the increase in spinal cord neuropharma- cological knowledge as to transmission and inhibition of nociceptive stimulations, there has been an increased interest in spinal drugs for anesthesiology and pain relief. This study aimed at prospectively evaluating the clinical efficacy of fentanyl (25 microg) and sufentanil (5 microg) with isobaric bupivacaine (10 mg), in patients submitted to spinal anesthesia for varicose vein surgery. ⋯ The addition of fentanyl (25 microg) and sufentanil (5 microg) to isobaric bupivacaine (10 mg) in spinal anesthesia affects sensory block levels.
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Dexmedetomidine is the newest alpha2-adrenergic agonist for clinical application. It has a fast onset, is metabolized by the liver and mostly excreted by the urine. This review aimed at presenting pharmacokinetic and pharmacodynamic profiles of dexmedetomidine and its clinical applications. ⋯ Dexmedetomidine is an innovative drug for sedation and analgesia. Its major qualities are fast onset and titration, allowing for changes in sedation and analgesia depth. In addition, it has a synergism with commonly used anesthetic drugs, with a low incidence of side effects and minor respiratory depression.
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Rev Bras Anestesiol · Sep 2002
[Comparison of intravenous and epidural morphine analgesia after thoracotomy.].
Patients undergoing thoracotomy experience severe postoperative pain. This study aimed at evaluating postoperative analgesia with the association of intravenous and epidural morphine as compared to a single route. ⋯ There has been a better analgesic effect with intravenous morphine or the association of intravenous and epidural morphine, with lower drug doses. This difference was significant when lower analgesic doses were used in these groups and represented an effective postoperative analgesic method for thoracotomy, with lower respiratory depression and emetic effects.
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Restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. In theory, the use of non-isobaric local anesthetics may induce unilateral anesthesia and limit sympathetic blockade to one side of the body. The local anesthetic dose and the time patients need to remain in the lateral position for achieving unilateral spinal anesthesia are not known. This prospective study investigated the incidence of unilateral spinal anesthesia following injection through a 27G Quincke needle of 0.15% hypobaric bupivacaine, prepared with 1.5 ml standard isobaric bupivacaine plus fentanyl (25 microg), in patients in the lateral position with the limb to be operated upwards. ⋯ Hypobaric 0.15% bupivacaine (7.5 mg) associated to fentanyl provided a predominantly unilateral block after twenty minutes in the lateral position. Major advantages of unilateral spinal anesthesia were hemodynamic stability, patient satisfaction and the absence of post-dural puncture headache.