Revista brasileira de anestesiologia
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Rev Bras Anestesiol · Nov 2002
[Simplified sciatic nerve approach by the posterior route at the median gluteus-femoral sulcus region, with a neurostimulator.].
The sciatic nerve may be blocked by several routes, all of them with advantages and disadvantages. It is the largest human nerve in diameter and length, being the prolongation of the upper sacral plexus fascicle (L4, L5, S2 and S3). It leaves the pelvis through the foramen ischiadicum majus, passing below the piriform muscle and going down between the greater trochanter and the ischial tuberosity, continuing along the femoral dorsum, anterior to biceps femoris and semitendinous muscles, to the lower femoral third, where it is divided in two major branches called tibial and common fibular nerves. It becomes superficial at the lower border of the gluteus maximus muscle. Based on this anatomic description, we developed a posterior approach with the following advantages: easy identification of the surface anatomy, superficial level of the nerve at this location; and less discomfort to patients since a 5 cm needle may be used. ⋯ This new approach is effective and easy. However, it is not indicated when the cutaneous femoris posterior nerve anesthesia is necessary.
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BACKGROUNG AND OBJECTIVES: Double lumen tubes may determine different flow resistances. This disparity may result in non-homogeneous ventilation. This study aimed at comparing the resistive pressure of 37 FR double lumen tubes to distinct flows as compared to conventional adult tracheal tubes. ⋯ Resistive patterns of 37 FR and 7,5 mm tubes were very similar. Any double lumen branch occlusion significantly increases resistance, however in a similar way for both branches for flows below 0.5 L.s-1. These results suggest the use of low inspiratory flow to minimize ventilatory system resistive pressure when any branch of a double-lumen tube is occluded.
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Rev Bras Anestesiol · Nov 2002
[Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report.].
Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias) is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia. ⋯ The use of a patch with colloid solutions, such as dextran 40, is not well established, but there are some successful reports and it is our understanding that its potential should be further investigated.
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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.