Articles: nerve-block.
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Patchy analgesia and incomplete motor blockade sometimes occur during surgery of the upper limb under axillary brachial plexus blockade. To avoid these problems, we sought an alternative approach to the brachial plexus to guarantee reliable anaesthesia. Based on anatomic studies, we undertook a prospective clinical study with 175 patients. ⋯ Tolerance of the upper arm tourniquet for even longer periods also demonstrates the effective anaesthesia. Other important advantages include a very rapid onset of complete neural blockade and long-lasting postoperative analgesia. The method had low risks and high acceptance by both patients and anaesthesists.
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This single-injection, peribulbar technique provides a painless and efficacious block without the need for intravenous supplements. One hundred consecutive patients achieved lid akinesia and complete akinesia and anesthesia of the globe by the transconjunctival route. Only 1% needed a supplemental injection, and complications were minor and infrequent.
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Regional anesthesia · May 1995
Case ReportsSelective musculocutaneous nerve block and infraclavicular brachial plexus anesthesia. Case report.
Regional anesthesia of the upper extremity may be achieved by the infraclavicular approach to the brachial plexus. ⋯ Stimulation of the musculocutaneous nerve in the infraclavicular region results in biceps muscle contraction. Inadequate anesthesia of the upper extremity may result due to exiting of the musculocutaneous nerve outside the axillary sheath in this region. Evidence of more distal stimulation (finger/wrist flexion) improves the likelihood of successful block of the brachial plexus by the infraclavicular route.
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Randomized Controlled Trial Clinical Trial Controlled Clinical Trial
[Intubation conditions and circulatory effects 90 seconds after a divided mivacurium dose with three different TIVA induction methods].
The aim of this study was to compare the intubating conditions of a mivacurium-induced neuromuscular block 90 s after a divided administration with three different methods of induction of anaesthesia. ⋯ A dose of mivacurium 3.57 times the ED95 does not produce any haemodynamic instability, if it is divided into two parts to induce a TIVA. After this dose, all patients could be safely intubated within 90 s. A prolongation of the neuromuscular block after higher mivacurium doses could not be seen, and this dose did not produce a more rapid onset of the maximal block in any group. The time for recovery from a mivacurium infusion did not differ among the groups. Etomidate, due to its short half-life, seems not ideal for induction of a TIVA together with mivacurium in the dosage used. Mivacurium meets the demands of good controllability as required for a TIVA and can be recommended for a 90-s injection-intubation interval as well as for maintenance of the neuromuscular block.
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Acta Anaesthesiol Scand · May 1995
Anaesthesia for microvascular surgery in children. A combination of general anaesthesia and axillary plexus block.
Nowadays, microvascular reconstructions are performed with high success rate even in small children. The combination of general anaesthesia and axillary plexus block was used in this prospective study in order to achieve optimal surgical conditions in these challenging operations. Fifteen children under eight years of age (1-8 years) were anaesthetised with a standardised anaesthesia method using a combination of general anaesthesia and axillary plexus block for microvascular toe-to-hand transfer. ⋯ One 1-year-old child developed a moderate hyperthermia of 39.1 degrees C. According to this study axillary plexus block can be combined with general anaesthesia in prolonged microvascular operations. When the effect of general anaesthesia ceased, the plexus block effectively increased peripheral circulation in the operated hand.