Articles: nerve-block.
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Comparative Study Clinical Trial Controlled Clinical Trial
Suxamethonium-induced facilitation of spontaneous frontal EMG activity.
The behaviour of spontaneous frontal electromyographic activity (FEMG) was studied during the recovery from suxamethonium and vecuronium block. In order to obtain comparable conditions in the study groups, the duration of the suxamethonium block was prolonged with a suxamethonium infusion. The FEMG was continuously recorded and the evoked electromyographic (EEMG) and twitch tension (ETT) responses were measured every 10 s from the thenar muscles. ⋯ In the suxamethonium group there was an increase in FEMG in all six patients when EEMG had recovered to 10%, and significantly higher FEMG readings were obtained during further recovery from the block. Thus, early recovery of neuromuscular transmission is detected by FEMG more easily when suxamethonium is used instead of vecuronium. The different behaviour of FEMG may reflect a difference in the recovery ratio of ETT/EEMG or in the anaesthetic depth caused by the two types of neuromuscular blockers.
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Relatively few emergency physicians are aware of the spectrum of regional anesthesia and the advantages it has to offer in the day-to-day practice of the specialty. Understanding the types of block and the principles that apply to neural blockade are only a beginning in the appropriate use of blockade techniques. A detailed knowledge of anatomy is essential to successful and safe practice; however, only repeated performance of the blocks will lead to predictable success!
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Randomized Controlled Trial Clinical Trial
Postoperative recovery after general anaesthesia with and without retrobulbar block in retinal detachment surgery.
This study was to determine whether general anaesthesia plus retrobulbar block would be a better anaesthetic technique than general anaesthesia alone in retinal detachment surgery. Twenty-eight patients were allocated randomly to either general anaesthesia with retrobulbar block or general anaesthesia alone. The anaesthetist involved was blinded as to whether a retrobulbar block was performed or not. ⋯ Those who received general anaesthesia plus block recovered significantly more rapidly than those receiving general anaesthesia alone. The time to opening of eyes on command (p less than 0.05), telling the correct date of birth (p less than 0.01), reaching a full recovery score (p less than 0.005) and performing a simple motor task (p less than 0.025) was shorter in patients with general anaesthesia plus block. Thus general anaesthesia plus retrobulbar block was superior to general anaesthesia alone in terms of pain and recovery after operation.
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Comparative Study
Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures.
Twelve thousand regional anaesthetics for cataract extraction and intraocular lens implantation surgery were administered by one anaesthetist over a period of 52 months in a free-standing outpatient surgical facility. The ophthalmologist, who did all the operations, assessed the quality of the blocks using an objective scoring system which is described. The first 3,595 patients had retrobulbar and seventh nerve blocks. ⋯ A final group of 1,061 had a combination of peribulbar and periorbital blocks with added retrobulbar injection if indicated. As the method of blocking evolved, the more closely was the goal of safe, painless and effective regional anaesthesia approached. The requirements for effective anaesthesia of this type are presented, the complications described and the importance of familiarity with the anatomy of the orbit and its contents stressed.