Anesthetic techniques

2004 ◽  
pp. 17-28
2013 ◽  
Vol 118 (4) ◽  
pp. 796-808 ◽  
Author(s):  
Pornswan Ngamprasertwong ◽  
Erik C. Michelfelder ◽  
Shahriar Arbabi ◽  
Yun Suk Choi ◽  
Christopher Statile ◽  
...  

Abstract Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal–fetal hemodynamic instability and fetal myocardial depression. The authors’ preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal–fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA. Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded. Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6–21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function. Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model.


2021 ◽  
Vol 46 (7) ◽  
pp. 571-580
Author(s):  
Kariem El-Boghdadly ◽  
Morné Wolmarans ◽  
Angela D Stengel ◽  
Eric Albrecht ◽  
Ki Jinn Chin ◽  
...  

BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuyan Nie ◽  
Weimin Zhou ◽  
Shaoqiang Huang

Abstract Background The preferable choice of anesthesia for the patients with congenital atlantoaxial dislocation (CAAD) and type I Arnold Chiari malformations (ACM-I) has been a very confusing issue in clinical practice. We describe the successful administration of combined spinal-epidural anesthesia for a woman with CAAD and ACM-1 accompanied by syringomyelia. Case presentation Our case report presents the successful management of a challenging obstetric patient with CAAD and ACM-1 accompanied by syringomyelia. She had high risks of difficult airway and aspiration. The injection of bolus drugs through the spinal or epidural needle may worsen the previous neurological complications. The patient was well evaluated with a multidisciplinary technique before surgery and the anesthesia was provided by a skilled anesthesiologist with slow spinal injection. Conclusions An interdisciplinary team approach is needed to weigh risks and benefits for patients with CAAD and ACM-1 undergoing cesarean delivery. Therefore, an individual anesthetic plan should be made basing on the available anesthetic equipments and physicians’ clinical experience on anesthetic techniques.


1994 ◽  
Vol 81 (SUPPLEMENT) ◽  
pp. A65
Author(s):  
R. B. Gorman ◽  
EJ. Norris ◽  
MJ. Breslow ◽  
JA. Grass ◽  
C. Beattie

2021 ◽  
pp. 56-59
Author(s):  
Nupur Vasava ◽  
Chintan Joshi ◽  
Vaishali Parekh

Background: It is important to control the pain associated with root canal treatment (RCT) in endodontic. Pain accompanying fear and anxiety due to endodontic treatment can be reduced by anesthetic techniques. The present study aims to compare the effect of articaine versus lidocaine local anesthesia for inferior alveolar nerve block (IANB) and long buccal nerve block on pain during RCT. METHODS: Twenty patients diagnosed with symptomatic irreversible pulpitis of mandibular posterior tooth were selected. The patients randomly received either cartridge of lidocaine or articaine using IANB and long buccal nerve block. The patients were randomly divided into two groups of ten. Group 1: patients received IANB and long buccal nerve block 2% lidocaine with 1:100000 epinephrine. Group 2: patients received IANB and long buccal nerve block with 4% articaine with 1:100000 epinephrine. Before the Injection, the patient received all information about the visual analysis scale (VAS). Pain was evaluated using VAS scale in numberic value 1 to 10 number. The pain was evaluated at three different stages: before administration of LA, after immediate access opening, and after immediate obturation procedure. Data were analyzed using various suitable statistical tests. RESULT: The mean value of efcacy of pain before administration of local anesthesia (LA) was 8.50 ± 0.97 for lidocaine and 8.30 ± 0.48 for articaine had no signicant difference. A signicant difference was observed at two different duration after immediate access opening and after immediate obturation where articaine has a lower mean value 3.60 ± 1.08 and 1.60 ± 0.17 respectively (P>0.05) as compared to the mean value of lidocaine 4.10 ± 1.10 and 1.60 ± 0.17 respectively Conclusion: Within the limitations of the study, in cases of symptomatic irreversible pulpitis articaine 4% did not alleviate pain much and showed better anesthetic efcacy than 2% lidocaine with IANB and long buccal nerve block.


2021 ◽  
Author(s):  
Sudipta Sen ◽  
Johanna B de Haan ◽  
Grace Guvernator ◽  
Andrzej P Kwater ◽  
Xuan T Langridge ◽  
...  

Aim: Feminizing genital gender affirmation surgery (fgGAS) is increasing in prevalence in the USA. Management of postoperative pain following fgGAS is challenging. We report a series of patients where post-fgGAS pain was adequately controlled with paraspinal blocks. Materials & methods: This is a case series of three patients who received bilateral lumbar and sacral erector spinae plane blocks after fgGAS. Block techniques, medications administered, opioid requirements and pain scores were reviewed. Results: Erector spinae plane blocks provided adequate analgesia for 24–48 h following the block. Conclusion: Currently, there are two regional anesthetic techniques described for the treatment of postoperative pain after fgGAS. We describe two additional approaches as options for improved pain management in this patient population.


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