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Sample records for anesthesia local

  1. [Local and regional anesthesia].

    Science.gov (United States)

    Meigel, W; Lengen, W

    1988-10-15

    Operations on the cutaneous surfaces are mainly performed under local anesthesia. Local infiltrative anesthesia is the most frequently used form in cutaneous surgery. Nerve or field block anesthesia can be used in areas like the external ear, nose, digits or penis. Local anesthesia is easy to administer, rapidly effective and relatively free of side effects. In contrast to general anesthesia it can be used in risk patients e.g. with ischemic heart disease or respiratory illnesses. Adverse reactions must be taken into account, especially toxic effects, allergy, drug interactions or traumatic lesions of nerves or blood vessels.

  2. Guideline implementation: local anesthesia.

    Science.gov (United States)

    Fencl, Jennifer L

    2015-06-01

    It is not uncommon in perioperative settings for patients to receive local anesthesia for a variety of procedures. It is imperative for patient safety that the perioperative RN has a comprehensive understanding of best practices associated with the use of local anesthesia. The updated AORN "Guideline for care of the patient receiving local anesthesia" provides guidance on perioperative nursing assessments and interventions to safely care for patients receiving local anesthesia. This article focuses on key points of the guideline to help perioperative personnel become knowledgeable regarding best practice as they care for this patient population. The key points address patient assessment, the importance of having an overall understanding of the local agent being used, recommended monitoring requirements, and potential adverse events, including life-threatening events. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  3. Local anesthesia for prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Simpson, Colleen; Roof, James; Arthurs, Sandy; Korssjoen, Tammy; Sutlief, Steven

    1999-01-01

    Purpose: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. Methods and Materials: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). Results: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the

  4. Open hemorrhoidectomy under local anesthesia for symptomatic ...

    African Journals Online (AJOL)

    standard treatment for prolapsed hemorrhoids. The procedure is commonly done under general or regional anesthesia. This study is aimed to assess the feasibility and tolerability of open – hemorrhoidectomy under local anaesthesia in our setting.

  5. Toxicity and allergy to local anesthesia.

    Science.gov (United States)

    Chen, A H

    1998-09-01

    Considering the amount of local anesthetic administered on a daily basis, dental professionals must be familiar with the factors that influence the dose and type of local anesthetic that induces a toxic or allergic reaction. In addition to the route and rate of administration, the patient's physical condition and health may also influence the dose of local anesthetic that could be safely administered. This article reviews the different causes of local anesthesia toxicity and allergy. With prevention and early recognition of the warning signs, poor prognosis can be avoided.

  6. Modern technologies of local injection anesthesia in dental practice

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    Sohov S.Т.

    2013-09-01

    Full Text Available Objective: To assess the importance of using the new system Quick Sleeper for local anesthesia, to highlight benefits of quick and comfortable anesthesia. Material and Methods. The examination of effectiveness, convenience of this kind of anesthesia has been carried out. Results. All patients, taking part in this examination, confirmed more comfortable condition after this anesthesia than conductor and infiltration methods of anesthesia. The effect of anesthesia is better than after conductor anesthesia. Conclusion. This technology guarantees equal introduction and spread of anesthetic, independently of tissue density, eliminating the risk of carpule breakage.

  7. Inguinal hernioraphy under local anesthesia in the elderly patients

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    Nurettin Kahramansoy

    2012-12-01

    Full Text Available Objectives: The incidence of inguinal hernia and the frequencyof comorbidity increase in the elderly. Therefore,in operations of these patients, anesthesia methods areimportant. The aim of our study was to investigate the feasibilityof local anesthesia in the operation of the elderly.Materials and methods: The patients operated for inguinalhernia were analyzed retrospectively. They weredivided into two groups: the elderly (>60 years and theyounger. Anesthesia methods, additional anesthesia requirementand complications were compared.Results: Of totally 177 patients, 30.5% were elderly.Operation type, anesthesia method and score of operationalrisk differed between groups. The percentage of comorbidity (55.6% in the elderly was significantly high (p<0.001. Among elderly, the frequency of co morbidity wasslightly higher in patients who had local anesthesia comparedto spinal and general anesthesia. Patients in youngand middle ages preferred to be operated less under localanesthesia (34.1% compared to elderly (70.4%. Therewas one case (2.6% converted to general anesthesiaas an additional anesthesia in the elderly group. Postoperativecomplications were slight more frequent in elderly.These cases were five in number (31.3% and were operatedunder spinal or general anesthesia (p=0.002.Conclusions: The frequency of co morbidity and riskscore of operation (ASA category rise in the elderly.However, inguinal hernioraphy can be performed underlocal anesthesia without complication and conversion togeneral anesthesia.Key words: Inguinal hernia; aged; comorbidity; local anesthesia

  8. Complications of local anesthesia used in oral and maxillofacial surgery.

    Science.gov (United States)

    Cummings, David R; Yamashita, Dennis-Duke R; McAndrews, James P

    2011-08-01

    Local anesthetics are used routinely in oral and maxillofacial surgery. Local anesthetics are safe and effective drugs but do have risks that practitioners need to be aware of. This article reviews the complications of local anesthesia. A brief history is provided and the regional and systemic complications that can arise from using local anesthesia are discussed. These complications include paresthesia, ocular complications, allergies, toxicity, and methemoglobinemia. Understanding the risks involved with local anesthesia decreases the chances of adverse events occurring and ultimately leads to improved patient care. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia

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    Kenichi Satoh

    2015-01-01

    Full Text Available Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed.

  10. Cholecystectomy with local anesthesia as a resource in the elderly

    International Nuclear Information System (INIS)

    Del Campo Abad, Roberto; Noel Mederos Curbelo, Orestes

    2011-01-01

    In the case of a patient presenting with acute cholescystectomy ideally is to remove the gallbladder. Sometimes there are special situations in malnourished elderlies with deterioration of its general status in whom a lengthy anesthesia intervention, even using not much invasive means as the videosurgery, put at risk the life of patient. In such cases the cholescystectomy with local anesthesia is an alternative that must to be taken into account. (author)

  11. [Patient suitability for cataract surgery under local anesthesia].

    Science.gov (United States)

    Vlajković, Gordana; Sindelić, Radomir; Marjanović, Ivan; Knezević, Miroslav

    2009-01-01

    In the past two decades local anesthesia has emerged as a reliable, safe and cost-effective first choice for cataract surgery in adults. However, the technique is not totally devoid of inherent risks, and requires not only an experienced and well-trained surgeon but also a cooperative patient. Thus, only the patient who is able to communicate, lie still in the supine position, and tolerate their face being covered by a drape is a suitable candidate for local anesthesia. In addition, the preoperative assessment should include particular features of the globe and orbit which may affect the operation as well as a history of allergy to local anesthetics. Finally, it is important to respond to patient preferences and wishes. A careful, patient selection for local anesthesia reduces the risk of surgical cancellation or delay and is essential for patient satisfaction and a successful visual outcome following cataract surgery.

  12. Anesthesia

    Science.gov (United States)

    ... arm or leg. A common type is epidural anesthesia, which is often used during childbirth. General - makes ... afterwards. Sedation can be used with or without anesthesia. The type of anesthesia or sedation you get ...

  13. Effect of a training model in local anesthesia teaching

    NARCIS (Netherlands)

    Brand, H.S.; Baart, J.A.; Maas, N.E.; Bachet, I.

    2010-01-01

    The aim of this study was to evaluate the preclinical use of a training model in local anesthesia teaching on the subsequent clinical administration of a local anesthetic. Sixty-five dental students gave their first injection to a fellow dental student: twenty-two students after previous experience

  14. A randomized trial comparing local intracervical and combined local and paracervical anesthesia in outpatient hysteroscopy.

    Science.gov (United States)

    Al-Sunaidi, Mohammed; Tulandi, Togas

    2007-01-01

    To compare the amount of pain during and after hysteroscopy using local intracervical and combined local and paracervical anesthesia. Prospective randomized trial (Canadian Task Force classification I). University teaching hospital. Eighty-four women who underwent outpatient hysteroscopy for evaluation of the uterine cavity at McGill University Health Center. Randomization to local intracervical or combined local and paracervical anesthesia. Amount of pain experienced during the procedure and at 10, 30, and 60 minutes after the procedure was measured using a visual analog scale ranging from zero to 10 (zero = no pain; 10 = excruciating pain). The mean age of the patients in the local anesthesia group was 36.1 +/- 0.7 years and in the combined local and paracervical anesthesia group was 35.2 +/- 0.7 years. Patients experienced significantly more pain during than after the procedure. The mean pain scores in the local anesthesia group were significantly higher than in the combined anesthesia group during the procedure (3.2 +/- 0.3 vs 2.1 +/- 0.2; p <.01; 95% CI 0-2), 10 minutes after the procedure (1.9 +/- 0.2 vs 1.5 +/- 0.3; p = .03; 95% CI 0-1), and 30 minutes after the procedure (1.7 +/- 0.2 vs 1.0 +/- 0.2; p = .02; 95% CI 0-1). However, there was no significant difference in pain scores at 60 minutes after the procedure between the local anesthesia and combined anesthesia groups (0.9 +/- 0.2 and 0.7 +/- 0.1, respectively). Outpatient hysteroscopy with local or combined local and paracervical anesthesia was well tolerated by patients. However, combined anesthesia was associated with less pain during and at 10 and 30 minutes after the procedure. Most patients considered the pain as mild.

  15. Review of knee arthroscopy performed under local anesthesia

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    Law Billy

    2009-01-01

    Full Text Available Abstract Local anesthesia for knee arthroscopy is a well documented procedure with diagnostic and therapeutic role. Numerous therapeutic procedures including partial menisectomy, meniscus repair, abrasion chondroplasy, synovectomy, loose body removal can be performed safely and comfortably. Appropriate case selection, anesthetic strategy and technical expertise are the key to smooth and successful surgery.

  16. Comparison of Sedation With Local Anesthesia and Regional Anesthesia in Transurethral Resection of Prostate (TURP

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    H Aghamohammadi

    2008-12-01

    Full Text Available ABSTRACT: Introduction & Objective: Transurethral Resection of Prostate (TURP is usually performed under regional or general anesthesia. An alternative to conventional anesthesia is performing of TURP under local anesthetic infiltration with sedation. The aim of this study was to evaluate the efficacy and complication of sedoanalgesia in TURP. Material & Methods: In a prospective clinical trial from September 2006 to December 2007, 60 patients (30 in each group with prostate hypertrophy, candidate for TURP, were randomly assigned into two groups. In the first group, standard spinal anesthesia was done. In the second group, five minutes before the operation, 25 mgs of diazepam plus 25-50 mgs of pethedine was intravenously administered followed by injection of 10 ml lidocaine 2% gel in the urethra and the skin in the suprapubic area was anesthetized with 2 ml of 1% lidocaine. Using a 22 gauge nephrostomy needle, the suprapubic skin was punctured and the needle was directed toward prostate apex and 10-20ml of 1% lidocaine was injected at the serosal aspect of the rectal wall. For dorsal nerve block, 5-10ml of 1% lidocaine was injected at penopubic junction, and then a standard TURP was performed. Patients were switched to another anesthetic technique if the selected technique failed. Severity of pain was assessed by visual analogue scale. Results: The average prostate size was 25 grs (range10-50grs in the local anesthetic group (group 1 and 27.5 grs (range 10-50 grs in the spinal group (group2. In the local anesthetic group, 82.3% had no or mild pain while moderate to severe pain was reported in 16, 7% of the patients. In the group with spinal anesthesia, these were 93.1% and 6.9% respectively. Intolerable pain was observed in 23.3% and 13.8% of groups 1 and 2 respectively (p>0.05. Two patients in spinal group and 5 in local anesthetic group (3 due to severe pain and 2 for unsatisfaction required conversion to general anesthesia or receiving

  17. Outpatient hysteroscopy with combined local intracervical and intrauterine anesthesia.

    Science.gov (United States)

    Agdi, Mohammed; Tulandi, Togas

    2010-01-01

    To evaluate the degree of pain during and after office hysteroscopy with combined intracervical and intrauterine anesthesia compared to intracervical anesthesia only. We evaluated the amount of pain experienced during office hysteroscopy using combined local intracervical and intrauterine anesthesia, 10, 30, and 60 min after, and during endometrial biopsy prospectively in 37 infertile women (study group). We used a visual analog scale ranging from 0 to 10. Seventy-six women who received only intracervical anesthesia served as historical controls. The mean ages of patients in the control and study groups were comparable. Patients' perception of pain was significantly higher during endometrial biopsy than during or after hysteroscopy in the study patients (p < 0.01, 95% CI 0-3). The mean pain score in the control group was significantly higher than that in the study group during hysteroscopy (3.3 +/- 0.2 vs. 2.2 +/- 0.3; p < 0.05, 95% CI 0-2). However, there was no significant difference in the pain scores between the control and study groups during endometrial biopsy and 10, 30, and 60 min after the procedure. Endometrial biopsy is associated with more pain than office hysteroscopy. Additional intrauterine anesthesia with 1% lidocaine significantly reduces pain sensation during office hysteroscopy. Copyright 2009 S. Karger AG, Basel.

  18. Evaluating a dental patient for local anesthesia allergy.

    Science.gov (United States)

    Brown, Ronald S; Paluvoi, Srinagesh; Choksi, Soli; Burgess, Cheryl M; Reece, Elena R

    2002-02-01

    The determination of particular allergens with respect to local anesthetics may present difficulty within the realm of clinical dentistry. A case is presented that dramatizes the difficulties in determining the specific allergen after a patient undergoing several episodes of restorative dentistry with several varying regimens of local anesthesia repeatedly reacted with skin rashes and pruritus approximately 36 hours after treatment. The patient was a 76-year-old man with a complex medical history. A challenge procedure performed with a commercial formulation of local anesthesia resulted in a positive delayed hypersensitivity reaction. An additional challenge procedure with cardiac lidocaine resulted in a negative challenge. A latex-induced delayed-type hypersensitivity reaction was suspected but unproven because the patient declined further allergy testing. Therefore, the conclusion was that the allergen was an unknown substance within the commercial local anesthetic formulation.

  19. An update on local anesthesia for pediatric dental patients

    OpenAIRE

    Peedikayil, Faizal C.; Vijayan, Ajoy

    2013-01-01

    Pain control is an important part of dentistry, particularly in the management of children. Behavior guidance, and dose and technique of administration of the local anesthetic are important considerations in the successful treatment of a pediatric patient. The purpose of the present review is to discuss the relevant data on topics involved, and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

  20. Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia

    DEFF Research Database (Denmark)

    Bertelsen, Claus Anders

    2011-01-01

    The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before.......The use of tumescent local anesthesia in the Bascom cleft-lift procedure has not been described before....

  1. The Thermodynamics of General and Local Anesthesia

    Science.gov (United States)

    Græsbøll, Kaare; Sasse-Middelhoff, Henrike; Heimburg, Thomas

    2014-05-01

    General anesthetics are known to cause depression of the freezing point of transitions in biomembranes. This is a consequence of ideal mixing of the anesthetic drugs in the membrane fluid phase and exclusion from the solid phase. Such a generic law provides physical justification of the famous Meyer-Overton rule. We show here that general anesthetics, barbiturates and local anesthetics all display the same effect on melting transitions. Their effect is reversed by hydrostatic pressure. Thus, the thermodynamic behavior of local anesthetics is very similar to that of general anesthetics. We present a detailed thermodynamic analysis of heat capacity profiles of membranes in the presence of anesthetics. This analysis is able to describe experimentally observed calorimetric profiles and permits prediction of the anesthetic features of arbitrary molecules. In addition, we discuss the thermodynamic origin of the cutoff-effect of long-chain alcohols and the additivity of the effect of general and local anesthetics.

  2. Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty

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    Hüseyin Balkarlı

    Full Text Available Abstract Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8 mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

  3. Guidelines for administration of local anesthesia for dermatosurgery and cosmetic dermatology procedures

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    Mysore Venkataram

    2009-08-01

    Full Text Available Introduction, definition, rationale and scope: Dermatosurgery and Cosmetic dermatology procedures are being performed by increasing number of dermatologists. Most dermatosurgeries are performed in an outpatient setting and as day care surgeries, under local anesthesia. Hence, it is important to improve patient comfort during all procedures. These guidelines seek to lay down directives in the use of local anesthesia, outline the different local anesthetics, the mode of administration, complications arising out of such procedure and management of the same. Facility for administration of local anesthesia: Local anesthesia is usually administered in the dermatologist′s procedure room. The room should be equipped to deal with any emergencies arising from administration of local anesthesia. Qualifications of local anesthesia administrator: Local anesthesia administrator is a person who applies or injects local anesthetic agent for causing analgesia. Procedures done under local anesthesia are classified as Level I office procedures and require the administrator to have completed a course in Basic Cardiac Life Support (BCLS. Evaluation of patients for topical or infiltrative anesthesia: Details of patient′s past medical history and history of medications should be noted. Allergy to any medications should be specifically enquired and documented. Patients for tumescent anesthesia need additional precautions to be observed as described in these guidelines. Methods of administration of local anesthesia: Different methods include topical anesthesia, field block, ring block, local infiltration and nerve block. Also, it includes use of local anesthetics for anesthetizing oral and genital mucosa. Tumescent anesthesia is a special form of local anesthesia used in liposuction and certain selected procedures. Local anesthetic agents: Different local anesthetics are available such as lignocaine, prilocaine, bupivacaine. The dermatologist should be aware of the

  4. MR arthrography of the shoulder: Do we need local anesthesia?

    International Nuclear Information System (INIS)

    Spick, Claudio; Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred

    2014-01-01

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  5. MR arthrography of the shoulder: Do we need local anesthesia?

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio, E-mail: claudio.spick@meduniwien.ac.at [Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna (Austria); Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred [Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz (Austria)

    2014-06-15

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  6. Advances in dental local anesthesia techniques and devices: An update.

    Science.gov (United States)

    Saxena, Payal; Gupta, Saurabh K; Newaskar, Vilas; Chandra, Anil

    2013-01-01

    Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.

  7. ARTHROSCOPIC MENISCUS REPAIR WITH BIOABSORBABLE ARROWS IN LOCAL ANESTHESIA

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    Vladimir Senekovič

    2004-11-01

    Full Text Available Background. The menisci have important function in the knee joint. Because of this it is universally accepted that we have to preserve them as much as possible. After open and partially arthroscopic suture techniques new methods of all-inside meniscus repair with bioabsorbable arrows have been developed in the last decade. The meniscus repair using these arrows represents an easy task for a skilled surgeon. In addition, it can be performed in local anesthesia. We have evaluated the results of the first group of patients who were treated by this method.Methods. From February 2001 to August 2002 15 patients with torn meniscuses have been treated at the Clinical Department for Traumatology, University Medical centre, Ljubljana. We repaired their torn menisci arthroscopically with bioabsorbable arrows in local anesthesia. We divided patients in three groups: a group with isolated meniscus injury, a group with meniscus injury and anterior cruciate ligament injury and a group with associated pathology. Four patients had incarcerated meniscuses. Preoperative Lysholm score in the first group was 38, in the second 42 and in the third group 48. We repaired 12 medial and 3 lateral meniscuses. On average we need 45 minutes for therapeutic arthroscopy. Torn meniscus was fixated with minimum of 1 and maximum of 5 bioabsorbable arrows. All patients except one had the affected knee immobilized with cylinder plaster for 15 days on average.Results. At least three months after the arthroscopic fixation of the torn meniscus in local anesthesia another clinical evaluation was made. In all groups significant improvement was observed regarding the range of motions and absence of pain. Postoperative Lysholm score in the first group was 89, in the second 75 and in the third 71. Average deficit of flexion was 3 degrees while extension was full. One patient complained about the same pain in the joint, he underwent another arthroscopy which showed that the meniscus was

  8. Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

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    Liehua Liu

    2016-01-01

    Full Text Available Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females with osteoporotic vertebral compression fractures with a mean age of 71.4±8.8 years (range: 60 to 89 received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA. Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5±0.7 and 4.3±1.0, respectively, and there was significant difference (P=0.001. In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

  9. Breakdown of local information processing may underlie isoflurane anesthesia effects.

    Science.gov (United States)

    Wollstadt, Patricia; Sellers, Kristin K; Rudelt, Lucas; Priesemann, Viola; Hutt, Axel; Fröhlich, Flavio; Wibral, Michael

    2017-06-01

    The disruption of coupling between brain areas has been suggested as the mechanism underlying loss of consciousness in anesthesia. This hypothesis has been tested previously by measuring the information transfer between brain areas, and by taking reduced information transfer as a proxy for decoupling. Yet, information transfer is a function of the amount of information available in the information source-such that transfer decreases even for unchanged coupling when less source information is available. Therefore, we reconsidered past interpretations of reduced information transfer as a sign of decoupling, and asked whether impaired local information processing leads to a loss of information transfer. An important prediction of this alternative hypothesis is that changes in locally available information (signal entropy) should be at least as pronounced as changes in information transfer. We tested this prediction by recording local field potentials in two ferrets after administration of isoflurane in concentrations of 0.0%, 0.5%, and 1.0%. We found strong decreases in the source entropy under isoflurane in area V1 and the prefrontal cortex (PFC)-as predicted by our alternative hypothesis. The decrease in source entropy was stronger in PFC compared to V1. Information transfer between V1 and PFC was reduced bidirectionally, but with a stronger decrease from PFC to V1. This links the stronger decrease in information transfer to the stronger decrease in source entropy-suggesting reduced source entropy reduces information transfer. This conclusion fits the observation that the synaptic targets of isoflurane are located in local cortical circuits rather than on the synapses formed by interareal axonal projections. Thus, changes in information transfer under isoflurane seem to be a consequence of changes in local processing more than of decoupling between brain areas. We suggest that source entropy changes must be considered whenever interpreting changes in information

  10. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

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    Kyu-Jin Chung

    2012-09-01

    Full Text Available Background Patients have anxiety and fear of complications due to general anesthesia.Through new instruments and local anesthetic drugs, a variety of anesthetic methods havebeen introduced. These methods keep hospital costs down and save time for patients. Inparticular, the target-controlled infusion (TCI system maintains a relatively accurate level ofplasma concentration, so the depth of anesthesia can be adjusted more easily. We conductedthis study to examine whether intravenous anesthesia using the TCI system with propofol andremifentanil would be an effective method of anesthesia in breast augmentation.Methods This study recruited 100 patients who underwent breast augmentation surgeryfrom February to August 2011. Intravenous anesthesia was performed with 10 mg/mLpropofol and 50 μg/mL remifentanil simultaneously administered using two separate modulesof a continuous computer-assisted TCI system. The average target concentration was set at2 μg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinicaleffect and vital signs. Oxygen saturation, electrocardiography, and respiratory status werecontinuously measured during surgery. Blood pressure was measured at 5-minute intervals.Information collected includes total duration of surgery, dose of drugs administered duringsurgery, memory about surgery, and side effects.Results Intraoperatively, there was transient hypotension in two cases and hypoxia in threecases. However, there were no serious complications due to anesthesia such as respiratorydifficulty, deep vein thrombosis, or malignant hypertension, for which an endotrachealintubation or reversal agent would have been needed. All the patients were discharged on theday of surgery and able to ambulate normally.Conclusions Our results indicate that anesthetic methods, where the TCI of propofol andremifentanil is used, might replace general anesthesia with endotracheal intubation in breastaugmentation surgery.

  11. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

    Directory of Open Access Journals (Sweden)

    Kyu-Jin Chung

    2012-09-01

    Full Text Available BackgroundPatients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation.MethodsThis study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects.ResultsIntraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally.ConclusionsOur results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast

  12. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery.

    Science.gov (United States)

    Chung, Kyu-Jin; Cha, Kyu-Ho; Lee, Jun-Ho; Kim, Yong-Ha; Kim, Tae-Gon; Kim, Il-Guk

    2012-09-01

    Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 µg/mL remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 µg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.

  13. Electronic dental anesthesia in a patient with suspected allergy to local anesthetics: report of case.

    Science.gov (United States)

    Malamed, S F; Quinn, C L

    1988-01-01

    A 56-year-old patient with alleged allergy to local anesthetics required restorative dental treatment. Electronic dental anesthesia was used successfully, in lieu of injectable local anesthetics, to manage intraoperative pain associated with the restoration of vital mandibular teeth.

  14. Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Christina Bognet

    2011-12-01

    Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

  15. Serial bronchoscopic lung lavage in pulmonary alveolar proteinosis under local anesthesia

    Directory of Open Access Journals (Sweden)

    K Rennis Davis

    2015-01-01

    Full Text Available Pulmonary alveolar proteinosis (PAP is a rare disease, characterized by alveolar accumulation of surfactant composed of proteins and lipids due to defective surfactant clearance by alveolar macrophages. Mainstay of treatment is whole lung lavage, which requires general anesthesia. Herein, we report a case of primary PAP, successfully treated with serial bronchoscopic lung lavages under local anesthesia.

  16. Guidelines for administration of local anesthesia for dermatosurgery and cosmetic dermatology procedures

    OpenAIRE

    Mysore Venkataram; Nischal K

    2009-01-01

    Introduction, definition, rationale and scope: Dermatosurgery and Cosmetic dermatology procedures are being performed by increasing number of dermatologists. Most dermatosurgeries are performed in an outpatient setting and as day care surgeries, under local anesthesia. Hence, it is important to improve patient comfort during all procedures. These guidelines seek to lay down directives in the use of local anesthesia, outline the different local anesthetics, the mode of administration, complic...

  17. Effect of Hypnosis During Administration of Local Anesthesia in Six- to 16-year-old Children.

    Science.gov (United States)

    Oberoi, Jyoti; Panda, Anup; Garg, Iti

    2016-01-01

    Hypnosis is a tool that can help pediatric dentists allay fear or increase patient cooperation while administering local anesthesia. The purpose of this study was to determine whether hypnosis altered a patient's physical and/or verbal resistance and oxygen saturation or heart rate during administration of local anesthesia. Two hundred six- to 16-year-olds were randomly allocated to either a control group or an experimental group that received hypnotic induction prior to the delivery of local anesthesia. Subjects were monitored for signs of physical or verbal resistance and changes in pulse rate and oxygen saturation at baseline and upon administration of local anesthetic. Children under hypnosis exhibited significantly less resistance to administration of local anesthesia (Phypnosis may increase patient cooperation, decrease resistance during painful procedures, and lead to a lower heart rate.

  18. The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

    NARCIS (Netherlands)

    A.P. Jairam (An); R. Kaufmann (Ruth); F.E. Muysoms (Filip); J. Jeekel (Hans); J.F. Lange (Johan)

    2017-01-01

    markdownabstractBackground: Yearly approximately 4500 umbilical hernias are repaired in The Netherlands, mostly under general anesthesia. The use of local anesthesia has shown several advantages in groin hernia surgery. Local anesthesia might be useful in the treatment of umbilical hernia as well.

  19. Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

    Directory of Open Access Journals (Sweden)

    Al-Khayat Jehad

    2008-04-01

    Full Text Available Abstract Background Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988 can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view. Purpose The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia. Methods 33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS (ranging from 0 = no pain to 10 = maximum pain. Results One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min. The pain score related to injection was 2.5 (0.8 and to tourniquet was 3.6 (0.9. Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred. Conclusion Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.

  20. Articaine: a review of its use for local and regional anesthesia

    Directory of Open Access Journals (Sweden)

    Snoeck M

    2012-06-01

    Full Text Available Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.Keywords: articaine, regional anesthesia, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability, neurotoxicity

  1. Effective local anesthesia for onabotulinumtoxin A injections to treat hyperhidrosis associated with traumatic amputation.

    Science.gov (United States)

    Shi, Lucy L; Sargen, Michael R; Chen, Suephy C; Arbiser, Jack L; Pollack, Brian P

    2016-06-15

    Botulinum toxin type A (BTX-A) injections are an effective treatment for controlling hyperhidrosis at sites of amputation. Hyperesthesia associated with amputated limbs is a major barrier to performing this procedure under local anesthesia. To present a novel method for improving local anesthesia with BTX-A injections. Methods & A 29-year-old military veteran with a below-the-knee amputation of his right leg was suffering from amputation site hyperhidrosis, which was impeding his ability to comfortably wear a prosthesis. Prior to presenting to our clinic, the patient received one treatment of BTX-A injections to his amputation stump while under general anesthesia for surgical repair of trauma-related injuries. In our dermatology clinic, we repeated the procedure using topical lidocaine-prilocaine (30 gm total) for local anesthesia. This provided effective relief of hyperhidrosis for 6 months, but the procedure was very painful (9/10 intensity). We repeated the same procedure 6 months later, using ice in addition to topical lidocaine-prilocaine (30 gm) for local anesthesia; this resulted in reduced pain (3/10 intensity) for the patient. We suggest using ice in combination with a topical anesthetic as an effective method for pain control that avoids general anesthesia in treating amputation-associated hyperhidrosis.

  2. Comparison of two local anesthesia techniques (conventional & akinosi for inferior alveolar dental nerve

    Directory of Open Access Journals (Sweden)

    Refua Y

    2001-09-01

    Full Text Available Different techniques for local anesthesia are used in the mandible. The purpose of this study"nwas to determine the effects of inferior alveolar dental nerve blocks by comparing the two akinosi and"nconventional techniques. 80 patients (aged 15-60 years old were randomly divided into tow groups for"nextracting the mandibuler posterior teeth by akinosi and conventional techniques. Patients were all"ninjected with 1.8 ml of Lidocaine 2% plus Adernaline j^nnnn .Then the Pain Sensation during injection,"npositive aspiration, beginning time of anesthesia, duration of anesthesia depth of anesthesia, and the anesthesia of soft tissue related to sensory nerves were evaluated. The results showed that the pain sensation in conventional technique was significantly higher than that of akinosi technique. The number of positive aspirations in conventional technique (12,5% was higher than that of akinosi (5% but not significantly different. The long buccal nerve anesthesia in akinosi technique (75% was significantly higher than that of conventional technique. There was no significant difference between the two techniques for the depth of anesthesia. The success rate was 87.5% in conventional technique and 80% in akinosi technique. The average time of lips anesthesia in conventional technique was 3 minutes compared with 4 minutes in akinosi technique, which was not significantly different from each other. However, the beginning time of aneshtesia in tongue was significantly lower in conventional technique. No significant difference in the duration of anesthesia in lips and tonques between the two techniques was observed.

  3. Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Krogh, J; Rye, B

    1992-01-01

    Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used...... less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy....... on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly...

  4. Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Krogh, J; Rye, B

    1992-01-01

    Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used...... on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly...... less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy....

  5. Radiofrequency-assisted Liposuction for Arm Contouring: Technique under Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Spero Theodorou, MD

    2013-08-01

    Conclusions: In appropriately selected patients, RFAL arm contouring under local anesthesia represents an alternative procedure with acceptably low morbidity and high patient satisfaction. To achieve consistent results while minimizing complications, consideration to anatomic details, infiltration of the local anesthetic, and application of the radiofrequency energy must be given.

  6. Articaine: a review of its use for local and regional anesthesia

    Science.gov (United States)

    Snoeck, Marc

    2012-01-01

    Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations. PMID:22915899

  7. Dental hygienists' evaluation of local anesthesia education and administration in the United States.

    Science.gov (United States)

    Boynes, Sean G; Zovko, Jayme; Bastin, Meghan R; Grillo, Michele A; Shingledecker, Brianna D

    2011-01-01

    The goal of this project was to investigate the educational experiences and the use of local anesthesia by dental hygiene providers in the U.S. Approved by the Institutional Review Board at the University of Pittsburgh and undertaken from February to May 2009, this study was designed using a questionnaire-based survey. Using a randomized list obtained via the American Dental Hygienists' Association (ADHA), the survey questionnaires were sent via mail to 1,200 dental hygienists in the U.S. Quantitative evaluations were confined to descriptive statistics including standard summation, an estimation of means and a valid percent for identified variables. A total of 432 (n=432) of the 1,200 survey questionnaires were returned, which represents a 36% response rate. The respondents represented a total of 296 dental hygiene educational programs, and included practice sites that span all 50 states. Findings indicate that the majority of responding dental hygienists perceive a need for the use of this pain control modality in their practice and administer local anesthetic injections. Additionally, the majority of respondents that administer local anesthetic injections reported that they perform local anesthetic administration for cases in which the dentist provides total care. Furthermore, the results revealed that the hygienists that received training in the administration of local anesthesia injections reported a higher rate of educational preparedness in 6 of the 7 educational topics listed in this survey: local anesthesia related topics (local anesthesia administration, local anesthetic pharmacology and local anesthetic complications), basic pharmacology, medical emergency management and special needs care. This examination parallels the results presented in previous studies, while offering new data relating to local anesthesia administration by dental hygienists. With the majority of dental hygienists reporting a perceived need and the use of this method of pain control

  8. When local anesthesia becomes universal: Pronounced systemic effects of subcutaneous lidocaine in bullfrogs (Lithobates catesbeianus)

    DEFF Research Database (Denmark)

    Williams, Catherine; Alstrup, Aage Kristian Olsen; Bertelsen, Mads Frost

    2017-01-01

    Sodium channel blockers are commonly injected local anesthetics but are also routinely used for general immersion anesthesia in fish and amphibians. Here we report the effects of subcutaneous injection of lidocaine (5 or 50mgkg-1) in the hind limb of bullfrogs (Lithobates catesbeianus) on reflexes...... regained over 4h. Systemic sedative effects were not coupled to local anti-nociception, as a forceps pinch test at the site of injection provoked movement at the height of the systemic effect (tested at 81±4min). Amphibians are routinely subject to general anesthesia via exposure to sodium channel blockers...

  9. Single-tooth anesthesia: pressure-sensing technology provides innovative advancement in the field of dental local anesthesia.

    Science.gov (United States)

    Hochman, Mark N

    2007-04-01

    This article will review standard techniques for intraligamentary injection and describe the technology and technique behind a new single-tooth anesthesia system. This system and technique represents a technological advancement and a greater understanding of intraligamentary anesthesia.

  10. Lumpectomy and sentinel lymph node navigation surgery for breast cancer under local anesthesia

    International Nuclear Information System (INIS)

    Nakajima, Hiroo; Fujiwara, Ikuya; Mizuta, Naruhiko; Sakaguchi, Koichi; Hachimine, Yasushi; Nakatsukasa, Katsuhiro; Kobayashi, Aya

    2007-01-01

    We studied and analyzed therapeutic outcomes of a radical surgery under local anesthesia for breast cancer in our department. Subjects were 53 patients with breast cancer whose diagnoses were definitely made before surgery. Indications were: localized ductal carcinoma in situ (DCIS) diagnosed preoperatively; invasive carcinoma less than 3 cm in tumor diameter on ultrasound and magnetic resonance imaging scan; and clinically tumors with negative axillary lymph nodes. Operative procedures included microdochectomy or lumpectomy associated with sentinel lymph node navigation biopsy (SLNB). We could perform the operation under local anesthesia in all the 53 patients, and were not demanded to shift from local to general anesthesia. Surgical stumps were positive in 10 patients (18.9%). Of the ten patients, additional resection was performed in one, and irradiation was added to the remaining nine patients. SLNB was performed in a total of 39 patients, six (15.4%) patients of them had metastasis and two out of the six patients underwent additional axillary lymph node dissection. None of serious complications were encountered. Local recurrence and hepatic metastasis occurred in each one patient in an averaged observation period of 15.1 months. This day's radical operation under local anesthesia for breast cancer is a useful procedure as minimally invasive surgery as for the indications employed in this study. (author)

  11. Radiofrequency-assisted Liposuction for Arm Contouring: Technique under Local Anesthesia.

    Science.gov (United States)

    Theodorou, Spero; Chia, Christopher

    2013-08-01

    Contouring of the arms that does not involve skin excision remains a difficult challenge due to the dependent nature and quality of the skin. Although brachioplasty remains effective, it requires a lengthy incision. Radiofrequency-assisted liposuction (RFAL) may improve skin retraction with a satisfactory aesthetic result without skin resection and the resultant scar. The purpose of this study is to present our experience of RFAL arm contouring under local anesthesia, detailing safety guidelines, the marking technique, operative technique, complications, third-party surgeon appraisal, and patient satisfaction survey. Forty patients underwent RFAL under local tumescent anesthesia for aesthetic arm contouring. Postoperative patient satisfaction surveys were conducted and independent third-party surgeons were surveyed to assess improvements in contour and skin quality with preoperative and postoperative photographs. Complications included 1 burn near the elbow treated successfully with local wound care and 1 seroma that resolved with aspiration. The patient survey indicated that most patients had minimal or no discomfort with the injection of local anesthesia, application of radiofrequency energy, or aspiration of fat. The majority of patients were satisfied with their contouring result and degree of skin tightening. Third-party plastic surgeons found the improvement in contouring and degree of skin tightening good to excellent. In appropriately selected patients, RFAL arm contouring under local anesthesia represents an alternative procedure with acceptably low morbidity and high patient satisfaction. To achieve consistent results while minimizing complications, consideration to anatomic details, infiltration of the local anesthetic, and application of the radiofrequency energy must be given.

  12. [Peribulbar anesthesia: efficacy of a single injection with a limited local anesthetic volume].

    Science.gov (United States)

    Clausel, H; Touffet, L; Havaux, M; Lamard, M; Savean, J; Cochener, B; Arvieux, C; Gueret, G

    2008-10-01

    Cataract surgery can be performed with peribulbar anesthesia. The classical technique consists of two injections of local anesthetics. The purpose of our study was to assess peribulbar anesthesia with a single injection and a limited volume of local anesthetics. After local ethics committee agreement and oral consent, patients scheduled for cataract surgery using peribulbar anesthesia were prospectively included. The lower temporal puncture was performed with a peribulbar needle with propofol sedation. The mixture of local anesthetics was administered with tactile control of orbital pressure. The puncture was followed by a 10-min compression of the ocular globe. Akinesia, analgesia, complications, and surgical conditions were noted. A total of 101 successive patients were included. We administered 1.2 mg/kg of propofol. The volume of local anesthetics administered was 5.0 +/- 0.9 ml. Ninety patients had akinesia at 10 min and 6.7% moderate chemosis. No puncture complication occurred. At the end of surgery, the pain noted by the patients was 0.4 +/- 2.1 out of 100 (range, 0-10). Surgical conditions were good for all patients. Peribulbar anesthesia performed with a single injection and a limited volume of local anesthetics allows cataract surgery in good conditions for the surgeon with very good analgesia for the patient.

  13. Ocular blood flow alterations during inferior turbinate radiofrequency reduction under local anesthesia.

    Science.gov (United States)

    Doğan, Sedat; Şimşek, Ali; Bayraktar, Cem; Yazıcı, Haşmet; Sarıkaya, Yasin; Karataş, Mehmet; Karadağ, Ayşe Sevgi; Çapkın, Musa

    2016-09-14

    Ocular blood flow alterations and blindness are uncommon and less-known adverse effects of nasal local anesthetic infiltrations. Our aim was to investigate ocular blood flow alterations during radiofrequency (RF) tissue reduction of inferior turbinates with the patient under local anesthesia by using a noninvasive method with optical coherence tomography. A total of 120 patients with inferior turbinate hypertrophy were prospectively randomized into two groups. In group 1, a total of 61 patients underwent RF tissue reduction while under local anesthesia with epinephrine. In group 2, a total of 59 patients underwent RF tissue reduction of inferior turbinates while under local anesthesia without epinephrine. Optical coherence tomography measurements were performed before surgery and at 5, 15, 30, 45, and 60 minutes after local anesthetic infiltration. Choroid thickness measurements decreased gradually after local anesthetic infiltration until 30 minutes and increased to the same plane with the baseline at 60 minutes in group 1 (p local anesthetic infiltration at 15 and 45 minutes (p local anesthetic with epinephrine infiltration into inferior turbinates. Otolaryngologists should be careful after local anesthetic infiltration, and monitor the vision. Further studies with larger series would be needed to discuss safety of local anesthetics.

  14. Intraperitoneal instillation of saline and local anesthesia for prevention of shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Bjerrum, Flemming; Gögenür, Ismayil

    2013-01-01

    instillation (IPI) of saline and local anesthesia (LA) to minimize SP. METHODS: A search of the literature was conducted using PubMed and Excerpta Medica Database (EMBASE). Eligibility criteria were: randomized clinical trials (RCT) evaluating IPI of saline and/or LA to minimize incidence or severity of SP...

  15. Using Mixed-Reality Technology to Teach Techniques for Administering Local Anesthesia

    Science.gov (United States)

    Hanson, Kami M.

    2011-01-01

    The ability to perform local anesthesia on dental patients is an important clinical skill for a dental hygienist. When learning this procedure in an academic situation, students often practice on their peers to build their skills. There are multiple reasons why the peer practice is not ideal; consequently, educators have sought the means to…

  16. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median...... anesthetic techniques with an acceptable rate of satisfaction, but intraoperative pain relief needs improvement. IMPLICATIONS: Inguinal hernia repair can be safely performed under unmonitored local anesthesia with infrequent postoperative morbidity and acceptable satisfaction, but intraoperative pain may...

  17. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    2001-01-01

    To evaluate the feasibility and safety of unmonitored local anesthesia (ULA) for elective open inguinal hernia repair, we made a prospective, consecutive data collection from 1000 operations on primary and recurrent hernias. Follow-up consisted of a questionnaire 1 mo after surgery and retrieval...... from the electronic patient data management system. In 921 ASA Group I and II and 79 ASA Group III and IV patients, the median age was 60 yr (range, 18-95 yr). ULA was converted to general anesthesia in 5 of 1000 cases, and 961 patients were discharged on the day of surgery after 95 min (median...... anesthesia, day-case setup, or both, primarily because of intraoperative pain (n = 74; 7.8%). We conclude that open inguinal hernia repair can be conducted under ULA, regardless of comorbidity, with a small rate of deviation from day-case setup and minimal morbidity. It provides a safe alternative to other...

  18. Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia

    Directory of Open Access Journals (Sweden)

    Robert A. Goldberg

    2014-01-01

    Full Text Available To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females underwent tumor removal through eyelid crease (17 eyes, conjunctival (nine eyes, lateral canthal (two eyes, and transcaruncular (two eyes approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range age and follow-up duration were 48.5 (31–87 years old and 24.5 (4–375 weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases, pleomorphic adenoma (5 cases, solitary fibrous tumor (4 cases, neurofibroma (2 cases, schwannoma (2 cases, and orbital varix (1 case. None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.

  19. Evaluation of surgical treatment of carpal tunnel syndrome using local anesthesia

    Directory of Open Access Journals (Sweden)

    Marco Felipe Francisco Honorato Barros

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the results and complications from surgical treatment of carpal tunnel syndrome by means of an open route, using a local anesthesia technique comprising use of a solution of lidocaine, epinephrine and sodium bicarbonate. MATERIAL AND METHODS: This was a cohort study conducted through evaluating the medical files of 16 patients who underwent open surgery to treat carpal tunnel syndrome, with use of local anesthesia consisting of 20 mL of 1% lidocaine, adrenaline at 1:100,000 and 2 mL of sodium bicarbonate. The DASH scores before the operation and six months after the operation were evaluated. Comparisons were made regarding the intensity of pain at the time of applying the anesthetic and during the surgical procedure, and in relation to other types of procedure. RESULTS: The DASH score improved from 65.17 to 16.53 six months after the operation (p < 0.01. In relation to the anesthesia, 75% of the patients reported that this technique was better than or the same as venous puncture and 81% reported that it was better than a dental procedure. Intraoperative pain occurred in two cases. There were no occurrences of ischemia. CONCLUSION: Use of local anesthesia for surgically treating carpal tunnel syndrome is effective for performing the procedure and for the final result.

  20. [Intravenous regional anesthesia with long-acting local anesthetics. An update].

    Science.gov (United States)

    Atanassoff, P G; Lobato, A; Aguilar, J L

    2014-02-01

    Intravenous regional anesthesia is a widely used technique for brief surgical interventions, primarily on the upper limbs and less frequently, on the lower limbs. It began being used at the beginning of the 20th century, when Bier injected procaine as a local anesthetic. The technique to accomplish anesthesia has not changed much since then, although different drugs, particularly long-acting local anesthetics, such as ropivacaine and levobupivacaine in low concentrations, were introduced. Additionally, drugs like opioids, muscle relaxants, paracetamol, neostigmine, magnesium, ketamine, clonidine, and ketorolac, have all been investigated as adjuncts to intravenous regional anesthesia, and were found to be fairly useful in terms of an increased onset of operative anesthesia and longer lasting perioperative analgesia. The present article provides an overview of current knowledge with emphasis on long-acting local anesthetic drugs. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  1. A novel distraction technique for pain management during local anesthesia administration in pediatric patients.

    Science.gov (United States)

    Kamath, Punitha S

    2013-01-01

    The aim of this study was to assess the effect of an active and novel distraction technique WITAUL (Writing In The Air Using Leg) on the pain behavior observed and reported by children receiving local anesthesia injections prior to dental treatment. The study was conducted on 160 children (80 in control and 80 in intervention group) between the ages of 4- 10 years. During the administration of anesthesia the children in the control group were made to relax by means of deep breathing and those in the intervention group were taught to use the WITAUL distraction technique. the behavior of the children aged 4- 5 years was noted using the Modified Toddler- Preschooler Post operative Pain Scale (TPPPS) and that of children aged above 6 years was measured using the FACES Pain Scale-Revised (FPS-R). The use of WITAUL was found to be statistically significant (p value managing pain during local anesthesia administration. The mean Modified TPPPS scores (4- 5 year olds) for the WITAL group was 2.46 +/- 1.752 and that of the control was 5.64 +/- 2.328. The mean FPS-R scores (6 - 10 year olds) for the WITAUL group was 3 +/- 1.748 and that of the control group was 6.26 +/- 1.858. The WITAUL technique therefore appears to be a simple and effective method of distraction during local anesthesia administration in pediatric patients.

  2. [Iontophoresis - local anesthesia at the ear canal and tympanic membrane (author's transl)].

    Science.gov (United States)

    Tolsdorff, P

    1980-02-01

    Operations to the external ear canal and tympanic membrane necessitate sufficient local anesthesia. General sedation followed by infiltration anestesia, is rather time-consumming, can be painful due to the injection, and is not particularly satisfactory for the treatment of outpatients. The iontophorese-technique, however, of local anesthesia, is applicable particularly for the treatment of outpatients. Principally, the local anesthetic is transported in ionisised form to the nerve membrane, by means of calvanic currents through the healthy surface epithelial tissue of the external ear canal or the eardrum. The technique described for the first time in 1911 no longer shows toxic sides-effects since the introduction of improved electrodes and more modern local anesthetic. The anatomic, pharmacological, chemical and physical basics of the technique will be described. The lecture will be based on personal experience of the method, taken from large groups of patients over a period of more than two years, using equipment specially designed for this purpose.

  3. Evaluation of blood glucose in type II diabetic patients submitted to local anesthesia with different vasoconstrictors

    OpenAIRE

    MELLO, Renan Pollettini de; RAMACCIATO, Juliana Cama; PERUZZO, Daiane Cristine; VICENTINI, Carllini Barroso; BERGAMASCHI, Cristiane de Cássia; MOTTA, Rogério Heládio Lopes

    2016-01-01

    ABSTRACT Objective: In the dental clinic, the use of local anesthetics containing vasoconstrictors in diabetic patients are still controversial raising some doubts. Thus, the objective of this randomized crossover clinical trial was to evaluate blood glucose, pulse oximetry and heart rate of type 2 diabetic patients when submitted to local anesthesia using prilocaine 3% associated to felypressin 0,03UI / ml (G1) and 2% lidocaine associated to epinephrine 1: 100,000 (G2). Methods: The sample...

  4. Ultrasound-guided multilevel paravertebral block versus local anesthesia for medical thoracoscopy

    Directory of Open Access Journals (Sweden)

    Maha A Abo-Zeid

    2017-01-01

    Conclusion: Unilateral 3-level TPVB was superior to 2-level TPVB and LA infiltration for anesthetic adequacy for patients undergoing medical thoracoscopy. Moreover, US-guided TPVB was followed by higher FEV1 values and lower pain scores during the next 12 h postthoracoscopy in comparison to local infiltration, so 3-level TPVB is an effective and relatively safe anesthetic technique for adult patients undergoing medical thoracoscopy which may replace local anesthesia.

  5. Local Anesthesia for Surgical Procedures of the Upper Eyelid Using Filling Cannula: Our Technique

    Directory of Open Access Journals (Sweden)

    Maria Trapasso, MD

    2014-05-01

    Full Text Available Summary: Sometimes, after local anesthetic injection for surgical procedures of the upper eyelid, it is possible to observe superficial preseptal hematomas or excessive lid swelling that may distort the tissues and obscure surgical landmarks. We present a technique to perform local anesthesia of the upper eyelids, using a 27-gauge needle and a 26-gauge filling cannula, that may decrease the incidence of hematomas and bruising.

  6. Simplified local anesthesia technique for external dacryocystorhinostomy without nasal packing: a new technique and pilot study outcome

    Directory of Open Access Journals (Sweden)

    Tawfik HA

    2013-11-01

    Full Text Available Hatem A Tawfik,1 Osama R Youssef21Department of Ophthalmology, 2Department of Anesthesiology, Ain Shams University, Cairo, EgyptBackground: The purpose of this paper is to describe a simplified local anesthesia technique for external dacryocystorhinostomy (EXT-DCR.Methods: In this pilot, retrospective, noncomparative, interventional case series, 448 patients (480 eyes underwent EXT-DCR using a simplified local anesthesia technique. Nasal mucosal anesthesia was achieved using combined application of 6 mL of oxymetazoline 0.025% nasal spray and lidocaine 1% in the same spray bottle, without any packing of the nose with either pledgets or ribbon gauze. Local infiltration anesthesia consisted of subcutaneous injection of a 7 mL mixture of 2% lidocaine with 1:100,000 epinephrine injected on the flat side of the nose beneath the incision site, in addition to a second medial peribulbar injection (3 mL, 2% lidocaine without epinephrine.Results: Successful unilateral or bilateral EXT-DCR was achieved in 432/448 patients (96.4%. Four patients could not tolerate the procedure under local anesthesia and were converted to general anesthesia. Four patients required additional local anesthetic injections because of intolerable pain. Heavy sedation was essential in eight uncooperative patients because surgical manipulation was impossible. The remaining patients tolerated the procedure well. The intraoperative bleeding rate was very low except in one patient. Mean operative time was 16 minutes. Severe postoperative epistaxis was observed in four patients. Temporary anosmia developed in one patient.Conclusion: Our simplified local anesthesia approach of EXT-DCR is convenient for the patient because it avoids unnecessary nasal packing. It is also safe and effective, as evidenced by the high rate of successful completion of the procedure without conversion to general anesthesia or the need for supplemental local anesthesia.Keywords: local anesthesia, external

  7. An endoscopic method for identifying sex of hatchling Chinese box turtles and comparison of general versus local anesthesia for coelioscopy.

    Science.gov (United States)

    Hernandez-Divers, Stephen J; Stahl, Scott J; Farrell, Raymond

    2009-03-15

    To establish a safe and effective endoscopic method for visualizing the gonads and identifying the sex of hatchling Chinese box turtles and to compare the effects of general versus local anesthesia during coelioscopy. Clinical trial. 58 hatchling Chinese box turtles (Cuora flavomarginata). Turtles were randomly assigned to be anesthetized with a mixture of ketamine, medetomidine, and morphine (n = 29) or to receive local anesthesia with lidocaine in the prefemoral region (29). Coelioscopy was performed with a rigid 1.9- or 2.7-mm telescope following insufflation with sterile lactated Ringer's solution. Ease of endoscopic sex identification and quality of anesthesia were scored. Body weights were recorded before and 7 and 14 days after surgery. Gonads were easily visualized and sex was easily identified in all 58 turtles without complications. Endoscopy scores and pre- and postoperative weights did not differ significantly between groups. However, anesthesia scores were significantly worse for animals that received local anesthesia alone, compared with those that underwent general anesthesia. All anesthetized turtles recovered within 21 minutes after administration of the reversal agents, atipamezole and naloxone. Results suggested that coelioscopy with a rigid endoscope and lactated Ringer's solution for insufflation was a safe and effective method for identifying the sex of hatchling Chinese box turtles. General anesthesia was effective and effects were rapidly reversible; local anesthesia with lidocaine alone was considered insufficient for coelioscopy.

  8. [Neonatal circumcision with local anesthesia. Results of a standardized protocol].

    Science.gov (United States)

    Ovalle, Alejandra; López, Pedro-Jose; Guelfand, Miguel; Zubieta, Ricardo

    2016-01-01

    Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. The protocol was applied to 108 patients over a 9year period. The mean age at procedure was 9days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Inguinal hernia repair with tension-free hernioplasty under local anesthesia

    International Nuclear Information System (INIS)

    Gao, Jia-Sen; Wang, Zhen-Jun; Zhao, Bo; Ma Song Zhang; Pang, Guo-Yi; Na, Dong-Ming; Zhang Yu-Dong

    2009-01-01

    To evaluate the use of local anesthesia in tension-free hernioplasty in a local hospital. The study took place at Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China during the period from January 2007 to May 2008. All 110 patients who had undergone inguinal hernia repair with mesh under local anesthesia were included in the study. To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, non-elective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. We performed a retrospective review of all 110 patients' data. The average operating time was 45 minutes (30-70 minutes), and the average hospital stay was 3-4 days. There was no postoperative mortality in this study. No surgical site infection occurred. Two patients (18%) that suffered from a moderate scrotal hematoma had recovered after extract injection therapy was applied. The duration of incisional pain was 2-3 days, and no patient required post-operative analgesia. During the follow-up, no recurrence occurred. The use of local anesthesia in inguinal hernia repair with tension-free hernioplasty is a safe and effective alternative for inpatient treatment. (aothor)

  10. Colateral effects of local anesthesia with vasoconstritors in bovine

    OpenAIRE

    Soares, P.C.; Costa, N.A.

    2000-01-01

    In order to study the effects of different local anaesthetics with and without vasoconstritor (epinefrine), 20 adult crossbred cows were used. The following treatments were carried out:T1 - control (bidistilled water); T2 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.005 mg/ml); T3 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.02 mg/ml); T4 - chloridrate of lidocaine (20 mg/ml) with epinephrine (0.05 mg/ml); T5 - chloridrate of lidocaine(20 mg/ml); T6 - chloridrate of ...

  11. Topical local anesthesia: focus on lidocaine–tetracaine combination

    Directory of Open Access Journals (Sweden)

    Giordano D

    2015-11-01

    Full Text Available Davide Giordano,1 Maria Gabriella Raso,2 Carmine Pernice,1 Vanni Agnoletti,3 Verter Barbieri1 1Otorhinolaryngology Unit, Department of Surgery, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, 2Anesthesiology, Intensive Care, and Pain Medicine Unit, Department of Surgical Sciences, University Hospital of Parma, Parma, 3Anesthesiology and Intensive Care Unit, Department of Cardiology, Thoracic and Vascular Surgery, and Critical Care Medicine, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: In recent years, the popularity of aesthetic and cosmetic procedures, often performed in outpatient settings, has strongly renewed interest in topical anesthetics. A number of different options are widely used, alone or in combination, in order to minimize the pain related to surgery. Moreover, interest in local anesthetics in the treatment of some painful degenerative conditions such as myofascial trigger point pain, shoulder impingement syndrome, or patellar tendinopathy is increasing. Numerous clinical trials have shown that lidocaine–tetracaine combination, recently approved for adults aged 18 or older, is effective and safe in managing pain. The present paper gives an overview of the recent literature regarding the efficacy and safety of lidocaine–tetracaine combination use. Keywords: lidocaine, tetracaine, local anesthetics, efficacy, safety

  12. Simplified Surgical Placement of Tenckhoff Catheter under Local Anesthesia: The Dammam Central Hospital Experience

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    Youmbissi T

    2001-01-01

    Full Text Available Many methods are used for the placement of Tenckhoff catheters. Eighteen consecutive Tenckhoff catheters were placed under local anesthesia through a mini laparotomy with a reduced operating team. There were only three total catheter failures. Complications were infrequent and operating time was less than one hour on average. This simple procedure should be a part of the training program of all junior surgeons and nephrologists.

  13. Inferior oblique muscle injury from local anesthesia for cataract surgery.

    Science.gov (United States)

    Hunter, D G; Lam, G C; Guyton, D L

    1995-03-01

    Vertical rectus muscle injury is commonly cited as a cause of strabismus after cataract surgery. Injury to the inferior oblique muscle or nerve as a complication of cataract surgery has not been described previously. Four patients without pre-existing strabismus who had diplopia after cataract surgery were studied. Analysis included prism and cover testing, Lancaster red-green testing, and fundus torsion assessment. Three patients had a delayed-onset hypertropia with fundus extorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle overaction secondary to presumed contracture. The fourth patient had an immediate-onset hypotropia with fundus intorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle paresis. Damage to a vertical rectus muscle or "unmasking" of a pre-existing superior oblique muscle paresis could not explain the history and findings in this group of four patients. The inferior oblique muscle contracture observed in three patients may have been caused by local anesthetic myotoxicity, whereas the paresis observed in one patient may have been due to mechanical trauma or anesthetic toxicity directly to the nerve innervating the muscle. Inferior oblique muscle or nerve injury should be considered as another possible cause of postoperative strabismus, especially when significant fundus torsion accompanies a vertical deviation.

  14. Repair of Adult Hypospadias Under Local Anesthesia: The Technique and Outcomes

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    Mehmet Kalkan

    2014-03-01

    Full Text Available Aim: In this study, we evaluated the outcomes of a hypospadias repair technique using local anesthesia in adult patients with distal hypospadias. Material and Method: Hypospadias repair was performed under local anesthesia in 24 cases of circumcised males from 2000%u20132010. The type of hypospadias was coronal in 11 cases and subcoronal in 13 cases. Tubularised incised-plate urethroplasty method was used in all of the patients. Subcutaneous prilocaine hydrochloride was administered into the root of the penis and 12.5 g of a gel containing 2% lidocaine was administered into the urethra as an anesthetic agent. The patients%u2019 pain levels were assessed using the Visual Analogue Scale (VAS. Patients were evaluated in terms of pain level, duration of the operation, and early and late complications. Results: All patients easily tolerated the operation, with a mean postoperative VAS pain assessment of 2.04 (0-4. The duration of the operation ranged between 16 and 35 min. One of the patients developed syncope during the operation. Urethral fistula was seen in three patients. No incidence of meatal stenosis or poor cosmetic appearance was observed. Discussion: Hypospadias repair under local anesthesia was demonstrated to be safely practicable with an acceptable degree of postsurgical pain in adult patients with distal hypospadias.

  15. Applicability and Effectiveness of Closed Reduction of Nasal Fractures under Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Vilela, Fernando

    2014-03-01

    Full Text Available Introduction A significant portion of patients treated in emergency departments have nasal fracture. It is important that the otolaryngologist know how to treat such damage. Objectives To evaluate the effectiveness of nasal fracture reduction under local anesthesia and tolerance to the procedure. Methods Twenty-four patients treated in the emergency department with closed reduction under local anesthesia were prospectively followed. Epidemiologic information and data regarding pain and complications during the management were noted. The degree of satisfaction was researched by visual analog scale. Results The majority of patients were male (75%, and the most common cause of injury was motor vehicle accident. We found a significant association between time to reduction and referred pain during the procedure. In patients in whom the procedure was delayed (over 3 days, there was less pain, and those who bled during the procedure had a shorter average time to reduction than the group of patients who did not bleed. Most patients were very satisfied, with more than 95% of these willing to undergo the same process again, if necessary. Conclusions The closed approach in the clinic under local anesthesia was effective and safe in restoration of the nose.

  16. Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia

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    Jafar Rafiei Kiasari

    2012-08-01

    Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.

  17. Effects of opioids on local anesthesia in the rat: a codeine and tramadol study

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    Talita Girio Carnaval

    2013-12-01

    Full Text Available Opioids are central analgesics that act on the CNS (central nervous system and PNS (peripheral nervous system. We investigated the effects of codeine (COD and tramadol (TRAM on local anesthesia of the sciatic nerve. Eighty Wistar male rats received the following SC injections in the popliteal fossa: local anesthetic with epinephrine (LA; local anesthetic without vasoconstrictor (LA WV; COD; TRAM; LA + COD; LA + TRAM; COD 20 minutes prior to LA (COD 20' + LA or TRAM 20 minutes prior to LA (TRAM 20' + LA. As a nociceptive function, the blockade was considered the absence of a paw withdraw reflex. As a motor function, it was the absence of claudication. As a proprioceptive function, it was the absence of hopping and tactile responses. All data were compared using repeated-measures analysis of variance (ANOVA. Opioids showed a significant increase in the level of anesthesia, and the blockade duration of LA + COD was greater than that of the remaining groups (p < 0.05. The associated use of opioids improved anesthesia efficacy. This could lead to a new perspective in controlling dental pain.

  18. Hyperparathyroidism in octogenarians: A plea for ambulatory minimally invasive surgery under local anesthesia.

    Science.gov (United States)

    Fui, Stéphanie Li Sun; Bonnichon, Philippe; Bonni, Nicolas; Delbot, Thierry; André, Jean Pascal; Pion-Graff, Joëlle; Berrod, Jean-Louis; Fontaine, Marine; Brunaud, Catherine; Cocagne, Nicolas

    2016-10-01

    With the current aging of the world's population, diagnosis of primary hyperparathyroidism is being reported in increasingly older patients, with the associated functional symptomatology exacerbating the vicissitudes of age. This retrospective study was designed to establish functional improvements in older patients following parathyroid adenomectomy under local anesthesia as outpatient surgery. Data were collected from 53 patients aged 80 years or older who underwent a minimally invasive parathyroid adenomectomy. All patients underwent a preoperative ultrasound, scintigraphy, and were monitored for the effectiveness of the procedure according to intra- and postdosage of parathyroid hormone (PTH) at 5min, 2h and 4h. Mean preoperative serum calcium level was 2.8mmol/L (112mg/L) and mean PTH was 180pg/ml. Thirty-eight patients were operated under local anesthesia using minimally invasive surgery and 18 patients were operated under general anesthesia. In 26 cases, the procedure was planned on an outpatient basis but could only be carried out in 21 patients. Fifty-one patients had normal serum calcium and PTH levels during the immediate postoperative period. Two patients were reoperated under general anesthesia, since immediate postoperative PTH did not return to normal. Four patients died due to reasons unrelated to hyperparathyroidism. Five patients were lost to follow-up six months to two years postsurgery. Of the 44 patients (83%) with long-term monitoring for PTH, none had recurrence of biological hyperparathyroidism. Excluding the three asymptomatic patients, 38 of the 41 symptomatic patients (93%) with long-term follow-up were considering themselves as "improved" or "strongly improved" after the intervention, notably with respect to fatigue, muscle and bone pain. Two patients (4.9%) reported no difference and one patient (2.4%) said her condition had worsened and regretted having undergone surgery. In patients 80 years or older, minimally invasive surgery as an

  19. Children′s behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ali Bagherian

    2016-01-01

    Conclusion: It may be concluded that the cotton-roll vibration method can be more helpful than the routine topical anesthesia in reducing behavioral pain reactions in children during local anesthesia administration.

  20. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial.

    Science.gov (United States)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels; Johnsen, Søren P; Yoo, Albert J; Andersen, Grethe; Rasmussen, Mads

    2016-12-01

    Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether the choice of anesthetic regime during endovascular therapy for acute ischemic stroke influence patient outcome. Our hypothesis is that that conscious sedation is associated with less infarct growth and better functional outcome. GOLIATH is an investigator-initiated, single-center, randomized study. Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging). Secondary outcomes include 90-day modified Rankin Scale score, time parameters, blood pressure variables, use of vasopressors, procedural and anesthetic complications, success of revascularization, radiation dose, and amount of contrast media. Choice of anesthesia may influence outcome in acute ischemic stroke patients undergoing endovascular therapy. The results from this study may guide future decisions regarding the optimal anesthetic regime for endovascular therapy. In addition, this study may provide preliminary data for a multicenter randomized trial. © 2016 World Stroke Organization.

  1. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    OpenAIRE

    Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Ant?, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the...

  2. A questionnaire study regarding local anesthesia in dentistry and safety measures in dental clinics among dental students

    OpenAIRE

    オオケ, ハナコ; クドウ, マサル; シンヤ, ノボル; Hanako, OHKE; Masaru, KUDO; Noboru, SHINYA

    2005-01-01

    This reports the results of a questionnaire study of dental students on the awareness of "local anesthesia" and "use of patient monitoring systems" in dental clinics. Subjects participated in the present study included 96 sixth year dental students (D6) and 93 first year dental students (D1). The results indicate that the majority of respondents including both D6 and D1 support the notion that a "dentist" is the most suitable person to perform local anesthesia in dental treatment. With respec...

  3. Local vaginal anesthesia during high-dose-rate intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Chen, H.-C.; Wan Leung, Stephen; Wang, C.-J.; Sun, L.-M.; Fang, F.-M.; Huang, E.-Y.; Wang, S.-J.; Yang, C.-W.

    1998-01-01

    Purpose: To evaluate the clinical efficacy of local vaginal lidocaine application for pain relief during high-dose-rate (HDR) intracavitary brachytherapy for patients with cervical cancer, and to investigate sequential changes in serum levels of lidocaine during the procedures. Methods and Materials: This prospective study was designed to examine the analgesic effect, physical response, and side effects of local anesthesia during HDR intracavitary brachytherapy. Forty patients were enrolled. All patients received 10-15 MV X-rays to the pelvis with a total dose of 45-59.4 Gy 5-6 weeks before undergoing HDR intracavitary brachytherapy. All patients underwent first intracavitary brachytherapy under general anesthesia. These patients were randomly allocated to receive one of two different treatment protocols as follows: (1) treatment session - control session - treatment session - control session; or (2) control session - treatment session- control session - treatment session. In the treatment sessions, topical anesthesia was administered using 4 ml of 10% lidocaine solution sprayed liberally on the cervix and vagina during intracavitary brachytherapy. In the control sessions, a placebo was administered in the same manner during brachytherapy. The Hensche's applicators for brachytherapy were inserted into the cervix and vagina 5 min after lidocaine application. The visual analogue scale (VAS) was used to assess pain and discomfort during brachytherapy. Blood pressure and heart rates were measured to evaluate the physiological response. Another prospective study was then performed to investigate the sequential changes of serum lidocaine levels during the anesthetic procedure. Eleven additional patients with similar disease state and demographic characteristics were enrolled and blood samples were obtained before, and 5, 15, 30, and 45 min after the initiation of lidocaine application. Results: The mean VAS values recorded during the treatment sessions and control

  4. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children

    Directory of Open Access Journals (Sweden)

    Mangalampally Shilpapriya

    2015-01-01

    Full Text Available Aim: Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural "gate" so that the central perception of itch and pain is reduced. This fact is based upon "gate control" theory of Melzack and Wall. The present study was carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Materials and Methods: Thirty patients aged 6-12 years old of both the genders with Frankel′s behavior rating scale as positive and definitely positive requiring bilateral local anesthesia injections for dental treatment were included in the split-mouth cross over design. Universal pain assessment tool was used to assess the pain with and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Results: Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001 compared to the injections without the use of vibe. Conclusion: The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.

  5. Analysis of direct costs of anesthesia-related materials between spinal and venous anesthesia with propofol associated with local perianal block in hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available There is no consensus on the ideal anesthesia for hemorrhoidectomy in ambulatory facilities. Spinal anesthesia and venous propofol associated with local perianal block (combined anesthesia are frequently used, and their direct costs may be crucial for the anesthesia type selection. The objective of this study was to compare the direct costs of anesthesia-related materials in hemorrhoidectomy between these two anesthetic techniques.Retrospective and cross-section analysis, comparing the direct costs of the materials of spinal and venous anesthesia with propofol associated with local perianal block, in hemorrhoidectomy. Twenty patients were included, ten submitted to each anesthesia type (five from each gender. The mean age in the spinal anesthesia group was 46.5 years and in the combined anesthesia group, 42.5 years (p=0.334. The mean cost of anesthesia-related materials was R$ 58.50 (R$ 36.48 - R$ 85.79 in the first group versus R$ 190.31 (R$ 98.16 - R$ 358.51 in the second - 69.27% difference between them (pNão há consenso sobre a técnica anestésica de escolha para hemorroidectomias em regime ambulatorial. A raquianestesia e a anestesia combinada (venosa com propofol + local são frequentemente utilizadas, e os custos das mesmas podem ser determinantes na escolha do melhor tipo de anestesia. O objetivo deste trabalho foi avaliar e comparar os custos diretos dos materiais anestésicos utilizados em hemorroidectomias entre essas duas técnicas. Foi feito um estudo retrospectivo e transversal, comparativo entre os custos diretos dos materiais anestésicos entre a raquianestesia e a anestesia venosa com poropofol associada ao bloqueio perianal local, em hemorroidectomias. Foram analisados 20 pacientes, 10 operados com cada técnica anestésica (5 de cada gênero. A média de idade do grupo da raquianestesia foi de 46,5 anos e do grupo da anestesia combinada foi de 42,5 anos (p=0,334. O custo médio do procedimento anestésico no primeiro grupo

  6. General Anesthesia versus Local Anesthesia in StereotaXY (GALAXY) for Parkinson's disease: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Holewijn, R. A.; Verbaan, D.; de Bie, R. M. A.; Schuurman, P. R.

    2017-01-01

    Background: The aim of the study is to investigate if deep brain stimulation (DBS) in the subthalamic nucleus (STN) for Parkinson's disease (PD) under general anesthesia further improves outcome by lessening postoperative cognitive, mood, and behavioral adverse effects; shorten surgical time and

  7. [Choice of local anesthetic volume at the infiltration anesthesia on the upper jaw].

    Science.gov (United States)

    Babikov, A S; Rabinovich, S A; Moskovets, O N; Antonenkov, R V; Chernikov, D N; Sherstkin, I S

    2015-01-01

    The aim of this study was to investigate the effect of volume and pressure, at which the solution of local anesthetic is injected into the tissue, on the effectiveness of infiltration anesthesia of the periosteum on the upper jaw. We used the technique of tooth pain sensitivity thresholds. According to the rate of development and the duration of the maximum analgesia effect, the optimum volume for different levels of pressure was determined. The influence of the tissue density at the injection site on the effect criteria of analgesia was demonstrated.

  8. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Just, Sven; Foegh, Pia

    2015-01-01

    BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired qu...... stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. CONCLUSION: Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS....

  9. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary...

  10. Transantral, endoscopically guided balloon dilatation of the ostiomeatal complex for chronic rhinosinusitis under local anesthesia.

    Science.gov (United States)

    Stankiewicz, James; Tami, Thomas; Truitt, Theodore; Atkins, James; Liepert, Douglas; Winegar, Bradford

    2009-01-01

    A multicenter study (BREATHE I - Entellus Medical, Inc.) was performed to assess the safety and outcomes of a new, less invasive system that uses direct endoscopic visualization to facilitate balloon dilation of the maxillary sinus ostia and ethmoid infundibulum. General anesthesia was avoided in most subjects to assess feasibility of performing transantral ostial dilatation in an office setting. Subjects with chronic rhinosinusitis of the maxillary sinuses alone or maxillary and anterior ethmoid sinuses underwent baseline evaluation including CT imaging and symptom assessment using the Sino-Nasal Outcome Test (SNOT 20). Subjects underwent transantral balloon dilation and follow-up evaluation at 1 week, 3 months, and 6 months post-procedure. Thirty subjects were treated at three centers. Fifty-five of 58 maxillary ostia were successfully treated for a procedural completion rate of 94.8%. Ninety-seven percent of the procedures were completed under local anesthesia with or without minimal intravenous sedation. There were no device-related serious adverse events or unanticipated adverse device effects. The mean overall SNOT 20 score at baseline was 2.9 +/- 1.0. Mean overall SNOT 20 scores at 1-week, 3-month, and 6-month follow-up were 0.8 +/- 0.8, 0.7 +/- 0.8, and 0.8 +/- 0.9 respectively. Patency at 3-months as confirmed by CT imaging was 95.8%. These results indicate that transantral balloon dilation of the ostiomeatal complex under local anesthesia appears to be a safe technique for managing isolated maxillary or maxillary and anterior ethmoid sinusitis and can potentially be performed safely in an office setting.

  11. Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia.

    Science.gov (United States)

    Thiem, Daniel G E; Schnaith, Florian; Van Aken, Caroline M E; Köntges, Anne; Kumar, Vinay V; Al-Nawas, Bilal; Kämmerer, Peer W

    2018-04-01

    The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible. In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min). IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P local numbness were found to be equal. For anesthetic efficacy as well as anesthetic success, block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique. Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.

  12. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

    Science.gov (United States)

    Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Antò, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  13. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    Directory of Open Access Journals (Sweden)

    Annelyse Garret-Bernardin

    2017-01-01

    Full Text Available Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years, requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  14. [Gonalgia: treatment with therapeutic local anesthesia. Results of a controlled comparative study versus diclofenac].

    Science.gov (United States)

    Berenfeld, A; Bessing, W D; Bisplinghoff, U; Bittner, G; Matthiesen, H O; Tilscher, H; Ramm, S; Ebeling, L; Schmitz, H

    1991-12-10

    The effectiveness and tolerance of therapeutic local anesthesia (TLA) with lidocaine was compared with those of oral diclofenac in a controlled, open, randomized study involving 76 patients with gonalgia due to gonarthrosis or patellar chondropathy. During the course of the three-week (maximum) treatment, the summed score of pain at rest, pain on movement, and restricted mobility, taken as the target parameter of effectiveness, decreased significantly more markedly (p = 0.008) under TLA, than under diclofenac. Side effects involving mainly the gastrointestinal tract occurred significantly more frequently in the diclofenac group (p = 0.012). The results of this study indicate that in the treatment of localized joint pain of degenerative genesis, TLA with lidocaine is superior to NSAID treatment in terms of effectiveness and tolerance.

  15. The efficacy of six local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia.

    Science.gov (United States)

    Abdulwahab, Mohammad; Boynes, Sean; Moore, Paul; Seifikar, Shahrooz; Al-Jazzaf, Abdulaziz; Alshuraidah, Abdullah; Zovko, Jayme; Close, John

    2009-08-01

    The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine. The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine (L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000 epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5 percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment trial involved 18 healthy participants. The investigators administered mandibular infiltration injections (six sessions per participant) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the mandibular first molar. The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test (EPT) stimulation. Twelve female and six male participants (mean age, 24.9 years; range, 18-53 years) completed the study. The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100, 44.8 percent for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and 77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor and not formulation dependent. The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.

  16. Comparison of Postoperative Pain between Infiltrative Local Anesthesia plus Paracetamol and Total Intravenous Anesthesia plus Paracetamol in Ambulatory Breast Surgery

    Directory of Open Access Journals (Sweden)

    Kasra Karvandian

    2015-08-01

    Full Text Available Background: Acute postoperative pain is an important surgical side effect that may delay patient discharge in ambulatory operations; moreover, the strategies used to alleviate pain may cause side effects that require longer hospitalization to recover. In this clinical trial, we compared two current anesthetic methods with special concerns about postoperative pain intensity beside other important components of ambulatory anesthesia.Methods: This clinical trial was conducted on two age-matched groups of 75 members who underwent ambulatory breast surgery. Patients in the first group (GA underwent general anesthesia with propofol plus remifentanil by employing a laryngeal mask airway. In the second group (LA, the surgeon used infiltration of 2% lidocaine in the breast tissue and midazolam was applied as premedication. At the end of surgery, paracetamol was administered to all patients in both groups. The pain score was evaluated when the patients were fully awake using a numerical pain rating scale. Patients with severe pain received analgesia. The length of postanesthesia care unit (PACU stay was recorded for each patient.Results: None of the patients in the LA group were satisfied because of the experience of needle insertion into their breast tissue (P = 0.001. The patients in the LA group experienced more pain in PACU requiring adjuvant analgesia (P = 0.001. Patients in the LA group had longer PACU admission (P = 0.001.Conclusions: Patients in the LA group had higher pain scores and were dissatisfied with the plan of their anesthesia. This may confirm the role of preemptive analgesia or the effect of emotional stress of breast tissue needling in wakeful patient.

  17. Relationship between Child and Parental Dental Anxiety with Child's Psychological Functioning and Behavior during the Administration of Local Anesthesia.

    Science.gov (United States)

    Boka, Vasiliki; Arapostathis, Konstantinos; Kotsanos, Nikolaos; Karagiannis, Vassilis; van Loveren, Cor; Veerkamp, Jaap

    2016-01-01

    The aims of this study were to determine: 1) the relationship between children's psychological functioning, dental anxiety and cooperative behavior before and during local anesthesia, 2) the relationship of parental dental anxiety with all the above child characteristics. There was a convenient sample of 100 children (4-12 years). Child dental anxiety and psychological functioning were measured using the "Children's Fear Survey Schedule" (CFSS-DS) and the "Strengths and Difficulties Questionnaire" (SDQ) respectively. Parental dental anxiety was measured using the "Modified Dental Anxiety Scale" (MDAS). All questionnaires were completed by parents. Before and during local anesthesia, the child behavior was scored by one experienced examiner, using the Venham scale. Non-parametric tests and correlations (Mann-Whitney, Spearman's rho) were used for the analysis. The mean SDQ score was 10±5.6 for boys (n=60) and 8.3±4.8 for girls (n=40) (p=0.038), but there was no correlation with children's age. The mean CFSS-DS score was 33.1±11.86 and there was no correlation with age or gender. Children with higher levels in the pro-social subscale of the SDQ had significantly less anxiety and better behavior before local anesthesia. Higher mean CFSS-DS scores were significantly associated with uncooperative behavior during local anesthesia (p=0.04). There was no correlation between parents' and their children's dental anxiety, psychological functioning and behavior. 46% of the children had previous dental experience in the last 6 months. As time since the last dental treatment increased, an improvement was found in children's behavior during local anesthesia. Child psychological functioning was related to dental anxiety and behavior during dental appointment involving local anesthesia.

  18. Update on emerging regional techniques and novel local anesthetics in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Szafran MJ

    2015-12-01

    Full Text Available Martin J Szafran, Eldhose Abrahams, Tong Joo Gan Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA Abstract: New regional anesthetic techniques have been incorporated into the multimodal approach to postoperative analgesia. Blocks such as the transversus abdominis plane block, adductor canal block, and pectoral nerves blocks all show promise as potential tools used in opioid-sparing techniques, but at the same time have significant limitations to their utility. Novel long-acting formulations of local anesthetics further add to the possible benefit of these blocks, but their application to peripheral nerve blocks is currently being investigated and is not well defined. This review focuses on evaluating the relevant anatomy, technique, and indications of several newer peripheral nerve blocks, the emerging evidence supporting the use of liposomal bupivacaine and SABER®-Bupivacaine, and the application of both in ambulatory anesthesia. Keywords: transversus abdominis plane (TAP block, adductor canal block, pectoral nerves block, regional anesthesia, liposomal bupivacaine, SABER®-Bupivacaine

  19. Ambulatory phlebectomy under tumescent local anesthesia in a kidney-transplant patient

    Directory of Open Access Journals (Sweden)

    Bjelanović Zoran

    2013-01-01

    Full Text Available Introduction. Tumescent local anesthesia (TLA is widely used for ambulatory surgery. Patients with transplanted organs are on immunosuppressive therapy and with risk for organ rejection or severe infection. Case report. Saphenectomy with phlebectomy on the left leg under TLA was performed in a patient with kidney transplantation performed four years ago. A combination of 35 mg of 1% prilocaine-hydrochloride, 5 mL of 8.4% sodium bicarbonate and 500 μg of epinephrine in 460 mL of normal saline was used for TLA. Overall 750 mL of the solution was used. The patient had satisfactory postoperative analgesia and was discharged home on the same day. Blood levels of urea, creatinine, estimated glomerular filtration rate (eGFR and tacrolimus concentration, measured preoperatively and on the second postoperative day, were in a regular range. Prilocaine blood concentrations determined on the 4th, 10th and 16th postoperative hours, were below toxic levels. Conclusion. TLA in a kidney-transplanted patient performed for saphenectomy with phlebectomy proved to be a safe and reliable anesthesia method.

  20. Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital's local population can be inaccurate.

    Science.gov (United States)

    Masursky, Danielle; Dexter, Franklin; O'Leary, Colleen E; Applegeet, Carol; Nussmeier, Nancy A

    2008-04-01

    Anesthesia department planning depends on forecasting future demand for perioperative services. Little is known about long-range forecasting of anesthesia workload. We studied operating room (OR) times at Hospital A over 16 yr (1991-2006), anesthesia times at Hospital B over 26 yr (1981-2006), and cases at Hospital C over 13 yr (1994-2006). Each hospital is >100 yr old and is located in a US city with other hospitals that are >50 yr old. Hospitals A and B are the sole University hospitals in their metropolitan statistical areas (and many counties beyond). Hospital C is the sole tertiary hospital for >375 km. Each hospital's choice of a measure of anesthesia work to be analyzed was likely unimportant, as the annual hours of anesthesia correlated highly both with annual numbers of cases (r = 0.98) and with American Society of Anesthesiologist's Relative Value Guide units of work (r = 0.99). Despite a 2% decline in the local population, the hours of OR time at Hospital A increased overall (Pearson r = -0.87, P population and hours of anesthesia (r = 0.97, P population and workload (r = -0.18). At Hospital C, despite a linear increase in population, the annual numbers of cases increased, declined with opening of two outpatient surgery facilities, and then stabilized. The predictive value of local personal income was low. In contrast, the annual increases in the hours of OR time and anesthesia could be modeled using simple time series methods. Although growth of the elderly population is a simple justification for building more ORs, managers should be cautious in arguing for strategic changes in capacity at individual hospitals based on future changes in the national age-adjusted population. Local population can provide little value in forecasting future anesthesia workloads at individual hospitals. In addition, anesthesia groups and hospital administrators should not focus on quarterly changes in workload, because workload can vary widely, despite consistent patterns

  1. Comparison of the Efficacy of Subtenon with Peribulbar Local Anesthesia without Hyaluronidase in Patients Undergoing Cataract Surgery

    International Nuclear Information System (INIS)

    Khan, S. A.; Aftab, A. M.; Iqbal, M.

    2014-01-01

    Objective: To compare the efficacy of subtenon with peribulbar local anesthesia without hyaluronidase in patients undergoing cataract surgery. Study Design: A randomized controlled trial. Place and Duration of Study: Eye B Unit, Khyber Teaching Hospital, Peshawar, from October 2009 to October 2010. Methodology: Patients undergoing cataract surgery were divided into two groups. Group A received subtenon anesthesia and group B received peribulbar anesthesia. Pain score, akinesia and intraocular pressure were compared in the two groups. Statistical Package for Social Sciences-14.0 was used for data analysis. Results: There were 304 patients, 152 patients in each group. At the time of injection, there was less pain in group A as compared to group B (p < 0.001). At the time of surgery and till 90 minutes after administration of anesthesia, there was no significant difference in pain between the 2 groups (p = 0.999 and 0.59 respectively). Group A had better akinesia as compared to group B (p = 0.04). There was a greater rise in mean intraocular pressure just after injection in group B as compared to group A (p < 0.001); in both groups, the intraocular pressure declined to its base level 10 minutes after the injection (p = 0.52). Conclusion: Subtenon anesthesia is less painful at the time of its administration, provides better akinesia and leads to smaller rise in intraocular pressure just after the injection than peribulbar anesthesia. (author)

  2. Radiofrequency-assisted liposuction device for body contouring: 97 patients under local anesthesia.

    Science.gov (United States)

    Theodorou, Spero J; Paresi, Robert J; Chia, Christopher T

    2012-08-01

    Radiofrequency-assisted liposuction involves the delivery of a controlled amount of energy to treated tissue resulting in fat liquefaction, accompanying hemostasis, and skin tightening. The purpose of this study is to report experience with a larger sample size using the BodyTite™ radiofrequency-assisted liposuction (RFAL) platform, and its first use with local tumescent anesthesia. The Bodytite™ device is currently awaiting FDA approval. We prospectively included 97 patients who underwent radiofrequency-assisted liposuction under local anesthesia under IRB approval. We treated 144 anatomical areas in 132 operations and collected the following data: age, sex, height, weight, body mass index (BMI), anatomical area of treatment, operative time, amount of tumescent solution used, amount of fat aspirated, amount of kilojoules (kJ) delivered, and the incidence of infections, seromas, adverse effects from medications, and thermal injuries. Patients were asked to complete an online survey assessing the aesthetic outcome and quality of life after treatment with RFAL-assisted liposuction. Three independent plastic surgeons were asked to evaluate photographs of our 6-month postoperative results in comparison to the preoperative photos. The average age and BMI of our study population was 37.6 years and 28.2 kg/m2, respectively. The study population was 88% female. The mean amount of lidocaine given per treatment session was 32.7 mg/kg (range=3.8-83.3 mg/kg). The mean amount of tumescent fluid given per anatomical treatment area was 1,575 cc. The average amount of total aspirate across all anatomical treatment areas was 1,050 cc, with an average total aspirate of 1,146 cc per treatment date. The overall incidence of major complications was 6.25% and the incidence of minor complications was 8.3%. Overall patient satisfaction was 82% for the degree of skin tightening and 85% for the body-contouring result with the BodyTite™ device. Three independent plastic surgeons graded

  3. Survival and complications of peritoneal dialysis catheters: introducing a laparoscopic method under local anesthesia

    Directory of Open Access Journals (Sweden)

    Chaman R

    2008-10-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Chronic peritoneal dialysis is a safe method for the treatment of end-stage renal failure. Worldwide, patients on chronic peritoneal dialysis constititute approximately 15% of the total number of patients on dialysis. In Iran, very few people have access to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This lack of access is primarily due to the high occurrence of mechanical complications. Improving catheterization procedures is an important way to extend the use of peritoneal dialysis in Iran. Thus, a prospective study was implemented to evaluate the outcome of a new laparoscopic technique for the insertion of peritoneal dialysis catheters under local anesthesia."n"n Methods: A total of 115 catheters (two-cuff, swan-necked, coiled were inserted into the peritoneal cavity of 109 patients with end-stage chronic renal failure during a 16-month period. The method of insertion was a two-port laparoscopic technique with local anesthesia and sedation. All patients were followed for 12 to 28 months. We prospectively evaluated mechanical and infectious complications and survival rates of the catheters."n"n Results: The average age of the patients was 51

  4. Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

    International Nuclear Information System (INIS)

    Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

    2011-01-01

    Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

  5. Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

    International Nuclear Information System (INIS)

    Kim, Dong Wook; Rho, Myung Ho; Kim, Ki Nam

    2009-01-01

    This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was

  6. Assessment of Thiel-Embalmed Cadavers as a Teaching Tool for Oral Anatomy and Local Anesthesia.

    Science.gov (United States)

    Lone, Mutahira; McKenna, Joseph P; Balta, Joy Y; O'Mahony, Siobhain M; Cryan, John F; Downer, Eric J; Toulouse, André

    2017-04-01

    The aim of this study was to determine whether Thiel-embalmed cadavers would provide a useful anatomy teaching tool for topics that cannot be approached using formalin-fixed cadavers such as oral cavity examination and maxillary anesthesia. The suitability of Thiel-embalmed bodies for performing oral examinations was assessed by asking first-year dental and dental hygiene students at a dental school in Ireland to identify oral structures on a classmate and on a Thiel-embalmed body. The study was conducted in 2016. The ease of location was compared in the two settings, and their quality was assessed on the cadavers. The suitability of Thiel-embalmed cadavers to teach maxillary anesthesia was assessed by students' performing mock injections at five adjacent sites daily for five consecutive days, followed by inspection of the gingival surface by experienced anatomists and dentists. Data were obtained from 57 students, but only the 54 forms that were fully completed were analyzed, for an overall response rate of 85.7%. The results showed that most oral structures were more difficult to locate on cadavers. The texture and appearance of features in the cadavers were rated at a midpoint between realistic and unrealistic. The relative inexperience of the participants, the accumulation of fixative in the oral cavity, and discoloration were mentioned as potential confounding factors. Visual analysis of images obtained following repeated injections revealed no deterioration of the tissue. Importantly, the puncture marks appeared to reduce over time, suggesting that the gingival tissue maintains some elasticity following Thiel fixation. These findings suggest that Thiel-embalmed cadavers may be a useful tool to provide students more time to localize and study aspects of the oral cavity. Likewise, the recoiling capacity of gingival tissue suggests that Thiel-embalmed cadavers may provide an ideal tool for teaching injection technique of local anesthetics.

  7. Pharmacokinetics and effect of intravenous meloxicam in weaned Holstein calves following scoop dehorning without local anesthesia

    Directory of Open Access Journals (Sweden)

    Coetzee Johann F

    2012-09-01

    Full Text Available Abstract Background Dehorning is a common practice involving calves on dairy operations in the United States. However, less than 20% of producers report using analgesics or anesthetics during dehorning. Administration of a systemic analgesic drug at the time of dehorning may be attractive to dairy producers since cornual nerve blocks require 10 – 15 min to take effect and only provide pain relief for a few hours. The primary objectives of this trial were to (1 describe the compartmental pharmacokinetics of meloxicam in calves after IV administration at 0.5 mg/kg and (2 to determine the effect of meloxicam (n = 6 or placebo (n = 6 treatment on serum cortisol response, plasma substance P (SP concentrations, heart rate (HR, activity and weight gain in calves after scoop dehorning and thermocautery without local anesthesia. Results Plasma meloxicam concentrations were detectable for 50 h post-administration and fit a 2-compartment model with a rapid distribution phase (mean T½α = 0.22 ± 0.087 h and a slower elimination phase (mean T½β = 21.86 ± 3.03 h. Dehorning caused a significant increase in serum cortisol concentrations and HR (P  Conclusions To our knowledge, this is the first published report examining the effects of meloxicam without local anesthesia on SP, activity and performance of calves post-dehorning. These findings suggest that administration of meloxicam alone immediately prior to dehorning does not mitigate signs of acute distress but may have long term physiological, behavior and performance effects.

  8. Clinical application of synthesized brain surface imaging for preoperative simulation of brain biopsy under local anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Ogura, Yuko; Katada, Kazuhiro; Imai, Fumihiro; Fujisawa, Kazuhisa; Takeshita, Gen; Kanno, Tetsuo; Koga, Sukehiko (Fujita Health Univ., Toyoake, Aichi (Japan))

    1994-06-01

    Surface anatomy scanning (SAS) is the technique which permits the direct visualization of brain surface structures, including cortical sulci, guri, subcortical lesions as well as skin markings for craniotomy. A synthesized brain surface image is a technique that combines MR angiography (MRA) with SAS, and it proposed by us for detecting cerebral superficial veins with these surface structures on the same image. The purpose of this report is to present the result of applying the synthesized brain surface image to the preoperative simulation of biopsy under local anesthesia in 2 cases of multiple metastatic brain tumors. The parameters for SAS were TR/TE=50/40 msec, flip angle=60deg by the fast T[sub 2] technique using refocused FID in steady-state (STERF technique). SAS images were processed by gray scale reversal. The MRA data were acquired with two-dimensional time of flight (TOF) sequence after intravenous administration of Gd-DTPA. Before imaging, the water-filled plastic tubes were placed on the patients scalp as markings for craniotomy. Their positions were planned by the neurosurgeons. On SAS, the markings for burr-hole appeared located above the tumors. However on the synthesized brain surface images, the positions of burr-hole were considered to be inadequate, since superficial cerebral vein and sinus were also visualized in the area of the markings. From these results, the positions of burr-hole were reset to avoid the venous structures, and so as to include the lesions in operations. The biopsies were performed successfully and safely because the venous structure could be excluded from the operative field. By this technique it was easy to confirm the relationships among lesions, skin markings and venous structures. The technique described appears to be a useful method for preoperative simulation of biopsies for multiple metastatic brain tumors under local anesthesia. (author).

  9. Effects of local anesthesia with bupivacaine plus epinephrine on blepharoptosis and levator palpebrae muscle function.

    Science.gov (United States)

    Aghai, Gholam Hoseyn; Vazirnia, Maryam; Poormatin, Rama; Falavarjani, Khalil Ghasemi

    2013-01-01

    To evaluate the effect of local anesthesia with bupivacaine plus epinephrine on the extent of blepharoptosis and levator palpebrae muscle function. : In this prospective interventional case series, patients with blepharoptosis who were candidates for aponeurotic surgery were included. After initial preparations in the operating room, a total of 1 ml of a mixture of bupivacaine 0.5% plus epinephrine 1:100,000 were injected into the upper eyelid. The margin reflex distance 1 (MRD1) and the extent of levator muscle function were measured before and 2, 5, 10, and 15 minutes after injection. A total of 36 eyes including 21 men (58.3%) and 15 women (41.7%) with an average age of 41.81 ± 23.09 (17-83 years) were studied. There were 21 eyes with myogenic and 15 eyes with aponeurotic blepharoptosis. The mean MRD1 was 1.18 ± 1.06 mm before injection and -0.02 ± 0.85, 0.52 ± 0.98, 0.98 ± 1.05, and 1.02 ± 1.06 mm at 2, 5, 10, and 15 minutes after injections, respectively. The changes in the MRD1 measurements were statistically significant at all time points. The MRD1 values decreased during the first 2 minutes after injection in 88.8% of eyes, but returned to initial value after 15 minutes in 84.3%. The change in the levator muscle function measurements was statistically significant at 2 and 5 minutes after injections; however, the differences were clinically negligible. : The local anesthesia of the eyelid with 1 ml bupivacaine plus epinephrine causes a temporary increase of blepharoptosis within the first few minutes with minimal effect on levator muscle function measurements.

  10. The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version.

    Science.gov (United States)

    Neal, Joseph M; Woodward, Crystal M; Harrison, T Kyle

    2018-02-01

    The American Society of Regional Anesthesia and Pain Medicine (ASRA) periodically revises and updates its checklist for the management of local anesthetic systemic toxicity. The 2017 update replaces the 2012 version and reflects new information contained in the third ASRA Practice Advisory on Local Anesthetic Systemic Toxicity. Electronic copies of the ASRA checklist can be downloaded from the ASRA Web site (www.asra.com) for inclusion in local anesthetic toxicity rescue kits or perioperative checklist repositories.

  11. Comparison of local anesthesia with articaine and lidocaine in septoplasty procedure.

    Science.gov (United States)

    Erkul, Evren; Babayigit, Mustafa; Kuduban, Ozan

    2010-01-01

    Only a few studies have so far compared the use of different local anesthetic agents in septoplasty procedure with regard to reduction in pain, effectiveness, and related complications. The aim of this study was to compare articaine and lidocaine as local anesthetics for septoplasty surgery, in terms of their efficacy and safety. Seventy patients randomized into two groups were included in this study. For local anesthesia, 35 patients received articaine and 35 received lidocaine. All patients were asked to rate their pain levels on a visual analog scale (VAS) at the 1st, 2nd, 4th, 6th, 8th, 12th, 18th, and 24th postoperative hours. In addition, analgesic consumption of each patient as well as postoperative complications was recorded in both groups. VAS scores for pain were significantly lower in the articaine group than in the lidocaine group at the 2nd, 6th, 8th, 12th, and 24th postoperative hours (plocal anesthetic agent with rapid onset of action. When compared with lidocaine, it is associated with improved tissue diffusion, rare postoperative complications, and less postoperative pain, thus, representing a safe and effective local anesthetic agent for septoplasty procedure.

  12. Comparison of cardiopulmonary responses during sedation with epidural and local anesthesia for laparoscopic-assisted jejunostomy feeding tube placement with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical jejunostomy feeding tube placement in healthy dogs.

    Science.gov (United States)

    Hewitt, Saundra A; Brisson, Brigitte A; Sinclair, Melissa D; Sears, William C

    2007-04-01

    To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. 15 healthy mixed-breed dogs. Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients.

  13. Infraorbital Foramen and Pterygopalatine Fossa Location in Dry Skulls: Anatomical Guidelines for Local Anesthesia

    Directory of Open Access Journals (Sweden)

    Omar Masabni

    2017-01-01

    Full Text Available Purpose. The aim of the study was to locate the infraorbital foramen (IOF in relation to the infraorbital margin (IOM for proper injections of local anesthetics in skull specimens. Another aim was to determine the depth of needle penetration into pterygopalatine fossa through the greater palatine canal (GPC. Materials and Methods. 102 skull halves were used to measure the distances between (1 IOF and IOM and (2 IOF and alveolar ridge of maxilla at second premolar. Needles were inserted and bent at a 45° angle, passing through the GPC at the level of hard palate. The depth of the tip of needle emerging out of GPC into pterygopalatine fossa was measured. Results. The mean distance between IOF and IOM was 6.46±1.57 mm on the right side and 6.74±1.72 mm on the left. The mean distance between IOF and alveolar bone process of the maxilla at second premolar was 29.07±3.58 mm on the right side and 29.39±3.78 mm on the left. The mean depth of penetration of the needle into the pterygopalatine fossa was similar on both sides. Conclusions. Proper identification of IOF and pterygopalatine fossa is of great significance during local anesthesia injections, due to their close proximity to vital anatomic structures.

  14. Sigmund Freud (1856-1939) and Karl Köller (1857-1944) and the discovery of local anesthesia.

    Science.gov (United States)

    dos Reis, Almiro

    2009-01-01

    The understanding, occasionally recognized, that Sigmund Freud had the intuition to use cocaine as local anesthetic for surgical procedures, or even that he played any role in the discovery of local anesthesia is not true. The objective of Freud's studies were different, and based in irrefutable evidence, Karl Köller was the real inventor of local anesthesia. In face of those facts, proper knowledge of this historically important subject is due. This report refers to the long-known properties of cocaine. It also remembers personal data, and the professional and scientific activities of Sigmund Freud and Karl Köller. It presents Freud's researches on the pathophysiological effects of cocaine. It exposes the reasons for the harsh criticism of Freud's concepts. It describes the sudden, but conscious and justified, idea of Karl Köller to study scientifically the use of cocaine as a local anesthetic in animals and humans. It indicates how those pioneering studies, that culminated with the discovery of local anesthesia by Köller and two presentations in Vienna on the subject, were done. It also reports the first ophthalmologic surgery under local anesthesia. It shows the immediate dissemination throughout the world of the discovery that marked the beginning of regional blocks. It comments several documents corroborating the role of Köller in this discovery. And, finally, it mentions the numerous homages received by Köller in different areas of the world. COCLUSIONS: Regional block was introduced by Karl Köller in 1884, when he demonstrated the feasibility of performing painless ophthalmologic surgeries by using cocaine as a local anesthetic. Sigmund Freud studied cocaine extensively, but he did not have direct participation in this important discovery.

  15. Fluoroscopy-guided biodegradable spacer implantation using local anesthesia: safety and efficacy study in patients with massive rotator cuff tears.

    Science.gov (United States)

    Gervasi, E; Maman, E; Dekel, A; Cautero, E

    2016-12-01

    The management of massive rotator cuff tears (MRCTs) is challenging and associated with a high failure rates. Studies have shown that advanced age, lower American Society of Anesthesiologists physical status score and concomitant comorbidities are associated with higher risks of death and postoperative complications. This study was designed to assess the safety and efficacy of fluoroscopy-guided biodegradable spacer implantation under local anesthesia, in patients with MRCT and comorbidities completely or partially contraindicating surgeries under general anesthesia. In this open-label, single arm, prospective study, subjects with MRCTs underwent subacromial fluoroscopy-guided implantation with a biodegradable spacer (InSpace™ system) under local anesthesia. Fifteen patients were treated and assessed. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant (CS) and American Shoulder and Elbow Society (ASES) scores. All patients demonstrated an overall improvement in the total CS and ASES beginning at 6 weeks and sustained by at least 12 months postoperatively. Of the 15 patients who reached the 1-year follow-up, 85% showed a clinically significant improvement of at least 15 points in their Constant score starting at 6 weeks postoperation and maintained throughout the entire follow-up period. We conclude that in this initial patient's cohort, fluoroscopy-guided implantation of InSpace™ system under local anesthesia, represented an effective alternative to the existing procedures. This procedure may be considered as a treatment option for elderly patients or for patients with multiple comorbidities complicating or contraindicating surgery under general anesthesia. Technically easy, this technique can be an effective tool in the armamentarium of most orthopedic surgeons. Level of proof: single-arm prospective study, Level II.

  16. Study on blood glucose concentration in patients with diabetes undergoing dental extraction under local anesthesia with and without adrenaline.

    Science.gov (United States)

    Haji, Irfan Ul Hassan; Siddiq, Mohamed; Rao, Sripathi; Rai, Gunachandra; Hiregoudar, Jagadish S; Pitale, Unnati

    2012-01-01

    The aim of this study was to compare the effect of adrenaline on blood glucose concentration in patients with diabetes undergoing tooth extraction under local anesthesia and also to find out whether blood glucose concentration differs if local anesthetics are injected in clinical doses with and without adrenaline. Patients included had a tooth in need of extraction, were in the 25-55 years age group, had a random blood sugar level ≤140 mg/dL and were on oral antidiabetic drugs. The 25 patients in Group A were injected with 2 mL of lignocaine hydrochloride without adrenaline (xylocaine 2%) and the other 25 patients (Group B) were injected with 2 mL lignocaine hydrochloride along with adrenaline 1:80,000. Serial blood glucose estimations were made at regular intervals of 10 min before local anesthesia and subsequently 10 and 20 min after local anesthesia. A statistically significant difference of the mean blood glucose concentration was noticed at three different time intervals between the two groups. Dental local anesthetic solutions containing adrenaline may safely be used in patients with diabetes who had taken their hypoglycemic medications preoperatively.

  17. When local anesthesia becomes universal: Pronounced systemic effects of subcutaneous lidocaine in bullfrogs (Lithobates catesbeianus)

    DEFF Research Database (Denmark)

    Williams, Catherine; Alstrup, Aage Kristian Olsen; Bertelsen, Mads Frost

    2017-01-01

    , gular respiration and heart rate (handled group, n=10) or blood pressure and heart rate via an arterial catheter (catheterized group n=6). 5mgkg-1 lidocaine did not cause loss of reflexes or change in heart rate in the handled group, but was associated with a reduction in gular respiratory rate (from 99......±7 to 81±17breathsmin-1). 50mgkg-1 lidocaine caused a further reduction in respiratory rate to 59±15breathsmin-1, and led to a progressive loss of righting reflex (10/10 loss by 40min), palpebral reflex (9/10 loss at 70min), and contralateral toe pinch withdrawal (9/10 loss at 70min). Reflexes were...... regained over 4h. Systemic sedative effects were not coupled to local anti-nociception, as a forceps pinch test at the site of injection provoked movement at the height of the systemic effect (tested at 81±4min). Amphibians are routinely subject to general anesthesia via exposure to sodium channel blockers...

  18. Comparison of Two Local Anesthesia Injection Methods During a Transrectal Ultrasonography-guided Prostate Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Song Ee; Oh, Young Taik [Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Jang Hwan; Rha, Koon Ho; Hong, Sung Joon; Yang, Seung Choul [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-09-15

    To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. The mean VAS score showed no significant differences between the groups (group 1, 3.4{+-}1.78: group 2, 2.8{+-}1.3: p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia: one of tinnitus and the other of mild dizziness. There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk

  19. Comparison of Two Local Anesthesia Injection Methods During a Transrectal Ultrasonography-guided Prostate Biopsy

    International Nuclear Information System (INIS)

    Baek, Song Ee; Oh, Young Taik; Kim, Jang Hwan; Rha, Koon Ho; Hong, Sung Joon; Yang, Seung Choul

    2010-01-01

    To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. The mean VAS score showed no significant differences between the groups (group 1, 3.4±1.78: group 2, 2.8±1.3: p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia: one of tinnitus and the other of mild dizziness. There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk

  20. Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders.

    Science.gov (United States)

    Carrion, A; D'Anna, M; Costa-Grau, M; Luque, P; García-Cruz, E; Franco, A; Alcaraz, A

    2018-03-01

    To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10ml of lidocaine gel and 50ml of lidocaine solution were instilled in the bladder. A 4.8Fr ureteral stent was placed using a 15.5Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Administration of Anesthesia

    Medline Plus

    Full Text Available ... based surgical residency program alongside medical residents in general surgery, anesthesia and other specialties. During this time, OMS ... administer local anesthesia, all forms of sedation and general anesthesia. They are ... your surgery, your OMS will review the type of anesthetic ...

  2. Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia

    Directory of Open Access Journals (Sweden)

    José Luiz Orlando

    2010-01-01

    Full Text Available INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4% and 10 were male (25.6%, with ages ranging from 11 to 59 years (median of 24 years. All of the lesions affected limbs, and the main symptom reported was pain (97.4%. Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients; medium, between 3 and 15 cm (27 patients; and large, greater than 15 cm (8 patients. RESULTS: The symptoms completely disappeared in 14 patients (35.9% and improved in 24 (61.5%. The lesion size reduced to zero in 6 patients (15.4% and decreased in 32 (82%. The median number of sessions was 7. There were no complications in 32 patients (82%, while 3 presented local paresthesia (7.7%, 2 superficial trombophlebites (5.1%, 1 skin ulcer (2.6%, and 1 case of hyperpigmentation (2.6%. CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.

  3. Effect of local anesthesia on atypical odontalgia--a randomized controlled trial.

    Science.gov (United States)

    List, Thomas; Leijon, Göran; Helkimo, Martti; Oster, Anders; Svensson, Peter

    2006-06-01

    The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO)--a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20mg/ml lidocaine and 12.5 microg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P<0.001) and treatment (ANOVA: P=0.018) with a significant interaction between the factors (ANOVA: P<0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P<0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P<0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO.

  4. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

    International Nuclear Information System (INIS)

    Medhi, Jayanta; Handique, Akash; Goyal, Amit; Lynser, Donbok; Phukan, Pranjal; Sarma, Kalyan; Padmanabhan, Aswin; Saikia, Manuj Kumar; Chutia, Happy

    2016-01-01

    To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. We achieved technical success in all the three patients with immediate relief of dyspnea. Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort

  5. Inadvertent brachial plexus anesthesia associated with local anesthetic infiltration during internal jugular venous cannulation: a case report.

    Science.gov (United States)

    Karabiyik, L; Tezer, T

    2011-01-01

    In the development of neurological complications due to central venous cannulation, the properties of the anatomical region and the experience of the practitioner are important. In this case report, an inadvertent brachial plexus anesthesia after repeated local anesthetic infiltrations during failed attempts of internal jugular venous cannulation by an inexperienced practitioner in cardiovascular intensive care unit is described. The neurological complications due to central venous cannulation are reviewed in the light of actual literature data.

  6. The evaluation of perioperative safety of local anesthesia with lidocaine containing epinephrine in patients with ischemic heart disease.

    Directory of Open Access Journals (Sweden)

    Mehdi Sanatkar

    2013-08-01

    Full Text Available The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study.  All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5% were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%. The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044. The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure

  7. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia

    Directory of Open Access Journals (Sweden)

    Almog Levi

    Full Text Available Abstract Objective To evaluate the medium-term outcome and patient's satisfaction after Single-incision mini-sling (SIMS procedure done under local anesthesia in ambulatory set up for patients with stress urinary incontinence (SUI. Materials and Methods This is a retrospective cohort study, including all patients submitted to SIMS procedure for SUI with MiniArc (AMS, U.S.A without concomitant surgery between January 2011 and March 2013. Patients were followed up during 12 months after surgery and once a year subsequently. Telephone interviews were conducted to evaluate patient satisfaction. Outcome masseurs included: SUI cure rate, urinary urge incontinence (UUI cure rate in patients with mixed urinary incontinence (MUI, intra and post-operative complications and patient satisfaction. Results Ninety-three patients were included with mean follow-up of 23 months. Fifty percent had MUI with predominant SUI. The cure rates of SUI (objective and subjective were 89%. UUI was cured in 40% of patients. No major complications occur, neither voiding obstruction or groin pain. Telephone interviews conducted after 26 months on average revealed high satisfaction rate from the procedure (8.8 out of 10 and from the local anesthesia. Visual analog scale (VAS rating was low during and after the procedure (2.38 and 2.69 respectively. Conclusions The SIMS procedure is safe and highly effective for SUI and it can be performed successfully under local anesthesia in an ambulatory setup.

  8. State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy.

    Science.gov (United States)

    Sairyo, Koichi; Chikawa, Takashi; Nagamachi, Akihiro

    2018-03-01

    Transforaminal (TF) percutaneous endoscopic surgery for the lumbar spine under the local anesthesia was initiated in 2003 in Japan. Since it requires only an 8-mm skin incision and damage of the paravertebral muscles would be minimum, it would be the least invasive spinal surgery at present. At the beginning, the technique was used for discectomy; thus, the procedure was called PELD (percutaneous endoscopic lumbar discectomy). TF approach can be done under the local anesthesia, there are great benefits. During the surgery patients would be in awake and aware condition; thus, severe nerve root damage can be avoided. Furthermore, the procedure is possible for the elderly patients with poor general condition, which does not allow the general anesthesia. Historically, the technique was first applied for the herniated nucleus pulposus. Then, foraminoplasty, which is the enlargement surgery of the narrow foramen, became possible thanks to the development of the high speed drill. It was called the percutaneous endoscopic lumbar foraminoplasty (PELF). More recently, this technique was applied to decompress the lateral recess stenosis, and the technique was named percutaneous endoscopic ventral facetectomy (PEVF). In this review article, we explain in detail the development of the surgical technique of with time with showing our typical cases. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  9. Colecistectomía con anestesia local como recurso en el paciente anciano Cholecystectomy with local anesthesia as a resource in the elderly

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    Roberto Del Campo Abad

    2011-03-01

    Full Text Available Ante un paciente con colecistitis aguda lo ideal es extirpar la vesícula biliar. A veces se presentan situaciones especiales en ancianos desnutridos, con deterioro de su estado general, en los que una intervención con anestesia prolongada, incluso con medios pocos invasivos como la videocirugía, pone en peligro la vida del enfermo. En tales casos la colecistectomía con anestesia local es una alternativa que se puede considerar.In the case of a patient presenting with acute cholescystectomy ideally is to remove the gallbladder. Sometimes there are special situations in malnourished elderlies with deterioration of its general status in whom a lengthy anesthesia intervention, even using not much invasive means as the videosurgery, put at risk the life of patient. In such cases the cholescystectomy with local anesthesia is an alternative that must to be taken into account.

  10. Pain and intra-operative amnesia evaluation with local anesthesia and sedation in patients subjected to rhinosseptoplasties

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    Weber, Raimar

    2010-03-01

    Full Text Available Introduction: The local anesthesia practice and sedation to rhinoplasty and others aesthetics procedures of the face are each time more frequents. In the Brazil, the Federal Council of Medicine defines it and regulate its practice. Objective: To analyze the analgesia' effectiveness and of the intro operative amnesia through analogous visual and subjective scales in the rhinosseptoplasties performed under local anesthesia and sedation, looking for associations with the medium quantities of medication utilized. Method: A retrospective study based in reports relatives to 158 aesthetic-functional rhinoplasties. The surgeon recorded in a protocol the data relatives to the use of local anesthetics and sedatives (including concentration and quantities utilized as well as the side effects. In the first return post surgery the patient quantifies the pain that he felt in the intra operative utilizing a analogous visual scale as described by Hasen and collaborators. The Amnesia considered ideal when the patient referred to remind "nothing" or "a few of the procedure. Results: The sample constituted of 80 (73,4% women and 29 26,6% men, average of age of 29,3 ± 9,5 years. The median of the pain by the analogous visual scale was 0,05; 80% under 3,35. The amnesia was ideal in 51 (46,8% surgeries. The midazolam was utilized in all the surgeries. Fentanyl in 32 (29,4% and, pethidine in 77 (70,6%. Had not statistically significants differences between the quantities of medication utilized between the groups of patients with ideal amnesia when compared with those that do not obtained satisfactory amnesia. Conclusion: Local anesthesia and sedation in rhinoplasties are comfortable and secures in the majority of the cases, even without have a satisfactory amnesia.

  11. Extraction of swallowed toothbrush in stomach by pneumatic insufflation and gastrotomy under local anesthesia: A rare occurrence.

    Science.gov (United States)

    Gupta, Mahesh; Gupta, Pooja; Gupta, Manoj

    2014-05-01

    Most of the ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction, perforation, and bleeding. Spontaneous passage of a toothbrush has not been reported till date and the technique of its removal is a curiosity for surgeons. Endoscopy is a recommended technique for the removal of such complex foreign bodies. However, if it fails, the foreign body can be removed successfully with a laparoscopic gastrotomy. We devised an innovative technique by using pneumatic gastric insufflation and extracted the toothbrush by a tiny gastrotomy under local anesthesia.

  12. Local anesthesia for pain control during transrectal ultrasound-guided prostate biopsy: a systematic review and meta-analysis

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    Yan P

    2016-10-01

    Full Text Available Pu Yan,* Xiao-yan Wang,* Wei Huang, Yong Zhang Beijing Tian Tan Hospital, Capital Medical University, Neurology Research Division, China National Clinical Research Center for Neurological Disease, Beijing, People’s Republic of China *These authors contributed equally to this work. Background: A meta-analysis was performed to evaluate the efficacy and safety of intrarectal local anesthestic (IRLA, periprostatic nerve block (PPNB, and the combined modalities in alleviating the pain during transrectal ultrasound (TRUS-guided prostate biopsy.Materials and methods: A literature review was performed to identify all published randomized controlled trials (RCTs about IRLA vs no anesthesia or placebo gel; PPNB vs no injection, periprostatic placebo injection, or IRLA; combined PPNB and IRLA vs PPNB alone; and combined PPNB and intraprostatic nerve block (IPNB vs PPNB alone before TRUS-guided biopsy. Sources included MEDILINE, EMBASE, and Cochrane Library from 1980 to 2016. The main outcomes were biopsy pain score, probe manipulation pain score, and anesthetic infiltration pain score assessed by the visual pain scale.Results: A total of 26 articles involving 36 RCTs were used in this analysis: Although IRLA can lead to pain reduction, the result was not statistically significant when compared with no anesthesia or placebo gel (weighted mean difference [WMD]: -0.22, 95% CI: -0.45 to 0, P=0.06. PPNB can lead to significantly lower biopsy pain scores when compared with no analgesia (WMD: -1.32, 95% CI: -1.68 to -0.95, P<0.00001, placebo injection (WMD: -2.62, 95% CI: -3.16 to -2.07, P<0.00001, or IRLA (WMD: -1.31, 95% CI: -1.40 to -1.22, P<0.00001. PPNB + IRLA can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.45, 95% CI: -0.62 to -0.28, P<0.00001. PPNB + IPNB can lead to significantly lower biopsy pain scores when compared with PPNB alone (WMD: -0.73, 95% CI: -0.92 to -0.55, P<0.00001. There were no severe

  13. Proximal Tibial Bone Harvesting Under Local Anesthesia Without Intravenous Sedation in the Dental Office: A Case Report

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    Chun-Ming Chen

    2008-02-01

    Full Text Available Maxillary sinus enlargement often occurs in the maxillary posterior edentulous area and reduces the available bone height for implantation. Therefore, maxillary sinus lift and bone graft procedures are necessary to provide sufficient available bone. Autogenous bone grafting is the best base for implant osseointegration. Recently, tibial bone has been recognized as an alternative extraoral donor site. We present a case in which we used a proximal tibia bone graft for maxillary sinus augmentation under local anesthesia without sedation in the dental office. During a 4-year postoperative follow-up, gait was not disturbed and the scar on the donor site remained unremarkable.

  14. [Phantom head used to acquire skill in local anesthesia in the mandibular and maxillary regions (author's transl)].

    Science.gov (United States)

    Benkert, P; Seela, W

    1979-01-01

    This paper describes a phantom head used to acquire skill in local anesthesia in the mandibular and maxillary regions, thus helping students in putting theoretical knowledge into practice. An electric display device enables the student's proficiency level to be determined objectively. Five years' clinical testing of the phantom in the practical training of students shows the advantages of simulatory methods of training. Although this form of instruction cannot of course be regarded as an alternative to practical anesthetizing exercises on patients, yet it has proved a valuable addition to the various possible ways of putting theoretical knowledge into clinical practice.

  15. Dexmedetomidine-based monitored conscious sedation combined local anesthesia for levator resection in a 10-year-old child with Marcus Gunn jaw-winking synkinesis

    OpenAIRE

    Tu, Ye; Gao, Feng

    2017-01-01

    Abstract Rationale: Levator resection has become a routine procedure for patients with severe Marcus Gunn jaw-winking synkinesis (MGJWS). To optimize the surgical outcome, adult patients need to be kept awake, or easily aroused and responsive to verbal commands during the operation. However, levator resection is commonly performed under general anesthesia in pediatric patients. In the present case, we described a successful anesthetic protocol of conscious sedation with local anesthesia for l...

  16. Dental local anesthesia in Family Health Units: use, pain and associated factors

    OpenAIRE

    Cabral, Etenildo Dantas

    2015-01-01

    ABSTRACT BACKGROUND AND OBJECTIVES: In spite of the relevance of controlling pain during dental procedures and of the fundamental role of Family Health Units in the Brazilian health system, there are few studies integrating both subjects. So, this study aimed at analyzing some aspects of dental anesthesia in Family Health Units of the city of Caruaru-PE. METHODS: We have interviewed 372 adolescent and adult patients from 12 units, in the waiting room or close to it, after dental treatment, ...

  17. Anesthesia: What to Expect (For Parents)

    Science.gov (United States)

    ... child or any blood relative has had to anesthesia any allergies (especially to foods, medicines, or latex) your child ... from general anesthesia or feel the area if local or regional anesthesia was used? Will my child feel pain and/ ...

  18. Heart rate, salivary α-amylase activity, and cooperative behavior in previously naïve children receiving dental local anesthesia.

    Science.gov (United States)

    Arhakis, Aristidis; Menexes, George; Coolidge, Trilby; Kalfas, Sotirios

    2012-01-01

    Psychosomatic indicators, such as heart rate (HR), salivary alpha amylase (sAA) activity, and behavior, can be used to determine stress. This study's aim was to assess the pattern of changes of salivary alpha amylase, heart rate, and cooperative behavior in previously naïve children receiving dental treatment under local anesthesia. Included were 30 children with no prior dental experience who needed 4 or more sessions of dental treatment involving local anesthesia. In each session, sAA, HR, and behavior were assessed before and during the application of local anesthesia and at the end of the treatment. The highest sAA value was always observed at the end of each session; overall, the value was lower in the fourth session. HR always increased during the local anesthesia, and did not vary across sessions. No significant relationship was found between child cooperation and either sAA or HR. In this sample, child cooperation may not be an accurate indicator of stress. Based on salivary alpha amylase activity changes, dental treatment involving local anesthesia in naïve children appeared to be less stressful after 3 sessions.

  19. Local O2 Balance in Cerebral Ischemia-Reperfusion Improved during Pentobarbital Compared with Isoflurane Anesthesia.

    Science.gov (United States)

    Chi, Oak Z; Barsoum, Sylviana; Rah, Kang H; Liu, Xia; Weiss, Harvey R

    2015-06-01

    Most anesthetics affect cerebral blood flow and metabolism. We compared microregional O2 balance in cerebral ischemia-reperfusion during pentobarbital and isoflurane anesthesia. After 1 hour of middle cerebral artery occlusion and a 2-hour reperfusion under isoflurane (1.4%, n = 14) or pentobarbital (50 mg/kg, n = 14) anesthesia in rats, regional cerebral blood flow using (14)C-iodoantipyrine autoradiography, microregional arterial and venous O2 saturation (20-60 μm in diameter) using cryomicrospectrophotometry, and the size of cortical infarct were determined. Ischemia-reperfusion decreased the average cortical venous O2 saturation in both pentobarbital and isoflurane groups (P pentobarbital despite a similar average regional cerebral blood flow and O2 consumption. The heterogeneity of venous O2 saturation reported as a coefficient of variation (100 × standard deviation/mean) was smaller (P pentobarbital than that with isoflurane (7.5 versus 16.1). The number of veins with low venous O2 saturation (pentobarbital (5 of 80 versus 24 of 80). The percentage of cortical infarct in total cortex was smaller with pentobarbital (5.2 ± 2.5% versus 12.3 ± 2.6%, P pentobarbital than isoflurane anesthesia. This improvement in microregional O2 balance with pentobarbital was accompanied by the reduced cortical infarct. Our data suggest that the neurologic outcome could vary during cerebral ischemia-reperfusion depending on the anesthetics used. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Prostate innervation and local anesthesia in prostate procedures Inervação prostática e anestesia local em procedimentos prostáticos

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    Alexandre Oliveira Rodrigues

    2002-01-01

    Full Text Available The nerve supply of the human prostate is very abundant, and knowledge of the anatomy contributes to successful administration of local anesthesia. However, the exact anatomy of extrinsic neuronal cell bodies of the autonomic and sensory innervation of the prostate is not clear, except in other animals. Branches of pelvic ganglia composed of pelvic (parasympathetic and hypogastric (sympathetic nerves innervate the prostate. The autonomic nervous system plays an important role in the growth, maturation, and secretory function of this gland. Prostate procedures under local anesthesia, such as transurethral prostatic resections or transrectal ultrasound-guided prostatic biopsy, are safe, simple, and effective. Local anesthesia can be feasible for many special conditions including uncomplicated prostate surgery and may be particularly useful for the high-risk group of patients for whom inhalation or spinal anesthesia is inadvisable.A prostáta, uma das glândulas sexuais acessórias masculinas, possui inervação muito rica. A anatomia detalhada dos corpos neuronais extrínsecos responsáveis pela inervação autonômica e sensorial da próstata não está totalmente esclarecida, exceto em animais. A próstata é inervada pelos nervos pélvico (parassimpático e hipogástrico (simpático, ramos dos gânglios nervosos pélvicos. O sistema nervoso autonômico possui importante papel no crescimento, maturação e na função secretora desta glândula. Alguns procedimentos prostáticos, como resecção transuretral ou biópsia transretal guiada por ultra-sonografia, são simples, eficazes e seguros com o uso de anestesia local. Esta opção pode ser factível frente à várias condições especiais, como cirurgias prostáticas simples, sendo particularmente útil no grupo de pacientes de alto risco cirúrgico, onde a anestesia inalatória ou espinhal não é aconselhável.

  1. Herniorrafia inguinal em crianças: valor da anestesia local associada Inguinal hernia repair in children: importance of local anesthesia association

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    José Guilherme Minossi

    2002-07-01

    Full Text Available OBJETIVO: Descrever uma técnica de anestesia local no tratamento de hérnias inguinais em crianças. MÉTODO: Foram operadas 48 crianças com hérnias inguinais sob anestesia local na Santa Casa de Misericórdia de Cerqueira César, SP, sendo 34 do sexo masculino e 14 do sexo feminino, com idades entre 3 meses e 12 anos. Apenas quatro crianças tinham hérnia bilateral. A anestesia local foi realizada com lidocaína a 1% na dose de 5 mg/kg de peso através do bloqueio dos nervos abdominogenitais próximos à espinha ilíaca ântero-superior, à altura do anel inguinal externo e na pele ao redor da incisão. A sedação foi feita com cetamina na dose de 1 a 2 mg/kg e diazepam 0,2 a 0,4 mg/kg de peso. RESULTADOS: Todas as cirurgias puderam ser realizadas com tranqüilidade com este método, com exceção de uma criança em que o bloqueio não foi efetivo e a anestesia complementada com inalação de halogenado, sob máscara. Como complicações pós-operatórias, ocorreram três hematomas, sendo um de parede e dois em bolsa escrotal, todos com boa evolução. CONCLUSÕES: O uso da anestesia local associada à sedação é procedimento simples e seguro para realizar herniorrafias inguinais em crianças.AIM: To describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children. PATIENTS/METHODS: Forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "Santa Casa de Misericórdia de Cerqueira César", State of São Paulo, Brazil. There were 34 male and 14 female patients, range from 3 months to 12 years old. Local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. Sedation was done with an association of ketamine (1 to 2 mg/kg and diazepam (0,2 to 0,4 mg/kg. RESULTS: In all patients except one the procedure was

  2. Outpatient surgical treatment of female stress urinary incontinence under local anesthesia-sedation with contrasure needleless incision.

    Science.gov (United States)

    Navalón, V; Navalón, P; Pallás, Y; Ordoño, F; Monllor, E

    2014-01-01

    To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 to December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. Tolerance to the procedure was good. Surgical time was less than 10 minutes and stay in the hospital up to discharge less than 2hours. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation "minibands" due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

  3. [Prader-Willi syndrome case with proliferative diabetic retinopathy in both eyes treated by early vitrectomy under local anesthesia].

    Science.gov (United States)

    Hori, Hideyuki; Sato, Yukihiro; Nakashima, Motohiro; Nakajima, Motohiro

    2012-02-01

    Although patients with Prader-Willi syndrome have a high rate of diabetes, to date, there have been only 4 reported cases (6 eyes) undergoing vitrectomy for proliferative diabetic retinopathy. Herein, we report a case of Prader-Willi syndrome with proliferative diabetic retinopathy that was treated by early vitrectomy OU under local anesthesia. A 30-year-old man was diagnosed as having Prader-Willi syndrome at the age of 2 years and diabetes at age 17. He was referred to our hospital as diabetic retinopathy had been detected in his first ophthalmological examination at age 29. Visual acuity was 0.6 bilaterally. Proliferative retinopathy, with cataract and macular edema, was identified in both eyes. Panretinal photocoagulation was performed on both eyes. However, proliferative membranes developed bilaterally, and vitreous hemorrhage occurred OS. Visual acuity decreased to 0.3 OU. The patient was hospitalized at our internal medicine department for blood glucose control. Subsequently, with an anesthesiologist on standby, a hypnotic sedative was injected intramuscularly, achieving retro-bulbar anesthesia. Combined cataract and vitreous surgery was performed on the left eye. One week later, a similar operation was performed on the right eye. The patient was discharged four days later. In the two years since these operation, visual acuity has been maintained at 0.8 OU. Patients with Prader-Willi syndrome should be examined for early detection and treatment of diabetic retinopathy.

  4. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

    Science.gov (United States)

    Suresh, Santhanam; Ecoffey, Claude; Bosenberg, Adrian; Lonnqvist, Per-Anne; de Oliveira, Gildasio S; de Leon Casasola, Oscar; de Andrés, José; Ivani, Giorgio

    2018-02-01

    Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07-0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

  5. Administration of Anesthesia

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find ... Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to appropriately administer local ...

  6. Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation.

    Science.gov (United States)

    Allen, Rebecca H; Singh, Rameet

    2018-01-31

    Satisfactory pain control for women undergoing surgical abortion is important for patient comfort and satisfaction. Clinicians ought to be aware of the safety and efficacy of different pain control regimens. This document will focus on nonpharmacologic modalities to reduce pain and pharmacologic interventions up to the level of minimal sedation. For surgical abortion without intravenous medications, a multimodal approach to pain control may combine a dedicated emotional-support person, visual or auditory distraction, administration of local anesthesia to the cervix with buffered lidocaine and a preoperative nonsteroidal anti-inflammatory drug. Oral opioids do not decrease procedural pain. Oral anxiolytics decrease anxiety but not the experience of pain. Further research is needed on alternative options to control pain short of moderate or deep sedation. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Endovascular Therapy for Ruptured Cerebral Aneurysms in the Elderly: Poor Accessibility of the Guiding Catheter and Use of Local Anesthesia as the Predictors of Procedure-Related Rupture.

    Science.gov (United States)

    Fukuda, Hitoshi; Handa, Akira; Koyanagi, Masaomi; Yoshida, Kazumichi; Lo, Benjamin W Y; Yamagata, Sen

    2015-10-01

    Endovascular therapy is favored for ruptured intracranial aneurysms in the elderly. However, poor accessibility to the aneurysm through the parent artery and use of local anesthesia in this age group may predispose to intraprocedural complications. To evaluate whether age-related poor access to the ruptured target aneurysm and use of local anesthesia are associated with increased incidence of procedure-related rupture during endovascular embolization. A total of 117 patients with 117 ruptured aneurysms underwent endovascular embolization at a single institution. Correlation of increasing age with poor accessibility of the guiding catheter was analyzed. In addition, the distance from the aneurysm to the guiding catheter was investigated to identify an association with incidence of procedure-related rupture. Correlation of local anesthesia with procedure-related rupture was also evaluated in the multivariable analysis. Increasing age was significantly associated with poor accessibility of the guiding catheter (P = .001, Mann-Whitney U test). Procedure-related rupture occurred in 9 of 117 aneurysms (7.7%). Longer distance between distal aneurysms and low-positioned guiding catheters carried a higher risk of procedure-related rupture than a shorter distance between proximal aneurysms and high-positioned guiding catheters (odds ratio, 19.3; 95% confidence interval, 1.84-201; P = .01, multivariable analysis). Use of local anesthesia was also a significant risk factor of procedure-related rupture by multivariable analysis. Increasing age was correlated with poor accessibility of the guiding catheter in endovascular embolization of ruptured intracranial aneurysms. Distally located aneurysms treated through a low-positioned guiding catheter and use of local anesthesia increased the risk of procedure-related rupture.

  8. Efeitos cardiovasculares da anestesia local com vasoconstritor durante exodontia em coronariopatas Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

    Directory of Open Access Journals (Sweden)

    Valeria C. L. S. Conrado

    2007-05-01

    during or after dental treatment under anesthesia with vasoconstrictor (epinephrine. METHODS: A total of 54 coronary patients undergoing dental extraction under local anesthesia with or without vasoconstrictor were included. They were divided into two groups (by drawing envelopes: group I (27 patients using anesthetics with vasoconstrictor, and group II (27 cases without vasoconstrictor. 24-hour Holter monitoring, Doppler-echocardiogram before and after dental intervention, and determination of biochemical markers (CK-MB mass, CK-MB activity, and troponin T before and 24 hours after dental extraction were performed in all patients. Heart rate and blood pressure were also measured in the pre, post-anesthesia and post-dental extraction phases. Doppler echocardiography assessed left ventricular segmental contractility and the occasional occurrence of mitral regurgitation. The usual pharmaceutical treatment prescribed by the cardiologist was maintained in all cases. RESULTS: Three patients in group I presented ST-segment depression (1.0 mm during administration of anesthesia; two other patients in group I had CK-MB mass elevation, and ischemia was not observed in any other case, as assessed by the other methods. No chest pain, arrhythmias, occurrence or worsening of left ventricular segmental hypocontractility or mitral regurgitation were observed in the study. CONCLUSION: Dental extraction performed under anesthesia with 1:100,000 epinephrine does not imply additional ischemic risks, as long as performed with good anesthetic technique and maintenance of the pharmacological treatment prescribed by the cardiologist.

  9. Ophthalmologic complications after intraoral local anesthesia: case report and review of literature

    NARCIS (Netherlands)

    Steenen, Serge A.; Dubois, Leander; Saeed, Peerooz; de Lange, Jan

    2012-01-01

    Intraoral administration of local anesthetics is one of the most common dental procedures. Ophthalmologic complications can occur after maxillary as well as mandibular local anesthetic injections and may be underreported and sometimes misinterpreted. A review of the literature from the years

  10. The Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions

    NARCIS (Netherlands)

    Lirk, Philipp; Hollmann, Markus W.; Strichartz, Gary

    2017-01-01

    Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Next to their classic action on voltage-gated sodium channels, local anesthetics

  11. The effect of preoperative administration of morphine in alleviating intraoperative pain of percutaneous transforaminal endoscopic discectomy under local anesthesia: A STROBE compliant study.

    Science.gov (United States)

    Fan, Yunshan; Gu, Guangfei; Fan, Guoxin; Zhu, Yanjie; Yang, Yitao; Gu, Xin; Zhang, Hailong; He, Shisheng

    2017-10-01

    Local anesthesia is routinely recommended for percutaneous transforaminal endoscopic discectomy (PTED). However, the intense intraoperative pain remains a serious problem. The purpose of the current study is to find a safe and effective method to alleviate the intense pain during PTED for lumbar disc herniation (LDH) under local anesthesia.This study retrospectively analyzed 63 LDH patients who accepted PTED under local anesthesia. Thirty-one patients received intramuscular injection of morphine before PTED, while the other 32 were not. The 10 points visual analogue scale (VAS) was used to assess the patients' maximum leg and back pain. Patients were asked to grade their experiences of surgery and anesthesia on a 5-point Likert-type scale after the surgery. Modified Mac Nab Criteria were used to evaluate the surgical outcomes after 3-month follow-up.The intraoperative VAS scores of patients who accepted preoperative intervention decreased significantly. The postoperative VAS scores of both groups showed no significance. Patients who received preoperative intervention reported a higher subjective satisfaction rate with the surgery experience. According to the Modified Mac Nab criteria, the surgical outcomes of both groups were similar through the 3-month follow-up. After injection of morphine, 4 patients complained nausea and 2 patients experienced vomiting.Preoperative intramuscular injection of morphine could reduce the patients' pain during the PTED surgery and improve the patients' satisfaction without affecting the surgical outcome. Except for a higher incidence of nausea and vomiting, this method is relatively safe and convenient.

  12. Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing – A split-mouth clinical trial

    Directory of Open Access Journals (Sweden)

    Kalyan Chintala

    2017-01-01

    Full Text Available Background and Aim: Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. Materials and Methods: Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group. Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. Results: No difference was observed in visual analog scale (P > 0.05 and verbal rating scale (P > 0.05 pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47% was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05. Conclusion: Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.

  13. Topical anesthesia

    Science.gov (United States)

    Kumar, Mritunjay; Chawla, Rajiv; Goyal, Manish

    2015-01-01

    Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects. PMID:26702198

  14. Topical anesthesia

    Directory of Open Access Journals (Sweden)

    Mritunjay Kumar

    2015-01-01

    Full Text Available Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

  15. Efficacy and safety of bupivacaine versus lidocaine in local anesthesia of the nasopharynx: A meta-analysis.

    Science.gov (United States)

    Yu, Xiaoyun; Wang, Jiyun; Huang, Lizhen; Yu, Xiao; He, Zheyun

    2016-09-30

    To assess the efficacy and safety of bupivacaine compared with lidocaine in local anesthesia of nasopharynx through meta-analysis. A number of medical literature data bases were searched electronically. Relevant journals and references of included studies were manually searched. Two reviewers independently performed data extraction and quality assessment. Four studies were included. Visual analog scale (VAS) scores, acceptable discomfort, and bleeding scores were analyzed for bupivacaine versus lidocaine. When considering the VAS scores, bupivacaine as a local anesthetic agent was better than lidocaine in controlling the pain of postoperative patients (p bupivacaine group demonstrated a higher acceptable discomfort than the patients in the lidocaine group (p = 0.008). With regard to the bleeding scores of the patients with nasal surgery, lidocaine was better at bleeding in postoperative patients compared with bupivacaine (p = 0.0007). These results indicated that bupivacaine showed better pain control of postoperative patients and acceptable discomfort in patients with upper gastrointestinal endoscopy. Lidocaine had a significantly increased ability the pain of patients with transnasal fiberoptic nasopharyngolaryngoscopic examination and bleeding in postoperative patients. No systemic adverse events were reported. Bupivacaine was found to have better promotion to pain control than did lidocaine for the patients after nasal surgery. Lidocaine had a significantly increased inhibition of bleeding in these postoperative patients; however, the efficacy between bupivacaine and lidocaine was unclear for the patients who had transnasal endoscopic examinations.

  16. Onset and duration of anesthesia for local anesthetic combinations commonly used in forefoot surgery; surprise results with sequential blocks.

    Science.gov (United States)

    Blazer, Marie Mantini; Petrozzi, Rocco; Harris, Samantha Y; Greer, Hillary; Goldfarb, Jacqueline; Biernacki, Tomasz; Kawalec, Jill S

    2015-06-01

    Local anesthetic nerve blocks are frequently used for postoperative analgesia and to the best of our knowledge no studies have evaluated the effects of injecting bupivacaine into an area previously injected with lidocaine. Sensation was tested in three groups of subjects receiving local anesthetic digital blocks. Group A received bupivacaine 0.25% plain. Group B received a 1:1 mixture of lidocaine 1% plain and bupivacaine 0.25%. Group C received an initial block of lidocaine 1% plain sequentially followed by bupivacaine 0.25% 1h later. Bupivacaine exhibited a delayed onset and the longest duration when compared to the other two groups. The group receiving the 1:1 mixture showed a rapid onset that resembled that of lidocaine and a shortened duration that did not resemble bupivacaine. The group receiving the sequential injections showed that even after a 1h interval following the lidocaine infiltration, there was a deleterious effect on duration of action of the bupivacaine. Using bupivacaine as a post-surgical block in the presence of residual lidocaine from a preoperative block is not warranted as once again, the extended duration of bupivacaine is mitigated. Bupivacaine alone as an initial operative block affords clinically acceptable onset of anesthesia while also providing extended duration of action. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. General anesthesia

    Science.gov (United States)

    ... generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Alternative Names Surgery - general anesthesia Patient Instructions Anesthesia - what to ask your doctor - adult ...

  18. The Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions.

    Science.gov (United States)

    Lirk, Philipp; Hollmann, Markus W; Strichartz, Gary

    2017-11-17

    Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Next to their classic action on voltage-gated sodium channels, local anesthetics interact with calcium, potassium, and hyperpolarization-gated ion channels, ligand-gated channels, and G protein-coupled receptors. They activate numerous downstream pathways in neurons, and affect the structure and function of many types of membranes. Local anesthetics must traverse several tissue barriers to reach their site of action on neuronal membranes. In particular, the perineurium is a major rate-limiting step. Allergy to local anesthetics is rare, while the variation in individual patient's response to local anesthetics is probably larger than previously assumed. Several adjuncts are available to prolong sensory block, but these typically also prolong motor block. The 2 main research avenues being followed to improve action of local anesthetics are to prolong duration of block, by slow-release formulations and on-demand release, and to develop compounds and combinations that elicit a nociception-selective blockade.

  19. Continuous spinal anesthesia.

    Science.gov (United States)

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a

  20. Anesthesia Basics

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anesthesia Basics KidsHealth / For Teens / Anesthesia Basics What's in ... español Conceptos básicos sobre la anestesia What Is Anesthesia? No doubt about it, getting an operation can ...

  1. Intracranial hemorrhagic infarct after local anesthesia on nasal mucosa: A case report

    Directory of Open Access Journals (Sweden)

    Murat Koçyiğit

    2015-01-01

    Conclusion: We want to emphasize that all surgeons especially the ENT surgeons should be careful while using local anesthetic medicines which contains adrenaline for rare complication of intracranial hemorrhagic infarction. Another fact is that the patients must sign an informed consent form including those situations even for all minor surgical procedures to avoid a medicolegal problem.

  2. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia

    Directory of Open Access Journals (Sweden)

    Krishna P. Shetty

    2016-03-01

    Full Text Available Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS. After checking the vital signs the initial pulpal oxygen saturation (initial SpO2 was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2 was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2 was measured. Results. The mean initial (SpO2 was 96.37% which significantly decreased to 90.76% (SpO2 after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2 after administration of local anesthetic solution. Statistical significance was set at P<0.0001. Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury.

  3. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...

  4. The anesthetic techniques of local anesthesia during the rumenotomi in cattle

    OpenAIRE

    Dashamir Mamuti; Paskal Gjino

    2013-01-01

    The present study comprises 12 female cows on one farm in Tirana district. The purpose of this study is to investigate and evaluate the efficiency of three common local anesthetics techniques used during rumenotomi. The purpose was to compare different conditions and types of foreign bodies syndrome which precipitated the need to perform the surgical intervention. The selected cows were divided into four groups with three cows belonging to each one of them. Rumenotomi was performed under the ...

  5. The pharmacokinetics and effects of meloxicam, gabapentin, and flunixin in postweaning dairy calves following dehorning with local anesthesia.

    Science.gov (United States)

    Glynn, H D; Coetzee, J F; Edwards-Callaway, L N; Dockweiler, J C; Allen, K A; Lubbers, B; Jones, M; Fraccaro, E; Bergamasco, L L; KuKanich, B

    2013-12-01

    Approved analgesic compounds in cattle are not currently available in the United States due to the lack of validated pain assessment methods and marker residue depletion studies. In this study, we compared the pharmacokinetic parameters and effect of preemptive analgesics administered to calves subjected to dehorning with local anesthesia. Holstein steers were randomly assigned to receive one of the following treatments per os (PO) or intravenously (IV) (n = 8/group): meloxicam (1 mg/kg PO), gabapentin (15 mg/kg PO), meloxicam (1 mg/kg), and gabapentin (15 mg/kg) PO, flunixin (2.2 mg/kg IV), or a placebo. Plasma drug, haptoglobin, substance P (SP) concentrations, serum cortisol concentrations, ocular thermography, mechanical nociceptive threshold (MNT), and average daily gain (ADG) were evaluated. Data were analyzed using mixed-effects models and noncompartmental pharmacokinetic analysis. Meloxicam, gabapentin, and meloxicam with gabapentin at the present doses did not reduce cortisol concentrations. Analgesic-treated calves had significantly lower plasma SP concentrations and improved ADG compared with controls. Flunixin calves had reduced circulating cortisol compared with controls. Meloxicam-treated calves showed an increase in MNT at two horn bud sites compared with the other treatments. Analgesics improved ADG and reduced biomarkers of pain, but effects differed by compound and route of administration. © 2013 John Wiley & Sons Ltd.

  6. The Effect of Different Local Anesthesia Methods on Pain Relief in Outpatient Endometrial Biopsy: Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Elaheh Olad-Saheb-Madarek

    2013-08-01

    Full Text Available Introduction: Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. Methods: In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB, candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3- intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Results: Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Conclusion: Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect.

  7. Modified Inguinal Microscope-Assisted Varicocelectomy under Local Anesthesia: A Non-randomised Controlled Study of 3565 Cases.

    Science.gov (United States)

    Wang, Jin; Liu, Qian; Wang, Xun; Guan, Rijian; Li, Sen; Zhang, Youpeng; Cheng, Yongbiao; Zeng, Hanqing; Tang, Yong; Zhu, Zhaohui

    2018-02-12

    Varicocele is a common abnormality, but the conventional microsurgical subinguinal varicocelectomy (CMSV) has some disadvantages. We invented Modified Inguinal Microscope-Assisted Varicocelectomy (MIMV) under local anesthesia. This study aims to evaluate MIMV by comparing it to CMSV in operating duration, time to return to normal activity, postoperative complications, achievement of natural pregnancy and improvement of semen quality for patients with infertility, pain score for those with scrotal pain, and so on. We enrolled 3089 patients who underwent MIMV and 476 who underwent CMSV in our hospital. Both the operating duration and the time to return to normal activity of MIMV was shorter than that of CMSV (P < 0.001). The recurrence rate (P < 0.001) and injury rate of vas deferens (P = 0.011) after MIMV were lower than that after CMSV. Moreover, patients with MIMV showed higher degree of satisfaction with the surgery experience and outcome than those with CMSV (P < 0.001). However, no statistical difference was found between the two groups in scores of pain due to surgery, postoperative varicose veins diameters, reflux duration, and the postoperative complications of wound infection, hydrocele, atrophy of testis, epididymitis, and scrotal hematoma. In summary, MIMV is a promising varicocelectomy and could be applied more in clinical practice.

  8. Cardiovascular effects of local anesthesia with vasoconstrictor during dental extraction in coronary patients

    OpenAIRE

    Conrado, Valeria C. L. S.; Andrade, Januário de; Angelis, Gabriella A. M. C. de; Andrade, Ana Carolina P. de; Timerman, Lilia; Andrade, Mercedes M.; Moreira, Dalmo R.; Sousa, Amanda G. M. R.; Sousa, J. Eduardo M. R.; Piegas, Leopoldo S.

    2007-01-01

    OBJETIVO: Avaliar a ocorrência de variáveis detectoras de isquemia miocárdica, durante ou após o tratamento odontológico, sob anestesia com vasoconstritor (adrenalina). MÉTODOS: Foram incluídos 54 pacientes coronariopatas submetidos a exodontia sob anestesia local com ou sem vasoconstritor, divididos em dois grupos (sorteio por envelope): grupo I, composto por 27 que receberam anestésico com vasoconstritor; e grupo II, composto por 27 que receberam anestésico sem vasoconstritor. Todos os paci...

  9. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures

    Science.gov (United States)

    Davoudi, Amin; Rismanchian, Mansour; Akhavan, Ali; Nosouhian, Saeid; Bajoghli, Farshad; Haghighat, Abbas; Arbabzadeh, Farahnaz; Samimi, Pouran; Fiez, Atiyeh; Shadmehr, Elham; Tabari, Kasra; Jahadi, Sanaz

    2016-01-01

    Dental anxiety and fear of needle injection is one of the most common problems encountered by dental practitioners, especially in the pediatric patient. In consequences, it might affect the patient's quality of life. Several methods are suggested to lower the discomfort of local anesthesia injection during dental procedures. Desensitization of injection site is one of the recommended strategies. Among chemical anesthetic topical agents that are effective but might have allergic side effects, using some nonpharmacological and safe techniques might be useful. This study aimed to overview the efficacy of using cooling techniques, mostly by ice or popsicles, warming or pH buffering of drug, and using modern devices to diminish the discomfort of local anesthesia injection during dental procedures. PMID:26957683

  10. Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration

    DEFF Research Database (Denmark)

    Honnens de Lichtenberg, M; Miskowiak, J; Mogensen, P

    1992-01-01

    A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration...... analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly....

  11. [Comparison of two methods for conscious sedation in maxillofacial surgery with local anesthesia].

    Science.gov (United States)

    Zöller, J; Zöller, B; Hassfeld, S; Köhler, J

    1992-01-01

    A randomised, prospective study was conducted to compare the efficiency and safety of methods for intravenous conscious sedation in patients undergoing oral surgery under local analgesia. 150 systemically healthy patients (ASA Class I and II) participated. Three groups were formed: group 1 received 0.05 mg/kg midazolam; group 2 0.05 mg/kg midazolam, 1.5 mg/kg tramadol, 50 mg alizaprid; group 3 0.05 mg/kg midazolam, 0.2 mg/kg nalbuphine, 50 mg alizaprid. Blood pressure, heart rate and oxygen saturation were measured throughout the procedure. The results confirmed that the use of nalbuphine (group 3) allows a reduction in the mean dosage of midazolam required to produce satisfactory sedation and effected a more rapid recovery time compared to group 12 and 2. With the combination nalbuphine and alizaprid nausea and vomiting could be reduced for the most part compared to group 2.

  12. A Comparison of Three Drug Combinations for Sedation during Middle Ear Surgeries under Local Anesthesia: A Multicentric Randomized Double Blind Study

    OpenAIRE

    Vikas Kumar; Jyotsna S. Paranjpe; Shishir D. Gosavi; Ruta H. Kulkarni; Rahul S. Gosavi; Tanuja M. Kulkarni

    2015-01-01

    Background: During Middle Ear Surgeries (MES) done under Local Anesthesia (LA), patients may feel discomfort due to noise of suction, manipulation of instruments, positioning of head-neck and sometimes due to pain. A bloodless microscopic field is also essential to facilitate surgical exposure in MES. Various combinations of analgesics and sedatives have been tried to alleviate apprehension of the patients and improve microscopic field which may result into reductio...

  13. [Therapeutic local anesthesia for the management of atypical odontalgia. A clinical case series].

    Science.gov (United States)

    Türp, Jens Christoph

    2005-01-01

    The management of patients diagnosed with atypical odontalgia (AO) is a challenging task. The aim of this longitudinal clinical case series was to document the effect of a 4% carticaine solution without epinephrine among ten patients with AO. Once or on two successive days, 1.7 ml of the local anesthetics was injected buccally in the area of the perceived pain. Pain intensity was recorded four times daily by each participant, beginning at least two weeks prior to the treatment and ending at least four weeks thereafter. The main outcome parameter was pain reduction (in percent) four weeks after treatment compared to the average pain intensity before the injection(s). In addition, study participants were asked to rate their satisfaction with the treatment. Four weeks after treatment, seven of the ten patients experienced significantly less pain than before. Among five individuals, there was a significant pain decrease (about 30% or more). Patient satisfaction was not significantly associated with the amount of pain reduction. Considering the limited treatment options and their side effects, injections with epinephrine-free carticaine seem to be a measure worth to be taken into consideration. Although results gained from uncontrolled case series have to be interpreted with caution, the findings of this observational study sound promising.

  14. Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure Ensaio clínico randomizado comparando raquianestesia com anestesia local, associadas à sedação para o fechamento de colostomia em alça

    Directory of Open Access Journals (Sweden)

    Rone Antônio Alves de Abreu

    2010-09-01

    Full Text Available CONTEXT: Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure. OBJECTIVES: Randomized clinical trial to compare the results from these two techniques. METHODS: Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25 and using local anesthesia (n = 25. Preoperatively, the bowel was evaluated by means of colonoscopy, and bowel preparation was performed with 10% oral mannitol solution and physiological saline solution for lavage through the distal colostomy orifice. All patients were given prophylactic antibiotics (cefoxitin. Pain, analgesia, reestablishment of peristaltism or peristalsis, diet reintroduction, length of hospitalization and rehospitalization were analyzed postoperatively. RESULTS: Surgery duration and local complications were greater in the spinal anesthesia group. Conversion to general anesthesia occurred only with spinal anesthesia. There was no difference in intraoperative pain between the groups, but postoperative pain, reestablishment of peristaltism or peristalsis, diet reintroduction and length of hospitalization were lower with local anesthesia. CONCLUSIONS: Local anesthesia plus sedation offers a safer and more effective method than spinal anesthesia for loop colostomy closure.CONTEXTO: Estudos recentes têm demonstrado que a anestesia local para o fechamento de colostomia em alça é tão segura quanto a raquianestesia para estes procedimentos. OBJETIVOS: Comparar os resultados do fechamento de colostomia em alça usando essas duas técnicas. MÉTODOS: Cinquenta pacientes foram randomizados para o fechamento de colostomia em alça sob raquianestesia (n = 25 e anestesia local (n = 25. No pré-operatório, o cólon foi avaliado por colonoscopia e o preparo intestinal foi realizado com solução oral de manitol a 10% e limpeza com solução salina fisiológica através do orifício distal da colostomia. Todos os

  15. Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy.

    Science.gov (United States)

    Chaki, Tomohiro; Sugino, Shigekazu; Janicki, Piotr K; Ishioka, Yoshiya; Hatakeyama, Yosuke; Hayase, Tomo; Kaneuchi-Yamashita, Miki; Kohri, Naonori; Yamakage, Michiaki

    2016-01-01

    Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed. Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

  16. Lipid emulsion injection-induced reversal of cardiac toxicity and acceleration of emergence from general anesthesia after scalp infiltration of a local anesthetic: a case report.

    Science.gov (United States)

    Hoshino, Rintaro; Kamiya, Yoshinori; Fujii, Yuka; Tsubokawa, Tsunehisa

    2017-01-01

    A scalp block or wound infiltration of local anesthetic is thought to effectively control post-craniotomy pain. However, it can result in local anesthetic toxicity (LAST), which is difficult to distinguish from brain damage due to the surgical procedure when emergence from general anesthesia is delayed. Lipid rescue (infusion of a lipid emulsion) is a widely accepted treatment for LAST. A 64-year-old man underwent surgical resection of a glioma in the brainstem. While still under general anesthesia, and before suturing of the wound, he received a 20-mL scalp infusion of ropivacaine 0.75%. His emergence from anesthesia was delayed, his respiration was suppressed, and premature ventricular contractions occurred; all of which are symptoms of LAST. Injection of a 20% lipid emulsion rapidly alleviated these symptoms. Interestingly, the blood concentration of ropivacaine increased after lipid rescue. The increase in ropivacaine concentration in the blood after lipid rescue suggests that the intravenously administered lipid emulsion absorbed the ropivacaine from the intoxicated brain and heart tissue. This finding is consistent with the lipid sink theory as a mechanistic explanation of lipid rescue.

  17. Resultados imediatos da herniorrafia inguinal com anestesia local associada com sedação Immediate results of inguinal hernia repair with local anesthesia associated with sedation

    Directory of Open Access Journals (Sweden)

    Edgar Valente de Lima Neto

    2003-10-01

    Full Text Available OBJETIVO: Avaliar os resultados imediatos da herniorrafia inguinal com anestesia local associada com sedação. MÉTODOS: Foram operados 30 pacientes portadores de hérnia inguinal, sendo 26 (86,6% do sexo masculino e 4 (13,4 do sexo feminino. Os anestésicos utilizados foram lidocaína a 1% e bupivacaína a 0,5% sem adrenalina, tendo sido adicionado 1mL de bicarbonato de sódio para cada 9mL da solução anestésica. A sedação foi realizada com midazolan. As hérnias mais freqüentes, de acordo com a classificação de Nyhus, foram as do tipo I, encontradas em 16 (53,3% pacientes. Praticou-se o reparo da parede posterior a em 17 (56,6% e em 13 (43,2% o reparo com prótese. Para a análise estatística utilizou-se o teste de McNemar para avaliar a correlação entre os escores de dor na escala E.V.A. agrupada. RESULTADOS: Em nenhum paciente houve necessidade de mudança da técnica anestésica. Entre as complicações, observaram-se: 1 (3,3% hematoma; 1 (3,3% sangramento e 1 (3,3% infecção da ferida operatória. A deambulação foi precoce em 28 (93,3% pacientes, assim como a alimentação oral. O tempo de internação médio foi 18 horas, e o escore de dor na escala visual analógica (E.V.A. foi menor ou igual a 3 em 80% dos pacientes. CONCLUSÃO: A anestesia local com sedação é um método seguro, eficaz, com baixos índices de complicações imediatas, e alto índice de satisfação para pacientes selecionados, portadores de hérnia inguinal.PURPOSE: To present the immediate results of the inguinal hernia repair with local anesthesia associated with sedation. METHODS: Thirty patients were operated on of which 26 (86,6% were male. The age varied from 21 to 76, and the average was of 47 years. The anesthetics used were lidocaine and bupivacaine, and the sedation was accomplished with midazolan. RESULTS: Among the complications was observed: 1 (3,3% bruising; 1 (3,3% blood; and 1 (3,3% case of infection of the operative wound. Early rise

  18. [The anesthesia of anesthesia].

    Science.gov (United States)

    Pfleiderer, G

    2005-03-01

    Viewed from a cultural-ethical perspective, anesthesiology can be understood as a comprehensive concept of medicine in general. As such it contains two dilemmas: very often pain must be inflicted in order to alleviate pain and this can only be done by somebody who is himself relatively free of pain. The necessary apathy or anesthesia of the anesthetist is correlated with a general twentieth century-type of perception: the cool observer. Nevertheless, it is also a modern variation of the original religious constellation of the priest in relationship to the sick person. Curing occurs by representation. The weak self of the sick person is able to take over the strong self, represented by the therapist. In twentieth century art and literature this process of self-therapy by representation was often illustrated. On the background of a phenomenological philosophy that process can be understood as the regaining of a balance between body and soul. In the psalms of the biblical Book of Job there a variety of fundamental forms of pain which may be helpful even in this secular age.

  19. Dexmedetomidine-based monitored conscious sedation combined local anesthesia for levator resection in a 10-year-old child with Marcus Gunn jaw-winking synkinesis: A case report.

    Science.gov (United States)

    Tu, Ye; Gao, Feng

    2017-12-01

    Levator resection has become a routine procedure for patients with severe Marcus Gunn jaw-winking synkinesis (MGJWS). To optimize the surgical outcome, adult patients need to be kept awake, or easily aroused and responsive to verbal commands during the operation. However, levator resection is commonly performed under general anesthesia in pediatric patients. In the present case, we described a successful anesthetic protocol of conscious sedation with local anesthesia for levator resection in a child. A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The patient was born through a normal delivery and had no previous history of allergy, no comorbidity, and no history of receiving anesthesia or operation. The laboratory tests of the patient were unremarkable. The diagnosis of MGJWS was made by two experienced ophthalmologists. A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The levator resection was performed under monitored conscious sedation with dexmedetomidine and local anesthesia. Patient with spontaneous breathing responded normally to verbal commands throughout the operation, and no adverse events occurred. The patient and ophthalmologist reported high satisfaction with anesthesia management. Dexmedetomidine-based monitored conscious sedation with local anesthesia is a feasible alternative to general anesthesia for levator resection in collaborative patients. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  20. Effects of Anesthesia

    Science.gov (United States)

    ... Media ASA Member Toolkit Anesthesia 101 Effects of Anesthesia Explore this page: Effects of Anesthesia How can ... of anesthesia and their side effects? Effects of Anesthesia If you’re having surgery, you most likely ...

  1. Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and for Patients in a Resource-Strained Environment.

    Science.gov (United States)

    Mahmood, Shaikh Danish; Waqas, Muhammad; Baig, Mirza Zain; Darbar, Aneela

    2017-10-01

    Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA). This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged 55 years or older undergoing surgery for CSDH. Clinical characteristics, hospital stay, and recurrence rates were compared between 2 groups, local versus general anesthesia. Thirty-five patients underwent mini-craniotomy for CSDH in the study period. Sixteen patients underwent mini-craniotomy under LA versus 19 patients for GA. Median age for the LA group was 67 years compared with 70 years in the GA group. Four patients from the LA group experienced postoperative complications versus 7 from the GA group. Only one patient in the LA group required an ICU bed in the postoperative period. There was no recurrence in LA group. The overall recurrence was 2.86%. Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Milligan-Morgan hemorrhoidectomy under local anesthesia - an old operation that stood the test of time. A single-team experience with 2,280 operations.

    Science.gov (United States)

    Argov, Samuel; Levandovsky, Olga; Yarhi, Danielle

    2012-07-01

    This study was carried out to evaluate the morbidity and efficacy of Milligan-Morgan (M&M) hemorrhoidectomy in comparison to novel techniques (e.g., hemorrhoidal artery ligation [HAL], stapler hemorrhoidopexy [PPH]). This is a retrospective review of a single-team experience with 2,280 M&M hemorrhoidectomy patients, with 1-12 years follow-up. All patients were operated upon in jack-knife position, using local anesthesia under light sedation in an ambulatory facility. This method allowed us to operate on 40 pregnant women. All operations were performed using simple, commercially available instruments. We found negligible morbidity, no mortality and a very efficient operation on long-term follow-up. The surgical literature is littered with dreadful complications and even mortality from stapled hemorrhoidopexy (Giordano et al., Dis Colon Rectum 51:1574-1576, 2008; Brown et al., Tech Coloproctol 11:357-358, 2007; Cipriani and Pescatori, Colorectal Dis 4:367-370, 2002; Mongardini et al., G Chir 26:275-277, 2005) and the inefficiency of Doppler HAL (Faucheron and Gangner, Dis Colon Rectum 51:945-949, 2008; Scheyer et al., Am J Surg, 191:89-93, 2006). In days of soaring medical expenditures, nobody will argue about the superiority of M&M hemorrhoidectomy as the cheapest operation available. In all aspects, M&M hemorrhoidectomy under local anesthesia beats its competitors in terms of morbidity, mortality, long-term efficiency and low cost.

  3. Anesthesia Fact Sheet

    Science.gov (United States)

    ... Education About NIGMS NIGMS Home > Science Education > Anesthesia Anesthesia Tagline (Optional) Middle/Main Content Area En español ... Version (464 KB) Other Fact Sheets What is anesthesia? Anesthesia is a medical treatment that prevents patients ...

  4. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ... and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively trained to ...

  5. A Prospective, Comparative Study of the Pain of Local Anesthesia Using 2% Lidocaine, 2% Lidocaine With Epinephrine, and 2% Lidocaine With Epinephrine-Bupivicaine Mixture for Eyelid Surgery.

    Science.gov (United States)

    Han, Jung-Woo; Nah, Seung Kwan; Lee, Sang Yeul; Kim, Chang Yeom; Yoon, Jin Sook; Jang, Sun Young

    A mixture of 2% lidocaine with epinephrine and bupivacaine was developed to achieve the fast-onset anesthetic effect of lidocaine and the long-lasting effect of bupivacaine. The authors compared pain scores between 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture during local anesthesia for eyelid surgeries. This was a double-blind, randomized, prospective, comparative study. In total, 120 consecutive patients (43 males, 77 females, mean age = 47.2 ± 21.2) who underwent bilateral eyelid surgery under subcutaneous anesthesia were asked to report pain scores for each eye during the first injection of anesthesia. Each patient was randomly assigned to receive 1 of the 3 anesthetic agents in 1 eyelid, and 1 of the remaining 2 agents in the other. The pH values of the 2% lidocaine, 2% lidocaine with epinephrine, and 2% lidocaine with epinephrine-bupivicaine mixture were 6.23 ± 0.21, 4.21 ± 0.37, and 3.87 ± 0.19, respectively. The pain scores of each were 4.3 ± 1.8, 5.1 ± 1.8, and 5.7 ± 1.9, respectively. The 2% lidocaine with epinephrine produced a statistically significantly higher pain score than 2% lidocaine (p = 0.044, generalized estimating equation method). The mixture also showed a significantly higher pain score than 2% lidocaine (p = 0.003, generalized estimating equation method). Epinephrine seemed to increase subjective pain scores. Compared with 2% lidocaine with epinephrine, 2% lidocaine with epinephrine-bupivicaine mixture was not significantly different in terms of subjective symptoms or pH.

  6. Hernias inguinales bilaterales operadas con anestesia local mediante hernioplastia de Lichtenstein Bilateral inguinal hernias operated on with local anesthesia by Lichtenstein hernioplasty

    Directory of Open Access Journals (Sweden)

    Bárbaro Agustín Armas Pérez

    2009-03-01

    . A descriptive cross-sectional study was conducted among the first 38 patients operated on by Lichtenstein's technique with local anesthesia (Braun and Sheleider's combined technique. The patients underwent ambulatory surgery between January 2001 and December 2007. The patients operated on in the morning were discharged in the afternoon, whereas those operated in the afternoon were discharged next morning in order to prevent the ecchymosis with the early mobilization. RESULTS. Four of the patients had recurrent hernias. The most used prosthetic material was polypropilene (86.9 %. The complications accounted for 9.1 % (referred not to the 38 patients, but to the 76 hernioplasties. After a follow-up ranging from 1 to 36 months, a rejection to the prosthetic material (1.3 % and a relapse (1.3 % were observed. CONCLUSIONS. It was concluded that this material may be applied to bilateral hernias, since stress, institutional costs and the patient's discomforts are reduced, showing this way its efficiency.

  7. Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla

    Directory of Open Access Journals (Sweden)

    Kämmerer PW

    2018-03-01

    Full Text Available Peer W Kämmerer, Monika Daubländer Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Centre Mainz, Mainz, GermanyWe read the article by Al-Shayyab1 with great interest, though we think that there is a methodical bias. Usage of standard dental syringes with 27-gauge needles is not recommended for periodontal ligament (PDL injections as they are very unlikely to achieve the correct pressure needed for successful single tooth anesthesia. In accordance with this, specialized syringes with short 30-gauge needles are commonly used all over the literature.2 The author addresses this in the “Discussion” section and writes that “a standard conventional dental syringe was used in the present study, not a special PDL syringe, since the former is readily available in the clinic and proves equally successful when a standard 27-gauge short needle was used,” citing Malamed from 1982 (a time during which the modern PDL syringes were not developed yet3 and Madan et al who write that “intraligamentary injection technique is equally effective when a standard 27-gauge needle is used”.4 The second assumption refers to the needle only, not the syringe. In addition, this needle issue is not proven by any reference or study. Therefore, one might come to the conclusion that PDL was not carried out correctly. Also, the authors did not evaluate pulp or tissue anesthesia and started the extraction procedure after a latency period of 5 minutes in all cases. In accordance with this, the success rates of the PDL injection cannot be given, but would be of interest.View the original paper by Al-Shayyab and colleagues.

  8. Current trends in local anesthesia in cosmetic plastic surgery of the head and neck: results of a German national survey and observations on the use of ropivacaine.

    Science.gov (United States)

    Koeppe, Tobias; Constantinescu, Mihai A; Schneider, Jochen; Gubisch, Wolfgang

    2005-05-01

    The goal of this study was to evaluate at the national level the current practice in the use of local anesthetics in cosmetic head and neck surgery and to compare the results with the novel local anesthesia technique used in the authors' department over the past 2 years. A questionnaire was posted to all 211 board-certified members of the Association of German Plastic Surgeons. The questions related to the daily practice in rhinoplasty, blepharoplasty, otoplasty, face lift, and forehead lift. The focus was laid on anesthesia techniques, local anesthetics, vasoconstricting agents, dosages, activity onset, observed side effects, mean duration of each procedure type, and surgeon satisfaction with the anesthetic used. A total of 86 questionnaires (40.8 percent) were returned. The overall analysis revealed that local anesthetics were used in 88.9 percent of all cosmetic procedures of the head and neck. Prilocaine 1% (Xylonest; AstraZeneca, Wedel, Germany) was the most frequently used local anesthetic (32.0 percent), followed by lidocaine 1% (Xylocaine; AstraZeneca) and mepivacaine 1% (Scandicaine; AstraZeneca). Ropivacaine 0.2% (Naropin; AstraZeneca) was used only by 1.1 percent and ropivacaine 0.75% only by 0.9 percent (including two of the authors). Approximately half of the respondents (47.2 percent) used epinephrine 1:100,000 for vasoconstriction. In face lifts, the necessity of repeated "top-up" infiltration was reported in more than half (54.7 percent) of the procedures. Ten percent of surgeons surpassed the maximum recommended dosages when working without ropivacaine. Overall adverse cardiovascular effects were reported in 5.9 percent of rhinoplasties and 8.1 percent of face lifts performed mostly with prilocaine and lidocaine. No adverse cardiovascular reactions or overdoses were noticed with the use of ropivacaine. The survey showed a clear trend toward the increasing use of local anesthetics in cosmetic surgery of the head and neck. Although the use of

  9. Factors predictive of the onset and duration of action of local anesthesia in mandibular third-molar surgery: a prospective study.

    Science.gov (United States)

    Al-Shayyab, Mohammad H; Baqain, Zaid H

    2018-04-01

    The aim of this study was to assess the influence of patients' and surgical variables on the onset and duration of action of local anesthesia (LA) in mandibular third-molar (M3) surgery. Patients scheduled for mandibular M3 surgery were considered for inclusion in this prospective cohort study. Patients' and surgical variables were recorded. Two per cent (2%) lidocaine with 1:100,000 epinephrine was used to block the nerves for extraction of mandibular M3. Then, the onset of action and duration of LA were monitored. Univariate analysis and multivariate regression analysis were used to analyze the data. The final cohort included 88 subjects (32 men and 56 women; mean age ± SD = 29.3 ± 12.3 yr). With univariate analysis, age, gender, body mass index (BMI), smoking quantity and duration, operation time, and 'volume of local anesthetic needed' significantly influenced the onset of action and duration of LA. Multivariate regression revealed that age and smoking quantity were the only statistically significant predictors of the onset of action of LA, whereas age, smoking quantity, and 'volume of local anesthetic needed' were the only statistically significant predictors of duration of LA. Further studies are recommended to uncover other predictors of the onset of action and duration of LA. © 2018 Eur J Oral Sci.

  10. Administration of Anesthesia

    Medline Plus

    Full Text Available ... Anesthesia Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) are trained in all aspects of anesthesia administration. Following dental ... evaluate patients for anesthesia, deliver the anesthetic and monitor post- ...

  11. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... SAMBA Link Digital Newsletter Educational Bibliography Research IARS/Anesthesia & Analgesia SCOR About SCOR Sponsor SAMBA Meetings Affinity Sponsor Program We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, ...

  12. Obesity and Anesthesia

    Science.gov (United States)

    ... likely. How does being overweight affect surgery and anesthesia? If you are overweight, you may also have ... can lead to challenges with a number of anesthesia-related processes: Locating veins to deliver anesthesia and ...

  13. Administration of Anesthesia

    Medline Plus

    Full Text Available ... further information Anesthesia: Safety and Comfort in the OMS Office Part I Introduction and History of Dental Anesthesia Part II OMS Education and Training Part III The OMS Anesthesia ...

  14. Administration of Anesthesia

    Medline Plus

    Full Text Available ... disease. Click here to find out more. Anesthesia Download Download the ebook for further information Anesthesia: Safety and ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four ...

  15. Needle localization using a moving stylet/catheter in ultrasound-guided regional anesthesia: a feasibility study

    Science.gov (United States)

    Beigi, Parmida; Rohling, Robert

    2014-03-01

    Despite the wide range and long history of ultrasound guided needle insertions, an unresolved issue in many cases is clear needle visibility. A well-known ad hoc technique to detect the needle is to move the stylet and look for changes in the needle appearance. We present a new method to automatically locate a moving stylet/catheter within a stationary cannula using motion detection. We then use this information to detect the needle trajectory and the tip. The differences between the current frame and the previous frame are detected and localized, to minimize the influence of tissue global motions. A polynomial fit based on the detected needle axis determines the estimated stylet shaft trajectory, and the extent of the differences along the needle axis represents the tip. Over a few periodic movements of the stylet including its full insertion into the cannula to the tip, a combination of polynomial fits determines the needle trajectory and the last detected point represents the needle tip. Experiments are conducted in water bath and bovine muscle tissue for several stylet/catheter materials. Results show that a plastic stylet has the best needle shaft and tip localization accuracy in the water bath with RMSE = 0:16 mm and RMSE = 0:51 mm, respectively. In the bovine tissue, the needle tip was best localized with the plastic catheter with RMSE = 0:33 mm. The stylet tip localization was most accurate with the steel stylet, with RMSE = 2:81 mm and the shaft was best localized with the plastic catheter, with RMSE = 0:32 mm.

  16. Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy

    OpenAIRE

    Fakhruddin, Kausar Sadia; Gorduysus, Mehmet Omer; El Batawi, Hisham

    2016-01-01

    Objective: Assessing the effectiveness of behavioral modification techniques in combination with visual distraction with/without video eyewear using computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in hearing-impaired pediatric patients undergoing pulp therapy of primary molars. Materials and Methods: This randomized, crossover clinical study includes 15 children (7 boys and 8 girls), mean age was 6.1 years. Children were randomly distributed into...

  17. Types of Anesthesia

    Science.gov (United States)

    ... Videos for Educators Search English Español Types of Anesthesia KidsHealth / For Teens / Types of Anesthesia What's in ... Get? Print en español Tipos de anestesia About Anesthesia Anesthesia is broken down into three main categories: ...

  18. 21 CFR 868.5150 - Anesthesia conduction needle.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction needle. 868.5150 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5150 Anesthesia conduction needle. (a) Identification. An anesthesia conduction needle is a device used to inject local anesthetics into a patient to...

  19. Poloxamer 407/188 binary thermosensitive hydrogels as delivery systems for infiltrative local anesthesia: Physico-chemical characterization and pharmacological evaluation.

    Science.gov (United States)

    Akkari, Alessandra C S; Papini, Juliana Z Boava; Garcia, Gabriella K; Franco, Margareth K K Dias; Cavalcanti, Leide P; Gasperini, Antonio; Alkschbirs, Melissa Inger; Yokaichyia, Fabiano; de Paula, Eneida; Tófoli, Giovana R; de Araujo, Daniele R

    2016-11-01

    In this study, we reported the development and the physico-chemical characterization of poloxamer 407 (PL407) and poloxamer 188 (PL188) binary systems as hydrogels for delivering ropivacaine (RVC), as drug model, and investigate their use in infiltrative local anesthesia for applications on the treatment of post-operative pain. We studied drug-micelle interaction and micellization process by light scattering and differential scanning calorimetry (DSC), the sol-gel transition and hydrogel supramolecular structure by small-angle-X-ray scattering (SAXS) and morphological evaluation by Scanning Electron Microscopy (SEM). In addition, we have presented the investigation of drug release mechanisms, in vitro/in vivo toxic and analgesic effects. Micellar dimensions evaluation showed the formation of PL407-PL188 mixed micelles and the drug incorporation, as well as the DSC studies showed increased enthalpy values for micelles formation after addition of PL 188 and RVC, indicating changes on self-assembly and the mixed micelles formation evoked by drug incorporation. SAXS studies revealed that the phase organization in hexagonal structure was not affected by RVC insertion into the hydrogels, maintaining their supramolecular structure. SEM analysis showed similar patterns after RVC addition. The RVC release followed the Higuchi model, modulated by the PL final concentration and the insertion of PL 188 into the system. Furthermore, the association PL407-PL188 induced lower in vitro cytotoxic effects, increased the duration of analgesia, in a single-dose model study, without evoking in vivo inflammation signs after local injection. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. A Comparison of Three Drug Combinations for Sedation during Middle Ear Surgeries under Local Anesthesia: A Multicentric Randomized Double Blind Study

    Directory of Open Access Journals (Sweden)

    Vikas Kumar

    2015-01-01

    Full Text Available Background: During Middle Ear Surgeries (MES done under Local Anesthesia (LA, patients may feel discomfort due to noise of suction, manipulation of instruments, positioning of head-neck and sometimes due to pain. A bloodless microscopic field is also essential to facilitate surgical exposure in MES. Various combinations of analgesics and sedatives have been tried to alleviate apprehension of the patients and improve microscopic field which may result into reduction in surgical time. In the present study, we have compared Dexmedetomedine (Dex with Midazolam-Fentanyl (MF and PentazocinePromethazine (PP combinations for their sedoanalgesia, anxiolysis and other pharmacological effects when administered during MES, not lasting for more than 60 min. Material and Methods: Ninety American Society of American Society of Anesthesiologists (ASA group I /II patients admitted in either of the three hospitals during May 2014 to January 2015 for MES under LA were randomly divided into three groups by an independent observer. Group D received intravenous bolus of Injection Dexmedetomidine 1 µg/ kg over 10 min. Group MF received Injection Midazolam 0.06 mg/ kg + Inj. Fentanyl 1 µg/ kg and Group PP received Injection Pentazocine 0.3 mg/kg + Injection Promethazine 0.5mg/kg given intravenously followed by LA before taking incision for the surgery. Need of a rescue sedoanalgesic dose of (Midazolam 0.01 mg/kg + Fentanyl 0.5 µg/kg during the surgery was noted. All the patients received 500 ml of normal saline infusion till the end of the surgery. All surgeries were finished within 60 min. Vital parameters and Ramsay Sedation Score (RSS of the patients were noted from the time of administration of sedative till the end of the surgery. Patient and surgeon satisfaction scores were recorded immediately after the surgery. Drug combinations of three groups were compared for their effectiveness, adverse effects and satisfaction scores in given doses. Children, mentally

  1. Assessment of patient’s anxiety and expectation associated with hemodynamic changes during surgical procedure under local anesthesia

    Directory of Open Access Journals (Sweden)

    Marcos Vinícius Mendes DANTAS

    Full Text Available Abstract Introduction The dental patient’s anxiety and expectation may significantly alter their vital signs. The use of local anesthetics associated with a vasoconstrictor may also alter the vital signs of these patients, promoting hemodynamic changes that may result in emergency situations. Objective To evaluate the influence of anxiety of patients submitted to third molar extraction and the use of different anesthetic substances with adrenaline on their vital signs (oxygen saturation, heart rate, and systolic and diastolic blood pressure in different moments. Material and method Forty patients answered the questionnaire of the Dental Anxiety Scale (Corah’s Scale and fear (KleinKnecht’s Scale and were submitted to third molar extraction in two surgical times for the use of articaine or mepivacaine, both associated with adrenaline. The results were analyzed by ANOVA followed by Tukey post hoc test, Student's t test, and Pearson's correlation coefficients (α=0.05. Result There was no significant differences in saturation or heart rate. The blood pressure showed significant variations during time for both anesthetics, however mepivacaine resulted in a longer postoperative time to restore blood pressure. Patients with high or moderate anxiety and high fear index were those who had positive correlations with the highest blood pressure values. Conclusion Anxiety and fear positively influence the increase in blood pressure. Mepivacaine promoted a greater resistance to the return of normal vital signs, especially blood pressure levels.

  2. Effectiveness of behavioral modification techniques with visual distraction using intrasulcular local anesthesia in hearing disabled children during pulp therapy.

    Science.gov (United States)

    Fakhruddin, Kausar Sadia; Gorduysus, Mehmet Omer; El Batawi, Hisham

    2016-01-01

    Assessing the effectiveness of behavioral modification techniques in combination with visual distraction with/without video eyewear using computerized delivery system-intrasulcular (CDS-IS) during the application of local anesthetic in hearing-impaired pediatric patients undergoing pulp therapy of primary molars. This randomized, crossover clinical study includes 15 children (7 boys and 8 girls), mean age was 6.1 years. Children were randomly distributed into two groups (Group A, n = 7; Group B, n = 8). The study involved three sessions, 1-week apart. During Session I, employing Tell-Show-Do technique, prophylactic dental cleaning was done while participants were watching a movie with sign-language interpretation with/without visual eyewear. At the end of Session I, score on Smiley Faces Program was used for anxiety assessment. During Session II and III, respectively, both groups underwent pulp treatment of equivalent teeth in the opposite sides of the mouth with/without video eyewear vice versa. After the procedure, children were instructed to rate their pain during treatment on the Wong-Bakers' (WBs') Faces Pain Scale. Changes in pulse oximeter and heart rate were recorded every 5 min. Paired sample t -test and independent sample t -test were used to assess the significance of changes during each visit. There was a significant ( P > 0.04) change in the heart rate observed for Group A underwent pulp treatment while watching video using video eyewear. Self-reported mean pain score also increases during treatment sessions' with video eyewear, for both groups. Routine psychological (Tell-Show-Do) intervention along with visual distraction with full visibility of the surrounding and use of CDS-IS system for anesthetic delivery is recommended as an effective behavior management technique for children with hearing impairment undergoing invasive dental treatment.

  3. Tactile sensibility of single-tooth implants and natural teeth under local anesthesia of the natural antagonistic teeth.

    Science.gov (United States)

    Enkling, Norbert; Heussner, Stefan; Nicolay, Claudia; Bayer, Stefan; Mericske-Stern, Regina; Utz, Karl-Heinz

    2012-04-01

    The term osseoperception describes the capability of developing a subtle tactile sensibility over dental implants. The present clinical study aims at clarifying the question of how far tactile sensibility is to be attributed to the periodontium of the natural opposing tooth of the implant. Thirty-two subjects with single-tooth implants with natural opposing teeth were included in this clinical, single-blind, split-mouth study. The natural antagonistic tooth of the implant and the corresponding natural contralateral tooth were anesthetized with a locally infiltrated articaine anesthetic. In a computer-assisted and randomized way, copper foils of varying thickness (0-100 µm) were placed interocclusally between the single-tooth implant and the natural opposing tooth, and between the contralateral pair of natural opposing teeth in order to investigate the active tactile sensibility according to the psychophysical method of constant stimuli and evaluate it statistically by the Weibull distribution. The average tactile sensibility of the implants with anesthetized antagonists at the 50% value calculated by means of the Weibull distribution was 20 ± 11 µm with a support area (90%-10% value) of 77 ± 89 µm. For the pair of natural teeth, the tactile sensibility at the 50% value was 16 ± 9 µm with a support area of 48.4 ± 93 µm. This resulted in an average intraindividual difference of 3.5 ± 7 µm at the 50% value and 29 ± 93 µm in the support area. The statistical calculations demonstrated an equivalent tactile sensibility (50% value) of the single-tooth implant and the contralateral natural control tooth with the natural antagonists being anesthetized in each case (double t-test, equivalence limit ± 8 µm, P 80%). Apparently, the active tactile sensibility of single-tooth implants with natural opposing teeth is not only to be attributed to the periodontium of the opposing tooth but also to a perception over the implant itself. This could support the hypothesis

  4. Effect of Time Interval Between Tumescent Local Anesthesia Infiltration and Start of Surgery on Operative Field Visibility in Hand Surgery Without Tourniquet.

    Science.gov (United States)

    Bashir, Muhammad Mustehsan; Qayyum, Rehan; Saleem, Muhammad Hammad; Siddique, Kashif; Khan, Farid Ahmad

    2015-08-01

    To determine the optimal time interval between tumescent local anesthesia infiltration and the start of hand surgery without a tourniquet for improved operative field visibility. Patients aged 16 to 60 years who needed contracture release and tendon repair in the hand were enrolled from the outpatient clinic. Patients were randomized to 10-, 15-, or 25-minute intervals between tumescent anesthetic solution infiltration (0.18% lidocaine and 1:221,000 epinephrine) and the start of surgery. The end point of tumescence anesthetic infiltration was pale and firm skin. The surgical team was blinded to the time of anesthetic infiltration. At the completion of the procedure, the surgeon and the first assistant rated the operative field visibility as excellent, fair, or poor. We used logistic regression models without and with adjustment for confounding variables. Of the 75 patients enrolled in the study, 59 (79%) were males, 7 were randomized to 10-minute time intervals (further randomization was stopped after interim analysis found consistently poor operative field visibility), and 34 were randomized to the each of the 15- and 25-minute groups. Patients who were randomized to the 25-minute delay group had 29 times higher odds of having an excellent operative visual field than those randomized to the 15-minute delay group. After adjusting for age, sex, amount of tumescent solution infiltration, and duration of operation, the odds ratio remained highly significant. We found that an interval of 25 minutes provides vastly superior operative field visibility; 10-minute delay had the poorest results. Therapeutic I. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Cardiac implantable electronic device lead extraction using the lead-locking device system: keeping it simple, safe, and inexpensive with mechanical tools and local anesthesia.

    Science.gov (United States)

    Manolis, Antonis S; Georgiopoulos, Georgios; Metaxa, Sofia; Koulouris, Spyridon; Tsiachris, Dimitris

    2017-10-01

    We have previously reported our successful approach for percutaneous cardiac implantable electronic device (CIED) lead extraction using inexpensive tools, which we have continued over the years. Herein we report the results of the systematic use of a unique stylet, the lead-locking device (LLD), which securely locks the entire lead lumen, aided with non-powered telescoping sheaths in 54 patients to extract 98 CIED leads. This prospective observational clinical study included 38 men and 16 women aged 68.9±13.1 years undergoing lead extraction for device infection (n=46), lead malfunction (n=5), or prior to defibrillator implant (n=3). Leads were in place for 6.7±4.3 years. Infections were more commonly due to Staphylococcus species (n=40). There were 78 pacing (31 ventricular, 37 atrial, 4 VDD, and 6 coronary sinus leads) and 20 defibrillating leads. Using simple traction (6 leads) and the LLD stylets (92 leads) aided with telescoping sheaths (15 patients), 96 (98%) leads in 52 (96.3%) patients were successfully removed, with all but one leads removed using a subclavian approach; in 1 patient, the right femoral approach was also required. In 2 patients, distal fragments from one ventricular pacing and one defibrillating lead could not be removed. Finally, lead removal was completely (52/54) (96.3%) or partially (2/54) (3.7%) successful in 54 patients for 96 of 98 leads (98%) without major complications. Percutaneous lead extraction can be successful with mechanical tools using the LLD locking stylet aided with non-powered telescoping sheaths through a simplified, safe, and inexpensive procedure using local anesthesia.

  6. Nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, local anesthetics, volume substitutes and medications used in general anesthesia.

    Science.gov (United States)

    Jurakić Toncić, Ruzica; Marinović, Branka; Lipozencić, Jasna

    2009-01-01

    Urticaria and angioedema are common allergic manifestations and medications are one of common triggering factors. The most severe immediate drug reaction is anaphylaxis. Apart from the well established IgE-mediated immediate type hypersensitivity reactions, the pathogenesis of drug-induced urticaria, angioedema and anaphylaxis often remains obscure. In this article, emphasis is put on nonallergic reactions to the most commonly used drug groups of nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, volume expanders and drugs used in general anesthesia. Urticaria is the second most common drug eruption after maculopapular exanthema. The mechanisms of acute urticarial reactions are multiple, mostly IgE mediated, but some drugs can induce immune complex reactions and activate complement cascade, while others can induce direct activation of mast cells and degranulation or activation of complement by non-immune mechanisms. With different types of medications different pathomechanisms are involved. Non-steroid anti-inflammatory drugs are thought to cause reaction due to cyclooxygenase-1 inhibition and overproduction of leukotrienes, blamed for cutaneous and respiratory symptoms. Angiotensin-converting enzyme inhibitors can cause fatal angioedema, which is partially explained with bradykinin excess and impairment of aminopeptidase P and dipeptidyl peptidase IV that are involved in the metabolism of substance P and bradykinin. It remains unknown what additional mechanisms are involved. Radiocontrast media and local anesthetics mostly cause nonallergic hypersensitivity reaction, but in rare cases true allergic reaction can occur. Dextran is known to cause IgG mediated, immune complex anaphylaxis and it is recommended to use human serum albumin as the safest colloid.

  7. Supplemental pulpal anesthesia for mandibular teeth

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    Thangavel Boopathi

    2013-01-01

    Full Text Available Clinical pulpal anesthesia is dependent on the interaction of three major factors. (1 the dentist (2 the patient and (3 local anesthesia. Many patients fear endodontic treatment due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. The purpose of this review article is to discuss the possible reasons for pulpal anesthetic failures and also to focus on the measures for developing effective approaches for the same.

  8. Presentation of a method at the Exploration Stage according to IDEAL: Percutaneous nephrolithotomy (PCNL) under local infiltrative anesthesia is a feasible and effective method - retrospective analysis of 439 patients.

    Science.gov (United States)

    Ecke, Thorsten H; Barski, Dimitri; Weingart, Guido; Lange, Carsten; Hallmann, Steffen; Ruttloff, Jürgen; Wawroschek, Friedhelm; Gerullis, Holger

    2017-01-01

    This study addresses minimally invasive anesthesiologic and analgetic approaches for stone surgery in the upper urinary tract. Aim of this retrospective analysis is to compare feasibility, safety and complication rates of percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia alone (Group I) and additive intravenous analgetics and/or sedative medications (Group II). This is a single center study. A total of 439 patients have been included from November 2003 until March 2012. A total of 226 patients were assigned to Group I receiving local infiltration anesthesia alone, whereas 213 patients were assigned to Group II receiving additive intravenous analgetics and/or sedative medications. Demographic characteristics and stone characteristics have been evaluated to determine feasibility, complication rates for safety, and stone-free rates for effectiveness. The study and the reported technique have then been retrospectively analysed according to the IDEAL stages of surgical innovation. All included patients who accepted local infiltration anesthesia underwent PCNL successfully. The mean American Society of Anesthesiologists score (ASA) of the included patients was 2.15 ±0.37 (range, 1-4). PCNL was indicated in 138 patients due to pelvic calculi, in 171 patients due to renal calculi, in 66 patients due to partial staghorn, in 48 patients due to complete staghorn and in 16 patients due to upper ureteral stones. The total stone free rate in our patients was 78.4% over all stone localizations. Compared to the possibility of using additive intravenous analgetics and/or sedative medications we could show differences in the median age ( p =0.005) suggesting that older patients did better tolerate the infiltration anesthesia than patients at younger ages. We did also remark not statistically significant differences in Group I and Group II as for number of tracts, operation duration, hemoglobin drop, fever, transfusion rate, and stone free rate, but not for

  9. Efeito colateral da anestesia local subcutânea com vasoconstritores em bovinos Colateral effects of local anesthesia with vasoconstritors in bovine

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    P.C. Soares

    2000-10-01

    Full Text Available In order to study the effects of different local anaesthetics with and without vasoconstritor (epinefrine, 20 adult crossbred cows were used. The following treatments were carried out:T1 - control (bidistilled water; T2 - chloridrate of lidocaine (20 mg/ml with epinephrine (0.005 mg/ml; T3 - chloridrate of lidocaine (20 mg/ml with epinephrine (0.02 mg/ml; T4 - chloridrate of lidocaine (20 mg/ml with epinephrine (0.05 mg/ml; T5 - chloridrate of lidocaine(20 mg/ml; T6 - chloridrate of procaine (22 mg/ml with epinefrine (0.02 mg/ml; T7 - chloridrate of procaine (22 mg/ml. The different solutions were injected, at the same time, into the subcutaneous space of the medial chest line, 10cm apart, of all cows. Observation at the infiltration sites was made 72 hours later, for the presence or not of tissue reaction, as well as lesion degrees. No differences were found among T1, T5, T6, and T7 , which did not cause tissue reaction. On the other hand, lower lesion tissue degrees were found in cows treated with T2 as compared to T3 and T4. It can be concluded that the use of both local anaesthetics alone or chloridrate of procaine with epinefrine are harmless to the skin while chloridrate of lidocaine associated with any concentration of vasoconstritor may give rise to tissue lesions in cattle.

  10. Administration of Anesthesia

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    Full Text Available ... more. Anesthesia Download Download the ebook for further information Anesthesia: Safety and Comfort in the OMS Office ... comfortable as possible when you get home. The information provided here is not intended as a substitute ...

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    Full Text Available ... Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and ... Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more surgeries ...

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  17. Efeitos do uso da adrenalina na anestesia local odontológica em portador de coronariopatia Effects of epinephrine in local dental anesthesia in patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Ricardo Simões Neves

    2007-05-01

    Full Text Available FUNDAMENTO: A literatura é controversa no que se refere ao uso de vasoconstritores para anestesia local em cardiopatas, havendo preocupação com a indução de descompensação cardíaca. OBJETIVO: Avaliar parâmetros eletrocardiográficos e de pressão arterial durante procedimento odontológico restaurador sob anestesia local com e sem vasoconstritor em portadores de doença arterial coronária. MÉTODOS: Neste estudo foram avaliados 62 pacientes. As idades variaram de 39 a 80 anos (média de 58,7 + 8,8 anos, sendo 51 pacientes (82,3% do sexo masculino. Do total de pacientes, 30 foram randomizados para receber anestesia com lidocaína 2% com adrenalina (grupo LCA e os demais para lidocaína 2% sem vasoconstritor (grupo LSA. Todos foram submetidos a monitorização ambulatorial da pressão arterial e eletrocardiografia dinâmica por 24 horas. Foram considerados três períodos: 1 basal (registros obtidos durante os 60 minutos que antecederam o procedimento; 2 procedimento (registros obtidos desde o início da anestesia até o final do procedimento e 3 das 24 horas. RESULTADOS: Houve elevação da pressão arterial do período basal para o procedimento nos dois grupos quando analisados separadamente; quando confrontados, não apresentaram diferença entre si. A freqüência cardíaca não se alterou nos dois grupos. Depressão do segmento ST > 1 mm não ocorreu durante os períodos basal e procedimento. Arritmias em número superior a 10 por hora estiveram presentes durante o procedimento em sete pacientes (12,5%, sendo quatro (13,8% do grupo que recebeu anestesia sem adrenalina e três (11,1% do grupo com adrenalina. CONCLUSÃO: Não houve diferença em relação a comportamento da pressão arterial, freqüência cardíaca, evidência de isquemia e arritmias entre os grupos. O uso de vasoconstritor mostrou-se seguro dentro dos limites do estudo.BACKGROUND: The use of vasoconstrictors for local anesthesia in patients with coronary heart

  18. Role of intraseptal anesthesia for pain-free dental treatment.

    Science.gov (United States)

    Gazal, G; Fareed, W M; Zafar, M S

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  19. Role of intraseptal anesthesia for pain-free dental treatment

    Directory of Open Access Journals (Sweden)

    G Gazal

    2016-01-01

    Full Text Available Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003, and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine, and intraosseous injection (2% lidocaine are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

  20. "Acupuncture anesthesia"--a clinical study.

    Science.gov (United States)

    Modell, J H; Lee, P K; Bingham, H G; Greer, D M; Habal, M B

    1976-01-01

    Forty-two patients who were to undergo plastic surgical procedures were asked whether they would accept acupuncture as a substitute for local anesthesia. Eight patients agreed to acupuncture; one of these had 2 operative procedures with acupuncture. Five of the 9 procedures were successful; the remaining 4 required conversion to local anesthesia. After interviewing the patients, we felt that the success of "acupuncture anesthesia" was largely dependent on patient motivation, and that a patient may experience pain during surgical procedures without any change in facial expression or vital signs. We concluded that "acupuncture anesthesia" is of little value in our patient population at present. Its results are unpredictable; therefore, we anticipate that patient acceptance will be small.

  1. When Only Buccal Anesthesia Was Done for Maxillary Teeth Extraction

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    Kubilay Isik

    2011-01-01

    Full Text Available Objective. Recently, some authors reported that maxillary teeth could be extracted without using palatal anesthesia, but they did not clearly specify the extracted teeth. This is important, because apparently the local anesthetic solution infiltrates the maxilla and achieves a sufficient anesthesia in the palatal side. Thus, thickness of the bone may affect the depth of anesthesia. The aim of this study was to compare the depth of anesthesia in different parts of the maxilla when only a buccal infiltration anesthesia was done. Patients and Method. The maxilla was divided into anterior, premolar, and molar regions. In each region, 15 teeth were extracted with a single buccal infiltration. The patient marked the pain level on a numerical rating scale. Results. Anesthesia depth was sufficient and was not significantly different (>0.05 among three maxillary regions. Conclusion. Except for surgical interventions, all maxillary teeth can be extracted using only a buccal infiltration anesthesia.

  2. Anesthesia Approach in Endovascular Aortic Reconstruction

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    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  3. Administration of Anesthesia

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    Full Text Available ... patients for anesthesia, deliver the anesthetic and monitor post-anesthetic patients. Your OMS trained alongside medical anesthesia ... of Use Privacy Policy © Copyright AAOMS 2008-2018 Facebook Twitter Instagram Pinterest YouTube Vimeo American Association of ...

  4. Thyroid and parathyroid surgery performed with patient under regional anesthesia.

    Science.gov (United States)

    Saxe, A W; Brown, E; Hamburger, S W

    1988-04-01

    Thyroid and parathyroid surgery is usually performed with the patient under general anesthesia; however, for selected patients regional anesthesia may be preferable. Between September 1977 and March 1986 regional anesthesia was used successfully as the sole anesthetic technique in 17 patients who underwent thyroid surgery and two patients who underwent parathyroid surgery. Procedures included two total thyroidectomies, 14 lobectomies or lobectomies with isthmusectomies, and one isthmusectomy. These 17 operations represent approximately 5% of the thyroid operations performed by the senior surgeon over the corresponding time. One patient underwent combined completion thyroidectomy and parathyroidectomy, and another patient underwent successful parathyroidectomy under regional anesthesia. In two additional patients, procedures could not be completed under regional anesthesia alone. In one of these two patients regional anesthesia appeared to effect a transient recurrent nerve paralysis. The indications for use of regional anesthesia have been primarily patient preference and associated cardiac or pulmonary disease. We now consider as contraindications to regional anesthesia patient apprehension about the technique, deafness, high spinal cord injury, recurrent laryngeal or phrenic nerve palsy, and allergy to local anesthesia. During this period, from 1977 to 1986, our administration of regional anesthesia has evolved from bilateral deep and superficial cervical plexus blocks to bilateral superficial blocks alone using bupivacaine with epinephrine, 1:200,000.

  5. [History of anesthesia : "From narcosis to perioperative homeostasis"].

    Science.gov (United States)

    Petermann, H; Goerig, M

    2016-10-01

    In the western World 16 October 1846 is often called "Ether Day", marking the beginning of anesthesia. Before that date, for physicians there was only a struggle against pain. In the following 170 years all fields of general anesthesia as well as regional and local anesthesia were continuously developed. Pharmacological developments and technical innovations made this evolution possible. The complexity of this field of medicine requires a specialist: the anesthesiologist, whose selection of the most suitable form of anesthesia for the patient makes the surgical intervention painless. In addition, the history of anesthesia was characterized by personalities who were responsible for the progress of this medical field. Anesthesia is one part of the discipline of anesthesiology, which also includes resuscitation, intensive care medicine, emergency medicine and pain therapy.

  6. Effect of magnesium added to local anesthetics for caudal anesthesia on postoperative pain in pediatric surgical patients: A systematic review and meta-analysis with Trial Sequential Analysis.

    Science.gov (United States)

    Kawakami, Hiromasa; Mihara, Takahiro; Nakamura, Nobuhito; Ka, Koui; Goto, Takahisa

    2018-01-01

    Magnesium has been investigated as an adjuvant for neuraxial anesthesia, but the effect of caudal magnesium on postoperative pain is inconsistent. The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of caudal magnesium. We searched six databases, including trial registration sites. Randomized clinical trials reporting the effect of caudal magnesium on postoperative pain after general anesthesia were eligible. The risk ratio for use of rescue analgesics after surgery was combined using a random-effects model. We also assessed adverse events. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE. Four randomized controlled trials (247 patients) evaluated the need for rescue analgesics. In all four trials, 50 mg of magnesium was administered with caudal ropivacaine. The results suggested that the need for rescue analgesia was reduced significantly by caudal magnesium administration (risk ratio 0.45; 95% confidence interval 0.24-0.86). There was considerable heterogeneity as indicated by an I2 value of 62.5%. The Trial Sequential Analysis-adjusted confidence interval was 0.04-5.55, indicating that further trials are required. The quality of evidence was very low. The rate of adverse events was comparable between treatment groups. Caudal magnesium may reduce the need for rescue analgesia after surgery, but further randomized clinical trials with a low risk of bias and a low risk of random errors are necessary to assess the effect of caudal magnesium on postoperative pain and adverse events. University Hospital Medical Information Network Clinical Trials Registry UMIN000025344.

  7. Análise de custos entre a raquianestesia e a anestesia venosa com propofol associada ao bloqueio perianal local em operações anorretais Cost analysis between spinal and venous anesthesia with propofol associated with local perianal block in anorectal procedures

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2009-09-01

    Full Text Available RACIONAL: Atualmente cerca de 90% das operações anorretais podem ser realizadas em regime ambulatorial. A técnica anestésica é fator fundamental na busca de menor tempo de internamento e redução de custos nestes procedimentos. Não há consenso na literatura sobre qual o melhor tipo de anestesia para essas operações. OBJETIVO: Comparar os custos da técnica de raquianestesia com bupivacaína 0,5% isobárica com a técnica de anestesia venosa com propofol associada ao bloqueio perianal local com lidocaína a 2% e bupivacaína 0,5% (anestesia combinada em pacientes submetidos a operações anorretais. MÉTODOS: Foram analisados dados de 99 pacientes submetidos à operações anorretais, divididos em dois grupos: grupo I (raquianestesia, composto por 50 pacientes e grupo II (anestesia combinada, composto por 49 pacientes. Foram estudados os procedimentos cirúrgicos, tempo de procedimento anestésico-cirúrgico, tempo de internamento e custos globais de cada paciente. RESULTADOS: Não houve diferença estatística significativa entre os grupos estudados em relação ao tipo de procedimento cirúrgico, sexo, idade e complicações. O tempo médio do procedimento anestésico-cirúrgico, no grupo I foi de 53,1 minutos e de 44,08 minutos no grupo II (P=0,034. O tempo médio de internamento foi de 19,68 horas no grupo I e de 7,08 horas no grupo II (PBACKGROUND: Approximately ninety percent of anorectal surgical procedures are performed in ambulatory basis. The choice of a proper anesthetic technique is important to achieve shorter hospital stay and low costs. There's no evidence in the literature that an ideal type of anesthesia for these procedures exists. AIM: To compare the costs of patients operated with spinal anesthesia (0,5% bupivacaine with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine in anorectal surgical procedures. METHODS: Data from 99 patients submitted to anorectal operations were

  8. THE HAZARD OF INDUCING FENERAL ANESTHESIA BEFORE CORRECTION OF AIRWAY OBSTRUCTION

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    ZEINALABEDIN JAVADZADEH

    1987-05-01

    Full Text Available Preoperative diagnosis of an airway obstruction should alert anesthetist to a potentially life threatening situation. Intubation of the trachea while the patient is awa- ke or tra~heostomy under local anesthesia is a most useful technique and safty method in induction of anesthesia where problems are anticipated during the induction or g e ne r a l anesthesia.

  9. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars: A multicenter, randomized, double-blind, crossover, phase IV trial.

    Science.gov (United States)

    Karm, Myong-Hwan; Park, Fiona Daye; Kang, Moonkyu; Kim, Hyun Jeong; Kang, Jeong Wan; Kim, Seungoh; Kim, Yong-Deok; Kim, Cheul-Hong; Seo, Kwang-Suk; Kwon, Kyung-Hwan; Kim, Chul-Hwan; Lee, Jung-Woo; Hong, Sung-Woon; Lim, Mi Hyoung; Nam, Seung Kwan; Cho, Jae Min

    2017-05-01

    The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups. There were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01). The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted

  10. Administration of Anesthesia

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    Full Text Available ... Download Download the ebook for further information Anesthesia: Safety and Comfort in the OMS Office Part I ... Evaluation Part V Broad Access to Care, Patient Safety and Comfort Oral and maxillofacial surgeons (OMSs) are ...

  11. Pediatric anesthesia and neurotoxicity

    DEFF Research Database (Denmark)

    Disma, Nicola; Hansen, Tom G.

    2016-01-01

    Many studies have demonstrated a neurodegenerative effect of anesthetic drugs in cubs and young animals, raising the concern that similar effects can happen in children, and that the administration of anesthesia in young children undergoing surgical or diagnostic procedures may cause long- Term...... neurocognitive impairment. Thus, several epidemiological studies have been performed with the aim to find a possible association between early anesthesia exposure and poor long- Term outcome, like learning disabilities or worse school grading and two prospective trials are currently running, the GAS...... and the PANDA study. Interim results from the GAS study, which compared infants undergoing general and regional anesthesia for hernia repair, have demonstrated that a single exposure of about one hour of anesthesia does not affect the neurological outcome at 2 years of age. Nowadays, most of the knowledge...

  12. Administration of Anesthesia

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    Full Text Available ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four years of training in a hospital-based surgical residency program alongside medical residents in ...

  13. Administration of Anesthesia

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    ... OMSs) are trained in all aspects of anesthesia administration. Following dental school, they complete at least four years of training in a hospital-based surgical residency program alongside medical residents in ...

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    Full Text Available ... Your OMS trained alongside medical anesthesia residents. Extensive Training and Experience As a result of their extensive training, every Oral and Maxillofacial Surgeon is well-prepared ...

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  16. Anesthesia information management systems

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    Feri Štivan

    2014-08-01

    Full Text Available Introduction: The use of anesthesia information management systems (AIMS is on the increase. This is particularly true for academic anesthesia departments. The main reasons for slow adoption of these systems in the past are financial barriers associated with implementation of these systems and their not so traditionally obvious potential to improve patient care. In addition, a major obstacle to acceptance of this technology is the concern of users over the impact of the electronic anesthesia record on malpractice exposure.Conclusions: The experience reported by departments using AIMS indicates that these systems are useful for managing malpractice risk. AIMS can enhance the efficiency and effectiveness of preoperative, intraoperative, and post-operative anesthesia care. However, AIMS are able to increase the quality of care and improve operating room efficiency only with careful planning, installation, and customization. Strengths, weaknesses, opportunities and threats (SWOT analysis performed for AIMS could help departments in making better decisions when implementing AIMS.

  17. Administration of Anesthesia

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become ... I Introduction and History of Dental Anesthesia Part II OMS ...

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    Full Text Available ... general surgery, anesthesia and other specialties. During this time, OMS residents serve on the medical anesthesiology service, ... during and after the operation. This is the time to discuss any concerns you may have about ...

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become ... Anesthesia: Safety and Comfort in the OMS Office Part I ...

  1. Administration of Anesthesia

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    Full Text Available ... can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... can also invite bacteria that lead to gum disease. Click here to find out more. Anesthesia Download ...

  2. Raquianestesia contínua com altas doses de anestésicos locais Raquianestesia continua con altas dosis de anestésicos locales Continuous spinal anesthesia with high dose of local anesthetics

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2010-10-01

    éteres intermediarios (catéter por fuera de la aguja y por su baja incidencia de cefalea y síntomas neurológicos, la técnica ha venido ganando credibilidad. El objetivo de este caso es relatar la posible seguridad del uso del nuevo catéter con una gran dosis de bupivacaína hiperbárica al 0,5% con glucosa al 1,6% asociada a la lidocaína al 2% hiperbárica y con glucosa al 1,6%. RELATO DEL CASO: Paciente masculino, de 78 años, 85 kg, 168 cm, estado físico ASA III, hipertenso, con coronariopatía e insuficiencia renal crónica. Candidato a cirugía de voluminosas hernias inguinales bilateral y umbilical, siendo sometido durante una semana a neumoperitoneo para crear espacio. Posteriormente a la venoclisis con catéter 18G, monitorización con cardioscopio, presión arterial no invasiva y oximetria de pulso, fue sedado con 1 mg de midazolam y fentanil 100 µg por vía venosa y colocado en decúbito lateral izquierdo. Sometido a la raquianestesia continua por vía mediana en L3-L4, y conjunto de aguja cortante 27G con catéter 22G. La dosis total de anestésico utilizada en el procedimiento fue 25 mg de bupivacaína al 0,5% (hiperbárica con glucosa al 1,6% y 160 mg de lidocaína al 2% (hiperbárica con glucosa al 1,6% y morfina (100 µg. Paciente con seguimiento hasta el 30º día sin quejidos neurológicos. CONCLUSIONES: Recientemente, la mala distribución del anestésico local a través de microcatéter, se atribuyó a una causa del síndrome de cola de caballo. Este relato de caso mostró que, con la administración de altas dosis de anestésicos hiperbáricos a través del nuevo catéter, no hubo una mala distribución ni el riesgo de síndrome de cola de caballoBACKGROUND AND OBJECTIVES: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter and its low incidence of headaches and neurological symptoms, the technique has

  3. Anesthesia training in Rwanda.

    Science.gov (United States)

    Enright, Angela

    2007-11-01

    In 2006 a program leading to a Master's degree in Anesthesia (MMed) was established in Rwanda as a joint venture between the National University of Rwanda (NUR), the Canadian Anesthesiologists' Society International Education Fund (CASIEF) and the American Society of Anesthesiologists Overseas Teaching Programme (ASAOTP). A MMed in Anesthesia is similar to a Fellowship in Canada and is common in many African countries. Most training programs are of three years duration. Rwanda has decided on a four-year program. The background, organization and problems of the program are described. Challenges exist in recruiting residents and in developing an academic culture and evaluation system. Inadequate equipment and drug shortages limit the types of anesthesia provided. There is need for improvement in biomedical support. Volunteer Canadian and American anesthesiologists visit Rwanda to teach for a minimum period of one month. They instruct in the operating room and also in the classroom. While the focus of the program is on residents in anesthesia, the volunteers also teach the nurse anesthetists. The program has been in existence for only one year but progress has been made. The CASIEF will devote special attention to improving the management of pain. In time, it is hoped that Rwanda will become self-sufficient in training its own anesthesiologists and in retaining them to provide anesthesia services throughout the country. As anesthesia and surgery evolve, there will be a need for subspecialty training in anesthesia. It is hoped that, with continued assistance from the CASIEF and ASAOTP, the goal of the NUR will be achieved.

  4. Comparison of NREM sleep and intravenous sedation through local information processing and whole brain network to explore the mechanism of general anesthesia.

    Science.gov (United States)

    Li, Yun; Wang, Shengpei; Pan, Chuxiong; Xue, Fushan; Xian, Junfang; Huang, Yaqi; Wang, Xiaoyi; Li, Tianzuo; He, Huiguang

    2018-01-01

    The mechanism of general anesthesia (GA) has been explored for hundreds of years, but unclear. Previous studies indicated a possible correlation between NREM sleep and GA. The purpose of this study is to compare them by in vivo human brain function to probe the neuromechanism of consciousness, so as to find out a clue to GA mechanism. 24 healthy participants were equally assigned to sleep or propofol sedation group by sleeping ability. EEG and Ramsay Sedation Scale were applied to determine sleep stage and sedation depth respectively. Resting-state functional magnetic resonance imaging (RS-fMRI) was acquired at each status. Regional homogeneity (ReHo) and seed-based whole brain functional connectivity maps (WB-FC maps) were compared. During sleep, ReHo primarily weakened on frontal lobe (especially preoptic area), but strengthened on brainstem. While during sedation, ReHo changed in various brain areas, including cingulate, precuneus, thalamus and cerebellum. Cingulate, fusiform and insula were concomitance of sleep and sedation. Comparing to sleep, FCs between the cortex and subcortical centers (centralized in cerebellum) were significantly attenuated under sedation. As sedation deepening, cerebellum-based FC maps were diminished, while thalamus- and brainstem-based FC maps were increased. There're huge distinctions in human brain function between sleep and GA. Sleep mainly rely on brainstem and frontal lobe function, while sedation is prone to affect widespread functional network. The most significant differences exist in the precuneus and cingulate, which may play important roles in mechanisms of inducing unconciousness by anesthetics. Institutional Review Board (IRB) ChiCTR-IOC-15007454.

  5. Risk management in anesthesia.

    Science.gov (United States)

    Cabrini, L; Levati, A

    2009-11-01

    Anesthesia is considered a leading discipline in the field of patient safety. Nevertheless, complications still occur and can be devastating. A substantial portion of anesthesia-related adverse events are preventable since risk factors can be detected and eliminated. Risk management (RM) in anesthesia includes preventive and remedial measures to minimize patient anesthesia-related morbidity and mortality. RM involves all aspects of anesthesia care. Classically, the following four steps are needed to prevent critical incidents or to learn from them: (1) detection of problems, (2) assessment, (3) implementation of solutions, and (4) verification of effectiveness. Problems and solutions can be identified into the fields of structures, processes and personnel. Authoritative agencies like the World Health Organization, the World Federation of Societies of Anesthesiologists, the Section and Board of Anesthesiology of the European Union of Medical Specialties and the Italian Scientific Society of Anesthesiologists (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva SIAARTI) have proposed initiatives addressing safety in the operating room. The central role of a well-trained, constantly present anesthesiologist and the usefulness of checklists have been highlighted. Cost cutting and production pressure in medical care are potential threats to safety. A shared knowledge of the best standards of care and of the potential consequences of unscrupulous actions could make the daily management of conflicting interests easier. A correctly applied RM can be a powerful, highly beneficial aid to our practice.

  6. Total Intravenous Anesthesia (TIVA) in pediatric cardiac anesthesia

    OpenAIRE

    Wong , Grace Lai Sze

    2011-01-01

    Abstract Inhalational anesthesia with moderate to high-dose opioid analgesia has been the mainstay of pediatric cardiac anesthesia but the advances in understanding of pharmacology and availability of new fast-acting drugs coupled with the advanced concepts in pharmacokinetic modeling and computer technology have made total intravenous anesthesia (TIVA) an attractive option. In this article, we review some of the TIVA techniques used in pediatric cardiac anesthesia. gracewong531...

  7. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia

    Science.gov (United States)

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha, Miguel

    2012-01-01

    Objective: To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. Material and method: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Conclusions: Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques. Key words:Intraosseous anesthesia, oral anesthesia, mandibular block, heart rate, adrenalin, complications. PMID:22143716

  8. Anesthesia for radiologic procedures

    International Nuclear Information System (INIS)

    Forestner, J.E.

    1987-01-01

    Anesthetic techniques for neurodiagnostic studies and radiation therapy have been recently reviewed, but anesthetic involvement in thoracic and abdominal radiology has received little attention. Patient reactions to radiologic contrast media may be of concern to the anesthesiologist, who is often responsible for injecting these agents during diagnostic procedures, and thus is included in this discussion. Finally, the difficulties of administering anesthesia for magnetic resonance imaging (MRI) scans are outlined, in an effort to help anesthesiologist to anticipate problems with this new technologic development. Although there are very few indications for the use of general anesthesia for diagnostic radiologic studies in adults, most procedures performed with children, the mentally retarded, or the combative adult require either heavy sedation or general anesthesia. In selecting an anesthetic technique for a specific procedure, both the patient's disease process and the requirements of the radiologist must be carefully balanced

  9. Sigmund Freud (1856-1939 e Karl Köller (1857-1944 e a descoberta da anestesia local Sigmund Freud (1856-1939 y Karl Köller (1857-1944 y el Descubrimiento de la anestesia local Sigmund Freud (1856-1939 and Karl Köller (1857-1944 and the Discovery of local anesthesia

    Directory of Open Access Journals (Sweden)

    Almiro dos Reis Jr

    2009-04-01

    : The understanding, occasionally recognized, that Sigmund Freud had the intuition to use cocaine as local anesthetic for surgical procedures, or even that he played any role in the discovery of local anesthesia is not true. The objective of Freud's studies were different, and based in irrefutable evidence, Karl Köller was the real inventor of local anesthesia. In face of those facts, proper knowledge of this historically important subject is due. CONTENTS: This report refers to the long-known properties of cocaine. It also remembers personal data, and the professional and scientific activities of Sigmund Freud and Karl Köller. It presents Freud's researches on the pathophysiological effects of cocaine. It exposes the reasons for the harsh criticism of Freud's concepts. It describes the sudden, but conscious and justified, idea of Karl Köller to study scientifically the use of cocaine as a local anesthetic in animals and humans. It indicates how those pioneering studies, that culminated with the discovery of local anesthesia by Köller and two presentations in Vienna on the subject, were done. It also reports the first ophthalmologic surgery under local anesthesia. It shows the immediate dissemination throughout the world of the discovery that marked the beginning of regional blocks. It comments several documents corroborating the role of Köller in this discovery. And, finally, it mentions the numerous homages received by Köller in different areas of the world. COCLUSIONS: Regional block was introduced by Karl Köller in 1884, when he demonstrated the feasibility of performing painless ophthalmologic surgeries by using cocaine as a local anesthetic. Sigmund Freud studied cocaine extensively, but he did not have direct participation in this important discovery.

  10. Anesthesia for interventional radiology

    International Nuclear Information System (INIS)

    van Sonnenberg, E.; Casola, G.; Varney, R.R.; D'Agostino, H.B.; Zornow, M.; Mazzie, W.

    1989-01-01

    We recognized that the complexity and surgical nature of many interventional radiology procedures dictate essential radiologic involvement into traditional anesthesiologic areas. They reviewed our experience with a variety of interventional procedures to document complications and problems related to anesthetic use (or misuse) and compile recommendations for rational monitoring and control for these procedures. In particular, the authors have studied complications of drug therapies and the treatment of these complications; use of complex anesthesia procedures (e.g., epidural anesthesia, succinylcholine blockage); reasons for choice of drugs (e.g., fentanyl vs meperidine vs morphine); and medico-legal aspects of radiologist performing traditional anesthesiology-type procedures

  11. NEURAXIAL ANESTHESIA and OBESITY

    Directory of Open Access Journals (Sweden)

    Aynur sahin

    2013-09-01

    Full Text Available Obesity is one of the serious condition that commonly effects health in modern age. It was reported that obesity was three-fold increased in the last three decades. According to the statement by World Health Organisation in 2005, 700 million people will be estimated obese in 2015. While neuraxial anesthesia is a commonly used technique in the worldwide, the process may have difficulties in obese patients. In this review, the pathophysiological changes and challenges in neuraxial anesthesia procedure in obesity were assessed with current literatures. [J Contemp Med 2013; 3(3.000: 234-236

  12. Effect of Injection Pressure of Infiltration Anesthesia to the Jawbone.

    Science.gov (United States)

    Yoshida, Kenji; Tanaka, Eri; Kawaai, Hiroyoshi; Yamazaki, Shinya

    To obtain effective infiltration anesthesia in the jawbone, high concentrations of local anesthetic are needed. However, to reduce pain experienced by patients during local anesthetic administration, low-pressure injection is recommended for subperiosteal infiltration anesthesia. Currently, there are no studies regarding the effect of injection pressure on infiltration anesthesia, and a standard injection pressure has not been clearly determined. Hence, the effect of injection pressure of subperiosteal infiltration anesthesia on local anesthetic infiltration to the jawbone was considered by directly measuring lidocaine concentration in the jawbone. Japanese white male rabbits were used as test animals. After inducing general anesthesia with oxygen and sevoflurane, cannulation to the femoral artery was performed and arterial pressure was continuously recorded. Subperiosteal infiltration anesthesia was performed by injecting 0.5 mL of 2% lidocaine containing 1/80,000 adrenaline, and injection pressure was monitored by a pressure transducer for 40 seconds. After specified time intervals (10, 20, 30, 40, 50, and 60 minutes), jawbone and blood samples were collected, and the concentration of lidocaine at each time interval was measured. The mean injection pressure was divided into 4 groups (100 ± 50 mm Hg, 200 ± 50 mm Hg, 300 ± 50 mm Hg, and 400 ± 50 mm Hg), and comparison statistical analysis between these 4 groups was performed. No significant change in blood pressure during infiltration anesthesia was observed in any of the 4 groups. Lidocaine concentration in the blood and jawbone were highest 10 minutes after the infiltration anesthesia in all 4 groups and decreased thereafter. Lidocaine concentration in the jawbone increased as injection pressure increased, while serum lidocaine concentration was significantly lower. This suggests that when injection pressure of subperiosteal infiltration anesthesia is low, infiltration of local anesthetic to the jawbone may

  13. Recent advances and perspectives in topical oral anesthesia.

    Science.gov (United States)

    Franz-Montan, Michelle; Ribeiro, Lígia Nunes de Morais; Volpato, Maria Cristina; Cereda, Cintia Maria Saia; Groppo, Francisco Carlos; Tofoli, Giovana Randomille; de Araújo, Daniele Ribeiro; Santi, Patrizia; Padula, Cristina; de Paula, Eneida

    2017-05-01

    Topical anesthesia is widely used in dentistry to reduce pain caused by needle insertion and injection of the anesthetic. However, successful anesthesia is not always achieved using the formulations that are currently commercially available. As a result, local anesthesia is still one of the procedures that is most feared by dental patients. Drug delivery systems (DDSs) provide ways of improving the efficacy of topical agents. Areas covered: An overview of the structure and permeability of oral mucosa is given, followed by a review of DDSs designed for dental topical anesthesia and their related clinical trials. Chemical approaches to enhance permeation and anesthesia efficacy, or to promote superficial anesthesia, include nanostructured carriers (liposomes, cyclodextrins, polymeric nanoparticle systems, solid lipid nanoparticles, and nanostructured lipid carriers) and different pharmaceutical dosage forms (patches, bio- and mucoadhesive systems, and hydrogels). Physical methods include pre-cooling, vibration, iontophoresis, and microneedle arrays. Expert opinion: The combination of different chemical and physical methods is an attractive option for effective topical anesthesia in oral mucosa. This comprehensive review should provide the readers with the most relevant options currently available to assist pain-free dental anesthesia. The findings should be considered for future clinical trials.

  14. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  15. Efficacy of local dexmedetomidine add-on for spermatic cord block anesthesia in patients undergoing intrascrotal surgeries: randomized controlled multicenter clinical trial

    Directory of Open Access Journals (Sweden)

    Hetta DF

    2017-11-01

    Full Text Available Diab Fuad Hetta,1 Emad E Kamal,2 Ali M Mahran,2 Doaa G Ahmed,1 Abdelraheem Elawamy,3 Abdelraouf MS Abdelraouf3 1Department of Anesthesiology and Pain Management, South Egypt Cancer Institute, 2Department of Dermatology and Andrology, 3Department of Anesthesiology and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt Study objective: The objective of this study was to evaluate the effect of adding dexmedetomidine (DEX to bupivacaine on the quality of spermatic cord block anesthesia and postoperative analgesia. Design: This is a randomized, double-blind study. Setting: This study was performed in an educational and research hospital. Patients: One hundred twenty adult males were scheduled for intrascrotal surgeries. Interventions: Patients were divided into two groups: group B received 10 mL of bupivacaine 0.25% for spermatic cord block and intravenous 50 µg of DEX and group BD received 10 mL of bupivacaine 0.25% added to 50 µg of DEX (9.5 mL bupivacaine 0. 25% + 0.5 mL [50 µg] DEX for spermatic cord block, and for masking purposes, the patients received isotonic saline intravenously. Measurements: Time to first analgesic request, analgesic consumption, and visual analog scale (VAS pain score in the first 24 hours postoperatively were assessed. Main results: Time to first rescue analgesic was significantly delayed in group BD in comparison with group B, median (interquartile range, 7 (6–12 hours versus 6 (5–7 hours, (p=0.000, the mean cumulative morphine consumption (mg in the first postoperative 24 hours was significantly lower in group BD compared with group B, 8.13±4.45 versus 12.7±3.79, with a mean difference (95% CI of −4.57 (−6.06 to −3.07 (p=0.000; also, there was a significant reduction of VAS pain score in group BD in comparison with group B at all measured time points, VAS 2 hours (1.28±0.9 vs 1.92±0.8, VAS 6 hours (2.62±1.5 vs 3.93±1.2, VAS 12 hours (2.40±1.1 vs 3.57±0.65, VAS 24 hours (1.90±0

  16. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  17. Administration of Anesthesia

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We Are Find a Surgeon News Videos Contact Anesthesia Cleft Lip/Palate and Craniofacial Surgery Corrective Jaw Surgery Dental Implant Surgery Extractions and Other Oral Surgeries Facial Cosmetic ...

  18. Defining depth of anesthesia.

    Science.gov (United States)

    Shafer, S L; Stanski, D R

    2008-01-01

    In this chapter, drawn largely from the synthesis of material that we first presented in the sixth edition of Miller's Anesthesia, Chap 31 (Stanski and Shafer 2005; used by permission of the publisher), we have defined anesthetic depth as the probability of non-response to stimulation, calibrated against the strength of the stimulus, the difficulty of suppressing the response, and the drug-induced probability of non-responsiveness at defined effect site concentrations. This definition requires measurement of multiple different stimuli and responses at well-defined drug concentrations. There is no one stimulus and response measurement that will capture depth of anesthesia in a clinically or scientifically meaningful manner. The "clinical art" of anesthesia requires calibration of these observations of stimuli and responses (verbal responses, movement, tachycardia) against the dose and concentration of anesthetic drugs used to reduce the probability of response, constantly adjusting the administered dose to achieve the desired anesthetic depth. In our definition of "depth of anesthesia" we define the need for two components to create the anesthetic state: hypnosis created with drugs such as propofol or the inhalational anesthetics and analgesia created with the opioids or nitrous oxide. We demonstrate the scientific evidence that profound degrees of hypnosis in the absence of analgesia will not prevent the hemodynamic responses to profoundly noxious stimuli. Also, profound degrees of analgesia do not guarantee unconsciousness. However, the combination of hypnosis and analgesia suppresses hemodynamic response to noxious stimuli and guarantees unconsciousness.

  19. [Anesthesia and Angelman syndrome].

    Science.gov (United States)

    Witte, W; Nobel, C; Hilpert, J

    2011-07-01

    Angelman syndrome (AS) is a rare neurodevelopmental disorder with an incidence of 1:10,000-1:40,000 caused by deficient genetic imprinting in the chromosomal segment 15q11-q13. Experimental data suggest that the gamma-aminobutyric acid A (GABA(A)) receptor as well as the N-methyl-D-aspartate (NMDA) or α-amino-3-hydroxy-5-methyl-4-isoxazole proprionic acid (AMPA) receptors may be affected by this condition. The first description of the syndrome goes back to 1965 when the British pediatrician Harry Angelman (1915-1996) recognized similar clinical features in three children. Angelman's description of puppet children was changed to happy puppet syndrome 2 years later before this euphemistic denotation was replaced by the concept Angelman syndrome over the years. Angelman syndrome is characterized by ataxia, jerky movements especially hand flapping, a seizure disorder with a characteristic electroencephalogram (EEG), severe learning difficulties, a happy disposition, lack of verbal communication and dysmorphic facial features. Most hospitalizations are caused by epilepsy and the most common indications for surgical procedures are in dental medicine. The first anesthesiology case report to be published dates back to 2001. A total of 13 cases have now been published and in 11 cases the age was registered (mean age 11.6 years, standard deviation 11.7 and 2 outliers aged 27 and 40 years). In this paper, the published case reports are contrasted with 15 cases of anesthesia in 6 patients with AS who underwent surgery during 14 years of routine operations at a Berlin anesthesiology clinic (mean age 15.9 years, standard deviation 4.2 with no outliers). Besides neurosurgical and orthopedic operations most were dental interventions. Summarized, these cases of anesthesia and the results of the published case reports allow the formulation of guidelines for administration of anesthesia in AS cases but do not permit conclusions on which method of anesthesia is the safest for AS

  20. Total spinal anesthesia in an achondroplasic patient: case report

    Directory of Open Access Journals (Sweden)

    Amiri H R

    2008-06-01

    Full Text Available Background: Total spinal anesthesia is a complication of lumbar epidural anesthesia following undiagnosed subarachnoid or subdural injection of local anesthetic. Although many achondroplastic dwarfs have a normal spine, catheter insertion may be more problematic with a narrow epidural space making a subarachnoid tap more probable.  Other malformations associated with achondroplasia, such as prolapsed intervertebral discs, reduced interpedicular distance, shortened pedicles, and osteophyte formation, combined with a narrow epidural space may make identification of the space difficult and increases the risk of dural puncture. Furthermore, subarachnoid tap or dural puncture may be hard to recognize if a free flow of CSF is difficult to achieve due spinal stenosis. Yet, for those who meet the criteria, epidural regional anesthesia is frequently preferred over other forms, which often have more or more dangerous side effects in this type of patient.Case report: A 22-year-old achondroplastic male dwarf patient was scheduled for pelvic mass resection and was considered a candidate for continuous epidural anesthesia. The anesthesia became complicated by total spinal anesthesia, which was reversed following supportive management for about two hours.Conclusion: There is significant debate over the composition and volume of the test dose, especially for patients with achondroplasia. We nevertheless recommend repeated test-doses during the accomplishment of epidural anesthesia to exclude unintended intravascular, intrathecal or subdural injection, keeping in mind that a test dose of local anesthetic does not completely prevent complications.

  1. USING OF FIRST GENERATION OF Hl ANTIHISTAMINES As ALTERNATIVE OF LOCAL ANESTHETIC IN ODONTOLOGIC USE IN ANESTHESIA INFILTRATIVE TECHNICS. EXPERIMENTAL STUDY IN ANIMALS

    OpenAIRE

    Rodríguez Alfaro, Miguel; Burga Sánchez, Jonny; Chumpitaz Cerrate, Victor; Varas Hilario, Roberto; López Bellido, Roger; Chuquihuaccha Granda, Vilma; Zegarra Cuya, Juan

    2014-01-01

    The presence of adverse drug reactions with local anesthetics takes us to the search of effective alternatives to this drugs. 60 albino rabbits divided into 6 groups were submifted to infiltrative anesthetic technique in the maxilla with lidocaine, mepivacaine, bupivacaine, chlorpheniramine and dimenhidrinate, in front of sodium chloride 0,9%. The pain threshold belzavior was evaluated with electrical stimulation from Ruhnkorff s bobbin behind the drllg application and comparison between grou...

  2. Comparative study between manual injection intraosseous anesthesia and conventional oral anesthesia

    Science.gov (United States)

    Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha-Diago, María; Peñarrocha, Miguel

    2012-01-01

    Objective: To compare intraosseous anesthesia (IA) with the conventional oral anesthesia techniques. Materials and methods: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for res-pective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. The mean patient age was 28.6±9.92 years. Fifty-five vestibular infiltrations and 45 mandibular blocks were performed. All patients were also subjected to IA. The type of intervention (conservative or endodontic) exerted no significant influence (p=0.58 and p=0.62, respectively). The latency period was 8.52±2.44 minutes for the conventional techniques and 0.89±0.73 minutes for IA – the difference being statistically significant (p<0.05). Regarding patient anesthesia sensation, the infiltrative techniques lasted a maximum of one hour, the inferior alveolar nerve blocks lasted between 1-3 hours, and IA lasted only 2.5 minutes – the differences being statistically significant (p≤0.0000, Φ=0.29). Anesthetic success was recorded in 89% of the conventional procedures and in 78% of the IA. Most patients preferred IA (61%) (p=0.0032). Conclusions: The two anesthetic procedures have been compared for latency, duration of anesthetic effect, anesthetic success rate and patient preference. Intraosseous anesthesia has been shown to be a technique to be taken into account when planning conservative and endodontic treatments. Key words: Anesthesia, intraosseous, oral anesthesia, Stabident®, infiltrative, mandibular block. PMID:22143700

  3. A randomized controlled trial comparing Ametop™ with placebo for reducing pain associated with local anesthetic skin infiltration before neuraxial anesthesia in parturients.

    Science.gov (United States)

    Kavanagh, T; Dube, A; Albert, A; Gunka, V

    2016-08-01

    Between 10-22% of the general population experience needle phobia. Needle phobic parturients are at increased risk of adverse outcomes. We assessed the efficacy of topical Ametop™ (tetracaine 4%) gel in reducing the pain associated with local anesthetic skin infiltration before neuraxial block in non-laboring women. This was a prospective, randomized, double-blind, placebo-controlled study. Ametop™ or placebo was applied to the skin of the lower back at least 20min before neuraxial block using a standardized technique with 1% lidocaine skin infiltration. The primary outcome was numeric pain score (0-10) 30s after lidocaine infiltration. Groups were compared using Welch's t-test. Thirty-six subjects in each group were analyzed. There was a statistically significant difference in the mean (standard deviation) pain score between the Ametop™ and the placebo groups: 2.36±1.80 and 3.51±2.22, respectively (P=0.019). There were no significant adverse events. The mean numeric pain score in the Ametop™ group was 33% lower compared to the placebo group. Topical Ametop™ gel applied at least 20min before local anesthetic infiltration of the skin prior to neuraxial block in elective cesarean delivery may be a useful adjunct in needle phobic women. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  4. Local Anaesthetic Neurotoxicity Mimicking Anaphylaxis

    OpenAIRE

    Deniz Özçeker; Zeynep Tamay; Nermin Güler

    2015-01-01

    Lidocaine and articaine are commonly used in infiltration anesthesia, extremity blockage, topical anesthesia and intravenous regional anesthesia due to high activity and rapid onset effect. Although commonly administered, the allergic drug reactions of local anesthetics are rarely reported. However, reactions related to systemic toxicity can be seen Hereby, we reported two cases related to drug allergy and convulsion after administering of lidocaine and articaine.

  5. Subconjunctival hemorrhage and vision loss after regional ocular anesthesia.

    Science.gov (United States)

    Behera, Umesh Chandra; Panda, Lapam; Gupta, Sumi; Modi, Rohit Ramesh

    2017-04-22

    To report two cases of retinal vascular occlusion and associated subconjunctival hemorrhage in needle optic nerve injury during local bulbar anesthesia. Surgical records of these two subjects who presented with acute vision loss after cataract extraction were studied, and systemic workup and ocular imaging were carried out to establish the cause. Computerized tomography showed evidence of optic nerve injury. Subconjunctival hemorrhage could be an associated clinical finding in hypodermic needle injury-related retinal vascular occlusion during ocular anesthesia.

  6. Anesthesia and cor triatriatum.

    Science.gov (United States)

    Scavonetto, Federica; Yeoh, Tze Yeng; Welch, Tasha L; Weingarten, Toby N; Sprung, Juraj

    2014-01-01

    Cor triatriatum sinistrum (CTS) and cor triatriatum dextrum (CTD) are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT) undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative course of patients with CT. A computerized search of a medical record database was conducted to identify patients with a clinical diagnosis of uncorrected CTD and CTS undergoing surgical procedures. Descriptive statistics were used. We identified 12 adult patients with asymptomatic CTS (n = 7) and CTD (n = 5) who underwent 23 anesthetics. There were no perioperative complications which could be attributed directly to the anatomy of CT. Our observation and review of the literature suggest that patients with asymptomatic CT typically tolerate anesthesia and surgical procedures well.

  7. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  8. Anesthesia for bariatric surgery.

    Science.gov (United States)

    Nishiyama, Tomoki; Kohno, Yumiko; Koishi, Keiko

    2012-02-01

    Bariatric surgery has a lot of problems in anesthesia. We retrospectively compared anesthesia for bariatric surgery in yellow race with that in normal weight patients. Twenty patients who received bariatric surgery and 20 normal body weight patients who received abdominal surgery in Japan were enrolled. Induction condition, depth of epidural space, dose of anesthetics, duration of the effects of muscle relaxants, ventilation, and fluid management in bariatric surgery were analyzed and compared with those in normal body weight patients. An epidural catheterization was successful under ultrasound guide in the bariatric group. The depth epidural space was significantly larger in the bariatric group. Cormack and Lehane classification and the number of intubation attempt were not different between the two groups, while one bariatric case was once awakened to intubate blindly. Pressure-controlled ventilation was used in the bariatric group. Four bariatric patients were continuously ventilated after surgery. The doses of anesthetics and fluid infusion rate were not different between the two groups when calculated by ideal body weight in the bariatric group. The duration of the effects of rocuronium and pancuronium were shorter in the bariatric group. For anesthesia of yellow race patients undergoing bariatric surgery, intravenous anesthetics and acetate Ringer's solution with 1% glucose could be administered per ideal body weight, the effects of muscle relaxants lasted shorter, pressure-controlled ventilation could keep oxygenation with adequate carbon dioxide, and ultrasound assist was useful in epidural catheterization in the bariatric patients.

  9. Local application of 133Xenon for measurement of regional cerebral blood flow (rCBF) during halothane, enflurane, and isoflurane anesthesia in humans

    International Nuclear Information System (INIS)

    Eintrei, C.; Leszniewski, W.; Carlsson, C.

    1985-01-01

    It is well known that halothane causes an increase in cerebral blood flow (CBF). In this study the effects of halothane, enflurane, and isoflurane on regional cerebral blood flow (rCBF) in humans were determined in the presence of 70% N 2 O at a combined MAC concentration of 1.5. CBF was determined in 24 patients from the washout of locally applied 133 Xenon with the use of an external scintillation. All 24 patients (control n = 6, halothane n = 6, enflurane n = 6, and isoflurane n = 6) were undergoing neurosurgical procedures. All patients were anesthetized with thiopental, fentanyl, droperidol, and 70% N 2 O in oxygen and paralyzed with pancuronium. The measurements were performed after the dura had been opened and before definitive surgery. The first measurement was done in the absence of any volatile agent, and the wash-out curve was registered for 6 min. The second measurement was done after one of the volatile agents had been added for at least 20 min and had reached a concentration of 0.58% for halothane, 1.14% for enflurane, or 1.0% for isoflurane in the expiratory gases in order to obtain about 1.5 MAC with each volatile anesthetic. The anesthetic concentrations were measured with the Engstroem multigas analyzer EMMA. The physiologic variables changed very little throughout the period of observation. Body temperature, heart rate, blood pressure, PaCO 2 , and PaO 2 were stable. Ephedrine was used to maintain a stable arterial pressure. At approximately 1.5 MAC, halothane (plus N 2 O) increased rCBF to nearly three times (166%) the control value, while enflurane induced only a slight increase (35%) in rCBF

  10. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus...... on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children....... The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps...

  11. Percutaneous nephrolithotripsy under assisted local anaesthesia for ...

    African Journals Online (AJOL)

    T.KH. Fathelbab

    Abstract. Objectives: The aim of the present study is to evaluate the feasibility and safety of performing PNL under local anesthesia in a selected group of patients who are at high risk for general anesthesia. Patients and methods: Forty seven patients underwent PNL under local anesthesia. There were 38 males.

  12. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  13. Inhibitory effect of pentobarbital anesthesia on venous stasis induced arteriolar vasoconstriction in the dog hindleg

    DEFF Research Database (Denmark)

    Bülow, J; Henriksen, O; Amtorp, Ole

    1984-01-01

    venous stasis. In another experimental series the effect of general pentobarbital anesthesia on the vasoconstrictor activity in response to venous stasis locally in subcutaneous and muscle tissue in the hind limb was examined in 6 dogs. It was found that during the first 2-3 h of anesthesia...... the vasoconstrictor response was present in both tissues although the response in muscle tissue exhibited a great variation between the dogs during this period. However, after 4-5 h of anesthesia the response was abolished in both tissues. During neurolept anesthesia with fentanyl/N2O the same vasoconstrictor...... response was demonstrated in the hindleg 1 h and 5 h after induction of the anesthesia. It is concluded that pentobarbital anesthesia abolishes the arteriolar constriction induced by venous stasis. The mechanism may be blockade of the local sympathetic vasoconstrictor fibres or interference with myogenic...

  14. Anesthesia Awareness (Waking Up) During Surgery

    Science.gov (United States)

    ... Resources About Policymakers Media ASA Member Toolkit Risks Anesthesia Awareness (Waking Up) During Surgery Explore this page: ... do you reduce the risk of anesthesia awareness? Anesthesia Awareness (Waking Up) During Surgery If you’re ...

  15. Anesthesia -- What to Expect (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anesthesia - What to Expect KidsHealth / For Teens / Anesthesia - What ... Operating Room After Surgery Print Different Kinds of Anesthesia If you're having any kind of procedure ...

  16. Ultrasound-guided ophthalmic regional anesthesia.

    Science.gov (United States)

    Gayer, Steven; Palte, Howard D

    2016-12-01

    Needle-based and cannula-based eye blocks are 'blind' techniques prone to rare but serious complications. Ultrasound, an established adjunct for peripheral nerve block, may be beneficial for ophthalmic anesthesia application. The present review details the evolution of ultrasound-guided eye blocks, outlines safety issues, and reviews recent studies and editorial opinions. Ultrasound-assisted ophthalmic regional anesthesia allows imaging of key structures such as the globe, orbit, and optic nerve. Recent findings reveal that needle path is not reliably predictable by clinical evaluation. Needle tips are frequently found to be intraconal, extraconal, or transfixed in the muscle cone independent of the intended type of block. In addition, contemporary human and animal studies confirm that real-time observation of local anesthetic spread inside of the muscle cone correlates directly with block success. Ultrasound-guided ophthalmic regional anesthesia is evolving beyond simple visualization of the anatomy. Recent research emphasizes the imprecision of needle tip location without ultrasound and the key role of imaging local anesthetic dispersion. There is ongoing debate in the literature regarding the utility of routine ultrasound for eye blocks.

  17. Fucosidosis and anesthesia

    International Nuclear Information System (INIS)

    Soltani, Alireza E.; Moharari, Reza S.; Ghaffari, R.; Zahedi, H.; Hajmahmoodi, M.

    2007-01-01

    Fucosidosis is a rare, autosomal recessive lysosomal storage disorder caused by a severe deficiency of alpha -L-fucosidase. Patients usually have some problems with glycoprotein storage in the brain and other organs and some structural abnormalities that need special consideration in anesthesia. It has 2 types, the early onset or infantile and the juvenile. Here we present 8-year-old girl with deformities in the maxillofacial region, with big tongue, small and retracted chin, saddle nose and short neck that could not be extended, causing difficult intubation and congenital cardiac problems requiring a special anesthetic strategy. (author)

  18. Anesthesia for intellectually disabled

    Directory of Open Access Journals (Sweden)

    Kapil Chaudhary

    2017-01-01

    Full Text Available Anesthetizing an intellectually disabled patient is a challenge due to lack of cognition and communication which makes perioperative evaluation difficult. The presence of associated medical problems and lack of cooperation further complicates the anesthetic technique. An online literature search was performed using keywords anesthesia, intellectually disabled, and mentally retarded and relevant articles were included for review. There is scarcity of literature dealing with intellectually disabled patients. The present review highlights the anesthetic challenges, their relevant evidence-based management, and the role of caretakers in the perioperative period. Proper understanding of the associated problems along with a considerate and unhurried approach are the essentials of anesthetic management of these patients.

  19. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  20. [Anesthesia and bodybuilding].

    Science.gov (United States)

    Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

    2008-05-01

    A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

  1. Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

    Science.gov (United States)

    Son, Andrew; Mannoia, Kristyn; Herrera, Anthony; Chizari, Mohammad; Hagdoost, Muhammad; Molkara, Afshin

    2016-05-01

    Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery including general endotracheal intubation, laryngeal mask airway, regional anesthesia with nerve blocks, and monitored anesthesia care with local infiltration. It is unclear what effect the method of anesthesia has on AVF creation success rate. It is our objective to determine if anesthesia type affects success of these surgeries defined by complication and maturation rates. A retrospective review was performed in a single institution, single surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross analyzed between 3 anesthesia types (General Endotracheal Intubation, Laryngeal Mask Airway and Local Infiltration with Monitored Anesthesia Care) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition). No patients had regional anesthesia performed. Demographic data including comorbidities and risk factors were stratified among all categories. Analysis of variance, chi-squared testing, and Fisher's exact P testing was performed across all anesthesia types and specific operations and measured according to success of fistula maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome). There were no significant differences in maturation rate in terms of all 3 anesthesia types for radiocephalic (P = 0.191), brachiocephalic (P = 0.191), and basilic vein transposition surgeries (P = 0.305). In addition, there were no differences in complication rates between the surgeries and the 3 types of anesthesia (P = 0.557). Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically

  2. Allergic reactions during anesthesia.

    Science.gov (United States)

    Levy, J H

    1988-01-01

    Any drug or blood product administered in the perioperative period has the potential to produce a life-threatening allergic (immune reaction) called anaphylaxis. Anaphylactic reactions represent adverse reactions mediated by immunospecific antibodies (IgE and IgG) that interact with mast cells, basophils, or the complement system to liberate vasoactive mediators and recruit other inflammatory cells. Activation of humoral and cellular pathways produces characteristic responses in the respiratory (bronchospasm and upper airway edema), cardiovascular (vasodilation and increased capillary permeability), and cutaneous systems (wheal and flare). Other predictable adverse drug reactions may mimic anaphylaxis to produce similar physiologic consequences independent of allergy (immune responses). Rapid and timely cardiopulmonary intervention with airway maintenance, epinephrine, and volume expansion is essential to avoid an adverse outcome. Severe reactions may be protracted, especially during anesthesia, requiring even larger doses of catecholamines and intensive care observation.

  3. Use of Laminaria Japonica in intracavitary radiation therapy when anesthesia is contraindicated

    International Nuclear Information System (INIS)

    Peeples, W.J.; Given, F.T. Jr.; Bakri, Y.N.

    1983-01-01

    Laminaria tents have been used to dilate the cervix for interruption of pregnancy and other intrauterine procedures. Their use is presented in 5 patients with cervical and endometrial carcinoma where general anesthesia was contraindicated. Cervical dilation was sufficient with a single Laminaria to carry out intrauterine and intravaginal instrumentation for radiation therapy with no local or general anesthesia

  4. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    Science.gov (United States)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  5. Avaliação da analgesia pós-operatória em pacientes submetidos à cirurgia orificial com anestesia local associada ou não à morfina Evaluation of the postoperative analgesia in patients submitted to anorectal surgery with local anesthesia associated or not the morphine

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2007-03-01

    Full Text Available Ainda não esta comprovada a eficácia dos derivados morfínicos ao nível de receptores opióides periféricos. Estudos procuram demonstrar o poder da droga em interferir na intensidade da dor quando infiltrada em nervos periféricos. Avaliamos, então, a infiltração local de morfina associada à anestesia local em cirurgias orificiais proctológicas. Nesse estudo foram analisados 61 pacientes, independentemente do gênero, sendo divididos aleatoriamente em dois grupos: a um grupo foi associada morfina ao anestésico local enquanto ao outro houve a administração do anestésico local sem a droga morfínica. Os pacientes de ambos os grupos foram submetidos à sedação e analgesia pós-operatória padronizadas. Foram avaliados: a intensidade da dor, a analgesia pós-operatória e a morbidade. A intensidade da dor, no momento de seu surgimento, foi semelhante nos dois grupos; o tempo de analgesia pós-operatória foi maior no grupo em que a morfina foi administrada, entretanto, não se mostrou estatisticamente significativo; as complicações pós-operatórias foram irrelevantes nos dois grupos. Dessa forma, a infiltração local de morfina na região anorretal tem benefícios em relação à analgesia pós-operatória que não mostraram significância estatística e não aumenta a incidência dos efeitos colaterais tão temidos relacionados às drogas morfínicas como retenção urinária e prurido.It has not been proved the efficacy of morphine derived at periphery opium receivers. Studies are trying to demonstrate the power of the drug to interfere in the intensity of surgical pain while infiltrating in the periphery nerves. This study evaluated the infiltration of morphine associated with local anesthesia in anorectal surgery. Sixty one patients were analyzed, male and female, divided in two groups: in one group was associated morphine in the local anesthesia while in the other group only the local anesthetic was used. The patients of both

  6. Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

    Directory of Open Access Journals (Sweden)

    Rochana Girish Bakhshi

    2011-11-01

    Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

  7. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  8. Dexmedetomidina associada a propofol em sedação durante anestesia local para cirurgia plástica Dexmedetomidina asociada a propofol en sedación durante anestesia local para cirugía plástica Dexmedetomidine/propofol association for plastic surgery sedation during local anesthesia

    Directory of Open Access Journals (Sweden)

    José Roberto Nociti

    2003-04-01

    grupo C. El tiempo medio para obedecer al comando de "abrir los ojos" fue menor en el grupo D (6,3 ± 2,5 min en relación al C (8,9 ± 2,7 min. El control del sangramiento per-operatorio fue superior en el grupo D en relación al C. CONCLUSIONES: El empleo de la dexmedetomidina asociada al propofol presenta las siguientes ventajas: reducción del consumo de propofol, estabilidad de los parámetros cardiovasculares, control adecuado del sangramiento per-operatorio, ausencia de efecto importante sobre la ventilación.BACKGROUND AND OBJECTIVES: Dexmedetomidine is a new alpha2-adrenergic receptor agonist with potentially useful characteristics for anesthesia. This comparative study aimed at evaluating the effects of dexmedetomidine on propofol requirements and cardiovascular/respiratory stability during plastic surgery sedation under local anesthesia. METHODS: Participated in this study 40 female patients aged 16 to 60 years, physical status ASA I or II, scheduled for elective face, nose and breast plastic surgeries under local anesthesia. Patients were randomly allocated into two groups of twenty patients: C (control and D (dexmedetomidine. Sedation was achieved in both groups with 1 mg.kg-1 bolus propofol followed by continuous infusion at an adjusted rate to provide conscious sedation. Group D patients received continuous intravenous dexmedetomidine at a rate of 0.01 µg.kg-1.min-1, concomitant with propofol infusion. The following were evaluated: effect of dexmedetomidine on propofol requirements; cardiovascular (SBP, DBP, MBP, HR and respiratory (SpO2, P ET CO2 parameters; quality of perioperative bleeding control and postanesthetic recovery features. RESULTS: Mean propofol infusion rate was lower in group D (35.2 ± 5.3 µg.kg-1.min-1 as compared to group C (72.6 ± 8.5 µg.kg-1.min-1. Mean SBP, DBP, MBP values have decreased as from 30 min in group D, remaining stable until procedure completion, while in Group C they have increased. HR remained stable in group D

  9. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  10. Alzheimer disease and anesthesia.

    Science.gov (United States)

    Inan, Gözde; Özköse Satirlar, Zerrin

    2015-01-01

    Alzheimer disease (AD) is one of the most common neurodegenerative diseases and the most prevalent form of dementia. Some factors in the development of AD, age being the best-known one, have been suggested; however, no causes have been found yet. The pathophysiology of the disease is highly complex, current therapies are palliative, and a cure is still lacking. Adverse effects of anesthetics in the elderly have been reported since the 1950s; however, awareness of this old problem has recently gained inportance again. Whether exposure to surgery and general anesthesia (GA) is associated with the development of AD has been questioned. As the population is aging, many elderly patients will need to be anesthetized, and maybe some were already anesthetized before they were diagnosed. Exposure to anesthetics has been demonstrated to promote pathogenesis of AD in both in vitro and in vivo studies. However, to date, there have not been any clinical trials to address a link between exposure to GA and the development of AD in humans. Therefore, before making any conclusions we need further studies, but we should be aware of the potential risks and take cautions with vulnerable elderly patients.

  11. Turner syndrome and anesthesia.

    Science.gov (United States)

    Maranhão, Marcius Vinícius M

    2008-01-01

    Turner syndrome is a frequent and complex genetic abnormality affecting women, being associated with a wide variety of anatomical and physiological changes, especially related with the airways and cardiovascular system. The objective of this report was to review the anatomopathologic changes of this syndrome that concern the anesthesiologist the most, discuss the perioperative management and review the literature regarding the anesthetic conduct in those patients. Turner syndrome is a genetic disorder characterized by an abnormality in the number or morphology of the sex chromosome. The most frequent abnormality is the absence of a sex chromosome, resulting in the 45X karyotype and a phenotype composed of gonadal dysgenesis. The main anatomo-physiological changes pertaining the anesthesiologist include a short neck, and maxillary and mandibular hipoplasia, which might be responsible for difficult airways. The shorter length of the trachea, as well as the higher location of its bifurcation, can predispose to bronchial intubation and accidental endotracheal extubation when the tracheal cannula is under traction. The presence of cardiopathies, endocrine and gastrointestinal disorders, liver and kidney changes, as well as osteoarticular involvement, besides ophthalmologic and hearing impairments, are very frequent, and should be detected during the pre-anesthetic evaluation. General or regional anesthesia seems to be safe for those patients. Turner syndrome is a genetic abnormality with important anatomo-physiological abnormalities important to the anesthesiologist. The knowledge of this disorder allows for a safer anesthetic management with low perioperative morbimortality.

  12. [Allergic reactions during anesthesia].

    Science.gov (United States)

    Escolano, F; Sierra, P

    1996-01-01

    Anaphylactic reaction during anesthesia is a constant source of concern for anesthesiologists, given that the rates of death and serious complications are high and predicting which patients will be susceptible is impossible. All substances used in the perioperative period carry a certain risk of releasing histamine and triggering an allergic reaction, though muscle relaxants are the drugs usually implicated. The incidence of serious anaphylaxis ranges between 1:4,000 and 1:23,000 anesthetic procedures, with mortality set at 3-9% and morbidity 10 times higher. Clinical signs vary from mild symptoms to anaphylactic shock and cardiac arrest. The diagnostic procedure to follow upon observing an allergic reaction is to first identify the responsible mechanism and later the responsible agent, as well as drugs that can be used safely. Prophylaxis is based mainly on recognizing predisposed patients before surgery and following recommendations and pharmacological protocols based on better understanding of the pathophysiological mechanisms that cause anaphylactic reaction and on experience in managing them.

  13. Effects of combined general anesthesia and thoracic epidural ...

    African Journals Online (AJOL)

    2015-11-02

    endocrine systems. Many factors such as .... operating room. A 20 G of epidural catheter was inserted under local analgesia (2 ml of 2% lidocaine) at T9–10, immediately before the induction of general anesthesia. The position of ...

  14. Brief anesthesia, but not voluntary locomotion, significantly alters cortical temperature

    Science.gov (United States)

    Shirey, Michael J.; Kudlik, D'Anne E.; Huo, Bing-Xing; Greene, Stephanie E.; Drew, Patrick J.

    2015-01-01

    Changes in brain temperature can alter electrical properties of neurons and cause changes in behavior. However, it is not well understood how behaviors, like locomotion, or experimental manipulations, like anesthesia, alter brain temperature. We implanted thermocouples in sensorimotor cortex of mice to understand how cortical temperature was affected by locomotion, as well as by brief and prolonged anesthesia. Voluntary locomotion induced small (∼0.1°C) but reliable increases in cortical temperature that could be described using a linear convolution model. In contrast, brief (90-s) exposure to isoflurane anesthesia depressed cortical temperature by ∼2°C, which lasted for up to 30 min after the cessation of anesthesia. Cortical temperature decreases were not accompanied by a concomitant decrease in the γ-band local field potential power, multiunit firing rate, or locomotion behavior, which all returned to baseline within a few minutes after the cessation of anesthesia. In anesthetized animals where core body temperature was kept constant, cortical temperature was still >1°C lower than in the awake animal. Thermocouples implanted in the subcortex showed similar temperature changes under anesthesia, suggesting these responses occur throughout the brain. Two-photon microscopy of individual blood vessel dynamics following brief isoflurane exposure revealed a large increase in vessel diameter that ceased before the brain temperature significantly decreased, indicating cerebral heat loss was not due to increased cerebral blood vessel dilation. These data should be considered in experimental designs recording in anesthetized preparations, computational models relating temperature and neural activity, and awake-behaving methods that require brief anesthesia before experimental procedures. PMID:25972579

  15. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.

    Science.gov (United States)

    Livingston, Patricia; Evans, Faye; Nsereko, Etienne; Nyirigira, Gaston; Ruhato, Paulin; Sargeant, Joan; Chipp, Megan; Enright, Angela

    2014-11-01

    High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training.

  16. A comparative study of pain following endodontic treatment under general anesthesia

    Directory of Open Access Journals (Sweden)

    Feizi Ghader

    2015-01-01

    Full Text Available   Background and Aims: Postoperativee endodontic pain is an outstanding problem for dental patients. Therefore, a successful management of endodontic pain has become as one of the main dental objectives. The aim of the present study was to compare the postoperative endodontic pain in patients under general anesthesia versus local anesthesia.   Materials and Methods: For conducting this clinical trial study, 50 patients having mandibular molars candidate for root canal therapy were selected. Twenty-five patients treated under general anesthesia because of their fear, anxiety or gag reflex. Other 25 patients treated under local anesthesia. All teeth were prepared using engine-driven rotary system in a crown-down technique and filled using lateral condensation technique. Heft- parker visual analog scale was used to measure the degree of pain at 6, 12, 24, and 48 hours after the treatment. Mann-Whitney, Chi-square, and T-tests were used to compare the intensity of postoperative pain between the groups.   Results: The mean intensity of postoperative pain in local and general anesthesia groups at 6, 12 and 24 hours had statistically significant difference (P<0.05.   Conclusion: Postoperative pain in patients who treated under general anesthesia was significantly less than the patients who treated under local anesthesia.

  17. Two-port Laparoscopic-assisted Appendicectomy Under Local ...

    African Journals Online (AJOL)

    Key words: Laparoscopic appendicectomy, laparoscopic- assisted appendicectomy, local anesthesia, monitored anesthesia care. Departments of Anesthesiology, and 1General Surgery,. Institute of Medical Sciences, Banaras Hindu University,. Varanasi, Uttar Pradesh, India. Address for correspondence: Dr. V. K. Shukla,.

  18. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  19. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Conditions Frequently Asked Questions Español Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “ ...

  20. [Anesthesia in urology: notes on its history and development in Spain, 1847 to 1950].

    Science.gov (United States)

    Franco, A; Cortés, J; Hernández, B; Alvarez, J

    2007-01-01

    This review of the historical course of anesthesia performed in the context of urology in Spain relies on primary sources: doctoral theses, dissertations, published articles, inaugural addresses, conference proceedings, and books belonging to various archives and libraries. We collected a large number of documents relating to urology and of particular interest regarding anesthesia, classified them, and subjected them to critical analysis. This allowed us to carefully follow the development of anesthesia and urology itself, both of which attained notable clinical and scientific importance in Spain. Anesthesia with chloroform and incomplete anesthesia were the norm during the second half of the 19th century. However, during the first half of the 20th century, the most widely used techniques were the application of ether or spinal or local infusions, although epidural and intravenous techniques were also mentioned.

  1. EEG entropy measures in anesthesia

    Science.gov (United States)

    Liang, Zhenhu; Wang, Yinghua; Sun, Xue; Li, Duan; Voss, Logan J.; Sleigh, Jamie W.; Hagihira, Satoshi; Li, Xiaoli

    2015-01-01

    Highlights: ► Twelve entropy indices were systematically compared in monitoring depth of anesthesia and detecting burst suppression.► Renyi permutation entropy performed best in tracking EEG changes associated with different anesthesia states.► Approximate Entropy and Sample Entropy performed best in detecting burst suppression. Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs' effect is lacking. In this study, we compare the capability of 12 entropy indices for monitoring depth of anesthesia (DoA) and detecting the burst suppression pattern (BSP), in anesthesia induced by GABAergic agents. Methods: Twelve indices were investigated, namely Response Entropy (RE) and State entropy (SE), three wavelet entropy (WE) measures [Shannon WE (SWE), Tsallis WE (TWE), and Renyi WE (RWE)], Hilbert-Huang spectral entropy (HHSE), approximate entropy (ApEn), sample entropy (SampEn), Fuzzy entropy, and three permutation entropy (PE) measures [Shannon PE (SPE), Tsallis PE (TPE) and Renyi PE (RPE)]. Two EEG data sets from sevoflurane-induced and isoflurane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, pharmacokinetic/pharmacodynamic (PK/PD) modeling and prediction probability (Pk) analysis were applied. The multifractal detrended fluctuation analysis (MDFA) as a non-entropy measure was compared. Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline variability, higher coefficient of determination (R2) and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an advantage in computation

  2. Epidural Combined with General Anesthesia versus General Anesthesia Alone in Patients Undergoing Free Flap Breast Reconstruction.

    Science.gov (United States)

    Lou, Feifei; Sun, Zhirong; Huang, Naisi; Hu, Zhen; Cao, Ayong; Shen, Zhenzhou; Shao, Zhimin; Yu, Peirong; Miao, Changhong; Wu, Jiong

    2016-03-01

    Addition of epidural anesthesia may have several benefits. The purpose of this study was to investigate the effectiveness and safety of epidural anesthesia combined with general anesthesia in patients undergoing free flap breast reconstruction. A retrospective chart review identified 99 patients who underwent free flap breast reconstruction under general anesthesia alone (46 patients) or general anesthesia plus epidural anesthesia (53 patients) between 2011 and 2014. Mean arterial blood pressure was measured before induction, after flap elevation but before flap transfer, 15 minutes after flap revascularization, and at the end of surgery. Postoperative pain was assessed using a visual analogue scale. The incidence of flap thrombosis was 3.8 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 1). Flap failure was 0 percent in the epidural anesthesia/general anesthesia group versus 4.3 percent in the general anesthesia group (p = 0.213). Patients in the epidural anesthesia/general anesthesia group had lower visual analogue scale scores at 2 hours (0.76 ± 0.62 versus 2.58 ± 0.99; p surgery. Epidural anesthesia/general anesthesia combination improves postoperative pain and side effects without increasing the risk of flap thrombosis. Therapeutic, III.

  3. Effect of General Anesthesia Compared to Regional Anesthesia on ...

    African Journals Online (AJOL)

    Background: cesarean section (CS) is one of the common operations performed in obstetric practice worldwide; it can be conducted as elective or emergency operation. Objective: to assess the effect of different types of anesthesia used during conducting elective cesarean sections (CS) on the health of neonates by using ...

  4. Descriptive Study: Anesthesia for Awake Craniotomy in Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Saipin Muangman

    2016-03-01

    Full Text Available Background: The purpose of awake craniotomy is to test neurological functions to ensure accurate lesion surgery and lessen postoperative neurological complications. There are several methods to provide anesthesia during awake craniotomy including local anesthesia infiltration, local anesthesia plus conscious sedation, general anesthesia and wake-up during surgery and sleep again (asleep-awake-asleep or AAA. Each method has its pro and con with different complications. In Siriraj Hospital, there was no prior study of anesthetic techniques and complications of awake craniotomy. Methods: The retrospective descriptive study of awake craniotomy was carried out with 60 patients in Siriraj Hospital 2007-2011. Results: There were 35 males (58.3% with average age 40.7±12.6 years and weight 64.2±12 kilograms undergoing awake craniotomy. Twenty patients (33.3% presented with seizure before surgery. Most diagnosis was oligodendroglioma in 25 patients (41.7%, mostly at the frontal lobe (44 patients or 73.3%. The most common position was supine(46patientsor76.7%. ICU lengthof stay was1.4±0.9(0,6days. Hospital stay was11.1±9 (4,55days. Total intravenous anesthesia (TIVA was mostlyused(52patientsor90% while18patients (30% received scalp block. Most patients (85% did not require nasal airways while 8 patients (13.3% did, and only 1 patient (1.7% required laryngeal mask airway (LMA to help open up air passage. The drugs used during asleep1 and asleep2 were propofol together with dexmedetomidine and fentanyl in 34 patients (56.7% and 23 patients (38.3%, respectively. Whilebeingawake (15patientsor20%,dexmedetomidine and/or fentanyl were administered. Complications during anesthesia were hypertension (33.3%, hypotension (26.7%, upper airway obstruction(23.3%, bradycardia (15%, tachycardia (10%, seizure (1.7% andnausea (1.7%. Conclusion: The most common anesthesia method inSiriraj Hospital for awake craniotomy was TIVA (90%, using propofol together with

  5. 42 CFR 415.178 - Anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Anesthesia services. 415.178 Section 415.178 Public..., AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.178 Anesthesia... schedule payment may be made if a physician is involved in a single anesthesia procedure involving an...

  6. 21 CFR 868.6700 - Anesthesia stool.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia stool. 868.6700 Section 868.6700 Food... DEVICES ANESTHESIOLOGY DEVICES Miscellaneous § 868.6700 Anesthesia stool. (a) Identification. An anesthesia stool is a device intended for use as a stool for the anesthesiologist in the operating room. (b...

  7. Effectiveness of Ibuprofen Administration on the Depth of Anesthesia in Inflamed Teeth

    Directory of Open Access Journals (Sweden)

    R Mahmodi

    2006-07-01

    Full Text Available Introduction: Incomplete anesthesia of inflamed teeth is a well known clinical occurrence and the purpose of this study was to evaluate the effectiveness of Ibuprofen as a premedication in improving the quality of anesthesia in patients with inflamed teeth pulps. Methods: Forty patients with the diagnosis of irreversible pulpitis in one mandibular tooth were selected. Two other teeth in the same quadrant were selected as controls. Electric pulp tester (EPT was used in this study to evaluate the quality of anesthesia. The subjects were divided into two groups randomly, and after recording of pulp tester response in each group, one of the two drugs; ibuprofen or placebo was administered 1 hour prior to anesthesia injection. After injection, EPT measurement was recorded. The reversed EPT scale was used for evaluation of the depth of anesthesia. Results : Data was analyzed to statistically compare the results before and after anesthesia and drug administration in cases and control group .Significantly lower TSLs were observed in the ibuprofen group (Pvalue= 0.001. Conclusion: This study concluded that preoperative administration of ibuprofen (if not contraindicated 1 hour before local anesthesia injection is an effective method for achieving deep anesthesia during RCT of teeth with irreversible pulpitis.

  8. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  9. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  10. Intestinal circulation during inhalation anesthesia

    International Nuclear Information System (INIS)

    Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.

    1985-01-01

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of 86 Rb and 9-microns spheres labeled with 141 Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO 2 ) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines

  11. How to teach regional anesthesia.

    Science.gov (United States)

    Bröking, Katrin; Waurick, René

    2006-10-01

    The demand for peripheral nerve blocks and neuroaxial blocks from both patients and surgeons has increased over the last few years. This change in attitude towards regional anesthesia is prompted by the insight that adequate perioperative pain management leads to earlier ambulation, shorter hospital stay, reduced cost and increased patient satisfaction. To avoid serious complications of these techniques structured residency programs need to be available. Until 2004, the Residency Review Committee for Anesthesiology in the United States required a minimum of 50 epidurals, 40 spinals and 40 peripheral nerve blocks during residency. Similarly, the German Society for Anesthesia and Intensive Care required 100 neuroaxial blocks and 50 peripheral nerve blocks. In 2004 the American Society of Regional Anesthesia and Pain Medicine endorsed standardized guidelines for regional anesthesia fellowships which regulate the administrative, equipment and educational demands. This review introduces the reader to the different teaching methods available, including cadaver workshops, three-dimensional videoclips, video filming, ultrasound guidance and acoustic assist devices as well as demonstrating their advantages and disadvantages. Moreover, an overview is given of future residency training programs, which integrate administrative, material and educative demands as well as the teaching means into the daily clinical routine.

  12. [Complications of peripheral regional anesthesia].

    Science.gov (United States)

    Neuburger, M; Büttner, J

    2011-11-01

    Peripheral regional anesthesia is a commonly used and safe procedure and eneral complications or side effects are generally rare. Nerve damage has an incidence allergies, dislocation of catheters and knotting or loops in catheters. Besides the general complications, there are some specific complications depending on the puncture site, such as pneumothorax or renal puncture.

  13. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted. Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening

  14. The modifying effect of anesthetic technique on the metabolic and endocrine responses to anesthesia and surgery

    DEFF Research Database (Denmark)

    Kehlet, H

    1988-01-01

    and the widespread use of the term "stress free anesthesia" in surgery is therefore not valid. However, continuous administration of local anesthetic agents in the epidural space is the most effective technique in so far as reduction of the stress response is concerned. The clinical implication of a variable...... reduction in the stress response to surgery by different anesthetic techniques remains largely unsettled, since only few controlled studies have been published on the clinical effects of pain relief and general anesthesia. However, a vast amount of data exist from controlled studies comparing regional...... anesthesia with local anesthetics and general anesthesia. The cumulative experience from these studies have demonstrated an advantageous effect on postoperative morbidity parameters such as blood loss, postoperative thromboembolic complications, pulmonary infective complications, gastrointestinal motility...

  15. Photobiomodulation: Implications for Anesthesia and Pain Relief.

    Science.gov (United States)

    Chow, Roberta T; Armati, Patricia J

    2016-12-01

    This review examines the evidence of neural inhibition as a mechanism underlying pain relief and anesthetic effect of photobiomodulation (PBM). PBM for pain relief has also been used for more than 30 years; however, the mechanism of its effectiveness has not been well understood. We review electrophysiological studies in humans and animal models and cell culture studies to examine neural responses to PBM. Evidence shows that PBM can inhibit nerve function in vivo, in situ, ex vivo, and in culture. Animal studies using noxious stimuli indicate nociceptor-specific inhibition with other studies providing direct evidence of local conduction block, leading to inhibited translation of pain centrally. Evidence of PBM-disrupted neuronal physiology affecting axonal flow, cytoskeleton organization, and decreased ATP is also presented. PBM changes are reversible with no side effects or nerve damage. This review provides strong evidence in neuroscience identifying inhibition of neural function as a mechanism for the clinical application of PBM in pain and anesthesia.

  16. Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia.

    Science.gov (United States)

    He, Liang; Xu, Jun-Mei; Liu, Su-Mei; Chen, Zhi-Jun; Li, Xin; Zhu, Rong

    2017-01-01

    Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient, which may also cause adverse effects. In this prospective, randomized, double-blind, placebo-controlled study, we sought to evaluate the effect of intrathecal dexmedetomidine, administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery, on the incidence and severity of shivering associated with spinal anesthesia. Patients undergoing Cesarean delivery were randomly allocated to three groups of 30 patients each. Experimental treatments were added to hyperbaric bupivacaine as follows: Patients in group I (control) were administered isotonic saline. Patients in groups II and III received dexmedetomidine (2.5, 5 µg, respectively), mixed with isotonic saline. Shivering was observed in 11, 10 and 2 patients in groups I, II and III, respectively. The incidence of shivering in group III was significantly lower than that in groups I (p=0.005) and II (p=0.01). The severity of shivering was significantly different between the three groups (p=0.01). There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia (p>0.05). Intrathecal dexmedetomidine (5 µg) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia.

  17. Anesthesia and analgesia for caesaren section in dog

    Directory of Open Access Journals (Sweden)

    Vasiljević Maja

    2014-01-01

    Full Text Available This work presents a case of a pregnant female dog, of English bulldog breed, three years old, which was brought to Belgrade Faculty of Veterinary Medicine because of inability for normal parturition. Cesarean section is an urgent intervention both in human and in veterinary medicine. Anesthesia of a pregnant dog should be carried out very carefully, because of all the physiological changes that appear during pregnancy, as well as the impact of anesthetics on embryos themselves. Anesthetics, analgesics and sedatives pass through blood brain barrier, but also their transport goes through placenta to embryo, so for that reason it is not possible to anesthetize only mother and to avoid anesthesia effects on the embryo. Therefore, anesthetics with short time of action which metabolize quickly and have minimal negative effect on embryos are recommended. When choosing the right analgesics and anesthetics, there should be known that female dogs in which it is necessary to do Cesarean section belong to the group of high risk patients. Pregnant female dogs are exposed to hypoventilation, hypoxia, hypercapnia, intense heart work, vomiting and regurgitation as well. Reversible anesthetics are recommended to provide shorter duration time of anesthesia, and in accordance, inhalation anesthetics doses are minimal. Application of α2- agonist in premedication, propophol in induction, as well as maintaining general inhalation anesthesia with sevofluran, along with local analgesia, proved to be the ideal combination in this case of cesarean section.

  18. Open lateral internal anal sphincterotomy under local anesthesia as the gold standard in the treatment of chronic anal fissures: A prospective clinical and manometric study Esfinterotomía lateral interna abierta con anestesia local como gold standard en el tratamiento de la fisura anal crónica: Estudio prospectivo clínico y manométrico a largo plazo

    Directory of Open Access Journals (Sweden)

    A. Sánchez Romero

    2004-12-01

    Full Text Available Background: chronic anal fissure is one of the most frequent proctological disorders in Western populations. Open lateral internal sphincterotomy is one of the therapeutic options accepted as the treatment of choice for chronic anal fissure, since it reduces the hypertonia of the internal anal sphincter (the main etiopathogenic mechanism of fissures, decreases anal pain, and allows the fissure to heal. Material and methods: we carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. No preoperative studies, bowel preparation, or antibiotic prophylaxis were carried out. All patients were followed up after 1 week, 2 months, 6 months, and 1 year, and underwent an anal manometry before and after surgery. Results: early complications: 3 hematoma-ecchymosis of the wound (2.5%, 3 self-limited hemorrhage events (2.5%. No hemorrhoidal thrombosis, fistulas, or perianal abscesses occurred. Fissures recurred in nine patients (7.5% within one year. The initial rate of incontinence of 7.5% at two months dropped down to 5% at six months. The mean resting pressure (MRP in incontinent patients was lower than in continent patients (55±7 mmHg versus 80.7 ± 21 mmHg. The difference in mean squeeze pressure (MSP between incontinent patients and continent patients was not statistically significant. Conclusions: open sphincterotomy under local anesthesia has a long-term rate of healing and a morbidity rate similar to other techniques. It may therefore be considered an effective treatment for chronic anal fissure.Introducción: la fisura anal crónica sigue siendo uno de los problemas proctológicos más frecuentes e incapacitantes en la población occidental actual. La esfinterotomía lateral interna abierta es una de las opciones terapéuticas descritas y aceptadas como tratamiento de elección de la fisura anal crónica, ya que reduce la

  19. The elderly and general anesthesia

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2010-01-01

    Due to the aging population, the number of elderly patients taking advantage of healthcare services is increasing. A general physical decline of all organ systems and a high frequency of chronic disease accompanying aging.Comorbidity and polypharmacy are therefore common in the elderly. Hence, th......, the administration of general anesthesia to the elderly can be a very challenging task. This paper aims to highlight some of the important issues presented to the elderly undergoing surgery and to suggest some strategies for management....

  20. Transient methemoglobinemia in three neonates due to maternal pudendal anesthesia

    International Nuclear Information System (INIS)

    Erol, S.; Celik, I.H.; Demirel, N.

    2017-01-01

    Methemoglobin (MetHb) is a form of hemoglobin which contains iron in ferric state. The delivery of oxygen to tissues is impaired and cellular hypoxia develops with an increase in MetHb levels. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. In this clinical brief, three cases of transient neonatal methemoglobinemia, caused by maternal pudendal anesthesia with prilocaine, are reported. (author)

  1. Anesthesia for minimally invasive neurosurgery.

    Science.gov (United States)

    Prabhakar, Hemanshu; Mahajan, Charu; Kapoor, Indu

    2017-10-01

    With an ultimate aim of improving patients overall outcome and satisfaction, minimally invasive surgical approach is becoming more of a norm. The related anesthetic evidence has not expanded at the same rate as surgical and technological advancement. This article reviews the recent evidence on anesthesia and perioperative concerns for patients undergoing minimally invasive neurosurgery. Minimally invasive cranial and spinal surgeries have been made possible only by vast technological development. Points of surgical interest can be precisely located with the help of stereotaxy and neuronavigation and special endoscopes which decrease the tissue trauma. The principles of neuroanethesia remain the same, but few concerns are specific for each technique. Dexmedetomidine has a favorable profile for procedures carried out under sedation technique. As the new surgical techniques are coming up, lesser known anesthetic concerns may also come into light. Over the last year, little new information has been added to existing literature regarding anesthesia for minimally invasive neurosurgeries. Neuroanesthesia goals remain the same and less invasive surgical techniques do not translate into safe anesthesia. Specific concerns for each procedure should be taken into consideration.

  2. Fatal anaphylactic reaction during anesthesia

    Directory of Open Access Journals (Sweden)

    Izidor Kern

    2012-01-01

    Full Text Available Background: Incidence of anaphylactic reactions occuring during anesthesia is not known. They occur most often in the induction  phase and can present with different levels of severity, also as an anaphylactic shock. Neuromuscular blocking drugs are the most frequently involved substances.Case presentation: We  report a case of a 77-year old female patient with granulomatous inflammation of unknown etiology. Surgical  biopsy of a neck lymph node was indicated. During the induction of anesthesia using propofol and succinylcholine she developed severe anaphylactic reaction presented with bronchospasm and cardiac arrest. Despite 80 min continous cardiopulmonary resuscitation the patient died. Elevated tryptase level in the patient’s blood sample taken before death confirmed anaphylactic reaction. On autopsy we confirmed the tuberculous etiology of generalized granulomatous inflammation.Conclusions: It is important to recognize anaphylactic reaction during anesthesia early and to take adequate measures in order to prevent unfavorable outcome. Tryptase assay of a blood sample taken during life or postmortem may help to identify anaphylactic reaction.

  3. Regional anesthesia and analgesia in cancer care: is it time to break the bad news?

    Science.gov (United States)

    Sekandarzad, Mir W; van Zundert, André A J; Doornebal, Chris W; Hollmann, Markus W

    2017-10-01

    There is ongoing controversy regarding the tumor-protective effects of regional anesthesia in patients undergoing cancer surgery. Evidence of up-to-date systematic reviews will be presented alongside recent updates on the effects of opioids and local anesthetics. In recent years, the literature regarding the effects of regional anesthesia techniques on cancer recurrence has raised many unanswered questions. Ongoing randomized controlled trials may not be able to shed light on the controversial discussion regarding the tumor protective effects of regional anesthesia because the expected effect size and event rate in those studies may be overstated.Recent more refined animal data, provides no evidence to suggest that opioids promote cancer recurrence or facilitate the development of metastatic disease.In addition, local anesthetics have promising preclinical anticarcinogenic effects that extend beyond their voltage-gated sodium channel blocking properties and could be of therapeutic value. Cancer recurrence in patients undergoing surgery remains a global burden. Current evidence suggests that regional techniques, opioid analgesia and local anesthetics in onco-anesthesia may require a tailored individual approach due to the phenotypic and genotypic heterogeneity within and between different tumors. The authors surmise that future or ongoing randomized controlled trials regarding regional anesthesia techniques and cancer outcome may not be able to reproduce clear results, as it will be challenging to prove the efficacy of one single intervention (e.g. regional anesthesia) in an otherwise complex multifactorial perioperative oncological setting.

  4. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

    Science.gov (United States)

    Barbosa, Fabiano Timbó; de Sousa Rodrigues, Célio Fernando; Castro, Aldemar Araújo; da Cunha, Rafael Martins; Barbosa, Tatiana Roa Bezerra Wanderley

    2016-01-01

    The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. The search was performed in Pubmed (January 1966 to December 2012), Embase (1974 to December 2012), The Cochrane Library (volume 10, 2012) and Lilacs (1982 to December 2012) databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  5. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE: To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT: The search was performed in Pubmed (January 1966 to December 2012, Embase (1974 to December 2012, The Cochrane Library (volume 10, 2012 and Lilacs (1982 to December 2012 databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS: The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.

  6. PERI-ANESTHESIA ANAPHYLAXIS (PAA): WE STILL HAVE NOT STARTED POST-PAA TESTING FOR INCITING ANESTHESIA-RELATED ALLERGENS.

    Science.gov (United States)

    Alshaeri, Taghreed; Gupta, Deepak; Nagabhushana, Ananthamurthy

    2016-02-01

    Anaphylaxis during anesthesia is uncommon. Diagnosis of peri-anesthesia anaphylaxis (PAA) requires anesthesia providers' vigilance for prompt diagnosis and treatment. In this case report, we present a challenging case with suspected PAA including its perioperative management, intensive care unit (ICU) course, and post-discharge follow-up. A 44-year-old female (body mass index = 26) presented for elective abdominal panniculectomy. Post-intubation, severe bronchospasm occurred that was non-responsive to nebulized albuterol and intravenous epinephrine. Continuous infusion of epinephrine was initiated. After aborting surgical procedure, the patient was transferred to ICU on continuous intravenous infusion of epinephrine. Venous blood sampling showed elevated troponin level. Echocardiography revealed ejection fraction of 25% suspicious of Takotsubo cardiomyopathy (mid cavitary variant). Tracheal extubation was only possible after three days. Subsequently, patient was discharged home with a cardiology follow-up appointment and a referral to an allergy specialist. Unfortunately at our institution (an academic university hospital in United States) along with neighboring institutions in near-by areas, the only allergy skin tests available are for local anesthetics and antibiotics, while neuromuscular blocking agents (NMBAs) cannot be tested (the suspected anaphylactic agent in our case was presumably rocuronium). In summary, PAA requires and responds to emergent diagnosis and immediate treatment; however there is still a long way to go to ensure post-PAA testing for inciting anesthesia-related allergens.

  7. A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients

    Directory of Open Access Journals (Sweden)

    Linsenmeier Claudia

    2008-06-01

    Full Text Available Abstract Background Radiotherapy (RT has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed. Methods To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A, 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B. This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy. Results Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4% patients in group A got anesthesia, only 8 (8.9% patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia. Conclusion We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT.

  8. A psychoeducational intervention reduces the need for anesthesia during radiotherapy for young childhood cancer patients

    International Nuclear Information System (INIS)

    Haeberli, Sonja; Grotzer, Michael A; Niggli, Felix K; Landolt, Markus A; Linsenmeier, Claudia; Ammann, Roland A; Bodmer, Nicole

    2008-01-01

    Radiotherapy (RT) has become an important treatment modality in pediatric oncology, but its delivery to young children with cancer is challenging and general anesthesia is often needed. To evaluate whether a psychoeducational intervention might reduce the need for anesthesia, 223 consecutive pediatric cancer patients receiving 4141 RT fractions during 244 RT courses between February 1989 and January 2006 were studied. Whereas in 154 RT courses corresponding with 2580 RT fractions patients received no psychoeducational intervention (group A), 90 RT courses respectively 1561 RT fractions were accomplished by using psychoeducational intervention (group B). This tailored psychoeducational intervention in group B included a play program and interactive support by a trained nurse according to age to get familiar with staff, equipment and procedure of radiotherapy. Group A did not differ significantly from group B in age at RT, gender, diagnosis, localization of RT and positioning during RT. Whereas 33 (21.4%) patients in group A got anesthesia, only 8 (8.9%) patients in group B needed anesthesia. The median age of cooperating patients without anesthesia decreased from 3.2 to 2.7 years. In both uni- and multivariate analyses the psychoeducational intervention significantly and independently reduced the need for anesthesia. We conclude that a specifically tailored psychoeducational intervention is able to reduce the need for anesthesia in children undergoing RT for cancer. This results in lower costs and increased cooperation during RT

  9. Preventing and managing awareness during general anesthesia

    Directory of Open Access Journals (Sweden)

    Jelena Berger

    2014-03-01

    Full Text Available Background: General anesthesia is a reversible state of a temporary loss of consciousness, analgesia, muscle paralysis, blunted autonomic responses and amnesia. To achieve this, an adequate depth of anesthesia should be maintained throughout the surgery. Awareness is a serious complication of general anesthesia, which occurs when the depth of anesthesia is not appropriate due to various causes.In this paper the underlying neurobiology of intraoperative awareness is presented, as well as risk factors for awareness and methods for assessing the depth of anesthesia. Possible psychological consequences of awareness and their management are also discussed. At the end, the recommendations for preventing intraoperative awareness are given.Conclusions: Awareness during general anesthesia may have adverse psychological sequelae in individual patients, therefore guidelines for preventing and managing of intraoperative awareness need to be adopted. In case of a possible awareness, the recommendations for offering a psychological support should also be followed.

  10. A unique anesthesia approach for carotid endarterectomy: Combination of general and regional anesthesia

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    Sukhen Samanta

    2014-01-01

    Full Text Available Carotid endarterectomy (CEA, a preventable surgery, reduces the future risks of cerebrovascular stroWke in patients with marked carotid stenosis. Peri-operative management of such patients is challenging due to associated major co-morbidities and high incidence of peri-operative stroke and myocardial infarction. Both general anesthesia (GA and local regional anesthesia (LRA can be used with their pros and cons. Most developing countries as well as some developed countries usually perform CEA under GA because of technical easiness. LRA usually comprises superficial, intermediate, deep cervical plexus block or a combination of these techniques. Deep block, particularly, is technically difficult and more complicated, whereas intermediate plexus block is technically easy and equally effective. We did CEA under a combination of GA and LRA using ropivacaine 0.375% with 1 mcg/kg dexmedetomidine (DEX infiltration. In LRA, we gave combined superficial and intermediate cervical plexus block with infiltration at the incision site and along the lower border of mandible. We observed better hemodynamics in intraoperative as well as postoperative periods and an improved postoperative outcome of the patient. So, we concluded that combination of GA and LRA is a good anesthetic technique for CEA. Larger randomized prospective trials are needed to support our conclusion.

  11. Dexmedetomidine: Expanding role in anesthesia

    Directory of Open Access Journals (Sweden)

    Jyotsna S Paranjpe

    2013-01-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical ′ideal′ sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction.

  12. Presbycusis: reversible with anesthesia drugs?

    Science.gov (United States)

    Kocher, Carl A

    2009-02-01

    Age-related hearing impairment, or presbycusis, is a degenerative condition not currently treatable by medication. It is therefore significant that the author, as a patient, experienced a reversal of high-frequency hearing loss during a 2-day period following abdominal surgery with general anesthesia. This report documents the surgery and the subsequent restoration of hearing, which was bilateral and is estimated to have exceeded 50dB at 4kHz. A possible role is noted for anesthetic agents such as lidocaine, propofol, or fentanyl. This experience may hold a clue for research toward the development of medical treatments for presbycusis.

  13. Chronic subdural hematoma following spinal anesthesia for cesarean section.

    Science.gov (United States)

    Metin, Kübra Mehel; Güzel, Is Il; Oskovi, Aslı; Guzel, Ali Irfan

    2017-09-01

    Intracranial subdural hematoma after spinal anesthesia is a rare and life-threatening complication of spinal anesthesia. The most common complication of spinal anesthesia is the postdural puncture headache. When severe and persistent headache after spinal anesthesia occur, differential diagnosis can be explored. In this report, we aimed to evaluate a patient with persistent headache following spinal anesthesia for cesarean section in a 31-year-old woman ,and emphasize a rare complication of spinal anesthesia which is subdural hematoma.

  14. Dental management of hemophiliac child under general anesthesia.

    Science.gov (United States)

    Rayen, R; Hariharan, V S; Elavazhagan, N; Kamalendran, N; Varadarajan, R

    2011-01-01

    Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  15. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia

  16. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia

  17. Ultrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques.

    Science.gov (United States)

    Sites, Brian D; Brull, Richard

    2006-12-01

    This article introduces the use of ultrasound to facilitate peripheral regional anesthesia. Regional anesthesia, despite its well known clinical benefits, has not gained the popularity of general anesthesia. This is secondary to multiple shortcomings including a defined failure rate, lack of simplicity, and the potential for patient discomfort or injury. Many of the negative aspects of regional anesthesia evolve from the reality that current nerve-localization techniques are unreliable. Given the great variation in human anatomy it is not surprising that even the most veteran clinician can be challenged by techniques that demand anatomical assumptions. The recent use of ultrasound imaging for nerve localization is an innovative application of an old technology which addresses many of the shortcomings of current techniques. Specifically, ultrasound imaging allows the operator to see neural structures, guide the needle under real-time visualization, navigate away from sensitive anatomy, and monitor the spread of local anesthetic. Ultrasound technology represents an ideal mechanism by which the regional anesthesiologist can attain the safety, speed, and efficacy of general anesthesia. Ultimately, it is the correct peri-neural spread of local anesthetic around a nerve that provides safe, effective, and efficient anesthetic conditions.

  18. Providing anesthesia in resource-limited settings.

    Science.gov (United States)

    Dohlman, Lena E

    2017-08-01

    The article reviews the reality of anesthetic resource constraints in low and middle-income countries (LMICs). Understanding these limitations is important to volunteers from high-income countries who desire to teach or safely provide anesthesia services in these countries. Recently published information on the state of anesthetic resources in LMICs is helping to guide humanitarian outreach efforts from high-income countries. The importance of using context-appropriate anesthesia standards and equipment is now emphasized. Global health experts are encouraging equal partnerships between anesthesia health care providers working together from different countries. The key roles that ketamine and regional anesthesia play in providing well tolerated anesthesia for cesarean sections and other common procedures is increasingly recognized. Anesthesia can be safely given in LMICs with basic supplies and equipment, if the anesthesia provider is trained and vigilant. Neuraxial and regional anesthesia and the use of ketamine as a general anesthetic appear to be the safest alternatives in low-resource countries. Environmentally appropriate equipment should be encouraged and pulse oximeters should be in every anesthetizing location. LMICs will continue to need support from outside sources until capacity building has made more progress.

  19. Simulation for Nurse Anesthesia Program Selection: Redesigned

    Science.gov (United States)

    Roebuck, John Arthur

    2017-01-01

    Purpose: This project is meant to answer the research question: What applicant character traits do Nurse Anesthesia Program Directors and Faculty identify as favorable predictors for successful completion of a nurse anesthesia program, and what evaluation methods are best to evaluate these traits in prospective students? Methods: A prospective…

  20. [Spinal anesthesia versus general anesthesia in the surgical treatment of inguinal hernia. Cost-effectiveness analysis].

    Science.gov (United States)

    Fernández-Ordóñez, M; Tenías, J M; Picazo-Yeste, J

    2014-05-01

    To compare the costs related to the clinical effectiveness of general anesthesia versus spinal anesthesia in inguinal hernioplasty ambulatory surgery. An observational, retrospective cohort study measurement and analysis of cost-effectiveness, in the ambulatory surgery unit of a general hospital. All patients over 18 years of age diagnosed with primary inguinal hernia and scheduled for unilateral hernioplasty between January 2010 and December 2011 were included. Duration of anesthetic induction, length of stay in both the operating room, and in the post-anesthesia care unit, the anesthetic effectiveness (the incidence of adverse effects and the patient's comfort level), and variable economic costs associated with the use of drugs, as well as the use of human resources, were compared. The final analysis included 218 patients, 87.2% male, with a mean age of 53 years (range: 18-85 years). Of these, 139 (63.76%) received subarachnoid anesthesia and 79,(36.2%) general anesthesia. The length of time a patient remained in the post-anesthesia care unit was 337.6±160.2min in the subarachnoid anesthesia group, and 210.0±97.5min for the general anesthesia group (P<.001). Costs of drugs for general anesthesia were higher than that for subarachnoid anesthesia (86.2±8.3 vs. 18.7±7.2). The total cost difference between the 2 techniques was €115.8 more for subarachnoid anesthesia (P<.001). Both techniques showed similar effectiveness. The overall costs for subarachnoid anesthesia were greater than for the general. The cost-effectiveness of general anesthesia is better for outpatient inguinal hernia repair surgery. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  1. Historical development of modern anesthesia.

    Science.gov (United States)

    Robinson, Daniel H; Toledo, Alexander H

    2012-06-01

    Of all milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world. It was in 1846 that one of mankind's greatest fears, the pain of surgery, was eliminated. This historical review article describes how the various elements of anesthesiology (gasses, laryngoscopes, endotracheal tubes, intravenous medications, masks, and delivery systems) were discovered and how some brilliant entrepreneurs and physicians of the past two centuries have delivered them to humanity. One name stands out amongst all others when the founder of modern anesthesia is discussed, William T.G. Morton (1819-1868). A young Boston Dentist, Dr. Morton had been in the search for a better agent than what had been used by many dentists: nitrous oxide. With Dr. Morton's tenacity driven by enthusiasm and discovery, he and renowned surgeon at Massachusetts General Hospital, John Collins Warren (1778-1856) made history on October 16, 1846 with the first successful surgical procedure performed with anesthesia. Dr. Morton had single-handedly proven to the world that ether is a gas that when inhaled in the proper dose, provided safe and effective anesthesia. One of the first accounts of an endotracheal tube being used for an airway comes from the pediatrician Joseph O'Dwyer (1841-1898). He used the metal "O'dwyer" tubes in diphtheria cases and passed them into the trachea blindly. Adding a cuff to the tube is credited to Arthur Guedel (1883-1956) and Ralph M. Waters (1883-1979) in 1932. This addition suddenly gave the practitioner the ability to provide positive pressure ventilation. The anesthesiologist Chevalier Jackson (1865-1958) promoted his handheld laryngoscope for the insertion of endotracheal tubes and its popularity quickly caught hold. Sir Robert Reynolds Macintosh's (1897-1989) breakthrough technique of direct laryngoscopy came after being appointed Nuffield professor of anesthetics at the University of Oxford

  2. Regional anesthesia practice in China: a survey.

    Science.gov (United States)

    Huang, Jeffrey; Gao, Huan

    2016-11-01

    Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. A survey was sent to all anesthesiologist members by WeChat. The respondents can choose mobile device or desktop to complete the survey. Each IP address is allowed to complete the survey once. A total of 6589 members read invitations. A total of 2654 responses were received with fully completed questionnaires, which represented an overall response rate of 40%. Forty-one percent of the respondents reported that more than 50% of surgeries in their hospitals were done under regional anesthesia. Most of the participants used test dose after epidural catheter insertion. The most common drug for test dose was 3-mL 1.5% lidocaine; 2.6% of the participants reported that they had treated a patient with epidural hematoma after neuraxial anesthesia. Most anesthesiologists (68.2%) performed peripheral nerve blocks as blind procedures based on the knowledge of anatomical landmarks. A majority of hospitals (80%) did not stock Intralipid; 61% of the respondents did not receive peripheral nerve block training. The current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Clonidine in pediatric caudal anesthesia.

    Science.gov (United States)

    Jamali, S; Monin, S; Begon, C; Dubousset, A M; Ecoffey, C

    1994-04-01

    Extradural clonidine produces analgesia in adults. To assess its efficacy in children, we randomized 45 pediatric patients aged 1-7 yr presenting for a subumbilical surgery into three groups of 15 each. After halothane and N2O/O2 induction, and with a double-blind protocol, caudal anesthesia was performed with 1 mL/kg of 0.25% bupivacaine. Epinephrine 1/200,000 was added in one group (EG), 1 microgram/kg of clonidine in another group (CG), and no additional medication in the last group (BG). Postoperative analgesia was evaluated using the Broadman "objective pain/discomfort scale" (OPS) at 1-h intervals until the first analgesic administration. There were no differences among the groups in age, weight, duration of surgery, baseline systolic arterial pressure, and heart rate. The mean (+/- SD) duration of analgesia was longer in the CG (987 +/- 573 min) than in the EG (377 +/- 341 min) and BG (460 +/- 439 min); P < 0.01. The maximal OPS scores were lower in the CG than in the EG and BG (2.3 +/- 1.6 vs 3.4 +/- 1.4 and 3.4 +/- 1.8, respectively; P < 0.05). More patients in the CG (n = 7) than in the EG (n = 1) and BG (n = 2) required no postoperative analgesia; P < 0.05. No differences were found among the groups for the minimal respiratory rate and minimal Spo2 values in the postoperative phase, and there were no differences among the groups for heart rate and systolic arterial pressure during the 3 h after caudal anesthesia. We conclude that the duration of postoperative analgesia with caudal bupivacaine was significantly increased by the addition of 1 microgram/kg of clonidine.

  4. The evolution of thoracic anesthesia.

    Science.gov (United States)

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients.

  5. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  6. Anesthesia for tracheal resection and reconstruction.

    Science.gov (United States)

    Hobai, Ion A; Chhangani, Sanjeev V; Alfille, Paul H

    2012-12-01

    Tracheal resection and reconstruction (TRR) is the treatment of choice for most patients with tracheal stenosis or tracheal tumors. Anesthesia for TRR offers distinct challenges, especially for the less experienced practitioner. This article explores the preoperative assessment, strategies for induction and emergence from anesthesia, the essential coordination between the surgical and anesthesia teams during airway excision and anastomosis, and postoperative care. The most common complications are reviewed. Targeted readership is practitioners with less extensive experience in managing airway surgery cases. As such, the article focuses first on the most common proximal tracheal resection. Final sections discuss specific considerations for more complicated cases. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Alzheimer’s disease and anesthesia

    Directory of Open Access Journals (Sweden)

    Marie-Amélie ePapon

    2011-01-01

    Full Text Available Cognitive disorders such as post-operative cognitive dysfunction, confusion, and delirium, are common following anesthesia in the elderly, with symptoms persisting for months or years in some patients. Alzheimer's disease (AD patients appear to be particularly at risk of cognitive deterioration following anesthesia, and some studies suggest that exposure to anesthetics may increase the risk of AD. Here, we review the literature linking anesthesia to AD, with a focus on the biochemical consequences of anesthetic exposure on AD pathogenic pathways.

  8. Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

    Science.gov (United States)

    Yoav, Leiser; Abu el-Naaj, Imad

    2015-01-01

    Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia. PMID:25811042

  9. Synchronous distance anesthesia education by Internet videoconference between Uganda and the United States.

    Science.gov (United States)

    Kiwanuka, J K; Ttendo, S S; Eromo, E; Joseph, S E; Duan, M E; Haastrup, A A; Baker, K; Firth, P G

    2015-09-01

    We evaluated the effectiveness of anesthesia education delivered via Internet videoconferencing between the Massachusetts General Hospital, Boston, MA, and Mbarara Regional Referral Hospital, Uganda. This is a prospective educational study. The setting is the education in 2 hospitals in Uganda and the United States. The subjects are anesthesia residents. The interventions are anesthesia education lectures delivered in person and via Internet videoconferencing. The average pre-lecture and post-lecture scores of the local, remote, and combined audiences were compared. Post-lecture test scores improved over pre-lecture scores: local audience, 59% ± 22% to 81% ± 16%, P = .0002, g = 1.144; remote audience, 51% ± 19% to 81% ± 8%, P educational capacity and international cooperation between academic institutions, a particular priority in the growing field of global health. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. A revisit of transthecal digital block and traditional digital block for anesthesia of the finger

    Directory of Open Access Journals (Sweden)

    Mohammad Dehghani

    2007-12-01

    Full Text Available BACKGROUND: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly performed blocks by care providers in several medical fields. There is another less known method, transthecal (Pulley block, in which local anesthesia is injected into the flexor tendon sheath.
    METHODS: A randomized clinical trial was performed to compare the transthecal (Pulley and traditional digital block with regard to the length of anesthesia and the need for another anesthetic method (due to insufficient anesthesia as a supplement. We divided 100 patients who needed digital block due to finger injury, into two groups randomly. In each group the patients were anesthetized either by traditional or transthecal digital block. All blocks were performed by the same investigator.
    RESULTS: Mean length of anesthesia was 34.2 minutes in the transthecal digital block method versus 33.8 minutes in the traditional digital block method (P>0.05. A repeated injection or local infiltration as a supplement was necessary only in 5 instances in the traditional digital block method (P<0.05.
    CONCLUSIONS: Regarding fewer injections and reduced amounts of lidocaine, absence of neurovascular bundles damage and comparable length of anesthesia and no need to supplemental anesthesia, transthecal digital block is an appropriate alternative to traditional digital block.
    KEY WORDS: Digital block, transthecal, pulley, finger, flexor tendon sheath.

  11. Intraoperative eye position after sub-Tenon's anesthesia for cataract surgery.

    Science.gov (United States)

    Kumar, Nishant; Jivan, Sharmila; Pulpa, Vidya; Butler, John; Khan, Mohammed Younis

    2006-08-01

    To evaluate the incidence and extent of ocular deviation associated with sub-Tenon's anesthesia. Seventy-five consecutive patients undergoing routine phacoemulsification with sub-Tenon's anesthesia at the Eye Unit, Royal Gwent Hospital, were prospectively enrolled in this observational case series. The exclusion criteria were patients taking warfarin, or patients with preexisting ocular motility disorders, allergy to local anesthetics, or previous surgery for squint or retinal detachment. Eleven patients were subsequently excluded from the study group as they required additional anesthesia blocks before measurements were taken for ocular deviation. We injected 5 mL of a local anesthetic mixture of 2% lignocaine and 7.5 mg/mL levobupivacaine in the sub-Tenon's space in the inferonasal quadrant. Ocular deviation was assessed objectively by means of the Krimsky test. Forced duction tests were performed before and after anesthesia. Hyperdeviation was documented in 49 (77%) eyes, exodeviation in 62 (97%), and hypodeviation in 6 (9.4%). No esodeviations were documented. Only 2 patients were orthophoric after anesthesia. Mean vertical deviation was 4.4 prism dioptres (PD) (SD 4.7 PD, 95% CI 3.2-5.5 PD, range 0-14 PD). Mean horizontal deviation was 19.5 (SD 9.6, 95% CI 17-22, range 0-50) PD. Forced duction test revealed no mechanical restriction before or after anesthesia. This study suggests that there is an appreciable ocular deviation with sub-Tenon's anesthesia. Intraoperative ocular deviation may make certain procedures more difficult; therefore, we recommend a low threshold for an additional corrective block administered before surgery to rectify the deviation.

  12. Dental anesthesia for patients with allergic reactions to lidocaine: two case reports.

    Science.gov (United States)

    Lee, Jiseon; Lee, Ju-Young; Kim, Hyun Jeong; Seo, Kwang-Suk

    2016-09-01

    Lidocaine, a local anesthetic commonly used in dental treatments, is capable of causing allergies or adverse effects similar to allergic reactions. However, the frequency of such occurrences in actual clinical settings is very rare, and even clinical tests on patients with known allergies to local anesthetics may often show negative results. When adverse effects, such as allergy to lidocaine, are involved, patients can be treated by testing other local anesthetics and choosing a local anesthetic without any adverse effects, or by performing dental treatment under general anesthesia in cases in which no local anesthetic without adverse effects is available. Along with a literature review, the authors of the present study report on two cases of patients who tested positive on allergy skin tests for lidocaine and bupivacaine and subsequently underwent successful dental treatments with either general anesthesia or a different local anesthetic.

  13. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Science.gov (United States)

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland

    2016-04-01

    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

  14. Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Kishimoto, Naotaka; Kinoshita, Ikue; Momota, Yoshihiro

    We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

  15. Conscious awareness and memory during general anesthesia.

    Science.gov (United States)

    Kiviniemi, K

    1994-10-01

    Conscious awareness is an infrequent complication of general anesthesia. All methods of anesthesia have been implicated, and no method guarantees amnesia. This article examines implicit and explicit memory and discusses factors associated with awareness. Common methods of detection are unreliable, and symptoms resembling post-traumatic stress disorder may result if awareness goes unrecognized and untreated. Patients who experience awareness may sue on grounds of malpractice, breach of contract, and lack of consent. Overhearing negative stimuli may affect patient outcome, because learning and language comprehension can occur during what appears to be clinically adequate anesthesia. Strategies to block threatening auditory stimuli include use of earphones, music tapes, white noise, reassuring statements, or positive suggestion. Behavioral anesthesia decreases patient stress to enhance recovery. Evidence of patient benefit resulting from therapeutic suggestion is inconclusive.

  16. Successful pulpal anesthesia for symptomatic irreversible pulpitis.

    Science.gov (United States)

    Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara

    2017-04-01

    Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible pulpitis. Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible pulpitis. The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible pulpitis based on a review of the available evidence. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  17. Anesthesia related Complications in Pediatric GI Endoscopy

    Directory of Open Access Journals (Sweden)

    A Sabzevari

    2014-04-01

    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  18. Total intravenous anesthesia for major burn surgery

    OpenAIRE

    Cancio, Leopoldo C; Cuenca, Phillip B; Walker, Stephen C; Shepherd, John M

    2013-01-01

    Total intravenous anesthesia (TIVA) is frequently used for major operations requiring general anesthesia in critically ill burn patients. We reviewed our experience with this approach. Methods: During a 22-month period, 547 major burn surgeries were performed in this center’s operating room and were staffed by full-time burn anesthesiologists. The records of all 123 TIVA cases were reviewed; 112 records were complete and were included. For comparison, 75 cases were selected at random from a t...

  19. Anesthesia for Pediatric Deep Brain Stimulation

    Directory of Open Access Journals (Sweden)

    Joseph Sebeo

    2010-01-01

    Full Text Available In patients refractory to medical therapy, deep brain stimulations (DBSs have emerged as the treatment of movement disorders particularly Parkinson's disease. Their use has also been extended in pediatric and adult patients to treat epileptogenic foci. We here performed a retrospective chart review of anesthesia records from 28 pediatric cases of patients who underwent DBS implantation for dystonia using combinations of dexmedetomidine and propofol-based anesthesia. Complications with anesthetic techniques including airway and cardiovascular difficulties were analyzed.

  20. Potential anesthesia protocols for space exploration missions.

    Science.gov (United States)

    Komorowski, Matthieu; Watkins, Sharmila D; Lebuffe, Gilles; Clark, Jonathan B

    2013-03-01

    In spaceflight beyond low Earth's orbit, medical conditions requiring surgery are of a high level of concern because of their potential impact on crew health and mission success. Whereas surgical techniques have been thoroughly studied in spaceflight analogues, the research focusing on anesthesia is limited. To provide safe anesthesia during an exploration mission will be a highly challenging task. The research objective is thus to describe specific anesthesia procedures enabling treatment of pre-identified surgical conditions. Among the medical conditions considered by the NASA Human Research Program Exploration Medical Capability element, those potentially necessitating anesthesia techniques have been identified. The most appropriate procedure for each condition is thoroughly discussed. The substantial cost of training time necessary to implement regional anesthesia is pointed out. Within general anesthetics, ketamine combines the unique advantages of preservation of cardiovascular stability, the protective airway reflexes, and spontaneous ventilation. Ketamine side effects have for decades tempered enthusiasm for its use, but recent developments in mitigation means broadened its indications. The extensive experience gathered in remote environments, with minimal equipment and occasionally by insufficiently trained care providers, confirms its high degree of safety. Two ketamine-based anesthesia protocols are described with their corresponding indications. They have been designed taking into account the physiological changes occurring in microgravity and the specific constraints of exploration missions. This investigation could not only improve surgical care during long-duration spaceflights, but may find a number of terrestrial applications in isolated or austere environments.

  1. THE EFFECT OF LOCAL ANESTHETICS ON TEAR PRODUCTION

    African Journals Online (AJOL)

    INTRODUCTION. Anesthetics are drugs which bring about the state of anesthesia and anesthesia is a measure, which produces insensitivity to external expression or a reversible lack of awareness which can be general or local . General anesthetics act on all parts of the body while local anesthetics act on some parts of the ...

  2. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive

  3. Anesthesia care for liver transplantation.

    Science.gov (United States)

    Hannaman, Michael J; Hevesi, Zoltan G

    2011-01-01

    Intraoperative transfusion practices for liver transplantation have evolved dramatically since the first transplants of the 1960s. It is important for today's clinicians to be current in their understanding of how transplant patients should be managed with regard to their coagulation profile, volume status, and general hemodynamic state. The anesthesia team is presented with the unique task of manipulating this tenuous balance in a rapid and precise manner when managing patients undergoing liver transplantation. Although significant progress has been made in reducing blood product administration, it is still common to encounter large volume blood loss in these cases. Increasingly, clinicians are challenged to justify transfusion practices with a stronger evidentiary base. The current state of the literature for transfusion guidelines and blood product management in this particular patient subset will be discussed, as well as a variety of means (both pharmacologic and otherwise) used to reduce the need for transfusion. The aim was to review the latest evidence on these topics, as well as to highlight areas that need further clarification regarding their role in the optimal care of these patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure

    Directory of Open Access Journals (Sweden)

    Al-mustafa Mahmoud

    2010-01-01

    Full Text Available Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF. The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients. The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05. The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019. Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.

  5. Postoperative urinary retention after general and spinal anesthesia in orthopedic surgical patients

    Directory of Open Access Journals (Sweden)

    Alaa Abdel aziz Niazi

    2015-01-01

    Conclusion: Urinary retention is more common after spinal than general anesthesia in orthopedic patients. Adding narcotics to the local anesthetics intrathecally causes more incidence of postoperative urinary retention, which may delay patients discharge and transabdominal ultrasonography is a reliable, noninvasive, inexpensive and simple method to measure bladder volume postoperatively.

  6. Regional anesthesia and analgesia in cancer care: is it time to break the bad news?

    NARCIS (Netherlands)

    Sekandarzad, Mir W.; van Zundert, André A. J.; Doornebal, Chris W.; Hollmann, Markus W.

    2017-01-01

    There is ongoing controversy regarding the tumor-protective effects of regional anesthesia in patients undergoing cancer surgery. Evidence of up-to-date systematic reviews will be presented alongside recent updates on the effects of opioids and local anesthetics. In recent years, the literature

  7. Sub-tenon anesthesia in the operation of cataract using phacoemulsification technique

    Directory of Open Access Journals (Sweden)

    Avramović Siniša

    2008-01-01

    Full Text Available INTRODUCTION Already in 1884, Knapp reported a successful cataract operation using 5% of cocaine in eyedrops. Today, different methods of local anesthesia in the operation of cataract are used, such as retrobulbary, peribulbary, subconjunctival, sub-tenon, topical and intracameral anesthesia. Phacoemulsification is a modern approach to the operation of cataract that is increasingly applied in our country. Aiming to eliminate the risk of severe complications caused by retrobulbary anesthesia, in our patients undergoing surgery to treat cataract we applied sub-tenon anesthesia. OBJECTIVE The aim of this work was to establish the efficacy and the safety of subtenal anesthesia in the operation of cataract using phacoemulsification technique. METHOD We examined 85 patients who were operated for cataract under sub-tenon anesthesia. The operation was performed using phacoemulsification technique. The surgeon injected about 2 ml of the mixture of lidocaine (2% and bupivacaine (0.5% in equal proportions into the bottom of the fornix at 11 o’clock or 1 o’clock position into one of the two upper eye quadrants. After phacoemulsification and the placement of intraocular lenses, the patients were asked to reply to the questions according to a standardized protocol. Priory, the patients were informed about the test and the pain scale ranging from 1 to 10, with 1 indicating the absence of pain and 10 unbearable pain. RESULTS Eighty-five patients underwent surgery for cataract using phacoemulsification technique and in whom posterior chamber intraocular lenses were placed under sub-tenon anesthesia. During the application of anesthesia, subjective pain experience was at the level of mild discomfort or non-existent in 3/4 of the patients. In relation to pain experience during surgery, it ranged from mild inconvenience to pain absence in 4/5 of the patients. The most frequent complication during surgery was eye rolling occurring in every 10th patient. In 4

  8. Postoperative pain management following ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Schug SA

    2015-01-01

    Full Text Available Stephan A Schug,1,2 Chandani Chandrasena2 1School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; 2Department of Anesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia Abstract: Worldwide, there is an increasing trend toward performing more and more complex surgery in an ambulatory setting, partially driven by economic considerations. Provision of appropriate pain relief is still often inadequate in this setting; poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. Therefore, improved analgesia after ambulatory surgery is an important goal; appropriate strategies include identification of at-risk patients, provision of multimodal analgesia, and early use of rescue strategies. Multimodal analgesia is based on the combined use of multiple medications or techniques for pain control, which have different mechanisms of action or act on different sites at the pain pathways. Thereby, such an approach improves analgesia, reduces opioid requirements, and reduces adverse effects of opioids. Important components of multimodal analgesia are nonopioids (acetaminophen and anti-inflammatory drugs, corticosteroids, and alpha-2-delta modulators (gabapentin, pregabalin, but most importantly the use of local and regional anesthesia techniques. Here, the use of adjuvants is one way to increase the duration of pain relief, but, increasingly, continuous peripheral nerve blocks via catheters are used in ambulatory patients, too. Finally, the planning of discharge medications needs a balancing act between the requirements for provision of good analgesia and the risk of opioids going out into the community. Keywords: ambulatory surgery, short-stay surgery, multimodal analgesia, nonopioids, local anesthetics, regional anesthesia

  9. Development of a Head and Neck Regional Anesthesia Task Trainer for Emergency Medicine Learners

    Directory of Open Access Journals (Sweden)

    Diane L Gorgas

    2017-04-01

    Full Text Available Audience: This innovation is designed for medical students through senior residents. Introduction: Regional anesthesia increases the EM physician’s ability to provide effective pain relief and to complete procedures within the Emergency Department (ED. Studies consistently demonstrate that emergency physicians undertreat pain when performing basic procedures such as suturing lacerations.1,2 Regional anesthesia allows for effective pain relief, while avoiding the risks associated with systemic analgesia/anesthesia or the tissue distortion of local anesthesia.3 Knowledge of the anatomy involved in various nerve blocks is crucial to the development of proper technique and successful performance of this skill. Three dimensional (3-D model simulation-based mastery of procedural skills has been demonstrated to decrease resident anxiety, improve success rates, and decrease complications during the resident’s transition into the clinical setting.5,6 Similarly, use of a 3-D head and neck model to practice application of facial regional anesthesia is hypothesized to improve provider confidence and competence which will in turn provide an improved patient experience. Objectives: In participating in the educational session associated with this task trainer, the learner will: 1 Identify landmarks for the following nerve blocks: Infraorbital, Supraorbital (V1, Mental, Periauricular 2 Demonstrate the appropriate technique for anesthetic injection for each of these nerve blocks 3 Map the distribution of regional anesthesia expected from each nerve block 4 Apply the indications and contraindications for each regional nerve block Method: This low-fidelity task trainer allows residents and medical students to practice various nerve blocks on the face in order to improve learner confidence and proficiency in performing facial regional anesthesia.

  10. Cancer Recurrence and Regional Anesthesia: The Theories, the Data, and the Future in Outcomes.

    Science.gov (United States)

    Le-Wendling, Linda; Nin, Olga; Capdevila, Xavier

    2016-04-01

    More than one million people each year in the United States are diagnosed with cancer. Surgery is considered curative, but the perioperative phase represents a vulnerable period for residual disease to spread. Regional anesthesia has been proposed to reduce the incidence of recurrence by attenuating the sympathetic nervous system's response during surgery, reducing opioid requirements thus diminishing their immunosuppressant effects, and providing antitumor and anti-inflammatory effects directly through systemic local anesthetic action. In this article, we present a description of the perioperative period, a summary of the proposed hypotheses and available literature on the effects of regional anesthesia on cancer recurrence, and put regional anesthesia in context in regard to its potential role in reducing cancer recurrence during the perioperative period. A literature review was conducted through PubMed by examining the following topics: effects of surgery on tumor progression, roles of multiple perioperative variables (analgesics, hypothermia, blood transfusion, beta-blockade) in cancer recurrence, and available in vitro, animal, and human studies regarding the effects of regional anesthesia on cancer recurrence. in vitro, animal and human retrospective studies suppport the hypothesis that in certain types of cancer, regional anesthesia may be associated with lower recurrence rates. A few well-planned human randomized clinical trials are currently under way that may provide more solid evidence to substantiate or refute the benefits of regional anesthesia in reducing cancer recurrence. The benefits of regional anesthesia in reducing cancer recurrence have a sound theoretical basis and, in certain cancers, are supported by the existing body of literature. This article outlines the current state of our knowledge on the relationship between cancer progression and regional analgesia. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions

  11. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    Directory of Open Access Journals (Sweden)

    Paulo V. M. Steagall

    2017-05-01

    Full Text Available This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect, perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique.

  12. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    Science.gov (United States)

    Steagall, Paulo V. M.; Simon, Bradley T.; Teixeira Neto, Francisco J.; Luna, Stelio P. L.

    2017-01-01

    This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side effects associated with systemic administration of drugs. However, the potential for cardiorespiratory compromise, neurotoxicity, and other adverse effects should be considered when using the epidural route of administration. When these variables are considered, the epidural technique is useful as a complementary method of anesthesia for preventive and postoperative analgesia and/or as part of a balanced anesthesia technique. PMID:28553642

  13. Spinal anesthesia with diphenhydramine and pheniramine in rats.

    Science.gov (United States)

    Hung, Ching-Hsia; Chu, Chin-Chen; Chen, Yu-Chung; Chen, Yu-Wen; Li, Zong-Ying; Wang, Jhi-Joung

    2011-12-30

    The aim of this study was to evaluate the local anesthetic effects of pheniramine and diphenhydramine, two histamine H₁ receptor antagonists, on spinal anesthesia and their comparison with lidocaine, a commonly used local anesthetic. After rats were injected intrathecally with diphenhydramine and pheniramine, the dose-response curves were obtained. The potency and duration of diphenhydramine and pheniramine on spinal anesthesia were compared with lidocaine. We showed that diphenhydramine and pheniramine produced dose-dependent spinal blockades in motor function, proprioception, and nociception. On a 50% effective dose (ED₅₀) basis, the rank of potency of drugs was diphenhydramine=pheniramine>lidocaine (ppheniramine or lidocaine (ppheniramine or lidocaine, elicited longer duration of sensory block than that of motor block at the same dose of 1.75 μmol. These preclinical data reported that diphenhydramine with a more sensory-selective action over motor blockade demonstrated more potent and longer-lasting spinal blockades, compared with pheniramine or lidocaine. Copyright © 2011 Elsevier B.V. All rights reserved.

  14. The use of multi-criteria decision making models in evaluating anesthesia method options in circumcision surgery.

    Science.gov (United States)

    Hancerliogullari, Gulsah; Hancerliogullari, Kadir Oymen; Koksalmis, Emrah

    2017-01-23

    Determining the most suitable anesthesia method for circumcision surgery plays a fundamental role in pediatric surgery. This study is aimed to present pediatric surgeons' perspective on the relative importance of the criteria for selecting anesthesia method for circumcision surgery by utilizing the multi-criteria decision making methods. Fuzzy set theory offers a useful tool for transforming linguistic terms into numerical assessments. Since the evaluation of anesthesia methods requires linguistic terms, we utilize the fuzzy Analytic Hierarchy Process (AHP) and fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). Both mathematical decision-making methods are originated from individual judgements for qualitative factors utilizing the pair-wise comparison matrix. Our model uses four main criteria, eight sub-criteria as well as three alternatives. To assess the relative priorities, an online questionnaire was completed by three experts, pediatric surgeons, who had experience with circumcision surgery. Discussion of the results with the experts indicates that time-related factors are the most important criteria, followed by psychology, convenience and duration. Moreover, general anesthesia with penile block for circumcision surgery is the preferred choice of anesthesia compared to general anesthesia without penile block, which has a greater priority compared to local anesthesia under the discussed main-criteria and sub-criteria. The results presented in this study highlight the need to integrate surgeons' criteria into the decision making process for selecting anesthesia methods. This is the first study in which multi-criteria decision making tools, specifically fuzzy AHP and fuzzy TOPSIS, are used to evaluate anesthesia methods for a pediatric surgical procedure.

  15. Pediatric anesthesia after the anaesthesia practice in children observational trial study: who should do it?

    Science.gov (United States)

    Habre, Walid

    2018-02-12

    This review highlights the requirements for harmonization of training, certification and continuous professional development and discusses the implications for anesthesia management of children in Europe. A large prospective cohort study, Anaesthesia PRactice In Children Observational Trial (APRICOT), revealed a high incidence of perioperative severe critical events and a large variability of anesthesia practice across 33 European countries. Relevantly, quality improvement programs have been implemented in North America, which precisely define the requirements to manage anesthesia care for children. These programs, with the introduction of an incident-reporting system at local and national levels, could contribute to the improvement of anesthesia care for children in Europe. The main factors that likely contributed to the APRICOT study results are discussed with the goal of defining clear requirement guidelines for anesthetizing children. Emphasis is placed on the importance of an incident-reporting system that can be used for both competency-based curriculum for postgraduate training as well as for continuous professional development. Variability in training as well as in available resources, equipment and facilities limit the generalization of some of the APRICOT results. Finally, the impact on case outcome of the total number of pediatric cases attended by the anesthesiologist should be taken into consideration along with the level of expertise of the anesthesiologist for complex pediatric anesthesia cases.

  16. [Severe hemodynamic deterioration during epidural anesthesia for endovascular treatment of thoracic aortic stenosis].

    Science.gov (United States)

    Monsma, M; Herrera, P; Moreno, I; Matoses, S; Ortí, I; López, A; Alepuz, R

    2005-10-01

    A 72-year-old woman diagnosed with critical descending aortic stenosis was scheduled for endovascular treatment by angioplasty and implantation of an aortic stent. Her medical history included arterial hypertension, lipid metabolic disorder, obesity, Takayasu disease, dermatopolymyositis, and alleged allergy to iodine contrast and local anesthetics. After the allergies were ruled out, it was decided to use a regional anesthetic technique to avoid the postoperative complications of general anesthesia and achieve better hemodynamic control during surgery. Surgery was carried out under epidural anesthesia and intravenous sedation. After angioplasty and during self-expansion of the stent, the patient's hemodynamics deteriorated rapidly; she lost consciousness and required orotracheal intubation and immediate resuscitation measures. The literature describes in detail the management of patients with thoracic aortic lesions, including the most appropriate way to provide anesthesia. General anesthesia seems to be preferred, although care is taken to individualize the decision. We analyze this case of a patient with severe thoracic aortic stenosis undergoing endovascular treatment under epidural anesthesia.

  17. Survey of international regional anesthesia fellowship directors

    Directory of Open Access Journals (Sweden)

    Lansdown AK

    2013-07-01

    Full Text Available Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results: The survey response rate was 66% (45/68. Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion: This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. Keywords: anesthesia, regional, fellowship, education

  18. Legal abortion mortality and general anesthesia.

    Science.gov (United States)

    Atrash, H K; Cheek, T G; Hogue, C J

    1988-02-01

    Legal abortion-related mortality as reported to the Centers for Disease Control declined eightfold between 1972 and 1981. However, the causes of legal abortion mortality have changed over time. We reviewed all legal abortion-related deaths that occurred between 1972 and 1985 in the United States. We found that, although the absolute number of legal abortion-related deaths caused by general anesthesia complications did not increase, the proportion of such deaths increased significantly, from 7.7% between 1972 and 1975 to 29.4% between 1980 and 1985. Women who died of general anesthesia complications did not differ by age, presence of preexisting medical conditions, or type of facility from women who died of other causes. However, the proportion of deaths from general anesthesia complications was significantly higher among women of black and other races, women obtaining abortions during the first trimester, and women obtaining abortions in the Northeast. Our results indicate that at least 23 of the 27 deaths were due to hypoventilation and/or loss of airway resulting in hypoxia. Persons administering general anesthesia for abortion must be skilled in airway management as well as the provision of general anesthesia.

  19. Anesthesia related complications of laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Qureshi, F.A.

    2003-01-01

    Objective: To determine the incidence of intraoperative anesthesia-related complications of laparoscopic cholecystectomy. Results: One hundred patients with male to female ratio of 1:8.09 in the age range of 20-80 years (mean 39 years) underwent general anesthesia for laparoscopic cholecystectomy. The duration of operation in 94 laparoscopic cholecystectomy was from 20 to 80 minutes (mean 60.63 minutes). The incidence of intraoperative hypotension was 9%. Four percent of the patients developed arrhythmias. Increase in end-tidal-carbon dioxide (ETCO/sub 2/) was observed in 3% of cases. Conversion rate to open cholecystectomy was 6%. Damage to intraabdominal vessels with trocar insertion occurred in 1% of cases. Conclusion: Although laparoscopic cholecystectomy has major surgical and anesthetic advantages, there are anesthesia related complications requiring specific anesthetic interventions to improve patients outcome without compromising their safety. (author)

  20. Transient Neurological Symptoms after Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Zehra Hatipoglu

    2013-02-01

    Full Text Available Lidocaine has been used for more than 50 years for spinal anesthesia and has a remarkable safety record. In 1993, a new adverse effect, transient neurologic toxicity was described in patients recovering from spinal anesthesia with lidocaine. Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h. The incidence of transient neurological symptoms reported in prospective, randomized trials varies from 4% to 37%. The etiology of transient neurological symptoms remains unkonwn. Despite the transient nature of this syndrome, it has proven to be difficult to treat effectively. Drug or some interventional therapy may be necessary. [Archives Medical Review Journal 2013; 22(1.000: 33-44

  1. Pulmonary Hypertensive Crisis on Induction of Anesthesia.

    Science.gov (United States)

    Schisler, Travis; Marquez, Jose M; Hilmi, Ibtesam; Subramaniam, Kathirvel

    2017-03-01

    Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.

  2. Anesthesia Management in Diabetic Cardiovascular Autonomic Neuropathy

    Directory of Open Access Journals (Sweden)

    Feride Karacaer

    2016-06-01

    Full Text Available Cardiovascular autonomic neuropathy is frequently observed in patients with diabetes mellitus and encompasses damage to the autonomic nerve fibers, resulting in abnormalities in heart rate control and vascular dynamics. There is an increased mortality and morbidity rate among these patients. A series of cardiovascular reflex tests known as Ewing's battery tests are used for diagnosis cardiac autonomic neuropathy and provide valuable information to the clinical assessment of these patients. As anesthesia has a major influence on perioperative autonomic function, the interplay between cardiovascular autonomic neuropathy and anesthesia may result in unexpected haemodynamic instability during surgery and postoperative recovery. A comprehensive preoperative assessment and perioperative cautious monitoring are necessary for successful anesthesia management. [Archives Medical Review Journal 2016; 25(2.000: 140-151

  3. [Allergic reaction during anesthesia: two case reports].

    Science.gov (United States)

    Okamoto, Shinji; Futagawa, Koichi; Sugiura, Junko; Uchida, Tomohisa; Okuda, Takahiko; Koga, Yoshihisa

    2009-10-01

    We experienced two cases of serious and potentially life-threatening allergic reactions. The first patient was a 28-year-old male patient scheduled for surgery for cerebral arteriovenous malformations and another patient was a 66-year-old male patient scheduled for hepatic resection. After uneventful anesthetic induction, anesthesia was maintained with sevoflurane, air and oxygen. Both patients developed allergic reactions characterized by cardiovascular failure during anesthesia. Resuscitative treatment included rapid fluid infusion, administration of adrenaline and steroid. Both patients were successfully resuscitated without any lasting sequelae. The causative agent in one of these cases was probably a prophylactically used antibiotic, while that of the other case was a reaction to latex. Both patients showed elevated histamine and tryptase concentrations in blood samples. Recently, the incidence of allergic reactions to antibiotics and latex during anesthesia is increasing. Anesthesiologists should, therefore, be aware of the possibility of allergic reactions to all drugs and substances, especially to latex, during the perioperative period.

  4. The optimal anesthetic depth for interventional neuroradiology: comparisons between light anesthesia and deep anesthesia.

    Science.gov (United States)

    Jung, Yoo Sun; Han, Ye-Reum; Choi, Eun-Su; Kim, Byung-Gun; Park, Hee-Pyoung; Hwang, Jung-Won; Jeon, Young-Tae

    2015-04-01

    This study was designed to determine the optimal anesthetic depth for the maintenance and recovery in interventional neuroradiology. Eighty-eight patients undergoing interventional neuroradiology were randomly allocated to light anesthesia (n = 44) or deep anesthesia (n = 44) groups based on the value of the bispectral index (BIS). Anesthesia was induced with propofol, alfentanil, and rocuronium and maintained with 1-3% sevoflurane. The concentration of sevoflurane was titrated to maintain BIS at 40-49 (deep anesthesia group) or 50-59 (light anesthesia group). Phenylephrine was used to maintain the mean arterial pressure within 20% of preinduction values. Recovery times were recorded. The light anesthesia group had a more rapid recovery to spontaneous ventilation, eye opening, extubation, and orientation (4.1 ± 2.3 vs. 5.3 ± 1.8 min, 6.9 ± 3.2 min vs. 9.1 ± 3.2 min, 8.2 ± 3.1 min vs. 10.7 ± 3.3 min, 10.0 ± 3.9 min vs. 12.9 ± 5.5 min, all P neuroradiology were associated with a more rapid recovery and favorable hemodynamic response, but also with more patient movement. We suggest that maintaining BIS values between 40 and 49 is preferable for the prevention of patient movement during anesthesia for interventional neuroradiology.

  5. [Pediatric caudal anesthesia: importance and aspects of safety concerns].

    Science.gov (United States)

    Mauch, J; Weiss, M

    2012-08-01

    Caudal block is a safe procedure commonly used for pediatric perioperative analgesia. Complications are extremely rare but nevertheless local and systemic contraindications must be excluded. Optimal safety and quality result when strict attention is paid to technical details. A local anesthetic (LA) containing epinephrine allows early detection of inadvertent intravascular LA administration; therefore an epinephrine/LA mixture is recommended at least for the test dose. In terms of safety the choice of LA itself is probably of secondary importance. Clonidine as an adjuvant has an excellent risk/benefit profile with minimal side effects. Inadvertent systemic LA intoxication is a rare but potentially fatal complication of regional anesthesia and measures for prevention and early detection are essential. Should circulatory arrest occur, immediate resuscitation following standard guidelines is to be initiated including the use of epinephrine as the first line drug. Intravenous administration of lipid solutions may be beneficial as a secondary adjunct to stabilize hemodynamics but is not an alternative to epinephrine.

  6. Pentobarbital anesthesia alters neural responses in the precedence effect.

    Science.gov (United States)

    Song, Penglong; Wang, Ningyu; Wang, Hui; Xie, Yan; Jia, Jun; Li, Huijun

    2011-07-01

    The precedence effect (PE) is thought to be beneficial for proper localization and perception of sounds. The majority of recent physiological studies focus on the neural discharges correlated with PE in the inferior colliculus (IC). Pentobarbital anesthesia is widely used in physiological studies. However, little is known of the effect of pentobarbital on the discharge of neurons in PE. Neuronal responses in the IC from 23 male SD rats were recorded by standard extracellular recording techniques following presentation of 4 ms white noise bursts, presented from either or both of two loud speakers, at different interstimulus delays (ISDs). The neural responses were recorded for off-line analysis before or after intraperitoneal administration of pentobarbital at a loading or maintenance dose. Data were assessed by one-way repeated measures analysis of variance and pairwise comparisons. When the ipsilateral stimuli were leading, pentobarbital at a loading dose significantly increased normalized response to lagging stimuli during recovery from anesthesia. However, it was not the case when the contralateral stimuli were leading. At a maintenance dose, the normalized response to lagging stimuli were significantly reduced, independent of whether contralateral or ipsilateral stimuli were leading. These data show that pentobarbital have no effect on the normalized response of leading stimuli but can prolong the recovery time of lagging stimuli to paired sources produced PE illusions, which was gradually attenuated during recovery from anesthesia. Thus, extracellular recording immediately after administration of pentobarbital should be avoided in physiological studies of neural correlates of PE. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

    Directory of Open Access Journals (Sweden)

    S.M.R. Rabani

    2010-01-01

    Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

  8. Effects of dexmedetomidine infusion during spinal anesthesia on ...

    African Journals Online (AJOL)

    Effects of dexmedetomidine infusion during spinal anesthesia on hemodynamics and sedation. ... Libyan Journal of Medicine ... evaluated the effects of intravenous dexmedetomidine during spinal anesthesia on hemodynamics, respiratory rate, oxygen saturation, sedpain, and compared them with those of saline infusion.

  9. 76 FR 16796 - Pediatric Anesthesia Safety Initiative (PASI)

    Science.gov (United States)

    2011-03-25

    ... central nervous system, as well as memory and learning deficits. Anesthetic agents that have been... of anesthesia and sedation, including stakeholders from industry, professional organizations... aforementioned experts in the fields of anesthesia and sedation, including stakeholders from industry...

  10. Anesthesia for pediatric external beam radiation therapy

    International Nuclear Information System (INIS)

    Fortney, Jennifer T.; Halperin, Edward C.; Hertz, Caryn M.; Schulman, Scott R.

    1999-01-01

    Background: For very young patients, anesthesia is often required for radiotherapy. This results in multiple exposures to anesthetic agents over a short period of time. We report a consecutive series of children anesthetized for external beam radiation therapy (EBRT). Methods: Five hundred twelve children ≤ 16 years old received EBRT from January 1983 to February 1996. Patient demographics, diagnosis, anesthesia techniques, monitoring, airway management, complications, and outcome were recorded for the patients requiring anesthesia. Results: One hundred twenty-three of the 512 children (24%) required 141 courses of EBRT with anesthesia. Anesthetized patients ranged in age from 20 days to 11 years (mean 2.6 ± 1.8 ). The frequency of a child receiving EBRT and requiring anesthesia by age cohort was: ≤ 1 year (96%), 1-2 years (93%), 2-3 years (80%), 3-4 years (51%), 4-5 years (36%), 5-6 years (13%), 6-7 years (11%), and 7-16 years (0.7%). Diagnoses included: primary CNS tumor (28%), retinoblastoma (27%), neuroblastoma (20%), acute leukemia (9%), rhabdomyosarcoma (6%), and Wilms' tumor (4%). Sixty-three percent of the patients had been exposed to chemotherapy prior to EBRT. The mean number of anesthesia sessions per patient was 22 ± 16. Seventy-eight percent of the treatment courses were once daily and 22% were twice daily. Anesthesia techniques included: short-acting barbiturate induction + inhalation maintenance (21%), inhalation only (20%), ketamine (19%), propofol only (12%), propofol induction + inhalation maintenance (7%), ketamine induction + inhalation maintenance (6%), ketamine or short-acting barbiturate induction + inhalation maintenance (6%). Monitoring techniques included: EKG (95%), O 2 saturation (93%), fraction of inspired O 2 (57%), and end-tidal CO 2 (55%). Sixty-four percent of patients had central venous access. Eleven of the 74 children with a central line developed sepsis (15%): 6 of the 11 were anesthetized with propofol (55%), 4 with a

  11. Spinal Anesthesia in a Patient with Scleroderma

    Directory of Open Access Journals (Sweden)

    Fatih Simsek

    2013-10-01

    Full Text Available Scleroderma, a multisystem connective tissue disease and etiology is still unclear. In the pathogenesis, it is charcterized by increased fibroblast proliferation with activation of immunological mechanisms and accumulation of collagen in the skin and internal organs. Patients might have anesthesia-related potential problems because many systems affected and have functional disorders due to accumulation of collagen. For this reason, anesthetic management is extremely important. A careful preoperative evaluation is essential. In this article, we will be discuss in the light of the literature a cachectic 60-year-old female patient who had urethral polyp excision with scleroderma applied spinal anesthesia.

  12. PERIPHERAL BLOCK ANESTHESIA OF UPPER EXTREMITY AND ITS COMPLICATIONS

    OpenAIRE

    Hakan Tapar; Mustafa Suren; Ziya Kaya; Semih Arici; Serkan Karaman; Mursel Kahveci

    2012-01-01

    Successful peripheral blocks and selection of appropriate technique according to surgery is possible with a good knowledge of anatomy. Regional peripheral block anesthesia of upper extremity which applied by single injection to plexus brachialis is the most recommended method of anesthesia in daily surgical procedures. The most important advantages of peripheral nerve blocks which are type of regional anesthesia according to general anesthesia and central blocks are less effect ...

  13. Nurse Anesthetists' Perceptions Regarding Utilization of Anesthesia Support Personnel

    Science.gov (United States)

    Ford, Mary Bryant

    2010-01-01

    Anesthesia support personnel (ASP) provide direct support to health care providers administering anesthesia (Certified Registered Nurse Anesthetists [CRNAs] and anesthesiologists). Because these anesthesia providers are caring for a patient whom they cannot legally or ethically leave unattended, ASP are employed to bring them extra supplies or…

  14. 21 CFR 868.5240 - Anesthesia breathing circuit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia breathing circuit. 868.5240 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5240 Anesthesia breathing circuit. (a) Identification. An anesthesia breathing circuit is a device that is intended to administer medical gases to a...

  15. 21 CFR 868.5170 - Laryngotracheal topical anesthesia applicator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Laryngotracheal topical anesthesia applicator. 868... topical anesthesia applicator. (a) Identification. A laryngotracheal topical anesthesia applicator is a device used to apply topical anesthetics to a patient's laryngotracheal area. (b) Classification. Class...

  16. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

  17. Outcome after regional anesthesia: weighing risks and benefits

    NARCIS (Netherlands)

    Lirk, P.; Hollmann, M. W.

    2014-01-01

    Regional anesthesia has become a widely used method to provide intraoperative anesthesia, and postoperative analgesia. This review seeks to address the question whether patient outcomes are improved to an extent that justifies using regional anesthesia as a routine method. During the past decade, a

  18. 21 CFR 868.5130 - Anesthesia conduction filter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction filter. 868.5130 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5130 Anesthesia conduction filter. (a) Identification. An anesthesia conduction filter is a microporous filter used while administering to a patient...

  19. 21 CFR 868.5140 - Anesthesia conduction kit.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction kit. 868.5140 Section 868...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5140 Anesthesia conduction kit. (a) Identification. An anesthesia conduction kit is a device used to administer to a patient conduction, regional, or...

  20. 21 CFR 884.5100 - Obstetric anesthesia set.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral, and...

  1. 42 CFR 482.52 - Condition of participation: Anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Anesthesia services... Optional Hospital Services § 482.52 Condition of participation: Anesthesia services. If the hospital furnishes anesthesia services, they must be provided in a well-organized manner under the direction of a...

  2. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study was to inve...

  3. Experience with caudal block regional anesthesia for transurethral ...

    African Journals Online (AJOL)

    It is concluded that caudal anesthesia with 2% xylocaine with 1 in 80,000 adrenaline gives adequate anesthesia for transurethral resection of the prostate gland. Keywords: Caudal regional anesthesia, Turp. Résumé Quatre vingt quinze patients consécutifs avec lobliteration hypertrophie prostatique exigent d' être opéré ont ...

  4. [YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia].

    Science.gov (United States)

    Tulgar, Serkan; Selvi, Onur; Serifsoy, Talat Ercan; Senturk, Ozgur; Ozer, Zeliha

    Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p>0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p>0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87±4.28 vs. 5.84±2.90, p=0.044 and 3.89±5.43 vs. 1.19±3.35, p=0.01 respectively). Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

    Directory of Open Access Journals (Sweden)

    Serkan Tulgar

    Full Text Available Abstract Introduction Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method A search of the YouTube website was performed using the keywords "spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia". Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1 evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2 was designed for evaluating patient information. Results After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p > 0.05. There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p > 0.05. Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 ± 4.28 vs. 5.84 ± 2.90, p = 0.044 and 3.89 ± 5.43 vs. 1.19 ± 3.35, p = 0.01 respectively. Conclusion Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions.

  6. Minidose Bupivacaine – Fentanyl Spinal Anesthesia for Cesarean Section In Preeclamptic Parturients

    Directory of Open Access Journals (Sweden)

    N. Fatholahzadeh

    2006-07-01

    Full Text Available Background:Spinal anesthesia for cesarean section is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods: Forty-four preeclamptic parturients undergoing cesarean section were randomized in two groups of 22 patients. Group A received a spinal anesthetic of bupivacaine 6 mg plus fentanyl 20 µg , and group B received 12 mg bupivacaine. Hypotension was defined as a 30% decrease in systolic and diastolic pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 2.5-5 mg up to maximum 50 mg. Results: All patients had satisfactory anesthesia. Five of 22 patients in group A required ephedrine, a single dose of 5 mg. Seventeen of 22 patients in group B required vasopressor support of blood pressure.The lowest recorded systolic,diastolic and mean blood pressures as fractions of the baseline pressures were 71.2%, 64.5% and 70.3% versus 59.9%, 53.5% and 60.2% respectively for group A versus group B. Conclusion: A “minidose” of 6 mg bupivacaine in combination with 20 µg fentanyl may provide satisfactory spinal anesthesia for cesarean section in the preeclamptic patient. The minidose combination caused dramatically less hypotension than 12 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure. 

  7. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...

  8. Anesthesia: A Topic for Interdisciplinary Study.

    Science.gov (United States)

    Labianca, Dominick A.; Reeves, William J.

    1977-01-01

    Describes an interdisciplinary approach for teaching the topic of anesthesia as one aspect of a chemistry-oriented course for nonscience majors which focuses on timely topics such as the energy crisis and drugs. Historical treatment with the examination of literature is emphasized in teaching. (HM)

  9. Syringe-delivered tumescent anesthesia made easier

    NARCIS (Netherlands)

    Lapid, Oren

    2011-01-01

    A simple method for the infiltration of tumescent anesthesia is presented. An assembly is made using an infusion set, a three-way tap, and two unidirectional valves. The assembly and use of this system are straightforward and easy. The addition of unidirectional valves prevents the risk of reverse

  10. Testing haptic sensations for spinal anesthesia.

    LENUS (Irish Health Repository)

    2011-01-01

    Having identified key determinants of teaching and learning spinal anesthesia, it was necessary to characterize and render the haptic sensations (feeling of touch) associated with needle insertion in the lower back. The approach used is to match recreated sensations (eg, "pop" through skin or dura mater) with experts\\' perceptions of the equivalent clinical events.

  11. The Biochemical Impact of Surgery and Anesthesia

    NARCIS (Netherlands)

    J.W. Hol (Jaap Willem)

    2014-01-01

    markdownabstract__Abstract__ General anesthesia has been considered by some medical historians as one of the most important contributions to modern medicine second to perhaps the concept of antiseptic medicine and hygiene. The first historical mention of a deep unnatural sleep so that surgery

  12. [Anesthesia and Alzheimer disease - Current perceptions].

    Science.gov (United States)

    Marques, Ana Filipa Vieira da Silva Ferreira; Lapa, Teresa Alexandra Santos Carvalho

    It has been speculated that the use of anesthetic agents may be a risk factor for the development of Alzheimer disease. The objective of this review is to describe and discuss pre-clinical and clinical data related to anesthesia and this disease. Alzheimer disease affects about 5% of the population over 65 years old, with age being the main risk factor and being associated with a high morbidity. Current evidence questions a possible association between anesthesia, surgery, and long-term cognitive effects, including Alzheimer disease. Although data from some animal studies suggest an association between anesthesia and neurotoxicity, this link remains inconclusive in humans. We performed a review of the literature in which we selected scientific articles in the PubMed database, published between 2005 and 2016 (one article from 1998 due to its historical relevance), in English, which address the possible relationship between anesthesia and Alzheimer disease. 49 articles were selected. The possible relationship between anesthetic agents, cognitive dysfunction, and Alzheimer disease remains to be clarified. Prospective cohort studies or randomized clinical trials for a better understanding of this association will be required. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  13. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin (Eilish)

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  14. Human mediotemporal EEG characteristics during propofol anesthesia.

    NARCIS (Netherlands)

    Fell, J.; Widman, G.; Rehberg, B.; Elger, C.E.; Fernandez, G.S.E.

    2005-01-01

    Evidence for a response-control-related kind of declarative memory during deep propofol anesthesia has recently been reported. Connectivity within the mediotemporal lobe (MTL), and in particular rhinal-hippocampal synchronization within the gamma band, has been shown to be crucial for declarative

  15. General anesthesia for horses with specific problems

    International Nuclear Information System (INIS)

    Hodgson, D.S.; Dunlop, C.I.

    1990-01-01

    We have discussed anesthetic techniques, special considerations, and expected complications involved in anesthetizing horses for abdominal, orthopedic, and head and neck surgery, and myelography and have described expected physiologic dysfunction that may require changes in anesthetic technique or supportive measures. The objective is high-quality patient care and reduction in anesthesia-related morbidity and death

  16. Anesthesia Providers’ Perspectives Regarding Parental Presence During Anesthesia Induction: A Pilot Study

    Science.gov (United States)

    1997-05-01

    was to ascertain anesthesia providers’ perspectives regarding parental presence during anesthesia induction. The work of Dr. John Bowlby (1973) laid...their parental surrogates. Bowlby looked at how orphans bonded with nurses and staff members. He found that children of all ages formed strong...during episodes of extreme stress only amplifies that stress ( Bowlby , 1973). Bowlby studied post World War II orphans in England and observed the

  17. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general

  18. Differences in Blood Pressure in Infants after General Anesthesia Compared to Awake Regional Anesthesia (GAS Study - A Prospective Randomized Trial)

    NARCIS (Netherlands)

    McCANN, M.E.; Withington, Davinia E.; Arnup, Sarah J.; Davidson, Andrew J.; DISMA, N.; FRAWLEY, G.; Morton, Neil S.; BELL, G.; Hunt, Rodney W.; Bellinger, David C; Polaner, D. M.; Leo-Macias, Alejandra; Absalom, Anthony R.; Von Ungern-Sternberg, Britta S.; Izzo, Francesca; Szmuk, Peter; Young, Vanessa; Soriano, S. G.; De Graaff, J. C.|info:eu-repo/dai/nl/249966271

    2017-01-01

    BACKGROUND: The General Anesthesia compared to Spinal anesthesia (GAS) study is a prospective randomized, controlled, multisite, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment at 5 years of age. A secondary aim obtained from the blood pressure data of the GAS

  19. Methylphenidate Actively Induces Emergence from General Anesthesia

    Science.gov (United States)

    Solt, Ken; Cotten, Joseph F.; Cimenser, Aylin; Wong, Kin F.K.; Chemali, Jessica J.; Brown, Emery N.

    2011-01-01

    Background Although accumulating evidence suggests that arousal pathways in the brain play important roles in emergence from general anesthesia, the roles of monoaminergic arousal circuits are unclear. In this study we tested the hypothesis that methylphenidate (an inhibitor of dopamine and norepinephrine transporters) induces emergence from isoflurane anesthesia. Methods Using adult rats we tested the effect of methylphenidate IV on time to emergence from isoflurane anesthesia. We then performed experiments to test separately for methylphenidate-induced changes in arousal and changes in minute ventilation. A dose-response study was performed to test for methylphenidate–induced restoration of righting during continuous isoflurane anesthesia. Surface electroencephalogram recordings were performed to observe neurophysiological changes. Plethysmography recordings and arterial blood gas analysis were performed to assess methylphenidate-induced changes in respiratory function. Droperidol IV was administered to test for inhibition of methylphenidate's actions. Results Methylphenidate decreased median time to emergence from 280 to 91 s. The median difference in time to emergence without compared to with methylphenidate was 200 [155, 331] s (median, [95% confidence interval]). During continuous inhalation of isoflurane, methylphenidate induced return of righting in a dose-dependent manner, induced a shift in electroencephalogram power from delta to theta, and induced an increase in minute ventilation. Administration of droperidol (0.5 mg/kg IV) prior to methylphenidate (5 mg/kg IV) largely inhibited methylphenidate-induced emergence behavior, electroencephalogram changes, and changes in minute ventilation. Conclusions Methylphenidate actively induces emergence from isoflurane anesthesia by increasing arousal and respiratory drive, possibly through activation of dopaminergic and adrenergic arousal circuits. Our findings suggest that methylphenidate may be clinically

  20. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    Newman, Beverley; Gawande, Rakhee; Krane, Elliot J.; Holmes, Tyson H.; Robinson, Terry E.

    2014-01-01

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  1. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  2. Olfactory bulb encoding during learning under anesthesia

    Science.gov (United States)

    Nicol, Alister U.; Sanchez-Andrade, Gabriela; Collado, Paloma; Segonds-Pichon, Anne; Kendrick, Keith M.

    2014-01-01

    Neural plasticity changes within the olfactory bulb are important for olfactory learning, although how neural encoding changes support new associations with specific odors and whether they can be investigated under anesthesia, remain unclear. Using the social transmission of food preference olfactory learning paradigm in mice in conjunction with in vivo microdialysis sampling we have shown firstly that a learned preference for a scented food odor smelled on the breath of a demonstrator animal occurs under isofluorane anesthesia. Furthermore, subsequent exposure to this cued odor under anesthesia promotes the same pattern of increased release of glutamate and gamma-aminobutyric acid (GABA) in the olfactory bulb as previously found in conscious animals following olfactory learning, and evoked GABA release was positively correlated with the amount of scented food eaten. In a second experiment, multiarray (24 electrodes) electrophysiological recordings were made from olfactory bulb mitral cells under isofluorane anesthesia before, during and after a novel scented food odor was paired with carbon disulfide. Results showed significant increases in overall firing frequency to the cued-odor during and after learning and decreases in response to an uncued odor. Analysis of patterns of changes in individual neurons revealed that a substantial proportion (>50%) of them significantly changed their response profiles during and after learning with most of those previously inhibited becoming excited. A large number of cells exhibiting no response to the odors prior to learning were either excited or inhibited afterwards. With the uncued odor many previously responsive cells became unresponsive or inhibited. Learning associated changes only occurred in the posterior part of the olfactory bulb. Thus olfactory learning under anesthesia promotes extensive, but spatially distinct, changes in mitral cell networks to both cued and uncued odors as well as in evoked glutamate and GABA

  3. Spinal anesthesia in children: A review

    Directory of Open Access Journals (Sweden)

    Anju Gupta

    2014-01-01

    Full Text Available Even after a vast safety record, the role of spinal anesthesia (SA as a primary anesthetic technique in children remains contentious and is mainly limited to specialized pediatric centers. It is usually practiced on moribund former preterm infants (<60 weeks post-conception to reduce the incidence of post-operative apnea when compared to general anesthesia (GA. However, there is ample literature to suggest its safety and efficacy for suitable procedures in older children as well. SA in children has many advantages as in adults with an added advantage of minimal cardio-respiratory disturbance. Recently, several reports from animal studies have raised serious concerns regarding the harmful effects of GA on young developing brain. This may further increase the utility of SA in children as it provides all components of balanced anesthesia technique. Also, SA can be an economical option for countries with finite resources. Limited duration of surgical anesthesia in children is one of the major deterrents for its widespread use in them. To overcome this, several additives like epinephrine, clonidine, fentanyl, morphine, neostigmine etc. have been used and found to be effective even in neonates. But, the developing spinal cord may also be vulnerable to drug-related toxicity, though this has not been systematically evaluated in children. So, adjuvants and drugs with widest therapeutic index should be preferred in children. Despite its widespread use, incidence of side-effects is low and permanent neurological sequalae have not been reported with SA. Literature yields encouraging results regarding its safety and efficacy. Technical skills and constant vigilance of experienced anesthesia providers is indispensable to achieve good results with this technique.

  4. Using digital media to keep anesthesia history alive.

    Science.gov (United States)

    Ortega, Rafael A; Rengasamy, Sundara K

    2005-01-01

    Multimedia applications have been developed to explain many aspects of anesthesiology, including anesthesia machines, cardiopulmonary bypass systems, airway management, anesthetic pharmacology, regional anesthesia, and more recently, the history of the specialty. This article describes how computer-assisted instruction and multimedia have made it possible for an anesthesia department in a teaching hospital to become involved in the preservation, publication, and distribution of historically related anesthesia materials. The production of a digital video disc (DVD) based on the career of Leroy D. Vandam is discussed to illustrate the value of digital media in preserving, rejuvenating, and distributing anesthesia-related historical materials.

  5. Postoperative Visual Analog Pain Scores and Overall Anesthesia Patient Satisfaction.

    Science.gov (United States)

    Burch, Tony; Seipel, Scott J; Coyle, Nina; Ortega, Keri H; DeJesus, Ozzie

    2017-12-01

    Patient satisfaction is evolving into an important measure of high-quality health care and anesthesia care is no exception. Pain management is an integral part of anesthesia care and must be assessed to determine patient satisfaction; therefore, it is a measure for quality of care. One issue is how patients reflect individual experiences into their overall anesthesia experience. There is a need to identify how postoperative pain scores correlate with anesthesia patient satisfaction survey results. Postoperative pain is not a dominant measure in determining anesthesia patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Robotic anesthesia: not the realm of science fiction any more.

    Science.gov (United States)

    Hemmerling, Thomas M; Terrasini, Nora

    2012-12-01

    Robots are present in surgery, to a much lesser extent in the field of anesthesia. The purpose of this review is to show the latest and most important findings in robotic anesthesia. Moreover, this review argues the importance and utility of robots in anesthesia. Over the years, many closed-loop systems have been developed; they were able to control only one or two of the three components of anesthesia: hypnosis, analgesia, or muscle relaxation. McSleepy controls all three components of anesthesia, from induction to emergence of anesthesia. Telemedical applications have not only led to remote monitoring but even to remotely controlled anesthesia, such as transcontinental anesthesia. A new closed-loop system for sedation, called Sedasys, could revolutionize the field of nonoperating room sedation. 'Manual robots' are used to help and replace anesthesiologists performing anesthesia procedures. Specific robots for intubation and nerve blocks have been developed and tested in humans. Robots can improve performance in anesthesia and healthcare. Closed-loop systems are the basis for pharmacological robots. Safe anesthetic care might be delivered through teleanesthesia whenever qualified personnel are not available or need support. Mechanical robots are being developed for anesthesia care.

  7. Pharmacologic Considerations for Pediatric Sedation and Anesthesia Outside the Operating Room: A Review for Anesthesia and Non-Anesthesia Providers.

    Science.gov (United States)

    Khurmi, Narjeet; Patel, Perene; Kraus, Molly; Trentman, Terrence

    2017-10-01

    Understanding the pharmacologic options for pediatric sedation outside the operating room will allow practitioners to formulate an ideal anesthetic plan, allaying anxiety and achieving optimal immobilization while ensuring rapid and efficient recovery. The authors identified relevant medical literature by searching PubMed, MEDLINE, Embase, Scopus, Web of Science, and Google Scholar databases for English language publications covering a period from 1984 to 2017. Search terms included pediatric anesthesia, pediatric sedation, non-operating room sedation, sedation safety, and pharmacology. As a narrative review of common sedation/anesthesia options, the authors elected to focus on studies, reviews, and case reports that show clinical relevance to modern day sedation/anesthesia practice. A variety of pharmacologic agents are available for sedation/anesthesia in pediatrics, including midazolam, fentanyl, ketamine, dexmedetomidine, etomidate, and propofol. Dosing ranges reported are a combination of what is discussed in the reviewed literature and text books along with personal recommendations based on our own practice. Several reports reveal that ketofol (a combination of ketamine and propofol) is quite popular for short, painful procedures. Fospropofol is a newer-generation propofol that may confer advantages over regular propofol. Remimazolam combines the pharmacologic effects of remifentanil and midazolam. A variety of etomidate derivatives such as methoxycarbonyl-etomidate, carboetomidate, methoxycarbonyl-carboetomidate, and cyclopropyl-methoxycarbonyl metomidate are in development stages. The use of nitrous oxide as a mild sedative, analgesic, and amnestic agent is gaining popularity, especially in the ambulatory setting. Utilizing a dedicated and experienced team to provide sedation enhances safety. Furthermore, limiting sedation plans to single-agent pharmacy appears to be safer than using multi-agent plans.

  8. Single tooth anesthesia versus conventional anesthesia: a cross-over study.

    Science.gov (United States)

    Campanella, Vincenzo; Libonati, Antonio; Nardi, Roberto; Angotti, Vincenzo; Gallusi, Gianni; Montemurro, Edoardo; D'Amario, Maurizio; Marzo, Giuseppe

    2018-03-10

    The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment. Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001). The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections. The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters. Single Tooth Anesthesia could be an efficacious alternative to

  9. Adding low dose rocuronium to local anesthetic mixture: Effect on quality of peribulbar blockade for vitreoretinal surgery

    Directory of Open Access Journals (Sweden)

    Mohamed T. Ghanem

    2016-04-01

    Conclusion: Adding low dose rocuronium to local anesthetics prolongs duration of peribulbar anesthesia and offers an optimal surgical condition without serious adverse effects for patients undergoing VR surgery.

  10. Radioimmunoassay of serum T3, T4 and TSH during anesthesia and operation

    International Nuclear Information System (INIS)

    Gosheva-Antonova, Ts.; Zakharieva, B.; Kurtev, I.

    1987-01-01

    The serum concentrations of thyroxine (T 3 ), triiodothyronine (T 4 ) and thyroid-stimulating hormone (TSH) were determined in 31 partients before and during urologic operations on the 30th and 60th minute since the onset of the operation, performed under endotracheal halotane or neuroleptanesthesia (NLA) in assisted breathing and intravenous drip anesthesia with ketalar-diazepam in spontaneous breathing. There was statistically significant rise in T 4 level, decrease in T 3 and negligible changes in TSH level, in patients operated under halotane anesthesia. In those operated under NLA, T 4 tended initially to be elevated, with subseguent fall to starting level, with a tendency toward rise in TSH and stable unchanged T 3 level. Ketalar-diazepam anesthesia was applied only to patients subjected to transurethral resections. T 4 in them tended to be decreased, while T 3 and TSH showed negligible changes. Since the operations of patients anesthesized with halotane and NLA had similar localizations and severity, the differences in the thyroid hormone reactions could be associated with the type of anesthesia. The negligible changes in TSH are highly suggestive that this hormone is not influenced by the operation stress and anesthetics, and does hot exert regulating effect upon the thyroid status under these conditions. The milder reactions in patients operated under ketalar-diazepam anestesia may largely be associated with the milder operation stress in transurethal resection

  11. Regional anesthesia in difficult airway: The quest for a solution continues.

    Science.gov (United States)

    Khetarpal, Ranjana; Chatrath, Veena; Dhawan, Akshay; Attri, Joginder Pal

    2016-01-01

    Difficult airway, a scenario with potentially life threatening outcome, is routinely encountered by an anesthesiologist leaving him with the dilemma of whether to use regional anesthesia (RA) or general anesthesia. Our study aims to look into this problem. The literature search was performed in the Google, PubMed, and Medscape using key words "regional anesthesia, difficult airway, pregnancy, ventilation, intubation, epidural anesthesia, nerve blocks." More than 38 free full articles and books published from the year 1987 to 2014 were retrieved and studied. At first sight, RA may appear to offer an ideal solution as it helps to avoid the problem of difficult airway. However, the possibility of a total spinal block, failed or incomplete RA, local anesthetic toxicity or unforeseen surgical complication may make it imperative that the airway is secured. The correct decision can only be made by the anesthetist when all the relevant clinical information is taken into account. It is also important to ensure that before considering RA in a patient of difficult airway, an anesthesiologist must have a preformulated strategy for intubation.

  12. General anesthesia for lumbar puncture and bone marrow aspiration /biopsy in children with cancer.

    Science.gov (United States)

    Ghasemi, A; Gharavi Fard, M; Sabzevari, Ar

    2013-01-01

    Multiple procedures (Lumbar puncture and bone marrow aspiration /biopsy) cause pain, stress, depression and etc for the patients and their families. Various methods have been recommended for pain reduction during invasive procedures. The aim of this study is to report the complications following general anesthesia. In this prospective observational study, two hundred and two children with cancer were enrolled. All patients received propofol 2.5 mg /kg and fentanyl 1 µg/kg. After adequate anesthesia, procedures were performed by a pediatric oncologist. All anesthesia complications were classified into two groups: Intraoperative and Postoperative complications. Complications which were recorded include: abnormal age-specific bradycardia (≤20 × baseline), decrease in arterial oxygen saturation (≤90%), laryngospasm, vomiting, agitation, headache, hypothermia (37/8 C°), signs of allergy, traumatic LP (bloody), and unusual local bleeding. In this study, 118 males and 84 females underwent 623 general anesthetic procedures with a median of 3 procedures per patient. Intraoperative period complications occurred in 48 of total 623 procedures (7.7 %). The most common complications were traumatic LP, bradycardia and decrease in arterial oxygen saturation which occurred in 25, 6 and 6 cases, respectively. Postoperative period complications occurred in 74 (11.9%) cases. The most common complications were vomiting, agitation and headache, decrease O2 saturation and bradycardia. General anesthesia by propofol and fentanyl may be a good choice for short-term painful procedures in children undergoing treatment for bone marrow aspiration/biopsy and intratechal injection.

  13. Delayed-type hypersensitivity (type IV) reactions in dental anesthesia.

    Science.gov (United States)

    Melamed, Julian; Beaucher, Wilfred N

    2007-01-01

    The recommended methodology of evaluating patients who have presented with reactions to local anesthetics consists of epicutaneous skin testing and serial subcutaneous challenge. However, the role of type IV reactions in this group has been poorly documented. Epicutaneous routine testing and subcutaneous challenge to local anesthetic was performed, as well as patch testing and subcutaneous rechallenge of both at 24 and 48 hours with evaluation up to 72 hours was performed. Three patients presented with a history of localized edema after dental anesthesia. All had negative lidocaine and mepivacaine testing as well as negative lidocaine challenge on evaluation at 1 hour. The first patient, who had previously reacted to EMLA, reacted to both lidocaine and mepivacaine patch testing and challenge, with delayed swelling at 24 and 48 hours after challenge. This patient subsequently tolerated the ester anesthetic chloroprocaine. Two other patients had strong histories of contact dermatitis. Patch testing and challenge with lidocaine was negative, but strong reactions were found to benzocaine on patch testing. Patients undergoing local anesthetic testing should be screened historically for features and risk factors associated with type IV reactions. This should be considered in patients who react to multiple amide anesthetics, who have delayed swelling, or who have a history of severe contact dermatitis. We confirm previous data showing that patients reacting to benzocaine can tolerate lidocaine and that lidocaine-allergic individuals can tolerate ester anesthetics.

  14. Anesthesia for cesarean section in pregnancies complicated by placenta previa

    International Nuclear Information System (INIS)

    Imarengiaye, Charles O.; Osaigbovo, Etinosa P.; Tudjegbe, Sampson O.

    2008-01-01

    Objective was to evaluate the factors affecting the choice of anesthetic technique for cesarean section in women with placenta previa. In this retrospective study, the records of the labor Ward Theatre of the University of Benin Teaching Hospital, Benin City, Nigeria were examined from January 2000 to December 2004 to identify all the women who had cesarean section for placenta previa. The patient's socio-demographic characteristics, type of placenta previa, anesthesia technique, estimated blood loss, maternal and fetal outcomes were recorded. One hundred and twenty-six patients had cesarean section for placenta previa, however, only 81 patients 64.3% were available for analysis. General anesthesia was administered to 52/81 patients 64.2% and 29/81 patients 35.8% received spinal anesthesia. A history of antepartum bleeding was recorded in 61.7% n=50. Of 31 patients without antepartum hemorrhage APH, 15/31 had general anesthesia and 16/31 had spinal anesthesia. The patients who had APH, 37/50 had general anesthesia and 1/50 had spinal anesthesia. There was an increased chance of using general anesthesia and if APH were present p=0.03, odds ratio=3.1, 95% confidence interval=1.2-7.7. Spinal anesthesia may useful in patients with placenta previa. The presence of APH may encourage the use of general anesthesia for cesarean delivery. (author)

  15. [Anesthesia for medical students : A brief guide to practical anesthesia in adults with a web-based video illustration].

    Science.gov (United States)

    Mathis, S; Schlafer, O; Abram, J; Kreutziger, J; Paal, P; Wenzel, V

    2016-12-01

    In Germany, Austria and Switzerland, anesthesiologists are the second largest group of physicians in hospitals, but this does not correspond to the amount of anesthesiology teaching that medical students receive in medical schools. Accordingly, the chances of medical students recognizing anesthesiology as a promising personal professional career are smaller than in other disciplines with large teaching components. Subsequent difficulties to recruit anesthesiology residents are likely, although many reasons support anesthesiology as a professional career.Traditional strategies to teach medical students in anesthesiology in medical school consist of airway management or cardiopulmonary resuscitation attempts in manikins. Anesthesiology is a complex interaction consisting of anatomy, physiology, pharmacology, clinical evaluation, experience, knowledge, and manual skills. While some medical schools offer teaching in high fidelity simulators, clinical teaching in the operating room is often limited. When medical students opt for a clinical rotation in anesthesiology, there is a chance to demonstrate the fascinating world of anesthesiology, but this chance has to be utilized carefully by anesthesiologists, as young talents have to be discovered, supported, and challenged.We have put together a short guide for medical students for a clinical rotation in anesthesiology in adults in order to generate basic knowledge and interest in anesthesiology as well as a sense of achievement. Basic knowledge about premedication, induction, maintenance and strategies for anesthesia is discussed. Further, the most important anesthesia drugs are discussed and manual skills, such as intravenous cannulation, mask ventilation, intubation, and regional anesthesia are featured with QR-code based video illustrations on a smartphone or personal computer. We did not discuss possible local mannerism and special patient groups (e. g., children, special medical history), local guidelines

  16. Preoperative anesthesia clinic in Japan: a nationwide survey of the current practice of preoperative anesthesia assessment.

    Science.gov (United States)

    Amaya, Fumimasa; Shimamoto, Saki; Matsuda, Megumi; Kageyama, Kyoko; Sawa, Teiji

    2015-04-01

    In order to investigate the current practice of preoperative anesthesia assessment in Japan, we conducted a nationwide survey of the preoperative anesthesia clinic (PAC). A written questionnaire was sent to anesthesia teaching hospitals certified by the Japanese Society of Anesthesiologists. Completed questionnaires were received from 789 hospitals (response rate 62.5 %). PACs were conducted in 52.0 % of these hospitals and were more frequently implemented in large hospitals. Services covered by the PAC included medical history taking, physical examination, review of laboratory data, and obtaining informed consent. Majority of the anesthesiologists at hospitals that did not have a PAC responded that although they acknowledged that a PAC is necessary, they were unable to set one up. The main obstacle preventing establishment of the PAC was shortage of human resources. Half the anesthesia teaching hospitals in Japan use a PAC for preoperative assessment. At such hospitals, all the procedures required before anesthesia are performed in the clinic. Lack of human resources is the major obstacle preventing establishment of PACs in all hospitals.

  17. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

    Directory of Open Access Journals (Sweden)

    Lucía Vizcaíno-Martínez

    2014-01-01

    Full Text Available Objective: The aim was to evaluate general anesthesia (GA plus ilioinguinal nerve block (IIB versus spinal anesthesia (SA in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001 and at discharge (P < 0.001 in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001, with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

  18. Anesthesia for myelomeningocele surgery in fetus.

    Science.gov (United States)

    Devoto, Juan Carlos; Alcalde, Juan Luis; Otayza, Felipe; Sepulveda, Waldo

    2017-07-01

    Administering anesthesia for prenatal repair of myelomeningocele reveals several issues that are unique to this new form of treatment. This includes issues such as fetal well-being, surgical conditions and monitoring, among others. Exploring, analyzing, and understanding the different variables that are involved will help us reduce the high level of risk associated with this surgery. This review provides a systematic approach to the issues that are faced by anesthesiologists during fetal surgery.

  19. Evaluation of a computerized anesthesia report.

    Science.gov (United States)

    Zamper, Raffael Pereira Cezar; Torres, Marcelo Luís Abramides; Ferraz, Janice Leão; Neto, Silvio Mori; Holzhacker, Rafael; Shimada, Vanessa; Carmona, Maria José Carvalho

    2010-01-01

    In Brazil, the use of information systems that allows filling out anesthesia reports automatically is still in its initial stages. The objective of this study was to validate an automated anesthesia record. This study was approved by the Ethics Commission of the institution; an industry-university partnership (Dixtal, São Paulo, Brazil and Universidade de São Paulo) was developed, and the study received a grant from FINEP (Financiadora de Estudos e Projetos do Ministério de Ciência e Tecnologia). The integration of hospital information systems for recovery of data regarding identification, preoperative evaluation, and laboratorial exams was the premise of this study. The applicability of the final version of the prototype of the automated system was evaluated by applying a semi-structured tool to 33 physicians, residents, and/or anesthesiologists during surgery procedures in 66 patients. Descriptive evaluation of the data was undertaken. The computerized system was considered reliable even for large surgeries by 81% of the participants. The majority of the anesthesiologists considered the prototype of great value for future studies and capable of meeting the requirements of anesthesia reports, bringing benefits for anesthesiologists, patients, and hospitals. The full use of the system requires training and some of its aspects can be improved. Validation of this prototype of a computerized system for elaboration of anesthesia reports showed the viability of this type of solution to help anesthesiologists in their daily tasks, increasing the reliability of the data. Besides, when evaluating the applicability, anesthesiologists considered that the prototype could be useful for patients, physicians, and hospitals. Copyright 2010 Elsevier Editora Ltda. All rights reserved.

  20. ANESTHESIA AND INTENSIVE CARE IN HEART RETRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2011-01-01

    Full Text Available In this review we describe our own experience of anesthetic management and early intensive care of two patients after heart retransplantation. As shown in this article, preretransplant clinical condition (severity of organs dys- function influences on character of intra- and postoperative periods including duration of anesthesia, surgery, postoperative ventilation and ICU stay, intra- and postoperative bleeding, volume of blood product transfusion, infection complications, need in renal replacement therapy, selective LPS-adsorption and other therapeutic op- tions. 

  1. An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

    OpenAIRE

    Steagall, Paulo V. M.; Simon, Bradley T.; Teixeira Neto, Francisco J.; Luna, Stelio P. L.

    2017-01-01

    This review aims to report an update on drugs administered into the epidural space for anesthesia and analgesia in dogs, describing their potential advantages and disadvantages in the clinical setting. Databases searched include Pubmed, Google scholar, and CAB abstracts. Benefits of administering local anesthetics, opioids, and alpha2 agonists into the epidural space include the use of lower doses of general anesthetics (anesthetic “sparing” effect), perioperative analgesia, and reduced side ...

  2. HEMODYNAMIC EFFECTS OF XENON ANESTHESIA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    M. V. Bykov

    2014-01-01

    Full Text Available The study was aimed at hemodynamic effects of xenon on operative interventions in children. Patients and methods: the study involved 30 5-17-year-old children – 10 (33.3% girls and 20 (66.7% boys with ASA score 1-3 admitted for surgical treatment. The children underwent endotracheal anesthesia with xenon-oxygen mixture (Xe:O2 = 60-65:30% and fentanyl (2.5‑3.5  mcg/kg per hour for the following operations: appendectomy – 10 (33.3% patients, herniotomy – 8 (26.7% patients, Ivanissevich procedure – 6 (20.0% patients, plastic surgery of posttraumatic defects of skin and soft tissues – 4 (13.3% patients, abdominal adhesiotomy – 2 (6.7% patients. Central hemodynamics was studied echocardiographically (Philips HD 11, the Netherlands using the Teichholz technique along the cephalocaudal axis (parasternal access. Results: the anesthesia was notable for hemodynamic stability during the operation: as a result, a statistically significant (p < 0.05 increase in systolic, diastolic and mean arterial pressure by 10, 18 and 17%, respectively, was observed. Conclusion: the analysis demonstrated that xenon anesthesia improves lusitropic myocardial function statistically significantly increasing cardiac output by 12% by way of increasing stroke volume by 30%. 

  3. Anesthesia Practices for Interventional Radiology in Europe

    Energy Technology Data Exchange (ETDEWEB)

    Vari, Alessandra, E-mail: alessandra.vari@uniroma1.it [University La Sapienza, Department of Anesthesiology, Intensive Care and Pain Medicine (Italy); Gangi, Afshin, E-mail: gangi@unistra.fr [Les Hôpitaux Universitaires de Strasbourg, Chef de Pôle, Imagerie (France)

    2017-06-15

    PurposeThe Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.MethodsAnonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.ResultsPredictable differences between countries and national regulations were confirmed, showing how significantly many “local” factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.ConclusionSignificant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

  4. The National Anesthesia Clinical Outcomes Registry.

    Science.gov (United States)

    Liau, Adrian; Havidich, Jeana E; Onega, Tracy; Dutton, Richard P

    2015-12-01

    The Anesthesia Quality Institute (AQI) was chartered in 2008 by the American Society of Anesthesiologists to develop the National Anesthesia Clinical Outcomes Registry (NACOR). In this Technical Communication, we will describe how data enter NACOR, how they are authenticated, and how they are analyzed and reported. NACOR accepts case-level administrative, clinical, and quality capture data from voluntarily participating anesthesia practices and health care facilities in the United States. All data are transmitted to the AQI in summary electronic files generated by billing, quality capture, and electronic health care record software, typically on a monthly basis. All data elements are mapped to fields in the NACOR schema in accordance with a publicly available data dictionary. Incoming data are loaded into NACOR by AQI technologists and are subject to both manual and automated review to identify systematically missing elements, miscoding, and inadvertent corruption. Data are deidentified in compliance with Health Insurance Portability and Accountability Act regulations. The database server of AQI, which houses the NACOR database, is protected by 2 firewalls within the American Society of Anesthesiologists' network infrastructure; this system has not been breached. The NACOR Participant User File, a deidentified case-level dataset of information from NACOR, is available to researchers at participating institutions. NACOR architecture and the nature of the Participant User File include both strengths and weaknesses.

  5. [Streptococcus salivarius meningitis after spinal anesthesia].

    Science.gov (United States)

    Conangla, G; Rodríguez, L; Alonso-Tarrés, C; Avila, A; de la Campa, A G

    2004-01-01

    Streptococcus salivarius is a usual commensal of skin, gastrointestinal tract, genitourinary tract, oral cavity and paranasal sinuses. Although it is usually considered to have low virulence, S. salivarius may cause life-threatening infections, particularly endocarditis. On the other hand, bacterial meningitis after spinal anesthesia is very rare, there being some reported cases caused by S. salivarius, S. mitis, Staphylococcus aureus and Enterococcus faecalis. We report a 57 year old man who developed meningitis symptoms within 10 h of an uncomplicated inguinal herniorrhaphy performed during spinal anesthesia. Cerebrospinal cultures grew S. salivarius sensitive to penicillin. The patient was successfully treated with penicillin G and left the hospital without sequelae. In the literature, bacterial meningitis due to S. salivarius is rarely reported. Of the 28 cases, 18 occurred after lumbar puncture for diagnostic or for spinal anesthesia, 5 occurred following a bacteriemia for upper gastrointestinal endoscopy or intestinal neoplasia, and the other 5 in patients who had dural defects. We discuss the possible etiological causes of the meningitis due to S. salivarius cases reports. The early recognition of this entity and the aseptic precautions likely to reduce the incidence of infectious complications after lumbar puncture are stressed.

  6. Anesthesia Practices for Interventional Radiology in Europe

    International Nuclear Information System (INIS)

    Vari, Alessandra; Gangi, Afshin

    2017-01-01

    PurposeThe Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.MethodsAnonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.ResultsPredictable differences between countries and national regulations were confirmed, showing how significantly many “local” factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.ConclusionSignificant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

  7. [Shivering associated with general anesthesia using remifentanil].

    Science.gov (United States)

    Koda, Kenichiro; Kitamura, Takayuki; Tagami, Megumi

    2014-09-01

    General anesthesia using remifentanil is accompanied with post-operative shivering at a high incidence. Post-operative shivering can be divided into thermoregulatory and non-thermoregulatory. Hypothermia causes thermoregulatory shivering. The interthreshold range is defined as the difference between the sweating threshold and the vasoconstriction threshold. Generally, the interthreshold range is shifted to higher temperatures immediately after surgery under general anesthesia. Thus, thermoregulatory shivering can be exaggerated in patients without hypothermia. The application of patient warming devices and the administration of non-steroidal anti-inflammatory drugs are considered as effective treatments for the prevention of thermoregulatory shivering. Remifentanil is an ultra-short acting agent. Pharmacological effects of remifentanil quickly disappear just after the discontinuing of remifentanil infusion, leading to a kind of opioid withdrawal syndrome resulting in non-thermoregulatory shivering. In addition, postoperative pain shifts the shivering threshold to higher temperatures, resulting in non-thermoregulatory shivering. Thus, opioid transition using fentanyl and/or morphine during anesthetic management is essential for the prevention of non-thermoregulatory shivering. It is also reported that magnesium, ketamine and pethidine have preventive effects on non-thermoregulatory shivering. The mechanism underlying post-operative shivering associated with general anesthesia using remifentanil is very complicated; therefore, we speculate that multimodal approach is required for its prevention.

  8. The comparison of anesthesia effect of lung surgery through video-assisted thoracic surgery: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Jing-Dong Ke

    2015-01-01

    Conclusion: These results indicated that epidural anesthesia can save operating time and postoperative hospital stay time. But epidural anesthesia and general anesthesia have the same effect on complications.

  9. Local anesthetics for brain tumor resection: current perspectives

    Science.gov (United States)

    Potters, Jan-Willem

    2018-01-01

    This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative factor predicting higher postoperative pain scores is infratentorial surgery. Postoperative analgesia can be achieved with multimodal pain management where local anesthesia is associated with lower postoperative pain intensity, reduction in opioid requirement and prevention of development of chronic pain. In awake craniotomy patients, sufficient local anesthesia is a cornerstone of the procedure. An awake craniotomy and brain tumor resection can be carried out completely under local anesthesia only. However, the use of sedative drugs is common to improve patient comfort during craniotomy and closure. Local anesthesia for craniotomy can be performed by directly blocking the six different nerves that provide the sensory innervation of the scalp, or by local infiltration of the surgical site and the placement of the pins of the Mayfield clamp. Direct nerve block has potential complications and pitfalls and is technically more challenging, but mostly requires lower total doses of the local anesthetics than the doses required in surgical-site infiltration. Due to a lack of comparative studies, there is no evidence showing superiority of one technique versus the other. Besides the use of other local anesthetics for analgesia, intravenous lidocaine administration has proven to be a safe and effective method in the prevention of coughing during emergence from general anesthesia and extubation, which

  10. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

    Directory of Open Access Journals (Sweden)

    Donmez T

    2016-10-01

    Full Text Available Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA. To date, no reports compare the efficacy of spinal anesthesia (SA with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods: Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I or the SA TEP group (Group II. Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg and fentanyl (10 µg were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results: All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001 and 4 h (P=0.002 after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020. Conclusion: TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better

  11. [Percutaneous maxillary nerve block anesthesia in maxillofacial surgery].

    Science.gov (United States)

    Robiony, M; Demitri, V; Costa, F; Politi, M

    1999-01-01

    Personal experience in percutaneous maxillary nerve block anesthesia in association with transmucosal anesthesia of the sphenopalatine ganglion in oral and maxillofacial surgery, is presented. Six Caldwell-Luc, 9 anthrotomies and biopsies of maxillary sinus, 8 removals of extensive odontogenic cysts and 12 surgical maxillary expansions were performed from 1994 to 1996 at our Department. Maxillary transcutaneous nerve block in association with transmucosal anesthesia of the sphenopalatine ganglion were performed. Carbocaine without adrenaline in association with NaCO3 1/10 for maxillary nerve block anesthesia and lidocaineoprilocaine cream (EMLA) for transmucosal anesthesia were employed. Intra- and post-operative pain were evaluated by visual analogue scale in all the patients. Anesthesiological procedures revealed to be effective in all surgical interventions and postoperative analgesia allowed easier pain control. The simplicity of execution, the effective pre- and postoperative anesthesia and the absence of side effects make this procedure particularly indicated in oral and maxillofacial surgery.

  12. Anesthesia Quality and Patient Safety in China: A Survey.

    Science.gov (United States)

    Zhu, Bin; Gao, Huan; Zhou, Xiangyong; Huang, Jeffrey

    There has been no nationwide investigation into anesthesia quality and patient safety in China. The authors surveyed Chinese anesthesiologists about anesthesia quality by sending a survey to all anesthesiologist members of the New Youth Anesthesia Forum via WeChat. The respondents could choose to use a mobile device or desktop to complete the survey. The overall response rate was 43%. Intraoperative monitoring: 77.9% of respondents reported that electrocardiogram monitoring was routinely applied for all patients; only 55% of the respondents reported that they routinely used end-tidal carbon dioxide monitoring for their patients under general anesthesia. 10.3% of respondents admitted that they had at least one wrong medicine administration in the past 3 months; 12.4% reported that they had at least one case of cardiac arrest in the past year. This is the first anesthesia quality survey in China. The findings revealed potential anesthesia safety issues in China.

  13. Anesthesia and perioperative pain management during cardiac electronic device implantation

    Directory of Open Access Journals (Sweden)

    Biocic M

    2017-04-01

    Full Text Available Marina Biocic,1 Dijana Vidosevic,2 Matija Boric,1,3 Teo Boric,4 Lovel Giunio,2 Damir Fabijanic,2 Livia Puljak1,5 1Laboratory for Pain Research, University of Split School of Medicine, 2Department of Cardiology, 3Department of Abdominal Surgery, 4Department of Vascular Surgery, University Hospital Split, Split, 5Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia Background: The degree of pain caused by the implantation of cardiac electronic devices (CEDs and the type of anesthesia or perioperative pain management used with the procedure have been insufficiently studied. The aim of this study was to analyze perioperative pain management, as well as intensity and location of pain among patients undergoing implantation of CED, and to compare the practice with published guidelines. Patients and methods: This was a combined retrospective and prospective study conducted at the tertiary hospital, University Hospital Split, Croatia. The sample included 372 patients who underwent CED implantation. Perioperative pain management was analyzed retrospectively in 321 patients who underwent CED implantation during 2014. In a prospective study, intensity and location of pain before, during, and after the procedure were measured by using a numerical rating scale (NRS ranging from 0 to 10 in 51 patients at the same institution from November 2014 to August 2015. Results: A quarter of patients received analgesia or sedation before surgery. All the patients received local lidocaine anesthesia. After surgery, 31% of patients received pain medication or sedation. The highest pain intensity was observed during CED implantation with the highest NRS pain score being 8. Some patients reported severe pain (NRS >5 also at 1, 3, 6, 8, and 24 hours after surgery. The most common pain locations were surgical site, shoulder, and chest. Adherence to guidelines for acute

  14. Comparison of seven different anesthesia protocols for nicotine pharmacologic magnetic resonance imaging in rat.

    Science.gov (United States)

    Paasonen, Jaakko; Salo, Raimo A; Shatillo, Artem; Forsberg, Markus M; Närväinen, Johanna; Huttunen, Joanna K; Gröhn, Olli

    2016-03-01

    Pharmacologic MRI (phMRI) is a non-invasive in vivo imaging method, which can evaluate the drug effects on the brain and provide complementary information to ex vivo techniques. The preclinical phMRI studies usually require anesthesia to reduce the motion and stress of the animals. The anesthesia, however, is a crucial part of the experimental design, as it may modulate the neural drug-induced (de)activation and hemodynamic coupling. Therefore, the aim of the present study was to address this methodologic question by performing phMRI experiments with five anesthetics (α-chloralose, isoflurane, medetomidine, thiobutabarbital, and urethane) and seven anesthesia protocols. Nicotine, a widely studied psychostimulant, was administered to rats while measuring blood oxygenation level-dependent (BOLD) signals. Notably different responses were observed depending on the anesthetic used. The highest responses were measured in urethane-anesthetized rats whereas the responses were hardly noticeable in α-chloralose group. As urethane is not commonly used in phMRI, hemodynamic coupling under urethane anesthesia was investigated with functional cerebral blood flow (CBF) and volume-weighted (CBVw) imaging, and simultaneous electrophysiologic and BOLD measurements. The BOLD, CBF, and CBVw measurements in response to nicotine were highly correlated (R(2) ≥ 0.70, p<0.001). BOLD values correlated well (R(2)=0.43, p<10(-6)) with local field potential (LFP) spectral power (13-70Hz) during pharmacologic stimulation. These findings indicate that urethane anesthesia combined with BOLD contrast provides a robust protocol for nicotine phMRI studies. As urethane has mild effects to individual receptor systems, and coupling between electrophysiologic activity and hemodynamic response is maintained, this anesthetic may also be suitable for other phMRI studies. Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.

  15. A Rare Complication of Spinal Anesthesia: Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Fuldem Yıldırım Dönmez

    2014-03-01

    Full Text Available The most common complication of spinal anesthesia is postdural puncture headache. Any injury of the dura may cause headache. After the injury of the dura, CSF leakage may occur and due to the tension of the veins between the cortex and the dural sinuses, subdural hematoma may be seen. Herein, we present a patient with persistent headache after the spinal anesthesia given during delivery of her baby, and emphasize a rare complication of spinal anesthesia which is subdural hematoma

  16. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    International Nuclear Information System (INIS)

    Isoyama-Shirakawa, Yuko; Abe, Madoka; Nakamura, Katsumasa

    2015-01-01

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  17. The application of sacral block anesthesia in pediatric interventional therapy

    International Nuclear Information System (INIS)

    Zhong Liang; Qin Zenghui

    2009-01-01

    Objective: To discuss the management and feasibility of sacral block anesthesia in pediatric interventional therapy. Methods: A total of 80 pediatric patients were randomly and equally divided into two groups. Patients in group A received sacral block anesthesia together with basic anesthesia with propofol, while patients in group B received intravenous anesthesia with propofol. Small amount of ketamine as maintaining dose was used in both groups when needed. Results: The interventional management was successfully completed in all patients. A marked decrease in blood pressure occurred in three patients of group A receiving sacral block anesthesia. In group B receiving intravenous anesthesia, a decrease of SpO 2 to below 90 percent was seen in 8 cases, and obvious bradycardia developed in 12 cases. All these patients were treated with intravenous medication or by reducing the dose of propofol. Additional small dose of ketamine was needed in 4 patients during the procedure. Conclusion: Sacral block anesthesia combined with intravenous anesthesia is one of the effective anesthesia management schemes for pediatric interventional therapy. (authors)

  18. [General anesthesia for two patients taking methylphenidate (Ritalin)].

    Science.gov (United States)

    Kasuga, Takaho; Meno, Aki; Honda, Masahiro; Momoeda, Kanako; Nagase, Masaki; Hanaoka, Kazuo

    2008-06-01

    We experienced anesthesia care for two patients taking methylphenidate (Ritalin), which is a central nervous system stimulant of amphetamine analogues, usually administered for narcolepsy or refractory depression. The proper dose of methylphenidate is 20-60 mg per day. General anesthesia with epidural anesthesia was administered to both cases for total hip replacement. One patient could discontinue taking methylphenidate five days before the operation, but the other patient could not. Both cases needed more anesthetics than usual on induction, but very stable condition could be maintained during and after the operations. We consider that it is possible to perform general anesthesia safely for patients taking a usual dose of methylphenidate.

  19. Anesthesia for cesarean section in a parturient with acute varicella: Is general anesthesia better than neuraxial anesthesia?

    Directory of Open Access Journals (Sweden)

    Bikash R Ray

    2012-01-01

    Full Text Available The incidence of varicella infection during pregnancy is low. However, it is associated with a significant risk of morbidity and mortality, both to the mother and the fetus. The risk for any complication is highest for the mother during the third trimester and pneumonia is the leading cause of maternal mortality. Anesthetic management in these patients depends upon the extent of involvement of the disease, associated complications of varicella, duration of antiviral therapy and natural course if the disease. We present the anesthetic management of a case of cesarean section in a patient with acute varicella infection, and discuss the various concerns regarding the choice of anesthesia.

  20. The Effectiveness of the Human Patient Simulator in Teaching Anesthesia Pharmacology to First Year Nurse Anesthesia Students

    National Research Council Canada - National Science Library

    Hall, Annie

    2002-01-01

    .... There is no substitute for case-based experience; however, recent innovations in computer technology provide high fidelity, realistic simulators, which are being used in many anesthesia programs...

  1. Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome

    Directory of Open Access Journals (Sweden)

    Gupta Sanjiv

    2009-01-01

    Full Text Available The authors here describe manual small incision cataract surgery (MSICS by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. Aims: To evaluate the patients′ and surgeons′ experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. Settings and Design: Prospective interventional case series. Materials and Methods: Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. Statistical Analysis Used: Statistical analysis software "Analyseit." Results: There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD ± 0.97, range 0-5, median 0.0, and mode 0.0. Fifty-one patients (53% had pain score of zero, that is, no pain. Ninety-one patients (~95% had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon′s experience was favorable in terms of patient′s cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. Conclusions: MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.

  2. Surgery under extreme conditions in the aftermath of the 2010 Haiti earthquake: the importance of regional anesthesia.

    Science.gov (United States)

    Missair, Andres; Gebhard, Ralf; Pierre, Edgar; Cooper, Lebron; Lubarsky, David; Frohock, Jeffery; Pretto, Ernesto A

    2010-01-01

    The 12 January 2010 earthquake that struck Port-au-Prince, Haiti caused >200,000 deaths, thousands of injuries requiring immediate surgical interventions, and 1.5 million internally displaced survivors. The earthquake destroyed or disabled most medical facilities in the city, seriously hampering the ability to deliver immediate life- and limb-saving surgical care. A Project Medishare/University of Miami Miller School of Medicine trauma team deployed to Haiti from Miami within 24 hours of the earthquake. The team began work at a pre-existing tent facility in the United Nations (UN) compound based at the airport, where they encountered 225 critically injured patients. However, non-sterile conditions, no means to administer oxygen, the lack of surgical equipment and supplies, and no anesthetics precluded the immediate delivery of general anesthesia. Despite these limitations, resuscitative care was administered, and during the first 72 hours following the event, some amputations were performed with local anesthesia. Because of these austere conditions, an anesthesiologist, experienced and equipped to administer regional block anesthesia, was dispatched three days later to perform anesthesia for limb amputations, debridements, and wound care using single shot block anesthesia until a better equipped tent facility was established. After four weeks, the relief effort evolved into a 250-bed, multi-specialty trauma/intensive care center staffed with >200 medical, nursing, and administrative staff. Within that timeframe, the facility and its staff completed 1,000 surgeries, including spine and pediatric neurological procedures, without major complications. This experience suggests that when local emergency medical resources are completely destroyed or seriously disabled, a surgical team staffed and equipped to provide regional nerve block anesthesia and acute pain management can be dispatched rapidly to serve as a bridge to more advanced field surgical and intensive care

  3. Emergence EEG pattern classification in sevoflurane anesthesia.

    Science.gov (United States)

    Liang, Zhenhu; Huang, Cheng; Li, Yongwang; Hight, Darren F; Voss, Logan J; Sleigh, Jamie W; Li, Xiaoli; Bai, Yang

    2018-03-07

    Objective. Significant spectral characteristics of electroencephalogram (EEG) patterns exist in individual patients during re-establishing consciousness after general anesthesia. However, these EEG patterns cannot be quantitatively identified using commercially available depth of anesthesia (DoA) monitors. This study proposed an effective classification method and indices to classify these patterns among patients. Approach. Four types of emergence EEG patterns were identified based on EEG data set from 52patients undergoing sevoflurane general anesthesia from two hospitals. Then, the relative power spectrum density (RPSD) of five frequency sub-bands of clinical interest (delta, theta, alpha, beta, and gamma) were selected for emergence state analysis. Finally, the genetic algorithm support vector machine (GA-SVM) was used to identify the emergence EEG patterns. Performance was reported in terms of sensitivity (SE), specificity (SP) and accuracy (AC). Main results. The combination of the mean and mode of RPSD in delta and alpha band (P (delta)/P (alpha) performed the best with the GA-SVM classification. AC indices obtained by GA-SVM across the four patterns were 90.64±7.61, 81.79±5.84, 82.14±7.99, and 72.86±11.11 respectively. Furthermore, the emergence time of the patients with EEG emergence pattern I and III increased with the increasing of patients' age. While for the patients with EEG emergence pattern IV, the emergence time positively correlates with the patients' age which less than 50, and negatively correlates with the patients' age which more than 50. Significance. The mean and mode of P (delta)/P (alpha) is a useful index to classify the different emergence EEG patterns. In addition, the EEG emergence patterns may correlate with underlying neural substrate which related with patients' age. © 2018 Institute of Physics and Engineering in Medicine.

  4. Evaluation of Stress Response During Mesiodens Extraction Under General Anesthesia Using Heart Rate Variability.

    Science.gov (United States)

    Hwang, Hye-Won; Hyun, Hong-Keun; Kim, Young-Jae; Kim, Jung-Wook; Shin, Teo Jeon

    2017-05-01

    Stress related to dental treatment can be associated with negative outcomes. Heart rate variability (HRV) is an objective measurement of autonomic nervous system activity. Therefore, HRV was used to identify autonomic nervous system reactions during mesiodens extraction under general anesthesia in children. Electrocardiography was performed with customized software during treatment. HRV parameters were analyzed according to time and frequency domains during each dental procedure (local anesthesia, incision, flap, bone removal, extraction of mesiodens, and suturing). The relations of HRV parameters to age also were determined. Total autonomic nervous system activity decreased markedly after local anesthesia injection. Depending on the responses of sympathetic nerve activity, patients were categorized in a stress group and a nonstress group. The ratio of low-frequency power (LF) to high-frequency power (HF), an indication of sympathetic and parasympathetic balance, increased in the stress group after incision and flap formation. Conversely, the LF/HF ratio decreased during treatment in the nonstress group. However, HR, widely used to evaluate stress responses, did not change statistically during mesiodens extraction in either group. HRV parameters did not differ statistically according to age. The internal stress related to mesiodens extraction can be evaluated more objectively with HRV parameters than with conventional methods. Sympathetic nerve activity in the stress group differed from that in the nonstress group during the treatment procedures. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Modifying effect of mexamine and esculamin on the course of infiltration anesthesia in irradiated animals

    Energy Technology Data Exchange (ETDEWEB)

    Lazovskaya, A.V.

    1979-03-01

    Investigations of distinctive features of pharmacological reactions associated with radiation sickness is one of the important practical tasks of radiobiology. Of particular importance is the question of possibility of using general and local anesthetics in cases of surgical pathology combined with radiation lesions. It has been previously demonstrated that, in irradiated animals, the local anesthetic effect of infiltration anesthesia is either considerably attenuated or not obtained at all; concurrently, there is distinct manifestation of the resorptive toxic effect of anesthetics. It has also been noted in the literature that there are changes in sensitivity of irradiated animals to narcotics and hypnotics. For this reason, it is a pressing task to explore the possibility of normalizing the pharmacological effect of anesthetics in the presence of radiation sickness. In a previous study, it was found that it was possible to prevent the pathological reaction of irradiated animals to ether anesthesia by using the radioprotective agent, AET (aminoethylisothiuronium). In this study, an effort was made to normalize the impaired course of infiltration anesthesia in irradiated animals using the radioprotective agent, 5-methoxytryptamine (mexamine) and esculamin (coumarin), an agent that affects tissular permeability and also has radioprotective activity.

  6. Anatomy of an anesthesia information management system.

    Science.gov (United States)

    Shah, Nirav J; Tremper, Kevin K; Kheterpal, Sachin

    2011-09-01

    Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Anesthesia for the patient with dementia

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    With a growing aging population, more patients suffering from dementia are expected to undergo surgery, thus being exposed to either general or regional anesthesia. This calls for specific attention ranging from the legal aspects of obtaining informed consent in demented patients to deciding...... on the use of premedication, choice of anesthetics, and management of postoperative pain. This review reflects on both general considerations concerning geriatric patients but also on the specific features of perioperatively used drugs and anesthetics that might have an impact on patients with Alzheimer...

  8. Oxidative Stress and Anesthesia in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Peivandi Yazdi A

    2014-04-01

    Full Text Available Free radical and peroxide production lead to intracellular damage. On the other hand, free radicals are used by the human immune system to defend against pathogens. The aging process could be limited by oxidative stress in the short term. Chronic diseases like diabetes mellitus (DM are full-stress conditions in which remarkable metabolic functional destructions might happen. There is strong evidence regarding antioxidant impairment in diabetes. Performing a particular method for anesthesia in diabetic patients might prevent or modify excessive free radical formation and oxidative stress. It seems that prescribing antioxidant drugs could promote wound healing in diabetics.  

  9. Orbital exenteration under trigeminal block: An innovative method of regional anesthesia

    Directory of Open Access Journals (Sweden)

    Manjunath Timmappa Bhat

    2013-01-01

    Full Text Available Orbital exenteration is a disfiguring operation involving the removal of the entire contents of the orbit, with or without the eyelids. It is widely felt that such extensive surgery can only be performed under general anesthesia. We report our experience with a patient who underwent orbitalexenteration under trigeminal block with intravenous sedation. A 68-year-old male patient was diagnosed to have orbital cellulitis (mucormycosis, uncontrolled diabetes mellitus, ischemic heart disease, dilated cardiomyopathy with severe left ventricular systolic dysfunction with severe pulmonary artery hypertension, and nephropathy. We decided to avoid general anesthesia for such a high-risk patient with many co-morbid illnesses. We gave trigeminal block using a 22-G spinal needle with local anesthetic solution of bupivacaine 0.5% by classic approach. A standard exenteration was performed and the patient tolerated the procedure well with no complications.

  10. Effectiveness comparison of inferior alveolar nerve block anesthesia using direct and indirect technique

    Directory of Open Access Journals (Sweden)

    Rehatta Yongki

    2016-12-01

    Full Text Available Local anesthesia is important to do prior to tooth extraction procedure to control the patient's pain. Local anesthetic technique in dentistry consists of topical, infiltration, and anesthetic blocks. For molar tooth extraction, mandibular block technique is used either direct or indirect. This study aimed to see if there are differences in effectiveness of inferior alveolar nerve block anesthesia techniques between direct and indirect. This clinical experimental design study used 20 patients as samples during February-April. 10 patients were taken as a group that carried out direct technique while 10 others group conducted indirect techniques. The sample selection using purposive sampling method. Pain level were measured using objective assessments (pain experienced by the patient after a given stimulus and subjective evaluation (thick taste perceived by the patient. The average time of onset in direct and indirect techniques in each sample was 16.88 ± 5.30 and 102.00 ± 19.56 seconds (subjectively and 22.50 ± 8.02 and 159.00 ± 25.10 (objectively. These results indicated direct techniques onset faster than indirect techniques. The average duration of direct and indirect techniques respectively was 121.63 ± 8.80 and 87.80 ± 9.96 minutes (subjectively and 91.88 ± 8.37 and 60.20 ± 10.40 minutes (objectively. These results indicated the duration of direct technique is longer than indirect technique. There was no significant difference when viewed from anesthesia depth and aspiration level. This study indicated that direct technique had better effect than indirect technique in terms of onset and duration, while in terms of anesthesia depth and aspiration level was relatively equal. Insignificant differences were obtained when assessing anesthetic technique successful rate based on gender, age and extracted tooth.

  11. General anesthesia suppresses normal heart rate variability in humans

    Science.gov (United States)

    Matchett, Gerald; Wood, Philip

    2014-06-01

    The human heart normally exhibits robust beat-to-beat heart rate variability (HRV). The loss of this variability is associated with pathology, including disease states such as congestive heart failure (CHF). The effect of general anesthesia on intrinsic HRV is unknown. In this prospective, observational study we enrolled 100 human subjects having elective major surgical procedures under general anesthesia. We recorded continuous heart rate data via continuous electrocardiogram before, during, and after anesthesia, and we assessed HRV of the R-R intervals. We assessed HRV using several common metrics including Detrended Fluctuation Analysis (DFA), Multifractal Analysis, and Multiscale Entropy Analysis. Each of these analyses was done in each of the four clinical phases for each study subject over the course of 24 h: Before anesthesia, during anesthesia, early recovery, and late recovery. On average, we observed a loss of variability on the aforementioned metrics that appeared to correspond to the state of general anesthesia. Following the conclusion of anesthesia, most study subjects appeared to regain their normal HRV, although this did not occur immediately. The resumption of normal HRV was especially delayed on DFA. Qualitatively, the reduction in HRV under anesthesia appears similar to the reduction in HRV observed in CHF. These observations will need to be validated in future studies, and the broader clinical implications of these observations, if any, are unknown.

  12. The Effect of Neuraxial Anesthesia on Maternal Cerebral Hemodynamics

    NARCIS (Netherlands)

    Postma, Ineke R.; van Veen, Teelkien R.; Mears, Scott L.; Zeeman, Gerda G.; Haeri, Sina; Belfort, Michael A.

    2014-01-01

    Objective Neuraxial anesthesia is known to reduce sympathetic tone and mean arterial pressure. Effects on cerebral hemodynamics in pregnancy are not well known. We hypothesize that cerebral hemodynamic parameters will change with respect to baseline following regional analgesia/anesthesia. Study

  13. Effects of combined general anesthesia and thoracic epidural ...

    African Journals Online (AJOL)

    Background: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro‑immuno‑endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, ...

  14. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase wh...

  15. Anesthesia for subglottic stenosis in pediatrics

    Directory of Open Access Journals (Sweden)

    Eid Essam

    2009-01-01

    Full Text Available Any site in the upper airway can get obstructed and cause noisy breathing as well as dyspnea. These include nasal causes such as choanal atresia or nasal stenosis; pharyngeal causes including lingual thyroid; laryngeal causes such as laryngomalacia; tracheobronchial causes such as tracheal stenosis; and subglottic stenosis. Lesions in the oropharynx may cause stertor, while lesions in the laryngotracheal tree will cause stridor. Subglottic stenosis is the third leading cause of congenital stridors in the neonate. Subglottic Stenosis presents challenges to the anesthesiologist. Therefore, It is imperative to perform a detailed history, physical examination, and characterization of the extent and severity of stenosis. Rigid endoscopy is essential for the preoperative planning of any of the surgical procedures that can be used for correction. Choice of operation is dependent on the surgeon′s comfort, postoperative capabilities, and severity of disease. For high-grade stenosis, single-stage laryngotracheal resection or cricotracheal resection are the best options. It has to be borne in mind that the goal of surgery is to allow for an adequate airway for normal activity without the need for tracheostomy. Anesthesia for airway surgery could be conducted safely with either sevofl uraneor propofol-based total intravenous anesthesia.

  16. Anesthesia during and Immediately after Spaceflight

    Science.gov (United States)

    Seubert, Christoph N.; Price, Catherine; Janelle, Gregory M.

    2006-01-01

    The increasing presence of humans in space and long-duration manned missions to the Moon or Mars pose novel challenges to the delivery of medical care. Even now, cumulative person-days in space exceed 80 years and preparations for a return to the Moon are actively underway. Medical care after an emergent de-orbit or an accident during a non-nominal landing must not only address the specific disease or injuries but also the challenges posed by physiologic adaptations to microgravity. In the highly autonomous situation of a long-term space mission the situation is even more complex, because personnel, equipment, specific training, and clinical experience are by definition limited. To summarize our current knowledge specifically for anesthetic care during and immediately after spaceflight, we will review physiologic adaptations to microgravity with particular emphasis on the resulting anesthetic risks, discuss veterinary experiences with anesthesia in weightlessness or in animals adapted to microgravity, describe current research that pertains to anesthesia and spaceflight and point out unresolved questions for future investigation.

  17. Fibromyalgia: A Primer for the Anesthesia Community

    Science.gov (United States)

    Brummett, Chad M.; Clauw, Daniel J.

    2012-01-01

    Purpose of the Review The present review is intended to give an overview of fibromyalgia for the anesthesiologist. While the basics of the treatment of fibromyalgia are included, the intent is to provide context to discuss the potential implications in perioperative management. Recent Findings One of the most important changes in the last year is the new criteria established by the American College of Rheumatology for the diagnosis of fibromyalgia. Instead of a combination of self-report and a tender point examination, there is a new self-report questionnaire that is now used diagnose fibromyalgia. This tool incorporates aspects of widespread body pain and some of the known comorbid symptoms. A score of 0-31 is given, which allows for the disease to be viewed as a continuum of sensitivity and symptomatology, instead of as a binary diagnosis. This continuum has been termed “fibromyalgia-ness.” This article also reviews the advances in understanding of the pathophysiology and emerging therapies. Little is known about the impact of fibromyalgia in the perioperative period. Summary The impact of fibromyalgia on anesthesia care is not known. Years of quality research have clearly demonstrated multiple pathophysiologic changes that could impact anesthesia care and future study is needed. PMID:21799404

  18. Intraoperative seizures during craniotomy under general anesthesia.

    Science.gov (United States)

    Howe, John; Lu, Xiaoying; Thompson, Zoe; Peterson, Gordon W; Losey, Travis E

    2016-05-01

    An acute symptomatic seizure is a clinical seizure occurring at the time of or in close temporal association with a brain insult. We report an acute symptomatic seizure occurring during a surgical procedure in a patient who did not have a prior history of epilepsy and who did not have a lesion associated with an increased risk of epilepsy. To characterize the incidence and clinical features of intraoperative seizures during craniotomy under general anesthesia, we reviewed cases where continuous EEG was acquired during craniotomy. Records of 400 consecutive cases with propofol as general anesthesia during craniotomy were reviewed. Demographic data, indication for surgery, clinical history, history of prior seizures, duration of surgery and duration of burst suppression were recorded. Cases where seizures were observed were analyzed in detail. Two out of 400 patients experienced intraoperative seizures, including one patient who appeared to have an acute symptomatic seizure related to the surgical procedure itself and a second patient who experienced two seizures likely related to an underlying diagnosis of epilepsy. This is the first report of an acute symptomatic seizure secondary to a neurosurgical procedure. Overall, 0.5% of patients monitored experienced seizures, indicating that intraoperative seizures are rare, and EEG monitoring during craniotomies is of low yield in detecting seizures. Copyright © 2016. Published by Elsevier Ltd.

  19. Total intravenous anesthesia: advantages for intracranial surgery.

    Science.gov (United States)

    Cole, Chad D; Gottfried, Oren N; Gupta, Dhanesh K; Couldwell, William T

    2007-11-01

    Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated ICP who undergo craniotomy, the increase in ICP during surgery from inhaled anesthetics can make the surgery more difficult, thereby increasing the risk of ischemic cerebral insults. Total intravenous anesthesia (TIVA) using propofol and analgesic drugs (remifentanil or fentanyl) and excluding simultaneous administration of any inhaled drugs is being used in patients undergoing craniotomy because of its potential to reduce ICP and ease access to the operative site. We reviewed the literature and describe our experience with TIVA, with emphasis on hemodynamic stability, effects on ICP, emergence from anesthesia, extubation times, and return of cognitive function in patients undergoing craniotomy for space-occupying lesions. TIVA with propofol is similar to inhaled anesthetics with regard to hemodynamic stability, emergence times, extubation times, early cognitive function, and adverse events. In several prospective, randomized clinical trials, evidence suggests that ICP is decreased and cerebral perfusion pressure is increased in patients receiving TIVA when compared with those receiving volatile anesthetics during elective craniotomy procedures. The impact of TIVA on ICP, brain swelling, and access to the operative site in patients with severely elevated ICP has yet to be evaluated and is the subject of a future study at our institution.

  20. Anesthesia considerations in the obese gravida.

    LENUS (Irish Health Repository)

    Tan, Terry

    2011-12-01

    Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly in the event of an emergency cesarean section, thus avoiding a general anesthesia, which has exceedingly high risks in the obese parturient. Successful management of the obese patient necessitates a comprehensive strategy that encompasses a multidisciplinary and holistic approach from all care-providers.

  1. Realistic and unrealistic direst costs in pharmacoeconomic anesthesia studies

    Directory of Open Access Journals (Sweden)

    Majstorović Branislava M.

    2017-01-01

    Full Text Available Introduction: Multiplicity of anesthetic services and practice consume few resources individually, but collectively, they mean significant cost. Economic and pharmacoeconomic studies are done in order to rationalize resources. Aim: 1. To calculate the direct expense in anesthesia and reanimation; 2. To compare expenses to the price of anesthesia according to the unit prices of National Health Insurance Fund (NHIF; 3. To compare the duration of general anesthesia with costs in anesthesia departments. Methodology: This paper is a part of the retrospectively-prospective academic study of fourth phase carried out in the Clinical Center of Serbia. With permission of Ethical committee, we have set for 2005 and 2006, the direct cost of 148.876 anesthetic services in 11 departments of Clinical Center of Serbia as tertiary-type institution of medical health care. Research group included all patients of both sexes, children and adults. We compared the direct cost per minute of general anesthesia with average duration of anesthesia in every anesthesia department of surgical clinics. The direct cost was compared with the same, 'unit' prices of NHIF. The direct cost was compared with the same, 'unit' prices of RHIF. We have used linear and regression statistical product and service solutions model for component cost analysis /SPSS 15/. Results: Most budget resources are selected for the employees' sallaries (40%, then the medicines and supplies (31,80% and the other expenses including the analysis and analytic devices (28,20%. Direct costs indicate a linear correlation and statistically marked difference p=0,012, F=9,270 compared to anesthesia duration indicating the coefficient of correlation r=0,694. Direct costs are highest considering longest segment of anesthesia. We have obtained linear correlation R=0,706 for direct costs excluding the neurosurgical anesthesia with 'unit prices'of anesthesia and anesthetic services indicating F=9,951 and p=0

  2. Improving Patient Safety in Anesthesia: A Success Story?

    International Nuclear Information System (INIS)

    Botney, Richard

    2008-01-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety

  3. [History of rachianesthesia and epidural anesthesia in Spain].

    Science.gov (United States)

    Gonzalo Rodríguez, Victoria; Rivero Martínez, Ma Dolores; Pérez Albacete, Mariano; López López, Ana I; Maluff Torres, Alejandro

    2007-10-01

    To show the beginning of spinal and epidural anesthesia in our country and the contributions of Spanish urologists. We reviewed books and writings of History of Medicine, Urology and Anesthesia and Doctoral thesis about spinal and epidural anesthesia. In the 20th century, surgeons also gave the anesthetic drugs to the patients. Spinal and epidural anesthesia were used for the first time in 1900. A lot of Spanish urologists like F Rusca Doménech, J.M. Batrina, M. Barragán Bonet, R. Lozano Monzón, L. Guedea Calvo, Gil Vernet, Fidel Pagés Miravé, V Sagarra Lascurain, Gómez Ulla, etc, did research, writings in scientific journals and Doctoral thesis about anesthesia.

  4. Progress in simulation education: developing an anesthesia curriculum.

    Science.gov (United States)

    Murray, David J

    2014-12-01

    Simulation's role in anesthesia education is expanding to include more advanced skills and training for subspecialty practice. This review will provide an overview of many recent studies that expand the simulation curriculum for anesthesia education. Recent studies describe a curriculum that uses a range of simulation modalities, including part-task trainers, mannequin-based simulation, virtual reality, in-situ techniques, screen-based simulations as well as encounters with 'standardized' patients, nurses or physician colleagues. A variety of studies describe the use of task-training devises to more effectively acquire skills, such as fibre-optic intubation, ultrasound-guided regional anesthesia and transthoracic echocardiography as well as expand on a variety of teamwork skills particularly in subspecialty anesthesia practice. A curriculum is emerging that utilizes a variety of simulation modalities as part of a more comprehensive educational strategy for anesthesia specialty training.

  5. A rare complication of spinal anesthesia: Intracranial subdural hemorrhage

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

    Full Text Available Spinal (subarachnoid anesthesia (SA is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur. [Arch Clin Exp Surg 2015; 4(1.000: 54-56

  6. Removal of Laryngeal Mask Airway: Awake or Deep Anesthesia?

    Directory of Open Access Journals (Sweden)

    SM Heidari

    2005-03-01

    Full Text Available Background: The aim of this study was to study the influence of depth of anesthesia (awake or deep anesthesia and choice of anesthetic drug (halothane or propofol on the incidence and severity of airway hyperreactivity associated with Laryngeal Mask Airway (LMA removal. Methods: A prospective, randomized, double blind study was done in 156 ASA physical status I and II patients, aged 18-65 years, who had under gone short time elective surgery (<1 hour. Patients were randomly assigned in one of the four subgroups: Hal-Aw (anesthesia maintenance with halothane and LMA removal in awaked state, Hal-Deep (anesthesia maintenance with halothane and LMA removal in deep anesthesia, Pro-Aw (anesthesia maintenance with propofol and LMA removal in awaked state, and Pro-Deep (anesthesia maintenance with propofol and LMA removal in deep anesthesia. The incidence of cough and straining, bronchospasm, laryngospasm, breathholding, vomiting, oxygen desaturation, and severity of airway hyperreactivity (mild, moderate, severe with LMA removal were evaluated. Results: There were no significant differences in bronchospasm, larynchospasm, oxygen desaturation among four subgroups. Significant differences were in cough and straining, breath holding, vomiting, and finally severity of airway hyperreactivity among four subgroups. Depth of anesthesia didn’t have any effect on incidence and severity of airway hyperreactivity but in those with propofol, they were lower than those with halothane. Conclusion: In short time surgery and with use of LMA, anesthesia with propofol is associated with lower incidence and severity of airway hyperreactivity than halothane. Keywords: propofol, halothane, airway hyperreactivity, Laryngeal Mask Airway (LMA.

  7. Memory Loss, Alzheimer's Disease and General Anesthesia: A Preoperative Concern.

    Science.gov (United States)

    Thaler, Adam; Siry, Read; Cai, Lufan; García, Paul S; Chen, Linda; Liu, Renyu

    2012-02-20

    The long-term cognitive effects of general anesthesia are under intense scrutiny. Here we present 5 cases from 2 academic institutions to analyze some common features where the patient's or the patient family member has made a request to address their concern on memory loss, Alzheimer's disease and general anesthesia before surgery. Records of anesthesia consultation separate from standard preoperative evaluation were retrieved to identify consultations related to memory loss and Alzheimer's disease from the patient and/or patient family members. The identified cases were extensively reviewed for features in common. We used Google® (http://www. google.com/) to identify available online information using "anesthesia memory loss" as a search phrase. Five cases were collected as a specific preoperative consultation related to memory loss, Alzheimer's disease and general anesthesia from two institutions. All of the individuals either had perceived memory impairment after a prior surgical procedure with general anesthesia or had a family member with Alzheimer's disease. They all accessed public media sources to find articles related to anesthesia and memory loss. On May 2 nd , 2011, searching "anesthesia memory loss" in Google yielded 764,000 hits. Only 3 of the 50 Google top hits were from peer-reviewed journals. Some of the lay media postings made a causal association between general anesthesia and memory loss and/or Alzheimer's disease without conclusive scientific literature support. The potential link between memory loss and Alzheimer's disease with general anesthesia is an important preoperative concern from patients and their family members. This concern arises from individuals who have had history of cognitive impairment or have had a family member with Alzheimer disease and have tried to obtain information from public media. Proper preoperative consultation with the awareness of the lay literature can be useful in reducing patient and patient family member

  8. Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke: Protocol for a randomized controlled (CANVAS) trial.

    Science.gov (United States)

    Peng, Yuming; Li, Yan; Jian, Minyu; Liu, Xiaoyuan; Sun, Jian; Jia, Bo; Dong, Jia; Zeng, Min; Lin, Nan; Zhang, Li; Gelb, Adrian W; Chan, Matthew Tv; Han, Ruquan

    2017-12-01

    Background Observational studies indicate that the type of anesthesia, local or general, may be associated with the post-procedural neurological function in patients with acute ischemic stroke undergoing endovascular treatment. However, these results need further confirmation, and the causal relationship has not yet been established. Methods This is a randomized controlled equivalence trial. Permuted block randomization stratified by culprit vessels will be used. Six hundred and forty patients with acute ischemic stroke undergoing endovascular recanalization will be randomized one to one to receive either general anesthesia or local anesthesia. The primary endpoint is the modified Rankin scale at 90 days after endovascular treatment. The secondary endpoints are the peri-procedural mortality and morbidity. Discussion The study aims to determine the effects of anesthetic choice on neurological outcomes in patients with acute ischemic stroke undergoing intra-arterial recanalization. If the results are positive, the study will indicate that the type of anesthesia does not affect neurological outcome after endovascular treatment. ClinicalTrial.gov identifier: NCT02677415.

  9. Epigenetic Manipulation of Brain-derived Neurotrophic Factor Improves Memory Deficiency Induced by Neonatal Anesthesia in Rats.

    Science.gov (United States)

    Wu, Jiang; Bie, Bihua; Naguib, Mohamed

    2016-03-01

    Although neonatal exposure to anesthetic drugs is associated with memory deficiency in rodent models and possibly in pediatric patients, the underlying mechanisms remain elusive. The authors tested their hypothesis that exposure of the developing brain to anesthesia triggers epigenetic modification, involving the enhanced interaction among transcription factors (histone deacetylase 2, methyl-cytosine-phosphate-guanine-binding protein 2, and DNA methyltransferase 1) in Bdnf promoter region(s) that inhibit brain-derived neurotrophic factor (BDNF) expression, resulting in insufficient drive for local translation of synaptic mRNAs. The authors further hypothesized that noninvasive environmental enrichment (EE) will attenuate anesthesia-induced epigenetic inhibition of BDNF signaling and memory loss in rodent models. Seven days after birth (P7), neonatal rats were randomly assigned to receive either isoflurane anesthesia for 6 h or sham anesthesia. On P21, pups were weaned, and animals were randomly assigned to EE or a standard cage environment (no EE). Behavioral, molecular, and electrophysiological studies were performed on rats on P65. The authors found a substantial reduction of hippocampal BDNF (n = 6 to 7) resulting from the transcriptional factors-mediated epigenetic modification in the promoter region of Bdnf exon IV in rats exposed postnatally to anesthetic drugs. This BDNF reduction led to the insufficient drive for the synthesis of synaptic proteins (n = 6 to 8), thus contributing to the hippocampal synaptic (n = 8 to 11) and cognitive dysfunction (n = 10) induced by neonatal anesthesia. These effects were mitigated by the exposure to an enriched environment. The findings of this study elucidated the epigenetic mechanism underlying memory deficiency induced by neonatal anesthesia and propose EE as a potential therapeutic approach.

  10. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  11. Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: A preliminary study

    Science.gov (United States)

    Beneito-Brotons, Rut; Peñarrocha-Oltra, David; Ata-Ali, Javier

    2012-01-01

    Objective: To compare a computerized intraosseous anesthesia system with the conventional oral anesthesia techniques, and analyze the latency and duration of the anesthetic effect and patient preference. Design: A simple-blind prospective study was made between March 2007 and May 2008. Each patient was subjected to two anesthetic techniques: conventional and intraosseous using the Quicksleeper® system (DHT, Cholet, France). A split-mouth design was adopted in which each patient underwent treatment of a tooth with one of the techniques, and treatment of the homologous contralateral tooth with the other technique. The treatments consisted of restorations, endodontic procedures and simple extractions. Results: The study series comprised 12 females and 18 males with a mean age of 36.8 years. The 30 subjects underwent a total of 60 anesthetic procedures. Intraosseous and conventional oral anesthesia caused discomfort during administration in 46.3% and 32.1% of the patients, respectively. The latency was 7.1±2.23 minutes for the conventional technique and 0.48±0.32 for intraosseous anesthesia – the difference being statistically significant. The depth of the anesthetic effect was sufficient to allow the patients to tolerate the dental treatments. The duration of the anesthetic effect in soft tissues was 199.3 minutes with the conventional technique versus only 1.6 minutes with intraosseous anesthesia – the difference between the two techniques being statistically significant. Most of the patients (69.7%) preferred intraosseous anesthesia. Conclusions: The described intraosseous anesthetic system is effective, with a much shorter latency than the conventional technique, sufficient duration of anesthesia to perform the required dental treatments, and with a much lesser soft tissue anesthetic effect. Most of the patients preferred intraosseous anesthesia. Key words:Anesthesia, intraosseous, oral anesthesia, infiltrating, mandibular block, Quicksleeper®. PMID

  12. [Quality management in regional anesthesia using the example of a Regional Anesthesia Surveillance System (RASS)].

    Science.gov (United States)

    Schulz-Stübner, S; Czaplik, M

    2013-02-01

    Regional anesthesia and regional analgesia techniques with or without a continuous catheter are frequently utilized in all areas of modern anesthesiology. There are individual and economic benefits but also risks involved with those techniques. While the incidence of severe complications is rare and preventive action not always possible, the consequences can be detrimental especially with hematoma or abscess formation associated with central neuraxial blocks. Therefore, it is important to create national and international databases with large case numbers utilizing standardized definitions of complications in order to allow realistic risk assessment and early discovery of potential dangers and preventive actions. This article shows the integration of standardized codes from the Regional Anesthesia Surveillance System with a software tool to allow high-quality data acquisition and the building of a foundation for national and international data collection and analysis as well as for feedback of institutional data for individual process optimization as part of a quality management system.

  13. Changes in the thalamocortical connectivity during anesthesia-induced transitions in consciousness.

    Science.gov (United States)

    Kim, Sung-Phil; Hwang, Eunjin; Kang, Jae-Hwan; Kim, Seunghwan; Choi, Jee Hyun

    2012-03-28

    Thalamocortical networks play an important role in information integration during consciousness. However, little is known about how the information flows between the thalamus and the cortex are affected by a loss of consciousness. To investigate this issue, we analyzed effective connectivity between the cortex and the thalamus in animals during anesthesia-induced transitions. By recording the electroencephalogram from the primary motor and the primary somatosensory cortex and by recording local field potentials from the ventral lateral and the ventrobasal thalamic nuclei, we evaluated changes in the conditional Granger causality between cortical and thalamic electrical activity as mice gradually lost consciousness from the use of anesthesia (ketamine/xylazine). The point of loss of consciousness was indicated by a moment of loss of movement that was measured using a head-mounted motion sensor. The results showed that 65% of the thalamocortical information flows were changed by anesthesia-induced loss of consciousness. Specifically, the effective connectivity between the cortex and the ventral lateral thalamus was altered such that the primary motor and the primary somatosensory cortex Granger-caused the ventral lateral thalamus before loss of consciousness whereas the ventral lateral thalamus Granger-caused the primary motor cortex and the primary somatosensory cortex after loss of consciousness. In contrast, the primary somatosensory cortex consistently Granger-caused the ventrobasal thalamus, regardless of the loss of consciousness. These results suggest how information flows change across the thalamocortical network during transitions in consciousness.

  14. Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

    Directory of Open Access Journals (Sweden)

    LaQuia A. Vinson

    2016-08-01

    Full Text Available The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA or office-based general anesthesia (OBGA in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029. Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

  15. Recent advances in neuromuscular block during anesthesia.

    Science.gov (United States)

    Boon, Martijn; Martini, Christian; Dahan, Albert

    2018-01-01

    Muscle relaxation is a routine part of anesthesia and has important advantages. However, the lingering effects of muscle relaxants in the postoperative period have historically been associated with postoperative adverse events. Neuromuscular reversal, together with neuromuscular monitoring, is a recognized strategy to reduce the rate of postoperative residual relaxation but has only marginally improved outcome in the past few decades. Sugammadex, a novel reversal agent with unique encapsulating properties, has changed the landscape of neuromuscular reversal and opened up new opportunities to improve patient care. By quickly and completely reversing any depth of neuromuscular block, it may reduce the rate of residual relaxation and improve respiratory recovery. In addition, sugammadex has made the use of deep neuromuscular block possible during surgery. Deep neuromuscular block may improve surgical working conditions and allow for a reduction in insufflation pressures during selected laparoscopic procedures. However, whether and how this may impact outcomes is not well established.

  16. Anesthesia in pregnancy with heart disease

    Directory of Open Access Journals (Sweden)

    Ankur Luthra

    2017-01-01

    Full Text Available Management of pregnant women with heart disease remains challenging due to the advancement of innovations in cardiac surgery and correction of complex cardiac anomalies, and more recently, with the successful performance of heart transplants, cardiac diseases are not only likely to coexist with pregnancy, but will also increase in frequency over the years to come. In developing countries with a higher prevalence of rheumatic fever, cardiac disease may complicate as many as 5.9% of pregnancies with a high incidence of maternal death. Since many of these deaths occur during or immediately following parturition, heart disease is of special importance to the anesthesiologist. This importance arises from the fact that drugs used for preventing or relieving pain during labor and delivery exert a major influence – for better or for worse – on the prognosis of the mother and newborn. Properly administered anesthesia and analgesia can contribute to the reduction of maternal and neonatal mortality and morbidity.

  17. Colonoscopic polypectomy of colorectal polyps in children under general anesthesia.

    Science.gov (United States)

    Lin, Chien-Heng; Wu, Rick Sai-Chuen; Lin, Wei-Ching; Wu, Shu-Fen; Chen, An-Chyi

    2009-02-01

    In many countries, general anesthesia is not routinely used for colonoscopic polypectomy in children because of either feasibility or cost-effectiveness issues. However, we have been using general anesthesia for colonoscopic polypectomy in pediatric patients in our hospital for the past 5 years. The aim of this study was to evaluate the safety of the procedure and the degree of satisfaction that the patients' parents and endoscopists had with the use of general anesthesia. We retrospectively analyzed the results of colonoscopic polypectomies under general anesthesia in 18 patients performed between January 2001 and December 2005. The removed polyps were examined histologically and the patients were observed to assess complications during the first 24-hour postoperative period. The patients' parents' and endoscopists' satisfaction with the use of general anesthesia was surveyed after the procedure. In our patient group, there were 10 boys and eight girls. The mean age was 5.5 +/- 3.4 years (range, 2-15 years). Seventeen of the 18 patients had rectal bleeding (mean duration, 3.7 months) as the main symptom. There were 12 patients with juvenile polyps, four with hyperplastic polyps, one with juvenile polyposis and one with Peutz-Jeghers syndrome. The majority (70.6%) of the polyps were located in the rectosigmoid colon. No significant complications related to colonoscopic polypectomy or anesthesia were observed. Satisfaction among parents and endoscopists ranged from good to excellent. General anesthesia is recommended for pediatric patients undergoing colonoscopic polypectomy.

  18. Colonoscopic Polypectomy of Colorectal Polyps in Children Under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Chien-Heng Lin

    2009-02-01

    Full Text Available In many countries, general anesthesia is not routinely used for colonoscopic polypectomy in children because of either feasibility or cost-effectiveness issues. However, we have been using general anesthesia for colonoscopic polypectomy in pediatric patients in our hospital for the past 5 years. The aim of this study was to evaluate the safety of the procedure and the degree of satisfaction that the patients' parents and endoscopists had with the use of general anesthesia. We retrospectively analyzed the results of colonoscopic polypectomies under general anesthesia in 18 patients performed between January 2001 and December 2005. The removed polyps were examined histologically and the patients were observed to assess complications during the first 24-hour postoperative period. The patients' parents' and endoscopists' satisfaction with the use of general anesthesia was surveyed after the procedure. In our patient group, there were 10 boys and eight girls. The mean age was 5.5 ± 3.4 years (range, 2–15 years. Seventeen of the 18 patients had rectal bleeding (mean duration, 3.7 months as the main symptom. There were 12 patients with juvenile polyps, four with hyperplastic polyps, one with juvenile polyposis and one with Peutz-Jeghers syndrome. The majority (70.6% of the polyps were located in the rectosigmoid colon. No significant complications related to colonoscopic polypectomy or anesthesia were observed. Satisfaction among parents and endoscopists ranged from good to excellent. General anesthesia is recommended for pediatric patients undergoing colonoscopic polypectomy.

  19. The development of pediatric anesthesia and intensive care in Scandinavia.

    Science.gov (United States)

    Nilsson, Krister; Ekström-Jodal, Barbro; Meretoja, Olli; Valentin, Niels; Wagner, Kari

    2015-05-01

    The initiation and development of pediatric anesthesia and intensive care have much in common in the Scandinavian countries. The five countries had to initiate close relations and cooperation in all medical disciplines. The pediatric anesthesia subspecialty took its first steps after the Second World War. Relations for training and exchange of experiences between Scandinavian countries with centers in Europe and the USA were a prerequisite for development. Specialized pediatric practice was not a full-time position until during the 1950s, when the first pediatric anesthesia positions were created. Scandinavian anesthesia developed slowly. In contrast, Scandinavia pioneered both adult and certainly pediatric intensive care. The pioneers were heavily involved in the teaching and training of anesthetists and nurses. This was necessary to manage the rapidly increasing work. The polio epidemics during the 1950s initiated a combination of clinical development and technical innovations. Blood gas analyses technology and interpretation in combination with improved positive pressure ventilators were developed in Scandinavia contributing to general and pediatric anesthesia and intensive care practice. Scandinavian specialist training and accreditation includes both anesthesia and intensive care. Although pediatric anesthesia/intensive care is not a separate specialty, an 'informal accreditation' for a specialist position is obtained after training. The pleasure of working in a relatively small group of devoted colleagues and staff has persisted from the pioneering years. It is still one of the most inspiring and pleasant gifts for those working in this demanding specialty. © 2014 John Wiley & Sons Ltd.

  20. [Rocuronium anesthesia induced anaphylactic shock: a case report].

    Science.gov (United States)

    Qiu, Min; Zong, Ya-nan; Lu, Jian; Ma, Lu-lin; Zheng, Qing; Guo, Xiang-yang

    2015-10-18

    Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen, and it could be an unpredictable and life-threatening cause during anesthesia. The main purpose of this paper is to report a case of anaphylactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period. A 63-year-old man, with a mass on his adrenal, was scheduled to a laparoscopic adrenal tumor excision. During the anesthesia induction period, after administrated sulfentanil, propofol and rocuronium, the blood pressure was decreased and the heart rate was increased. Then, the patient had rash on his whole body and developed an anaphylactic shock. After being treated with the anti-allergic agents and norepinephrine, the rash disappeared and the vital sign become stable. The patient felt nothing uncomfortable during the two weeks'follow-up. Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period. The most common inducements are muscle relaxant, latex and antibiotics. Anaphylactic reactions in the perioperative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Before anesthesia, we should acquire the allergic history. During the anesthesia period, the vital sign and the skin should be observed carefully.