RESUMEN
BACKGROUND: Recent investigations of local anesthetic distribution in the lower extremity have revealed that completely surrounding the sciatic nerve with local anesthetic provides the advantage of more rapid and complete anesthesia in the territory served by the nerve. We hypothesized that a pattern of distribution that entirely envelops the targeted nerve roots during interscalene block would provide similar benefits of more rapid anesthesia onset. METHODS: During interscalene block guided by ultrasound with nerve stimulator confirmation, the pattern of local anesthetic distribution was recorded and later classified as complete or incomplete envelopment of the visible nerve elements in 50 patients undergoing ambulatory shoulder arthroscopic surgery. The pattern was then compared with the extent of block setup at pre-determined intervals, as well as to post-operative pain levels and block duration. RESULTS: Twenty-two patients (44%) had complete envelopment of the nerves in the plane of injection during ultrasound imaging of the interscalene block. There was no difference in the fraction of blocks that were fully set-up at 10 min with regards to complete or incomplete envelopment of the nerves by local anesthetic. All of the patients had complete setup of the block by 20 min. In addition, the post-operative pain levels and duration of block did not vary among the two groups with complete vs. incomplete local anesthetic distribution around the nerves. CONCLUSION: The presence or absence of complete envelopment of the nerve elements in the interscalene groove by local anesthetic did not determine the likelihood of complete block effect at pre-determined time intervals after the procedure.
Asunto(s)
Anestésicos Locales/farmacocinética , Plexo Braquial/diagnóstico por imagen , Bloqueo Nervioso/métodos , Ultrasonografía Intervencional/métodos , Procedimientos Quirúrgicos Ambulatorios , Artroscopía , Interpretación Estadística de Datos , Estimulación Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/epidemiología , Hombro/cirugía , Raíces Nerviosas Espinales/diagnóstico por imagen , Factores de Tiempo , Resultado del TratamientoRESUMEN
Preventive medicine is an increasingly important area of clinical practice. Conceptually, preventive medicine involves three tasks of the clinician: screening, counseling, and immunization/prophylaxis. This opening article reviews some of the basic tenets underlying screening including basic epidemiologic principles, characteristics of a good screening situation, barriers to screening, and some of the potential hazards of screening.
Asunto(s)
Tamizaje Masivo/normas , Medicina Preventiva/normas , Humanos , Tamizaje Masivo/efectos adversos , Tamizaje Masivo/métodos , Valor Predictivo de las Pruebas , Medicina Preventiva/métodos , Estados UnidosRESUMEN
Invasive aspergillosis developed in a patient without preexisting lung disease or immunosuppression, after she had received only a one-month course of corticosteroid therapy. Surgical excision, without antifungal therapy, resulted in eradication of the infection.
