RESUMO
We describe a novel supraclavicular approach to the brachial plexus. Designated as the intersternocleidomastoid technique, this new approach was tested in unembalmed cadavers. It was then applied for evaluation to 150 ASA grade I or II patients scheduled for elective surgery or physiotherapy of the upper limb or for treatment of reflex sympathetic dystrophy associated with painful shoulder. The new approach was easy to master because of a very simple surface landmark, i.e., the triangle formed by the sternocleidomastoid heads, which were visible and palpable in most patients studied (90%). The procedure was effective intraoperatively, providing satisfactory anesthesia in 140 patients (93%), partially satisfactory blocks in 6 (4%), and unsatisfactory blocks in only 4 (3%). The catheter entry point is cephalad enough not to obscure the surgical field on the shoulder. Catheter insertion was successful in 63 of 70 patients. Postoperative analgesia was provided for 48 h or more in 45 patients and for 24 h in 18 patients. Only minor complications were observed: asymptomatic phrenic nerve block in 89 patients (60%), transient Horner's syndrome in 15 (10%), transient recurrent laryngeal nerve blockade in 2, and misplacement of the catheter into the subclavian vein in 1 patient. No pneumothorax was observed.
Assuntos
Plexo Braquial , Bloqueio Nervoso/métodos , Adulto , Braço/cirurgia , Feminino , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Dor/reabilitação , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Modalidades de Fisioterapia , Articulação do OmbroRESUMO
Sixteen patients (13-38 yr) undergoing spinal fusion for scoliosis under controlled hypotension were studied to determine the haemodynamic and neuroendocrine responses to IV dihydralazine (1.0 mg.kg-1) followed by 0.5 and 1 MAC of enflurane or isoflurane. Twenty minutes after dihydralazine administration mean arterial pressure (-20 per cent) and systemic vascular resistance (-50 per cent) decreased, and cardiac index (+57 per cent), heart rate (+37 per cent) and intrapulmonary shunt increased. Plasma renin activity and aldosterone and norepinephrine levels increased. Further decreases in mean arterial pressure and in systemic vascular resistance were observed when 0.5 MAC enflurane or isoflurane were added. With 1 MAC anaesthetic levels a further decrease in mean arterial pressure was observed in both groups, but pressure fell to a lower level with isoflurane than with enflurane (p less than 0.01). The reduction of arterial blood pressure to a level of 50-60 mmHg for three to four hours was easy to control and was free of complications. The preliminary IV administration of dihydralazine allowed a reduced volatile agent concentration which attenuated undesirable haemodynamic effects, in spite of renin and norepinephrine release, and permitted a rapid intraoperative awakening.
Assuntos
Anestésicos/administração & dosagem , Di-Hidralazina/administração & dosagem , Hidralazina/análogos & derivados , Hipotensão/induzido quimicamente , Adolescente , Adulto , Anestesia , Sinergismo Farmacológico , Enflurano/administração & dosagem , Feminino , Humanos , Isoflurano/administração & dosagem , Masculino , Escoliose/cirurgia , Fusão VertebralAssuntos
Doenças Ósseas/cirurgia , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Tromboflebite/prevenção & controle , Ensaios Clínicos como Assunto , Esquema de Medicação , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Distribuição AleatóriaRESUMO
CT and sonography were compared in 78 cases of retroperitoneal lymph nodes. The results obtained with both methods are similar. Thus, ultrasound can be chosen as the first procedure in the evaluation of retroperitoneal lymph nodes. CT will be used as a complement in case of technically insufficient sonograms.