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1.
Medicine (Baltimore) ; 99(10): e19240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150060

RESUMO

BACKGROUND: With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. METHODS: The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T0), at the start of the surgical procedure (T1), 15 minutes later (T2), 30 minutes later (T3), and before the end of the surgical procedure (T4). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T5), 12 hours after surgery (T6), 24 hours after surgery (T7), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. RESULTS: There was no significant difference with the surgical visual field of the 3 groups (P > .05). The MAP, HR and SpO2 of the 3 groups were decreased from T2 to T3 compared with T0(P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier (P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher (P < .05). The static and dynamic NRS scores were lower from T5 to T7 (P < .05). Ramsay sedation scores were higher (P < .05), and the incidence of adverse reactions was lower (P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T6 to T7 (P < .05). CONCLUSION: Supraglottic device with assist ventilation under general anesthesia combined with nerve block in uniportal video-assisted thoracoscopic surgery is safe and feasible.


Assuntos
Anestesia Geral/instrumentação , Bloqueio Nervoso/instrumentação , Respiração Artificial , Cirurgia Torácica Vídeoassistida , Adulto , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Anestésicos Gerais/administração & dosagem , Pressão Sanguínea , Procedimentos Cirúrgicos Eletivos , Estudos de Viabilidade , Feminino , Frequência Cardíaca , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Oximetria
2.
Anaesthesia ; 75(1): 72-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506918

RESUMO

Technology that facilitates performance of deep peripheral nerve blocks is of clinical interest. The Onvision™ is a new device for ultrasonographic needle tip tracking that incorporates an ultrasound sensor on the needle tip that is then represented by a green circle on the ultrasound screen. The primary aim of this study was to investigate the effect of needle tip tracking on procedural time in the first human volunteer study. Secondary outcome measures included: number of hand movements; hand movement path length; block success rate; block onset time; block duration; discomfort experienced by the volunteers; and the anaesthetists' confidence as to whether their block would be successful. Two anaesthetists performed ultrasound-guided lumbar plexus blocks with an out-of-plane technique, with and without the use of needle tip tracking. In total, data from 25 volunteers were studied. Mean (SD) procedural time was 163 (103) s with needle tip tracking and 216 (117) s without (p = 0.10). Hand motion analysis showed that needle tip tracking was associated with a significant decrease in the mean (SD) number of intended needling hand movements (39 (29) vs. 59 (36); p = 0.03) and path lengths (3.2 (3.1) m vs. 5.5 (4.5) m; p = 0.03). No differences were found for any other secondary outcomes. The use of Onvision needle tip tracking did not reduce procedural time for out-of-plane ultrasound-guided lumbar plexus block but did reduce the number of hand movements and path lengths. This may indicate improved needle control but further studies are needed to confirm this finding.


Assuntos
Anestésicos Locais/administração & dosagem , Agulhas , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Estudos Cross-Over , Feminino , Humanos , Plexo Lombossacral , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Anaesthesia ; 75(1): 80-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506921

RESUMO

Visibility of the needle tip is difficult to maintain during ultrasound-guided nerve block. A new needle has been developed that incorporates a piezo element 2-2.3 mm from the tip, activated by ultrasound. The electrical signal manifests as a coloured circle surrounding the needle tip, and allows real-time tracking. We hypothesised that novice regional anaesthetists would perform nerve block better with the tracker turned on rather than off. Our primary objective was to evaluate the new needle by measuring the performance of novice anaesthetists conducting simulated sciatic block on the soft embalmed Thiel cadaver. Training consisted of a lecture, scanning in volunteers and practice on cadavers. Testing entailed scanning the sciatic nerve of a cadaver and conducting 20 in-plane sciatic blocks in the mid-to-upper thigh region. Subjects were randomised equally, in groups of five, according to the sequence: tracker on/off/on/off; or tracker off/on/off/on. Video recordings were assessed by six raters for steps performed correctly and errors committed. Eight subjects were recruited and 160 videos were analysed. Using the tracking needle, five correct steps improved and one error reduced. The benefits included: better identification of the needle tip before advancing the needle, OR (95%CI) 3.4 (1.6-7.7; p < 0.001); better alignment of the needle to the transducer, 3.1 (1.3-8.7; p = 0.009); and better visibility of the needle tip 3.0 (1.4-7.3; p = 0.005). In conclusion, use of the tracker needle improved the sciatic block performance of novices on the soft embalmed cadaver.


Assuntos
Anestesia por Condução/instrumentação , Agulhas , Bloqueio Nervoso/instrumentação , Nervo Isquiático , Ultrassonografia de Intervenção/métodos , Anestesia por Condução/métodos , Cadáver , Humanos , Bloqueio Nervoso/métodos
4.
Curr Med Sci ; 39(5): 794-799, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612398

RESUMO

To evaluate the anesthetic effect of ultrasound-guided (USG) ilioinguinal/iliohypogastric nerve (II/IHN) block combined with genital branch of genitofemoral nerve (GFN) block in the elderly undergoing inguinal hernia repair, 54 old patients (aged 60-96years, ASA I-III) with indirect hernia were enrolled and scheduled for unilateral tension-free herniorrhaphy. Patients were grouped randomly to receive either USG II/IHN plus GFN block (Group G) or USG II/IHN block alone (Group I). The intraoperative visual analogue scale (VAS) scores were recorded at skin incision, at spermatic cord/round ligament traction and at sac ligation. The resting and dynamic VAS scores were recorded postoperatively. The requirements of extra sedatives and analgesics for intra- and postoperative analgesia were assessed. Occurrence of complications of the block, postoperative nausea and vomiting and femoral nerve palsy was also reported. Both groups showed similar sensory block. When stretching spermatic cord/round ligament, the patients in group G had significantly lower VAS scores than in group I. And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia. In addition, group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested. No significant difference was found in the postoperative requirement of rescue medication. Both groups showed no complications related to the block and group G reported no femoral nerve palsy. The addition of GFN block to II/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.


Assuntos
Nervo Femoral/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Herniorrafia , Bloqueio Nervoso/métodos , Nervos Esplâncnicos/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Analgésicos , Anestésicos Intravenosos , Feminino , Flurbiprofeno , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/etiologia , Náusea/fisiopatologia , Bloqueio Nervoso/instrumentação , Medição da Dor , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Distribuição Aleatória , Sufentanil , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Vômito/diagnóstico , Vômito/etiologia , Vômito/fisiopatologia
5.
Vet Clin North Am Exot Anim Pract ; 22(3): 419-439, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395323

RESUMO

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.


Assuntos
Analgesia/veterinária , Anestesia/veterinária , Animais Exóticos/fisiologia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Manuseio das Vias Aéreas/veterinária , Analgesia/tendências , Anestesia/tendências , Anestésicos/administração & dosagem , Animais , Aves/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/veterinária , Endoscopia/instrumentação , Endoscopia/métodos , Endoscopia/tendências , Endoscopia/veterinária , Humanos , Mamíferos/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Bloqueio Nervoso/veterinária , Manejo da Dor , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/tendências , Respiração Artificial/veterinária
6.
Curr Opin Anaesthesiol ; 32(5): 638-642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31415044

RESUMO

PURPOSE OF REVIEW: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. RECENT FINDINGS: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some examples of fascial blocks. Because injecting into a fascial plane is not controversial, these blocks are not included in our discussion of optimal placement of the needle.To determine optimal needle placement, it is important to have a clear definition of what constitutes intraneural. Although, there is almost universal agreement that the violation of the epineurium defines the intraneural concept, the literature include several studies where this assessment is erroneous.Although intentional intraneural injection is still considered objectionable, some literature suggests that injecting intraneurally, especially if extrafascicular, may be benign. This evidence is limited and anecdotal. SUMMARY: It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.


Assuntos
Agulhas/efeitos adversos , Bloqueio Nervoso/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervos Periféricos/anatomia & histologia , Humanos , Injeções/efeitos adversos , Injeções/instrumentação , Injeções/métodos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção
7.
Anaesthesia ; 74(11): 1397-1405, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31465115

RESUMO

We performed a randomised, blinded, controlled study with adult patients scheduled for primary total knee arthroplasty under spinal anaesthesia. The aim was to investigate the analgesic effects of adductor canal block using catheter-based repeated boluses, either through a new suture-method catheter or a standard perineural catheter, compared with a single-injection technique. All patients received an adductor canal block after surgery with an initial bolus of 20 ml ropivacaine 0.75%, followed by 20 ml of ropivacaine 0.2% every 8 h in the standard and suture-method catheter groups, and sham boluses for the single-injection group. The primary outcome measure was total opioid consumption (intravenous morphine equivalents) from the end of surgery until 12:00 on postoperative day 2. Secondary outcomes were pain, muscle strength and ambulation. We randomly assigned (1:1:1) and analysed 153 patients. Total opioid consumption was median (IQR [range]) 24 (11-37 [0-148]) mg in the suture-method group, 38 (17-51 [0-123]) mg in the standard catheter group and 37 (14-57 [0-158]) mg in the single-injection group (p = 0.049). Differences were not statistically significant after Bonferroni correction (α = 0.05/3). There were no differences between groups on postoperative day 1. On postoperative day 2, there were no differences between catheter groups, but muscle strength and ambulation were improved compared with the single-injection group. We conclude that providing repeated boluses via a catheter did not decrease opioid consumption or pain compared with a single injection, but improved muscle strength and ambulation on postoperative day 2. The two types of catheters were similar.


Assuntos
Anestésicos Locais/farmacologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/farmacologia , Idoso , Analgesia/métodos , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Cateteres , Feminino , Humanos , Injeções , Masculino , Ropivacaina/administração & dosagem , Método Simples-Cego , Suturas , Resultado do Tratamento
8.
Best Pract Res Clin Anaesthesiol ; 33(1): 47-56, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272653

RESUMO

Nerve injury is a relatively rare but devastating complication of peripheral nerve blockade (PNB). Monitoring injection pressure during PNB is one method advocated to prevent injury by detecting needle tip placement in a noncompliant position (intraneural or abutting the epineurium). Animal studies show that gross neural damage and clinical injury are associated with injection pressures exceeding 15-20 psi. In contrast, pressures <15 psi are associated with an extraneural needle tip position and no histologic or clinical injury. Injection pressure monitoring has been shown to prevent injection against the brachial plexus roots or femoral nerve during peripheral nerve block. Multiple methods are available to monitor injection pressure, and most of them are inexpensive and easy to use. Large-scale registry database or pragmatic trials are indicated to show that injection pressure monitoring reduces injury in a patient setting.


Assuntos
Reação no Local da Injeção/patologia , Monitorização Intraoperatória/métodos , Bloqueio Nervoso/efeitos adversos , Traumatismos dos Nervos Periféricos/patologia , Humanos , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/prevenção & controle , Injeções/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Pressão/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
9.
Medicine (Baltimore) ; 98(22): e15896, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145351

RESUMO

Caudal block has limited injectate distribution to the desired lumbar level due to the relatively long distance from the injection site and reduction in the volume of injectate due to leakage into the sacral foramen. The objective of this study was to investigate the influence of needle gauge on fluoroscopic epidural spread and to assess the correlation between the spread level and analgesic efficacy in patients undergoing caudal block. We retrospectively analyzed data from 80 patients who received caudal block for lower back and radicular pain. We categorized patients based on the epidural needle gauge used into group A (23 gauge), group B (20 gauge), and group C (17 gauge). Fluoroscopic image of the final level of contrast injected through the caudal needle and pain scores before the block and 30 minutes after the block recorded using a numerical rating scale, were evaluated. Of the 80 patients assessed for eligibility, 7 were excluded. Thus, a total of 73 patients were finally analyzed. Age, sex, body mass index, diagnosis, lesion level, lesion severity, and duration of pain did not differ among the 3 groups. All patients showed cephalic spread of contrast. Contrast spread beyond L5 was seen in 26.9% of patients in group A, 41.7% in group B, 39.1% in group C, and 35.6% overall; there was no significant difference among the groups (P = .517). Analgesic efficacy was not significantly different among the groups (P = .336). The needle gauge did not influence the level of epidural spread or analgesic efficacy in caudal block.


Assuntos
Anestesia Caudal/instrumentação , Fluoroscopia/métodos , Injeções Epidurais/instrumentação , Agulhas , Bloqueio Nervoso/instrumentação , Idoso , Anestesia Caudal/métodos , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/efeitos dos fármacos , Feminino , Humanos , Injeções Epidurais/métodos , Dor Lombar/tratamento farmacológico , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
10.
J Vet Dent ; 36(1): 46-51, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31138051

RESUMO

Blinded techniques to desensitize the inferior alveolar nerve (IAN) include intraoral, angled, and vertical extraoral approaches with reported success rates of 100%, 73%, and 59%, respectively. It has not been determined whether an ultrasound-guided extraoral approach is feasible. Further, the fascicular nature of the inferior alveolar and lingual nerves of the horse has not been described. The objectives of this study were to describe a low-volume ultrasound-guided vertical extraoral inferior alveolar nerve block technique and to describe the fascicular nature of these nerves. An ultrasound-guided approach to the IAN was conducted with a microconvex transducer and an 18-G, 15-cm spinal needle using a solution containing iodinated-contrast and methylene blue dye. Accuracy was assessed by contrast visualized at the mandibular foramen on computed tomography (CT) and methylene blue dye staining of the nerves on gross dissection. Sections of inferior alveolar and lingual nerves were submitted for histological analysis. Assessment by CT and dissection determined success rates of 81.3% and 68.8%, respectively; 68.8% of injections had inadvertent methylene blue dye staining of the lingual nerve. Nerve histology revealed both the inferior alveolar and lingual nerves to be multifascicular in nature. Mean fascicle counts for the inferior alveolar and lingual nerves were 29 and 30.8, respectively. The technique is challenging and no more accurate than previously published blinded techniques. Any extraoral approach to the IAN is likely to also desensitize the lingual nerve.


Assuntos
Cavalos/cirurgia , Nervo Lingual/cirurgia , Nervo Mandibular/cirurgia , Bloqueio Nervoso/veterinária , Ultrassonografia/veterinária , Animais , Cadáver , Nervo Lingual/efeitos dos fármacos , Nervo Lingual/fisiologia , Nervo Mandibular/efeitos dos fármacos , Nervo Mandibular/fisiologia , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos
11.
A A Pract ; 13(5): 162-165, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30973349

RESUMO

Harvesting of iliac crest bone graft for alveolar cleft repair in children is associated with significant postoperative pain. Transversalis fascia plane block has emerged as an alternative to local wound infiltration for iliac crest bone graft harvesting and has been used with good effect in adult patients requiring bone graft for orthopedic surgery. Little is known about the use of the transversalis fascia plane block in children or the feasibility of placing a continuous infusion catheter. In this report, we describe our experience using a continuous transversalis fascia plane infusion catheter in the management of a 6-year-old girl undergoing alveolar cleft repair with iliac crest bone graft.


Assuntos
Cateterismo/métodos , Fissura Palatina/cirurgia , Bloqueio Nervoso/instrumentação , Transplante Ósseo , Criança , Feminino , Humanos , Ílio/transplante , Bombas de Infusão , Ultrassonografia de Intervenção
12.
A A Pract ; 12(9): 299-301, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30844822

RESUMO

Thoracotomy is associated with significant postoperative pain. While postoperative pain control after thoracotomy is most commonly managed with a thoracic epidural or paravertebral catheter, both are fraught with significant risks and are technically challenging to perform in pediatric patients. The erector spinae plane block is a relatively novel, easy-to-perform block used to provide thoracic wall analgesia. We present a case of a pediatric patient undergoing thoracotomy whose postoperative pain was managed with an erector spinae plane catheter.


Assuntos
Bloqueio Nervoso/instrumentação , Dor Pós-Operatória/tratamento farmacológico , Toracotomia/efeitos adversos , Analgesia/métodos , Criança , Humanos , Masculino , Nervos Espinhais , Resultado do Tratamento
13.
Pain Med ; 20(4): 779-783, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30759260

RESUMO

OBJECTIVE: To determine if skin wheals reduce procedural pain associated with lumbar medial branch blocks (MBBs) performed with 25-gauge needles. DESIGN: Prospective comparative observational study. SETTING: Outpatient Physical Medicine & Rehabilitation and interventional pain practice within an academic tertiary care center. SUBJECTS: Ninety-nine consecutive patients who underwent lumbar MBBs for facet pain were included. Patients who were obese or required larger-diameter needles were excluded. METHODS: One to three facet joints were targeted per side, with some patients receiving bilateral procedures. All injections were performed with 25-gauge, 3.5-inch Quincke tip needles under fluoroscopic guidance. A total of 306 needle sticks were recorded. MBBs were performed without skin wheals or any other type of local anesthesia (35 patients, 108 needle sticks), with skin wheals (30 patients, 94 needle sticks), and in mixed groups (34 patients, 47 needle sticks with skin wheals, 57 needle sticks without skin wheals or other type of local anesthesia). Patients rated the pain of each needle placement immediately after the multilevel MBB procedure. RESULTS: Considering all 306 needle sticks, needles that were placed using skin wheals caused slightly more pain than those placed without skin wheals or any other type of local anesthesia (P = 0.007). CONCLUSIONS: Skin wheals do not reduce and may increase procedural pain associated with lumbar MBBs performed with 25-gauge needles.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/efeitos adversos , Dor Processual , Idoso , Feminino , Humanos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Agulhas , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Articulação Zigapofisária
14.
Agri ; 31(1): 9-14, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30633308

RESUMO

OBJECTIVES: Ultrasonography-guided regional anesthesia (UGRA) applications are important in the practice of the anesthesiology and algology in our country as well as in the world. Despite the positive effect on the patient care of the UGRA, there is concern that ultrasound probes may be used repeatedly and assume a vector role in pathogen transport. There is no standard protocol in our country to provide basic hygiene before UGRA techniques, which is a part of the daily practices of anesthesiologists. In the study, it was aimed to investigate the probes and skin disinfection habits applied by the anesthesiologists. METHODS: After the approval of the ethics committee, random selection was made from the UGRA-administered clinics in our country and the questionnaire consisting of 14 questions was e-mailed (e-mail) to 430 participants. RESULTS: Distribution of preferred agents for USG probe disinfectant: povidone iodine 45.5%, octenidine 8%, chlorhexidine 5.4%, alcohol solutions 7.1 %. The rate of participants who indicated that they had received a disinfection course or certificate to engage in UGRA-related initiatives was 39.3%. CONCLUSION: Although the most commonly used disinfectant povidone iodide and disinfection training rate is less than 50%, the incidence of UGRA-associated infection is very low. In our country, we believe that the study has provided data on the preferences of disinfection methods of anesthetists in UGRA applications. However, we believe that it is required to be worked in larger study groups that include more anesthesiologists, in order to provide more generalizable data.


Assuntos
Anestesiologia , Desinfecção , Bloqueio Nervoso/instrumentação , Padrões de Prática Médica , Ultrassonografia de Intervenção/instrumentação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Turquia , Adulto Jovem
19.
Abdom Radiol (NY) ; 44(1): 327-332, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30078081

RESUMO

PURPOSE: Demonstrate the use of a new steerable needle for CT-guided neural plexus blockade to avoid traversing the kidneys. MATERIALS AND METHODS: Retrospective evaluation of 23 consecutive CT-guided neural plexus blockade procedures in which a new steerable needle was used in the last 13 and compared with the prior 10 procedures in which a standard needle was used. RESULTS: Use of the steerable needle was beneficial to reach the target area without traversing a kidney or other organs in 6/13 (46%) procedures; in the other 7 procedures there was no benefit. A kidney was traversed in 0/13 procedures performed with the steerable needle. In contrast, a kidney was traversed in 4/10 (40%) procedures using a standard needle (P = 0.02). There was no significant difference in clinical benefit (P = 1.00) or complications (P = 0.56) between procedures using the steerable needle versus a standard needle. Three complications were observed (1 major and 2 minor) felt to be related to the injection and not the needle type. CONCLUSIONS: The utility of a steerable 21-gauge needle during neural plexus blockades was found to allow for avoidance of the kidneys when compared to a standard (non-steerable) needle. Interventional radiologists may find this needle and its future iterations useful for neural blockades, as well as other procedures, when intervening structures need to be avoided. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort.


Assuntos
Agulhas , Bloqueio Nervoso/instrumentação , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
20.
Rev Bras Anestesiol ; 69(1): 95-98, 2019.
Artigo em Português | MEDLINE | ID: mdl-30459088

RESUMO

BACKGROUND AND OBJECTIVE: Erector spinae plane block is a valid technique to provide simultaneously analgesia for combined thoracic and abdominal surgery. CASE REPORT: A patient underwent open esophagectomy followed by reconstructive esophagogastroplasty but refused thoracic epidural analgesia; a multi-modal analgesia with a multiple erector spinae plane block was then planned. Three erector spinae plane catheters (T5 and T10 on the right side and T9 on the left side) for continuous analgesia were placed before surgery. During the first 48h pain was never reported in the thoracic area but the patient reported multiple times to feel a pain well localized in epigastrium, but never localized in any other abdominal quadrant. DISCUSSION: Erector spinae plane block is a valid technique to provide analgesia simultaneously for combined thoracic and abdominal surgery and could be a valid alternative strategy if the use of epidural analgesia is contraindicated.


Assuntos
Analgesia/métodos , Esofagectomia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Idoso , Cateteres , Esofagectomia/métodos , Humanos , Masculino , Bloqueio Nervoso/instrumentação , Músculos Paraespinais
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