Search PubMed⌕ Search

Biomedical subjects

B Ben-David

Publications and source records attributed to B Ben-David.

46 records · Page 3Linked to original sources
PubMed1988

Spinal cord monitoring.

This article serves as a review of the use of spinal cord monitoring in spine surgery, including both the wake-up test and the various approaches to electrophysiologic (evoked-potential) monitoring. Physiologic and technical aspects of evoked-potential monitoring are presented. The different ways of performing evoked potentials are presented, examined, and compared, with a discussion of the pros and cons of each.

Electrophysiology↗
PubMedDate not supplied

Anterior spinal fusion complicated by paraplegia. A case report of a false-negative somatosensory-evoked potential.

A case of an anterior spinal artery syndrome complicating an anterior spinal fusion is reported. Besides documenting a relatively rare complication of anterior spinal surgery, the level of the lesion (T6) and the association of spinal shock are relatively unusual. Intraoperative somatosensory-evoked potentials (SEP) deteriorated only transiently and failed to reflect adequately the neurologic injury either intraoperatively or postoperatively. The shortcomings of SEP monitoring are discussed, and the recommendation is made to use the combination of SEPs with the wake-up test when possible.

Evoked Potentials, Somatosensory↗
PubMedDate not supplied

Posterior spinal fusion complicated by posterior column injury. A case report of a false-negative wake-up test.

A case is reported of an isolated posterior column injury secondary to direct mechanical trauma complicating a posterior spinal fusion. This case documents a rare complication of posterior spinal surgery. Intraoperative somatosensory-evoked potential (SEP) monitoring documented the injury whereas two intraoperative wake-up tests did not. This case demonstrates the value of intraoperative spinal cord monitoring in general. It also demonstrates the value of combining means to assess both anterior and posterior cord separately, intraoperatively. It is recommended that the wake-up test be used in conjunction with SEPs intraoperatively.

Adult↗
PubMedDate not supplied

Using rate-based events to improve clinical practice.

This article describes the implementation and utilization of a continuous quality improvement (CQI) program in the identification, analysis, and correction of a rate-based event in anesthesia, in this case, intraoperative hypertension. A CQI program was implemented based on voluntary, handwritten, anonymous reports of intraoperative and postanesthesia care unit events. This CQI program detected a high incidence of intraoperative hypertension, indicated major causal factors, suggested a set of corrective measures, and allowed for measurement of their efficacy.

Anesthesiology↗
PubMedDate not supplied

Axillary block complicated by hematoma and radial nerve injury.

BACKGROUND AND OBJECTIVES: Hematoma is typically cited as one mechanism of nerve injury following axillary block. However, documented cases of this are lacking. METHODS: A healthy 38-year-old man was scheduled for surgical removal of a tumor of the hand. A transarterial axillary block was performed with a 22-gauge short-bevel needle using 40 mL of a mixture of equal volumes of 1.5% lidocaine and 0.5% bupivacaine containing 1:200,000 epinephrine. No paresthesias were reported. Postoperative, the patient developed a large axillary hematoma accompanied by paresthesias and radial nerve weakness. RESULTS: With conservative management, nerve recovery was complete in 6 months. CONCLUSIONS: Hematoma complicating axillary block may result in nerve dysfunction.

Adult↗
PubMedDate not supplied

Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery.

BACKGROUND AND OBJECTIVES: The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension. METHODS: Thirty-two women scheduled for cesarean delivery were divided into 2 groups of patients who received a spinal injection of either 10 mg of isobaric (plain) bupivacaine 0.5% or 5 mg of isobaric bupivacaine with 25 microg fentanyl added. Each measurement of a systolic blood pressure less than 95 mm Hg or a decrease in systolic pressure of greater than 25% from baseline was considered as hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine. RESULTS: Spinal block provided surgical anesthesia in all patients. Peak sensory level was higher (T3 v T4. 5) and motor block more intense in the plain bupivacaine group. The plain bupivacaine patients were more likely to require treatment for hypotension (94% v 31%) and had more persistent hypotension (4.8 v 0.6 hypotensive measurements per patient) than patients in the minidose bupivacaine-fentanyl group. Mean ephedrine requirements were 23.8 mg and 2.8 mg, respectively, for the 2 groups. Patients in the plain bupivacaine group also complained of nausea more frequently than patients in the minidose bupivacaine-fentanyl group (69% v 31%). CONCLUSIONS: Bupivacaine 5 mg + fentanyl 25 microg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Manipulation under anesthesia combined with epidural steroid injection.

OBJECTIVE: To demonstrate the benefit of cooperation between medical and chiropractic specialists and the usefulness of combining chiropractic and epidural injection in particular cases of back pain. CLINICAL FEATURES: Two cases of low back pain, both with disk protrusions and osteophytic changes, had no response to several weeks of alternate day (or more) chiropractic care. A third case of herniated intervertebral disks and low back pain had no improvement from treatment with epidural steroidal injection. INTERVENTION AND OUTCOME: The two cases of failed response to chiropractic each experienced a dramatic therapeutic leap with a single treatment of manipulation under anesthesia/epidural steroid injection (MUA/ESI). Both patients maintained their improved condition on tapering schedules of maintenance chiropractic care. In the third case of failed response to ESI, severe pain precluded initial chiropractic treatment. This was only possible at the first treatment with MUA provided by epidural injection. A single treatment of MUA/ESI brought rapid and profound relief and was followed by continued chiropractic care. The patient remained pain-free except for a brief partial relapse that responded promptly to chiropractic. CONCLUSIONS: Cooperation between medical and chiropractic specialists is to be encouraged. These cases demonstrate cooperation between an anesthesiologist and a chiropractor. By using a single treatment of manipulation under epidural anesthesia/epidural steroid followed by continued chiropractic, we were able to lead our patients out of therapeutic dead ends and deal with the dilemma of a patient in too much pain to tolerate an initial chiropractic treatment.

Adult↗