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Results for “CERVICAL PLEXUS”

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At least 91 records · Page 5Linked to original sources
PubMed1993

Perioperative myocardial ischemia in carotid endarterectomy under cervical plexus block and prophylactic nitroglycerin infusion.

Perioperative myocardial ischemia was evaluated in 36 consecutive carotid endarterectomy procedures carried out on patients with a high (72.2%) prevalence of ischemic heart disease. The procedures were performed under cervical plexus block plus a prophylactic intravenous nitroglycerin infusion. Findings of myocardial ischemia on perioperative (48 hours) continuous electrocardiogram recordings were correlated with preoperative cardiac status, perioperative continuous intra-arterial blood pressure measurements, and postoperative cardiac outcome. In two patients, ST segment analysis was un-interpretable because of bundle-branch blocks. Altogether, 64 episodes of significant ST segment depression were detected in 18 (52.9%) of the remaining procedures. In 8 (23.5%) procedures, ST segment depressions occurred either during carotid artery clamping at the time of the largest rise in blood pressure or within 2 hours of declamping, when blood pressure tended to decline. There were four (11.7%) postoperative cardiac events: three myocardial infarctions (one Q wave and two non-Q wave) and one episode of unstable angina pectoris. All four patients with cardiac events had early signs of myocardial ischemia either at the time of cross-clamping, or soon after declamping of the carotid artery. All myocardial infarctions developed following prolonged (> 10 hours) myocardial ischemia, starting with the first 20 hours after surgery. Thus, ST segment depression occurring during clamping or soon after carotid declamping was associated with cardiac complications (sensitivity 100% and specificity 86.6%) and suggests the possible usefulness of on-line ST segment trend monitoring.

Aged↗
PubMed1993

Neurotizations by means of the cervical plexus in over 100 patients with from one to five root avulsions of the brachial plexus.

In the years 1982-1991, we treated over 100 patients with avulsion of from one to five roots in perinatal (n = 21) and traumatic (n = 81) lesions of the brachial plexus. Based on the clinical diagnosis and the surgical findings, we divided all operated patients into four groups: 1) avulsion of all roots or avulsions and disruption of the rest of the brachial plexus; 2) avulsion and disruption of one to four roots and preservation of some elements of the brachial plexus with fibrotic changes; 3) avulsion and disruption of one to three roots, with some elements showing no macroscopic changes; and 4) children with perinatal brachial plexus palsy. In cases of root avulsion, we performed neurotization from the cervical plexus, the accessory and intercostal nerves. In patients with one to three root avulsions, we have performed selective neurotization for 3 years. The best results were obtained in groups 3 and 4, but some improvement was also noted in the other groups.

Adolescent↗
PubMed1993

The effect of epidural/general and cervical plexus block anesthesia on activated clotting time in patients undergoing vascular surgery.

The effect of anesthetic induction and surgical incision on activated clotting time (ACT) was determined in patients undergoing vascular surgery. Patients undergoing carotid endarterectomy (CAE) (n = 50) and abdominal aortic aneurysm repair (AAA) (n = 45) were studied. Patients in the CAE group had cervical plexus block anesthesia, whereas patients in the AAA group had a combination of epidural and general anesthesia. The ACT was measured 1) before induction of anesthesia, 2) 5 min after induction, 3) 5 min after incision, 4) 5 min after heparinization, and 5) at the onset of skin closure. Heparin was reversed with protamine only if the ACT after revascularization was > 200 s. Reversal was considered adequate if the ACT was < 200 s and the surgeon felt that hemostasis was adequate. The ACT decreased by 12.26 +/- 1.23 (mean +/- SE) (P = 0.006) in the CAE group and by 12.47 +/- 1.01 (P = 0.002) in the AAA group with induction of anesthesia. There was a further decrease of 5.06 +/- 0.62 (P = 0.26) in the CAE group and 5.17 +/- 0.83 (P = 0.22) in the AAA group with incision. There was a significant difference in ACT in both groups from postinduction and postincision to skin closure (higher at skin closure). No patient in either group required additional protamine or clotting factors post-operatively, or return to the operating room for excessive bleeding. This study demonstrates that anesthetic induction with cervical block or epidural/general anesthesia decreases ACT.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed2006

Primary malignant schwannoma of the cervical plexus with melanocytic differentiation.

Primary malignant schwannomas are rare neoplasms of nerve sheath origin, especially in the location of the head and neck where few cases are described in the literature. These tumours may pose a diagnostic dilemma in the work-up of a neck mass. The case presented here is of a malignant schwannoma that originated in the cervical plexus with the rare histological feature of melanocytic differentiation. Histopathological examination with immunostaining techniques is essential for the diagnosis of these tumours. The management of these neoplasms is still controversial, although the treatment of choice is radical surgical excision of the lesion. The role of postoperative radiotherapy or chemotherapy is not clear, although some authors recommend its use to prevent local recurrence, for unresectable recurrent tumours or in cases of distant metastases.

Aged↗
PubMed1997

Cervical plexus block for carotid endarterectomy: a nursing care plan.

Historically, carotid surgery is identified in the operating room as a major surgical procedure. Although the surgical intervention remains the same, a regional anesthetic technique calls upon perioperative nurses to utilize their assessment and planning skills astutely preparing innovative nursing interventions that enable successful patient outcomes. The key to a successful nursing care plan for a carotid endarterectomy performed under cervical plexus block is an awareness of the patient's physiological needs as well as the environmental influences they may be experiencing. As the administration of regional anesthesia for major surgery become more prevalent, there is a resurgent demand for traditional holistic nursing interventions in the operating room. The perioperative nurse must couple technical expertise with intuitive assessment skills and administration of compassionate nursing care.

Cervical Plexus↗
PubMed1990

The use of combination cervical plexus block and general anesthesia for radical neck dissection in a patient with severe chronic obstructive pulmonary disease.

Patients with severe chronic obstructive pulmonary disease (COPD) who receive a general anesthetic are at increased risk for postoperative pulmonary complications; therefore, it is desirable to avoid or to limit the dose of general anesthesia in these patients. Regional anesthesia, or a combination of regional and light general anesthesia, is an ideal choice for achieving this goal. This case report demonstrates how we used cervical plexus blocks in combination with light levels of general anesthesia for radical neck dissection in a patient with severe COPD.

Aged↗
PubMedDate not supplied

[Block of the cervical plexus in surgery of the carotid artery. Our experience with 142 cases].

The main anesthesiological problem in TEAC operations is the possibility of evaluating the degree of tolerance after carotid artery clamping. When facing this situation, some anesthesiologists prefer to administer general anesthesia, others prefer loco-regional anesthesia. On the basis of their background and experience, the Authors, from 1.1.1987 to 12.31.1988, have performed 142 nerve blocks of the superficial and the cervical plexus. The proposed technique is simple. No side effects are observed. Moreover it is gratifying for the surgeon and safe from risks for patients. Loco-regional anesthesia permits a close neurologic monitoring that is easily understandable and inexpensive. When performing this kind of surgery, this technique seems to be valid and effective.

Adult↗
PubMed1996

Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus.

The application of digital pressure above the injection site during interscalene block has been advocated to prevent cephalad spread of local anesthetic. In prior studies, radiographs taken immediately after interscalene injection of radiographic contrast have supported this concept. However, the clinical efficacy of digital pressure has not been previously tested. If digital pressure were effective in inhibiting cephalad spread of local anesthetic, attenuation of both hemidiaphragmatic paresis and the resulting compromise in pulmonary function would be expected. Sensory, motor, and pulmonary effects were prospectively evaluated in 20 patients presenting for elective shoulder surgery. Patients were randomly assigned to receive interscalene block with or without digital pressure. No clinical differences were seen between groups. All 20 patients had ipsilateral hemidiaphragmatic paresis by ultrasonographic evaluation and large mean decreases in forced vital capacity, 31.2% +/- 7.8% (with digital pressure), 33.7% +/- 12.8% (without digital pressure), and forced expiratory volume at one second, 27.9% +/- 9.3% (with digital pressure), 33.7 +/- 12.8% (without digital pressure). Peak sensory level of anesthesia to pinprick was not significantly different between groups, each group having mean levels of C-2 to C-3. Digital pressure was ineffective in limiting the flow of local anesthetic into the cervical plexus. Digital pressure influenced neither the incidence of diaphragmatic paresis nor the resulting large decreases in pulmonary function that result from interscalene block.

Adolescent↗