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Carotid endarterectomy under regional anesthesia.

Regional anesthesia for carotid endarterectomy is a simple, reliable, and virtually complication-free technique. We began to perform a series of carotid endarterectomy under regional anesthesia at our institution in May 1990. This report describes our experience with 180 operated patients from May 1990 till December 1995, with regional anesthesia. All patients were operated with microsurgery and we utilized the deeply cervical plexus block at the C-4 level associated with superficial block, along the posterior border of the externocleidomastoid muscle. The main advantage of this technique of anesthesia is that it is the only exact method of assessing the need of a shunt by using the neurological status of the awaken patient during trial carotid cross-clamping. The regional anesthesia allows carotid endarterectomy to be safely performed on patients with advanced cardiac disease or severe chronic obstructive pulmonary disease who were not good candidates for general anesthesia. In this 180 patients we performed 198 consecutive endarterectomies (10% bilateral) with a total morbidity-mortality rate of 2.0%.

Anesthesia, Conduction↗

Carotid endarterectomy under regional anesthesia.

Regional anesthesia generally has been satisfactory in performing carotid endarterectomy as reviewed in a previous five-year experience from Walter Reed Army Medical Center. The results are comparable to other reported series with no operating room deaths, an overall operative mortality of 2.6 per cent, and an incidence of transient neurological deficits of 3.0 per cent with permanent neurological deficits in 2.2 per cent.

Anesthesia, Conduction↗

Complications of regional anesthesia.

Regional anesthesia is fraught with potential risks and complications. Proper training and careful experience with specific techniques will go a long way to improve our skills. Vigilance, conscientiousness, and attention to detail are the qualities that will not only help us to avoid complications, but also help us to detect early signs of developing complications and treat them promptly. Early detection and treatment will improve the ultimate outcome even when complications do occur.

Anesthesia, Conduction↗

Clinical aspects of CRNA practice. Regional anesthesia.

Regional techniques have become increasingly popular for anesthesia and analgesia for surgical patients. It is also frequently used for the patient with nonsurgical pain such as cancer. New discoveries in physiology, pharmacology, pain modulation and transmission as well as pain management therapies are a dynamic field of study in regional anesthesia and analgesia. Nurse-anesthetists provide regional techniques as part of their armamentarium of clinical skills.

Adjuvants, Anesthesia↗

General anesthesia versus regional anesthesia.

No distinct advantage is apparent between regional and general anesthesia when considering perioperative cardiac morbidity and mortality in peripheral vascular surgery. However, there is some evidence to support regional anesthesia over general anesthesia in an effort to optimize graft patency if the regional technique is extended into the postoperative period to provide neuraxial analgesia. An inadequate number of randomized, controlled trials have been conducted to determine whether regional or general anesthesia should be performed for carotid endarterectomy. The nonrandomized trials do support regional anesthesia by virtue of reductions in stroke, myocardial infarction, and death. A randomized, prospective trial is needed to verify these outcomes. The choice of technique does not appear to affect mortality in patients requiring hip fracture surgery, although Urwin et al. (29) reported less 1-month mortality in patients receiving regional anesthesia. General anesthesia has been associated with increased blood loss and thromboembolic complications in patients undergoing hip fracture repair. Epidural anesthesia has been shown to promote quicker return of bowel function postoperatively when the catheter has been sited at T12 or higher. Anastomotic breakdown in patients with epidural anesthesia/analgesia has rarely been reported. Most studies tend to show quicker return of bowel function when local anesthetics alone are administered epidurally.

Anesthesia, Conduction↗

A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: a critical review.

We evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded. In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Anesthesia, Conduction↗

Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service.

BACKGROUND: Several previous surveys have estimated the rate of major complications that occur after regional anesthesia. However, because of the increase in the use of regional anesthesia in recent years and because of the introduction of new techniques, reappraisal of the incidence and the characteristics of major complications is useful. METHODS: All French anesthesiologists were invited to participate in this 10-month prospective survey based on (1) voluntary reporting of major complications related to regional anesthesia occurring during the study period using a telephone hotline service available 24 h a day and managed by three experts, and (2) voluntary reporting of the number and type of regional anesthesia procedures performed using pocket booklets. The service was free of charge for participants. RESULTS: The participants (n = 487) reported 56 major complications in 158,083 regional anesthesia procedures performed (3.5/10,000). Four deaths were reported. Cardiac arrest occurred after spinal anesthesia (n = 10; 2.7/10,000) and posterior lumbar plexus block (n = 1; 80/10,000). Systemic local anesthetic toxicity consisted of seizures only, without cardiac toxicity. Lidocaine spinal anesthesia was associated with more neurologic complications than bupivacaine spinal anesthesia (14.4/10,000 vs. 2.2/10,000). Most neurologic complications were transient. Among 12 that occurred after peripheral nerve blocks, 9 occurred in patients in whom a nerve stimulator had been used. CONCLUSION: This prospective survey based on a free hotline permanent telephone service allowed us to estimate the incidence of major complications related to regional anesthesia and to provide a detailed analysis of these complications.

Acute Disease↗

Technique of ocular regional anesthesia.

Regional anaesthesia by retrobulbar injection by the anaesthetist is recommended for day care ophthalmic surgery. Patient management and anaesthetic technique are detailed. The preferred anaesthetic is 2% lidocaine with hyaluronidase and adrenaline added. Fine, sharp pointed needles are recommended.

Ambulatory Surgical Procedures↗

Regional anesthesia for clubfoot surgery in children.

In children, general anesthesia is usually chosen as the primary technique during lower extremity orthopedic procedures. Certain situations or underlying conditions may be present, however, that make the conduct of general anesthesia more difficult or even relatively contraindicated. We present 10 patients with underlying conditions or circumstances that may increase the risk of general anesthesia. Regional anesthesia (spinal or epidural) was used to provide surgical anesthesia, thereby eliminating the need for general anesthesia. The techniques used and the applications of regional anesthesia during orthopedic procedures in children are discussed.

Anesthesia, Conduction↗

[Complications of regional anesthesia (author's transl)].

In spite of the great advances in anesthesia, regional anesthesia has not lost its importance. The development of new, longer-acting local anesthetics has extended its indication still more. The causes of accidents lie mostly in ignorance ofthe pharmacology of local anesthetics and their adjuvants, in faulty technical performance of the nerve blockade and last but not least in inadequate knowledge of the therapy, of the side effects and complications. The various complications of regional anesthesia are reported on and the necessary therapy dealt with.

Adjuvants, Anesthesia↗

Intraosseous regional anesthesia as an alternative to intravenous regional anesthesia.

A series of 109 orthopedic operations was performed under intraosseous regional anesthesia on the upper and lower limbs. Anesthesia was satisfactory in 106 of the cases; in the other three, inadequate anesthesia was caused by faulty technique. The spread of lidocaine into the bone and venous network was demonstrated by radiography, and the blood levels after tourniquet release were below the toxic level. Intraosseous regional anesthesia proved to be a valuable technique to be used whenever intravenous anesthesia fails or is not feasible. Injection into cancellous bone (osteoclysis) is easily and quickly performed under aseptic conditions, and there were no systemic complications.

Adult↗