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Biomedical subjects

L D Bridenbaugh

Publications and source records attributed to L D Bridenbaugh.

At least 19 recordsLinked to original sources
PubMed1993

Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax.

Supraclavicular nerve blocks are technically easy to perform, but may be associated with pneumothorax. The objective of this study is to define the parasagittal anatomy important to our modified technique of supraclavicular nerve block designed to decrease the incidence of pneumothorax and to determine whether this technique is anatomically sound. Two cadaver specimens were studied. One embalmed specimen was dissected to establish the relationship of the brachial plexus to our modified needle entry site. The neck and upper thorax of an unembalmed cadaver were frozen, and parasagittal serial sections were made to establish the relationship of the brachial plexus to surface features and the chest cavity. Additionally, 12 volunteers underwent magnetic resonance (MR) imaging and anatomic measurements of their supraclavicular anatomy important to our modified block. MR imaging showed that in no instance using our modified technique was the lung contacted by the simulated needle before entering either the subclavian artery or contacting the brachial plexus. Our technique has been used in more than 110 patients without pneumothorax. The combination of our cadaver and magnetic resonance data suggests that our plumb-bob technique of supraclavicular nerve block is anatomically sound and may minimize the development of pneumothorax during supraclavicular block.

Brachial Plexus↗
PubMed1989

Epinephrine increases the effectiveness of tetracaine spinal anesthesia.

The effect of epinephrine on the need for supplementation of spinal anesthesia produced with hyperbaric tetracaine was assessed in 60 patients undergoing transurethral resection of the prostate. Patients were randomly assigned to receive either 6 mg tetracaine alone (n = 20), 6 mg tetracaine with 0.2 mg epinephrine (n = 20), 10 mg tetracaine alone (n = 10), or 10 mg tetracaine with 0.2 mg epinephrine (n = 10). Observers were blinded to the presence or absence of epinephrine. Sensory level of anesthesia was assessed by pin prick, and surgery did not start until the level reached T10. Anesthesia was considered successful if the patient had no pain at the operative site. The success rate of low-dose tetracaine (6 mg) with epinephrine was 95% compared with 65% in patients receiving low-dose tetracaine alone (P = 0.04). All patients receiving 10 mg had successful anesthesia. Compared with patients receiving 6 mg tetracaine, those given 10 mg had higher dermatomal levels of anesthesia (P = 0.0001) and a higher incidence of nausea (P = 0.04). Thus, epinephrine can increase the effectiveness of low-dose tetracaine.

Aged↗
PubMed1988

Preoperative intercostal nerve block: effect on the endocrine metabolic response to surgery.

The plasma cortisol and glucose responses to cholecystectomy were studied in 20 healthy patients. Ten patients received preoperative intercostal nerve blocks of the 6th to 12th nerves bilaterally using 0.5% bupivacaine with adrenaline 250 micrograms. The control group had the same quantity of adrenaline infiltrated into the intercostal space. Both groups had general anaesthesia with endotracheal intubation and controlled ventilation. In the non-blocked group, the mean cortisol concentration increased from a control value of 182.5 nmol litre-1 to a peak of 686.2 nmol litre-1 at 5.5 h after incision. In the blocked group the baseline serum cortisol concentration was 283.8 nmol litre-1 and it increased to a similar peak at 5.5 h. There were no significant differences between groups. The baseline plasma glucose concentration was also higher in the blocked group (4.45 mmol litre-1 compared with 3.94 mmol litre-1), but after a brief increase following the performance of the block decreased to only 14% above control values. The unblocked group exhibited substantial increase following the start of the surgery which continued for the duration of the study period to end at a mean of 6.48 mmol litre-1. These differences were significant (P less than 0.001). It is concluded that bilateral intercostal blocks may inhibit the glucose response to surgery, but have no effect on the cortisol response.

Anesthesia, General↗
PubMed1979

Lumbar epidural block anesthesia for outpatient laparoscopy.

This study confirms that lumbar epidural block is a satisfactory anesthetic technique for outpatient laparoscopic tubal sterilization. Oxygenation during the period of pneumoperitoneum was adequate. The technique resulted in a shortened postanesthesia recovery period and fewer postanesthesia complications. Surgeon, anesthesiologist and patient acceptance was excellent.

Anesthesia, Epidural↗
PubMed1977

Factors determining dosages of amide-type local anesthetic drugs.

The physical status of the patient (sex, age, weight, height, and underlying disease) has been thought to influence the dosage of local anesthetic drugs that can be injected without causing a systemic toxic reaction, but this belief is not supported by statistically significant data. Furthermore, previous studies of plasma levels of bupivacaine and mepivacaine showed no correlation between dosage and physical status, even when maximum dosages recommended by pharmaceutical companies were exceeded. This study of 9,287 regional blocks, using the statistical tests of multiple regression and chi square, substantiates that the occurrence of systemic toxic reactions in adults does not correlate with dosages and/or physical status of the patient when 400 mg or less of bupivacaine, 450 mg or less of etidocaine, or 500 mg or less of mepivacaine is used. Therefore, the study questions the maximum dosages established for certain local anesthetic drugs, as well as the method by which such dosages were established.

Anesthesia, Epidural↗
PubMed1977

Bupivacaine (Marcaine): an evaluation of its tissue and systemic toxicity in humans.

In countries other than the U.S.A., dosages of bupivacaine have been limited to 100 mg without epinephrine and 150 mg with epinephrine. A review of 7,688 regional block procedures employing bupivacaine in concentrations of 0.25, 0.5, and 0.75%, and in dosages as high as 600 mg, indicated that such stringent restrictions: (1) are unwarranted, (2) make comparisons with other local anesthetic agents difficult, and (3) are in need of revision.

Adolescent↗
PubMed1976

Arterial and venous plasma levels of bupivacaine following epidural and intercostal nerve blocks.

Arterial and peripheral venous plasma levels of bupivacaine were determined in 30 patients following epidural anesthesia using 150 and 225 mg, as well as following intercostal nerve block with 400 mg. Arterial levels were consistently higher than levels in simultaneously sampled venous blood, and the highest levels occurred with bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine may have a wider margin of safety in man than is now stated.

Adult↗