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Biomedical subjects

L M Capan

Publications and source records attributed to L M Capan.

At least 19 recordsLinked to original sources
PubMed2004

Deep venous thrombosis revealed during ultrasound-guided femoral nerve block.

Ultrasound imaging used to facilitate performance of a femoral nerve block also affords imaging of adjacent anatomical structures. Following a fracture of the femur, an ultrasound guided femoral nerve block (UGFNB) was performed to provide analgesia; this led to the incidental finding of a previously undiagnosed femoral vein thrombosis (DVT), resulting in a change in patient management before surgery. An inferior vena cava (IVC) filter was placed before intramedullary nailing of the fracture.

Adult↗
PubMed2002

Ultrasound-guided infraclavicular brachial plexus block.

BACKGROUND: Peripheral nerve blocks are almost always performed as blind procedures. The purpose of this study was to test the feasibility of seeing individual nerves of the brachial plexus and directing the block needle to these nerves with real time imaging. METHODS: Using ultrasound guidance, infraclavicular brachial plexus block was performed in 126 patients. Important aspects of this standardized technique included (i) imaging the axillary artery and the three cords of the brachial plexus posterior to the pectoralis minor muscle, (ii) marking the position of the ultrasound probe before introducing a Tuohy needle, (iii) maintaining the image of the entire length of the needle at all times during its advancement, (iv) depositing local anaesthetic around each of the three cords and (v) placing a catheter anterior to the posterior cord when indicated. RESULTS: In 114 (90.4%) patients, an excellent block permitted surgery without a need for any supplemental anaesthetic or conversion to general anaesthesia. In nine (7.2%) patients local or perineural administration of local anaesthetic, and in three (2.4%) conversion to general anaesthesia, was required. Mean times to administer the block, onset of block and complete block were 10.0 (SD 4.4), 3.0 (1.3) and 6.7 (3.2) min, respectively. Mean lidocaine dose was 695 (107) mg. In one patient, vascular puncture occurred. In 53 (42.6%) patients, an indwelling catheter was placed, but only three required repeat injections, which successfully prolonged the block. CONCLUSION: The use of ultrasound appears to permit accurate deposition of the local anaesthetic perineurally, and has the potential to improve the success and decrease the complications of infraclavicular brachial plexus block.

Adolescent↗
PubMed2001

Monitoring for suspected pulmonary embolism.

It is fortunate that serious embolic phenomena are uncommon because, with the exception of neurosurgery in the sitting position and cardiac surgery, thoracic echocardiography and the precordial Doppler device, the most sensitive indicators of embolism, are seldom used. Vigilance is required of the anesthesiologist to recognize the rapid fall in end-tidal PCO2, the usual first indicator of a clinically significant PE. Any sudden deterioration in the patient's vital signs should include embolism in the differential diagnosis, particularly during procedures that carry a high risk of the complication.

Embolism, Air↗
PubMed1986

Prolongation of lidocaine spinal anesthesia with phenylephrine.

The effect of added phenylephrine on the duration of sensory analgesia during lidocaine spinal anesthesia was determined in 65 ASA class I-III patients randomly divided into three groups. Group 1 (n = 25) received 62.5 mg lidocaine in 7.5% glucose; group 2 (n = 21) received lidocaine with 2 mg phenylephrine; and group 3 (n = 19) received lidocaine with 5 mg phenylephrine. The level of analgesia to pin prick was assessed by an anesthesiologist unaware of the drug combination used. The mean +/- SD cephalad level of analgesia did not differ among the groups. In group 1, the times for two- and for four-segment regression of the level of analgesia, and the time for regression of analgesia to the T-12 dermatome, were 77 +/- 19 (1 SD), 99 +/- 24, and 109 +/- 26 min, respectively. The corresponding values were 98 +/- 25, 118 +/- 27, and 130 +/- 36 min in group 2 and 124 +/- 32, 142 +/- 31, and 162 +/- 35 min in group 3. All the regression times in group 2 were significantly longer than those in group 1 (P less than 0.05). All the regression times in group 3 were significantly longer than those in group 2 (P less than 0.02). It is concluded that clinically useful prolongation of sensory analgesia may be obtained by addition of phenylephrine to lidocaine during spinal anesthesia.

Aged↗
PubMed1985

Arterial to end-tidal CO2 gradients during spontaneous breathing, intermittent positive-pressure ventilation and jet ventilation.

Arterial to end-tidal CO2 tension gradients were measured in 18 dogs during spontaneous breathing (SB), intermittent positive-pressure ventilation (IPPV), and both low-frequency and high-frequency jet ventilation (LFJV and HFJV). The dogs were anesthetized with nembutal and permitted to breathe spontaneously through an 8-mm internal diameter endotracheal tube; blood gas tensions, cardiac output, and end-tidal CO2 partial pressure (PetCO2) were measured. IPPV, LFJV, and HFJV were then instituted in a random sequence and measurements repeated. PaO2, PaCO2 and cardiac output were similar during all four ventilatory modes. The mean PaCO2 differed significantly (p less than .001) from PetCO2 during IPPV, LFJV, and HFJV but not during SB. The mean PaCO2-PetCO2 gradient was 3.7 +/- 1 (SD), 12.6 +/- 5.0, and 24.3 +/- 8 torr during IPPV, LFJV and HFJV, respectively. The large gradients during LFJV and HFJV were not produced by dilution of tracheal CO2 by entrained air or by oxygen delivered by the jet. These results suggest that both LFJV and HFJV may be associated with a large PaCO2-PetCO2 gradient.

Animals↗