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Biomedical subjects

Robert Koorn

Publications and source records attributed to Robert Koorn.

6 recordsLinked to original sources
PubMed2003

An indication for continuous cervical paravertebral block (posterior approach to the interscalene space).

We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. She presented for amputation of her arm as a last resort for management of pain. In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.

Anesthesia, General↗
PubMed2002

Interactions between psychotropics, anaesthetics and electroconvulsive therapy: implications for drug choice and patient management.

Despite many predictions that electroconvulsive therapy (ECT) would be replaced by pharmacotherapy, ECT has remained an invaluable adjunct in the management of severe psychiatric disease. Both pharmacotherapy and ECT continue to be used extensively, and will frequently be administered concurrently. The majority of patients requiring ECT will need anaesthesia; therefore, interactions could conceivably occur between the psychotropic drugs, ECT and the anaesthetic agents utilised. In managing an anaesthetic for ECT the effects of the anaesthetic agents and other medications on seizure intensity are important determinants influencing outcome. With regard to the antidepressants, tricyclic antidepressants (TCAs) and ECT can be combined safely and beneficially. More care is required when ECT is administered in the setting of a monoamine oxidase inhibitor (MAOI), especially the older irreversible varieties and in patients recently placed on MAOI therapy. Of the anticonvulsants and mood stabilisers, lithium and ECT given concurrently add significant risk of delirium and/or organic syndromes developing. Possible concerns with valproate, carbamazepine, lamotrigine, gabapentin and topiramate are that they may inhibit seizure activity. Additionally, carbamazepine may prolong the action of suxamethonium (succinylcholine). The combination of antipsychotics and ECT is well tolerated, and may in fact be beneficial. As regards the anxiolytics, benzodiazepines have anticonvulsant properties that might interfere with the therapeutic efficacy of ECT. CNS stimulants on the other hand may prolong seizures as well as produce dysrhythmias and elevate blood pressure. Calcium channel antagonists should be used with great care to avoid significant cardiovascular depression. The anaesthesiologist should therefore remain vigilant at all times, as untoward responses during ECT might occur suddenly due to interactions between psychotropics, anaesthetic agents and/or ECT.

Anesthetics↗
PubMedDate not supplied

The use of cervical paravertebral block as the sole anesthetic for shoulder surgery in a morbid patient: a case report.

OBJECTIVES: The purpose of this case report is to describe the use of the cervical paravertebral block as the sole anesthetic for shoulder surgery in a patient unable to tolerate general anesthesia. Recent literature describes the continuous cervical paravertebral block as an effective alternative to the interscalene block for the management of postoperative pain after shoulder surgery. CASE REPORT: An 85-year-old man with severe respiratory and cardiac disease presented for major shoulder surgery. The patient's complex medical history required an anesthetic technique that would avoid general anesthesia and preserve phrenic nerve function. This case report describes, to our knowledge, the first successful use of the continuous cervical paravertebral block as the sole anesthetic for shoulder surgery. CONCLUSIONS: Continuous cervical paravertebral block provided excellent surgical conditions and postoperative pain relief for this patient and allowed gradual and intermittent dosing of the catheter and continuous assessment of the anesthetic impact on respiratory function.

Aged↗
PubMedDate not supplied

Electrical nerve stimulation using a stimulating catheter: what is the lower limit?

OBJECTIVES: To minimize the risk of intraneural injection when performing nerve blocks, some authors caution against injecting through a needle placed with motor responses observed at nerve stimulator output settings of 0.3 mA or less. We present a case of placing a continuous cervical paravertebral catheter with brisk motor response while stimulating the catheter at 0.05 mA, with no adverse sequelae. CASE REPORT: A 56-year-old man scheduled for rotator cuff repair received a continuous cervical paravertebral block for intraoperative and postoperative pain control. A stimulating catheter was used for the block. During catheter placement, nerve stimulator output was decreased to 0.05 mA at 300 micros and the motor response remained brisk. The patient was not significantly sedated and experienced no pain during placement or with injection of 40 mL of 0.5% ropivacaine through the catheter. Narcotic drugs were not required during surgery, and the block provided excellent postoperative pain control. Catheter position was evaluated by fluoroscopy to further identify the catheter's relationship to the brachial plexus. The nerve trunks of C5 and C6 were clearly visible after 1 mL of iohexol (Omnipaque) was injected through the catheter. The catheter was removed the following day. At the follow-up visit 2 weeks later, the patient's neurological examination remained unremarkable. CONCLUSION: We present a single case of successful placement of a stimulating catheter with no neurological injury even when motor response occurred at very low nerve stimulator output settings.

Anesthetics, Local↗