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PubMed1999

[Choice of anesthesia in gunshot wounds of extremities].

The analysis of treatment of 452 victims with wounds of extremities for the period from 1984 to 1994 years was carried out. 171 patients had fire-arm wounds in local conflicts. Surgical wound management in 43% of victims was carried out under local infiltration anesthesia, in 28.3%--under conduction and prolonged conduction anesthesia, 27.8%--under general anesthesia and in 0.9%--under intraosseal anesthesia. The author suggests that as the gravity of firearm wound increases and wound infection progresses, the indications for infiltration and intraosseal anesthesia should be limited. In multiple and combined wounds, damages and tearing off the extremities, followed by shock, blood loss, general anesthesia would be indispensable. Conduction, prolonged anesthesia is quite reliable in mechanical cleansing of wound in process of surgical treatment, in early postoperative period, promotes improvement of regional hemodynamics and favours uneventful wound healing.

Adult↗
PubMed1995

Axon-reflex-mediated vasodilatation in the psoriatic plaque?

Blood flow in the psoriatic plaque is increased, but the underlying mechanisms are not known. The aim of the present study was to examine whether neurogenic factors are important for blood flow regulation in the plaque. Local neurogenic mechanisms were inhibited by surface anesthesia and central nervous control by conduction anesthesia of nerves to the psoriatic plaque. The differences in skin perfusion before and after anesthesia were measured with a laser Doppler perfusion imager. The skin perfusion in psoriatic plaques located in hairy skin was unaffected by conduction anesthesia, but surface anesthesia of the plaque evoked a marked blood flow reduction. The perfusion in ultraviolet-B-irradiated skin, used as a control for nonspecific phenomena, was reduced after local application of indomethacin but was unaffected or increased after surface anesthesia. The results are compatible with the idea that a local neurogenic mechanism (axon-reflex) contributes to the high blood flow in the psoriatic plaque.

Adult↗
PubMedDate not supplied

[The comparative characteristics of anesthesia methods in operations for tumors located on the extremities].

Seventy patients operated on for malignant tumors located in the extremities have been examined, 30 of them were operated on under conduction anesthesia. The adequacy of anesthesia was assessed using clinical metabolic and electrophysiological techniques. Evident advantages of conduction anesthesia over general anesthesia during short-term interventions have been substantiated. Anesthesia with bupivacaine proved most effective.

Adolescent↗
PubMed1980

[Experts' experiences in lesions of the lingual nerve connected with dental-surgical interventions].

On rare occasions, the lingual nerve may be damaged during operative removal of a third molar. Anesthesia and paresthesia of this nerve have been observed following conduction anesthesia in the mandibular foramen. In terms of the damage to the lingual nerve associated with conduction anesthesia in the mandibular foramen, no technique is absolutely reliable. The patient with a manifest iatrogenic deficit in one branch of the trigeminus should be referred to a hospital for oral surgery which is experienced with microsurgical techniques and which is in a position to cooperate closely with a neurologist.

Anesthesia, Conduction↗
PubMed1998

Prevalence and risk factors of chorioamnionitis among adolescents.

OBJECTIVE: To identify the prevalence of chorioaminionitis and unique risk factors for this disorder among adolescents under 18 years of age. METHODS: At their first prenatal visit we interviewed 352 adolescents who received prenatal care and delivered an infant at our institution between April 20, 1992, and November 10, 1994, to elicit information on demographic characteristics and behavioral risk factors. Retrospective chart review confirmed the presence of chorioamnionitis using accepted clinical criteria. We determined reproductive history, evidence of sexually transmitted disease, duration of labor, use of oxytocin, an internal uterine pressure monitor or conduction anesthesia, timing and duration of ruptured membranes, type of delivery, and infant birth weight from review of subjects' charts. Logistic regression analysis was used to develop adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors of chorioaminionitis. RESULTS: Ten percent (34 of 352) of adolescents met the clinical definition for chorioamnionitis. Alcohol and tobacco use during pregnancy (OR 7.6; 95% CI 2.3, 25.8) and being married or living with a partner (OR 2.7; 95% CI 1.1, 6.5) were significantly associated with chorioamnionitis, as was conduction anesthesia (OR 4.1; 95% CI 1.1, 15.4), a second stage labor longer than 2 hours (OR 3.5; 95% CI 1.4, 8.5), and rupture of the membranes longer than 18 hours (OR 6.9; 95% CI 2.5, 18.9). Parity or preterm delivery did not differ significantly between those with or without chorioamnionitis. CONCLUSION: These data suggest that in addition to risk factors observed in adults, adolescents who concurrently use tobacco and alcohol during pregnancy, are married or living with a male partner, and have conduction anesthesia are at increased risk for chorioamnionitis.

Adolescent↗
PubMed2000

General versus spinal/epidural anaesthesia for surgery for hip fractures in adults.

BACKGROUND: The majority of hip fracture patients are treated surgically, requiring anaesthesia. OBJECTIVES: To compare different types of anaesthesia for surgical repair of hip fractures (proximal femoral fractures) in adults. This is primarily regional (spinal or epidural) anaesthesia versus inhalation general anaesthesia, but also includes ketamine anaesthesia versus inhalation general anaesthesia. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, selected orthopaedic and anaesthetic journals and conference proceedings, and reference lists of relevant articles. Date of the most recent search: August 1998. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different methods of anaesthesia for hip fracture surgery in skeletally mature persons. Trials comparing the use of local nerve blocks are not considered in this review. Neither are trials using different types of drugs or techniques with one type of anaesthesia. The primary outcome was mortality. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a nine item scale, and extracted data. The other two reviewers independently checked these results. Wherever appropriate and possible, results were pooled. MAIN RESULTS: Fifteen trials, involving 2162 patients, which compared regional anaesthesia with general anaesthesia, were included. All trials had methodological flaws. Regional anaesthesia was associated with a decreased mortality at one month (49/766 (6.4%) versus 76/812 (9.4%)) of borderline statistical significance (Peto odds ratio 0.66, 95% confidence interval 0.46 to 0.96)). The results for three month mortality were not statistically significant, although the confidence interval does not exclude the possibility of a clinically relevant reduction (86/726 (11.8%) versus 98/765 (12.8%), Peto odds ratio 0.91, 95% confidence interval 0.67 to 1.24). The reduced numbers at one year, coming exclusively from two studies, preclude any useful conclusions for long term mortality (80/354 (22.6%) versus 78/372 (21.0%), Peto odds ratio 1.10, 95% confidence interval 0.77 to 1.57). Regional anaesthesia was associated with a tendency to a longer operation (weighted mean difference 4.8 minutes, 95% confidence interval 1.1 to 8.6 minutes), and a reduced risk of deep venous thrombosis (39/129 (30%) versus 61/37(76%); Peto odds ratio 0. 41, 95% confidence interval 0.23 to 0.72), although this conclusion is insecure due to possible selection bias in the subgroups in whom this outcome was measured. No other statistically significant differences in outcome were identified. There was insufficient evidence to draw any conclusions from a further two included trials, involving a total of 100 patients, which compared other types of anaesthesia. REVIEWER'S CONCLUSIONS: Regional anaesthesia and general anaesthesia appear to produce comparable results for most of the outcomes studied. Regional anaesthesia may reduce short-term mortality but no conclusions can be drawn for longer term mortality.

Adult↗
PubMed1980

[The history of local anesthesia (author's transl)].

Methods of local anesthesia by compression in classical antiquity found supporters in the New Era in A. Paré, in I. M. Velpeau and finally J. v. Esmarch gave it a very practicable form in 1873. Cold was tried by Severinus in the 17th century. In 1866 B. Richardson introduced the ether atomizer. Ethyl chloride has been used since about 1882. Cocaine won its place in ophthalmology through the efforts of K. Koller in 1884 and opened the way to surface anesthesia. The Scotsman A. Wood introduced the principle of conduction anesthesia in 1855 with his hypodermic injection. K. Schleich (1892) is looked upon as the pioneer of infiltration anesthesia. H. Braun takes the credit for the addition of adrenaline when using procaine (1900).

Anesthesia, Conduction↗
PubMed1993

Dosing regimens for spinal and epidural anesthesia.

Spinal anesthesia has proven to be a reliable and safe technique of major conduction anesthesia for nearly a century. Epidural anesthesia is being used for a multitude of applications in the operating room, labor and delivery setting, and more for the relief of postoperative analgesia. It is also noted that a growing number of nurse anesthetists are expanding their expertise in regional anesthesia to include continuous spinal, spinal techniques for infants, and epidural anesthesia techniques. This article reviews the physiological and pharmacological factors influencing the choice of anesthetic agents for major conduction anesthesia and the suggested dosing regimens.

Anesthesia, Epidural↗
PubMedDate not supplied

[Perioperative management of patients during general endoprosthethic operations on the knee joint (a review of literature)].

Arthrosis deformans of the knee joint (gonarthrosis) is a common disease accompanied by pain syndrome and disability. Medical treatment of the disease ensures only a temporary analgesic effect and fails to restore the range of motion in the legs. General endoprosthetic operations on the knee joint can significantly improve the results of treatment, alleviate pain, and restore the patients' working capacity. Most patients undergoing endoprosthetic repair of the knee joint are elderly and senile, who have concomitant multiple organ somatic pathology. Comorbidity, old age, the specific features and traumaticity of a surgical intervention make high requirements for anesthesic maintenance at surgery and for stability of hemodynamic parameters in the perioperative period, and adequate analgesia in the postoperative period. Different approaches to adequate anesthesia are considered in both intra- and postoperative period. Numerous references lead to the conclusion that many widely used anesthetic procedures (general inhalational and intravenous anesthesia, high-conduction anesthesia, etc.) are incompletely adequate during a general endoprosthetic repair of the knee joint. A number of authors state that spinal or combined spinal epidural anesthesia is the most adequate methods of intra- and postoperative anesthesia at general endoprosthetic repair of the knee joint.

Anesthesia↗
PubMed1979

[Surgical treatment of osseous paronychia in children].

Bony panaritium was treated in 48 children from 1 to 15 years of age by a new method consisting in the early and careful removal of the purulent-necrotic substrate and making the continuous suture. The most rational access to the injured phalanx (oval and semioval incisions) were found. Local regional forms of anesthesia (conduction and intraosseous anesthesia) and general anesthesia were used. The analysis of remote results has shown the children treated by this methods to be able to work, play and perform fine and exact manipulations.

Adolescent↗
PubMedDate not supplied

Successful epidural anesthesia in a patient with an arachnoid cyst, preeclampsia, and triplets.

BACKGROUND AND OBJECTIVES: Arachnoid cysts are a frequent finding on magnetic resonance imaging; however, the use of major conduction anesthesia in patients with these cysts has not been reported. METHODS: Epidural anesthesia was used in a parturient with a triplet pregnancy preeclampsia, and a documented arachnoid cyst extending from TII to LI. RESULTS: Epidural anesthesia was successfully used in this high-risk patient, and airway manipulation, which would have been difficult in this patient, was thereby avoided. CONCLUSIONS: Arachnoid cysts are not a contraindication to major conduction anesthesia, as is confirmed by a review of arachnoid cysts and anesthetic considerations.

Adult↗
PubMed1985

Cesarean section.

Although the cesarean section rate has increased steadily for the past 12 years, further increase seems unlikely since the indications for performing the operation are already broadly defined. Most of the earlier indications will remain unchanged (eg, the presence of placenta previa and cephalopelvic disproportion). The trend toward vaginal delivery in perhaps 30% to 40% of breech births will probably have no material effect on the number of cesarean sections performed, and the present use of cesarean section for multiple pregnancy will probably continue. The two conditions under which cesarean section rates might become significantly lower are (1) automatic repeat cesarean section (which now accounts for more than 25% of all cesarean sections), a procedure which will probably decline as increasing numbers of such women have vaginal deliveries, and (2) a redefinition of the present midforceps classification, which will permit some of the easy midforceps deliveries from a low level to be performed without the legally abhorrent stigma of mid-forceps delivery. The value of prophylactic antibiotics for women predisposed to infection has now been proved, and further placebo studies to demonstrate this are not warranted. In the past, "type and match 2 units" was a routine prelude to cesarean section, and for every unit of blood transfused to cesarean section patients, some 25 units were cross-matched and held in (unnecessary) readiness. This formula is gradually giving way to type and screen, eliminating countless crossmatches. Because of possible harmful fetal effects, preoperative fluid loading, a necessary part of conduction anesthesia, is changing from the customary 5% glucose to the use of fluids containing no glucose. It has been suggested that conduction anesthesia may not offer unlimited time for cesarean section, as used to be thought. Apgar scores are lower if the time from uterine incision to delivery is longer than three minutes, a diminution that may be a function of the anesthesia or may reflect difficulty in delivery. Cesarean section mortality is much lower than it was in former years, but one may expect from one to two deaths per 1,000 operations. Overall, the maternal mortality from cesarean section per se is probably from three to five times higher than that of vaginal delivery (in one series, 11.5 times higher than vaginal delivery). The incidence of mild, transient respiratory signs in the newborn is higher after cesarean than after vaginal delivery, and the incidence of respiratory distress syndrome is also slightly higher.(ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia, Obstetrical↗
PubMed1997

[Techniques of local anesthesia in the area of the head].

In the head and neck region, many procedures can be performed under local anesthesia. The anesthetic agent can be applied onto the surface of the skin or mucosa (surface anesthesia), it can be infiltrated into the tissue to be treated, or it can be used to block the regional sensory nerve (conduction anesthesia). In this paper, the most important techniques for local anesthesia of the face are presented as a short clinical guide.

Anesthesia, Conduction↗
PubMed2000

Postpartum stroke: a twenty-year experience.

OBJECTIVE: The aim of this study was to characterize the clinical presentation, etiology, and acute and subsequent outcomes of postpartum stroke. STUDY DESIGN: This 20-year, single-center, retrospective review included 20 women without previous neurologic deficit with clinical and neuroimaging diagnoses of postpartum stroke. RESULTS: Eight of 20 women (40%) were delivered abdominally. Conduction anesthesia was induced in 9 of 20 women (45%). Causes of stroke included cerebral infarction (n = 13; 7 venous, 6 arterial), intracerebral hemorrhage (n = 5; 1 cocaine-induced, 1 anatomic malformation), cerebritis (n = 1), and cerebral atrophy (n = 1). The median time at onset of stroke was 8 days post partum (range, 3-35 days). Headache, seizures, visual change, and hemiparesis were the most common presenting findings but were neither specific to the underlying pathologic condition nor predictive of ultimate maternal outcome. There were 2 maternal deaths, both caused by severe intracerebral hemorrhage. Intracerebral hemorrhage was associated with the poorest outcome (2 deaths and 1 residual neurologic deficit). Eight women had residual neurologic deficit. There was no correlation between a trial of labor (P =.4; odds ratio, 0.4; 95% confidence interval, 0.01-6.5) or vaginal versus cesarean mode of delivery (P =.6; odds ratio, 1.3; 95% confidence interval 0.1-16.8) and ultimate neurologic diagnosis (cerebral infarction or intracerebral hemorrhage). However, the incidence of cesarean delivery was greater in the cohort of women with postpartum stroke than in the overall obstetric population (P =.015; odds ratio, 3.2; 95% confidence interval, 1.2-8.5). One of the 20 women received methergine; 1 received bromocriptine. All women were either normotensive or had well-controlled hypertension at postpartum discharge. New-onset hypertension or exacerbation of existing hypertension occurred after the acute neurologic insult; subsequent mean (+/-SD) arterial blood pressure was 128.9 +/- 24.0 mm Hg. CONCLUSION: Postpartum stroke is a multifactorial, uncommon, and nonpreventable complication of pregnancy. There was an association between postpartum stroke and hypertensive disorders of pregnancy and cesarean delivery. However, this study refutes any etiologic association between conduction anesthesia and postpartum stroke.

Adolescent↗