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At least 55 records · Page 3Linked to original sources
PubMed1993

Perioperative myocardial ischemia in carotid endarterectomy under cervical plexus block and prophylactic nitroglycerin infusion.

Perioperative myocardial ischemia was evaluated in 36 consecutive carotid endarterectomy procedures carried out on patients with a high (72.2%) prevalence of ischemic heart disease. The procedures were performed under cervical plexus block plus a prophylactic intravenous nitroglycerin infusion. Findings of myocardial ischemia on perioperative (48 hours) continuous electrocardiogram recordings were correlated with preoperative cardiac status, perioperative continuous intra-arterial blood pressure measurements, and postoperative cardiac outcome. In two patients, ST segment analysis was un-interpretable because of bundle-branch blocks. Altogether, 64 episodes of significant ST segment depression were detected in 18 (52.9%) of the remaining procedures. In 8 (23.5%) procedures, ST segment depressions occurred either during carotid artery clamping at the time of the largest rise in blood pressure or within 2 hours of declamping, when blood pressure tended to decline. There were four (11.7%) postoperative cardiac events: three myocardial infarctions (one Q wave and two non-Q wave) and one episode of unstable angina pectoris. All four patients with cardiac events had early signs of myocardial ischemia either at the time of cross-clamping, or soon after declamping of the carotid artery. All myocardial infarctions developed following prolonged (> 10 hours) myocardial ischemia, starting with the first 20 hours after surgery. Thus, ST segment depression occurring during clamping or soon after carotid declamping was associated with cardiac complications (sensitivity 100% and specificity 86.6%) and suggests the possible usefulness of on-line ST segment trend monitoring.

Aged↗
PubMed1993

The effect of epidural/general and cervical plexus block anesthesia on activated clotting time in patients undergoing vascular surgery.

The effect of anesthetic induction and surgical incision on activated clotting time (ACT) was determined in patients undergoing vascular surgery. Patients undergoing carotid endarterectomy (CAE) (n = 50) and abdominal aortic aneurysm repair (AAA) (n = 45) were studied. Patients in the CAE group had cervical plexus block anesthesia, whereas patients in the AAA group had a combination of epidural and general anesthesia. The ACT was measured 1) before induction of anesthesia, 2) 5 min after induction, 3) 5 min after incision, 4) 5 min after heparinization, and 5) at the onset of skin closure. Heparin was reversed with protamine only if the ACT after revascularization was > 200 s. Reversal was considered adequate if the ACT was < 200 s and the surgeon felt that hemostasis was adequate. The ACT decreased by 12.26 +/- 1.23 (mean +/- SE) (P = 0.006) in the CAE group and by 12.47 +/- 1.01 (P = 0.002) in the AAA group with induction of anesthesia. There was a further decrease of 5.06 +/- 0.62 (P = 0.26) in the CAE group and 5.17 +/- 0.83 (P = 0.22) in the AAA group with incision. There was a significant difference in ACT in both groups from postinduction and postincision to skin closure (higher at skin closure). No patient in either group required additional protamine or clotting factors post-operatively, or return to the operating room for excessive bleeding. This study demonstrates that anesthetic induction with cervical block or epidural/general anesthesia decreases ACT.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1997

Cervical plexus block for carotid endarterectomy: a nursing care plan.

Historically, carotid surgery is identified in the operating room as a major surgical procedure. Although the surgical intervention remains the same, a regional anesthetic technique calls upon perioperative nurses to utilize their assessment and planning skills astutely preparing innovative nursing interventions that enable successful patient outcomes. The key to a successful nursing care plan for a carotid endarterectomy performed under cervical plexus block is an awareness of the patient's physiological needs as well as the environmental influences they may be experiencing. As the administration of regional anesthesia for major surgery become more prevalent, there is a resurgent demand for traditional holistic nursing interventions in the operating room. The perioperative nurse must couple technical expertise with intuitive assessment skills and administration of compassionate nursing care.

Cervical Plexus↗
PubMed1990

The use of combination cervical plexus block and general anesthesia for radical neck dissection in a patient with severe chronic obstructive pulmonary disease.

Patients with severe chronic obstructive pulmonary disease (COPD) who receive a general anesthetic are at increased risk for postoperative pulmonary complications; therefore, it is desirable to avoid or to limit the dose of general anesthesia in these patients. Regional anesthesia, or a combination of regional and light general anesthesia, is an ideal choice for achieving this goal. This case report demonstrates how we used cervical plexus blocks in combination with light levels of general anesthesia for radical neck dissection in a patient with severe COPD.

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PubMed2000

Recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.

We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.

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PubMedDate not supplied

Interscalene cervical plexus block: a single-injection technic.

A review of the anatomy of the cervical plexus and surrounding structures suggests a single-injection technic which simplifies anesthesia of the cervical plexus and increases the margin of safety in this procedure. Used by the authors, the technic has been successful in 97 percent of over 100 cases.

Anesthesia, Conduction↗
PubMedDate not supplied

[Carotid surgery with cervical plexus block: personal experience].

Although this is an unfrequently used technique, the authors report their early experience concerning twenty-seven cases of carotid artery revascularization under cervical plexus anesthesia. They express their surgical judgement about the advantages and the limits of the simplest and most reliable way of cerebral monitoring during the surgical procedure, but it might have only a limited indication.

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