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At least 883 records · Page 49Linked to original sources
PubMed1989

Compartment syndrome. A complication of intravenous regional anesthesia in the reduction of lower leg shaft fractures.

Forty-one consecutive patients who had closed reduction of closed lower leg shaft fractures under an intravenous regional anesthetic are reviewed for the complication of compartment syndrome. Four patients were graded as having mild compartment syndrome, two as moderate, and five as severe, giving an overall rate of 27%. This was compared with a control group of 39 consecutive patients who also underwent closed reduction of closed lower leg shaft fractures, but under general anesthesia or intravenous analgesia alone rather than an intravenous regional anesthetic. In the control group, three patients were graded as having mild compartment syndrome, and two as severe, giving an overall complication rate of 13%. The authors feel that the use of the thigh tourniquet with the intravenous regional anesthetic technique increases the frequency of compartment syndrome as a complication in lower leg fractures.

Anesthesia, Conduction↗
PubMed1991

Anesthesia for male aesthetic surgery.

The male patient for aesthetic plastic surgery should expect to have a good experience, with few, if any complications from anesthesia. Proper planning is essential to the process, from setting up the surgical facility to selection and preparation of patients. Anesthetic techniques should be adapted to the needs of each patient, with his safety and comfort the most important consideration. Anesthesia for plastic surgery has progressed from simple injection of local anesthetics to sophisticated sedation and general endotracheal techniques. Better anesthetic drugs, monitors, and procedures for dealing with complications have made anesthesia a major factor in the advances of the plastic surgery specialty. Male patients frequently have different medical problems than their female counterparts have, including cardiovascular disease, hypertension, and smoking history. Other problems include back discomfort and prostate enlargement, both factors that must be taken into consideration with local sedation anesthesia techniques. The use of basic monitoring equipment has made ambulatory surgery safer for patients and has been instrumental in reduction of medication-related complications. Monitoring standards changed in anesthesia in the late 1980s to include electrocardiogram (EKG), precordial or pretracheal continuous monitoring, blood pressure, and pulse oximetry. In addition, if general anesthesia is used, end-tidal carbon dioxide and temperature monitoring and oxygen analysis of the anesthesia gases are also recommended. General anesthesia is being utilized more frequently in cosmetic surgery procedures and offers many advantages over local and conscious sedation techniques. The modern agents and techniques permit the patient to recover quickly, with minimum postoperative sequelae, and provide obvious comfort during the operative procedure. The traditional anesthesia technique for facial plastic surgery has been local anesthesia supplemented by sedation. This technique requires a combination of skillful local administration, selection of appropriate sedation drugs in proper doses, and a cooperative patient. Ideally, the selection and administration of drugs and monitoring of the patient should be by an anesthetist, who understands drug interactions and synergistic and additive effects of sedation drugs. Facility set-up, professional personnel, and recovery and discharge criteria are essential to good anesthesia care for the male aesthetic patient.

Anesthesia↗
PubMed2006

Bipolar radiofrequency induced thermotherapy of the tongue base: Its complications, acceptance and effectiveness under local anesthesia.

We assessed adverse events and complications of bipolar radiofrequency induced thermotherapy of the tongue base (RFTB) in patients with socially unacceptable snoring (SUS) or obstructive sleep apnea syndrome (OSAS) and determine its acceptance and effectiveness when conducted under local anesthesia. This investigation consisted of (1) a prospective, open-enrollment study of 24 consecutive patients with snoring and OSAS at the tongue base level only (Fujita III), assessed by sleep endoscopy. Polysomnography, questionnaires, and visual analog scales (VAS) were used to assess outcome. (2) In addition, a retrospective review of 83 patients, who underwent RFTB (in 59 cases as part of a multilevel treatment), was performed to evaluate adverse events and complications. Twenty-two of the 24 patients completed postoperative questionnaires and VAS, and ten patients had postoperative polysomnography. Reduction in snoring (P = 0.0003), hypersomnolence (P = 0.002), and globus (P = 0.031) was significant. A positive trend in AHI (P = 0.001, n = 3) is shown in patients with moderate to severe OSAS. Concerning postoperative adverse events and complications, only two patients had a mild and transient tongue deviation directly after the procedure, which resolved within an hour postoperatively (adverse event rate 1.8%). No postoperative complications such as infections, abscesses, hematomas, or ulcerations of the tongue base occurred. This study demonstrates that bipolar RFTB in patients with obstruction at the tongue base only (Fujita type III) as visualized by sleep endoscopy is a safe and simple procedure under local anesthesia and can be effective in patients with SUS. No complications during this study were observed. Its effect on OSAS has been shown by other authors, although long-term effects are not stable. The RFTB can be considered as first choice treatment in case of snoring and mild OSAS in Fujita type III obstruction. In the case of moderate to severe sleep apnea, RFTB can be considered as an additional treatment.

Adult↗
PubMed1989

Postabortal paracervical abscess as a complication of paracervical block anesthesia. A case report.

A paracervical abscess occurred after paracervical block anesthesia was administered for induced abortion in an 18-year-old multigravida. She presented with vaginal, low abdominal and low back pain and with nausea, vomiting, chills and fever. Incision and drainage of the abscess were performed and a vaginal drain inserted under antibiotic coverage. Cultures of the abscess contents revealed multiple anaerobic organisms. Laparoscopy showed normal pelvic organs, and the peritoneal fluid cultures were negative. Postoperatively the patient became afebrile and was discharged after three days on antibiotics. To our knowledge, this case report is the first one on paracervical abscess as a complication of induced abortion with paracervical block anesthesia.

Abortion, Induced↗
PubMed1998

Spinal anesthesia for elective lumbar spine surgery.

STUDY OBJECTIVE: To evaluate a large series of elective lumbar spine surgical procedures by a single surgeon whose patients were all offered spinal anesthesia. DESIGN: Retrospective chart review. SETTING: Tertiary-care teaching hospital. MEASUREMENTS AND MAIN RESULTS: The records of all elective lumbar spine procedures between 1984 and 1995 performed by one surgeon (GRB) were obtained, and 803 were identified. Of those 803 patients, 611 accepted spinal anesthesia. Data collected included patient demographics, details of the spinal and general anesthesia, perioperative complications, and impact of the spinal anesthetic options on the outcome of spinal anesthesia. General and spinal anesthesia patients were comparable for age, gender, height, and ASA physical status. Patients who received spinal anesthesia were significantly heavier than the general anesthesia patients. Among perioperative complications, nausea and deep venous thrombosis occurred significantly more often in the general than spinal anesthesia patients. Mild hypotension and decreased heart rate (HR) were the most common hemodynamic changes with spinal anesthesia, whereas hypertension and increased HR were the result of general anesthesia. Among spinal anesthetic drugs, plain bupivacaine was associated with the lowest incidence of supplemental local anesthetic use intraoperatively compared to hyperbaric bupivacaine or hyperbaric tetracaine. CONCLUSION: Spinal anesthesia is an effective alternative to general anesthesia for lumbar spine surgery and has a reduced rate of minor complications.

Anesthesia, General↗
PubMed1996

Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.

We report the results of a prospective study on the practice of pediatric regional anesthesia by the French-Language Society of Pediatric Anesthesiologists (ADARPEF) during the period from May 1, 1993 to April 30, 1994. This study was designed to provide data concerning the epidemiology of regional anesthesia and its complications in a totally anonymous way. Data from 85,412 procedures, 61,003 pure general anesthetics and 24,409 anesthetics including a regional block, were prospectively collected. Central blocks (15,013), most of which were caudals, accounted for more than 60% of all regional anesthetics. Peripheral nerve blocks and local anesthesia techniques represented only 38% of regional blocks and Bier block was used only 69 times. Central and peripheral nerve blocks were performed in all pediatric age groups with some intergroup differences. Most blocks were performed under light general anesthesia (89%), confirming the fact that regional anesthetics are used as techniques of analgesia rather than anesthesia. Complications were rate (25 incidents involving 24 patients) and minor, and did not result in any sequelae or medicolegal action. Peripheral nerve blocks and local anesthesia techniques were generally safe. The overall complication rate of regional anesthesia was 0.9 per 1000, but because all complications occurred with central blocks, the complication rate of central blocks is in fact 1.5 per 1000 with significant variations in different age groups. This prospective study, based on a large and representative series of pediatric anesthetics, establishes the safety of regional anesthesia in children of all ages. It provides new insights on the practice of regional blocks and reveals that complications are rare and minor as they occur most often in the operating room and are readily managed by experienced anesthesiologists with resuscitative equipment at hand. The extremely low incidence of complications (zero in this study) after peripheral nerve blocks should encourage pediatric anesthesiologists to use them more often when they are appropriate, in the place of a central block.

Adolescent↗
PubMed2003

Airway problems and new solutions for the obstetric patient.

Anesthesia-related complications are the sixth leading cause of pregnancy-related maternal mortality in the United States. Difficult or failed intubation following induction of general anesthesia for cesarean delivery remains the major contributory factor to anesthesia-related maternal complications. Although the use of general anesthesia has been declining in obstetric patients, it may still be required in selected cases. Because difficult intubation in obstetric anesthesia practice is frequently unexpected, careful and timely preanesthetic evaluation of all parturients should identify the majority of patients with difficult airway and avoid unexpected difficult airway management.

Adult↗