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At least 91 records · Page 5Linked to original sources
PubMed1993

Neurologic changes during carotid endarterectomy under cervical block predict a high risk of postoperative stroke.

BACKGROUND: This study was undertaken to confirm a previous report that patients having neurologic changes with carotid artery clamping were at greater risk of developing permanent postoperative neurologic complications after carotid endarterectomy. METHODS: Superficial and deep cervical plexus blocks were performed in 389 patients undergoing carotid endarterectomy. The patients were premedicated and sedated to a level that allowed awake neurologic assessment. Intraoperative neurologic changes were recorded and all patients were examined postoperatively by an independent anesthesiologist to record postoperative neurologic outcome. RESULTS: Trial carotid artery cross clamping resulted in 24% of patients having neurologic changes that usually responded to declamping and shunt insertion. Postoperative permanent neurologic complications occurred in 2.6% of patients, but were more common in patients who had neurologic changes associated with carotid artery cross clamping (6.6% compared to 1.1%, P < 0.01). Thrombosis of the carotid artery was the most common finding in patients who underwent reexploration of the carotid artery after developing postoperative neurologic changes. CONCLUSIONS: This study confirms that patients undergoing carotid endarterectomy under cervical plexus block who have intraoperative neurologic changes have a sixfold increase in the chance of developing a postoperative stroke. This high-risk group may benefit from antithrombotic therapies to improve their outcome.

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PubMed2000

Complications from regional anaesthesia for carotid endarterectomy.

The complications of carotid endarterectomy (CEA) under cervical plexus blockade have yet to be fully evaluated. Two different cases are presented; both patients suffered sudden collapse following superficial and deep cervical plexus block in preparation for CEA. The causes, presenting signs and differential diagnoses are discussed. The safest cervical plexus anaesthetic block technique has not yet been established.

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PubMed1993

[Loco-regional anesthesia for surgery of the shoulder].

Regional anesthesia represents a selective approach in shoulder surgery. The following technics can be used: brachial plexus block, cervical epidural and intra-articular anesthesia. The advantages of each technique are discussed.

Anesthesia, Epidural↗
PubMed1993

[Shoulder surgery using a plexus block: for or against. Against].

Brachial plexus block is an alternative and elegant procedure for shoulder surgery. Three main concerns have to be considered when this technique is planed. Firstly, large amounts of local anaesthetic solution are necessary to achieve complete blockade of the region especially when the deeper tissues of the shoulder are concerned by the procedure. Secondly interscalenic cervical plexus block produces homolateral phrenic paralysis and may impair respiratory function in patients at risk or when supplemental IV drugs are administered. Thirdly, when nerve lesions of different mechanisms including plexus block itself occur, the origin of the lesion may be difficulty related to its cause. Indications of cervical block are therefore to be considered cautiously when shoulder surgery is performed.

Brachial Plexus↗
PubMed1987

Interscalene block anesthesia for shoulder surgery.

One hundred patients had major shoulder surgery with interscalene brachial and cervical plexus block anesthesia. Successful anesthesia was obtained by using this method in 82 patients. Failure was the result of incomplete anesthesia in 16 patients or the presence of a complication. Complications from high blood levels of anesthetic included loss of consciousness and respiratory depression in three patients and seizure in one. The block lasted a mean of eight hours, decreasing the need for postoperative analgesic medications. No postoperative medical complication developed. Ninety-one percent of the patients with successful blocks were satisfied with the procedure.

Adult↗
PubMed2005

Does the investing layer of the deep cervical fascia exist?

BACKGROUND: The placement of the superficial cervical plexus block has been the subject of controversy. Although the investing cervical fascia has been considered as an impenetrable barrier, clinically, the placement of the block deep or superficial to the fascia provides the same effective anesthesia. The underlying mechanism is unclear. The aim of this study was to investigate the three-dimensional organization of connective tissues in the anterior region of the neck. METHODS: Using a combination of dissection, E12 sheet plastination, and confocal microscopy, fascial structures in the anterior cervical triangle were examined in 10 adult human cadavers. RESULTS: In the upper cervical region, the fascia of strap muscles in the middle and the fasciae of the submandibular glands on both sides formed a dumbbell-like fascia sheet that had free lateral margins and did not continue with the sternocleidomastoid fascia. In the lower cervical region, no single connective tissue sheet extended directly between the sternocleidomastoid muscles. The fascial structure deep to platysma in the anterior cervical triangle comprised the strap fascia. CONCLUSIONS: This study provides anatomical evidence to indicate that the so-called investing cervical fascia does not exist in the anterior triangle of the neck. Taking the previous reports together, the authors' findings strongly suggest that deep potential spaces in the neck are directly continuous with the subcutaneous tissue.

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PubMed1991

A complete regional anesthesia technique for cardiac pacemaker insertion.

Sixteen consecutive adult patients scheduled for permanent transvenous cardiac pacemaker insertion received as their total anesthetic the combination of a cervical plexus block and blocks of the second, third, and fourth intercostal nerves using a combination of 1% mepivacaine and 0.2% tetracaine with epinephrine, 1:200,000. This technique consistently provided complete surgical anesthesia of the third cervical (C3) through the fourth thoracic (T4) dermatomes, without anesthesia of the brachial plexus. Anesthesia was adequate for the surgical procedure without the need for supplemental analgesia or anesthesia in all cases. Because fluoroscopy was used routinely for the surgical procedure, it was possible to document that there were no instances of diaphragmatic paralysis or pneumothorax. In contrast to other reports, this technique provides surgical anesthesia that is adequate for all of the approaches used for transvenous pacemaker implantation, except for placement of a battery in an abdominal pouch. There were no serious complications and/or side effects in any of the patients studied.

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PubMed1992

Prevention of tachycardia with atenolol pretreatment for carotid endarterectomy under cervical plexus blockade.

A double-blind, randomised, controlled trial of forty patients was carried out to determine if oral atenolol pretreatment would reduce the incidence of tachycardia during carotid endarterectomy performed under cervical plexus block. Twenty patients received a placebo and twenty patients 50 mg of atenolol two hours prior to surgery. The superficial and deep cervical blocks were performed with 1.5% lignocaine containing 1:200,000 adrenaline. The patients were monitored with the V5 lead of the electrocardiogram and intra-arterial blood pressure. These measurements were recorded on a correctly calibrated paper recorder. Tachycardia (heart rate greater than 90 beats per minute for more than three minutes) occurred in thirteen patients in the placebo group and two patients in the atenolol group (P less than 0.01). There was no difference in the occurrence of bradycardia, hypotension or hypertension between the two groups. It is concluded that atenolol pretreatment is an effective method of reducing the incidence of tachycardia during carotid endarterectomy performed under cervical plexus blockade.

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PubMed1996

AANA journal course: update for nurse anesthetists--carotid endarterectomy: anesthetic implications.

Carotid endarterectomy reduces the risk of stroke or death in patients with high-grade symptomatic carotid artery disease. Regional anesthesia-which uses the awake patient as a monitor for cerebral ischemia-is a viable alternative to general anesthesia for patients undergoing carotid endarterectomy. There are very few complications with the deep and superficial cervical plexus blocks when administered by a careful anesthetist trained to perform this procedure. Patients receiving regional anesthesia also have fewer intraoperative carotid artery shunts and cardiac complications. The preoperative, intraoperative, and postoperative management of the carotid endarterectomy patient receiving either a regional or general anesthetic is reviewed.

Carotid Stenosis↗
PubMed1993

[Loco-regional anesthesia and orthopedic surgery of the shoulder].

Interscalene block can induce by itself anesthesia for shoulder surgery, if the opening does not reach the delto-pectoral site nor the shoulder-blade, but medical indications must be thoroughly talked over on account of the risk of phrenic paralysis with patients suffering from breezing trouble, and the surgical position that may disturb the anesthesiologist in case he has to increase anesthesia. A superficial cervical plexus block is required in anesthesia of the upper part of the shoulder. Regional anesthesia is quite useful too as a complement to general anesthesia, for it provides excellent postsurgical analgesia. A catheter may be inserted at the end of the surgical process through a nerve stimulator, but the patient does not tolerate it long, its efficiency greatly diminishes after the first day, and paresthesias may occur as after-effects. Today we prefer set interscalene block before the patient is anaesthetized, searching for paresthesias with a thin needle: this process does not take long to install, it is relatively painless and provides excellent analgesia during the per and post-surgical period, until the next day with long acting local anesthetics. Not any complication happened in fifty patients for one year.

Cervical Plexus↗
PubMed1984

Plasma bupivacaine concentrations during combined regional and general anaesthesia for resection and reconstruction of head and neck carcinomata.

Venous plasma bupivacaine concentrations were measured in patients undergoing resection and reconstruction surgery for intra-oral malignancy. Vth cranial nerve and cervical plexus blocks were performed using 0.5% bupivacaine. Total dosage was higher than recommended by U.K. manufacturers. Mean peak venous plasma concentrations were higher than previously recorded. A significant different was found in the peak concentrations when adrenaline was included. The significance of these results in relation to systemic toxicity and recommended dosage is discussed.

Aged↗
PubMed1994

Thyroid surgery using monitored anesthesia care: an alternative to general anesthesia.

Forty consecutive patients undergoing thyroid surgery under local anesthesia (LA) by a single surgeon over a 5-year period were included in this retrospective review. In all cases, the indication for LA was patient request. The study included 29 females and 11 males with an average age of 44 years (range 22-66 years). Body habitus was thin in 12.5%, average in 67.5%, and obese in 20%. Operations consisted of 21 unilateral thyroid lobectomies, 3 partial thyroidectomies, 3 subtotal thyroidectomies, and 13 total thyroidectomies. The pathology revealed benign disease in 45% and malignant disease in 55%. All procedures were performed using lidocaine and/or bupivacaine to administer a deep cervical plexus block as well as a field block. Mild additional intraoperative intravenous sedation was provided in most cases. Two patients were converted emergently to general endotracheal anesthesia because of inability to tolerate LA in one and a seizure secondary to intraarterial injection of lidocaine in the other patient. There were no instances of wound infection hemorrhage, recurrent laryngeal nerve injury, or hypoparathyroidism. In conclusion, thyroid surgery in selected patients can be performed safely using LA by experienced surgeons. If patients are carefully prepared preoperatively, LA offers a simple and reasonable alternative to general anesthesia.

Adult↗
PubMed2006

[Effect of electroacupuncture on bispectral index of electroencephalography in patients undergoing subtotal thyroidectomy].

OBJECTIVE: To investigate the effects of electroacupuncture on bispectral index (BIS) of electroencephalography in patients undergoing subtotal thyroidectomy. METHODS: Sixty patients were equally randomized into group A given electroacupuncture combined with cervical plexus block (CPB) and group B given CPB alone. After needling sensation was reached in bilateral "Hegu" and "Neiguan" acupoints, 5 min of high frequency electrical stimulation by electrical stimulation device followed with CPB was applied to group A, while only CPB was performed in group B. Visual analog scale (VAS) and verbal stress scale (VSS) were monitored, complication and adverse reaction were observed and BIS, mean arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (SaO2) were monitored continuously in the perioperative period. RESULTS: HR increased and BIS decreased in group A, both were lower significantly than those in group B (P < 0.01); MAP, the complementary dosage of fentanyl and lidocaine used and scores of VAS and VSS were also lower in group A than those in group B (P < 0.01). CONCLUSION: Electroacupuncture could enhance the anesthetic effect of CPB, lower the BIS value during subtotal thyroidectomy.

Acupuncture Analgesia↗
PubMed1999

Perioperative strokes after 1001 consecutive carotid endarterectomy procedures without an electroencephalogram: incidence, mechanism, and recovery.

HYPOTHESIS: That alternative methods of cerebral protection, especially routine shunting of all patients undergoing general anesthesia or shunting on the basis of neurologic assessment with the patient awake under cervical plexus block, result in outcomes of carotid endarterectomy comparable with those reported using electroencephalographic monitoring. DESIGN: Retrospective review of cases from a vascular registry established in 1990. SETTING: Tertiary care center. PATIENTS: Consecutive sample of 1001 patients who underwent carotid endarterectomy. INTERVENTIONS: Carotid endarterectomy procedures were performed without electroencephalographic monitoring, using general anesthesia with routine shunting or using regional anesthesia. MAIN OUTCOME MEASURES: Overall stroke and mortality rates and cause and consequence of the postoperative strokes. RESULTS: There were 14 nonfatal strokes (1.4%) and 2 deaths (0.2%), for a combined stroke and death rate of 1.6%. Nine (64%) of the 14 strokes appeared to result from a technical error during the endarterectomy. Mild deficits were noted after 7 strokes (50%), with the remainder resulting in deficits that required inpatient rehabilitation. Twelve patients with strokes (86%) eventually returned home without need for assistance. CONCLUSIONS: Most postoperative strokes in this series were due to technical errors. Overall, even in patients with strokes initially requiring inpatient rehabilitation, there was good recovery of function. Low stroke and mortality rates can be achieved in carotid endarterectomy without the use of electroencephalographic monitoring.

Adult↗
PubMed1979

Hand-held toy squeaker during carotid endarterectomy in the awake patient.

A toy squeaker held by the patient in the contralateral hand is used to monitor cerebral circulation during carotid endarterectomy. Regional anesthesia--cervical plexus block--allowed the patient to cooperate and give useful information, especially during the crucial period of test clamping. In a series of 300 cases, during a period of five years, it was instrumental in avoiding brain damage in 6% of the cases.

Anesthesia, Conduction↗
PubMed1984

Myocardial infarction following regional anaesthesia for carotid endarterectomy.

From 1969 through 1982, 185 carotid endarterectomies were performed under regional anaesthesia on 153 patients. Of these patients, 38 (25 per cent) had suffered a previous myocardial infarction, 63 (41 per cent) had documented coronary artery disease, and 115 (75 per cent) had hypertension. Anaesthesia was provided by a superficial cervical plexus block. Monitoring consisted of measurement of direct arterial pressure and continuous display of the electrocardiogram. Oxygen was administered by nasal cannula throughout the procedure. Mean arterial pressure was elevated when necessary by infusion of phenylephrine. No patient in this study suffered an acute myocardial infarction. The only cardiac complications consisted of eight episodes of non-life-threatening dysrhythmias. We conclude that regional anaesthesia for carotid endarterectomy is associated with a low risk of perioperative myocardial infarction.

Anesthesia, Conduction↗