Regional anesthesia has been used by anesthetists for decades. Anesthesiologist perform central neuroaxial block, peripheral nerve block and interventional pain injection as a procedure for anesthesia or acute or chronic pain control. Traditional regional anesthetic techniques usually is done by help of the anatomical landmarks and clinical judgment . Anatomic landmarks are usually an anatomic sign on the skin of injection site which identified by palpation on the bony prominence or arterial pulse. It could be near bony prominence or arterial pulse or a few centimeters away from it, based on the passage of a nerve or nearby organ-specific. But many disadvantages like anatomical differences, small adjacent nerves and blood vessels, lungs, …show more content…
Studies have demonstrated that ultrasound guidance leads to faster and denser blocks, as well as a reduction in local anesthetic requirements, when compared to nerve stimulation guidance.(1,2,6,12-14) Recent data suggest that ultrasound guidance reduces the number of needle passes required to perform interscalene block and that more consistent anesthesia of the lower trunk is possible with USG techniques.(15-16) Ultrasound guidance is emerging as a reliable, effective technique for perineural catheter insertion too. USG help to placed catheters in the vicinity of peripheral nerves for continuous infusion of drugs (17) but not improve the ease of insertion of labour epidural catheters in patients with easily palpable lumbar spines (18 ). Pain medicine practice guidelines recommend that almost all procedures perform by image guidance to enhance the accuracy, precision, safety, and diagnostic information derived from the procedure.(19) Evidence suggests that USG epidural puncture …show more content…
USG use for doing many procedures for example; nerve blocks (e.g. the brachial or lumbar plexus, more distal branches of the plexus, or at less common locations such as proximal to sites of trauma or entrapment or neuroma formation), blockade of various small sensory or mixed nerves, such as the suprascapular(24), pudendal(25), intercostal(26), genitofemoral(27), ilioinguinal &iliohyoigasteric(28), lateral femoral cutaneous( LFCN)(29) , greater occipital and third occipital nerve blocks(31) and various other sites. As well as spinal procedures including epidurals, selective spinal nerve blocks(31) facet joint, medial branch blocks(33,34) could be done by US, further sympathetic blocks like stellate ganglion(34), celiac plexus block(35), superior hypogasteric plexus block(36) and impare ganglion block(37) is done by US, also injection into interfascial planes like transverse abdominal plane block (38), rectus sheet block(39) plus myofacial injection(40) , joint injection(41) and bursitis ,tendonitis injection (42) is perform by US, although the outcome of intra-articular procedures is not specifically known.(43) Finally, there are possible to place peripheral neuromodulation electrode with ultrasound guidance( 44) or fill interathecal pump by US.(45)
US faces many challenges such as difficulty in visualization
Prior to intubation for a surgical procedure, the anesthesiologist administered a single dose of the neuromuscular blocking agent, succinylcholine, to a 23-year-old female to provide muscular relaxation during surgery and to facilitate the insertion of the endotracheal tube. Following this, the inhalation anesthetic was administered and the surgical procedure completed.
In order to be completely informed a mother needs to know what exactly an epidural is and how it works. An epidural is the most popular form of pain relief during labor. An epidural is a regional pain reducer. An epidural is analgesia, which is meant for pain relief. This is much different than an anesthesia, which provides total lack of feeling to a region of the body. Epidurals are giving intravenously. There are two types of epidurals a woman can get. The first method is a regular epidural. In a regular epidural, after the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. The second type of epidural is a combined spinal-epidural, these are often called the “”walking epidural”. In this type of epidural, an initial dose of narcotic, anesthetic or a combination of the two is injected beneath the outermost membrane covering the spinal cord.
This book has a detailed account of the discovery and controversy over anesthesia. I used this book mostly for its primary documents. It was extremely useful.
This could be due to the particular patient's situation or to the type of medical procedure being done. If the surgeon uses a local anesthetic, no modifier is required. If the surgeon uses a general or regional anesthetic, Modifier 47 is used to distinguish this difference.
John B. Pollard, Ann L. Zboray, Richard I Mazze. The International Anesthesia Research Society. (1996).
Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). The 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secondary' of the 'Secon Alternatives to indwelling catheter include condom catheter, or intermittent straight catheterization. One of the protocols used in this study is urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters.
Other basic cases happen when managed weight has been connected over a nerve, hindering/fortifying its capacity. Evacuating the weight ordinarily brings about continuous help of these paresthesias. (Paresthesia 1)
...ure anesthesia, auricular needling is often used. By stimulating sensory receptors at auricular points, signals inputted into the body are transmitted through the trigeminal lemniscuses instead of the spinal cord. There were studies demonstrated anterior and posterior portions of the nucleus of spinal tract of trigeminal nerve had similar feedback effects to the gate system in the posterior horn of spinal cord, which could be used to modulate transmissions of pain impulses. This might be able to explain why auricular acupuncture has analgesia effects on surgical or painful irritation on the head and face. However, anesthesia effects of auricular acupuncture during thoracic and abdominal surgeries cannot be explained by any hypotheses about the gate control occurring at either posterior horns of the spinal cord or the nucleus of spinal tract of trigeminal nerve [27].
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
Volles, D. F. (2011, April 11). University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures. Retrieved May 12, 2011, from University of Virgina Health System: University of Virginia Health System Adult and Geriatric Sedation/Analgesia for Diagnostic and Therapeutic Procedures
Today scientist found a way to create 3-D organ prints, physicians have a large variety of options to use as medication such as antibiotics. Also, many surgical procedures have been discovered throughout the years. An improvement toward surgery has bee anesthesia. “Modern surgery is possible because of the development of anesthesia” ("Anesthesia & Types of Anesthesia”). There has been developed three types of anesthesia: local, regional, and general. “The type of anesthesia used for a surgical procedure is determined by several factors: type and length of the surgery, patient health, and preference of the patient and physician.” (“Anesthesia & Types of Anesthesia”). Local anesthesia is used for minor surgeries in a very specific region, it can come as a spray or a cream. Regional anesthesia numbs a whole body region, usually done on the lower part of the body. This anesthesia is used for intensive surgeries. General anesthesia makes you completely unconscious. It is inhaled by a mask through the patient, but it is only used if regional or local anesthesia could not be utilized. The advancement of anaesthesia makes more surgical procedures possible. Today's surgery pain is not as cruel as it used to be during the civil war. If a person got wounded due to a bullet they most likely would not need amputation because of the medical advancements. Amputation is not as painful as before and
Debate on the superiority of regional anesthesia to general anesthesia continues to date. Current literature does not support any difference in mortality between regional and general anesthesia. The largest randomized study to date highlighting this issue, the General Anesthesia Local Anesthesia (GALA) study group, demonstrated no significant difference amongst patients receiving local versus general anesthesia for carotid endarterectomy surgery45. Following that randomized clinical trial, a retrospective review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) reported similar results46. In another report from the ACS-NSQIP focusing on endovascular aortic repair, a lack of difference in mortality amongst local anesthesia, spinal anesthesia or general anesthesia emerged47. Moreover, meta-analyses of regional anesthesia versus general anesthesia for total hip arthroplasty and total knee arthroplasty revealed no difference in mortality.48, 49
The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety issues surrounding PCA use include infusion pump programing errors, basal infusion dosing, and proxy errors when using PCA by proxy (Ladak, Chan, Easty, & Chagpar, 2007). Therefore, the purpose of this report is to examine the benefits and risks of patient-controlled analgesia and how it relates to nursing practice.
Neurological procedures can lead to significant postoperative deficits. It is important for physicians to assess nervous system function intraoperatively so that any deficits can be corrected before they become permanent. The oldest method of assessing spinal cord function is with the Stagnara wake up test where patients are awoken in the middle of surgery in order to assess motor function(1). Once the neurological status of the patient is evaluated, the patient would be reanesthetized and the surgery would resume. The wake up test is limited in that it only provides a brief assessment of motor function. It fails to detect ischemia and sensory function(2). Now, intraoperative neurophysiological monitoring with motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs), electromyography (EMG), electrocorticography (ECoG), and cortical mapping has become the new standard of care. It allows physicians to examine the nervous system function without waking the patient. It has become an essential intraoperative tool to improve safety in surgical procedures and helping minimize postoperative deficits. It has allowed surgeons to accept high-risk patients who might have been otherwise denied for a surgical procedure. There are many intraoperative monitoring modalities used to assess different part of brain, spinal cord, and the peripheral nervous system. The strength of each modality is able to offset the limitations of other monitoring modalities, and when combined together, they provide a comprehensive picture on the complex spinal cord function.
Unlike vaginal birth delivery, the process of a cesarean delivery is quite different, but just as safe as giving vaginal birth (Taylor, 1). When delivering a baby using the cesarean method, there are two ways anesthetic can be used. The women can be put into an unconscious state using the anesthetic, therefore she will be asleep during the entire operation and her coach may not be present. The other way for the anesthetic to be used would be in an epidural or spinal block to temporarily numb the woman from her waist down. In this case the mother will be awake and her coach may be present to give her extra support. Once the anesthetic is working, an incision is made in the abdomen either horizontally or vertically, depending on the reason for the cesarean delivery. A vertical incision is made when the baby is in trouble and needs to be out as quickly as possible, when there is more time the horizontal incision is used. The baby is then lifted out of the uterus and gone for the APGAP procedure. The placenta is then removed and the mother’s reproductive organs are examined before closing the incision (Taylor, 1).