Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 3 de 3
Filter
Add more filters











Database
Language
Publication year range
1.
Medicine (Baltimore) ; 100(35): e27142, 2021 Sep 03.
Article in English | MEDLINE | ID: mdl-34477168

ABSTRACT

RATIONALE: Unlike brachial plexus block, erector spinae plane block (ESPB) does not target specific nerves, so the analgesic effect may differ depending on the extent of diffusion of local anesthetic. Therefore, needle size, which can affect the diffusion of local anesthetic, may be an important factor in the analgesic effect. PATIENT CONCERNS: Four patients with end-stage renal disease on hemodialysis received vascular surgery due to arteriovenous fistula occlusion. Vascular bypass surgery was performed on the axillary vein. DIAGNOSES: Four patients with end-stage renal disease on hemodialysis were diagnosed with arteriovenous fistula occlusion. One in 4 patients was diagnosed with diaphragm paralysis after ESPB, and the other 3 did not develop diaphragm paralysis. INTERVENTIONS: ESPB was conducted by ultrasound using a 25- or 22-gauge needle at the C7 level. The extent of nerve blockade was determined based on cold sensation, and diaphragm excursion and thickness were measured via ultrasound. OUTCOMES: The analgesic effect was excellent in 2 patients treated using a 22-gauge needle, but was poor in 2 other patients treated with a 25-gauge needle. LESSONS: ESPB at the C7 level can cause diaphragm paralysis, and needle size may affect the extent of diffusion of local anesthetic.


Subject(s)
Nerve Block/methods , Aged , Female , Humans , Male , Middle Aged , Needles , Nerve Block/instrumentation , Vascular Surgical Procedures
2.
Medicine (Baltimore) ; 99(27): e21129, 2020 Jul 02.
Article in English | MEDLINE | ID: mdl-32629747

ABSTRACT

RATIONALE: The left internal jugular vein has a higher possibility of anatomical variation than the right side. Therefore, the complication risk during cannulation is expected to be higher. PATIENT CONCERNS: A 74-year-old woman was scheduled for elective surgery for left upper lobe wedge resection. We observed an anatomical abnormality at the location of the common carotid artery (CCA) and left internal jugular vein (IJV). DIAGNOSIS: During the ultrasound, the left IJV was detected at the medial side of the CCA, and this anatomical variation was confirmed by color Doppler ultrasonography. Enhanced chest computed tomography showed that the left CCA ran across the left IJV from medial to lateral at the level of the clavicle. INTERVENTION: A triple-lumen central venous catheter was inserted at the right IJV to avoid complications caused by the anatomical variation. OUTCOMES: There were no intraoperative or postoperative complications. LESSONS: Anesthesiologists should consider anatomical variation during central venous cannulation, especially with the left IJV approach. Because of anatomical variation, ultrasound-guided intervention is highly recommended to prevent procedure-related complications.


Subject(s)
Catheterization, Central Venous/methods , Jugular Veins/diagnostic imaging , Pulmonary Aspergillosis/surgery , Ultrasonography, Interventional/methods , Aged , Anatomic Variation , Carotid Artery, Common/diagnostic imaging , Female , Humans , Jugular Veins/anatomy & histology , Pulmonary Aspergillosis/diagnostic imaging , Pulmonary Aspergillosis/pathology , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler, Color/methods
3.
Medicine (Baltimore) ; 99(3): e18773, 2020 Jan.
Article in English | MEDLINE | ID: mdl-32011469

ABSTRACT

Cervical epidural anesthesia (CEA) is generally not used during upper-arm vascular surgery for hemodialysis in end-stage renal disease (ESRD) patients, despite its advantages. The Quality of Recovery-40 questionnaire (QOR-40) has been validated as a tool for assessing the degree of recovery after surgery. We hypothesized that CEA could provide a better outcome on the QOR-40 than general anesthesia after upper-arm vascular surgery for hemodialysis in ESRD patients.We divided anesthetic methods into general anesthesia and CEA. The QOR-40 was administered to 70 patients on the night before surgery and at 24 hours after surgery. Additional data, including consumption of opioid analgesics, occurrence of postoperative nausea and vomiting, and scores on a numeric rating scale (NRS) were collected.The total QOR-40 scores of the two groups differed significantly (P = .024) on postoperative day 1. Opioid consumption (P = .005) and occurrence of postoperative nausea (P = .019) in the post-anesthesia care unit (PACU) were significantly lower in the CEA group, whose NRS scores were significantly lower in the PACU (P < .001) and at postoperative day 1 (P = .016).Assessment of postoperative quality of recovery after upper-arm vascular surgery in ESRD patients showed that the CEA group had significantly better total QOR-40 and NRS scores. CEA could be used as an alternative anesthetic technique for upper-arm vascular surgery for hemodialysis in ESRD patients to improve the quality of recovery.


Subject(s)
Anesthesia Recovery Period , Anesthesia, Epidural/methods , Anesthesia, General/methods , Arm/blood supply , Arm/surgery , Arteriovenous Shunt, Surgical , Kidney Failure, Chronic/therapy , Renal Dialysis , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires
SELECTION OF CITATIONS
SEARCH DETAIL