Algodystrophy: treatment.

Treatment of reflex sympathetic dystrophies involves early reduction of the nociceptive input, transient interruption of the sympathetic activity, modulation of central mechanisms of pain control, prevention of neurotrophic changes and treatment of associated behavioural problems. The fundamental steps are early control of pain by means of local anesthetic blocks and antiinflammatory agents followed by sympathetic blocks, physical therapy, transcutaneous electrical stimulation and supportive psychotherapy. The results obtained are not always satisfactory and about 40% of the patients is not susceptible to cure. The best results are obtained when treatment is started early.

Insufficient venous drainage following axillary approach to brachial plexus blockade.

Progressive obstruction of an axillary vein following an axillary approach to brachial plexus blockade is described. At surgical exploration, the axillary vein was narrowed with an aneurysm of its wall. It is likely that, during the performance of the block, the needle penetrated the adventitia of the vein, causing a sub-adventitial haematoma and an aneurysm of the vein wall. Normal venous drainage was re-established surgically and the patient recovered completely.

Regional intravenous guanethidine vs. stellate ganglion block in reflex sympathetic dystrophies: a randomized trial.

Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial. Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated. The performance of the intravenous guanethidine block is of longer duration and superior to stellate ganglion block, as regards some early pharmacological effects (skin temperatures and amplitude of plethysmographic waves recorded before blockade and 15 min, 60 min, 24 h, 48 h after institution of the block). In fact the intravenous guanethidine group shows a persistent and significant increase of the skin temperature and of the plethysmographic traces in the blocked side 24 h and 48 h after blockade in comparison with the patients treated with stellate ganglion block. Concerning the therapeutic effects (changes in pain scores and clinical signs--hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks. The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications.

[Technique of general anesthesia with tracheal intubation for endoscopic maneuvers in otorhinolaryngologic surgery]. / Metodica di anestesia generale senza intubazione tracheale per le manovre endoscopiche in chirurgia otorinolaringoiatrica.

On the basis of experience of 25 patients subjected to suspension laryngoscopy and bronchoscopy, it is shown that the technique of anaesthesiology conduction adopted responds to the needs of the anaesthesist and the laryngoscopist. Althesin in particular has been found to possess the requisites for this type of diagnostic manoeuvre.