lunes, 4 de mayo de 2015

Más de anestesia cervical epidural/Cervical epidural anaesthesia

Comparación de tres formulaciones diferentes de anestésicos locales para anestesia epidural cervical en cirugía de tiroides
Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery.
Jain G, Bansal P, Garg GL, Singh DK, Yadav G.
Indian J Anaesth. 2012 Mar;56(2):129-34. doi: 10.4103/0019-5049.96306.
BACKGROUND: To compare the efficacy and safety of local anaesthetics under cervical epidural anaesthesia (CEA) using lignocaine (1%), bupivacaine (0.25%) and ropivacaine (0.5%) for thyroid surgery. METHODS: In a prospective, randomized fashion, 81 patients were selected for thyroid surgery under CEA. They were assigned to one of three groups: Group L, B and R to receive 10 mL of 1% lignocaine, 0.25% bupivacaine and 0.5% ropivacaine, respectively. We compared their efficacy in terms of pulmonary and haemodynamic parameters, blockade quality and complications. RESULTS: Of the total, 74 patients completed the study successfully. Sensory block attained the median dermatomal range of C2-T4/T5 in all the groups. Motor block was more pronounced in the ropivacaine group. Cardiorespiratory parameters decreased significantly in all the groups; however, none of the patients had any major complications except for bradycardia in two patients. Among the measured variables, the decrease in heart rate and peak expiratory force was more in the lignocaine group while forced vital capacity and forced expiratory volume at 1 sec declined to a greater extent in the ropivacaine group. The lignocaine group required significantly more epidural top-ups compared with the other two groups. CONCLUSION: We conclude that cervical epidural route can be safely used for surgery on thyroid gland in patients with normal cardiorespiratory reserve, using either of local anaesthetics chosen for our study. Under the selected dose and concentrations, the decrease in cardiorespiratory parameters was lesser with bupivacaine.
KEYWORDS: Bupivacaine; cervical epidural anaesthesia; lignocaine; ropivacaine; thyroid surgery
Burbujas de aire simulan hernia discal en la RNM después de bloqueo cervical epidural
Air bubbles mimic disc herniation in MRI after cervical epidural block.
Kim TS1, Shin SS, Kim JR, Kim DY.
Korean J Pain. 2010 Sep;23(3):202-6. doi: 10.3344/kjp.2010.23.3.202. Epub 2010 Aug 26.
Magnetic resonance image (MRI) is the most sensitive imaging test of the spine in routine clinical practice. Unlike conventional x-ray examinations and computed tomography scans, high-quality magnetic resonance images can be assured only if patients are able to remain perfectly still. However, some patients find it uncomfortable to remain still because of pain. In that condition, interlaminar cervical epidural injections can reduce pain and allow the procedure. When using air with the "loss of resistance" technique in epidural injections to identify the epidural space, there is the possibility of injected excessive air epidurally to mimic a herniated disc. We describe a case report of epidural air artifact in a cervical MRI aftercervical epidural injections.
KEYWORDS: artifact; epidural injections; herniated disc; magnetic resonance image
Manejo de la cefalea cervicogénica con inyección cervical epidural de esteroides
Treatment of cervicogenic headache with cervical epidural steroid injection.
Wang E, Wang D.
Curr Pain Headache Rep. 2014 Sep;18(9):442. doi: 10.1007/s11916-014-0442-3.
Cervicogenic headache (CGH) is defined as referred pain from various cervical structures innervated by the upper three cervical spinal nerves. Such structures are potential pain generators, and include the atlanto-occipital joint, atlantoaxial joint, C2-3 zygapophysial joint, C2-3 intervertebral disc,cervical myofascial trigger points, as well as the cervical spinal nerves. Various interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat this disorder. And while steroids administered by cervical epidural injection have been used in clinical practice to provide anti-inflammatory and analgesic effects that may alleviate pain in patients with CGH, the use of CESI in the diagnosis and treatment of CGH remains controversial. This article describes the neuroanatomy, neurophysiology, and classification of CGH as well as a review of the available literature describing CESI as treatment for this debilitating condition.
Bloqueo cervical epidural para manejo de cirugía de trauma de miembro superior
Dra. Leslian Janet Mejía-Gómez
Rev Mex Anestesiología Vol. 36. Supl. 1 Abril-Junio 2013 pp S211-S215
Bloqueo cervicotorácico en cirugía mamaria
Cervical Epidural Block technique for mastectomy (C7-T1)
Cervical Epidural Injection
Anestesia y Medicina del Dolor
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