Extension of Sensory Blockade After Thoracic Epidural Administration of a Test Dose of Lidocaine at Three Different Levels

Visser, W.; Liem, Tiong H.; Egmond, J. van; Gielen, M.J.M.

doi:10.1097/00000539-199802000-00022

“…It has been reported that after TOF stimulation was applied at the ulnar nerve, the thumb did not return to the baseline prior to the ®rst three twitches (T1±T3) [2,12]. The famous fault of the accelographic measurement, namely that the accelographic TOF ratio tends to be higher than the mechanical TOF ratio is probably due to`baseline displacement' of the thumb [2,12], and the degree of baseline ........................................................................................................................................................................................................................................ displacement becomes less as the stimulating current decreases [12]. Hence, we presume that when the TOF ratio is monitored accelographically at the great toe at a low current, the degree of baseline displacement would become less, resulting in a lower TOF ratio.…”

Section: Discussionmentioning

confidence: 99%

Aspiration in severe trauma: a prospective study

Lockey

¹

,

Coats

²

,

Parr

³

1999

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SummaryThe incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway. Since victims of major trauma may have full stomachs and impaired airway reflexes they are assumed to be at high risk of large airway and pulmonary aspiration [1]. Both gastric contents and debris from the upper airway, particularly blood, may be aspirated. The actual incidence of aspiration in trauma patients is unknown. It is also unclear whether the risk of aspiration comes primarily from blood and debris from the upper airway or from gastric contents. Where the major risk lies has implications for airway management. We examined the incidence and nature of aspiration in a group of trauma patients. MethodsOver a 10-week period, we studied 53 consecutive adult patients with major trauma who required tracheal intubation before admission to hospital by members of the London Helicopter Emergency Medical Service (London HEMS). Four doctors and five paramedics were involved in the study. After each intubation was performed, the presence and nature of gross contamination of the vocal cords visible at direct larangoscopy was recorded. Patient age, sex, mortality, mechanism of injury, nature of injuries and Glasgow coma score (GCS) before intubation were recorded. The status of the person intubating (doctor or paramedic) was also recorded. Pathologists performing post-mortem examinations on patients who died within 4 h of injury were asked to look specifically for evidence and nature of pulmonary aspiration. ResultsThere were 42 males and 11 females. The mean age of the patients was 41 years (range 16-80 years). Twenty-one patients survived and 32 died. Of the nonsurvivors, 17 died within 4 h of injury. Forty-four patients (83%) had head injuries of which 32 were isolated, six head and chest and six head and multiple injuries. Twenty-nine patients had a GCS of 3 and 39 scored 8 or below. Twenty-nine patients sustained their injuries in road-traffic accidents (20 as pedestrians). Eleven were injured in falls from a height.Twenty patients (38%) were intubated by paramedics and 33 (62%) by doctors.Eighteen (34%) patients had evidence of gross contamination of the vocal cords at direct laryngoscopy. All 18 had head injuries and a GCS below 8. In 15 of these patients, the airway was contaminated with blood and, in three, by gastric contents. The results of post-mortem examinations on 10 of the 17 patients who died within the first 4 h were available to us. One confirmed aspiration of gastric contents seen at laryngoscopy, one confirmed aspiration of blood, seven confirmed that no aspiration had occurred and one showed no evidence of aspiration 1097ᮊ 1999 Blackwell Science Ltd where a moderate amount of blood had been seen at intubat...

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“…It has been reported that after TOF stimulation was applied at the ulnar nerve, the thumb did not return to the baseline prior to the ®rst three twitches (T1±T3) [2,12]. The famous fault of the accelographic measurement, namely that the accelographic TOF ratio tends to be higher than the mechanical TOF ratio is probably due to`baseline displacement' of the thumb [2,12], and the degree of baseline ........................................................................................................................................................................................................................................ …”

Section: Discussionmentioning

confidence: 99%

“…displacement becomes less as the stimulating current decreases [12]. Hence, we presume that when the TOF ratio is monitored accelographically at the great toe at a low current, the degree of baseline displacement would become less, resulting in a lower TOF ratio.…”

Section: R E T R a C T E Dmentioning

confidence: 95%

THIS ARTICLE HAS BEEN RETRACTED: Relationship between stimulating current and accelographic train‐of‐four response at the great toe

Saitoh

¹

,

Narumi

²

,

Fujii

³

et al. 1999

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SummaryThe incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway. Since victims of major trauma may have full stomachs and impaired airway reflexes they are assumed to be at high risk of large airway and pulmonary aspiration [1]. Both gastric contents and debris from the upper airway, particularly blood, may be aspirated. The actual incidence of aspiration in trauma patients is unknown. It is also unclear whether the risk of aspiration comes primarily from blood and debris from the upper airway or from gastric contents. Where the major risk lies has implications for airway management. We examined the incidence and nature of aspiration in a group of trauma patients. MethodsOver a 10-week period, we studied 53 consecutive adult patients with major trauma who required tracheal intubation before admission to hospital by members of the London Helicopter Emergency Medical Service (London HEMS). Four doctors and five paramedics were involved in the study. After each intubation was performed, the presence and nature of gross contamination of the vocal cords visible at direct larangoscopy was recorded. Patient age, sex, mortality, mechanism of injury, nature of injuries and Glasgow coma score (GCS) before intubation were recorded. The status of the person intubating (doctor or paramedic) was also recorded. Pathologists performing post-mortem examinations on patients who died within 4 h of injury were asked to look specifically for evidence and nature of pulmonary aspiration. ResultsThere were 42 males and 11 females. The mean age of the patients was 41 years (range 16-80 years). Twenty-one patients survived and 32 died. Of the nonsurvivors, 17 died within 4 h of injury. Forty-four patients (83%) had head injuries of which 32 were isolated, six head and chest and six head and multiple injuries. Twenty-nine patients had a GCS of 3 and 39 scored 8 or below. Twenty-nine patients sustained their injuries in road-traffic accidents (20 as pedestrians). Eleven were injured in falls from a height.Twenty patients (38%) were intubated by paramedics and 33 (62%) by doctors.Eighteen (34%) patients had evidence of gross contamination of the vocal cords at direct laryngoscopy. All 18 had head injuries and a GCS below 8. In 15 of these patients, the airway was contaminated with blood and, in three, by gastric contents. The results of post-mortem examinations on 10 of the 17 patients who died within the first 4 h were available to us. One confirmed aspiration of gastric contents seen at laryngoscopy, one confirmed aspiration of blood, seven confirmed that no aspiration had occurred and one showed no evidence of aspiration 1097ᮊ 1999 Blackwell Science Ltd where a moderate amount of blood had been seen at intubat...

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“…Despite the large volume of the solution used, 20 mL, 75 mg of anesthetic is not considered a high dose, and this dilution was used because this procedure does not require intense muscle relaxation. A recent study 11 demonstrated that the median thoracic approach, such as the one used in the present study, tends to present greater caudal dispersion of the local anesthetic, justifying the use of larger volumes. A high blockade can affect hemodynamic and respiratory parameters, which was not detected in our patients.…”

Section: Discussionmentioning

confidence: 74%

Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica

Belzarena¹

2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO CIENTÍFICO 2008; 58: 6: 561-568 SCIENTIFIC ARTICLE RESUMO Belzarena SD -Estudo Comparativo entre Anestesia Peridural Torácica e Anestesia Geral em Mastectomia Oncológica. JUSTIFICATIVA E OBJETIVOS:A anestesia peridural torácica é utilizada com freqüência para procedimentos estéticos da mama e há poucos relatos de seu emprego para mastectomias com exploração axilar. O presente estudo comparou a técnica com anestesia geral em operações oncológicas da mama. MÉTODO: CONCLUSÕES:A técnica peridural tem algumas vantagens com relação à anestesia geral e pode ser considerada uma opção para anestesia em mastectomias oncológicas com esvaziamento axilar.Unitermos: ANESTESIA: Regional, peridural; CIRURGIA: Oncológica, mastectomia. SUMMARY Belzarena SD -Comparative Study between Thoracic EpiduralBlock and General Anesthesia for Oncologic Mastectomy. BACKGROUND AND OBJECTIVES:Thoracic epidural block is frequently used for esthetic breast surgeries but reports of its use in mastectomies with axillary exploration are very rare. The present study compared this technique with general anesthesia in oncologic surgeries of the breasts. METHODS:Forty patients were divided in two groups. The epidural group (n = 20) underwent epidural thoracic block with bupivacaine and fentanyl associated with sedation with midazolam. The other group (n = 20) underwent conventional general anesthesia with propofol, atracurium, and fentanyl, and maintenance with O 2 and isoflurane. Duration of the surgery, the need for intraoperative complementation of anesthesia or sedation, and intraoperative hemodynamic parameters were recorded. In the postoperative period, length of time until discharge from the recovery room and from the hospital, severity of pain, analgesic consumption, adverse effects, and satisfaction with the anesthetic techniques were recorded. RESULTS:Both groups were similar and differences in the duration of the surgery were not observed. Complementary sedation was necessary in 100% of the patients who underwent epidural block and complementary sedation with infiltration of local anesthetic in the axilla in 15% of the patients in this group. The rate of hypertension was more frequent in the group of patients who underwent general anesthesia, while hypotension was more frequent in the epidural group. Pruritus was observed in 55% of the patients in the epidural group. Nausea (30%) and vomiting (45%) were more frequent in the general anesthesia group. The quality of postoperative analgesia was better in the epidural group, which also presented lower consumption of analgesics; the length hospitalization in this group was also lower. CONCLUSIONS:Epidural block has some advantages when compared with general anesthesia and can be considered an anesthesia option in oncologic mastectomies with axillary lymph node dissection.

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Extension of Sensory Blockade After Thoracic Epidural Administration of a Test Dose of Lidocaine at Three Different Levels

Cited by 16 publications

References 7 publications

Aspiration in severe trauma: a prospective study

Aspiration in severe trauma: a prospective study

THIS ARTICLE HAS BEEN RETRACTED: Relationship between stimulating current and accelographic train‐of‐four response at the great toe

Estudo comparativo entre anestesia peridural torácica e anestesia geral em mastectomia oncológica

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