Đang tải... (xem toàn văn)
Cẩm nang thực hành gây tê gây mê trong y khoa 2010 Một tài liệu hay và quý hiếm cho các bạn trong ngành y nha dược
[...]... potentially improve the techniques of ultrasonography-assisted peripheral nerve block Use of these devices is limited by their cost, the need for training in their use and familiarity with ultrasonographic image anatomy, and the extra set of hands required They work best with superficial nerve plexuses and can be limited by excessive obesity or anatomically distant structures One of the keys to using... Tunneling Pass stylet through catheter entry site Exit skin approximately 10 cm away A Pass needle back over stylet Non–skin bridge needle exit site Skin bridge needle exit site B Figure 2-3. Skin bridge and non–skin bridge techniques used in securing the catheters A, Tuohy stylet is inserted B, Tuohy needle is passed over stylet as a guide 24 Atlas of Regional Anesthesia Remove stylet and pass proximal... regional anesthesia found many variations in the method of joining needle to syringe Around the turn of the century, Schneider developed the first all-glass syringe for Hermann Wolfing-Luer Luer is credited with the innovation of a simple conical tip for easy exchange of needle to syringe, but the “Luer-Lok” found in use on most syringes today is thought to have been designed by Dickenson in the mid-1920s... synthesized in 1931, has become widely used in the United States for spinal anesthesia It may be used as an isobaric, hypobaric, or hyperbaric solution for spinal anesthesia Without epinephrine it typically lasts 1.5 to 2.5 hours, and with the addition of epinephrine it may Lidocaine was the first clinically used amide local anesthetic, having been introduced by Lofgren in 1948 Local Anesthetics and... anatomically distant structures One of the keys to using this technology effectively is a sound understanding of the physics behind ultrasonography A corollary to understanding the physics is the need for study and appreciation of the relevant human anatomy 10 Atlas of Regional Anesthesia Ultrasound is a form of acoustic energy defined as the longitudinal progression of pressure changes (Fig 1-10)... commonly used, although it may also be used as a 0.5% hypobaric solution in a volume of 6 to 8 mL Others use lidocaine as a short-acting 2% solution in a volume of 2 to 3 mL The suggestion that lidocaine causes an unacceptable frequency of neurotoxicity with spinal use needs to be balanced against its long history of use I believe that the basic science research may not completely reflect the typical... seamless By convention, whiter (hyperechoic) objects represent a larger degree of reflection and higher signal intensities, whereas darker (hypoechoic) images represent less reflection and weaker signal intensities Clinical Issues Related to Physics Resolution. Resolution refers to the ability to clearly distinguish two structures lying beside one another Although there are several different types of... important is being able to positively identify blood vessels by visualizing color flow This is especially important when interrogating a projected trajectory of the needle when placing a block By placing color-flow Doppler over the expected needle path, the clinician should be able to screen for and avoid any unanticipated vasculature General Principles of an UltrasonographyGuided Nerve Block During ultrasonographic... Cardiotoxicity during systemic toxic reactions with bupivacaine became a concern in the 1980s Although it is clear that bupivacaine alters myocardial conduction more dramatically than lidocaine, the need for appropriate and rapid resuscitation during any systemic toxic reaction cannot be overemphasized Levobupivacaine is the single enantiomer (l-isomer) of bupivacaine and appears to have a systemic toxicity profile... anesthetics available and the varied techniques described Certainly, unfamiliarity with any subject will make it look complex; thus, the goal throughout this book is to simplify regional anesthesia rather than add to its complexity One of the first steps in simplifying regional anesthesia is to understand the two principal decisions necessary in prescribing a regional technique First, the appropriate technique . technology effectively is a sound understanding of the physics behind ultrasonography. A corollary to under- standing the physics is the need for study and appreciation of the relevant human anatomy. . and we have wisely chosen experts in our specialty to contribute to this edition. The first two editions of the Atlas were based on my experience in my practice; thankfully, as my academic practice. It may be used as an isobaric, hypobaric, or hyperbaric solution for spinal anesthesia. Without epinephrine it typically lasts 1.5 to 2.5 hours, and with the addition of epinephrine it may last