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Satyajeet Ghatge - One of the best experts on this subject based on the ideXlab platform.
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epidural injection of lidocaine reduces the response to dural puncture accompanying spinal Needle insertion when performing combined spinal epidural anesthesia
Anesthesia & Analgesia, 2005Co-Authors: Anton A Van Den Berg, Monzer Sadek, Steven Swanson, Satyajeet GhatgeAbstract:During placement of Needles for combined spinal-epidural anesthesia (CSEA), patients may experience pain, pressure, paresthesia, or discomfort during skin and deeper injection of local Anesthetic, Needle impingement on periosteum, dural puncture by the spinal Needle, and insertion of the epidural catheter. We investigated the incidence of perception of and spontaneous verbal and motor responses to insertion of a spinal Needle through the dura mater and pia mater and the effect of injecting lidocaine into the epidural space through the epidural Needle before inserting the spinal Needle through the meninges. Forty-three patients presenting for elective cesarean delivery under CSEA were studied. After localization of the epidural space using loss of resistance to air using a 17-gauge Tuohy Needle, either 3 mL preservative free normal saline or 3 mL lidocaine 2% plus epinephrine 1:200,000 was injected through the Tuohy Needle. "Needle through Needle" dural puncture was performed 1 min later using a 27-gauge Whitacre pencil-point Needle. At the moment of dural puncture, 2 (9%) parturients given lidocaine and 17 (81%) parturients given saline (P < 0.005) responded to dural puncture by spontaneously moving (33%), spontaneously vocalizing (62%), or, in response to direct questioning, by acknowledging (76%) having perceived sensation during thecal penetration. This study reveals that dural puncture by a Whitacre 27-gauge pencil-point Needle inserted through a Tuohy epidural Needle sited using loss of resistance to air causes involuntary movement, spontaneous vocalization, or is perceived by the majority of patients presenting for cesarean delivery under CSEA and that lidocaine injected into the epidural space before dural puncture largely eliminates these responses and sensations.
Timothy M Murphy - One of the best experts on this subject based on the ideXlab platform.
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a novel case of a broken dental Anesthetic Needle transecting the right internal carotid artery
Journal of the American Dental Association, 2016Co-Authors: Jeffrey Brooks, Timothy M MurphyAbstract:Abstract Background and Overview Although dental Anesthetic Needle fractures remain an uncommon occurrence, there is a lack of consensus on the management of the treatment of this complication. Complications could include trismus, dysphagia, or infection that may lead to more deleterious results. Case Description In this case study, a 47-year-old man underwent a routine dental extraction at a private office. During administration of the inferior alveolar nerve block, a dental Anesthetic Needle fractured. The general dental practitioner dismissed the patient and reassured him that no retrieval of the Needle was needed. Several weeks later, the patient sought care for severe, acute pain and dysphagia. Traditional retrieval techniques were unsuccessful, and the authors consulted the neurosurgery team. The patient underwent endovascular surgery with digital subtraction angiography for retrieval of the Needle from the right internal carotid artery. Conclusions and Practical Implications Most authors in the literature agree that proper technique and equipment are paramount in avoiding fractures of dental Anesthetic Needles. Although Needle fracture is a rare complication, immediate referral and retrieval of the broken Needle by an appropriately trained surgeon is essential for optimal outcomes. This case demonstrates an example of a broken Needle that migrated and transected the internal carotid artery at the jugular foramen. All dental practitioners must be cognizant of the potentially serious complications associated with a retained broken Needle.
Anton A Van Den Berg - One of the best experts on this subject based on the ideXlab platform.
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epidural injection of lidocaine reduces the response to dural puncture accompanying spinal Needle insertion when performing combined spinal epidural anesthesia
Anesthesia & Analgesia, 2005Co-Authors: Anton A Van Den Berg, Monzer Sadek, Steven Swanson, Satyajeet GhatgeAbstract:During placement of Needles for combined spinal-epidural anesthesia (CSEA), patients may experience pain, pressure, paresthesia, or discomfort during skin and deeper injection of local Anesthetic, Needle impingement on periosteum, dural puncture by the spinal Needle, and insertion of the epidural catheter. We investigated the incidence of perception of and spontaneous verbal and motor responses to insertion of a spinal Needle through the dura mater and pia mater and the effect of injecting lidocaine into the epidural space through the epidural Needle before inserting the spinal Needle through the meninges. Forty-three patients presenting for elective cesarean delivery under CSEA were studied. After localization of the epidural space using loss of resistance to air using a 17-gauge Tuohy Needle, either 3 mL preservative free normal saline or 3 mL lidocaine 2% plus epinephrine 1:200,000 was injected through the Tuohy Needle. "Needle through Needle" dural puncture was performed 1 min later using a 27-gauge Whitacre pencil-point Needle. At the moment of dural puncture, 2 (9%) parturients given lidocaine and 17 (81%) parturients given saline (P < 0.005) responded to dural puncture by spontaneously moving (33%), spontaneously vocalizing (62%), or, in response to direct questioning, by acknowledging (76%) having perceived sensation during thecal penetration. This study reveals that dural puncture by a Whitacre 27-gauge pencil-point Needle inserted through a Tuohy epidural Needle sited using loss of resistance to air causes involuntary movement, spontaneous vocalization, or is perceived by the majority of patients presenting for cesarean delivery under CSEA and that lidocaine injected into the epidural space before dural puncture largely eliminates these responses and sensations.
Jeffrey Brooks - One of the best experts on this subject based on the ideXlab platform.
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a novel case of a broken dental Anesthetic Needle transecting the right internal carotid artery
Journal of the American Dental Association, 2016Co-Authors: Jeffrey Brooks, Timothy M MurphyAbstract:Abstract Background and Overview Although dental Anesthetic Needle fractures remain an uncommon occurrence, there is a lack of consensus on the management of the treatment of this complication. Complications could include trismus, dysphagia, or infection that may lead to more deleterious results. Case Description In this case study, a 47-year-old man underwent a routine dental extraction at a private office. During administration of the inferior alveolar nerve block, a dental Anesthetic Needle fractured. The general dental practitioner dismissed the patient and reassured him that no retrieval of the Needle was needed. Several weeks later, the patient sought care for severe, acute pain and dysphagia. Traditional retrieval techniques were unsuccessful, and the authors consulted the neurosurgery team. The patient underwent endovascular surgery with digital subtraction angiography for retrieval of the Needle from the right internal carotid artery. Conclusions and Practical Implications Most authors in the literature agree that proper technique and equipment are paramount in avoiding fractures of dental Anesthetic Needles. Although Needle fracture is a rare complication, immediate referral and retrieval of the broken Needle by an appropriately trained surgeon is essential for optimal outcomes. This case demonstrates an example of a broken Needle that migrated and transected the internal carotid artery at the jugular foramen. All dental practitioners must be cognizant of the potentially serious complications associated with a retained broken Needle.
Monzer Sadek - One of the best experts on this subject based on the ideXlab platform.
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epidural injection of lidocaine reduces the response to dural puncture accompanying spinal Needle insertion when performing combined spinal epidural anesthesia
Anesthesia & Analgesia, 2005Co-Authors: Anton A Van Den Berg, Monzer Sadek, Steven Swanson, Satyajeet GhatgeAbstract:During placement of Needles for combined spinal-epidural anesthesia (CSEA), patients may experience pain, pressure, paresthesia, or discomfort during skin and deeper injection of local Anesthetic, Needle impingement on periosteum, dural puncture by the spinal Needle, and insertion of the epidural catheter. We investigated the incidence of perception of and spontaneous verbal and motor responses to insertion of a spinal Needle through the dura mater and pia mater and the effect of injecting lidocaine into the epidural space through the epidural Needle before inserting the spinal Needle through the meninges. Forty-three patients presenting for elective cesarean delivery under CSEA were studied. After localization of the epidural space using loss of resistance to air using a 17-gauge Tuohy Needle, either 3 mL preservative free normal saline or 3 mL lidocaine 2% plus epinephrine 1:200,000 was injected through the Tuohy Needle. "Needle through Needle" dural puncture was performed 1 min later using a 27-gauge Whitacre pencil-point Needle. At the moment of dural puncture, 2 (9%) parturients given lidocaine and 17 (81%) parturients given saline (P < 0.005) responded to dural puncture by spontaneously moving (33%), spontaneously vocalizing (62%), or, in response to direct questioning, by acknowledging (76%) having perceived sensation during thecal penetration. This study reveals that dural puncture by a Whitacre 27-gauge pencil-point Needle inserted through a Tuohy epidural Needle sited using loss of resistance to air causes involuntary movement, spontaneous vocalization, or is perceived by the majority of patients presenting for cesarean delivery under CSEA and that lidocaine injected into the epidural space before dural puncture largely eliminates these responses and sensations.