The Experts below are selected from a list of 159 Experts worldwide ranked by ideXlab platform
J J Pandit - One of the best experts on this subject based on the ideXlab platform.
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comparison of intermediate vs subcutaneous Cervical plexus block for carotid endarterectomy
BJA: British Journal of Anaesthesia, 2011Co-Authors: Satya Krishna Ramachandran, Paul Picton, Amy Shanks, Perma Dorje, J J PanditAbstract:BACKGROUND: Carotid endarterectomy surgery can be performed under regional anaesthesia alone or under general anaesthesia. However, there are several types of regional block available and reported complication rates after superficial Cervical plexus blocks are significantly lower than Deep blocks. It is not known if subcutaneous and intermediate blocks are equally effective, although anatomical evidence suggests that the latter (where the injectate diffuses below the Deep Cervical Fascia) might provide superior quality of intraoperative anaesthesia. METHODS: Forty-four patients were randomized to receive either subcutaneous or intermediate Cervical plexus blocks for carotid endarterectomy. The primary endpoint was supplemental lidocaine requirement during surgery. Secondary outcome measures included: total amount of fentanyl administered during surgery, recall of pain scores during surgery, complications, and patient and surgeon satisfaction. RESULTS: There was no statistically significant difference for median (range) lidocaine supplementation between the subcutaneous and intermediate groups 65 (20-170) mg vs. 85 (30-345) mg, respectively; P=0.31. There were no statistical differences in the secondary outcome measures and no major complications during the study. CONCLUSIONS: Intermediate and subcutaneous Cervical plexus blocks are equally effective for carotid endarterectomy. This study adds to the body of evidence supporting the safe use of superficial blocks for this type of surgery.
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spread of injectate with superficial Cervical plexus block in humans an anatomical study
BJA: British Journal of Anaesthesia, 2003Co-Authors: J J Pandit, D Dutta, J F MorrisAbstract:Background This study was undertaken to investigate why the superficial Cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the Deep Cervical Fascia and blocks the Cervical nerves at their roots. Methods Superficial Cervical plexus blocks (injections just below the investing Fascia) were performed using methylene blue (30 ml) in four cadavers. In one additional control cadaver, a Deep Cervical plexus injection was performed. In a second control cadaver, a subcutaneous injection (superficial to investing Fascia) was performed at the posterior border of the sternomastoid muscle. Results Anatomical dissection showed that with superficial block there was spread of the dye to structures beneath the Deep Cervical Fascia. In the first control, dye remained in the Deep Cervical space. In the second control, dye remained subcutaneous. Conclusions The superficial Cervical space communicates with the Deep Cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial Cervical plexus block is below the investing Fascia of the neck, and not just subcutaneous.
Ming Zhang - One of the best experts on this subject based on the ideXlab platform.
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does the investing layer of the Deep Cervical Fascia exist
Anesthesiology, 2005Co-Authors: Lance Nash, H D Nicholson, Ming ZhangAbstract:Background:The placement of the superficial Cervical plexus block has been the subject of controversy. Although the investing Cervical Fascia has been considered as an impenetrable barrier, clinically, the placement of the block Deep or superficial to the Fascia provides the same effective anesthesi
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the investing layer of the Deep Cervical Fascia does not exist between the sternocleidomastoid and trapezius muscles
Otolaryngology-Head and Neck Surgery, 2002Co-Authors: Ming Zhang, Antonio S J LeeAbstract:Abstract Objective: We sought to describe the 3-dimensional organization of connective tissues in the suboccipital region. Study Design and Setting: We conducted a sectional anatomic investigation with the use of E12 sheet plastination. Subjects: Six human adult cadavers (2 male and 4 female; age range, 54 to 86 years) were used in this study. Five of them were sectioned as 2.5-mm-thick coronal (1 cadaver), transverse (2 cadavers), or sagittal (2 cadavers) sections. Results: No aggregation of fibrous connective tissue was seen between the sternocleidomastoid and trapezius muscles. The intervening space was fully occupied by fatty tissue that was indistinguishable from the subcutaneous tissue. Conclusions: The investing layer of the Deep Cervical Fascia is incomplete so that the carotid sheath is directly exposed to the subcutaneous tissue via a gap between the sternocleidomastoid and trapezius muscle. Significance: This anatomic feature should be considered when designing a minimally invasive endoscopic approach to the carotid sheath and the surrounding Deep Cervical structures. (Otolaryngol Head Neck Surg 2002;127:452-7.)
Sung Tae Kim - One of the best experts on this subject based on the ideXlab platform.
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Nodular Fasciitis in the Head and Neck: CT and MR Imaging Findings
2015Co-Authors: Sung Tae Kim, Hyung-jin Kim, Sun-won Park, Jung Hwan Baek, Hong Sik Byun, Young Mo KimAbstract:imaging findings of nodular fasciitis occurring in the head and neck region. METHODS: CT (n 6) and MR (n 4) images obtained from 7 patients (3 men and 4 women; mean age, 19.4 years; age range, 1–48 years) with surgically confirmed nodular fasciitis in the head and neck were retrospectively reviewed. All patients presented with a palpable mass in the head and neck that was noticed 1–3 months earlier: 5 in the face, one in the occipital scalp, and the remaining one in the supraclavicular fossa. We investigated the CT and MR imaging characteristics with emphasis on the location, size, internal content, margin, enhance-ment pattern, and signal intensity of the lesion. RESULTS: All lesions appeared as a discrete mass on imaging, ranging from 1.0 cm to 4.6 cm in diameter (mean, 2.2 cm). Six lesions, all of which appeared benign, were located in the subcutaneous tissue superficial to the Deep Cervical Fascia. The remaining lesion was located Deep to the temporalis muscle and showed an aggressive imaging appearance, markedly eroding the bony orbit and skull. Five lesions were solid, and 2 lesions were partly or completely cystic in appearance. Five lesions were well defined, whereas 2 lesions were ill defined. Four of 5 solid lesions showed moderate to marked diffuse enhancement, whereas the remaining lesion dem
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nodular fasciitis in the head and neck ct and mr imaging findings
American Journal of Neuroradiology, 2005Co-Authors: Sung Tae Kim, Hyung-jin Kim, Sun-won Park, Jung Hwan Baek, Hong Sik Byun, Young Mo KimAbstract:BACKGROUND AND PURPOSE: The purpose of this study was to describe the CT and MR imaging findings of nodular fasciitis occurring in the head and neck region. METHODS: CT ( n = 6) and MR ( n = 4) images obtained from 7 patients (3 men and 4 women; mean age, 19.4 years; age range, 1–48 years) with surgically confirmed nodular fasciitis in the head and neck were retrospectively reviewed. All patients presented with a palpable mass in the head and neck that was noticed 1–3 months earlier: 5 in the face, one in the occipital scalp, and the remaining one in the supraclavicular fossa. We investigated the CT and MR imaging characteristics with emphasis on the location, size, internal content, margin, enhancement pattern, and signal intensity of the lesion. RESULTS: All lesions appeared as a discrete mass on imaging, ranging from 1.0 cm to 4.6 cm in diameter (mean, 2.2 cm). Six lesions, all of which appeared benign, were located in the subcutaneous tissue superficial to the Deep Cervical Fascia. The remaining lesion was located Deep to the temporalis muscle and showed an aggressive imaging appearance, markedly eroding the bony orbit and skull. Five lesions were solid, and 2 lesions were partly or completely cystic in appearance. Five lesions were well defined, whereas 2 lesions were ill defined. Four of 5 solid lesions showed moderate to marked diffuse enhancement, whereas the remaining lesion demonstrated mild enhancement. Two cystic lesions showed peripheral, nodular, or rimlike enhancement. Compared with muscle, both solid lesions had isointense signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images, whereas the signal intensity of the solid portions of the Deep-seated, partly cystic lesion was isointense on both T1-weighted and T2-weighted images. CONCLUSION: Although rare, nodular fasciitis occurs as a discrete solid or cystic mass in the head and neck, depending on the predominant stromal components. When one sees a head and neck mass with a superficial location and moderate to marked enhancement on CT and MR imaging, nodular fasciitis should be included in the differential diagnosis, especially in patients with a recently developed, rapidly growing mass and a history of recent trauma.
Satya Krishna Ramachandran - One of the best experts on this subject based on the ideXlab platform.
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comparison of intermediate vs subcutaneous Cervical plexus block for carotid endarterectomy
BJA: British Journal of Anaesthesia, 2011Co-Authors: Satya Krishna Ramachandran, Paul Picton, Amy Shanks, Perma Dorje, J J PanditAbstract:BACKGROUND: Carotid endarterectomy surgery can be performed under regional anaesthesia alone or under general anaesthesia. However, there are several types of regional block available and reported complication rates after superficial Cervical plexus blocks are significantly lower than Deep blocks. It is not known if subcutaneous and intermediate blocks are equally effective, although anatomical evidence suggests that the latter (where the injectate diffuses below the Deep Cervical Fascia) might provide superior quality of intraoperative anaesthesia. METHODS: Forty-four patients were randomized to receive either subcutaneous or intermediate Cervical plexus blocks for carotid endarterectomy. The primary endpoint was supplemental lidocaine requirement during surgery. Secondary outcome measures included: total amount of fentanyl administered during surgery, recall of pain scores during surgery, complications, and patient and surgeon satisfaction. RESULTS: There was no statistically significant difference for median (range) lidocaine supplementation between the subcutaneous and intermediate groups 65 (20-170) mg vs. 85 (30-345) mg, respectively; P=0.31. There were no statistical differences in the secondary outcome measures and no major complications during the study. CONCLUSIONS: Intermediate and subcutaneous Cervical plexus blocks are equally effective for carotid endarterectomy. This study adds to the body of evidence supporting the safe use of superficial blocks for this type of surgery.
J F Morris - One of the best experts on this subject based on the ideXlab platform.
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spread of injectate with superficial Cervical plexus block in humans an anatomical study
BJA: British Journal of Anaesthesia, 2003Co-Authors: J J Pandit, D Dutta, J F MorrisAbstract:Background This study was undertaken to investigate why the superficial Cervical plexus block for carotid endarterectomy is so effective. Initial consideration would suggest that a superficial injection would be unlikely to block all terminal fibres of relevant nerves. One possibility is that the local anaesthetic crosses the Deep Cervical Fascia and blocks the Cervical nerves at their roots. Methods Superficial Cervical plexus blocks (injections just below the investing Fascia) were performed using methylene blue (30 ml) in four cadavers. In one additional control cadaver, a Deep Cervical plexus injection was performed. In a second control cadaver, a subcutaneous injection (superficial to investing Fascia) was performed at the posterior border of the sternomastoid muscle. Results Anatomical dissection showed that with superficial block there was spread of the dye to structures beneath the Deep Cervical Fascia. In the first control, dye remained in the Deep Cervical space. In the second control, dye remained subcutaneous. Conclusions The superficial Cervical space communicates with the Deep Cervical space and this may explain the efficacy of the superficial block. The method of communication remains unknown. Our findings also indicate that the suitable site of injection for the superficial Cervical plexus block is below the investing Fascia of the neck, and not just subcutaneous.
