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Shuchiung Chiang - One of the best experts on this subject based on the ideXlab platform.
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the impact of exsanguination by Esmarch Bandage on venous hemodynamic changes in total knee arthroplasty a prospective randomized study of 38 knees
Knee, 2012Co-Authors: Fangyao Chiu, Shihhsin Hung, Tienyow Chuang, Shuchiung ChiangAbstract:Elastic (Esmarch) Bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch Bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch Bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set. We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch Bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch Bandage before knee arthroplasty.
Dimitrios Pavlakis - One of the best experts on this subject based on the ideXlab platform.
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fatal intra operative pulmonary embolism following application of an Esmarch Bandage
Injury-international Journal of The Care of The Injured, 2002Co-Authors: Spyridon Darmanis, Athanasios Papanikolaou, Dimitrios PavlakisAbstract:The objective of this paper is to raise the awareness of a possible fatal complication during operations in the lower limbs, when an Esmarch Bandage is used for exsanguination of the affected limb during the operation. After reviewing the literature, four cases of fatal massive pulmonary embolism have been identified after Esmarch Bandage application in trauma patients [Acta Anaesthesiol Belg 50(2) (1999) 95, Reg. Anaesth 6 (1983) 83, Anesthesiology 58 (1983) 373, Anaesthesia 25(3) (1970) 445] but there is no any reference to an elective case. The authors would like to report two cases of fatal embolism after Esmarch Bandage application for both elective surgery (total knee replacement) and trauma (trimalleolar fracture). Both patients had received regional anaesthesia. After comparing the data from our cases and the literature, it is recommended that the Esmarch Bandage should not be used in trauma, especially when there has been a delay in time for surgery. In elective cases of the lower limbs, preoperative cardiovascular evaluation and the exclusion of other factors predisposing to DVT are necessary, especially for patients more than 50 years old.
Mingjiuh Wang - One of the best experts on this subject based on the ideXlab platform.
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massive pulmonary embolism after application of an Esmarch Bandage
Anesthesia & Analgesia, 2004Co-Authors: Yisharng Chen, Mingjiuh WangAbstract:UNLABELLED A 71-yr-old patient who underwent spinal anesthesia for left femoral fracture operation became hypotensive and unconscious after the application of an Esmarch Bandage. The transesophageal echocardiography performed during resuscitation revealed pulmonary embolism and acute right ventricular failure. Pulmonary embolectomy with cardiopulmonary bypass was undertaken immediately after the echocardiographic diagnosis. Extracorporeal membrane oxygenation was used after the operation to support the failing right ventricle. The patient was successfully weaned from extracorporeal membrane oxygenation 10 days after the operation. We conclude that transesophageal echocardiography can be very useful in the immediate differential diagnosis of sudden cardiovascular collapse and that extracorporeal membrane oxygenation can be very helpful when acute right ventricular failure follows massive pulmonary embolism. IMPLICATIONS Transesophageal echocardiography was highly valuable in finding the cause of sudden intraoperative cardiovascular collapse. The use of extracorporeal membrane oxygenation to support the failing right ventricle after emergent pulmonary embolectomy could help to rescue patients with massive pulmonary embolism.
P H Rosenberg - One of the best experts on this subject based on the ideXlab platform.
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comparison of 0 5 articaine and 0 5 prilocaine in intravenous regional anesthesia of the arm a cross over study in volunteers
Regional Anesthesia and Pain Medicine, 1999Co-Authors: M Pitkanen, Mei Xu, Juhani Haasio, P H RosenbergAbstract:Abstract Background and Objectives. Earlier studies of the use of articaine in intravenous regional anesthesia (IVRA) are conflicting. In fact, despite similar physicochemical properties and regional anesthetic action, significant differences between articaine and prilocaine in IVRA have been reported. Articaine, being a potent local anesthetic with low degree of toxicity and being rapidly metabolized by esterases, could be a useful local anesthetic particularly in IVRA and, perhaps, could challenge prilocaine, the present local anesthetic of choice for this technique. Methods. A double-blind, cross-over study of IVRA of the upper extremity in 10 healthy volunteers was performed. There was at least a 1-week interval between the use of the two anesthetics in each volunteer. After exsanguination with an Esmarch Bandage, IVRA was induced either with preservative-free 0.5% articaine (5% Ultracaine, Hoechst, Germany, diluted with 0.9% NaCl) or 0.5% prilocaine (Citanest, Astra, Sodertalje, Sweden) (35–50 mL, according to weight), injected in 2 minutes. Sensation at defined skin spots that were innervated by the median, musculocutaneous, radial, and ulnar nerves was tested by pinprick; motor function was tested by the movements of the wrist. After 20 minutes, the tourniquet cuff was deflated in one step. Circulatory, toxic, and skin reactions were registered. At least 1 week after the second IVRA intracutaneous allergy testing with 0.5% articaine, 0.5% prilocaine, histamine, and saline was performed. Results. There were no significant differences between the two local anesthetics in the onset of analgesia or anesthesia, degree of motor block, and recovery of IVRA. Onset of analgesia occurred 4.2–5.6 minutes, on average, after the injection. One volunteer had short-lasting tinnitus after tourniquet cuff deflation when prilocaine was used. Erythematous nonitching skin rashes developed in 8 of 10 volunteers when articaine was used, and two volunteers had rashes when prilocaine was used. These rashes disappeared within an hour, and negative intracutaneous test results confirmed their nonallergic origin. Conclusion. Both 0.5% articaine and 0.5% prilocaine, in a median dose of 40 mL in adults, injected in 2 minutes, are effective and equipotent local anesthetics in IVRA of the arm. An earlier reported four-time faster onset time of the block by articaine in comparison with prilocaine may be caused by a very rapid injection rate (40 mL/30 sec) by the investigators of that study. The erythematous skin rashes after IVRA, in particular when articaine was used, may be a sign of venous endothelial irritation.
Fangyao Chiu - One of the best experts on this subject based on the ideXlab platform.
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the impact of exsanguination by Esmarch Bandage on venous hemodynamic changes in total knee arthroplasty a prospective randomized study of 38 knees
Knee, 2012Co-Authors: Fangyao Chiu, Shihhsin Hung, Tienyow Chuang, Shuchiung ChiangAbstract:Elastic (Esmarch) Bandage exsanguination is widely used in lower limb surgery to provide a bloodless operating field. Nevertheless, it is still not known exactly how exsanguination through Esmarch Bandage usage contributes to venous pressure physiology following TKA. We wished to determine whether exsanguination with Esmarch Bandage affects the venous hemodynamics of the lower limb in the first few weeks following TKA, so a prospectively randomized study was set. We prospectively collected consecutive 38 male patients with unilateral advanced osteoarthritis of the knee. All of the subjects were randomly assigned to one of two TKA procedures: TKA with (Group A) or without (Group B) Esmarch Bandage exsanguination. No pharmacologic thromboembolic prophylaxis was used in this study. The venous hemodynamics of each operated leg was assessed by strain-gage plethysmography, firstly before the operation, then postoperatively on days 2, 6, 14 and 28. The postoperative results revealed significant falls in venous outflow 2, 6 and 14 days following TKA in Group A; and 2 and 6 days following TKA in Group B. Twenty-eight days after TKA, venous outflow in both groups had returned to baseline level. Over the 28 days following the operation, Group A venous outflow tended to fall more significantly than in Group B. As with venous outflow, venous capacitance in both groups showed significant falls 2 and 6 days following TKA, with recovery to baseline levels 28 days postoperation. More significant falls in arterial filling index were recorded in Group A 6 days following TKA, returning to their baseline level 14 days postoperation. It appears that better leg venous hemodynamic changes are attained during the first month after TKA in Group B. We therefore question the need for exsanguination with Esmarch Bandage before knee arthroplasty.