The Experts below are selected from a list of 33 Experts worldwide ranked by ideXlab platform

Misa Dzoljic - One of the best experts on this subject based on the ideXlab platform.

  • spinal anesthesia as a complication of brachial plexus block using the posterior approach
    Anesthesia & Analgesia, 2002
    Co-Authors: M Aramideh, Huub L A Van Den Oever, Gerard J Walstra, Misa Dzoljic
    Abstract:

    For surgical procedures of the upper extremities, the brachial plexus block is a suitable technique and offers several advantages for the patient, surgeon, and anesthesiologist (1). The brachial plexus block can be performed at several sites, but the most frequently used are the axillary, interscalene, infraclavicular, and supraclavicular approaches (2). Pippa et al. (3) described an alternative, posterior approach to the plexus with a similar field of analgesia. In this article, we report a patient who developed a lifethreatening paralysis without loss of consciousness during a brachial plexus block with the posterior approach. Case Report A 52-yr-old man (weight, 90 kg; height, 180 cm) was scheduled for acromioplasty of the left shoulder. His medical history was remarkable for gastric ulcerations, herniated L2-3 disc, and previous arthroscopy of the same shoulder under a brachial plexus block with the posterior approach. The patient requested the same anesthetic procedure. Before brachial plexus blockade, a 16-gauge IV cannula was inserted. Routine monitoring included electrocardiogram, pulse oxymetry, and automated blood pressure measurement. The patient was placed in a sitting position with the head bent forward. A hollow Teflon-coated Needle (100mm, 21-gauge, Short-Bevel Needle, Stimuplex ® A; B. Braun, Melsungen, Germany) was introduced 3 cm left of the midline at the intervertebral space C6-7 and was advanced perpendicular to the skin in a sagittal plane. The introduction was smooth, without contacting lamina C6 or the transverse process of C7. Contractions of the triceps muscles were noted on the first attempt, and the Needle was immobilized at a depth of approximately 6 cm. After negative aspiration, bupivacaine 0.37% (without epinephrine) was slowly injected. The aspiration test was repeated after every 5 mL. Injection was painless, and the muscle contractions, which could be evoked at a current of 0.44 mA, disappeared after the first bolus of local anesthetic. A few minutes after the start of injection (18 mL bupivacaine), a slight acceleration in heart rate (from 75 to 90 bpm) was noted, and the patient reported feeling unwell. Injection was stopped immediately. His upper body drifted slowly backward, and he was unable to vocalize. The Needle was removed, and the patient was placed in the supine position. Within a few seconds, total flaccid paralysis of all extremities and apnea were noted. The blood pressure decreased to 80/40 mm Hg; the patient was still able to move his eyes on command. He was told that ventilation would be assisted. In the following minutes he was ventilated with 100% oxygen by use of a face mask, and general anesthesia was induced with etomidate (0.25 mg/kg), succinylcholine (1 mg/kg), and fentanyl (2 g/kg) IV. Anesthesia was maintained with isoflurane (0.7%–1.5% end-tidal concentration) in an oxygen/nitrous oxide mixture (fraction of inspired oxygen, 0.3). Acromioplasty was initiated under general anesthesia and was performed without complications. During the 2-h operation, ephedrine (5 mg) was administered three times because of hypotension and bradycardia. After the operation, the patient awoke and was able to breathe spontaneously. There was full motor control and normal sensibility of the left upper extremity. Further neurologic examination showed a left-sided miosis and ptosis. The patient reported that, until oxygenation through a face mask was introduced, he was able to understand the verbal commands, but was unable to move his extremities, talk, or breathe. The patient was told that paralysis had occurred during brachial plexus blockade, and questions and fears were discussed. Professional psychological support was offered, but the patient considered this unnecessary.

M Aramideh - One of the best experts on this subject based on the ideXlab platform.

  • spinal anesthesia as a complication of brachial plexus block using the posterior approach
    Anesthesia & Analgesia, 2002
    Co-Authors: M Aramideh, Huub L A Van Den Oever, Gerard J Walstra, Misa Dzoljic
    Abstract:

    For surgical procedures of the upper extremities, the brachial plexus block is a suitable technique and offers several advantages for the patient, surgeon, and anesthesiologist (1). The brachial plexus block can be performed at several sites, but the most frequently used are the axillary, interscalene, infraclavicular, and supraclavicular approaches (2). Pippa et al. (3) described an alternative, posterior approach to the plexus with a similar field of analgesia. In this article, we report a patient who developed a lifethreatening paralysis without loss of consciousness during a brachial plexus block with the posterior approach. Case Report A 52-yr-old man (weight, 90 kg; height, 180 cm) was scheduled for acromioplasty of the left shoulder. His medical history was remarkable for gastric ulcerations, herniated L2-3 disc, and previous arthroscopy of the same shoulder under a brachial plexus block with the posterior approach. The patient requested the same anesthetic procedure. Before brachial plexus blockade, a 16-gauge IV cannula was inserted. Routine monitoring included electrocardiogram, pulse oxymetry, and automated blood pressure measurement. The patient was placed in a sitting position with the head bent forward. A hollow Teflon-coated Needle (100mm, 21-gauge, Short-Bevel Needle, Stimuplex ® A; B. Braun, Melsungen, Germany) was introduced 3 cm left of the midline at the intervertebral space C6-7 and was advanced perpendicular to the skin in a sagittal plane. The introduction was smooth, without contacting lamina C6 or the transverse process of C7. Contractions of the triceps muscles were noted on the first attempt, and the Needle was immobilized at a depth of approximately 6 cm. After negative aspiration, bupivacaine 0.37% (without epinephrine) was slowly injected. The aspiration test was repeated after every 5 mL. Injection was painless, and the muscle contractions, which could be evoked at a current of 0.44 mA, disappeared after the first bolus of local anesthetic. A few minutes after the start of injection (18 mL bupivacaine), a slight acceleration in heart rate (from 75 to 90 bpm) was noted, and the patient reported feeling unwell. Injection was stopped immediately. His upper body drifted slowly backward, and he was unable to vocalize. The Needle was removed, and the patient was placed in the supine position. Within a few seconds, total flaccid paralysis of all extremities and apnea were noted. The blood pressure decreased to 80/40 mm Hg; the patient was still able to move his eyes on command. He was told that ventilation would be assisted. In the following minutes he was ventilated with 100% oxygen by use of a face mask, and general anesthesia was induced with etomidate (0.25 mg/kg), succinylcholine (1 mg/kg), and fentanyl (2 g/kg) IV. Anesthesia was maintained with isoflurane (0.7%–1.5% end-tidal concentration) in an oxygen/nitrous oxide mixture (fraction of inspired oxygen, 0.3). Acromioplasty was initiated under general anesthesia and was performed without complications. During the 2-h operation, ephedrine (5 mg) was administered three times because of hypotension and bradycardia. After the operation, the patient awoke and was able to breathe spontaneously. There was full motor control and normal sensibility of the left upper extremity. Further neurologic examination showed a left-sided miosis and ptosis. The patient reported that, until oxygenation through a face mask was introduced, he was able to understand the verbal commands, but was unable to move his extremities, talk, or breathe. The patient was told that paralysis had occurred during brachial plexus blockade, and questions and fears were discussed. Professional psychological support was offered, but the patient considered this unnecessary.

Gerard J Walstra - One of the best experts on this subject based on the ideXlab platform.

  • spinal anesthesia as a complication of brachial plexus block using the posterior approach
    Anesthesia & Analgesia, 2002
    Co-Authors: M Aramideh, Huub L A Van Den Oever, Gerard J Walstra, Misa Dzoljic
    Abstract:

    For surgical procedures of the upper extremities, the brachial plexus block is a suitable technique and offers several advantages for the patient, surgeon, and anesthesiologist (1). The brachial plexus block can be performed at several sites, but the most frequently used are the axillary, interscalene, infraclavicular, and supraclavicular approaches (2). Pippa et al. (3) described an alternative, posterior approach to the plexus with a similar field of analgesia. In this article, we report a patient who developed a lifethreatening paralysis without loss of consciousness during a brachial plexus block with the posterior approach. Case Report A 52-yr-old man (weight, 90 kg; height, 180 cm) was scheduled for acromioplasty of the left shoulder. His medical history was remarkable for gastric ulcerations, herniated L2-3 disc, and previous arthroscopy of the same shoulder under a brachial plexus block with the posterior approach. The patient requested the same anesthetic procedure. Before brachial plexus blockade, a 16-gauge IV cannula was inserted. Routine monitoring included electrocardiogram, pulse oxymetry, and automated blood pressure measurement. The patient was placed in a sitting position with the head bent forward. A hollow Teflon-coated Needle (100mm, 21-gauge, Short-Bevel Needle, Stimuplex ® A; B. Braun, Melsungen, Germany) was introduced 3 cm left of the midline at the intervertebral space C6-7 and was advanced perpendicular to the skin in a sagittal plane. The introduction was smooth, without contacting lamina C6 or the transverse process of C7. Contractions of the triceps muscles were noted on the first attempt, and the Needle was immobilized at a depth of approximately 6 cm. After negative aspiration, bupivacaine 0.37% (without epinephrine) was slowly injected. The aspiration test was repeated after every 5 mL. Injection was painless, and the muscle contractions, which could be evoked at a current of 0.44 mA, disappeared after the first bolus of local anesthetic. A few minutes after the start of injection (18 mL bupivacaine), a slight acceleration in heart rate (from 75 to 90 bpm) was noted, and the patient reported feeling unwell. Injection was stopped immediately. His upper body drifted slowly backward, and he was unable to vocalize. The Needle was removed, and the patient was placed in the supine position. Within a few seconds, total flaccid paralysis of all extremities and apnea were noted. The blood pressure decreased to 80/40 mm Hg; the patient was still able to move his eyes on command. He was told that ventilation would be assisted. In the following minutes he was ventilated with 100% oxygen by use of a face mask, and general anesthesia was induced with etomidate (0.25 mg/kg), succinylcholine (1 mg/kg), and fentanyl (2 g/kg) IV. Anesthesia was maintained with isoflurane (0.7%–1.5% end-tidal concentration) in an oxygen/nitrous oxide mixture (fraction of inspired oxygen, 0.3). Acromioplasty was initiated under general anesthesia and was performed without complications. During the 2-h operation, ephedrine (5 mg) was administered three times because of hypotension and bradycardia. After the operation, the patient awoke and was able to breathe spontaneously. There was full motor control and normal sensibility of the left upper extremity. Further neurologic examination showed a left-sided miosis and ptosis. The patient reported that, until oxygenation through a face mask was introduced, he was able to understand the verbal commands, but was unable to move his extremities, talk, or breathe. The patient was told that paralysis had occurred during brachial plexus blockade, and questions and fears were discussed. Professional psychological support was offered, but the patient considered this unnecessary.

Huub L A Van Den Oever - One of the best experts on this subject based on the ideXlab platform.

  • spinal anesthesia as a complication of brachial plexus block using the posterior approach
    Anesthesia & Analgesia, 2002
    Co-Authors: M Aramideh, Huub L A Van Den Oever, Gerard J Walstra, Misa Dzoljic
    Abstract:

    For surgical procedures of the upper extremities, the brachial plexus block is a suitable technique and offers several advantages for the patient, surgeon, and anesthesiologist (1). The brachial plexus block can be performed at several sites, but the most frequently used are the axillary, interscalene, infraclavicular, and supraclavicular approaches (2). Pippa et al. (3) described an alternative, posterior approach to the plexus with a similar field of analgesia. In this article, we report a patient who developed a lifethreatening paralysis without loss of consciousness during a brachial plexus block with the posterior approach. Case Report A 52-yr-old man (weight, 90 kg; height, 180 cm) was scheduled for acromioplasty of the left shoulder. His medical history was remarkable for gastric ulcerations, herniated L2-3 disc, and previous arthroscopy of the same shoulder under a brachial plexus block with the posterior approach. The patient requested the same anesthetic procedure. Before brachial plexus blockade, a 16-gauge IV cannula was inserted. Routine monitoring included electrocardiogram, pulse oxymetry, and automated blood pressure measurement. The patient was placed in a sitting position with the head bent forward. A hollow Teflon-coated Needle (100mm, 21-gauge, Short-Bevel Needle, Stimuplex ® A; B. Braun, Melsungen, Germany) was introduced 3 cm left of the midline at the intervertebral space C6-7 and was advanced perpendicular to the skin in a sagittal plane. The introduction was smooth, without contacting lamina C6 or the transverse process of C7. Contractions of the triceps muscles were noted on the first attempt, and the Needle was immobilized at a depth of approximately 6 cm. After negative aspiration, bupivacaine 0.37% (without epinephrine) was slowly injected. The aspiration test was repeated after every 5 mL. Injection was painless, and the muscle contractions, which could be evoked at a current of 0.44 mA, disappeared after the first bolus of local anesthetic. A few minutes after the start of injection (18 mL bupivacaine), a slight acceleration in heart rate (from 75 to 90 bpm) was noted, and the patient reported feeling unwell. Injection was stopped immediately. His upper body drifted slowly backward, and he was unable to vocalize. The Needle was removed, and the patient was placed in the supine position. Within a few seconds, total flaccid paralysis of all extremities and apnea were noted. The blood pressure decreased to 80/40 mm Hg; the patient was still able to move his eyes on command. He was told that ventilation would be assisted. In the following minutes he was ventilated with 100% oxygen by use of a face mask, and general anesthesia was induced with etomidate (0.25 mg/kg), succinylcholine (1 mg/kg), and fentanyl (2 g/kg) IV. Anesthesia was maintained with isoflurane (0.7%–1.5% end-tidal concentration) in an oxygen/nitrous oxide mixture (fraction of inspired oxygen, 0.3). Acromioplasty was initiated under general anesthesia and was performed without complications. During the 2-h operation, ephedrine (5 mg) was administered three times because of hypotension and bradycardia. After the operation, the patient awoke and was able to breathe spontaneously. There was full motor control and normal sensibility of the left upper extremity. Further neurologic examination showed a left-sided miosis and ptosis. The patient reported that, until oxygenation through a face mask was introduced, he was able to understand the verbal commands, but was unable to move his extremities, talk, or breathe. The patient was told that paralysis had occurred during brachial plexus blockade, and questions and fears were discussed. Professional psychological support was offered, but the patient considered this unnecessary.

Tinni T. Maskoen - One of the best experts on this subject based on the ideXlab platform.

  • Perbandingan Penggunaan Jarum Sudut Tumpul dengan Jarum Tuohy untuk Transversus Abdominis Plane Block terhadap Penyebaran Anestetik Lokal pada Operasi Ginekologi
    Universitas Padjadjaran, 2015
    Co-Authors: Aris Darmoko, Dedi Fitri Yadi, Tinni T. Maskoen
    Abstract:

    Tranversus abdominis plane block (TAPB) is one of the regional anesthesia techniques which enable multimodal analgesia involving skin incision in abdominal wall. This study aimed to compare the use of Short Bevel Needle and tuohy Needle for TAPB on the spread of local anesthetics in gynecological surgeries through a experimental randomized single blind trial. This study was conducted in Dr. Hasan Sadikin General Hospital Bandung on July–August 2014 to 30 woman between 18–60 years with the American Society of Anesthesiologists (ASA) physical status I–II underwent gynecological surgery under general anesthesia. The subjects were divided into 2 groups, Short Bevel Needle and tuohy Needle groups. The block was given on both sides of the abdomen using 20 mL of bupivacaine 0.125%. Before and after TAPB, an ultrasonography was performed to assess the spread of local anesthetics. Mann Whitney and Z test were used for statistical analysis. The results showed the spread of local anesthetic with Short Bevel Needle was 50%, and with tuohy Needle was 26.7%, the difference based on statistical analysis was significant (p