Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Pati...Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.展开更多
Turner-Kieser syndrome is a rare genetic disorder, autosomal dominant, which is related to variable gene expression and high penetrance, due to mutations in the LMX1B gene that affects connective tissue. The clinic ha...Turner-Kieser syndrome is a rare genetic disorder, autosomal dominant, which is related to variable gene expression and high penetrance, due to mutations in the LMX1B gene that affects connective tissue. The clinic has characteristics with alterations in nails, knees, elbows, and presence of iliac horns that makes the anesthetic difficult. However, data in the literature needs more research on this area. The present report is a cesarean section under general intravenous anesthesia performed on a 32-week pregnant woman due to the maternal risk of full-term evolution and aims to contribute to the anesthetic management of patients with this syndrome as there are few descriptions in the literature regarding the anesthetic management in Turner-Kieser syndrome. Even being a case report, the syndrome is rare and it is important to be reported to all anesthesiologists becoming aware of its management and to choose the best technique and anticipate possible complications. During general anesthesia, the technique chosen for the case reported here, we emphasize the risks of possible difficulty in intubating and positioning the patient, as well as renal impairment caused by changes in the cardiovascular autonomic response due to the choice of some drugs. Therefore, in the present report, our option was intravenous general anesthesia because of maternal complications, where fast acting drugs without renal metabolism or excretion were selected, resulting in an uneventful anesthetic procedure.展开更多
文摘Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.
文摘Turner-Kieser syndrome is a rare genetic disorder, autosomal dominant, which is related to variable gene expression and high penetrance, due to mutations in the LMX1B gene that affects connective tissue. The clinic has characteristics with alterations in nails, knees, elbows, and presence of iliac horns that makes the anesthetic difficult. However, data in the literature needs more research on this area. The present report is a cesarean section under general intravenous anesthesia performed on a 32-week pregnant woman due to the maternal risk of full-term evolution and aims to contribute to the anesthetic management of patients with this syndrome as there are few descriptions in the literature regarding the anesthetic management in Turner-Kieser syndrome. Even being a case report, the syndrome is rare and it is important to be reported to all anesthesiologists becoming aware of its management and to choose the best technique and anticipate possible complications. During general anesthesia, the technique chosen for the case reported here, we emphasize the risks of possible difficulty in intubating and positioning the patient, as well as renal impairment caused by changes in the cardiovascular autonomic response due to the choice of some drugs. Therefore, in the present report, our option was intravenous general anesthesia because of maternal complications, where fast acting drugs without renal metabolism or excretion were selected, resulting in an uneventful anesthetic procedure.
