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  • 机译 进行腰穿时戴口罩:见习医生的当前实践快照
    摘要:PurposeInfective complications of lumbar puncture are not common, but are a significant source of mortality. Causative pathogens have been traced to the oropharynx of the operator, and it is likely that wearing facemasks will minimize the risk of iatrogenic meningitis. The aim of this survey was to assess whether doctors currently wear facemasks when performing lumbar punctures.
  • 机译 局部用眼用氨甲卡因缓解三叉神经痛
    摘要:BackgroundTrigeminal neuralgia (TGN) is a challenging pain syndrome.
  • 机译 局部麻醉药心脏毒性和脂质乳剂治疗的综述
    摘要:Cardiovascular collapse from accidental local anesthetic toxicity is a rare but catastrophic complication of regional anesthesia. The long-acting amide local anesthetics bupivacaine, levobupivacaine and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the chance discovery that lipid emulsion may improve the chance of successful resuscitation has lead to recommendations that it should be available in every location where regional anesthesia is performed. This review will outline the mechanisms of local anesthetic toxicity and the rationale for lipid emulsion therapy.
  • 机译 瑞芬太尼预防和治疗手术及手术后疼痛的功效和安全性综述
    摘要:Remifentanil is an ultrashort-acting synthetic opioid. It is metabolized by nonspecific tissue and plasma esterases. Remifentanil’s metabolism is responsible for its unique pharmacokinetic profile and flat, context-sensitive half-time. Since its introduction into clinical practice, remifentanil has been used for a variety of anesthetic and analgesic applications; however, concerns regarding a potential for rapid induction of tolerance and/or induced hyperalgesia, coupled with an ultrarapid offset of effect, make the drug less than optimal for use in the pharmacologic management of pain.
  • 机译 新型利多卡因盐酸盐眼用凝胶用于局部眼麻醉
    摘要:Topical anesthetics play an important role in the practice of ophthalmology, both for procedures in the office and in the operating room. The need for safe, long-acting topical ocular anesthetic agents is ongoing, and has been highlighted by the increase of intravitreal administration of pharmacologic agents. Current practices for ocular anesthesia include subconjunctival injection of 2% aqueous lidocaine, topical 2% lidocaine drops and topical 0.5% tetracaine. Tetracaine is not yet FDA approved, and is associated with corneal epithelial toxicity and delayed epithelial healing after multiple administrations. Lidocaine jelly (2%) preparations have been reported to be beneficial in several systemic procedures, including those of the upper airway, dental, urogenital, and gastrointestinal. It has been theorized, and recent studies support the idea, that gel formulations of lidocaine may enhance anesthetic effect, and therefore be superior to anesthetic solutions for topical cataract surgery. The viscous nature of gel formulations is thought to lengthen contact time, resulting in better anesthesia at lower drug concentrations. Furthermore, several studies suggest that lidocaine is bactericidal and bacteriostatic, and may have a supplementary role in preventing and treating surgical site infections. Akten™, lidocaine 3.5% gel (Akorn, Buffalo Grove, IIlinois) was FDA approved for all ophthalmic procedures in October 2008. This gel is a preservative-free, lidocaine-based anesthetic gel consisting of 35 mg/mL of lidocaine hydrochloride. We describe the properties, including chemical structure, indications, evidence of support, use, adverse effects, and precautions, which we believe enable Akten to provide superior anesthesia, while minimizing side effects.
  • 机译 纳米凝胶系统在局部麻醉药管理中的应用
    摘要:Nanogels are robust nanoparticles that could be used to deliver active drug compounds in controlled drug delivery applications. This review discusses the design, synthesis, loading, and release of local anesthetics using polymeric nanoparticles produced via various types of polymerization techniques. The strategy of using layer-by-layer approach to control the burst release of procaine hydrochloride (PrHy; a local anesthetic drug of the amino ester group) is described and discussed.
  • 机译 局部麻醉后的神经系统不良事件
    摘要:Regional anesthesia and analgesia have been associated with improved analgesia, decreased postoperative nausea and vomiting, and increased patient satisfaction for many types of surgical procedures. In obstetric anesthesia care, it has also been associated with improved maternal mortality and major morbidity. The majority of neurological adverse events following regional anesthesia administration result in temporary sensory symptoms; long-term or permanent disabling motor and sensory problems are very rare. Infection and hemorrhagic complications, particularly with neuraxial blocks, can cause neurological adverse events. More commonly, however, there are no associated secondary factors and some combination of needle trauma, intraneural injection, and/or local anesthetic toxicity may be associated, but their individual contributions to any event are difficult to define.
  • 机译 鞘内注射布比卡因治疗头颈部疼痛
    摘要:Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients.
  • 机译 内窥镜检查过程中因局部咽部麻醉引起的高铁血红蛋白血症
    摘要:Acquired methemoglobinemia is a known complication of topical anesthesia during endoscopic procedures. Benzocaine has been implicated in a majority of cases and has been removed from some hospital formularies. However, a lot of uncertainty exists about the risk factors for this uncommon complication. This review attempts to summarize the current knowledge of this condition and describe known risk factors. Anesthetic and patient-specific risk factors are described along with some hypothetical procedure-related factors. Clinicians should identify patients who are at high risk and apply appropriate postprocedure screening. Prospective studies are needed to further our knowledge and improve patient safety.
  • 机译 硬膜外分娩镇痛:最新技术
    摘要:Epidural analgesia is an extremely effective and popular treatment for labor pain. In this review, we trace the history of the use of epidural analgesia and its refinements. We then outline the goals of treatment and methods used to attain those goals. The use of low concentrations of local anesthetics, combined with lipid-soluble opioids, does not impede the progress of labor or depress the newborn. The incidence of side effects is low. Maintenance of analgesia that allows patient control enhances patient satisfaction.
  • 机译 利用超声针引导系统放置Pop导管
    摘要:While ultrasound (US)-guided placement of peripheral nerve blocks is rapidly gaining popularity, expert practitioners agree that two of the most significant barriers to safety and efficacy are keeping the needle tip within the image and unintentional probe movement during the procedure. In addition, placing a nerve catheter past the needle tip under direct US observation requires two practitioners: one to hold the US probe and needle and another to advance the catheter. We present a case of a needle guidance system that attaches to the ultrasound probe and facilitates in-plane imaging. It enables a single practitioner to successfully execute a popliteal sciatic nerve block and visualize catheter placement. Therefore, a needle guidance system may represent an additional modification to ultrasound imaging that increases both time efficiency as well as safety.
  • 机译 5%利多卡因药膏治疗瘢痕局部性创伤后神经性疼痛
    摘要:ObjectiveTo evaluate the use of 5% lidocaine medicated plaster (LMP) for treating painful scars resulting from burns or skin degloving.
  • 机译 局部麻醉下腋股旁路术:高危患者保肢的一种方法
    摘要:For an active, ambulant patient with critical, lower limb ischemia, amputation can lead to a poor quality of life. A small group of older people with critical limb ischemia are considered at high risk for revascularization under conventional anesthesia owing to their comorbid conditions. In these cases, when endovascular therapy is not an option, the decision to amputate or revascularize presents a dilemma, especially in ambulant patients. In this article, we present 2 cases in which the individuals had diabetic foot gangrene, rest pain, and multiple comorbidities, and were unfit to undergo conventional anesthesia. In addition, they had severe aortoiliac occlusive disease, which cannot be managed by endovascular methods. Both patients were living independently and were ambulant before their foot ulcer and ischemia. They underwent an axillofemoral bypass under local anesthesia. The postoperative course was uneventful. After a 3-year follow-up, both patients continue to be ambulant and have no complaints. With selective use of local anesthetic techniques, surgical teamwork to shorten the procedure time, and close meticulous postoperative care, an axillofemoral bypass can enable limb salvage for ambulant patients who are considered unfit for conventional anesthesia.
  • 机译 麻醉师对区域麻醉下患者焦虑的理解
    摘要:The aim of this survey is to report anesthesiologists’ perception of patients’ anxiety under regional anesthesia, its frequency, effects and causes, and the strategies employed to reduce it. Electronic questionnaires were sent to all grades of anesthesiologists in Nottingham, UK. The response rate for the survey was 79%. Over half of the anesthesiologists in our region believe that anxiety during regional anesthesia is not common. Surgery and anesthesia, followed by block failure were reported by anesthesiologists as the most common causes of patients’ anxiety. Frequently employed techniques to manage anxiety were communication or sedation. Most respondents felt that regional anesthesia provides good analgesia and patient satisfaction. However, 20% felt that regional anesthesia is painful or unpleasant for patients, perhaps explaining the reluctance by some anesthesiologists to perform regional anesthesia.
  • 机译 区域麻醉中的超声引导:通过具有挑战性的临床方案进行最新技术回顾
    摘要:Ultrasound guided regional anesthesia (UGRA) for peripheral nerve blockade is becoming increasingly popular. The advantage of ultrasound technology is that it affords the anesthesiologist the real time ability to visualize neural structures, needle advancement, and local anesthetic spread. Recent data suggest that UGRA generates improved success rates and reductions in performance times in comparison to traditional approaches. Further, the use of ultrasound technology in peripheral nerve blocks has provided insight into needle–nerve interactions, revealing distinct limitations of nerve stimulator techniques. Given that UGRA requires a unique set of skills, formal standards and guidelines are currently being developed by leadership societies in order to foster education and training. This review article, in a case vignette format, highlights important techniques, concepts, and limitations regarding the use of ultrasound to facilitate regional anesthesia. Clinically relevant aspects of ultrasound physics are also discussed.
  • 机译 带电局麻药衍生物的膜相互作用和局麻药对映体膜相互作用中的立体选择性
    摘要:With respect to the membrane lipid theory as a molecular mechanism for local anesthetics, two critical subjects, the negligible effects of charged drugs when applied extracellularly and the stereoselective effects of enantiomers, were verified by paying particular attention to membrane components, phospholipids with the anionic property, and cholesterol with several chiral carbons. The membrane interactivities of structurally-different anesthetics were determined by their induced fluidity changes of liposomal membranes. Lidocaine (3.0 μmol/mL) fluidized phosphatidylcholine membranes, but not its quaternary derivative QX-314 (3.0 μmol/mL). Similarly to the mother molecule lidocaine, however, QX-314 fluidized phosphatidylserine-containing nerve cell model membranes and acidic phospholipids-constituting membranes depending on the acidity of membrane lipids. Positively charged local anesthetics are able to act on lipid bilayers by ion-pairing with anionic (acidic) phospholipids. Bupivacaine (0.75 mol/mL) and ropivacaine (0.75 and 1.0 μmol/mL) fluidized nerve cell model membranes with the potency being S(−)-enantiomer < racemate < R(+)-enantiomer (P < 0.01, vs antipode and racemate) and cardiac cell model membranes with the potency being S(−)-ropivacaine < S(−)-bupivacaine < R(+)-bupivacaine (P < 0.01). However, their membrane effects were not different when removing cholesterol from the model membranes. Stereoselectivity is producible by cholesterol which increases the chirality of lipid bilayers and enables to discriminate anesthetic enantiomers. The membrane lipid interaction should be reevaluated as the mode of action of local anesthetics.
  • 机译 局麻药对中央静脉通路的疼痛和功效
    摘要:PurposeTo compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.

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