Running Head: ANESTHETIC MANAGEMENT in ERAS PROTOCOLS 1
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(12) United States Patent (10) Patent No.: US 7,074,961 B2 Wang Et Al
US007074961B2 (12) United States Patent (10) Patent No.: US 7,074,961 B2 Wang et al. (45) Date of Patent: Jul. 11, 2006 (54) ANTIDEPRESSANTS AND THEIR 6.211,171 B1 4/2001 Sawynok et al. ANALOGUES AS LONG-ACTING LOCAL 6,545,057 B1 4/2003 Wang et al. ANESTHETCS AND ANALGESCS 2001/0036943 A1 11/2001 Coe et al. (75) Inventors: Ging Kuo Wang, Westwood, MA (US); FOREIGN PATENT DOCUMENTS Peter Gerner, Weston, MA (US); Donald K. Verrecchia, Winchester, MA CH 534124 A 2, 1973 (US) WO WO95/17903 A1 7, 1995 WO WO95/1818.6 A1 7, 1995 (73) Assignee: The Brigham and Women's Hospital, WO WO 99.59.598 A1 11, 1999 Inc., Boston, MA (US) WO WO O2/060870 A2 8, 2002 (*) Notice: Subject to any disclaimer, the term of this OTHER PUBLICATIONS patent is extended or adjusted under 35 U.S.C. 154(b) by 451 days. Luo et al., Xenobiotica, vol. 25, No. 3, pp. 291-301, 1995.* (21) Appl. No.: 10/117,708 Ehlert et al., The Interaction of Amitriptyline, Doxepin, Imipramine and Their N-Methyl Quaternary Ammonium (22) Filed: Apr. 4, 2002 Derivatives with Subtypes of Muscarinic Receptors in Brain (65) Prior Publication Data and Heart, The Journal of Pharmacology and Experimental Therapeutics, Apr. 1990, vol. 253, No. 1, pp. 13–19. US 2003/00968.05 A1 May 22, 2003 Gerner, P., et al., Anesthesiology (2002) 96:1435–42. Related U.S. Application Dat e pplication Uata Khan, M.A., et al., Anesthesiology (2002) 96:109–16. (63) stripps'965,138, filed on Sep. -
The Femoral Nerve Block Characteristics Using Ropivacaine 0.2% Alone, with Epinephrine, Or with Lidocaine and Epinephrine
SCIENTIFIC ARTICLES THE FEMORAL NERVE BLOCK CHARACTERISTICS USING ROPIVACAINE 0.2% ALONE, WITH EPINEPHRINE, OR WITH LIDOCAINE AND EPINEPHRINE A.M. TAHA1,2 AND A.M. ABD-ELmaKSOUD31* Keywords: anesthetic techniques, regional, femoral; anaesthetics local, ropivacaine; equipment, ultrasound machines. Abstract Background: The objective of this study was to evaluate the femoral nerve block characteristics (onset, success rate and duration) using ropivacaine 0.2% alone; with epinephrine, or with lidocaine and epinephrine compared with that using ropivacaine 0.5%. Methods: Ninety six patients were included in this prospective controlled double blind study and were randomly allocated into four equal groups (n=24). All the patients received ultrasound guided femoral nerve block using 15 ml of either ropivacaine 0.5% (group 1), ropivacaine 0.2% (group 2), ropivacaine 0.2% with epinephrine (group 3) and ropivacaine 0.2% with lidocaine and epinephrine (group 4). The block onset, success rate and duration were recorded. Results: The motor onset was significantly delayed in group 2 (compared with the other three groups) and in group 3 (compared with group 4). However, the block success rate and duration were comparable in the four groups. Conclusion: In femoral nerve block, ropivacaine 0.2% may have a comparable success rate and duration to ropivacaine 0.5% but with a remarkably delayed motor onset that may be improved by adding epinephrine. Addition of lidocaine may further accelerate the motor onset. Introduction The femoral nerve block (FNB) is a commonly indicated block, and ropivacaine is a widely used long acting local anesthetic (LA)1,2. Peripheral nerve blocks can provide excellent anesthesia and postoperative analgesia 3,4. -
Ultrasound Guided Femoral Nerve Block
Ultrasound Guided Femoral Nerve Block Michael Blaivas, MD, FACEP, FAIUM Clinical Professor of Medicine University of South Carolina School of Medicine AIUM, Third Vice President President, Society for Ultrasound Medical Education Past President, WINFOCUS Editor, Critical Ultrasound Journal Sub-specialty Editor, Journal of Ultrasound in Medicine Emergency Medicine Atlanta, Georgia [email protected] Disclosures • No relevant disclosures to lecture Objectives • Discuss anatomy of femoral nerve • Discuss uses of femoral nerve block classically and 3-in-1 variant • Discuss technique of femoral nerve blockade under ultrasound • Discuss pitfalls and potential errors Femoral Nerve Block Advantages • Many uses of regional nerve blocks • Avoid narcotics and their complications • Allow for longer term pain control • Can be used in patients unfit for sedation – Poor lung health – Hypotensive – Narcotic dependence or sensitivity Femoral Nerve Blocks • Wide variety of potential indications for a femoral nerve block – Hip fracture – Knee dislocation – Femoral fracture – Laceration repair – Burn – Etc. Nerve Blocks in Community vs. Academic Setting • Weekend stays • Night time admissions • Time to get consult and clear • Referral and admission patters • All of these factors can lead to patients spending considerable time prior to OR • Procedural sedation vs. block Femoral Nerve Blocks • Several basic principles with US also • Specialized needles +/- • No nerve stimulator • Can see nerve directly and inject directly around target nerve or nerves • Only -
The International Student Journal of Nurse Anesthesia
Volume 15 Issue 1 Spring 2016 The International Student Journal of Nurse Anesthesia TOPICS IN THIS ISSUE Ondansetron to prevent SAB-induced Hypotension Hyperthermic Intraperitoneal Chemotherapy Carnitine Palmitoyltransferase Deficiency Adductor Canal vs. Femoral Nerve Block Ketamine Induction for Awake Intubation Airway Management for Tracheostomy TIVA for Gastroenterology Procedures Hematoma Following Thyroidectomy Tranexamic Acid in Trauma Tracheoesophageal Fistula Reintubation in the PACU Venous Air Embolism Emergence Delirium Preventing OR Fires INTERNATIONAL STUDENT JOURNAL OF NURSE ANESTHESIA Vol. 15 No. 1 Spring 2016 Editor Vicki C. Coopmans, CRNA, PhD Associate Editor Julie A. Pearson, CRNA, PhD Editorial Board Laura Ardizzone, CRNA, DNP Memorial Sloan Kettering Cancer Center; NY, NY MAJ Sarah Bellenger, CRNA, MSN, AN Darnall Army Medical Center; Fort Hood, TX Laura S. Bonanno, CRNA, DNP Louisiana State University Health Sciences Center Carrie C. Bowman Dalley, CRNA, MS Georgetown University Marianne Cosgrove, CRNA, DNAP Yale-New Haven Hospital School of Nurse Anesthesia LTC Denise Cotton, CRNA, DNAP, AN Winn Army Community Hospital; Fort Stewart, GA Janet A. Dewan, CRNA, PhD Northeastern University Kären K. Embrey CRNA, EdD University of Southern California Millikin University and Rhonda Gee, CRNA, DNSc Decatur Memorial Hospital Marjorie A. Geisz-Everson CRNA, PhD University of Southern Mississippi Johnnie Holmes, CRNA, PhD Naval Hospital Camp Lejeune Anne Marie Hranchook, CRNA, DNP Oakland University-Beaumont Donna Jasinski, -
Femoral and Sciatic Nerve Blocks for Total Knee Replacement in an Obese Patient with a Previous History of Failed Endotracheal Intubation −A Case Report−
Anesth Pain Med 2011; 6: 270~274 ■Case Report■ Femoral and sciatic nerve blocks for total knee replacement in an obese patient with a previous history of failed endotracheal intubation −A case report− Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea Jong Hae Kim, Woon Seok Roh, Jin Yong Jung, Seok Young Song, Jung Eun Kim, and Baek Jin Kim Peripheral nerve block has frequently been used as an alternative are situations in which spinal or epidural anesthesia cannot be to epidural analgesia for postoperative pain control in patients conducted, such as coagulation disturbances, sepsis, local undergoing total knee replacement. However, there are few reports infection, immune deficiency, severe spinal deformity, severe demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle decompensated hypovolemia and shock. Moreover, factors relaxation during total knee replacement. We experienced a case associated with technically difficult neuraxial blocks influence of successful FSNBs for a total knee replacement in a 66 year-old the anesthesiologist’s decision to perform the procedure [1]. In female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 these cases, peripheral nerve block can provide a good solution minutes, 3 days before these blocks. FSNBs were performed with for operations on a lower extremity. The combination of 50 ml of 1.5% mepivacaine because she had conditions precluding femoral and sciatic nerve blocks (FSNBs) has frequently been neuraxial blocks including a long distance from the skin to the used for postoperative pain control after total knee replacement epidural space related to a high body mass index and nonpalpable lumbar spinous processes. -
VHA/Dod CLINICAL PRACTICE GUIDELINE for the MANAGEMENT of POSTOPERATIVE PAIN
VHA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE PAIN Veterans Health Administration Department of Defense Prepared by: THE MANAGEMENT OF POSTOPERATIVE PAIN Working Group with support from: The Office of Performance and Quality, VHA, Washington, DC & Quality Management Directorate, United States Army MEDCOM VERSION 1.2 JULY 2001/ UPDATE MAY 2002 VHA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTOPERATIVE PAIN TABLE OF CONTENTS Version 1.2 Version 1.2 VHA/DoD Clinical Practice Guideline for the Management of Postoperative Pain TABLE OF CONTENTS INTRODUCTION A. ALGORITHM & ANNOTATIONS • Preoperative Pain Management.....................................................................................................1 • Postoperative Pain Management ...................................................................................................2 B. PAIN ASSESSMENT C. SITE-SPECIFIC PAIN MANAGEMENT • Summary Table: Site-Specific Pain Management Interventions ................................................1 • Head and Neck Surgery..................................................................................................................3 - Ophthalmic Surgery - Craniotomies Surgery - Radical Neck Surgery - Oral-maxillofacial • Thorax (Non-cardiac) Surgery.......................................................................................................9 - Thoracotomy - Mastectomy - Thoracoscopy • Thorax (Cardiac) Surgery............................................................................................................16 -
Femoral Nerve Block Versus Spinal Anesthesia for Lower Limb
Alexandria Journal of Anaesthesia and Intensive Care 44 Femoral Nerve Block versus Spinal Anesthesia for Lower Limb Peripheral Vascular Surgery By Ahmed Mansour, MD Assistant Professor of Anesthesia, Faculty of Medicine, Alexandria University. Abstract Perioperative cardiac complications occur in 4% to 6% of patients undergoing infrainguinal revascularization under general, spinal, or epidural anesthesia. The risk may be even greater in patients whose cardiac disease cannot be fully evaluated or treated before urgent limb salvage operations. Prompted by these considerations, we investigated the feasibility and results of using femoral nerve block with infiltration of the genito4femoral nerve branches in these high-risk patients. Methods: Forty peripheral vascular reconstruction of lower limbs were performed under either spinal anesthesia (20 patients) or femoral nerve block with infiltration of genito-femoral nerve branches supplemented with local infiltration at the site of dissection as needed (20 patients). All patients had arterial lines. Arterial blood pressure and electrocardiographic monitoring was continued during surgery, in PACU and in the intensive care units. Results: Operations included femoral-femoral, femoral-popliteal bypass grafting and thrombectomy. The intra-operative events showed that the mean time needed to perform the block and dose of analgesics and sedatives needed during surgery was greater in group I (FNB,) compared to group II [P=0.01*, P0.029* , P0.039*], however, the time needed to start surgery was shorter in group I than in group II [P=0. 039]. There were no block failures in either group, but local infiltration in the area of the dissection with 2 ml (range 1-5 ml) of 1% lidocaine was required in 4 (20%) patients in FNB group vs none in the spinal group. -
FDA Briefing, Joint Meeting of Anesthetic and Analgesic Drug
1 FDA Briefing Document Joint Meeting of Anesthetic and Analgesic Drug Products Advisory Committee and Drug Safety and Risk Management Advisory Committee January 15, 2020 (AM Session) 2 DISCLAIMER STATEMENT The attached package contains background information prepared by the Food and Drug Administration (FDA) for the panel members of the advisory committee. The FDA background package often contains assessments and/or conclusions and recommendations written by individual FDA reviewers. Such conclusions and recommendations do not necessarily represent the final position of the individual reviewers, nor do they necessarily represent the final position of the Review Division or Office. The new drug application (NDA) 213426 for tramadol 44mg and celecoxib 56mg tablet, which contains a fixed dose combination of an opioid and an NSAID for the management of acute pain in adults that is severe enough to require an opioid analgesic and for which alternative treatments are inadequate, has been brought to this Advisory Committee in order to gain the Committee’s insights and opinions. The background package may not include all issues relevant to the final regulatory recommendation and instead is intended to focus on issues identified by the Agency for discussion by the advisory committee. The FDA will not issue a final determination on the issues at hand until input from the advisory committee process has been considered and all reviews have been finalized. The final determination may be affected by issues not discussed at the advisory committee meeting. 3 FOOD AND DRUG ADMINISTRATION Center for Drug Evaluation and Research Joint Meeting of the Anesthetic and Analgesic Drug Products Advisory Committee and Drug Safety & Risk Management Advisory Committee January 15, 2020 Table of Contents 1 Division Memorandum ....................................................................................................... -
3Rd International Congress on Ambulatory Surgery April 25–28, 1999
Ambulatory Surgery 7 (1999) S1–S108 Abstracts 3rd International Congress on Ambulatory Surgery April 25–28, 1999 suitable and consistent information about the disease, its treatment Organization and Management and possible consequences both of the disease and of its treatment. Lack of information can make the contract null and void causing a physician to act against the law. For the consent to be valid it has to Severity of symptoms following day case cystoscopy be given by a Subject in full possession of his/her faculties or aged to be as such. The surgeon’s obligation so established in the contract is M Cripps the obligation of means or diligence in his/her performance and not Lecturer Practitioner, Day Surgery Unit, Salisbury District Hospital, an obligation to results. A surgeon therefore acts within the limits of Wiltshire, England a behaviour obligation and not of an obligation to results. Neverthe- less this is an apparent distinction, as a fact, considered as a mean in INTRODUCTION: This is the result of a collaborative study under- respect of a subsequent aim, will be a result when assessed as such, taken by six Day Surgery Units around South West England looking and as the final stage of a limited sequence of facts. at the morbidity following day case cystoscopy. Critical management factors (CMF) in an ambulatory surgery center METHODS: The study investigated, through patient questionnaire, the patients’ experience in the first 48 hours post surgery of pain, RC Williams sickness, presence of haematuria, burning on micturition, frequency of micturition and contacts with health care professionals. -
Femoral Nerve Block: Landmark Approach
Sign up to receive ATOTW weekly - email [email protected] FEMORAL NERVE BLOCK: LANDMARK APPROACH ANAESTHESIA TUTORIAL OF THE WEEK 249 6TH FEBRUARY 2012 Dr Andrew McEwen, Specialist Registrar Anaesthesia Torbay Hospital, Torquay Correspondence to [email protected] QUESTIONS Before continuing, try to answer the following questions. The answers can be found at the end of the article, together with an explanation. 1. Please answer True or False: The femoral nerve: a. Is derived from the dorsal rami of L2 to L4 b. Is covered by 2 fascial layers, the fascia lata and fascia iliaca c. Is contained within the femoral sheath d. Emerges from the psoas muscle at its medial border. e. Divides into anterior (superficial) and posterior (deep) branches after passing under the inguinal ligament 2. Please answer True or False: The femoral nerve block provides: a. Sensory block of the skin over the anterior aspect of the lower leg b. Motor block of the extensor muscles of the knee c. Sensory block of the skin over the lateral aspect of the hip joint d. Surgical anaesthesia for skin grafting from the anterior aspect of the thigh e. Analgesia for all lower leg surgery in combination with sciatic nerve block 3. Please answer True or False: With regard to the performance of the femoral nerve block: a. Stimulation of the sartorius muscle implies the needle tip is too lateral b. The femoral nerve is usually found at the midpoint between the anterior superior iliac spine and pubic symphysis c. Directing the needle cranially and injecting a volume of 30mls will also result in blockade of the lateral femoral cutaneous and obturator nerves d. -
Anesthetic Requirements Measured by Bilateral Bispectral Analysis and Femoral Blockade in Total Knee Arthroplasty
Rev Bras Anestesiol. 2017;67(5):472---479 REVISTA BRASILEIRA DE Publicação Oficial da Sociedade Brasileira de Anestesiologia ANESTESIOLOGIA www.sba.com.br SCIENTIFIC ARTICLE Anesthetic requirements measured by bilateral bispectral analysis and femoral blockade in total knee arthroplasty ∗ Maylin Koo , Javier Bocos, Antoni Sabaté, Vinyet López, Carmina Ribes Hospital Universitario de Bellvitge, Servicio de Anestesia y Medicina Intensiva, Barcelona, Spain Received 14 January 2016; accepted 20 July 2016 Available online 28 August 2016 KEYWORDS Abstract Nerve block; Background and objectives: A continuous peripheral nerve blockade has proved benefits on Pain management; reducing postoperative morphine consumption; the combination of a femoral blockade and Bispectral index general anesthesia on reducing intraoperative anesthetic requirements has not been studied. monitor; The objective of this study was to determine the relevance of timing in the performance of Levopubicaine femoral block to intraoperative anesthetic requirements during general anesthesia for total hydrochloride; knee arthroplasty. Knee arthroplasty Methods: A single-center, prospective cohort study on patients scheduled for total knee arthro- plasty, were sequentially allocated to receive 20 mL of 2% mepivacaine throughout a femoral catheter, prior to anesthesia induction (Preoperative) or when skin closure started (Postopera- tive). An algorithm based on bispectral values guided intraoperative anesthetic management. Postoperative analgesia was done with an elastomeric pump of levobupivacaine 0.125% con- nected to the femoral catheter and complemented with morphine patient control analgesia for 48 hours. The Kruskall Wallis and the chi-square tests were used to compare variables. Statistical significance was set at p < 0.05. Results: There were 94 patients, 47 preoperative and 47 postoperative. -
Peripheral Nerve Stimulation in Regional Anesthesia
REVIEW ARTICLE Peripheral Nerve Stimulation in Regional Anesthesia Stephen M. Klein, MD,* M. Steve Melton, MD,* Warren M. Grill, PhD,Þ and Karen C. Nielsen, MD* the patient; (2) improved patient comfort, because a paresthesia Abstract: Peripheral nerve stimulation has a long history in regional technique can be painful or unpleasant compared with nerve anesthesia. Despite the advent of ultrasound-guided peripheral nerve stimulation; and (3) a perceived improvement in accuracy.4Y6 blockade, nerve stimulation remains a popular technique used alone or, This transition in clinical practice preceded a great deal of the now, in combination with ultrasound-guided techniques. In light of this literature that describes the principles of electrical nerve locali- evolving utility of nerve stimulation, this is an appropriate time to review zation. Today, a similar, more rapid evolution in technology and the basic concepts and knowledge base of this historically important tool. practice is occurring between nerve stimulation and ultrasound- Electrical nerve stimulation facilitates nerve localization, using threshold guided regional anesthesia. However, despite the popularity current as a surrogate for needle-to-nerve distance. Preferential activation of ultrasound-guided peripheral nerve blocks, nerve stimulation of motor nerves is possible because motor nerve fibers are more readily remains a common technique used alone or in combination activated with a shorter duration of current compared with sensory with ultrasound guidance. The developing utility of combining nerves. The association between current and needle-to-nerve distance these 2 techniques signals an opportunity to review the history predicts that less current is needed to evoke a motor response as the and present the status of nerve stimulation.