tailieunhanh - Ebook Orthopaedic surgery essentials hand and wrist: Part 2

Part 2 book “Orthopaedic surgery essentials hand and wrist” has contents: Anesthesia, hand fractures and fracture-dislocations, dislocation and ligament injuries, carpal injuries, tendon injuries, nerve injuries, amputations, compartment syndrome, injection injuries. | GRBT045-08 Doyle-2055G 8 July 15, 2005 22:9 ANESTHESIA CHARLES L. MCDOWELL KEVIN CUNNINGHAM Relief from pain delivered with a minimum of discomfort and a high degree of safety is a building block of patient reassurance and a hallmark of modern outpatient surgery. The methods to be described are effective and safe in emergency rooms, outpatient settings, as well as in more formalized operating theaters. Emphasis upon outpatient surgery has dramatically increased the desirability of effective regional and local anesthesia methods that can be used by operating surgeons and anesthesiologists. In many of the settings where surgery is performed today, there is not an anesthesiologist available—or even necessary. This is an additional stimulus to the operating surgeon to become proficient in the administration of local and regional anesthesia. GUIDELINES 1. Determine the patient’s allergy status to the drugs. ■ Despite the fact that genuine allergies to local anesthetics are exceedingly rare, if the patient describes an allergy to a local anesthetic, the surgeon should not use it, even if the history is inconclusive or vague. ■ If the patient is right, and a reaction occurs, the physical and legal consequences can be serious. ■ If a local anesthetic agent is necessary for medical or other reasons, the surgeon should consider using an alternative drug or skin testing. ■ Of the two types of local anesthetics, esters, being derived from para-aminobenzoic acid (PABA), are far more likely to produce an allergic reaction than amide-type agents are. ■ Symptoms of allergic reactions include itching, burning, tingling, hives, erythema, angioedema, dyspnea, chest discomfort, wheezing, coughing, sneezing, shock, and tachycardia. ■ Much more commonly, the patient will not have had a true allergic reaction to the local anesthetic, but rather symptoms associated with one of the following: ■ Inadvertent direct intravenous or arterial injection of the agent .