tailieunhanh - Ebook Handbook of clinical anesthesia (7/E): Part 2

(BQ) Part 2 book “Handbook of clinical anesthesia” has contents: Peripheral nerve blockade, anesthesia for neurosurgery, neonatal anesthesia, obstetrical anesthesia, pediatric anesthesia, anesthesia for otolaryngologic surgery, anesthesia for ophthalmologic surgery, . and other contents. | Anesthesia for Surgical Subspecialties VII S E C T I O N C H A P T E R 35 Peripheral Nerve Blockade Regional anesthesia enables site-specific, long-lasting, and effective anesthesia and analgesia (Tsui BCH, Rosenquist RW. Peripheral nerve blockade. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Ortega R, Stock MC, eds. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013:937–995). Peripheral nerve blocks (PNBs) can be used as the only anesthetic, as a supplement to provide analgesia and muscle relaxation along with general anesthesia, or as the initial step in the provision of prolonged postoperative analgesia such as with intercostal blocks or continuous peripheral nerve catheters. The two most common techniques for nerve localization and block performance are nerve stimulation (NS) and ultrasound (US) imaging. I. GENERAL PRINCIPLES AND EQUIPMENT. An exciting advance in technology in relation to regional anesthesia in recent years has been the introduction of anatomically based US imaging to visualize the target nerve. In many situations, it is prudent to combine the two technologies of NS and US imaging to achieve the goal of 100% success with all regional blocks. A. Setup and Monitoring (Table 35-1) B. Common Techniques: Nerve Stimulation 1. Basics of Technique and Equipment. A low-current electrical impulse applied to a peripheral nerve produces stimulation of motor fibers and theoretically identifies proximity to the nerve without actual needle contact of the nerve or related patient discomfort. 2. Practical Guidelines. After a low-threshold response is obtained, 2 to 3 mL of local anesthetic is injected, and the operator watches for disappearance of the motor twitch, which is a signal to inject the remainder of the 535 535 1/4/13 9:18 PM 536    Anesthesia for Surgical Subspecialties T a b l e 3 5 - 1   Setup and Monitoring for Regional Blocks Setup All supplies located in this area must be .