Professional Documents
Culture Documents
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Review
Delayed complications of epidurals
Post dural puncture headache (PDPH)
Low back pain
Urinary retention
Infection
Intraneural injection
Injection of wrong medications
Undiagnosed neurological disease
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Peripheral Nerve
Blocks
General information Contents
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General information Contents
hematomas
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General information Contents
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Cervical plexus block
A.Technique: With the patient’s head turned
to the opposite side, a line connecting the
tip of the mastoid process of the temporal
bone and the anterior tubercle of the
transverse process of the sixth cervical
vertebra identifies theapproximate plane
in which the cervical transverseprocesses
lie.
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Cervical plexus block
Using a 22-gauge needle, penetrate
the skin over each point, directing the
needle in aslightly caudal direction to
contact each transverseprocess.
Confirm the position by ‘walking’ the
needle off the tip of the transverse
process.
Ensure that neither blood nor CSF can
be aspirated.
Inject 3-5 mL of local anesthetic
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Cervical plexus block
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Cervical plexus block
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Cervical plexus block
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Cervical plexus block
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Cervical plexus block
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Cervical plexus block
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Cervical plexus block
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Peripheral Nerve Blocks
Brachial plexus blocks
A. Interscalene block
1. Technique: The needle is inserted in the
interscalene groove at the level of the
cricoidcartilage and advanced perpendicular
to the skin until a paresthesia is elicited or a
transverse spinous process is contacted, at
which point 30-40 cc of local anesthetic is
injected.
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Peripheral Nerve Blocks
Brachial plexus blocks
A. Interscalene block
2. Indications: any procedure on the upper
extremity, including the shoulder. This
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Peripheral Nerve Blocks
Brachial plexus blocks
A. Interscalene block
3. Special contraindications: contralateral
phrenic paresis, severe asthma.
4. Side effects: Horner's syndrome, phrenic
paresis.
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Brachial plexus blocks
A. Interscalene block
5. Complications:
• intra-arterial injection
• massive epidural, subarachnoid, or subdural
•Horner’s sign
Other complications
•laryngeal nerve block (30-50%) leading to
hoarseness
•phrenic nerve block
•pneumothorax, infection, bleeding, and nerve
injury.
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Brachial plexus blocks
A. Interscalene block
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Peripheral Nerve Blocks
Brachial plexus blocks
A. Interscalene block
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Brachial plexus blocks
A. Interscalene block
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Brachial plexus blocks
A. Interscalene block
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Peripheral Nerve Blocks
Brachial plexus blocks
B. Supraclavicular block
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Brachial plexus blocks
B. Supraclavicular block
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Brachial plexus blocks
B. Supraclavicular block
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Peripheral Nerve Blocks
Brachial plexus blocks
C. Axillary block
1. Indications: procedures on the lower arm and
hand.
2. Anatomy: it should be noted that in the axilla,
the musculocutaneous nerve has already left
its sheath and lies within the coracobrachialis.
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Brachial plexus blocks
C. Axillary block
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Peripheral Nerve Blocks
Brachial plexus blocks
C. Axillary block
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Brachial plexus blocks
C. Axillary block
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Peripheral Nerve Blocks
Intercostal nerve block
A. Technique: optimally performed with patient
prone or sitting, a 22-gauge needle is inserted
perpendicular to the skin in the posterior axillary
line over the lower edge of the rib, the needle then
is ‘walked’ off the rib inferiorly until it slips off
the rib, after negative aspiration for blood 5 mL of
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Peripheral Nerve Blocks
Intercostal nerve block
B. Complications: the principle risks are
pneumothorax and accidental intravascular
injection of local anesthetic solutions.
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Nerve blocks of the lower extremity
A. Sciatic nerve block
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Peripheral Nerve Blocks
Nerve blocks of the lower extremity
A. Sciatic nerve block
Technique: the patient is placed in the Sim’s
position (the lateral decubitus position
with the leg to be blocked uppermost and
flexed at the hip and knee) a line is drawn
from the posterior iliac spine and the
greater trochanter of the femur,
the needle is inserted about 5 cm caudad
from the midpoint of this line, and about 25
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Nerve blocks of the lower extremity
C. 3 in 1 block (femoral, obturator, and lateral
cutaneous nerves)
1. Technique: identical to femoral nerve block
but a greater volume of local anesthetic used
(inject 30 mL)
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Nerve blocks of the lower extremity
D. Ankle block (requires 5 separate nerve blocks)
1. Posterior tibial nerve: insert needle behind the
posterior tibial artery and advanced until a
paresthesia to the sole of the foot is elicited, inject
5 mL of local anesthetic.
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Nerve blocks of the lower extremity
D. Ankle block (requires 5 separate nerve blocks)
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Nerve blocks of the lower extremity
D. Ankle block (requires 5 separate nerve blocks)
3. Saphenous nerve: inject 5 mL of local
anesthetic anterior to the medial
malleolus.
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Nerve blocks of the lower extremity
D. Ankle block (requires 5 separate nerve blocks)
4. Deep peroneal nerve: inject 5 mL of local
anesthetic lateral to the anterior tibial artery
at the distal end of the tibia at the level of the
skin cease.
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Nerve blocks of the lower extremity
D. Ankle block (requires 5 separate nerve blocks)
5. Superficial peroneal nerve: infiltrate a
ridge of local anesthetic (10 mL) from
the anterior tibia to lateral malleolus.
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Postanesthesia Care Unit
( P A C U)
For most patients, recovery from anesthesia is
uneventful. Postoperative complications, however,
may be sudden and life-threatening. The
postanesthesia care unit (PACU) is designed to
provide close monitoring and care to patients
recovering from anesthesia and sedation, assuring
safety to the transition between anesthesia and the
fully awake state, before patients are transferred to
unmonitored general wards.
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Admission
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Transport
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Monitor and management
Consciousness
Respiration
Circulation
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Respiratory complications
Airway obstruction
Hypoventilation
Hypoxemia
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Airway Obstruction
Tongue falled backwards
Laryngospasm (喉痉挛)
Airway edema
Wound hematoma.
Vocal cord (VC) paralysis (声带麻痹)
Bronchospasm
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Hypoventilation
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Hypoxemia
Atelectasis
Hypoventilation
Aspiration of gastric contents
Pulmonary edema
Pulmonary embolism.
Bronchospasm,
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Hemodynamic complications
Hypotension
Hypertension
Arrhythmias
Myocardial ischemia and infarction
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Hypotension
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Hypertension
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Beta-adrenergic blockers.
Labetalol esmolol
Calcium-channel blockers.
Verapamil Nifedipine
Nitrates. Nitroglycerin Sodium
nitroprusside,
Alpha-adrenergic blockers phentolamine
labetalol
Hydralazine
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Arrhythmias
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Neurologic complications
Delayed awakening
persistent effect of anesthesia,
decreased cerebral perfusion,
hypoglycemia, sepsis,
electrolyte or acid-base derangements
neurologic damage
Emergence delirium
Peripheral neurologic lesions
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Others
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pharmacologic reversal
opioid naloxone
benzodiazepines flumazenil
neuromuscular neostigmine
blockade drug
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Criteria for discharge
easily arousable and oriented
hemodynamically stable
adequate ventilation
able to protect their airway
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The PACU is staffed by a dedicated team of an
anesthesiologist, nurses, and aides.
It is located in immediate proximity to the
operating room (OR) with access to radiology and
the laboratory.
Drugs and equipment for routine care (O2, suction,
and monitors) and advanced support (mechanical
ventilators, pressure transducers, infusion pumps,
and code cart) must be readily available.
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Thanks
Thanks !
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Definition and History
Acute pain: a normal, predicted, physiological response