Ultrasound Block of the Medial Branch: Learning the Technique Using CUSUM Curves.

Background: Blocking the medial branch of the lumbar facet joints plays a fundamental diagnostic and therapeutic role in the treatment of lumbar pain. Attempts to replace the typical guided X-ray techniques with ultrasound-guided techniques have also involved treating the lumbar medial branches. By applying the cumulative sum control chart (CUSUM method), we sought to evaluate the learning curve associated with ultrasound-guided block of the lumbar medial branches in operators experienced in locoregional anesthesia but without expertise in pain therapy.

Clinical complications, monitoring and management of perioperative mild hypothermia: anesthesiological features.

Background And Aim Of The Work: Perioperative hypothermia is a frequent occurrence and can lead to several complications, which adversely affect the patient's outcome, expecially in high risk patient. Nonetheless, central temperature is not frequently monitored in the clinical routine. The aim of this work is to make the point on complications, monitoring techniques, prevention and treatment of mild perioperative hypothermia.

Forehead reflectance oximetry: a clinical comparison with conventional digit sensors during laparotomic and laparoscopic abdominal surgery.

Objective: This study compared the performance of forehead reflectance and conventional pulse oximetry (SpO(2)) in mechanically ventilated, anesthetized patients undergoing major abdominal surgery with either laparoscopic or laparotomic techniques.

Methods: SpO(2) was continuously measured both with a forehead reflectance and a conventional digit sensor in 20 ASA physical status I-III, anesthetized patients undergoing either a laparotomic (group Laparotomy, n = 10) or laparoscopic (group Laparoscopy, n = 10) major abdominal surgery. SpO(2) values measured with the two sensors were continuously recorded at 10-second intervals during the entire procedure, and then analyzed for consistency.

Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison.

Background: In this prospective, randomized, double-blind study we tested the hypothesis that 50 mg of 1% preservative-free 2-chloroprocaine would provide a faster resolution of spinal block than the same dose of 1% plain lidocaine.

Methods: After IV midazolam premedication (0.03 mg/kg), 30 ASA physical status I-II outpatients undergoing knee arthroscopy were randomly allocated to receive 50 mg of either 1% plain lidocaine (n = 15) or 1% preservative-free plain chloroprocaine (n = 15).

Transcutaneous monitoring of partial pressure of carbon dioxide in the elderly patient: a prospective, clinical comparison with end-tidal monitoring.

Study Objective: To evaluate the accuracy and precision of estimation of partial pressure of carbon dioxide (Pa(CO2)) using end-tidal or transcutaneous CO2 (TcP(CO2)) measurements during mechanical ventilation in the elderly patient.

Design: A prospective, observational study was conducted.

Settings: The study was done in the anesthesia department of a university hospital.

Bupivacaine, levobupivacaine and ropivacaine: are they clinically different?

Two new, long-acting local anaesthetics have been developed after the evidence of bupivacaine-related severe toxicity: levobupivacaine and ropivacaine. Both these agents are pure left-isomers and, based on their three-dimensional structure, they have less toxic potential both on the central nervous system and on the heart. Several clinical studies have evaluated their toxicology and clinical profiles: theoretically and experimentally, some differences can be seen, but the reflections of these characteristics into clinical practice have not been evident.

Anesthesia in the obese patient: pharmacokinetic considerations.

The prevalence of obesity has increased 15% up to 20% and represents an important challenge for the anesthesiologist in drug-dosing management. The aim of this work is to provide an overview on physiological changes and pharmacokinetic implications of obesity for the anesthesiologist. Obesity increases both fat and lean masses; however, the percentage of fat tissue increases more than does the lean mass, affecting the apparent volume of distribution of anesthetic drugs according to their lipid solubility.

Adding clonidine to the induction bolus and postoperative infusion during continuous femoral nerve block delays recovery of motor function after total knee arthroplasty.

We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.

Cardiovascular changes after extraglottic airway insertion: a prospective, randomized comparison between the laryngeal mask or the new PAXpress.

Study Objective: To compare hemodynamic responses induced with the new extraglottic airway, PAXpress, and the classic Laryngeal Mask Airway (LMA).

Design: Prospective, randomized study.

Setting: Anesthesia department of a university teaching hospital.

Levobupivacaine 0.2% or 0.125% for continuous sciatic nerve block: a prospective, randomized, double-blind comparison with 0.2% ropivacaine.

In 60 patients receiving elective hallux valgus repair, we compared the efficacy of continuous popliteal sciatic nerve block produced with 0.2% ropivacaine (n = 20), 0.2% levobupivacaine (n = 20), or 0.