Comparison of laryngeal mask airway insertion methods, including the external larynx lift with pre-inflated cuff, on postoperative pharyngolaryngeal complications: A randomised clinical trial.

Background: Postoperative pharyngolaryngeal complications are commonly reported following laryngeal mask airway (LMA) insertion. After induction of anaesthesia, the airway structures fall backwards under the influence of gravity, and this may contribute to difficulty in placement of a LMA. External airway alignment by lifting the larynx during insertion of an airway may avoid collision of the airway with laryngeal structures.

The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study.

Background: Perineural dexamethasone has been investigated as an adjuvant for brachial plexus nerve blocks, but it is not known whether the beneficial effect of perineural dexamethasone on analgesia duration leads to a better quality of surgical recovery. We hypothesized that patients receiving dexamethasone would have a better quality of recovery than patients not receiving dexamethasone. We also sought to compare the effect of perineural with that of IV dexamethasone on block characteristics.

Nerve block of the infrapatellar branch of the saphenous nerve in knee arthroscopy: a prospective, double-blinded, randomized, placebo-controlled trial.

Background: With the rising use of outpatient knee arthroscopy over the past decade, interest in peripheral nerve blocks during arthroscopy has increased. Femoral nerve blocks are effective but are associated with an inherent risk of the patient falling postoperatively because of quadriceps weakness. We studied blocks of the infrapatellar branch of the saphenous nerve, which produce analgesia in the knee that is similar to that resulting from a femoral nerve block but without associated quadriceps weakness.

Ambulatory anesthesia in an adult patient with corrected hypoplastic left heart syndrome.

With recent advancements in clinical science, an increasing number of patients with congenital heart defects are surviving into adulthood and presenting for noncardiac surgeries. We describe one such example of a 26-year-old patient with corrected hypoplastic left heart syndrome presenting for knee arthroscopy and performed under general anesthesia with preoperative ultrasound guided saphenous nerve block. In this case, we review the anesthetic implications of corrected single ventricle physiology, anesthetic implications, as well as discuss the technique and role of saphenous nerve block in patients undergoing knee arthroscopy.

Nerve stimulator-guided supplemental popliteal sciatic nerve block after a failed sciatic block does not increase the incidence of transient postoperative neurologic sequelae.

Background: Supplemental peripheral nerve blocks are not commonly performed in adults because of concerns of cumulative exposure of the nerve to the local anesthetic as well as increased ischemia from epinephrine. The purpose of this study was to compare the incidence of postoperative neurologic symptoms after a failed subgluteal sciatic nerve block and a supplemental popliteal sciatic nerve block.

Methods: Five hundred twelve adult patients undergoing ambulatory surgery were prospectively studied (1 yr).

Sensory testing of distal sural and posterior tibial nerves provides early prediction of surgical anesthesia after single-injection infragluteal-parabiceps sciatic nerve block.

Background: Surgical anesthesia for reconstructive ankle surgery requires sensory and motor block of all the terminal nerve distributions of the sciatic nerve. In this prospective observational study, we investigated the value of sensory and motor testing of the foot, after local anesthetic injection, for predicting complete sciatic nerve blockade and the duration of testing required for identifying incomplete anesthesia.

Methods: Sciatic nerve blocks (n = 180) using the infragluteal-parabiceps approach were performed in patients undergoing reconstructive ankle surgery.

A case report of reappearance of spinal anesthesia.

Objective: We present a case of reappearance of spinal anesthesia despite the use of plain (isobaric) lidocaine and without an associated cough or Valsalva maneuver.

Case Report: A 66-year-old man had spinal anesthesia for knee arthroscopy. Two hours after the induction of spinal anesthesia and after the patient's motor strength had returned to the lower extremities, his head was elevated to 30 degrees.

Alkmaion's discovery that brain creates mind: a revolution in human knowledge comparable to that of Copernicus and of Darwin.

Without special examination the brain offers no clue that it is the organ of the mind. From the dawn of time man thus either ignored the problem as to the source of thought, or attributed it to a variety of anatomical structures, usually the heart. The brain held no place in such intuitions, and in most languages it is analogized to bone marrow.

Evaluation of a proximal block site and the use of nerve-stimulator-guided needle placement for posterior tibial nerve block.

Background: Posterior tibial nerve (PTN) block has traditionally been performed in the para-medial malleolar area without nerve stimulator (NS) guidance. The PTN can also be blocked proximally (7 cm) above the medial malleolus in the subfascial plane between the flexor hallucis longus and flexor digitorum longus tendons. In this study we compared the frequency of successful PTN block at the traditional distal (D) site (2 cm above the medial malleolus) with and without NS guidance.

Konorski and conditional reflexes: a historical summary and an addendum.

There have been four major pioneers from Eastern Europe in the neuroscientific study of memory and learning: Pavlov, Bekhterev, Beritashvili and Konorski. The thinking of each evolved with the progress of neuroscientific knowledge throughout the world, and save for Pavlov, each encountered governmental opposition to their views. Among the clues largely overlooked in their examination of conditional reflexes was the fact that the animal appreciates not only its own appetitive state but its immersion in the experimental setting.

Psychophysics of electrical stimulation of striate cortex in macaques.

Macaques indicated their detection of onset or alteration of 0.2-ms pulses applied in various configurations through electrodes implanted in striate cortex. When microelectrodes were introduced and left in place, the threshold for detection of 100-Hz pulses nearly doubled within 24 h.

Laminar variation in threshold for detection of electrical excitation of striate cortex by macaques.

Macaques were trained to signal their detection of electrical stimulation applied by a movable microelectrode to perifoveal striate cortex. Trains of < or =100 cathodal, 0.2-ms, constant current pulses were delivered at 50 or 100 Hz.

Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course.

We determined the incidence, distribution, and resolution of neurologic sequelae and the association with anesthetic, surgical, and patient factors after single-injection interscalene block (ISB) using levobupivacaine 0.625% with epinephrine 1:200,000 in subjects undergoing shoulder or upper arm surgery, or both, in 693 consecutive adult patients. After a standardized ISB, assessments were made at 24 and 48 h and at 2 and 4 wk for anesthesia, hypesthesia, paresthesias, pain/dysesthesias, and motor weakness.

Nerve stimulator-assisted evoked motor response predicts the latency and success of a single-injection sciatic block.

Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I-II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.

Frontal cortex, laterality, and memory: encoding versus retrieval.

The cerebral hemispheres differ in their capabilities and response to verbal versus nonverbal visual material. A priori, it might thus be expected that the right hemisphere would be best activated during a mnemonic task with fMRI when using nonverbalizable images, and the left hemisphere with verbal material. However, previous psychological tests had shown a high degree of similarity in measures of memory for these disparate items.

Unity from duality.

When, in the primeval sea, creatures first began to crawl, "right" and "left" came into being, yielding neuronal nets to control response to the sidedness of stimuli. In the half billion years of moving and sensing, two brains have evolved, the right and the left; and human experience now shows them to be roughly equivalent, potentially independent, conscious entities. This dramatic fact is evidenced by "split-brain" patients and by numerous cases of therapeutic removal of either hemisphere.

Efficiency of the forebrain commissures: memory for stimuli seen by the other hemisphere.

How well will one cerebral hemisphere recognize items viewed initially via the other? Nonverbalizable images or words were presented to one visual field and memory for them tested in the same or the other visual field. The initially viewing hemisphere subsequently had no secure advantage in accuracy, and only for images was there a 30-ms (ca 3%) penalty in reaction time for viewing with the "other" hemisphere. Interhemispheric mnemonic communication is thus highly reliable.

Infragluteal-parabiceps sciatic nerve block: an evaluation of a novel approach using a single-injection technique.

Unlabelled: Clinical use of the sciatic nerve block (SNB) has been limited by technical difficulties in performing the block using standard approaches, substantial patient discomfort during the procedure, or the need for two injections to block the tibial and peroneal nerves. In this report, we describe a single-injection method for SNB using an infragluteal-parabiceps approach, where the nerve is located along the lateral border of the biceps femoris muscle. SNB was performed in the prone or lateral decubitus position.