Biier's Block Case Study

When there is a complication of the regional anesthesia which might include anaphylaxis, overdose, incorrect delivery technique and systemic absorption, the nurse will monitor for systemic toxic reaction which comprises of monitoring the central nervous system (CNS) stimulation along with CNS and cardiac depression. The nurse will also assess the patient for incoherent speech, restlessness, blurred vision, excitement, headache, nausea, vomiting, metallic taste, seizures, tremors, increase blood pressure, respiration and pulse. The patient may become apnea, hypotensive, unconscious, and have a cardiac arrest which may lead to death if the toxic reaction is not treated. Nursing intervention for the complication of regional anesthesia include establishing an open airway, administering oxygen, and notifying the surgeon. Treatment usually comprise of a fast acting barbiturate with epinephrine being administered for cardiac arrest. Edema and inflammation is an early sign of local complication with abscess formation, tissue necrosis and /or gangrene occurring later (Ignatavicius & Workman, 2013). Since general anesthesia was administer in addition to the regional anesthesia, the nurse and anesthesiologist will have to also monitor for complication of general anesthesia which range from a minor sore throat to death. Certain drugs used for general anesthesia may cause an acute, life threatening complication know as malignant hyperthermia (MH). The exposure of these agent to the skeletal muscle causes an increases in serum calcium and potassium level, metabolic rate leading to increased body temperature, acidosis and cardiac dysrhythmias. MH might occur immediately after the administration of the anesthesia, or several hours into the

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

A general anaesthetic always involves hypnotic agent, usually an analgesic and may also include muscle relaxation. This combination is referred to as “triad of anaesthesia”. The relative importance of each component depends on surgical and patient factors: the intervention planned, site, surgical access requirement and the degree of pain or stimulation anticipated. The technique is tailored to the individual

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

Postoperative surgical pain can often be moderate to severe leaving the client in a state of discomfort that requires the administration of opioid analgesic medications. Morphine intravenous (IV) patient-controlled analgesia (PCA) is commonly provided through a pump to treat postoperative surgical pain, but with advances in the medication administration field, a fentanyl iontophoretic transdermal system (ITS) has become another popular method (Lindley, Pestano, & Gargiulo, 2009). Morphine and fentanyl are similar medications in that they are both opioid analgesics and are both equally effective to reduce pain, but they offer differences through their administration techniques, comfort for the client, and providing care in a timely manner by the nurse. The nurse must take into consideration these differences to choose the proper medication for their specific client.

Numerous studies have been conducted on the use of local anesthetic agents with adjuvants such as clonidine (a partial α2-adrenoreceptor agonist) and tramadol3, 4 for a brachial plexus block to improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may prolong anesthesia and analgesia. Moreover, dexmedetomidine is a α2-receptor agonist that has more selectivity than clonidine and has analgesic and sedative properties.5, 6 Although several studies have described the effects of dexmedetomidine on neuroaxial and peripheral nerve blocks,7, 8, 9 to date, there is only 1 study available, performed by Esmaoglu et al,10 on the effect of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. In view of the idea that decreasing the dose of dexmedetomidine may help to reduce side effects such as bradycardia and hypotension, we wanted to evaluate the effect of dexmedetomidine at a lower dose than that used in their study and the results. We think that more studies on this issue are needed.

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

This feature also enables the use of this technique into the postoperative period for analgesia, using lower concentrations of local anaesthetic drugs or in combination with different agents.

Cardiac surgery is among the most frequently performed surgical procedures in the United States. According to the American Heart Association, over 575,000 open heart surgeries were performed in 2005. Until relatively recently, sedation and prolonged ventilatory support through the first twelve to eighteen hours post operatively have been standard. This allowed adequate time for the patient’s hemodynamic, respiratory and coagulation physiological

Different types of anesthetics can be used for different scenarios and part of an anesthesiologist’s job is to identify

However, this statistically significant decrease is not clinically significant as the maximum decrease in MAP below the baseline values was less than 30%. The latter is less the 33% suggested by Mikko (2009) as the point below which hypotension is clinically significant and necessitates treatment. When the two groups were compared to each other, the maximum decrease in the MAP was more in the CEA group and this statistically significant. This is consistent with the findings from other studies done by Sutter and colleagues (1989) as well as Denny and Selander (1998) where the decrease in blood pressures was less in CSA so that cardiovascular stability was easily achieved. The height of the block is best controlled by titration of intermittent injections of a small volume of local anesthetic through the catheter with assessment of block level after each injection, so CSA (with titration by intermittent injections of small volumes of local anesthetic) seems to be a valuable method for anesthetic management of patients who either will not tolerate the administration of large amount of fluids or in whom the use of sympathomimetic for correction of spinal block induced hypotension should be avoided (Schnider et al, 1993). In the present study, there were no statistical significant in

Residual neuromuscular blockade is commonly seen in the post anesthesia care unit (PACU) after nondepolarizing neuromuscular blocking drugs (NMBDs) are administered intraoperatively. Despite the use of intermediate-acting NMBDs and antagonism of neuromuscular blockade at the conclusions of the procedure, PORC is still a clinical problem in the PACU indicating the need for objective neuromuscular monitoring to be performed per operatively to ensure patient

You may be given an injection of a medicine that numbs the area (local anesthesia).

Background: Propofol is a widely used intravenous anesthetic drug. One of its side effects is pain during injection. We investigate the effects of intravenous ondansetron, lidocaine, and their combination on pain reduction of intravenous propofol.

Central neuroaxial block offers certain advantages that have made it a worthy alternative to general anaesthesia in infraumblical surgeries. Compared to general anaesthesia central neuroaxial block is associated with advantages like less blood loss, decreased incidence of deep vein thrombosis, conscious patient with normal airway reflexes, reduced surgical stress resulting in decreased plasma catecholamines level, improved ambulation and fewer cardio respiratory complications. The most common central neuroaxial blockade is subarachnoid block.