THE TECHNIQUE OF EPIDURAL LYSIS OF ADHESIONS Our discussion is limited mostly to the procedure that involves accessing the epidural space via the sacral hiatus. This is similar to the…
THE DOCTRINE OF INFORMED CONSENT Definition of Informed Consent Informed consent is obtained when a patient intentionally agrees to treatment in the absence of external controlling influences, based on an…
DEFINITION Unintended neuraxial anesthesia is one of the most severe complications that can occur during performance of a peripheral or plexus block (Box 18-1). The interscalene approach to the brachial…
DEFINITION The term toxicity, as it is considered in regional anesthesia and pain medicine, refers generally to the effects of substances that are injurious to tissues and/or the body. In…
DEFINITION OF THE PROBLEM Local anesthetic systemic toxicity (LAST) may result from unintended intravascular injection of what would have been an appropriate dose of LA (had it been injected in…
DEFINITION Broadly speaking, the spinal cord is at risk of ischemic injury under any circumstances in which the supply of oxygen or nutrients is insufficient to meet metabolic demands. Thus,…
DEFINITION Recent clinical experience and experimental data define a rather narrow therapeutic index for local anesthetics with respect to their potential for neurotoxic injury.1 The actual risk varies based on…
DEFINITION This chapter defines mechanical neuraxis injury as fulfilling one of two criteria. The first, direct mechanical injury, encompasses those circumstances in which a needle or catheter directly damages the…
The right dose differentiates a poison and a remedy. —Paracelsus (1493–1541) Marc A. Huntoon and Halena M Gazelka OVERALL SCOPE GLUCOCORTICOSTEROID PHYSIOLOGY HYPOTHALAMIC-PITUITARY-ADRENAL AXIS SUPRESSION Scope Pathophysiology Risk Factors Diagnosis…
DEFINITION The performance of regional anesthesia may cause muscle injury by several mechanisms. Ischemia from an occlusive tourniquet such as during an intravenous regional anesthetic may produce muscle damage, but…
