Ebook A practical approach to regional anesthesia (4/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook A practical approach to regional anesthesia (4/E): Part 2
Ebook A practical approach to regional anesthesia (4/E): Part 2
Sympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2static functions including vasomotor tone, myocardial contractility, heart rate, bronchial tone, perspiration, gastrointestinal secretions, genitourinary function, pupil diameter, and so on. Sympathetic blocks can be used both diagnostically and therapeutically to block these functions (e.g., perspi Ebook A practical approach to regional anesthesia (4/E): Part 2ration in hyperhydrosis or vasomotor tone in vascular insufficiency). Also, there are pathological pain states involving the sympathetic nervous systeEbook A practical approach to regional anesthesia (4/E): Part 2
m (e.g., sympathetically maintained pain) that can benefit from sympathetic block.In addition, there are afferent sensory nerves, particularly from thSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2thesia or to treat both malignant and nonmalignant chronic pain.Sympathetic blockade can be performed based solely on the anatomic landmarks described ill the subsequent text and this degree of accuracy is generally sufficient when using these blocks as an adjunct to surgical anesthesia (e.g., celia Ebook A practical approach to regional anesthesia (4/E): Part 2c plexus block as part of a general anesthetic for cholecystectomy). However, when used for diagnostic or neurolytic block use of radiographic (e.g.,Ebook A practical approach to regional anesthesia (4/E): Part 2
computed tomography I’CTI, fluoroscopy) or ultrasound guidance is recommended because of the greater accuracy these techniques provide.II.AnatomyA.TheSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2eceive input from both local spinal interneurons as part of sympathetic reflex arcs and descending control from brainstem centers (Figure 11.1).B.Sympathetic preganglionic neurons from each spinal cord segment course within the corresponding spinal nerve as it traverses the intrathecal and epidural Ebook A practical approach to regional anesthesia (4/E): Part 2spaces. After exiting the spinal canal, the sympathetic neurons leave the spinal nerve as the white rami comniunicantes to enter one of the sympathetiEbook A practical approach to regional anesthesia (4/E): Part 2
c chain ganglia where they then take one of three paths (Figure 11.1):1The preganglionic neuron may synapse with the second order (postganglionic) neuSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2he right and left anterolateral aspect of the T1 to L2 vertebral bodies.2The preganglionic neuron may pass through the paravertebral ganglion and travel rostral or caudal to synapse with a postganglionic neuron in another local or distant paravertebral ganglion.a.The postganglionic neurons originati Ebook A practical approach to regional anesthesia (4/E): Part 2ng in the paravertebral ganglia pass through the gray rami communicantes to rejoin the adjacent spinal nerve and travel with it to provide sympatheticEbook A practical approach to regional anesthesia (4/E): Part 2
innervation to the tissues innervated by that nerve.15611. Sympathetic Blockade 157Figure 11.1. Sympathetic nervous system pathways. Sympathetic pregSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2tem and from local interneurons. Preganglionic sympathetic fibers (cholinergic) exit the spinal cord within the corresponding spinal nerve and enter the sympathetic chain ganglia through the white rami communicantes where they may (i) synapse with a postganglionic sympathetic neurons (adrenergic), ( Ebook A practical approach to regional anesthesia (4/E): Part 2ii) pass through the sympathetic chain ganglion without synapsing and reenter the spinal nerve of origin through the gray rami communicantes and synapEbook A practical approach to regional anesthesia (4/E): Part 2
se with a postganglionic neuron in one of the distant prevertebral ganglia, or (iii) travel along the sympathetic chain to synapse with a postganglionSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2 may carry sympathetic activity arising in multiple spinal cord segments.3The preganglionic neuron may pass through the paravertebral ganglion to synapse with the postganglionic neuron in a prevertebral ganglion (e.g., superior cervical, superior mesenteric) or the adrenal gland.158 A Practical Appr Ebook A practical approach to regional anesthesia (4/E): Part 2oach to Regional Anesthesiac.Plexuses. Aggregations of sympathetic nerves and prevertebral ganglia in the thoracic, abdominal, and pelvic cavities areEbook A practical approach to regional anesthesia (4/E): Part 2
termed plexuses. There are four generally recognized plexuses: cardiac, pulmonary, celiac, and hypogastric, which innervate the heart, lungs, abdominSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2 them course along nearby blood vessels to reach their target organs.III.IndicationsA.Autonomic indications. Blocks performed specifically to interrupt sympathetic nervous system activity are generally done to produce vasodilatation in an effort to improve blood flow in a particular area (1) or to t Ebook A practical approach to regional anesthesia (4/E): Part 2reat hyperhydrosis. Tor example, block of the sympathetic chain has been used successfully to increase blood flow in the setting of vascular insufficiEbook A practical approach to regional anesthesia (4/E): Part 2
ency, particularly in patients who are not candidates for surgical revascularization (2). More recently, stellate ganglion block has been shown to be Sympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2c blocks are probably most often used to treat malignant and nonmalignant pain. In this context, they are employed not to block the sympathetic ganglia per se; rather the intent is to block afferent sensory' fibers that travel with the sympathetic fibers and pass through or near the sympathetic gang Ebook A practical approach to regional anesthesia (4/E): Part 2lion. Blockade of the celiac plexus to treat malignant and nonma lignant intra-abdominal pain is a classic example. Celiac plexus blockade combmed witEbook A practical approach to regional anesthesia (4/E): Part 2
h intercostal blocks can be used for upper abdominal surgery. Ganglionic blockade has a Iso been used to supplement surgical general anesthesia arid tSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2locks. Because motor block is not an issue when performing ganglionic blocks (there are no somatic motor fibers present), dilute local anesthetic solutions can be used if desired (e.g., 0.25% bupivacaine, 0.5% lidocaine). Shorter-acting agents might be useful for diagnostic blocks or for efficacy tr Ebook A practical approach to regional anesthesia (4/E): Part 2ials before surgical extirpation or neurolytic block.B.Neurolytic agents. Both alcohol and phenol have been used successfully to produce neurolytic blEbook A practical approach to regional anesthesia (4/E): Part 2
ock of ganglia. Alcohol is often preferred for use around great vessels (e.g., celiac block) because it is thought to be less likely to damage them. BSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2ock1. Anatomy. The stellate ganglia are formed by a variable fusion of the first (sometimes second, third, and even fourth) thoracic ganglion and the lower two cervical segmental ganglia, which is why it is sometimes called the cervicolhonicic ganglion. Position is somewhat variable but "on average" Ebook A practical approach to regional anesthesia (4/E): Part 2 the ganglion lies just anterior to the lateral edge of the C7 and T1 vertebral bodies. At this level, a good portion of the ganglion is behind the veEbook A practical approach to regional anesthesia (4/E): Part 2
rtebral and subclavian arteries and medial to the cupola of the lung (Figure 11.2).https: //k hot h u V i e n .com11. Sympathetic Blockade 159Figure 1Sympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2 and inferior cervical ganglia (sometimes middle cervical ganglion also).The ganglion generally lies along the lateral border of C7andTl vertebrae sometimes extending to the inferior edge of C6 or as low as T4. The bulk of the ganglion lies posterior to the carotid and vertebral arteries and postero Ebook A practical approach to regional anesthesia (4/E): Part 2medial to the cupula of the lung. Because of the proximity of multiple "high-risk" structures the block is usually performed at the level of the C6 orEbook A practical approach to regional anesthesia (4/E): Part 2
C7 transverse processes and sufficient volume (7-10 mL) is used to assure sufficient inferior spread. SCM, sternocleidomastoid.a.Ilccausc of the proxSympathetic BlockadeChristopher M. BernardsI.IntroductionThe sympathetic nervous system is a purely efferent system involved in a wide range of homeos Ebook A practical approach to regional anesthesia (4/E): Part 2rse process and ganglionic blockade relies on administration of a sufficient local anesthetic volume to spread caudally to reach the ganglion. Direct block of the ganglion, as would be needed for neurolytic drugs, is probably best accomplished under CT guidance.2Techniquea.Position the patient supin Ebook A practical approach to regional anesthesia (4/E): Part 2e with the neck in slight extension.Gọi ngay
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