Epinephrine Use in the Fingers
Notice bibliographique
Résumé
Sir: We thank Drs. Mandrekas and Zambacos for their interest in the elective use of epinephrine in the finger and for their confirmation of its safety in their experience. We have heard from several other groups around the world who have also been routinely using adrenaline electively in the finger with no adverse effects. Our own interest in adrenaline in the hand began with the large clinical experience of excellent Canadian hand surgeons, including Bob MacFarlane, Pat Shoemaker, John Fielding, and Mike Bell, who had a combined experience of well over 100 surgeon-years of elective injection of epinephrine into fingers without a single loss of a digit. There was a clear disconnect between the real experience of these good surgeons and the myth of epinephrine danger in the finger, which is still erroneously taught to many medical students and quoted in some major textbooks. We confirmed that phentolamine was a reliable and safe reversal agent for epinephrine-induced vasoconstriction in the finger by enrolling 18 Dalhousie University alumni hand surgeons among volunteers to have their own fingers injected with epinephrine and phentolamine.1 We then undertook a prospective study of 3110 consecutive cases of elective epinephrine injections by nine surgeons in six cities. This study confirmed that not one patient experienced any necrosis, and not even one patient required phentolamine rescue.2 Keith Denkler’s landmark article3 showed that there was not one case of lidocaine with epinephrine causing finger infarction in the world literature from 1880 to 2000. This work led us to the discoveries in our current article, which indicate that the likely source of the epinephrine myth was degenerated acidic procaine. Why is this topic a very important one? We were first interested in elective use of epinephrine in the finger so we could operate on these patients under pure local anesthesia. The main goal was to avoid the tourniquet, anesthesiology, and dependency on main operating rooms, which can be difficult to access in Canada. We then found other important benefits, which included improving the results of our hand surgery team by communicating with pain-free (tourniquet-free) patients during surgery and having them actively move reconstructed structures so that adjustments could be made before the skin was closed. This has been particularly helpful in tendon repair, tendon transfer, tenolysis, finger fractures, and so on. We no longer have to subject older hand patients with medical problems to the risks of sedation. We have also found it much cheaper and much more comfortable for patients to have tourniquet-free carpal tunnel and trigger finger releases in the clinic or office outside the main operating room. Almost all of our hand surgery procedures are now performed with the patient under pure local anesthesia, with no tourniquet and no sedation (wide awake approach), outside of the main operating room with field sterility. For much of the world that cannot afford the expense of a main operating room and general anesthesia, this approach will be a major step forward for hand surgery. Donald H. Lalonde, M.D., M.Sc. Christopher James Thomson, M.D. Keith Denkler, M.D. Anton Feicht, Ph.D. Division of Plastic Surgery Queen Elizabeth II Health Sciences Center Dalhousie University Halifax, Nova Scotia, Canada
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».