Notice bibliographique
Résumé
University of Calgary, Department of Anesthesia, Foothills Hospital, Calgary, Alberta, Canada. scottalang@shaw.caTo the Editor:—I wish to congratulate Dr. Karmakar on his very thorough and informative review on paravertebral anesthesia and analgesia. 1Dr. Karmakar has overlooked one technique of paravertebral blockade that, in my opinion, has shown particular merit and is worthy of further investigation—the use of a nerve stimulator. To my knowledge, the use of a nerve stimulator as a guide to the performance of paravertebral blockade was first alluded to by Drs. J. J. Bonica and F. P. Buckley. 2I have used and refined this technique for more than 5 yr now. As with any technique it has advantages and limitations. Some of its advantages include the following:Potential disadvantages may include the expense of the nerve stimulator and associated insulated needle, and the inability to easily observe a motor response in obese patients. Therefore, it may be prudent to have an assistant that can palpate a motor response. It is always prudent to use all of your senses to guide the needle, as with any technique.The technique is simple and can be used on either an awake or heavily sedated or anesthetized patient. Any of the approaches described in Dr. Karmakar's review article can be used. 1I sedate the patient with intravenous ketamine (2.5–5.0 mg), versed (0.5–1 mg), and sufentanil (2.5–5.0 μg), administer oxygen by nasal prongs (2 to 3 l/min) and monitor with a pulse oximeter. The nerve stimulator (Braun) is set to deliver a supramaximal current (5.0 mamp). I use an insulated 5 cm Stimuplex needle and have found that it is the ideal length for virtually all adult patients in the thoracic region (T2–T12). The patient is warned that they may feel a pulsating “buzz” or feel some movement in their chest or abdomen. They are asked to report these phenomena as soon as they are perceived. The technique that is chosen determines how the needle is advanced. If the transverse process is encountered the needle is redirected either above or below the transverse process and advanced until a motor or sensory response is elicited. If the transverse process is not encountered the needle is advanced slowly until either a sensory or a motor response is elicited in the distribution of the “ventral” ramus of the spinal nerve. It does not seem necessary to refine the motor end-point although it is my practice to do so. I have found that when the needle is positioned in this manner a motor response will be elicited at a current of between 0.2–2.0 mamp. Approximately 30–40% of the patients will report a simultaneous electrically induced paresthesiae. The technique can also be used to facilitate difficult intercostals nerve blocks.
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 | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| 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 | 0,001 | 0,001 |
| 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 ».