Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".