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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We monitored myogenic motor evoked potentials (MEPS) during intracranial surgery in 21 patients anesthetized with nitrous oxide in oxygen, fentanyl, and 0.75-1.5 minimum alveolar anesthetic concentration (MAC) isoflurane (n = 11) or sevoflurane (n = 10). The exposed motor cortex was stimulated with a single or train-of-five rectangular pulses at a high frequency (500 Hz), while the compound muscle action potentials (CMAPS) were recorded from the abductor pollicis brevis muscle. Neuromuscular block was monitored by recording the CMAPs from the abductor pollicis brevis muscle in response to electrical stimulation of the median nerve at the wrist (M-response). Stimulation of the motor cortex with a single pulse elicited MEPs in none of the patients, while stimulation with a train-of-five rectangular pulses at high frequency elicited MEPs in all patients. The relationship between MEP amplitude and the level of neuromuscular block induced by vecuronium infusion was evaluated in seven patients. For comparison of the individual measurements, the MEP amplitude at a M-response amplitude of 100% was calculated by means of the individual regression curve as 100% of MEP amplitude. There was a linear correlation between percent MEP amplitude and percent M-response amplitude (r = 0.81; P < 0.01). Intraoperative monitoring of MEP could be performed at a M-response amplitude above 90 % of the baseline value in 10 patients and at a M-response amplitude of 20%-50% of the baseline value in 11 patients. During monitoring of the 21 patients, MEPs did not change in 18 patients and disappeared in two patients. In the remaining patient, MEP amplitudes were attenuated to approximately 10% of the baseline value and recovered after cessation of surgical manipulation. In the two patients in whom MEPs disappeared, motor paresis developed postoperatively. We conclude that 1) intraoperative myogenic MEP monitoring is feasible during isoflurane or sevoflurane anesthesia if stimulation is performed with a short train of rectangular pulses, and 2) that electromyographic monitoring of neuromuscular block is useful to assess intraoperative MEP changes under partial neuromuscular block.
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PMID:Intraoperative myogenic motor evoked potentials induced by direct electrical stimulation of the exposed motor cortex under isoflurane and sevoflurane. 862 67

The application of digital pressure above the injection site during interscalene block has been advocated to prevent cephalad spread of local anesthetic. In prior studies, radiographs taken immediately after interscalene injection of radiographic contrast have supported this concept. However, the clinical efficacy of digital pressure has not been previously tested. If digital pressure were effective in inhibiting cephalad spread of local anesthetic, attenuation of both hemidiaphragmatic paresis and the resulting compromise in pulmonary function would be expected. Sensory, motor, and pulmonary effects were prospectively evaluated in 20 patients presenting for elective shoulder surgery. Patients were randomly assigned to receive interscalene block with or without digital pressure. No clinical differences were seen between groups. All 20 patients had ipsilateral hemidiaphragmatic paresis by ultrasonographic evaluation and large mean decreases in forced vital capacity, 31.2% +/- 7.8% (with digital pressure), 33.7% +/- 12.8% (without digital pressure), and forced expiratory volume at one second, 27.9% +/- 9.3% (with digital pressure), 33.7 +/- 12.8% (without digital pressure). Peak sensory level of anesthesia to pinprick was not significantly different between groups, each group having mean levels of C-2 to C-3. Digital pressure was ineffective in limiting the flow of local anesthetic into the cervical plexus. Digital pressure influenced neither the incidence of diaphragmatic paresis nor the resulting large decreases in pulmonary function that result from interscalene block.
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PMID:Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus. 869 20

Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. For minor surgery, regional anaesthesia associated to a light sedation is sufficient. However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.
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PMID:[Analgesia after surgery of the shoulder]. 874 51

At Flinders Medical Centre in Adelaide, eye surgery under local anaesthesia (peribulbar block) has been carried out in the day ophthalmic surgery unit since 1987. In a subset of 536 patients, 112 patients required additional anaesthesia (supplementary retrobulbar block or regional muscle infiltration) to achieve full ocular paresis, and 10 patients required intraoperative supplementation of anaesthesia because of discomfort. Six patients had their surgery postponed (one had a retrobulbar haemorrhage and five became anxious after the procedure commenced). Sedation was rarely required and there were no adverse effects of the anaesthetic on surgical procedures or patients' vision. The authors conclude that peribulbar block provides satisfactory anaesthesia and that day ophthalmic surgery is safe and effective.
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PMID:Day ophthalmic surgery: aspects of perioperative care. 915 52

The expanded role for antiplatelet drugs and anticoagulant therapy has resulted in more surgical patients receiving these medications during the perioperative period. The risk of developing a spinal hematoma (epidural, subdural, or subarachnoid) remains exceedingly small in most patients despite receiving these therapies. Despite the low incidence, potentially devastating neurologic sequelae often occur in the patient who develops a spinal hematoma. Irreversible paresis/paralysis can result despite excellent emergent care. Management of the patient with an abnormal bleeding history or other hemostatic abnormality must be individualized. Each situation is unique and should be considered in its totality. Certainly, patients receiving fibrinolytic agents such as streptokinase or patients with diffuse hemorrhagic problems (eg, disseminated intravascular coagulation) should avoid regional anesthesia and spinal blocks (27,28). Other situations are often less clear and require appropriate judgments by the anesthesiology consultant as to the risk/benefit ratio. Issues that must be entered into the equation include degree of hemostatic abnormality present, surgery anticipated, what if any anticoagulation is planned postoperatively, emergent versus elective surgery, skill of the regional anesthesiologist, patient desires, and associated medical abnormalities. Clearly, it is of extreme importance that documentation be thorough and include knowledge of the associated risks and why the risks are acceptable in the particular patient. This documentation provides good medical information and can be helpful should a medicolegal issue arise. This documentation should include informed consent, which is thoroughly explained to the patient and/or family. It is unlikely that anesthesiologists will be able to develop exact numbers on the incidence of spinal hematomas because of the rarity of this event. It remains extremely important that practitioners continue to report the occurrence of such hematomas, so that information can be gleaned from their experience. The experience of practitioners with LMWH and central neuraxial block, described above, currently is providing us with important information, which may ultimately affect the way we practice. Without case reporting of this information, the knowledge would remain unobtainable.
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PMID:The anticoagulated patient. 895 22

The authors analyze the most current methods for the treatment of ulcerated breast cancer in the elderly. They describe a peculiar case recently observed, characterized by an ulcerative lesion spreading from the hemiclavicle to the foreaxilla including the axillary cavity, causing a large phlebo-lymphaedema, anaesthesia and paresis of the homoteral upper limb. After an initial treatment with tamoxifen a scapulo-humeral disarticulation and a suture of the cutaneous wide defect were performed using a myo-skin graft which included the deltoid muscle. A radiotherapeutic treatment followed by tamoxifen therapy was carried out. No distant metastases and no local relapses were registered in the one year follow up. The Authors on the basis of their experience and according to the review of the Literature suggest that age itself is not a limiting factor to the therapeutic approach of ulcerated breast cancer.
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PMID:[Ulcerated carcinoma of the breast in an elderly woman. An unusual clinical case report]. 920 78

A case of cervical epidural hematoma caused by cervical twisting after epidural anesthesia was reported. A 41-year-old man who had had anterior fusion of C5 - 7 using a plate due to cervical spondylosis fifteen months before admission, had undergone epidural anesthesia through the C7/T1 interspace without difficulty for shoulder pain in a pain clinic. Two hours after injection, he complained of severe pain in his neck and both shoulders just after cervical twisting as was his custom. Within minutes he noted paresis of his left extremities. Neurological examination on admission revealed left side dominant tetraparesis and loss of pain and temperature sensations below the level of T4 on his right side. Laboratory data analysis and coagulation tests were normal. CT scans and MRI demonstrated an epidural hematoma with a small amount of air extending from C3 to the upper margin of C7. Four hours after the onset, a laminoplasty was performed from C3 to C7 with total removal of the hematoma. No bleeding site or any vascular abnormality was found to account for the hematoma formation. He was discharged with good recovery after operation. Most of the reported epidural hematomas associated with epidural anesthesia were related to coagulopathy, anticoagulant therapy or difficult puncture. On review of the literature, this is the first case of spinal epidural hematoma cause by cervical twisting after spinal anesthesia and which was without impaired coagulation or difficult spinal puncture. Cervical epidural hematoma should be considered as a possible complication in patients with pain or neurological deficits after some cervical manipulations.
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PMID:[Cervical epidural hematoma caused by cervical twisting after epidural anesthesia: a case report]. 966 97

Based on the results of several electrodiagnostic and biomechanical studies, the following classification of muscle dysfunction in spastic hemiplegia is proposed: changes in muscle activation (excess symptoms, e.g., spasticity, and deficit symptoms, e.g., paresis); changes in muscle stiffness; and changes in muscle length. The clinical significance of this classification is that different types of muscle dysfunction might require specific treatment. The authors have developed techniques to measure quantitatively each type of muscle dysfunction: free frequency repetitive movement (FFRM) and torque angle diagram (TAD). Surface EMGs of tibialis anterior, gastrocnemius, and soleus muscle are recorded during active (FFRM) and passive (TAD) ankle movements. EMG data are converted to parameters for abnormal muscle activation (excess and deficit symptoms). Parameters for muscle stiffness and muscle length are derived from the hysteresis curve of the TAD. This article describes the measurements and the results of a validation study. For the validation study, four hypotheses were formulated: 1) in nonimpaired control subjects, parameters expressing abnormal muscle activation are low; 2) in hemiplegic subjects, differences between the affected and the unaffected sides will be found for all types of parameters; 3) after local anaesthesia of the tibial nerve on the hemiplegic side, excess symptoms will decrease, while muscle stiffness remains unchanged; and 4) despite a uniform gait pattern, between-subject differences can be detected with regard to muscle activation, stiffness, and length. The first hypothesis was tested and confirmed in two controls; the remaining three were tested and confirmed in ten hemiplegic subjects (mean age 47.7 yrs, mean time since onset 10.7 yrs). However, the level of co-contraction of the gastrocnemius muscle was low, probably indicating that the clinical significance of this phenomenon might be limited. The results support the validity of the proposed classification and measurements.
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PMID:Measurement of impaired muscle function of the gastrocnemius, soleus, and tibialis anterior muscles in spastic hemiplegia: a preliminary study. 970 15

The author presents an account on different causes of ophthalmological torticollis and rotational nystagmus in paresis of the trochlear nerve and abducent nerve, in Duan's syndrome I or acute Brown's syndrome or in bilateral ptosis combined with paresis of the levators. He recommends different surgical techniques and prefers combined operations performed with a single anaesthesia in pareses of the levators, the abducent nerve and trochlear nerve. For release of the horizontal direct muscles within the framework of paretic affections of the eye he recommends adjustable elongations as described by Gonin-Hollwich. In ptosis he uses frontotarsal suspension as described by Fox, using lyophilized fasciae. The paper contains also a family history of congenital fibrous syndrome.
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PMID:[Ocular torticollis]. 972 81

In order to evaluate complications due to cervical spine surgery using the anterior cervical approach a prospective study was conducted on 125 patients. ENT examination with the fibroscope was employed for all the patients before the procedure. The patients were operated on under general anesthesia and were intubated with an armoured tube, and then were placed in an intensive care unit for 24 hours. Assessment of deglutition and an ENT examination were performed the day after surgery. Before surgery, two cases of vocal cord paralysis were noted. 111 patients (88.8%) presented with subjective disorders: problems such as sore throat, odynophagia, dysphagia, dysphagia with overspill and hoarseness were respectively noted in 55 (44%), 34 (27.2%), 32 (25.6%), 11 (8.8%) and 13 (10.4%) cases. Dyspnoea was found in 2 cases (1.6%). 117 patients (93.6%) presented postoperative anomalies which were found on the posterolateral pharyngeal wall, on the arytenoids and on posterior third of the vocal cords. Inflammatory and/or swollen lesions were slight, moderate, significant or very significant in respectively 22.4%, 22.4%, 15.2% and 1.6% of cases. Very significant circumferential swelling of the pharyngeal wall and of the arytenoids was responsible for two cases of respiratory distress, and the patients required reintubation and return to theatre. Severe pharyngeal lesion correlated with duration of surgery (r = 0.20; p < 0.05), with the number levels of fusion (r = 0.02; p < 0.02) and with the age of the patient (p < 0.02). Six patients presented problems of mobility of the vocal cords: 3 had a right vocal cord paresis which was temporary and 3 had paralysis, also on the right but which persisted. There were no other complications. It is concluded that (i) ENT complications are frequently found in postoperative cervical spine surgery using the anterior cervical approach, some of them being severe. An ENT examination must be performed before the procedure for legal reasons. It is also recommended in the postoperative period in the case of discomfort; (ii) patients need to be placed in an intensive care unit during for the first 24 hours (iii). This study needs to be attended over more patients (iv) comparison with a control group of patients having non cervical surgery and intubated in the same way is needed to differentiate lesions related to surgery or intubation.
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PMID:[A prospective study of ENT complication following surgery of the cervical spine by the anterior approach (preliminary results)]. 977 50


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