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Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia
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- Dostępność:
- dostępny na zamówienie - czas oczekiwania około 5 tygodni
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Cena:
796,96 zł
Cena netto:
759,01 zł
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- The first book to correlate ultrasound and MRI images
- Helps anesthesiologists become familiar with anatomy as it appears in ultrasound
- Combines ultrasound and nerve stimulation-guided techniques
There are few situations in anesthesia where precise anatomic location is more important than in regional anesthesia. But, of course, any anesthesiologist who performs regional on a regular basis is fully aware of the frustration of attempting to locate nerves on a trial and error basis. Ultrasound imaging now enables us to visualize nerves, and this exciting technology offers several distinct benefits over conventional nerve locating techniques. The Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia illustrates how to use ultrasound technology and nerve stimulation techniques to achieve consistently good results. Throughout the book, ultrasound images are correlated with MRI images to enhance anatomic identification. In addition, peripheral nerve block techniques for upper and lower extremities and the trunk are demonstrated step-by-step. With the luxury of being able to actually see the target nerve and the course of the needle as it approaches that nerve, anesthesiologists can now perform regional anesthesia with much greater accuracy. This approach allows the anesthesiologist to conduct regional anesthesia with much greater confidence and efficiency and in doing so the patient is the ultimate beneficiary in terms of success and safety.
The book features well-illustrated comparisons of anatomic drawings, cadaveric images, and ultrasound and MRI images. Also:
- Detailed description of relevant anatomy followed by a clinical description of performing ultrasound imaging and subsequent blockade of target nerves
- Side-by-side comparison of labeled and unlabeled ultrasound images simulating the clinician’s experience in everyday practice
- Both common and alternative approaches are discussed in detail, each discussion calling upon the wisdom of experts in the field of regional anesthesia
- Clinical pearls about needle adjustment included in troubleshooting tables in the nerve stimulation sections
Written for:
Anesthesiologists (including residents/fellows), radiologists/radiology residents, emergency physicians, CRNAs (certified registered nurse anesthetists)
XV
Foreword by David L. Brown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Chapter 1 Regional Block Room Setup
and Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ban C.H. Tsui
1.1. Introduction 1
1.2. Equipment and Monitoring 1
1.2.1. Block Room Setup 2
1.2.2. Equipment Storage Cart 2
1.2.3. Monitoring 3
1.2.4. Needles, Catheters, and Related Equipment 4
1.2.5. Ultrasound Equipment 6
1.2.6. Nerve Stimulator 7
Chapter 2 Electrical Nerve Stimulation . . . . . . . . . . . . . . . . . . . . 9
Ban C.H. Tsui
2.1. Introduction 9
2.2. Electrophysiology 10
2.2.1. Characteristics of Electrical Impulses 10
2.2.2. Polarity of Stimulating and Returning Electrodes 11
2.2.3. Distance–Current Relationship 12
2.2.4. Current Density of Electrodes and Injectates 13
2.3. Useful Features of Equipment Variables 15
2.3.1. Constant Current Output and Display 15
2.3.2. Variable Pulse Width and Frequency 16
2.3.3. Specialized Polarity Electrodes 16
2.3.4. Disconnection and Malfunction Indicators 17
2.3.5. Other Accessories 17
Contents
XVI
2.4. Practical Considerations 17
2.4.1. Documentation 17
2.4.2. Population Considerations 17
2.4.3. Does Neurostimulation Make a Difference: Can It Be
Replaced by Ultrasound? 17
Chapter 3 Ultrasound Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Ravi Bhargava, Michelle Noga, and Lawrence Lou
3.1. Introduction 19
3.2. Basic Ultrasound Physics and Technology 20
3.2.1. Resolution and Line Density: Two Factors Infl uencing
Image Quality 22
3.2.2. Field and Gain Functions 22
3.2.3. Amplifi er Gain Function 24
3.2.4. Time Gain Compensation 24
3.2.5. Doppler Effect 24
3.2.6. Artifacts: The Importance of Anisotropy and
Acoustic Shadowing 24
3.3. Echogenic Appearance of Various Tissues 26
3.3.1. Nerves and Tendons 26
3.3.2. Muscles 28
3.3.3. Bone 28
3.3.4. Vascular Structures 28
3.3.5. Fat 29
3.3.6. Fascial Tissue 29
3.3.7. Pleura and Air 29
3.4. Equipment Selection and Preparation 29
3.4.1. Equipment Selection 29
3.4.2. Are Specifi c Needles Available and/or Necessary? 32
3.4.3. Equipment Preparation 32
Chapter 4 Practical and Clinical Aspects of Ultrasound
and Nerve Stimulation-Guided Peripheral Nerve Blocks . . . 35
Ban C.H. Tsui and Derek Dillane
4.1. Introduction 36
4.2. Clinical Aspects of Block Accuracy and Sedation 36
4.2.1. Importance of Block Accuracy 36
4.2.2. Image Acquisition 36
4.2.3. Practical Approach: Traceback Method 40
4.2.4. Control of Needle Trajectory 43
4.2.5. Needle Insertion Technique 44
4.2.6. “Training Wheel” Laser Attachment 45
4.2.7. Out-of-Plane Technique: Walk Down Approach 47
4.2.8. Local Anesthetic Application 48
4.2.9. Injection Pressure 49
4.2.10. Appropriate Sedation 51
4.3. Ultrasound-Guidance Training 51
Chapter 5 Clinical Anatomy for Upper Limb Blocks . . . . . 53
Ban C.H. Tsui
5.1. Origin of Spinal Nerves 53
5.2. The Brachial Plexus 54
Contents
XVII
5.2.1. The Brachial Plexus 55
5.2.2. Branches of the Brachial Plexus 55
5.3. Distribution of Spinal Nerves in the Upper Extremity 58
5.3.1. Dermatomes 58
5.3.2. Myotomes 58
5.3.3. Osteotomes 61
Chapter 6 Interscalene Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Ban C.H. Tsui
6.1. Clinical Anatomy 63
6.2. Patient Positioning and Surface Anatomy 66
6.2.1. Patient Positioning 66
6.2.2. Surface Anatomy 66
6.3. Sonographic Imaging and Needle Insertion Technique 67
6.3.1. Scanning Technique 67
6.3.2. Sonographic Appearance 68
6.3.3. Needle Insertion Technique 70
6.4. Nerve Stimulation 72
6.5. Local Anesthetic Application 73
Chapter 7 Supraclavicular Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Ban C.H. Tsui
7.1. Clinical Anatomy 75
7.2. Patient Positioning and Surface Anatomy 78
7.2.1. Patient Positioning 78
7.2.2. Surface Anatomy 78
7.3. Sonographic Imaging and Needle Insertion Technique 78
7.3.1. Scanning Technique 80
7.3.2. Sonographic Appearance 80
7.3.3. Needle Insertion Technique 80
7.4. Nerve Stimulation 82
7.5. Local Anesthetic Application 82
Chapter 8 Infraclavicular Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Ban C.H. Tsui
8.1. Clinical Anatomy 88
8.2. Patient Positioning and Surface Anatomy 90
8.2.1. Patient Positioning 90
8.2.2. Surface Anatomy 91
8.3. Sonographic Imaging and Needle Insertion Technique 91
8.3.1. Scanning Technique 93
8.3.2. Sonographic Appearance 93
8.3.3. Needle Insertion Technique 95
8.4. Nerve Stimulation 96
8.5. Local Anesthetic Application 97
Chapter 9 Axillary Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Ban C.H. Tsui
9.1. Clinical Anatomy 99
9.2. Patient Positioning and Surface Anatomy 102
9.2.1. Patient Positioning 102
9.2.2. Surface Anatomy 102
Contents
XVIII
9.3. Sonographic Imaging and Needle Insertion Technique 102
9.3.1. Scanning Technique 103
9.3.2. Sonographic Appearance 104
9.3.3. Needle Insertion Technique 104
9.4. Nerve Stimulation 106
9.5. Local Anesthetic Application 107
Chapter 10 Selective Terminal Nerve Blocks
of the Upper Extremity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Ban C.H. Tsui
10.1. Introduction 110
10.2. Radial Nerve Block at Lateral Aspect of Elbow 111
10.2.1. Clinical Anatomy 112
10.2.2. Patient Positioning and Surface Anatomy 114
10.2.3. Sonographic Imaging and Needle Insertion Technique 114
10.2.4. Nerve Stimulation 118
10.2.5. Local Anesthetic Application 118
10.3. Median Nerve 118
10.3.1. Clinical Anatomy 119
10.3.2. Patient Positioning and Surface Anatomy 121
10.3.3. Sonographic Imaging and Needle Insertion Technique 122
10.3.4. Nerve Stimulation 124
10.3.5. Local Anesthetic Application 124
10.4. Musculocutaneous Nerve 125
10.4.1. Clinical Anatomy 125
10.4.2. Patient Positioning and Surface Anatomy 126
10.4.3. Sonographic Imaging and Needle Insertion Technique 126
10.4.4. Nerve Stimulation 129
10.4.5. Local Anesthetic Application 129
10.5. Ulnar Nerve 130
10.5.1. Clinical Anatomy 130
10.5.2. Patient Positioning and Surface Anatomy 131
10.5.3. Sonographic Imaging and Needle Insertion Technique 131
10.5.4. Nerve Stimulation 134
10.5.5. Local Anesthetic Application 135
Chapter 11 Clinical Anatomy for Lower Limb Blocks . . . . 137
Ban C.H. Tsui
11.1. Origin of Spinal Nerves 137
11.2. Lumbar and Sacral Plexuses 138
11.2.1. Formation and Branches of the Lumbar Plexus 138
11.2.2. Formation and Relations of the Sacral Plexus 139
11.3. Distribution of Spinal Nerves in the Lower Extremity 141
11.3.1. Dermatomes 141
11.3.2. Myotomes 143
11.3.3. Osteotomes 144
Chapter 12 Lumbar Plexus/Psoas Compartment Block . . . 147
Ban C.H. Tsui
12.1. Clinical Anatomy 148
12.1.1. Lumbar Plexus Within the Psoas Compartment 148
12.1.2. Terminal Nerves of Lumbar Plexus 150
Contents
XIX
12.2. Patient Positioning and Surface Anatomy 151
12.2.1. Patient Positioning 151
12.2.2. Surface Anatomy 151
12.3. Sonographic Imaging and Needle Insertion Technique 152
12.3.1. Scanning Technique 154
12.3.2. Sonographic Appearance 157
12.3.3. Needle Insertion Technique 158
12.4. Nerve Stimulation 159
12.5. Local Anesthetic Application 160
Chapter 13 Femoral Block . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Ban C.H. Tsui
13.1. Clinical Anatomy 161
13.2. Patient Positioning and Surface Anatomy 164
13.2.1. Patient Positioning 164
13.2.2. Surface Anatomy 164
13.3. Sonographic Imaging and Needle Insertion Technique 165
13.3.1. Scanning Technique 165
13.3.2. Sonographic Appearance 167
13.3.3. Needle Insertion Technique 167
13.4. Nerve Stimulation 168
13.5. Local Anesthetic Application 169
Chapter 14 Sciatic and Popliteal Blocks . . . . . . . . . . . . . . . . . . . 171
Ban C.H. Tsui
14.1. Clinical Anatomy 172
14.2. Labat (Gluteal) Sciatic Nerve Block Approach 178
14.2.1. Patient Positioning and Surface Anatomy 178
14.2.2. Sonographic Imaging and Needle Insertion Technique 178
14.2.3. Nerve Stimulation 181
14.2.4. Local Anesthetic Application 182
14.3. Subgluteal Sciatic Nerve Block Approach 183
14.3.1. Patient Positioning and Surface Anatomy 183
14.3.2. Sonographic Imaging and Needle Insertion Technique 183
14.3.3. Nerve Stimulation 186
14.3.4. Local Anesthetic Application 187
14.4. Anterior Sciatic Nerve Block Approach 187
14.4.1. Patient Positioning and Surface Anatomy 187
14.4.2. Sonographic Imaging and Needle Insertion Technique 188
14.4.3. Nerve Stimulation 191
14.4.4. Local Anesthetic Application 191
14.5. Popliteal Sciatic Nerve Block (Posterior Approach) 192
14.5.1. Patient Positioning and Surface Anatomy 192
14.5.2. Sonographic Imaging and Needle Insertion Technique 193
14.5.3. Nerve Stimulation 198
14.5.4. Local Anesthetic Application 199
14.6. Popliteal Sciatic Nerve Block (Lateral Approach) 200
14.6.1. Patient Positioning and Surface Anatomy 200
14.6.2. Sonographic Imaging and Needle Insertion Technique 200
14.6.3. Nerve Stimulation 202
14.6.4. Local Anesthetic Application 202
Contents
XX
Chapter 15 Ankle Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Ban C.H. Tsui
15.1. Clinical Anatomy 205
15.2. Patient Positioning and Surface Anatomy 207
15.2.1. Patient Positioning 207
15.2.2. Surface Anatomy 207
15.3. Sonographic Imaging and Needle Insertion Technique 208
15.3.1. Scanning Technique 208
15.3.2. Sonographic Appearance 209
15.3.3. Needle Insertion Technique 210
15.4. Nerve Stimulation 211
15.5. Local Anesthetic Application 212
Chapter 16 Regional Block Catheter Insertion
Using Ultrasonography and Stimulating Catheters . . . . . . . . . . 215
Sugantha Ganapathy
16.1. Introduction 216
16.2. Equipment and Injectates 216
16.2.1. Stimulating Catheters 216
16.2.2. What Injectate Should One Use? 218
16.3. Technique 218
16.3.1. Confi rming the Catheter Tip Location with Nerve
Stimulation Technique 219
16.3.2. Confi rmation of Catheter Tip Location with Ultrasonography 220
16.4. Examples of Specifi c Blocks 221
16.4.1. Interscalene Catheterization 221
16.4.2. Infraclavicular Catheritization 221
16.4.3. Femoral Nerve 221
16.4.4. Sciatic Nerve 221
16.5. Summary and Advantages 223
Chapter 17 Anatomy of the Trunk for Paravertebral,
Intercostal, and Epidural Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Ban C.H. Tsui
17.1. Vertebral Column 225
17.1.1. Developmental Anatomy of the Thoracic and Lumbar Spine 226
17.1.2. Developmental Anatomy of the Sacrum 227
17.2. Costovertebral Articulations 228
17.3. Paravertebral Space 229
17.4. Spinal Membranes (Meninges) and Nerves Above the Sacrum 229
17.5. Intercostal Nerves 230
17.6. Caudal Epidural Space 230
17.7. Dermatomes 233
Chapter 18 Epidural Anesthesia Using Electrical
Epidural Stimulation and Ultrasound Guidance. . . . . . . . . . . . . . 235
Ban C.H. Tsui
18.1. Introduction 236
18.1.1. Technical Issues in Epidural Analgesia 236
18.1.2. Issues Related to Caudal Needle Puncture and
Catheter Advancement 237
Contents
XXI
18.2. Electrical Epidural Stimulation 238
18.2.1. Test Equipment and Procedure 238
18.2.2. Mechanism of the Test 239
18.2.3. Considerations for Test Performance and Interpretation 240
18.2.4. Stimulating Epidural Catheter Requirements 241
18.2.5. Safety of Epidural Electrical Stimulation 242
18.2.6. Clinical Applications 242
18.3. Ultrasound Imaging in Neuraxial Anesthesia 245
18.3.1. Visibility Through Ultrasound 245
18.3.2. Summary of the Ultrasound Appearance of
Neuraxial Structures 250
18.3.3. Clinical Applications 252
18.4. Conclusion 253
Chapter 19 Paravertebral and Intercostal Blockade . . . . . . . . 257
Ban C.H. Tsui
19.1. Introduction 257
19.2. Clinical Anatomy 258
19.2.1. Skeletal Anatomy of the Trunk 258
19.2.2. Anatomy of the Paravertebral Space and
Intercostal Nerves 259
19.3. Patient Positioning and Surface Anatomy 260
19.3.1. Patient Positioning 260
19.3.2. Surface Anatomy 260
19.4. Sonographic Imaging and Needle Insertion Technique 261
19.4.1. Scanning Technique 261
19.4.2. Sonographic Appearance 265
19.4.3. Needle Insertion Technique 265
19.5. Nerve Stimulation 269
19.5.1. Paravertebral Block 269
19.6. Local Anesthetic Application 269
Chapter 20 Caudal and Epidural Blockade. . . . . . . . . . . . . . . . . . 271
Ban C.H. Tsui
20.1. Introduction 272
20.1.1. Caudal Blocks: Single-Shot Blocks and Advancement of Catheters
Cephalad from the Caudal Spine 272
20.1.2. Lumbar and Thoracic Epidurals 273
20.2. Clinical Anatomy 273
20.3. Patient Positioning and Surface Landmarks 275
20.3.1. Patient Positioning 275
20.3.2. Surface Anatomy 275
20.4. Single-Shot Caudal Anesthesia 277
20.4.1. Sonographic Imaging and Ultrasound-Guided Block Procedure 277
20.4.2. Needle Insertion and Local Anesthetic Application 279
20.4.3. Epidural Stimulation Guidance and Block Technique 279
20.5. Catheter Advancement from the Caudal Epidural Space 280
20.5.1. Sonographic Imaging and Ultrasound-Guided Block Procedure 280
20.5.2. Catheter Insertion and Local Anesthetic Application 284
20.5.3. Epidural Stimulation Guidance Technique 284
20.5.4. Electrocardiograph Monitoring Technique 286
Contents
XXII
20.6. Direct Lumbar and Thoracic Epidurals 287
20.6.1. Sonographic Imaging and Ultrasound-Guided
Block Procedure 287
20.6.2. Epidural Stimulation Test for Direct Lumbar and Thoracic
Continuous Epidurals 292
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
| Rok wydania |
2008 |
| Autor |
Tsui, Ban |
| Liczba stron |
304 |
| Liczba ilustracji |
71 |
| ISBN |
978-0-387-68158-0 |
| Oprawa |
Twarda |
|
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