Inderjeet S. Julka

Pre-operative regional block anesthesia enhances operative strategy for arteriovenous fistula creation

Purpose We aim to assess the effect of regional block anesthesia on vein diameter, type of AVF placement, and fistula size and flow volume. Methods 30 patients presenting for AV access procedures were followed prospectively. Vein diameters via venous ultrasound and planned location for AV access were documented. Supraclavicular brachial plexus block was followed by repeat ultrasound and alterations in operative plan were noted. Patients returned to clinic for duplex ultrasound assessment. Results Average increase from baseline vein diameter with regional block was most pronounced in the lower cephalic (34%), upper cephalic (24.2%), and basilic veins (31.3%) and less in the brachial vein (8.7%). Type of AVF was modified following regional block in 14%. The rate of native AVF placement improved from 89% to 93% with regional block. Twenty-three AVF patients were available for follow-up (mean 24 weeks). Average fistula size was 7.9 mm (CI 6.9–8.9) and all patent fistulas developed flow volume >600 mL/min. Primary patency was attained in 83%. One thrombosis occurred after a basilic artery was lacerated during dialysis access. The average fistula increased 0.33 cm from post-block diameter (SD 0.22, P<.05). Conclusions Vein diameter increases significantly in the basilic and cephalic veins following regional block anesthesia and may improve the rate of native fistula placement. Propensity to dilate after regional block anesthesia does not predict size of the fistula.

Stellate ganglion block for postoperative analgesia in patients with upper extremity orthopaedic injuries

htm;jsessionid=2DD4749FA 5D7C11DE1DEA1A63DD04D17? year=2005&index=11&absnum= 1575 (accessed 20 ⁄ 08 ⁄ 2011). 4 Bantel C, Trapp S. The role of the autonomic nervous system in acute surgical pain processing – what do we know? Anaesthesia 2011; 66:

Acute ascending aortic intramural hematoma as a complication of the endovascular repair of a Type B aortic dissection

Endovascular aortic graft repair (EVAR) for patients with Type B aortic dissection is a less invasive surgical procedure (compared to traditional open surgical repair) that is associated with less morbidity and shortened recovery times. However, there are notable complications for the patients undergoing EVAR. We report a patient who was brought to our hospital with a Type B dissection and underwent a thoracic EVAR but suffered iatrogenic aortic injury resulting in cardiac tamponade. This case study highlights the importance of intraoperative transesophageal echocardiography to facilitate early detection of possible EVAR complications.

Anesthesia Techniques for Endovascular Surgery

In the United States each year there are about 15,000 deaths directly related to abdominal aortic aneurysms (AAA) [1]; 62% may die outside the hospital from rupture of their aneurysms; the overall mortality is 90% [2]. In the year 1984 in patients with ruptured aneurysms, hospitals lost some

The anesthetic technique of choice for better outcomes in high-risk elderly patients undergoing endovascular repair of aortic aneurysms

24,000 per patient [3]. If repaired electively, 2,000 patients were saved per year and annual costs were

Efficacy of an ultrasound-guided subsartorial approach to saphenous nerve block: a case series.

50 million in 1984 [4]. Elective repair is indicated when aneurysms are 5 cm in diameter or greater and may lead up to 20% mortality if the patients have comorbid diseases [5, 6], Now add thoracic aneurysms, aortic dissections, and transections to the picture and the same as stated previously can be staggering.

Stellate Ganglion Blockade for Acute Postoperative Upper Extremity Pain

To the Editor: We read with great interest the recent article by Asakura et al. [1] and wish to comment on their retrospective study of an anesthetic technique for patients undergoing endovascular repair of aortic aneurysms (EVAR), which has improved patient outcomes. Their review of 31 patients points out that ‘‘locoregional’’ anesthesia was well tolerated and has advantages over general anesthesia. We concur with their findings, as their retrospective analysis of patient’s corroborates with our results [2–4]. Based on our studies involving more than 500 patients with aortic abdominal and thoracic aneurysms, dissections, and transections [2–4], monitored anesthesia care (MAC) technique consisting of an opioid (fentanyl) and local anesthetic infiltration of the groin area with an adjunctive ilioinguinal/iliohypogastric nerve block has positive outcomes in this high-risk population with multiple comorbidities. The advantages of this technique include shorter intensive care unit (ICU) stays and faster hospital discharges, thus significantly cutting cost. Patients experience better pain control leading to reduced use of perioperative opioids. Avoidance of airway instrumentation and inhalational agents provides smoother intraoperative hemodynamics, resulting in less cardiopulmonary complications [2–4]. In addition, an awake, responsive patient is readily treated in case of adverse reactions (namely, to contrast material) due to early detection of signs and symptoms than in a patient under general anesthesia [5]. Use of the ultrasound-guided nerve blocks by Asakura et al. [1] was the only remarkable difference from our approach. Although the authors’ references are recent and do not site information from years past, their study substantiates what we have stressed over the years in the anesthesia and surgical literature. In conclusion, the efficacy of local anesthesia with MAC plus the adjunctive use of groin nerve blocks is an excellent alternative to general anesthesia and has previously been established in larger prospective clinical trials.