scholarly journals Sixth nerve palsy following epidural spinal cord stimulation for lower limb ischaemia

Eye ◽  
2000 ◽  
Vol 14 (5) ◽  
pp. 811-812 ◽  
Author(s):  
Thomas J. Wolfensberger ◽  
François-Xavier Borruat
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Spinal Cord Stimulation ◽  
Nerve Palsy ◽  
Limb Ischaemia ◽  
Lower Limb Ischaemia ◽  
Sixth Nerve Palsy ◽  
Epidural Spinal Cord Stimulation ◽  
Sixth Nerve

Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study

VASA ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 89-97
Author(s):  
Karin Yeung ◽  
Jonas Peter Eiberg ◽  
Henrik Kehlet ◽  
Eske Kvanner Aasvang
Keyword(s):  
Lower Limb ◽  
Severe Pain ◽  
Observational Cohort Study ◽  
Limb Ischaemia ◽  
Post Anaesthesia Care Unit ◽  
Lower Limb Ischaemia ◽  
Acute Complications ◽  
Observational Cohort ◽  
Anaesthesia Care ◽  
Pacu Stay

Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.

scholarly journals Brain fMRI during orientation selective epidural spinal cord stimulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Antonietta Canna ◽  
Lauri J. Lehto ◽  
Lin Wu ◽  
Sheng Sang ◽  
Hanne Laakso ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Positive Impact ◽  
Sensory Information ◽  
Activation Patterns ◽  
Promising Tool ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation ◽  
Brain Fmri

AbstractEpidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury. Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.

scholarly journals Augmented superior rectus muscle transposition in management of defective ocular abduction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed F. Farid ◽  
Ahmed E. M. Daifalla ◽  
Mohamed A. Awwad
Keyword(s):  
Nerve Palsy ◽  
Rectus Muscle ◽  
Muscle Transposition ◽  
Primary Position ◽  
Superior Rectus ◽  
Sixth Nerve Palsy ◽  
Abnormal Head ◽  
Duane Retraction Syndrome ◽  
Sixth Nerve ◽  
Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

Preliminary Experience with Defibrotide in Severe Lower Limb Ischaemia

1986 ◽  
Vol 16 (1) ◽  
pp. 63-66
Author(s):  
J.S.K. Gelister ◽  
W.E. James ◽  
J.A. Fox
Keyword(s):  
Lower Limb ◽  
Limb Ischaemia ◽  
Lower Limb Ischaemia
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