Robert Emmett Farr (1875–1932): A pioneer of pediatric regional anesthesia

2016 ◽  
Vol 26 (3) ◽  
pp. 182-188
Author(s):  
MaryKate Driscoll ◽  
Hyun Kee Chung ◽  
Manisha S Desai
Keyword(s):  
Brachial Plexus ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Surgical Procedures ◽  
Local Anesthetics ◽  
Clinical Care ◽  
The Other ◽  
Local Infiltration ◽  
Surgical Practice ◽  
The Future

Surgeons influence the introduction and development of anesthesia in many ways. Robert Emmett Farr is frequently cited as the first to describe the use of brachial plexus anesthesia in children. A surgeon based in Minneapolis, Minnesota, he passionately believed that regional anesthesia was superior to general anesthesia for many surgical procedures. He wrote extensively promoting other regional techniques, including local infiltration of local anesthetics for pyloromyotomy and harelip repairs, as well as caudal blocks for lower abdominal procedures. Anesthesia texts from the early 1900’s suggest that regional anesthesia was not popular as a reliable alternative to general anesthesia. Undeterred, Farr continued promoting his view that regional anesthesia was the future of surgery. We examine how Farr promoted regional anesthesia in children and adults, in a way changing surgical practice and improving clinical care. We also hope to highlight the other contributions to medicine made by this pioneer.

scholarly journals Anesthesia in Pediatric Eye Surgery (Review)

2018 ◽  
Vol 14 (6) ◽  
pp. 114-125
Author(s):  
Lyudmila S. Korobova ◽  
Vladimir V. Lazarev
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Local Anesthetics ◽  
Anesthetic Techniques ◽  
Eye Surgery

The review dwells on the analysis of anesthetic techniques for pediatric eye surgery, including the use of drugs used and methods of anesthesia. While preparing the paper, Cyberleninka (www.cyberleninka.ru), PubMed, Medline databases were used with the targeted search using the following keywords: propofol, sevoflurane, paracetamol, regional anesthesia, ophthalmology, children. The search was not restricted by the date of paper publishing; the focus was made on papers published within the last 10 years. The purpose of the review was to assess the scope of various anesthetic techniques (general anesthesia and regional blockades), anesthetics (sevoflurane, propofol, paracetamol, local anesthetics) in pediatric eye surgery.

scholarly journals Recomendaciones ESRA/ASRA en anestésicos locales y adyuvantes empleados en la población pediátrica

2019 ◽  
Vol 11 (2) ◽  
pp. 5
Author(s):  
Marcos Salmerón Martín ◽  
Pedro Torres Mosquera
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
European Society ◽  
Local Anesthetics ◽  
Pediatric Population ◽  
American Society

Dada la preocupación creciente respecto al efecto de los anestésicos empleados en anestesia general en el neurodesarrollo de la población pediátrica; toma mayor importancia la Anestesia Locorregional en dicha población. Pero, ¿Qué sabemos sobre la dosificación en esta población de los anestésicos locales?. Debido a dicha incertidumbre y a lo poco publicado al respecto la ESRA (European Society of Regional Anesthesia) y la ASRA (American Society of Regional Anesthesia) han decido reunirse para establecer una serie de recomendaciones sobre la dosificación de anestésicos locales y adyuvantes en anestesia locorregional en la población pediátrica. Dicho documento lo hemos resumido, de forma esquemática y con ayuda de tablas, con el fin de facilitar su comprensión y tenerlo a la disposición de todo aquel interesado en este campo. ABSTRACT  ESRA/ASRA recommendations in local anesthetics and adjuvants in the pediatric population Growing concern regarding the effect of anesthetics used in general anesthesia in the neurodevelopment of the pediatric population; Loco-regional Anesthesia in this population takes greater importance. But, what do you know about the dosage of local anesthetics in this population? Due to this uncertainty and the little published about it, the ESRA (European Society of Regional Anesthesia) and the ASRA (American Society of Regional Anesthesia) have decided to meet to establish recommendations about the dosage of local anesthetics and adjuvants in loco-regional anesthesia in the pediatric population. This document has been summarized, in a schematic way with tables, to facilitate understanding. In this way, its content is available to all those interested.

Anesthesia method for toe-to-hand transfer in children

2016 ◽  
Vol 10 (2) ◽  
pp. 105-110
Author(s):  
Dmitrii V. Zabolotskii ◽  
V. A Koryachkin ◽  
M. D Ivanov ◽  
N. V Zaytseva ◽  
N. S Malashenko
Keyword(s):  
Brachial Plexus ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Hand Function ◽  
Perioperative Period ◽  
Control Group ◽  
Study Group ◽  
Drug Load ◽  
Regional Block

Background: toe-to-hand transfer - an effective method of surgical reconstructive restoration of hand function in children, which is highly traumatic and characterized by complexity, duration and multiple stages. These aspects determine the importance and relevance of the choice of anesthesia method is not only in the perioperative period, but at the stage of rehabilitation in this group of the patients. Aim of the study: To evaluate the efficacy of the continuous regional blocks in pediatric toe-to-hand transfer. A total of 136 children had toe-to-hand transfer, and received general anesthesia with regional anesthesia (study group n = 84) and general anesthesia alone (control group n = 52). In the first group regional blockade was used on foot / feet, and continuous regional block of the brachial plexus. We studied the temperature and Doppler on the limbs at different accesses to the brachial plexus, the effect of regional anesthesia on hemostasis, compared intraoperative drug load in the groups, the level of awakening, the quality of early postoperative analgesia and the final outcome of the surgical treatment. The data of thermometry and Doppler showed increase in microcirculation in blocked limbs. Data from thromboelastography showed a tendency to hypocoagulation, due to the influence of regional blocks on the platelet aggregation. The effectiveness of regional block has reduced drug load in the perioperative period. The therapeutic effect of continuous regional blocks helped to reduce the number of surgical complications in 1.9 times.

The Sheath of the Brachial Plexus

2006 ◽  
Vol 105 (3) ◽  
pp. 563-565 ◽  
Author(s):  
Philip B. Cornish ◽  
Christopher Leaper
Keyword(s):  
Sciatic Nerve ◽  
Lower Extremity ◽  
Brachial Plexus ◽  
Chest Wall ◽  
Regional Anesthesia ◽  
The Other ◽  
Anatomical Structures ◽  
Central Tenet ◽  
Cast Doubt ◽  
Pectoral Fascia

Background The concept of the axillary "sheath" has been a central tenet of brachial plexus regional anesthesia for many years. Recent investigations have cast doubt on its nature and existence. This study further examines the issue. Methods Computerized axial tomographic dye studies were performed using continuous catheter systems for the sciatic nerve and the brachial plexus. The resultant images were compared and contrasted. Results The images of the two catheter systems were the same, with the exception that one was of the upper extremity and the other was of the lower extremity. Conclusions The sciatic nerve is not surrounded or enveloped by a "sheath"--it lies in the tissue plane between rigid anatomical structures. Similarly, the brachial plexus lies in the tissue plane between the rigid anatomy of the chest wall, scapula, humerus, and pectoral fascia. This finding is inconsistent with the concept of the axillary sheath.

P3-592: RISK OF DEVELOPING DEMENTIA AMONG OLDER ADULTS UNDERGOING ELECTIVE SURGICAL PROCEDURES WITH GENERAL ANESTHESIA WHEN COMPARED TO REGIONAL ANESTHESIA

2006 ◽  
Vol 14 (7S_Part_25) ◽  
pp. P1353-P1353
Author(s):  
Clive Velkers ◽  
Marlo Whitehead ◽  
Cara Reimer ◽  
Roderic Eckenhoff ◽  
Miles Berger ◽  
...  
Keyword(s):  
Older Adults ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Surgical Procedures ◽  
Elective Surgical Procedures

Anesthesia-related Deaths during Obstetric Delivery in the United States, 1979–1990

1997 ◽  
Vol 86 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Joy L. Hawkins ◽  
Lisa M. Koonin ◽  
Susan K. Palmer ◽  
Charles P. Gibbs
Keyword(s):  
United States ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Local Anesthetics ◽  
Case Fatality ◽  
The United States ◽  
Death Certificates ◽  
Obstetric Delivery ◽  
Live Births

Background Anesthesia-related complications are the sixth leading cause of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979-1990. Methods Each state reports deaths that occur within 1 yr of delivery to the Centers for Disease Control and Prevention as part of the ongoing Pregnancy Mortality Surveillance. Maternal death certificates (with identifiers removed) matched with live birth or fetal death certificates when available from 1979-1990 were reviewed to identify deaths due to anesthesia, the cause of death, the procedure for delivery, and the type of anesthesia provided. Maternal mortality rates per million live births were calculated. Case fatality rates and risk ratios were computed to compare general to regional anesthesia for cesarean section deliveries. Results The anesthesia-related maternal mortality rate decreased from 4.3 per million live births in the first triennium (1979-1981) to 1.7 per million in the last (1988-1990). The number of deaths involving general anesthesia have remained stable, but the number of regional anesthesia-related deaths have decreased since 1984. The case-fatality risk ratio for general anesthesia was 2.3 (95% confidence interval [CI], 1.9-2.9) times that for regional anesthesia before 1985, increasing to 16.7 (95% CI, 12.9-21.8) times that after 1985. Conclusions Most maternal deaths due to complications of anesthesia occurred during general anesthesia for cesarean section. Regional anesthesia is not without risk, primarily because of the toxicity of local anesthetics and excessively high regional blocks. The incidence of these deaths is decreasing, however, and deaths due to general anesthesia remain stable in number and hence account for an increased proportion of total deaths. Heightened awareness of the toxicity of local anesthetics and related improvements in technique may have contributed to a reduction in complications of regional anesthesia.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

On the role of the dispute between "non-possessors" and "Josephites" in the culture of Moscow's prediction

1998 ◽  
pp. 61-62
Author(s):  
N. S. Jurtueva
Keyword(s):  
The Other ◽  
Moral Transformation ◽  
15Th Century ◽  
The Future ◽  
Secular Power

In the XIV century. centripetal tendencies began to appear in the Moscow principality. Inside the Russian church, several areas were distinguished. Part of the clergy supported the specificobar form. The other understood the need for transformations in society. As a result, this led to a split in the Russian church in the 15th century for "non-possessors" and "Josephites". The former linked the fate of the future with the ideology of hesychasm and its moral transformation, while the latter sought support in alliance with a strong secular power.

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