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PerioPerAtive ACute And ChroniC PAin MAnAGeMent ● 427 allodynia. She thus meets the International Association for the Study of Pain’s criteria for the diagnosis, which are sensitive but not specific for the disorder. Although not considered definitive, a strongly suggestive diagnostic test is a favorable response to sympathetic blockade of the affected extremity. You could perform a localized chemical sympathectomy of the limb by infusing phentolamine into the arm isolated by a tourniquet. More commonly, you could block the stellate ganglion on the affected side (see below). If evidence of sympathectomy is seen, for example by vasodilation and warming of the extremity, and if some pain relief is observed, the diagnosis is strongly supported. What treatment would you offer her? A stellate ganglion block is performed by injecting local anesthetic adjacent to the transverse process of C6, palpated medial to the carotid artery at the level of the cricoid cartilage in the neck. Fluoroscopic guidance can improve the efficacy and possibly safety of the block. The spinal and epidural spaces lie close to the correct needle position, as do the carotid and vertebral arteries. If a stellate ganglion block is effective, the block can be repeated several times over the next few weeks. In a fortunate proportion of patients, the pain relief lasts far longer than the effect of the local anesthetic, and may actually lengthen over time. Unfortunately, some patients do not experience progressively longer relief or even relief extending longer than the block, and other treatments will be needed. Multimodal therapy is recommended whether blocks are successful or not. First, the patient needs psychological counseling that her symptoms are not the result of direct tissue damage, and that she can and must begin to use the extremity more as analgesia allows. Physical therapy taking advantage of less painful periods is essential. Anxiety, depression, and sleep disorders should be addressed by counseling and likely medication. Other medications that may be helpful include those directed at neuropathic pain (such as antiepilepsy or antidepression drugs), opioids, and NSAIDs. The condition can be difficult to treat, so if one therapy fails, a different one should be tried, in order to facilitate rehabilitation efforts.
428 ● AnesthesiA student survivAl Guide Suggested Further Reading Benzon HT, Rathemell JP, Wu CL, Turk DC, Argoff CE (2008) Raj’s practical management of pain, 4th edn. Mosby-Elsevier, Philadelphia Bonica JJ, Loeser JD, Chapman CR, Fordyce WE (2001) The management of pain, 3rd edn. Lippincott, Williams & Williams, Philadelphia Kandel ER, Schwartz JH, Jessell TM (2000) Principles of neural science, 4th edn. McGraw-Hill, New York Longnecker DE, Brown DL, Newman MF, Zapol WM (2007) Anesthesiology, 1st edn. McGraw-Hill, New York
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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The Preoperative Patient Evaluation
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THe PreoPerATIve PATIenT evAluATIon
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Therapy-based indications radiation
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Table 8.5 Formulation an anesthetic
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Anesthesia Equipment and Monitors B
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AnesthesiA eQuiPment And mOnitOrs
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● ● ● AnesthesiA eQuiPment An
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Table 11.3 Data typically obtained
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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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PhysioloGy And AnesthesiA for elder
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ProfessionAlism, sAfety, And teAmwo
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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