الفهرس 
PHYSIOLOGY OF NERVE CONDUCTIONOnly 14 pages are availabe for public view
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Abstract
The time-honored statement that ”an ounce of prevention is worth a pound of cure” is essential to remember when considering the management of adverse outcomes in regional anesthesia practice. It is most effective to prevent and minimize the risk of regional anesthesia complications. Neurologic injury is one of the most dreaded complications associated with all anesthesia techniques, including regional anesthesia, and it is important to realize that once a serious neurologic injury occurs, the chances of full recovery are unlikely(Atlee. 2007)
Although allergies to local anesthetics are rare, a full array of allergic symptoms and signs ranging from mild skin irritation to full-blown anaphylaxis have been described. These signs and symptoms are almost always associated with amino ester preparations or preservatives (eg, methylparaben). Allergic reactions are more common after exposure to ester compounds than amides. The initial treatment recommended for the management of patients with systemic toxicity is very similar to that used for any resuscitation. Because hypoxia, hypercapnia, and acidosis exacerbate all local anesthetic toxic reactions, control of the airway and ventilation is of paramount importance in the treatment of local anesthetic toxicity(Chin and Tsui. 2010)
Neuraxial injuries may be limited by possessing a detailed knowledge of those anatomic conditions that place the spinal cord, spinal nerves, or spinal vasculature at risk for mechanically induced injury from needles, catheters, improper positioning, space-occupying lesions, or drug-induced neurotoxicity. When neurologic injury is suspected, diagnosis and treatment must proceed without delay to avoid adverse or incomplete recovery. The likelihood of full or partial recovery in these circumstances rapidly diminishes as time to decompression approaches or exceeds 8 hours. In most cases, magnetic resonance imaging (MRI) is the preferred imaging modality for spinal canal pathology, although diagnosis should not be delayed if only computed tomography (CT) is available (Horlocker et al. 2003)
Diagnosis of suspected peripheral nerve injury is guided by presenting symptoms, history, and physical examination. Complete or progressive neural deficits should prompt urgent evaluation by a neurologist or peripheral nerve surgeon. Although peripheral nerve injuries may be reduced by minimizing trauma to neural fibers, no nerve localization or monitoring technique has been shown to be clearly superior in terms of reducing the frequency of clinical injury. These techniques include paresthesia-seeking, peripheral nerve stimulation, defined minimal or maximal milliamperage for acceptance of a motor response,ultrasound guidance, or monitoring of injection pressures. (Tsui, et al, 2008)
The time-honored statement that ”an ounce of prevention is worth a pound of cure” is essential to remember when considering the management of adverse outcomes in regional anesthesia practice. It is most effective to prevent and minimize the risk of regional anesthesia complications. Neurologic injury is one of the most dreaded complications associated with all anesthesia techniques, including regional anesthesia, and it is important to realize that once a serious neurologic injury occurs, the chances of full recovery are unlikely(Atlee. 2007)
Although allergies to local anesthetics are rare, a full array of allergic symptoms and signs ranging from mild skin irritation to full-blown anaphylaxis have been described. These signs and symptoms are almost always associated with amino ester preparations or preservatives (eg, methylparaben). Allergic reactions are more common after exposure to ester compounds than amides. The initial treatment recommended for the management of patients with systemic toxicity is very similar to that used for any resuscitation. Because hypoxia, hypercapnia, and acidosis exacerbate all local anesthetic toxic reactions, control of the airway and ventilation is of paramount importance in the treatment of local anesthetic toxicity(Chin and Tsui. 2010)
Neuraxial injuries may be limited by possessing a detailed knowledge of those anatomic conditions that place the spinal cord, spinal nerves, or spinal vasculature at risk for mechanically induced injury from needles, catheters, improper positioning, space-occupying lesions, or drug-induced neurotoxicity. When neurologic injury is suspected, diagnosis and treatment must proceed without delay to avoid adverse or incomplete recovery. The likelihood of full or partial recovery in these circumstances rapidly diminishes as time to decompression approaches or exceeds 8 hours. In most cases, magnetic resonance imaging (MRI) is the preferred imaging modality for spinal canal pathology, although diagnosis should not be delayed if only computed tomography (CT) is available (Horlocker et al. 2003)
Diagnosis of suspected peripheral nerve injury is guided by presenting symptoms, history, and physical examination. Complete or progressive neural deficits should prompt urgent evaluation by a neurologist or peripheral nerve surgeon. Although peripheral nerve injuries may be reduced by minimizing trauma to neural fibers, no nerve localization or monitoring technique has been shown to be clearly superior in terms of reducing the frequency of clinical injury. These techniques include paresthesia-seeking, peripheral nerve stimulation, defined minimal or maximal milliamperage for acceptance of a motor response,ultrasound guidance, or monitoring of injection pressures. (Tsui, et al, 2008)