Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided ep...

background: the aim of this study is comparing acth changes in epidural and intravenous analgesia technique after lower limb orthopedic surgery.methods: in a randomized clinical trial in hazrat rasool  akram hospital during 1387-88 , 60 patients candidate for surgery on the lower extremities were randomly allocated to receive either postoperative analgesia  with epidural analgesia (pcea) or iv ...

In recent years levobupivacaine, the pure S (-)-enantiomer of bupivacaine, emerged as a safer alternative for regional anesthesia than its racemic parent. It demonstrated less affinity and strength of depressant effects onto myocardial and central nervous vital centers in pharmacodynamic studies, and a superior pharmacokinetic profile. Clinically, levobupivacaine is well tolerated in a variety ...

In this issue, we look at the axillary brachial plexus block and the terminal nerves of the hand. The axillary block is an approach that has maintained its simplicity and effectiveness throughout the years. Most anaesthesiologists will reminiscence this technique being amongst their first experiences in regional anesthesia. With the advent of ultrasound, this block is now more reliable than eve...

Melatonin has been suggested as a new natural pain killer in inflammatory pain and during surgical procedures. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy and also optimal preemptive dose of melatonin in patients undergoing cesarean section under spinal anesthesia . One hundred twenty patients scheduled for cesarean section under spinal anesthesi...

Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise....

Patients with preexisting neurologic disease present a unique challenge to the anesthesiologist. The cause of postoperative neurologic deficits is difficult to evaluate, because neural injury may occur as a result of surgical trauma, tourniquet pressure, prolonged labor, improper patient positioning, or anesthetic technique. Progressive neurologic diseases such as multiple sclerosis may coincid...