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2018-THE ROLE OF REGIONAL ANESTHESIA (RA) IN PATIENTS AT RISK FOR ACUTE COMPARTMENT SYNDROME (ACS)

Volkmann 1 described 1881 myonecrosis and secondary contracture after prolonged muscle ischemia. He suspected that splints caused muscle cell death due to diminished arterial blood flow describing an untreated compartment syndrome. Bardenheuer 2 described 1911 the first forearm compartment decompression for impending compartment syndrome and Griffiths 3 described 1940 patients developping Volkmann’s contractures after embolectomy
of the brachial artery. He was the first to introduce the “5 P’s” of compartment syndrome (pain, pallor, paresthesias, paralysis, pulselessness) in clinical practice. Bywaters and Beall 4 described during the second world war several victims with a “crush syndrome”. Thereafter, Bentley et al. 5 made similar reports describing crushed extremities leading to multiorgan system failure suggesting that myoglobin precipitation in renal tubules led to mechanical obstruction and
consecutive renal failure. Only in the 1970s, the focus was put on basic science and treatment of compartment syndrome. Rorabeck 6-8 described compartment syndrome following arterial insufficiency or venous obstruction showing that the clearance of radioactive technetium from a compartment was inversely related to compartment pressures and directly related to blood flow and a normal blood flow after fasctiotomy of this compartment.

2017-ROLE OF MENINGEAL FIBROBLASTS AND MAST CELLS IN OPIATE INDUCED INFLAMMATORY MASSES

ROLE OF MENINGEAL FIBROBLASTS AND MAST CELLS IN OPIATE INDUCED INFLAMMATORY MASSES

Tony L. Yaksh, Ph.D.
Department of Anesthesiology, University of California,
San Diego, La Jolla, CA, USA

Spinal opiates yield a potent naloxone reversible analgesia. The first report of continuous intrathecal morphine delivery to manage chronic pain was in 1978. (Onofrio, et al, 1978). Aside from anticipated opiate effects, no evidence of untoward effects on spinal function were reported. Beginning in 1991, numerous clinical case series describe patients receiving intrathecal morphine infusion who present with neurologic signs secondary to a local compressive lesion. Retrospective data indicate an overall incidence of 0.1% although estimates in limited populations have been as high as 43% (Deer et al., 2017c).

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