Precision Anesthesia Techniques in Brachial Plexus Injury Repair: A Case Study with Neuromuscular Monitoring and Dexmedetomidine Infusion"
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Abstract
Introduction: Precision anesthesia techniques play a pivotal role in optimizing outcomes for patients undergoing surgical repair of brachial plexus injuries. Utilizing tailored approaches, such as neuromuscular monitoring and selective drug infusions, enhances surgical conditions and postoperative recovery.
Case Presentation: In this case, a 35-year-old male with a left global brachial plexus injury underwent surgical repair. Anesthesia induction included fentanyl, thiopentone, and succinylcholine, followed by intubation. Neuromuscular monitoring obviated the need for further muscle relaxants. Anesthesia maintenance utilized a combination of oxygen, nitrous oxide, isoflurane, dexmedetomidine (0.5 mcg/kg/hr), and propofol via a Target-Controlled Infusion (TCI) pump. The surgery lasted 5.5 hours with stable vital signs post-extubation.
Discussion: The combination of dexmedetomidine and propofol allowed for precise control over anesthesia depth, ensuring hemodynamic stability and optimal surgical conditions. This tailored approach minimized adverse effects and provided effective analgesia without respiratory depression.
Conclusion: Precision anesthesia techniques, including neuromuscular monitoring and dexmedetomidine-propofol infusions, optimize perioperative management in brachial plexus repair. These strategies enhance patient safety, surgical outcomes, and postoperative recovery, highlighting the importance of individualized anesthesia care in complex procedures.
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References
Bertelli JA, Ghizoni MF. Results and current approach for Brachial Plexus reconstruction. J Brach Plexus Peripher Nerve Injury 2011;6:2.
Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998;45:116–22.
Kim DH, Murovic JA, Tiel RL, Kline DG. Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 2004;16:2.
Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493.
Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth 2000;84:450–5.
Hadzic A, Arliss J, Kerimoglu B, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology 2004;101: 127–32.
Chan VW, Peng PW, Kaszas Z, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesth Analg 2001;93:1181–4.
Guler G, Akin A, Tosun Z, et al. Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand 2005;49:1088–91.
Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999;83:372–80.
Jaakola M-L, Salonen M, Lehtinen R, Scheininet H. The analgesic action of dexmedetomidine––a novel a2-adrenoceptor agonist––in healthy volunteers. Pain 1991;46:281–5.