neuroaxial anesthesia and Multiple sclerosis

Although regional central conduction blockade, and especially spinal anesthesia, has been implicated in the exacerbation of MS , the studies are very small.

Local anesthetic neurotoxicity has been speculated as being a more likely in nerves which are demyelinated, i.e. in MS patients.

As such, theoretically epidural anesthesia may be less of a risk as concentrations of local anesthetic in the white matter of the spinal cord are lower than with spinal anesthesia

Overall, however, the use of epidural anesthesia appears safe. Bader et al. noted that in women who received epidural anesthesia for vaginal delivery, relapse rates were similar to those who received local infiltration. Additional prospective and randomized studies will need to be conducted to evaluate the true relationship between regional anesthesia and MS exacerbations.

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power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

The 12 decision making steps for post dural puncture headache treatment

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