[Controlled circulatory blockade. Historical principles and future perspectives].
Von Esmarch described the method known as "Blutleere". A tourniquet is applied to the thigh of the extremity whose blood has been previously withdrawn. We demonstrate that patients with chronic arterial obstructive disease (CAOD) tolerate without damage an one hour circulatory transient blockade (CTB). This CTB is followed by a conspicuous and significant improvement of the pain free walking distance and of the ankle-arm quotient in patients with CAOD. Bier (8), who was a pupil of von Esmarch, developed the regional i.v. anesthesia of the limbs, which he obtained by injecting procain in a superficial vein of the limb excluded from circulation. We have proved that it is possible to reach the capillaries with such a regional i.v. injection. We administered reserpin and guanetidin obtaining a long lasting sympathetic blockade which we used with good results in the treatment of patients with distal types of arterial occlusion. The use of antibiotics, which we injected in this regional i.v. way in diabetic patients with foot phlegmone, brought a considerable improvement of the prognosis. Indications and contraindications of this procedure are discussed.
Acevedo
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Chirurgischen Abteilung der Medizinische Fakultät der Chilenischen Universität, Hospital del Salvador, Santiago, Chile.
D000765:Anesthesia, Conduction; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D006145:Guanethidine; D006801:Humans; D007262:Infusions, Intravenous; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply* / Q000294:innervation; D012110:Reserpine; D013563:Sympathectomy, Chemical; D014111:Tourniquets
D012110:Reserpine; D006145:Guanethidine