title: Cervical epidural anesthesia for combined neck and upper extremity procedure: a pilot study.
abstract: In a prospective pilot study, we evaluated the possibility of performing a total parathyroidectomy with parathyroid gland implantation into the forearm (a combined neck and upper extremity procedure) under cervical epidural anesthesia (CEA) at C6-7 level using ropivacaine. The indication for CEA was the patient's choice or a previous procedure on the neck with unilateral vocal cord paralysis. Anesthesia was induced by 10 mL of 0.75% ropivacaine plus 10 mug of sufentanil in 2 mL. Block onset time, success rate, analgesia, sensory block extent, changes in respiratory and hemodynamic variables, complications, and length of hospital stay were assessed. All 15 procedures were successfully performed under CEA. Sensory block was registered in the range C2-T10, with a lower median of T3. The upper margin of sensory block was C2 in all patients. Of the respiratory variables, the only significant decrease was observed in forced vital capacity; none of the patients developed clinically significant respiratory insufficiency. We conclude that combined procedures involving the neck and upper limbs can be performed using CEA with ropivacaine. CEA allows verbal communication with patients and early detection of vocal cord paralysis.
authors.affiliation: *Department of Cardiovascular Anesthesia and Intensive Care, Na Homolce Hospital; and Department of †Anesthesia and Intensive Care and ‡Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Michalek
authors.forename: Ivan
authors.initials: I
authors.lastname: David
authors.forename: Milos
authors.initials: M
authors.lastname: Adamec
authors.forename: Libor
authors.initials: L
authors.lastname: Janousek
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D002572:Cervical Plexus; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D019148:Neuromuscular Blockade; D010243:Paralysis / Q000139:chemically induced; D010280:Parathyroid Glands / Q000601:surgery / Q000637:transplantation; D016105:Parathyroidectomy; D010865:Pilot Projects; D015656:Respiratory Mechanics / Q000502:physiology; D034941:Upper Extremity / Q000601:surgery*; D014797:Vital Capacity; D014827:Vocal Cords / Q000187:drug effects