Anestesia Regional B.Braun: La primera opción del profesional para una terapia de dolor segura. Catálogo de productos

Nuevos productos

Anestesia Regional B. Braun La primera opción del profesional para una terapia de dolor segura.

La mejor recuperación para su paciente En los últimos años se ha hecho evidente que el uso de la Anestesia Regional mejora considerablemente la recuperación de su paciente. Por lo tanto, es nuestro objetivo fomentar el uso de la Anestesia Regional y hacer que sea su primera elección en aquellos pacientes donde esté indicada. Mas allá de ofrecerle excelentes productos nuestro compromiso es brindarle servicios excepcionales: • En cooperación con nuestros clientes, desarrollamos productos novedosos, perfectamente adaptados a sus necesidades clínicas en su practica diaria • Usted encontrará material de información valioso y actualizado sobre Técnicas de Anestesia Regional como también la correcta utilización de todos nuestros productos • Queremos beneficiarlo con nuestra experiencia, al compartir conocimientos y experiencias clínicas con sus colegas durante talleres educativos, lecturas y simposios. • Le ofrecemos un portafolio bien balanceado de productos novedosos y de alta calidad, los cuales han sido desarrollados para satisfacer sus necesidad clínicas.

Anestesia Regional B. Braun La primera opción del profesional para una terapia de dolor segura.

2

Educación y Servicio

Anestesia Espinal

Anestesia Epidural Anestesia combinada Espinal & Epidural Bloqueo de Nervios Periféricos Infiltración Continua de Heridas 3

Anestesia Regional B. Braun Sharing Expertise – Nuestro compromiso para hacer los procesos clínicos mas fáciles rápidos y seguros. Compartiendo el conocimiento

El poder del conocimiento

El desarrollo profesional de la anestesia regional no solamente requiereequipamientoexcepcionalsinotambiénunprofundoconocimiento y habilidades. Por ejemplo, educación y entrenamiento en anatomía, técnicas y aplicaciones de producto.

ProductossobresalientesysolucionesinteligentesparaAnestesia Regional son los beneficios esenciales que usted puede esperar de B.Braun. Ofrecemos una fuente de conocimiento desde el mundo de la práctica para el mundo de la práctica.

A lo largo del mundo, B.Braun promueve y sostiene entrenamientos profesionales de anestesia regional bajo el ala de la Academia Aesculap así como también a través de talleres y simposios. Mas aun, ofrecemos mediar directamente el contacto con expertos que cubran todos los aspectos de la anestesia regional, desde simples preguntas hasta entrenamientos individuales de practica clínica. Únase a los varios eventos, aprenda de expertos internacionales y utilice nuestro servicio multimedia para enseñarle a estudiantes y jóvenes profesionales.

Sea parte de la red Benefíciese de la educación y el entrenamiento adecuado a sus necesidades

„„

Obtenga crédito CME

„„

Talleres personalizados perfectamente adaptados a sus necesidades

„„

Servicio multimedia profesional y constantemente actualizado para mejorar su conocimiento

„„

4

Proveyendo a los estudiantes, médicos, y personal de enfermería con tal información B.Braun contribuye significativamente a un nivel de calidad más alto en cuidados médicos. Anestesia Regional B. Braun La primera opción del profesional para una terapia de dolor segura.

ocks

A Nerve Bl NYSOmRity Lower Extremity Nerve Blocks

Upper Extre

THE NEW

YORK SCHOOL

OF REGIONAL

B. Braun

ANESTHES

Cross-section

B. Braun Edition

Imaging Placement Transducer Ultrasound

IA

Edition

Transducer

Placement

Ultrasound Imaging

Cross-sectional Anatomy

Femoral Nerve Block Indications:

Interscalene

Block

Surgery on femur, anterior thigh, and knee

ns:

Indicatio

on shoulder, Surgery distal clavicle, humerus proximal

of breath Tips: artery imaging proves with shortness r level when • Avoid vertebral in patients medial • Re-consider from supraclavicula lateral to • Start scanning common),groove In plane (most challenging Technique interscalene based on spread; Within the possible, Technique: Patient Position: SupineNeedle insertion: Initial depth setting: 4cm As few as LA deposit: trunks Ideal array Needle insertion: In plane, lateral to medial, (out of plane less Transducer: 8-16 MHz, linear Local Anesthetic (LA): 15-20mL of injections: MSM around ASM and common), Transducer Placement: Number Femoral 1-2 crease, parallel and inferior to Ideal view: Fascia iliaca and FN LA: Between typically or 3 round inguinal2ligament Key anatomy: Femoral nerve lateral to femoral artery, below fascia Ideal spread of LA: Beneath fascia iliaca around femoral nerve (LA): 15-20mL Initial depth spread of Idealneedle visualized scalene muscles, Number of injections: One iliaca Needle: 22G 5 cm short bevel (8-10cm for obese patients) Local Anesthetic 2-3 trunks middle two muscles Ideal view: Anterior and between the Nerve stimulation response: Quadriceps muscle contraction Key anatomy:structures (trunks) hypoechoic

Tips: • When FN is not seen, track fascia illiaca medially towards FA to identify FN • For analgesia, catheters may be placed underneath fascia iliaca • Beware: Risk of falls due to motor weakness of quadriceps muscle

ABBREVIATIONS FA Femoral Artery FN Femoral Nerve FV Femoral Vein setting: 3cm

semi-lateral chair, or 3cm Supine, beacharray vein, approx linear Patient Position: 10-16 MHz, external jugular Transducer: Placement: Over Transducer forearm above clavicle5cm short bevel Shoulder, arm, response: Needle: 22G Nerve stimulation

ABBREVIATIONS Scalene Muscle ASM AnteriorPlexus

BP Brachial Artery CA Carotid Jugular Vein IJV Internal Scalene Muscle id muscle MSM Middle SCM Sternocleidomasto Process TP TransverseArtery VA Vertebral

ns:

Indications: Surgery at and below the knee

,

Indicatio

Sciatic Nerve Block (Subgluteal level)

r Block

Supraclavicula

on humerus Surgery elbow, hand

lateral medial lateral to sheath (grey arrows) In plane, Technique: insertion: brachial plexus

artery puncture subclavian DSA , TCA, DSA. avoid TCA, Tips: pneumothorax detect and • Avoid pneumothorax Doppler tobe shallow to avoidof the sheath • Use power in swelling angle should • Needle of LA should result • Injection

Within Needle ABBREVIATIONS Initial depth setting:subclavian 5cm (highly dependent on patient size) Patient Position: Prone, lateral or oblique (shown) LA deposit: the Idealcurved GMM Gluteus Maximus Muscle Local Transducer: 6-16 MHz, Linear in artery larger patients lateral to (LA): 15-20mL 2-3 rib (shown)toorsubclavian ScN Sciatic Nerve sheathAnesthetic the BP Ideal of injections: above first view: Sciatic nerve in epineural sheath (grey arrows) Placement: Gluteal crease, the highest crease if more setting: 3cm ml Transducer IT Ischial Tubercle artery Number of LA: Within (LA): 20-25and subclavian Initial depth Key anatomy: Sciatic nerve, gluteus maximus muscle than one GT Greater Trochanter the first rib Ideal spread Anesthetic semi-lateral to Supine, or array linear r fossa, lateral Patient Position: 10-16 MHz, supraclavicula Transducer: Placement: In caudally Transducerhead of SCM, pointedneedle bevel hand clavicular 5cm short Forearm, response: Needle: 22G Nerve stimulation

ABBREVIATIONS Plexus BP Brachial Scapular artery DSA Dorsal Scalene Muscle MSM Middle Artery SA Subclavian Cervical Artery TCA Transverse

Technique: Needle insertion: In plane, lateral to medial, (out of plane in larger patients) Ideal spread of LA : Around the nerve Number of injections: One or two

Local Needle: 21G 10cmhyper short and bevel needle artery and above Brachial plexus to the artery Ideal view: respectively. artery;Nerve a honeycombed stimulation response: Twitch of foot or calf superficial and pleura, Subclavian lateral and Key anatomy:structure (divisions) hypoechoic

Tips: • Needle should enter the sheath of the ScN either at the lateral or medial aspect of nerve. • Significant amount of transducer pressure may be required to image ScN * The cross-sectional anatomy shown can be used as a reference for both transgluteal and subgluteal techniques.

Popliteal Block Indications: Surgery on ankle, achilles tendon, and foot

Block

vicular

Infracla

ns:

,

Indicatio

on humerus Surgery elbow, hand

ABBREVIATIONS BFM Biceps Femoris Muscle CPN Common Peroneal Nerve PA Popliteal Artery PV Popliteal Vein

ScN Sciatic Nerveat elbow flexed andSemimembranosus SmM Muscle arm abductedStM Semitendinosus Muscle TN Tibial Nerveclavicle, Supine with array linear to and below Patient Position: 10-16 MHz, Transducer: Placement: Perpendicular Transducercoracoid process bevel needle medial to 8-10cm short Hand twitch Needle: 21-22G response: Nerve stimulation

ABBREVIATIONS Artery AA Axillary Vein AV Axillary Vein CV CephalicCord LC Lateral Cord MC Medial Cord Major Muscle PC Posterior PMaM Pectoralis Minor Muscle PMiM Pectoralis

and pneumothorax puncture axillary vein to detect artery or vein Tips: (Subclavian) before injection to visualize pressure injection • Avoid Axillary transducerrisk of intravenouselbow can be helpful • Release in the and flexion caudal and decrease of the arm artery cranial to In plane, and lateral to the artery • Abductionfascie Technique: pectoral lateral to Needle insertion: Posterior andsetting: PMiM fascia Technique: depth Patient Position: Prone, oblique (shown) or supine.Ideal LA deposit: Initial 2, deep the4cm AA, under(LA): 15-25 ml of injections: Needle insertion: In plane or out of plane Transducer: 8-16 MHz, linear array 5cm AroundAnesthetic pectoralis Number LA: Local setting:Transducer fascia of Ideal spread of LA: Around ScN, or between TN and CPN Placement: popliteal spread of Ideal view: Where ScN starts diverging into TN and CPN Ideal (LA): 20-30mL Initial depth below theTransverse at the base of the veinabove Number of injections: One or two Key anatomy: Popliteal artery, sciatic nerve superficial and fossa 4and -5cm popliteal crease Local Anesthetic of pectoralis Axillary artery fascia needle and bevel X- Needle path for out of plane approach lateral to it, femur, common epineural sheath of ScN Needle: 22 G 5-8cm Ideal view: artery,short Note: Gray arrows indicate common epineural sheath Nerve stimulation response: Twitch of foot or toes (subclavian) minor muscle Axillary Key anatomy: (grey arrow) minor muscles

Tips: • Injection can be made also more proximally at either medial or lateral aspect of ScN under epineural sheath • After injection, scan proximally-distally to assure the LA spread around TN and CPN • Catheter best placed within epineural sheath

Saphenous Nerve Block Indications:

Axillary

Poster NYSORA para PNB Extremidad superior: aproximación por canal humeral „„Extremidad inferior: bloqueo de nervio ciático. „„

y

al Anatom

THE NEW YORK SCHOOL OF REGIONAL ANESTHESIA

RA NYSO

Block

Supplement to popliteal or sciatic blocks for surgery below the knee

ns:

Indicatio

on elbow, Surgery hand forearm,

ABBREVIATIONS FA Femoral Artery Medialis M. (Vastus) SaM Sartorius Muscle

SaN Saphenous Nerve at elbow and flexed arm abducted Supine with array in the linear to humerus Patient Position: 10-16 MHz, Transducer: Placement: Perpendicular Transducer needle axillary fossa 5cm short bevel Hand twitch response: Needle: 22G Nerve stimulation

with

separately must be blocked axillary Tips: eous nerve to detect • Musculocutan before injection pressure intravenous injection 5mL of LA of transducer nerves to the artery; plane • Release decrease the risk individual or out ofand 10mL anterior In plane veins and 1:00 Technique: to visualize/block redirect to 10 mL posterior NeedleLAinsertion: • Not necessary deposit: at 6:00, then Ideal Initial to artery Technique: depthdeep setting: 3cm Patient Position: Supine with leg abducted and externally rotated 5mL forofMcN sheath; separate + McN injection: 3cmMHz, linear array Transducer: Needle insertion: InIC plane Anesthetic2-3 (LA): 10-15mL within the TOXICITY Point Local setting:8-16 AA, arrows); separate of injections: 20-30mLTransverse (grey Around Transducer(LA): Placement: view at medial aspect of lower Ideal spread of LA: Around or underneath the artery, between Ideal view: Artery below Initial depth ANESTHET Number of LA: McN the sartorius muscle and its sheath distally AA, infusion Propofol) around Ideal spread arterylevel thighAxillary to mid-thigh 100% O2 T OF LOCAL vastus and sartorius muscle Keyrequired anatomy: Femoral artery below sartorius muscle, nerve often Local Anesthetic tion,medialis McN more scattered around Midazolam, then continuous injection TREATMEN Needle: 22G 5-8cmfor short bevel needle nerves Ideal view: Number of injections: One or two not visualized required hyperventila (Diazepam, radial (~100mL),

1) Airway, convulsions Nerve stimulation response: If used, paresthesia of medial aspect of view sometimes Median, ulnar, over 1 minute minutes) 2) Abolish (1.5 mL/kg lower legthe cansheath be elicited over 30 Key anatomy: Nerve Blocks nary bypass (~500 mL 3) Intralipid McN outside n During cardiopulmo 0.25 mL/kg/min consider to Injection Injectio G CHECK-LIST 4) CPR/ACLS, + Resistance ent and Monitoring of Needle Placement and Injection During Nerve Blocks AND MONITORIN Placem Stimulation q TATION to Injection + Nerve + Resistance 2 Hz)Combining Ultrasound + Nerve Stimulation obtained of Needle DOCUMEN 0.1msec, Ultrasound q consent q (0.5mA, • Patient checked q Oxymetry) Monitoring Combining stimulator Connect needle to nerve stimulator (0.5mA, 0.1msec, 2 Hz)equipment present BP, Pulse to nerve • Laterality

ABBREVIATIONS Artery AA Axillary Vein Muscle AV Axillary CBM Coracobrachialis Nerve McN Musculocutaneous Nerve MN MedianNerve RN Radial Nerve UN Ulnar

Connect

http://itunes.apple.com

needle

Advance

applied • Resuscitative monitoring

●

●

●

of LA spread 1-2 mL injection adequate normal?‡ results in pressure Injection

response ● Motor the needleassure present ● Reposition mA) to● 1-2 mL injection of LA at (or decrease response results in adequate spread NO motor ● Injection pressure normal?‡