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A regional block, also known as a localized block, is a type of anesthetic that blocks nerve transmission to prevent or alleviate pain. Regional anesthesia is the process of injecting an anesthetic substance into a peripheral nerve and inhibiting transmission to avoid or treat pain. It is distinct from general anesthesia in that it does not alter the patient’s level of awareness to alleviate pain. There are numerous advantages of regional anesthesia over general anesthesia, including avoidance of airway manipulation, lower dosages, fewer systemic medication adverse effects, shorter recovery period, and considerably less discomfort following surgery.
Shoulder surgery can be accomplished arthroscopically or open, and is usually performed in either a lateral decubitus (LDP) or beach-chair (BCP) position. The LDP involves placing the patient on their side on a padded table on top of a bean bag to support the pelvis and lower torso. For the BCP, the patient is placed on a table with a headrest and the bed is positioned in Trendelenburg, with the feet elevated to 15 degrees and the knees flexed to 30 degrees. Some potential advantages of the BCP over the LDP include shorter surgical times, less difficult conversion to an open procedure, and a lower incidence of neuropathies. The BCP can present a unique challenge for the anesthesia provider in accessing the airway and has been associated with rare, but catastrophic, neurologic complications, including transient visual loss, spinal cord ischemia, and strokes. These complications have been suggested to be from the gravitational effects of the sitting position and the blunting of cerebral autoregulation under general anesthesia (GA). There is some evidence that patients in the BCP have diminished cerebral autoregulation and lower regional cerebral oxygenation, when compared to the LDP. This, however, do not relate to cognitive outcomes.
The intercostal nerves are the continuations of the ventral ramus of the thoracic spinal nerves. To perform an effective ICB, the block should be performed proximal to the mid-axillary line, where the lateral cutaneous branch takes off. ICBs can be performed using landmarks, a nerve stimulator, or under ultrasound guidance. Evidence supports the effectiveness of ICBs for chest tube placement, rib fractures, and procedures of the breast and chest wall. Limitations of ICBs include the need to perform blocks at multiple levels (each level of fractured rib) and their association with a shorter duration of action, compared to other chest wall fascial plane blocks such as pectoralis (PECS) II block and serratus anterior plane block (SAP). This is mainly related to a high rate of absorption of local anesthetic within the intercostal space. These considerations make ICBs a less favorable option, as with each injection, there is a potential risk of complications, such as neurovascular injury and pneumothorax. The risk of local anesthetic systemic toxicity (LAST) may also be increased with multiple intercostal injections related to the highly vascularized bundle located underneath each rib, resulting in a high rate of absorption.
Scientific studies of challenges of climate change could be improved by including other sources of knowledge, such as traditional ecological knowledge (TEK), in this case relating to the Sámi. This study focuses on local variations in snow and ice conditions, effects of the first durable snow, and long term changes in snow and ice conditions as pre-requisites for understanding potential future changes. Firstly, we characterised snow types and profiles based on Sámi categories and measured their density and hardness. Regression analysis showed that density can explain much of the variation in hardness, while snow depth was not significantly correlated with hardness. Secondly, we found that whether it is dry/cold or warm/wet around the fall of the first durable snow is, according to Sámi reindeer herders, crucial information for forecasting winter grazing conditions, but this has had limited focus within science. Thirdly, elderly herders’ observations of changes in snow and ice conditions by ‘reading nature’ can aid reinterpretation of meteorological data by introducing researchers to alternative perspectives. In conclusion we found remarkable agreement between scientific measurements and Sámi terminology. We also learnt that TEK/science cooperation has much potential for climate change studies, though time and resources are needed to bridge the gap between knowledge systems. In particular, TEK attention to shifts in nature can be a useful guide for science.
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