The following statement is incorrect regarding local anaesthetic administration:
Rate of subcutaneous injection rarely influences the perception of pain by the patient. This statement is incorrect; increasing the rate of subcutaneous injection increases the pain. Warming and alkalinising the anaesthetic with bicarbonate also reduces the pain of infiltration. Although the ‘safe’ dose of lidocaine for direct infiltration is 4 or 7mg/kg with or without adrenaline (epinephrine), respectively, it can safely be used in much higher concentrations such as during tumescent infiltration for liposuction.
Requirements for successful and effective microsurgical training:
All of the above is true. Effective microsurgical education is based on training centres with appropriate education programs, infrastructure and equipment. The individualised programs are more effective and require good hand-eye co-ordination, good manual skills and patience both of the participant and tutor.
After serious ischaemia of tissues in the microcirculation the ‘no-reflow’ phenomenon can appear, that consists of several events and factors except for:
Tissue/organ ischaemia causes complex pathophysiological processes depending on the duration and extent of the ischaemia. During reperfusion in the microcirculatory bed a ‘no-reflow’ phenomenon can be caused by microvascular spasm, swelling of endothelial cells, endothelial ‘blebs’, increased capillary permeability, interstitial oedema, microthrombi, plugged red blood cell aggregates, adhesion and plugging of neutrophil leukocytes, local acidosis and swollen myocytes around compressing vessels.
1. Reffelmann T, Kloner RA. The ‘no-reflow’ phenomenon: basic science and clinical correlates. Heart 2002; 87: 162-8.
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