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Assessment – Nutrition-Focused Physical Exam to Detect Macronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Similarly, the external intercostal muscles can be inspected with the patient in the sitting position. Intercostal muscles lie in the intercostal spaces between the ribs. Inspect the thoracic region for protruding ribs and depressions between the ribs. A severe depression between the ribs may indicate muscle loss. Palpate the muscles between the ribs with the index finger to identify whether loss of chest wall muscle mass is apparent. In well-nourished patients, the chest muscles will be well-defined with no apparent depressions. In severely malnourished patients, the apparent depression between ribs will be visible and can be felt on palpation.
Role of Intercostal Drainage Tube in Chest Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Though the intercostal drainage tube is commonly used, approximately 4%–5% of intercostal drainage tube placements have complications. To prevent these complications, good anatomical knowledge and appropriate sizing of tubes and accurate placement are necessary. The intercostal space is filled with intercostal muscles with the intercostal neurovascular bundle commonly present in the groove of the superior rib. Newer research shows the ideal spot is 50%–70% of the way down the interspace.
Blocks of Nerves of the Trunk
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Since the report by Nunn and Slavin9 describing the spread of significant amounts of local anesthetics to several adjacent intercostal spaces, several studies have been performed in adults to verify this fact and to develop single-puncture procedures for multiple intercostal nerve blockade, including the placement of catheters into this space for additional (continuous or intermittent) injections.9,22–26 There is no reason why the spread reported in adults could not occur in children, but at this time, this has not been evaluated and the single injection of a large volume of local anesthetic should not be recommended (because of risks of toxic complications and extensive spread of anesthesia) until more data are available.
Metformin ameliorates ferroptosis in cardiac ischemia and reperfusion by reducing NOX4 expression via promoting AMPKα
Published in Pharmaceutical Biology, 2023
Zhenhua Wu, Yunpeng Bai, Yujuan Qi, Chao Chang, Yan Jiao, Yaobang Bai, Zhigang Guo
A cardiac I/R rat model was constructed according to the following procedure: rats were deeply anesthetized by inhalation of 5% isoflurane and then maintained by inhalation of 2% isoflurane (Denorme et al. 2020). After intubation, the rodent respirator (Yuyan Scientific Instrument, Shanghai, China) was utilized for the ventilation of rats. The skin on the chest of rats was exposed and sterilized. The thoracic cavity was opened at the fourth intercostal space. We then applied a 6-0 silk suture to ligate the left anterior descending coronary artery of the rats for 30 min at about 2 mm distal to the original of the left anterior descending coronary artery. After 30 min ischemic treatment, the slipknot was released to perfuse the heart for 24 h (Shi and Hou 2021). The elevated ST segment on the electrocardiogram indicated a successful establishment of the cardiac I/R rat model. Rats without the ST segment elevation were excluded from this research.
Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS)
Published in Postgraduate Medicine, 2023
The 4th or 5th intercostal space is used as the surgical incision site in uniportal VATS in clinical practice. Intraoperative injury to the intercostal nerve may lead to postoperative pain. The intercostal nerve is a mixed nerve branch formed by the union of the anterior and posterior roots after the thoracic spinal cord. Each intercostal nerve emerges from the intervertebral foramen and travels at the lower edge of the rib angle to the costal groove accompanying the intercostal artery. The pain felt by the nerve endings travels from the intercostal nerve to the nerve roots, spinal cord, and cerebral cortex. Therefore, ICNB is performed primarily from the rib angle. In addition, the adjacent intercostal skin is innervated by the intercostal nerve; therefore, the surrounding skin should also be blocked. Various regional analgesic techniques have been used to improve postoperative pain management in VATS and promote the normalization of the concept of rapid recovery [23,24].
Breast augmentation under local anesthesia with intercostal blocks and light sedation
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Martine Ditlev, Erik Loentoft, Lisbet R. Hölmich
When the maximum effect of the intravenously administered medicine was achieved within a few minutes, bupivacaine (0.25%)-epinephrine (5 µg/mL) intercostal blocks 2 × 20 cc were introduced using a 20 cc syringe with a 21 gauge needle with the patient in the supine position and the arms at a 90-degree angle (Supplementary Video 1). The injections were made at the midaxillary line before the takeoff of the anterior and lateral cutaneous branches of the intercostal nerve, ensuring both branches were anesthetized. Beginning at the uppermost palpable costae (costa three), the injections were done by palpating the costae with the non-dominant hand and using the same hand to retract the skin overlying the costae cephalad. With the dominant hand, the needle was placed and advanced through the skin just above the upper margin of the rib using the non-dominant hand still in contact with the patient for needle support. 1.5–2 cc of the anesthetic solution was slowly injected into the intercostal space, targeting the neurovascular bundle of the rib above. The needle was then walked caudad off the inferior margin of the rib, further injecting 1.5–2 cc into the neurovascular bundle of the next intercostal space. This process was then repeated for the next lower rib continuing down to the intercostal space just inferior to the inframammary fold [6], corresponding to the intercostal spaces from above costa three to below costa seven. This technique ensures injection into two intercostal spaces by only one puncture of the skin, reducing the overall number of injections. A maximum of 20 cc was used on each side of the thorax.