Clinical indications for epidural anesthesia and analgesia have expanded significantly over the past several decades. In addition, epidural techniques are used increasingly for diagnostic procedures, acute pain therapy, and management of chronic pain. Epidural blockade may also reduce the surgical stress response, the risk of cancer recurrence, the incidence of perioperative thromboembolic events, and, possibly, the morbidity and mortality associated with major surgery. This chapter covers the essentials of epidural anesthesia and analgesia. After a brief history of the transformation from single-shot to continuous epidural catheter techniques, it reviews 1 indications for and contraindications to epidural blockade; 2 basic anatomic considerations for epidural placement; 3 physiologic effects of epidural blockade; 4 pharmacology of drugs used for epidural anesthesia and analgesia; 5 techniques for successful epidural placement; and 6 major and minor complications associated with epidural blockade. This chapter also addresses several areas of controversy concerning epidural techniques. These include controversies about epidural space anatomy, the traditional epinephrine test dose, methods used to identify the epidural space, and whether particular clinical outcomes may be improved with epidural techniques when compared to GA. More detailed information about local anesthetics LAs , the mechanism of neuraxial blockade, the combined spinal-epidural CSE technique, obstetric anesthesia , and complications of central neuraxial blockade is provided following the links. The neurologist J. Leonard Corning proposed injecting an anesthetic solution into the epidural space in the s, but devoted his research primarily to subarachnoid blocks.
Circumcision is a surgical procedure in which the foreskin also known as the prepuce is cut from the penis. Male circumcision is not performed routinely for any medical conditions. However, there are a number of conditions affecting the genitals of adult men which circumcision is sometimes used to treat. Conditions which circumcision might be used to treat. Phimosis is a condition where the foreskin is constricted and cannot be pulled back over the head of the penis glans.
Circumcision is the surgical removal of foreskin. Foreskin covers the head of a flaccid penis. When the penis is erect, the foreskin pulls back to reveal the penis.
This information is designed to help you, your family and friends prepare for your surgery. It will also help you plan how to take care of yourself in the weeks following discharge from hospital. A circumcision is an operation that removes the foreskin from the penis, exposing the underlying head medically known as the glans. Circumcisions are usually carried out because of phimosis an abnormally tight foreskin , or if the foreskin is stuck to the underlying glans. Both of these conditions prevent the foreskin being retracted, which can cause hygiene problems, infection and pain.