Anesthesiologists, Pain Management Specialist
48 years of experience

Accepting new patients
Texas Tech University
4430 S Loop 289
Lubbock, TX 79414
806-743-7246
Locations and availability (3)

Education ?

Medical School
University Of Liverpool (1962)
Foreign school

Awards & Distinctions ?

Awards  
Castle Connolly America's Top Doctors® (2002 - 2008, 2010 - 2014)
Patients' Choice Award (2011)
Compassionate Doctor Recognition (2011)
Appointments
Texas Tech Univ H.s.c. (1977 - Present)
Associations
American Academy of Pain Medicine
American Board of Anesthesiology

Affiliations ?

Dr. Racz is affiliated with 12 hospitals.

Hospital Affilations

Score

Rankings

  • Covenant Medical Center
    3615 19th St, Lubbock, TX 79410
    • Currently 4 of 4 crosses
    Top 25%
  • Covenant Hospital Levelland
    1900 College Ave, Levelland, TX 79336
    • Currently 2 of 4 crosses
  • Covenant Children's Hospital
    3610 21st St, Lubbock, TX 79410
    • Currently 2 of 4 crosses
  • University Medical Center - Lubbock *
    602 Indiana Ave, Lubbock, TX 79415
    • Currently 2 of 4 crosses
  • Covenant Hospital Plainview
    2601 Dimmitt Rd, Plainview, TX 79072
    • Currently 1 of 4 crosses
  • Lincoln County Medical Center
  • Covenant Health Sys -Lakeside, Lubbock, Tx
  • University Medical Center Health System
  • Parkland Hospital System
  • University Med Ctr, Lubbock, Tx
  • Covenant
  • TX Tech Physicians Associates
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Racz has contributed to 63 publications.
    Title Using Procedure-specific Needles: What is Blunt?
    Date July 2010
    Journal Southern Medical Journal
    Title Peri-venous Counter Spread - Be Prepared.
    Date May 2010
    Journal Pain Physician
    Title An Updated Interdisciplinary Clinical Pathway for Crps: Report of an Expert Panel.
    Date June 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    The goal of treatment in patients with complex regional pain syndrome (CRPS) is to improve function, relieve pain, and achieve remission. Current guidelines recommend interdisciplinary management, emphasizing 3 core treatment elements: pain management, rehabilitation, and psychological therapy. Although the best therapeutic regimen or the ideal progression through these modalities has not yet been established, increasing evidence suggests that some cases are refractory to conservative measures and require flexible application of the various treatments as well as earlier consideration of interventions such as spinal cord stimulation (SCS). While existing treatment guidelines have attempted to address the comprehensive management of CRPS, all fail to provide guidance for contingent management in response to a sudden change in the patient's medical status. This paper reviews the current pathophysiology as it is known, reviews the purported treatments, and provides a modified clinical pathway (guideline) that attempts to expand the scope of previous guidelines.

    Title Sphenopalatine Ganglion Pulsed Radiofrequency Treatment in 30 Patients Suffering from Chronic Face and Head Pain.
    Date June 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    This study evaluated the efficacy of sphenopalatine ganglion pulsed radiofrequency (SPG-PRF) treatment in patients suffering from chronic head and face pain. Thirty patients were observed from 4 to 52 months after PRF treatment. The primary efficacy measures were the reduction in oral medication use, including opioids, time-to-next-treatment modality for presenting symptoms, duration of pain relief, and the presence of residual symptoms. Secondary objectives included the evaluation of adverse effects and complications. All data were derived from patient charts, phone conversations, and clinical follow-up visits. Fourteen percent of respondents reported no pain relief, 21% had complete pain relief, and 65% of the patients reported mild to moderate pain relief from SPG-PRF treatment. Sixty-five percent of the respondents reported mild to moderate reduction in oral opioids. None of the patients developed significant infection, bleeding, hematoma formation, dysesthesia, or numbness of palate, maxilla, or posterior pharynx. A large-scale study of SPG-PRF for the treatment of face and head pain has not been previously reported. Our results suggest that a prospective, randomized, controlled trial study to confirm efficacy and safety of this novel treatment for chronic head and face pain is justified.

    Title Sharp Versus Blunt Needle: a Comparative Study of Penetration of Internal Structures and Bleeding in Dogs.
    Date June 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    BACKGROUND AND OBJECTIVES: Complications associated with interventional pain procedures have raised questions regarding the relative safety of sharp vs. blunt needles. It has been speculated that the incidence of hemorrhage, intraneural and/or intravascular injections may be reduced by the use of blunt needles. In this study we compared penetration and bleeding associated with sharp vs. blunt needle punctures. METHODS: Attempts were made to insert blunt and sharp needles (18-, 20-, 22-, and 25-gauge) directly or percutaneously into kidney, liver, renal artery, intestine or spinal nerve/nerve root of anesthetized dogs. Penetration and bleeding were ascertained by direct vision through a surgical wound. RESULTS: All attempts to directly puncture the kidney and liver with sharp needles were successful. All but one attempt to puncture a spinal nerve/nerve root with 20-, 22-, and 25-gauge sharp needles were successful but half or less attempts to puncture the intestines were successful. All attempts to puncture the renal artery with sharp needles were successful. Blunt needles never punctured the renal artery, spinal nerve/nerve root and intestines and rarely penetrated the kidney (22- and 25-gauge one time each). All attempts to puncture the liver with blunt needles were successful. Bleeding scores for kidney punctures were generally higher for larger sharp needles than for smaller ones. Bleeding scores for blunt needle punctures of the liver were generally smaller than for sharp needle puncture. CONCLUSION: Blunt needles are less likely than sharp ones to enter vital structures and/or produce hemorrhage. Thus, blunt needles may be preferable to sharp ones for performing interventional pain procedures.

    Title Pulsed Mode Radiofrequency Lesioning to Treat Chronic Post-tonsillectomy Pain (secondary Glossopharyngeal Neuralgia).
    Date June 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    Glossopharyngeal neuralgia (GPN) is an uncommon orofacial pain syndrome. Primary GPN is idiopathic, whereas secondary GPN has identifiable causes: tonsillectomy, peritonsillar abscesses, invasive cancer, and trauma. Despite these differences, both types of GPN present similarly and can recur. Pulsed mode radiofrequency lesioning is a safe, non-destructive treatment method and hence, useful in neuropathic pain conditions. We present the first case of chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia), that was successfully managed with pulsed radiofrequency lesioning.

    Title Lumbar and Thoracic Sympathetic Radiofrequency Lesioning in Complex Regional Pain Syndrome.
    Date June 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Title Cervical Spinal Cord Neoplasm in a Patient with an Implanted Cervical Spinal Cord Stimulator: the Controversial Role of Magnetic Resonance Imaging.
    Date June 2007
    Journal Pain Physician
    Excerpt

    OBJECTIVE: To discuss the diagnostic relevance and safety concerns of performing magnetic resonance imaging (MRI) in the presence of an implanted spinal cord stimulator (SCS). CASE REPORT: A 39-year old man with CRPS I and major depression fell and fractured his humerus. A cervical SCS had been placed several years earlier. After the fall, he developed progressive lower extremity weakness. Eventually, he became wheelchair dependent and required assistance with transfers. These symptoms were attributed to CRPS and deconditioning. He was admitted to an inpatient rehabilitation unit for functional restoration. At presentation, he reported developing neck and upper thoracic pain, which started several months before the fall - a pain that was distinct from his total body pain. A contrast-enhanced CT scan of the neck was normal, except for the spinal cord stimulator induced artifact. Our pain service was consulted. After performing a neurological exam, cervical myelopathy was suspected. An MRI of the spine demonstrated a mass compressing the cervical spinal cord. The patient tolerated the MRI, despite the presence of a neurostimulator. The mass was identified as an extramedullary, intradural schwannoma and was completely excised during surgery. The patient made a profound neurological recovery. CONCLUSION: The diagnostic value of MRI may outweigh the potential dangers of using this imaging modality when a patient with a neurostimulation device presents with a new-onset neurological deficit. Thorough informed consent and close physician monitoring of these patients during the MRI is imperative.

    Title Targeting the Spinal Nerve Via a Double-needle, Transforaminal Approach in Failed Back Surgery Syndrome: Demonstration of a Technique.
    Date June 2007
    Journal Pain Physician
    Excerpt

    Spinal surgery, particularly spinal fusion surgery, alters the anatomy of the spine and hence, may increase the difficulty of performing an interventional spine procedure. Transforaminal epidural procedures have gained popularity as an alternative to interlaminar epidural steroids in the management of radicular pain syndromes. Patients with failed back surgery syndrome are often excluded or represent a minor subset in many clinical studies evaluating the efficacy of transforaminal procedures. When included, however, patients with FBSS have typically undergone laminectomies or microdiscectomies: these procedures are less likely to violate the foraminal space in the spine compared to fusion surgery. We describe the specific details of a transforaminal approach to the epidural space/spinal nerve in a patient with a posterolateral and posterior interbody fusion.

    Title Evolution of Interventional Pain Management.
    Date June 2007
    Journal Pain Physician
    Excerpt

    Interventional pain management dates back to the origins of neural blockade and regional analgesia. Over the years, it evolved into a distinct specialty with the application of interventional techniques beyond those of simple neural blockade. The first therapeutic nerve block in pain management was described in 1899 by Tuffer. Subsequently, numerous techniques of interventional pain management with neural blockade were described. Diagnostic blockade in pain management was pioneered by von Gaza with the use of procaine for determining the pathways of obscure pain. Interventional pain management has entered into the modern era in the twenty-first century, driven by contributions from pioneers including Bonica, Winnie, Raj, Racz, Bogduk, and others. This historical review examines the origins of interventional pain management, its pathophysiologic basis, the role of precision diagnostic interventional techniques, therapeutic interventional techniques, and the future of interventional pain management.

    Title Pulsed Mode Radiofrequency Lesioning of the Suprascapular Nerve for the Treatment of Chronic Shoulder Pain.
    Date June 2007
    Journal Pain Physician
    Excerpt

    Suprascapular nerve blockade improves pain, range of motion, and disability in acute and chronic shoulder pain. Pain relief usually lasts several hours with local anesthetic. If steroids are added, the relief lasts several weeks. Since repetitive steroid exposure is associated with several hazards, alternative long-term therapies would be desirable. Pulsed mode radiofrequency is a non-destructive, safe, and repeatable long-term pain control therapy. We report a case, wherein a series of fluoroscopically guided, suprascapular nerve pulsed mode RF treatments were performed. Each provided 4-5 months of pain relief and improvement in shoulder function, without deterioration in muscle strength.

    Title Evidence-based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain.
    Date June 2007
    Journal Pain Physician
    Excerpt

    Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain. The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. The guidelines include a discussion of their purpose, rationale, and importance, including descriptions of the patient population served, the methodology, and the pathophysiologic basis for intervention. Multiple diagnostic and therapeutic interventional techniques are included in this document. Strong evidence was shown for diagnostic facet joint blocks for the diagnosis of facet joint pain, and lumbar provocative discography for discogenic pain. Moderate evidence was shown for sacroiliac joint blocks in the diagnosis of sacroiliac joint pain, and for transforaminal epidural injections in the preoperative evaluation of patients with negative or inconclusive imaging studies, but with clinical findings of nerve root irritation. Moderate to strong evidence was shown for multiple therapeutic interventional techniques including medial branch blocks and medial branch neurotomy; caudal epidural steroid injections and transforaminal epidural steroid injections; lumbar percutaneous adhesiolysis; and implantable therapies. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."

    Title Methods for Evidence Synthesis in Interventional Pain Management.
    Date June 2007
    Journal Pain Physician
    Excerpt

    Healthcare decisions are increasingly being made on research-based evidence, rather than on expert opinion or clinical experience alone. Consequently, the process by which the strength of scientific evidence is evaluated and developed by means of evidence-based medicine recommendations and guidelines has become crucial resulting in the past decade in unprecedented interest in evidence-based medicine and clinical practice guidelines. Systematic reviews, also known as evidence-based technology assessments, attempt to minimize bias by the comprehensiveness and reproducibility of the search for and selection of articles for review. Evidence-based medicine is defined as the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. Thus, the practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external evidence from systematic research. To arrive at evidence-based medicine decisions all valid and relevant evidence should be considered alongside randomized controlled trials, patient preferences and resources. However, many systematic reviews in interventional pain management fail to follow evidence-based medicine principles. Clinical practice guidelines are systematically developed statements that assist clinicians, consumers and policy makers to make appropriate healthcare decisions. The complex processes of guideline development depend on integration of a number of activities, from collection and processing of scientific literature to evaluation of the evidence, development of evidence-based recommendations or guidelines and implementation and dissemination of the guidelines to relevant professionals and consumers. Guidelines are being designed to improve the quality of healthcare and decrease the use of unnecessary, ineffective or harmful interventions. This review describes various aspects of evidence-based medicine, systematic reviews in interventional pain management, evaluation of the strength of scientific evidence, differences between systematic and narrative reviews, rating the quality of individual articles, grading the strength of the body of evidence and appropriate methods for searching for the evidence.

    Title Complications of Transforaminal Epidural Injections.
    Date June 2007
    Journal Pain Physician
    Title Radiofrequency Procedures.
    Date March 2007
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    Radiofrequency is a minimally invasive, target-selective technique that has been in clinical use for more than 25 years and has demonstrated success at reducing pain in several chronic pain conditions, including trigeminal neuralgia, chronic low back pain, postherpetic neuralgia, and complex regional pain syndrome. However, the success of radiofrequency in chronic pain has not been adequately reproduced in good-quality, randomized controlled trials, and its use in the management of neuropathic pain is under some debate. In addition, conventional radiofrequency occasionally leads to worsening and even new onset of neuropathic pain. Nevertheless, clinical experience suggests that radiofrequency may be a useful tool in the overall management of refractory neuropathic pain. Pulsed radiofrequency in particular is a minimally destructive procedure that may offer new opportunities and a broader perspective for therapy with radiofrequency.

    Title Evolution of Epidural Lysis of Adhesions.
    Date October 2006
    Journal Pain Physician
    Excerpt

    Epidural neuroplasty (lysis of epidural adhesions) is an interventional technique that has emerged over the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain when conservative management has failed. Neuroplasty was at one time performed as a single-catheter technique using the caudal approach. It now has many variations, including placement of the catheter tip in the anterior epidural space. This article will discuss the evolution and refinement of epidural neuroplasty at our institution.

    Title A Comparison of Pulsed Radiofrequency and Continuous Radiofrequency on Thermocoagulation of Egg White in Vitro.
    Date July 2006
    Journal Pain Physician
    Excerpt

    BACKGROUND: Clinical studies have demonstrated the efficacy of pulsed radiofrequency (PRF). PRF energy is delivered to neural structures via specifically designed, percutaneously placed needles to treat some chronic pain states. PRF was introduced as a non-destructive alternative to destructive lesioning produced by continuous radiofrequency (CRF) energy. However, there is an ongoing controversy regarding the potential tissue-destructive effects of PRF used for pain management. OBJECTIVE: To evaluate the ability of PRF to coagulate egg white at various temperatures used clinically and to compare with CRF. METHODS: A commercially available (TYCO-Radionics Labs) 5 cm, 22G (0.7 mm) SMK needle with 5 mm active tip was inserted into a 10 mL test tube containing raw egg white at 37 degrees C and the tip was heated up to 80 degrees C. The photographic patterns of thermocoagulation of egg white in vitro produced by continuous and pulsed radiofrequency (RF) were compared and the lowest temperature at which PRF produced thermocoagulation was determined. RESULTS: Pulsed RF produced barely detectable thermocoagulation at 60 degrees C. Above 60 degrees C, the pattern of coagulation produced by PRF resembled that observed with CRF. However, the density and size of the coagulation ball appeared somewhat greater with CRF. CONCLUSION: PRF coagulated egg white at temperatures above 60degrees C in a manner similar to CRF. Monitoring needle tip temperature using the thermode supplied with the needle during PRF and keeping the recorded tip temperature below 60degrees C may minimize unwanted thermal destruction of tissue.

    Title Long-term Relief of Posttraumatic Headache by Sphenopalatine Ganglion Pulsed Radiofrequency Lesioning: a Case Report.
    Date July 2004
    Journal Archives of Physical Medicine and Rehabilitation
    Excerpt

    Posttraumatic headache is a common and disabling pain syndrome in patients who sustain a head injury. Unfortunately, conventional treatments may fail or cause intolerable side effects. Because chronic headache may be mediated by central and peripheral neural processes, these structures may be therapeutic targets. One target, the sphenopalatine ganglion (SPG), is implicated in several headache disorders and has been lesioned for headache relief. Because of the risks of neurolytic procedures, nonablative procedures that provide pain relief would be useful. We present a case wherein a man in his late twenties with posttraumatic headache obtained more than 17 months of relief with SPG pulsed-mode radiofrequency lesioning. SPG pulsed-mode radiofrequency is a nonablative, neural lesioning method that may be useful in the treatment of posttraumatic headache.

    Title Special Techniques in Pain Management: Lysis of Adhesions.
    Date February 2004
    Journal Anesthesiology Clinics of North America
    Excerpt

    Low back pain, with or without radicular symptoms, is a common medical condition. It can cause mild to severe suffering, high health costs, and disability. Most sufferers recover quickly and are left without sequelae. The less fortunate group of patients who do not improve despite conservative and mildly interventional therapy, find themselves in search of a more effective treatment. To enhance treatment outcome, an understanding of the pathophysiology of the underlying pain and the design of target-specific treatment modalities is important.

    Title Percutaneous Epidural Neuroplasty: Prospective Evaluation of 0.9% Nacl Versus 10% Nacl with or Without Hyaluronidase.
    Date July 1999
    Journal Regional Anesthesia and Pain Medicine
    Excerpt

    BACKGROUND AND OBJECTIVES: Percutaneous epidural neuroplasty (epidural neurolysis, lysis of epidural adhesions) is an interventional pain management technique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. In addition to local anesthetic and corticosteroid, hypertonic saline (10% NaCl) and hyaluronidase are used for the technique. The objective of this study was to determine if hypertonic saline or hyaluronidase influenced treatment outcomes. METHODS: Eighty-three subjects with radiculopathy plus low back pain were assigned to one of four epidural neuroplasty treatment groups: (a) hypertonic saline plus hyaluronidase, (b) hypertonic saline, (b) isotonic saline (0.9% NaCl), or (d) isotonic saline plus hyaluronidase. Subjects in all treatment groups received epidural corticosteroid and local anesthetic. RESULTS: Twenty-four subjects did not complete the study. Most of the other 59 subjects receiving any of the four treatments as part of their pain management obtained significant relief immediately after treatment. Visual analog scale (VAS) scores for the area of maximal pain (VASmax; back or leg) were reduced in 25% or more of subjects in all treatment groups at all post-treatment follow-up times (1, 3, 6, 9, and 12 months). A smaller fraction of subjects treated with hypertonic saline or hyaluronidase and hypertonic saline required more additional treatments than did subjects receiving the other treatments. CONCLUSIONS: Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for over one year) in 25% or more of subjects with radiculopathy plus low back pain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.

    Title Laser Pointer As a Teaching Tool in Operating Rooms.
    Date March 1998
    Journal Anesthesiology
    Title Clinical Realities and Economic Considerations: Efficacy of Intrathecal Pain Therapy.
    Date October 1997
    Journal Journal of Pain and Symptom Management
    Excerpt

    Studies of analgesia in cancer patients have revealed that intrathecal administration of opioids can deliver potent analgesia with fewer systemic side effects than equivalent doses of systemic opioids. In addition, several trials have examined the safety and efficacy of this modality in patients with pain of nonmalignant origin. In one survey of 35 physicians involving 429 patients treated with intrathecal therapy, physician reports of global pain relief scores were excellent in 52.4% of patients, good in 42.9%, and poor in 4.8%. In another study of 120 patients, the mean pain intensity score had fallen from 93.6 to 30.5 six months after initiation of therapy. In both studies, patients reported significant improvement in activities of daily living, quality of life measures, and satisfaction with the therapy. Constipation, urinary retention, nausea, vomiting, and pruritus are typical early adverse effects of intrathecal morphine and are readily managed symptomatically. Other potential adverse effects include amenorrhea, loss of libido, edema, respiratory depression, and technical issues with the intrathecal system.

    Title Thermal Grill Illusion and Complex Regional Pain Syndrome Type I (reflex Sympathetic Dystrophy).
    Date July 1997
    Journal Regional Anesthesia
    Excerpt

    BACKGROUND AND OBJECTIVES: In normal humans, placing a hand on a thermal grill containing warm elements separated by cool ones produces a burning sensation. In this case report, responses to a thermal grill in a patient with neuropathic pain were examined. METHODS: The responses of a 31-year-old woman with complex regional pain syndrome type I (reflex sympathetic dystrophy) to a thermal grill were evaluated before and after stellate ganglion block. RESULTS: The patient experienced a burning sensation when the unaffected hand was placed on the grill and could distinguish which element was warm and which was cool. An intolerable burning sensation caused the patient to quickly (within 4 seconds) withdraw the affected hand when it was placed on the grill. Touching cool elements with the affected hand produced an intense burning sensation (cold allodynia), whereas touching warm elements produced a pleasant warm sensation. Stellate ganglion block with phenol, local anesthetic, and steroid resulted in long-lasting absence of cold allodynia. CONCLUSION: The thermal grill may be a useful a tool to help understand the pathophysiology of complex regional pain syndrome type I.

    Title In Response to Article by Drs. Devulder Et Al.
    Date November 1995
    Journal The Clinical Journal of Pain
    Title Iliohypogastric Nerve Entrapment in Pregnancy: Diagnosis and Treatment.
    Date December 1994
    Journal Anesthesia and Analgesia
    Title General Anesthesia for Cesarean Section in a Parturient with a Single Ventricle and Pulmonary Atresia.
    Date October 1993
    Journal Journal of Clinical Anesthesia
    Excerpt

    The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is discussed. After cyanosis at birth, the patient underwent cardiac catheterization, which showed an apparent severe tetralogy of Fallot, atresia of the main pulmonary artery (PA), and a large patent ductus arteriosus. When she was 7 months of age, a Blalock-Taussig shunt (right subclavian artery to right PA) was done. She remained stable until age 11, when cyanosis increased and exercise tolerance decreased. Recatheterization more clearly defined the lesion: closed shunt, pulmonary valvular atresia, severe ductal stenosis, reduced pulmonary flow, double-outlet right ventricle, and severe hypoplasia of the left atrium, mitral valve, and left ventricle. A Potts shunt (left descending aorta to left PA) was done. Compliance with therapy was poor and follow-up difficult. Exercise tolerance was poor, but the patient remained otherwise stable. At 28 weeks' gestation, this 23-year-old parturient presented with severe congestive heart failure (CHF). After initial therapy with oxygen, bed rest, digoxin, and diuretics, she improved and remained stable for a month. At that time (32 weeks' gestation), CHF worsened. Because the cervix was unfavorable for a vaginal delivery, a cesarean section was planned. The patient was then taken to the operating room electively, and an opioid-based general anesthetic was administered. Both mother and infant did well. This case is presented because the physiology of the patient's lesion and her unusual social history presented challenges for her anesthetic management.

    Title Hyperkalaemia: a Complication of Warm Heart Surgery.
    Date February 1993
    Journal Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
    Excerpt

    A case is presented of hyperkalaemia (13.6 mEq.L-1) occurring during cardiopulmonary bypass using warm blood cardioplegia (K+ 40-60 mEq.L-1). Treatment with epinephrine, calcium chloride, sodium bicarbonate, and furosemide reduced K+ to 6.5 mEq.L-1 within 30 min and myocardial performance was enhanced with amrinone and cardiac rhythm was controlled with A-V segmental pacing. It is believed that the hyperkalaemia resulted from a combination of the surgical procedure (mitral valve replacement) and the use of warm cardioplegia. The purpose of this report is to increase the awareness of the possibility of hyperkalaemia with warm cardioplegia and to describe a successful therapeutic regimen.

    Title Backache After Extradural Anaesthesia in the Postpartum Period: Dissection of Thoracic Aneurysm.
    Date November 1991
    Journal British Journal of Anaesthesia
    Excerpt

    We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.

    Title Loss of Consciousness After Emergence from Anaesthesia. A Case of Suspected Micturition Syncope.
    Date December 1990
    Journal Anaesthesia
    Excerpt

    A case of postanaesthesia micturition syncope with respiratory arrest is described. If syncope occurs, the temporary myocardial ischaemia and cerebral hypoperfusion may increase anaesthetic risk in the marginally compensated patient. The loss of airway protection during the syncopal period is also a cause of concern. We recommend the use of an indwelling bladder catheter during any prolonged surgical procedure.

    Title Pain Management of the Oncologic Patient.
    Date June 1990
    Journal Seminars in Surgical Oncology
    Excerpt

    After the first 5 years of life, cancer is one of the three most common causes of death. Most investigations of cancer pain have shown that 50-70% of patients suffer needlessly. Pain may be due to the tumor or a co-existant benign pain syndrome. Methods of pain management include: 1) neurolytic blockade: stellate ganglion block, celiac plexus block, lumbar sympathetic block, epidural phenol, subarachnoid neurolysis; and 2) non-pharmacologic methods: radiofrequency thermocoagulation lumbar sympathectomy, transcutaneous nerve stimulation (TENS), dorsal column stimulation (DCS). In summary, we utilize every possible combination of therapeutic modalities for cancer pain management. With so many safe procedures available, we encourage the primary physician to refer patients early in their disease process. Neurolytic procedures should be performed prior to initiation of high dose narcotic therapy, radiation, chemotherapy, and surgery when possible.

    Title Comments on "a Spiral Nerve Cuff Electrode for Peripheral Nerve Stimulation".
    Date November 1989
    Journal Ieee Transactions on Bio-medical Engineering
    Title Peripheral Stimulator Implant for Treatment of Causalgia Caused by Electrical Burns.
    Date April 1989
    Journal Texas Medicine
    Title Percutaneous Dorsal Column Stimulator for Chronic Pain Control.
    Date March 1989
    Journal Spine
    Excerpt

    This is a retrospective review of 26 patients with chronic intractable pain in which dorsal column stimulation was used as a salvage procedure. On follow-up of 12 to 42.7 months, 21 of the patients had diminished narcotic usage. Seventeen patients subjectively rated their pain relief as good to excellent. Another five patients reported some relief of pain. Two-thirds of the patients reported an increase in their ability to perform daily activities such as walking, stair climbing, and time spent sitting. There are still many technical problems that plague this procedure, as evidenced by a very high technical complication rate of lead migration and lead breakage. Whether or not results diminish over long-term follow-up remains to be seen.

    Title Epidural Phenol Neurolysis Using Daily Needle Placements.
    Date July 1986
    Journal Anesthesia and Analgesia
    Title A New Pressure-sensitive Laryngoscope.
    Date April 1985
    Journal Anesthesiology
    Title Improved Vision Modification of the Macintosh Laryngoscope.
    Date February 1985
    Journal Anaesthesia
    Title Intractable Pain Therapy Using a New Epidural Catheter.
    Date September 1982
    Journal Jama : the Journal of the American Medical Association
    Title Reversibility of Diazepam Overdose by Physostigmine.
    Date September 1981
    Journal Proceedings of the Western Pharmacology Society
    Title Physostigmine, Naloxone, Narcotics and Sedatives in Patients Recovering from General Anesthesia.
    Date September 1981
    Journal Proceedings of the Western Pharmacology Society
    Title Isoflurane (forane)--in Search of the Ideal Anesthetic.
    Date August 1981
    Journal Texas Medicine
    Title Effects of Adenine Guanine and Inosine Nucleotides on Procaine Induced Nerve Blockade in Vivo.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Antagonism of Procaine Conduction Block by Adenosine 5' Triphosphate in Vitro.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Effect of Naloxone on Ketamine Induced Narcosis in Rats.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Adenosine Triphosphate Protection of Global Hypoxia in the Mouse.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Effects of Adenine Nucleotides on Lidocaine Induced Contractions in Isolated Uterine Artery.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Responsiveness of Isolated Cerebral Arteries to Various Pharmacologic Agents and to Transmural Electrical Stimulation.
    Date October 1980
    Journal Proceedings of the Western Pharmacology Society
    Title Postoperative Hyperthermia Following Posterior Fossa Craniotomy.
    Date February 1978
    Journal Modern Problems in Paediatrics
    Title Changes in Plasma Potassium and Calcium Levels and in the Electrocardiogram After a Single Dose of Succinylcholine Preceded by D-tubocurarine.
    Date September 1976
    Journal Canadian Anaesthetists' Society Journal
    Excerpt

    One hundred and eighteen patients undergoing surgical procedures not requiring immediate tracheal intubation, nor producing visceral reflexes, were pretreated with d-tubocurarine 6 mg, three minutes before the administration of a bolus of succinylcholine (2 mg/kg). Electrocardiographic changes, venous and arterial plasma potassium and calcium levels, CPK changes (12 patients) and appearance of myoglobinuria (35 patients) were followed. Pretreatment with a small dose of d-tubocurarine did not change the overall incidence and pattern of arrhythmias; it did, however, prevent increases in plasma potassium in 90.4 per cent of the patients, mean plasma potassium values remaining below pre-induction levels. The CPK level changed in only one of 12 patients (from 10 to 21 I.U., the normal range being 0 to 34 I.U.). No myoglobinuria was detected in any of the patients tested. A rapid but short-lasting change in the K+/Ca++ ratio did not seem to influence the occurrence of arrhythmias. Pretreatment with a small dose of d-tubocurarine is effective in preventing or decreasing fasciculations, plasma potassium and CPK changes and myoglobinuria described after the intravenous administration of succinylcholine. The already useful role of succinylcholine in our armamentarium can be made safer by pretreatment with a small dose of d-tubocurarine.

    Title Occupational Hazards in Anesthesia: Survey of Blood Enzymes, Morphology and Serum Proteins in Anesthesia Residents.
    Date May 1975
    Journal Anaesthesia, Resuscitation, and Intensive Therapy
    Title Problems and Errors in Teaching Cardiopulmonary Resuscitation.
    Date May 1975
    Journal Anaesthesia, Resuscitation, and Intensive Therapy
    Title Fat-embolism Syndrome (respiratory Insufficiency Syndrome). A Rationale for Treatment.
    Date March 1975
    Journal The Journal of Bone and Joint Surgery. American Volume
    Title Pulmonary Blood Flow in Normal and Abnormal States.
    Date December 1974
    Journal The Surgical Clinics of North America
    Title The Hemodynamics of Experimental Fat Embolism and Associated Therapy.
    Date May 1974
    Journal Chest
    Title A Comparative Study of Plastic (polypropylene) and Glass Syringes in Blood-gas Analysis.
    Date March 1972
    Journal Anesthesia and Analgesia
    Title Humidification in a Semiopen System for Infant Anesthesia.
    Date February 1972
    Journal Anesthesia and Analgesia
    Title Red Blood Cell Survival After Mannitol Infusion: a Clinical Study in Human Volunteers Using Cr 51 .
    Date January 1972
    Journal Canadian Anaesthetists' Society Journal
    Title Anesthesiologist's Role in Modern Cardiopulmonary Resuscitation. Program in Teaching Hospital.
    Date September 1970
    Journal New York State Journal of Medicine
    Title Postinfusion Phlebitis.
    Date March 1970
    Journal Anesthesia and Analgesia
    Title A Study of Plasma Potassium and Electrocardiographic Changes After a Single Dose of Succinylcholine.
    Date October 1969
    Journal Canadian Anaesthetists' Society Journal
    Title Orahesive As a Protection for the Teeth During General Anaesthesia and Endoscopy.
    Date October 1967
    Journal Canadian Anaesthetists' Society Journal
    Title Selective Spinal Injections for Lower Back Pain.
    Date
    Journal Current Review of Pain
    Excerpt

    Tremendous progress has been made in the understanding of neural pathways and tissues involved in back pain, and new treatment techniques for back pain have evolved. This article focuses on a technique called epidural neuroplasty (lysis of epidural adhesions). Originally performed as a single-catheter technique using the caudal approach, this technique now features a number of variations. These variations include emphasis on anterior placement of the catheter tip, use of a transforaminal approach, and use of one or two catheters.

    Title Percutaneous Lysis of Epidural Adhesions--evidence for Safety and Efficacy.
    Date
    Journal Pain Practice : the Official Journal of World Institute of Pain
    Excerpt

    BACKGROUND: Percutaneous lysis of epidural adhesions is done worldwide. Over 1.7 million of these procedures were done in the U.S.A. by 2006. This interventional pain management technique is used to treat chronic low back pain (LBP) and/or radiculopathy. The primary object of the approach is to target drug delivery to areas of pathology in the spinal epidural space. The procedure involves removing barriers, such as epidural fibrosis, that prevent drug from reaching target sites. LITERATURE SEARCH: Primary sources of information for this manuscript include: (1) 2 systematic literature reviews that include literature published through September 2006; (2) expert opinions; and (3) peer reviewed publications from September 2006 to January 2008. The focus was on percutaneous entry using catheters via the sacral hiatus to treat pain in the lumbosacral region. RESULTS: The evidence is strong for short-term efficacy (3 months) and moderate for long-term efficacy (greater than 3 months). Complications do occur, but limited literature exists that documents incidence. CONCLUSION: The cumulative evidence through January 2008 show that percutaneous adhesiolysis with targeted drug delivery is an effective treatment for LBP and/or radiculopathy.

    Title Cervical Spinal Canal Loculation and Secondary Ischemic Cord Injury--pvcs--perivenous Counter Spread--danger Sign!
    Date
    Journal Pain Practice : the Official Journal of World Institute of Pain

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