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A simplified, predictable method of peripheral nerve block at the ankle and foot with a long acting anesthetic agent bupivacaine (Marcaine) 0.5% is presented. Combined with the use of a pneumatic tourniquet it allows the performance of mid and forefoot surgery on an inpatient or outpatient basis. It alleviates the risks of general or spinal anesthesia and avoids the use of analgesics for a period of 10 to 25 hours. The posterior tibial nerve is blocked at the level or the neurovascular tunnel on the posterior aspect of the distal tibia. The deep peroneal nerve is blocked at the level of the midtarsus in the fourth fascial compartment. The intermediate and medial dorsal cutaneous branches of the superficial peroneal nerve and the saphenous nerve are blocked subcutaneously on the dorsum of the foot. The sural nerve is blocked subcutaneously at one fingerbreadth distal to the tip of the lateral malleolus. The results have been excellent to good. No adverse reactions occurred affecting the central nervous system of the myocardium.

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No abstract

Calcium-sensitizing drugs, such as levosimendan, are a novel class of drug therapy for heart-failure treatment. The lung circulation affects both right- and left-sided heart failure. Levosimendan decreased lobar arterial pressure via a partial K(+)(ATP) (potassium channel sensitive to intracellular adenosine triphosphate levels)-dependent mechanism. These data suggest that, in addition to calcium-sensitizing activity, levosimendan decreases pulmonary resistance, which may also aid in the treatment of heart failure.