Regional Intravenous Anesthesia

In 1963, Holmes¹repopularized a technique for regional anesthesia first fully described in 1908. The method, regional intravenous anesthesia, offers many technical advantages in managing a variety of difficult anesthetic problems, of which a common and dangerous example is the patient who has sustained a Colles' fracture and has a full stomach. Nevertheless, there is as yet no clear consensus as to the desirability or safety of using regional intravenous anesthesia. The procedure is not complicated. An intravenous needle is installed into a peripheral vein in the limb to be anesthetized. The arm or leg is then elevated. An Esmarch bandage may be used to completely remove pooled blood; then a blood pressure cuff on the limb is inflated to supersystolic pressures. Local anesthetic is next injected intravenously, with the pressure in the blood pressure cuff maintained. Analgesia occurs quickly, is satisfactory in a large proportion of patients, and