By James P. Rathmell MD
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Extra resources for Atlas of Image-Guided Intervention in Regional Anesthesia and Pain Medicine
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Reg Anesth Pain Med. 2000;25:540–545. Shetty SK, Nelson EN, Lawrimore TM, et al. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction. Skeletal Radiol 2007;36:301– 307. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010;125 (2 suppl 2):S161–S181. Spring DB, Bettman MA, Barkan HE. S. Food and Drug Administration 1978–1994: effect of availability of low osmolality contrast media. Radiology. 1997;204:333–337. Tali ET, Ercan N, Kaymaz M, et al.
In the event that steroid is administered into a critical reinforcing artery supplying the spinal cord or brain, the smaller particles might be 9/22/2011 1:33:01 PM Chapter 4 Pharmacology of Agents Used During Image-Guided Injection 27 Table 4 –6 Duration of Suppression of the Hypothalamic-pituitary-adrenal Axis Following Intramuscular Administration of Several Commercially Available Steroid Preparations Drug Brand Name (How Supplied) Particulate Steroid Preparations Betamethasone sodium phosphate/ betamethasone acetate suspension Methylprednisolone acetate Triamcinolone acetonide Triamcinolone diacetate Nonparticulate Steroid Preparations Dexamethasone sodium phosphate Duration of HPA IM Dose (mg) Axis Suppression Celestone Soluspan (betamethasone 6 mg/mL, betamethasone sodium phosphate 3 mg/mL, and betamethasone acetate 3 mg/mL) Depo-Medrol (20, 40, or 80 mg/mL) Kenalog (10 and 40 mg/mL) Aristocort Intralesional (25 mg/mL) Aristocort Forte (40 mg/mL) 9 1 wk 40–80 40–80 50 40 4–8 d 2–4 wk 1 wk 2–4 wk Decadron (4 and 10 mg/mL) 4 3–4 wk less likely to cause spinal cord infarction or stroke (Fig.