51
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Marrone F, Fusco P, Paventi S, Tomei M, Failli S, Fabbri F, Pullano C. Combined thoracic erector spinae plane and inter-transverse plane blocks for awake breast surgery. Anaesth Rep 2024; 12:e12294. [PMID: 38708145 PMCID: PMC11062893 DOI: 10.1002/anr3.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Worldwide, breast cancer is the most commonly diagnosed cancer in women. Surgical procedures are typically performed using general anaesthesia, often complemented by regional anaesthesia to manage postoperative pain. However, avoidance of general anaesthesia for breast surgery may be desirable for clinical reasons or patient choice. It is theorised that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes, and there is some evidence to support this. While many patients successfully undergo awake breast surgery, a limited number of anaesthetists possess direct experience of this approach, despite familiarity with regional anaesthesia techniques. Undertaking regional anaesthesia for awake breast surgery requires patient cooperation and excellent staff teamwork. Here, we present a case of a patient who underwent awake bilateral mastectomy with reconstruction. This was carried out under two 'paravertebral-by-proxy' blocks: the thoracic erector spinae plane and inter-transverse plane blocks, with intravenous sedation.
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Affiliation(s)
- F. Marrone
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - P.F. Fusco
- Unit of Anaesthesia and Intensive CareSS Filippo e Nicola HospitalAvezzanoL'AquilaItaly
| | - S. Paventi
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - M. Tomei
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - S. Failli
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - F. Fabbri
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - C. Pullano
- Unit of AnaesthesiaVilla Pia ClinicRomeItaly
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52
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Senger A, Irouschek A, Weber M, Lutz R, Rompel O, Kesting M, Schmidt J. Airway management in a two-year-old child with a tongue tumor using video laryngoscope-assisted flexible bronchoscopic nasotracheal intubation (hybrid technique). Clin Case Rep 2024; 12:e8425. [PMID: 38197059 PMCID: PMC10774545 DOI: 10.1002/ccr3.8425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
Airway management in children can be challenging. A hybrid technique using a video laryngoscope-assisted flexible bronchoscopic nasotracheal intubation allowed a successful airway management in a two-year-old child with a large tongue tumor.
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Affiliation(s)
- Anne‐Sophie Senger
- Department of AnesthesiologyUniversity Hospital Erlangen, Faculty of Medicine, Friedrich Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Andrea Irouschek
- Department of AnesthesiologyUniversity Hospital Erlangen, Faculty of Medicine, Friedrich Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Manuel Weber
- Department of Oral and Maxillofacial SurgeryUniversity Hospital Erlangen, Faculty of Medicine, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Rainer Lutz
- Department of Oral and Maxillofacial SurgeryUniversity Hospital Erlangen, Faculty of Medicine, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Oliver Rompel
- Institute of Radiology, University Hospital Erlangen, Faculty of Medicine, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Marco Kesting
- Department of Oral and Maxillofacial SurgeryUniversity Hospital Erlangen, Faculty of Medicine, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Joachim Schmidt
- Department of AnesthesiologyUniversity Hospital Erlangen, Faculty of Medicine, Friedrich Alexander‐Universität Erlangen‐NürnbergErlangenGermany
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53
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Yamauchi Y, Kojima T. Follow-up to 'Glycaemic management in a child with ornithine transcarbamylase deficiency undergoing cardiac surgery with hypothermic cardiopulmonary bypass'. Anaesth Rep 2024; 12:e12277. [PMID: 38229661 PMCID: PMC10788310 DOI: 10.1002/anr3.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Affiliation(s)
- Y. Yamauchi
- Aichi Children's Health and Medical CenterAichiJapan
| | - T. Kojima
- Aichi Children's Health and Medical CenterAichiJapan
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54
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Chan OW, Lee EP, Chou CC, Lai SH, Chung HT, Lee J, Lin JJ, Hsieh KS, Hsia SH. In-hospital care of children with COVID-19. Pediatr Neonatol 2024; 65:2-10. [PMID: 37989708 DOI: 10.1016/j.pedneo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 11/23/2023] Open
Abstract
Children have been reported to be less affected and to have milder severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than adults during the coronavirus disease 2019 (COVID-19) pandemic. However, children, and particularly those with underlying disorders, are still likely to develop critical illnesses. In the case of SARS-CoV-2 infection, most previous studies have focused on adult patients. To aid in the knowledge of in-hospital care of children with COVID-19, this study presents an expert review of the literature, including the management of respiratory distress or failure, extracorporeal membrane oxygenation (ECMO), multisystem inflammatory syndrome in children (MIS-C), hemodynamic and other organ support, pharmaceutical therapies (anti-viral drugs, anti-inflammatory or antithrombotic therapies) and management of cardiopulmonary arrest.
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Affiliation(s)
- Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Che Chou
- Division of Paediatric Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Shen-Hao Lai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Cardiovascular Internal Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, China
| | - Jung Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, ROC
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Sheng Hsieh
- Center of Structure and Congenital Heart Disease/Ultrasound and Department of Cardiology, Children's Hospital, China Medical University, Taichung, Taiwan; Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan.
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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55
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Magoon R, Suresh V. Comment on 'Brachial plexus blockade arising from a combined pectoralis (PECS) 1 and 2 block'. Anaesth Rep 2024; 12:e12304. [PMID: 38812749 PMCID: PMC11130758 DOI: 10.1002/anr3.12304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Affiliation(s)
- Rohan Magoon
- Department of AnaesthesiaAtal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh MargNew DelhiIndia
| | - Varun Suresh
- Department of Anesthesia and Intensive CareJaber Al Ahmad Al Sabah HospitalKhalid Ben AbdulAziz StreetZahraArabian GulfKuwait
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56
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Kurzbuch AR, Bourlond B, García Martínez JJ, Bonjour T, Novaes NP, Tuleasca C, Millán DS. Postoperative Intracranial Hypotension-Associated Venous Congestion after Spinal Surgery Managed with Multiple Blood Patches: Case Report. J Neurol Surg A Cent Eur Neurosurg 2024; 85:112-115. [PMID: 36302518 DOI: 10.1055/s-0042-1757173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage. METHODS A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain. RESULTS Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic-clonic seizure. Computed tomography (CT) and serial magnetic resonance imaging (MRI) were performed showing convexity subarachnoid hemorrhages (SAHs), diffuse swelling of the brain and thalami and striatum bilaterally without diffusion restriction, and signs of intracranial hypertension resulting in pseudohypoxic brain swelling in PIHV. A dural leak at L3-L4 was treated with several CT-guided patches combining autologous blood and fibrin glue injections. The patient recovered without neurologic deficit and follow-up MRI revealed progressive complete reversal of brain swelling, and re-expansion of CSF spaces. CONCLUSION PIHV is a rare but potentially fatal entity. Awareness of PIHV after cranial or spinal surgery leads to early treatment of CSF hypovolemia and possibly better clinical outcome. Following acute CSF volume loss, an acute elevation of cerebral blood volume overcoming autoregulatory mechanisms seems a likely explanation for diffuse cerebral vasogenic edema and SAH in PIHV.
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Affiliation(s)
- Arthur Robert Kurzbuch
- Department of Neurosurgery, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Baudouin Bourlond
- Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Juan José García Martínez
- Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Thierry Bonjour
- Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Natalia P Novaes
- Department of Neurology, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, (EPFL), Lausanne, Switzerland
| | - Diego San Millán
- Unit of Neuroradiology, Service of Diagnostic and Intervention Radiology, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
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57
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Trincado Cobos M, Tapia Salinas B, Gutiérrez Venturini A, Aragón Niño I, Del Castillo Pardo de Vera JL, Cebrián Carretero JL, Uña Orejón R. The application of three-dimensional printing in the management of a difficult airway due to Treacher Collins syndrome. Anaesth Rep 2024; 12:e12290. [PMID: 38645478 PMCID: PMC11026849 DOI: 10.1002/anr3.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/23/2024] Open
Abstract
We describe the use of three-dimensional printing to create precise airway models for a patient with Treacher Collins syndrome who presented for bimaxillary temporomandibular joint prostheses, and for whom airway management was predicted to be difficult. The model was based on pre-operative cone beam computed tomography images and printed in the 3D Lab of Hospital Universitario La Paz. Transparent models allowed clear visualisation for simulation and iterative refinement of airway management techniques and aided in risk assessment and instrument sizing. This case report emphasises the utility of this approach in complex airway scenarios.
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Affiliation(s)
| | | | | | - I. Aragón Niño
- Department of Maxillo‐facial SurgeryHospital La PazMadridSpain
| | | | | | - R. Uña Orejón
- Department of AnaesthesiologyHospital La PazMadridSpain
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58
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Flower L, Manson JJ. Secondary haemophagocytic lymphohistiocytosis: time for a united approach to diagnosis and cytokine blockade. Anaesth Rep 2024; 12:e12291. [PMID: 38655565 PMCID: PMC11035011 DOI: 10.1002/anr3.12291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- L. Flower
- Barts Health NHS TrustLondonUK
- Queen Mary University of LondonLondonUK
| | - J. J. Manson
- University College London Hospital NHS Foundation TrustLondonUK
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59
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Kundra P, Senthilnathan M. Amalgamation of artificial intelligence and simulation in anaesthesia training: Much-needed future endeavour. Indian J Anaesth 2024; 68:8-10. [PMID: 38406343 PMCID: PMC10893798 DOI: 10.4103/ija.ija_1264_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Muthapillai Senthilnathan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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60
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Stanley S, Hansel J. Comment on 'Potential interaction between exogenous anabolic steroids and sugammadex: failed reversal of rocuronium in a patient taking testosterone and trestolone acetate'. Anaesth Rep 2024; 12:e12280. [PMID: 38250051 PMCID: PMC10799306 DOI: 10.1002/anr3.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
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61
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de Carvalho CC, Santos Neto JM. Uncertainties regarding erector spinae plane block as a primary anaesthetic technique. Anaesth Rep 2024; 12:e12303. [PMID: 38784859 PMCID: PMC11110480 DOI: 10.1002/anr3.12303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
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62
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Marrone F, Paventi S, Tomei M, Failli S, Crecco S, Pullano C. Unilateral sacral erector spinae plane block for hip fracture surgery. Anaesth Rep 2024; 12:e12269. [PMID: 38187935 PMCID: PMC10764292 DOI: 10.1002/anr3.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
The provision of anaesthesia for hip fracture surgery in elderly and frail patients can be challenging, with potentially significant risks associated with both general and neuraxial techniques. Here, we report the use of a sacral erector spinae plane block as an alternative to conventional anaesthetic approaches for a frail 89-year-old woman with significant cardiovascular and respiratory comorbidity who underwent intramedullary nailing for a proximal femoral fracture. A unilateral injection of local anaesthetic at the intermediate crest of the second sacral vertebra resulted in bilateral sensory block of the T12 to S2 dermatomes. The technique did not result in hypotension or motor block of the limbs, and the surgery was completed uneventfully. Sacral erector spinae plane block warrants further investigation as an alternative to spinal and general anaesthesia for hip and lower limb surgery.
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Affiliation(s)
- F. Marrone
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - S. Paventi
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - M. Tomei
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - S. Failli
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - S. Crecco
- Unit of Anaesthesia and Intensive CareSanto Spirito HospitalRomeItaly
| | - C. Pullano
- Unit of AnaesthesiaVilla Pia ClinicRomeItaly
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63
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Aldridge M. Airway fire with use of diathermy in conjunction with high-flow nasal oxygen. Anaesth Rep 2024; 12:e12309. [PMID: 38882448 PMCID: PMC11168967 DOI: 10.1002/anr3.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/18/2024] Open
Abstract
Operating theatre fires are rare but can result in significant morbidity. A 76-year-old male with complex airway disease sustained superficial facial burns during an elective airway debulking procedure. His airway was being managed with high-flow nasal oxygen at 70 l.min-1 and FiO2 1.0 delivered by Optiflow™ (Fisher and Paykel Healthcare Limited, Auckland, New Zealand). When suction monopolar diathermy was used to excise hyperkeratotic tissue beside his epiglottis, an arc was created to the tip of the suspension laryngoscope, followed by a jet of flame as the Optiflow circuit ignited. This resulted in burns to the patient's face and shoulder. He required admission to the intensive care unit and had a complicated postoperative course that included the need for surgical tracheostomy to facilitate weaning from mechanical ventilation. This case highlights the dangers of using high-flow nasal oxygen alongside an ignition source.
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Affiliation(s)
- M Aldridge
- Te Whatu Ora-Waitaha Christchurch New Zealand
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64
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Kriege M, Demare T, Ruemmler R, Schmidtmann I, Wojciechowski J, Busch A, Ott T. Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)-A Prospective, Randomised Controlled Study. J Clin Med 2023; 13:16. [PMID: 38202022 PMCID: PMC10779719 DOI: 10.3390/jcm13010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway technique offers the highest success rate concerning a secure airway in established supraglottic airway and tracheal tube airway exchange scenarios. METHODS After ethical approval, anaesthesiologists were randomised 1:1 into simulated scenarios: an LTS group (malpositioned laryngeal tube) and a Cuff group (relevant cuff leakage of a placed tracheal tube). After that, both groups completed a common scenario consisting of a partially obstructed tracheal tube lumen in a fixed prone position with a Mayfield clamp. The primary endpoint was a successful tracheal airway exchange within ten minutes after the start of the scenario and before severe hypoxemia (SpO2 < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min. RESULTS In total, 60 anaesthesiologists (LTS group n = 30; Cuff group n = 30) with a median experience of 7 years (IQR 4-11) were observed. Within 10 min, a malpositioned laryngeal tube was successfully exchanged by 27/30 (90%) participants, compared to the exchange of a tracheal tube with a relevant cuff leakage by 29/30 (97%; p > 0.05). An airway exchange in an obstructed tube scenario occurred in 22/59 (37%). Loss of airway maintenance showed an obvious association with failure in the common scenario (p = 0.02). CONCLUSION The results of this simulation-based study reflect that the exchange of an existing but insufficient airway device in clinical practice is a high-risk procedure. Especially in a fixed prone position, the deliberate evaluation of the existing airway patency and well-conceived airway management in the case of the accidental loss of the airway or obstructed airway access are crucial.
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Affiliation(s)
- Marc Kriege
- Department of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, Germany
| | - Tim Demare
- Department of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, Germany
| | - Robert Ruemmler
- Department of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Janosh Wojciechowski
- Department of Anaesthesiology and Intensive Care, Asklepios Paulinen Hospital Wiesbaden, 65197 Wiesbaden, Germany
| | - Anneke Busch
- Department of Anaesthesiology and Intensive Care, Asklepios Paulinen Hospital Wiesbaden, 65197 Wiesbaden, Germany
| | - Thomas Ott
- Department of Anaesthesiology, University Medical Centre, Johannes Gutenberg—University Mainz, 55131 Mainz, Germany
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Siegler BH, dos Santos Pereira RP, Keßler J, Wallwiener S, Wallwiener M, Larmann J, Picardi S, Carr R, Weigand MA, Oehler B. Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients. Biomedicines 2023; 11:3296. [PMID: 38137518 PMCID: PMC10741192 DOI: 10.3390/biomedicines11123296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Postdural puncture headache (PDPH) remains a serious complication in obstetric patients. While the epidural blood patch represents the current gold standard in therapy, a growing number of alternative measures are thought to be beneficial for clinical management. The purpose of this study was to retrospectively analyze the efficacy of intranasal lidocaine administration to treat PDPH in obstetrics at our university hospital; (2) Methods: A retrospective analysis of the medical records of patients with PDPH has been performed focusing on the techniques of administration, dosing, treatment duration, impact on pain intensity as well as side effects of intranasal lidocaine; (3) Results: During the study period, 5610 obstetric patients received neuraxial anesthesia, of whom 43 (0.77%) developed PDPH. About one third of the patients with PDPH after spinal anesthesia (n = 8), epidural anesthesia (n = 5) or both (n = 2) were treated with intranasal lidocaine. Lidocaine was administered either via gauze compresses (GC, n = 4), a mucosal atomization device (MAD, n = 8) or with a second-line mucosal atomization device due to low gauze compress efficacy (n = 3). All patients treated with lidocaine refused the epidural blood patch. Nebulization of lidocaine resulted in a significant reduction in pain intensity after the first dose (p = 0.008). No relevant side effects developed except sporadic temporal pharyngeal numbness. The utilization of the mucosal atomization device averted the necessity for an epidural blood patch, whether employed as the primary or secondary approach; (4) Conclusions: Our data imply that the mucosal atomization device enhances the efficacy of intranasal lidocaine administration in obstetric patients suffering from PDPH.
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Affiliation(s)
- Benedikt Hermann Siegler
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Rui Pedro dos Santos Pereira
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Jens Keßler
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Stephanie Wallwiener
- Department of General Gynecology and Obstetrics with Polyclinic, Women’s Hospital, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 440, D-69120 Heidelberg, Germany; (S.W.); (M.W.)
| | - Markus Wallwiener
- Department of General Gynecology and Obstetrics with Polyclinic, Women’s Hospital, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 440, D-69120 Heidelberg, Germany; (S.W.); (M.W.)
| | - Jan Larmann
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Susanne Picardi
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Richard Carr
- Department of Anesthesiology, Medical Faculty Heidelberg, Universitaetsmedizin Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, D-68167 Mannheim, Germany;
| | - Markus Alexander Weigand
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
| | - Beatrice Oehler
- Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany; (R.P.d.S.P.); (J.K.); (J.L.); (S.P.); (M.A.W.); (B.O.)
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Bozer J, Vess A, Pineda P, Essandoh M, Whitson BA, Seim N, Bhandary S, Awad H. Venovenous Extracorporeal Membrane Oxygenation for a Difficult Airway Situation-A Recommendation for Updating the American Society of Anesthesiologists' 'Difficult Airway Algorithm'. J Cardiothorac Vasc Anesth 2023; 37:2646-2656. [PMID: 37211518 DOI: 10.1053/j.jvca.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Jordan Bozer
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Andrew Vess
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Pedro Pineda
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Bryan A Whitson
- Department of Cardiac Surgery, The Ohio State Wexner Medical Center, Columbus, OH
| | - Nolan Seim
- Department of Otolaryngology, The Ohio State Wexner Medical Center, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State Wexner Medical Center, Columbus, OH.
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Michelon I, Vilbert M, Pinheiro IS, Costa IL, Lorea CF, Castonguay M, Tran TH, Forté S. COVID-19 outcomes in patients with sickle cell disease and sickle cell trait compared with individuals without sickle cell disease or trait: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102330. [PMID: 38162948 PMCID: PMC10755716 DOI: 10.1016/j.eclinm.2023.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background Clinical manifestations and severity of SARS-CoV-2 infection in individuals with sickle cell disease (SCD) and sickle cell trait (SCT) are not well understood yet. Methods We performed a systematic review and meta-analysis to assess COVID-19 outcomes in individuals with SCD or SCT compared to individuals without sickle cell disease or trait. An electronic search on PubMed, Embase, and Cochrane Library was performed on August 3, 2023. Two authors (IFM and ISP) independently screened (IFM and ISP) and extracted data (IFM and ILC) from included studies. Main exclusion criterion was the absence of the non-SCD/SCT group. Exposure effects for binary endpoints were compared using pooled odds ratio (OR) with 95% confidence intervals (CI). I2 statistics was used to assess the heterogeneity and DerSimonian and Laird random-effects models were applied for all analyses to minimize the impact of differences in methods and outcomes definitions between studies. The overall quality of evidence was assessed using the GRADE system. Review Manager 5.4 and R software (v4.2.2) were used for statistical analyses. Registered with PROSPERO, CRD42022366015. Findings Overall, 22 studies were included, with a total of 1892 individuals with SCD, 8677 individuals with SCT, and 1,653,369 individuals without SCD/SCT. No difference in all-cause mortality was seen between SCD/SCT and non-SCD/SCT (OR 1.18; 95% CI 0.78-1.77; p = 0.429; I2 = 82%). When considering only studies adjusted for confounders (8 studies), patients with SCD/SCT were shown to be at increased risk of death (OR 1.86; 95% CI 1.30-2.66; p = 0.0007; I2 = 34%). No significant difference was seen between individuals with SCD and SCT (p = 0.863). The adjusted for confounders analysis for hospitalisation revealed higher rates for the SCD (OR 5.44; 95% CI 1.55-19.13; p = 0.008; I2 = 97%) and the SCT groups (OR 1.31; 95% CI 1.10-1.55; p = 0.002; I2 = 0) compared to the non-SCD/SCT population. Moreover, it was significantly higher for the SCD group (test for subgroup difference; p = 0.028). Interpretation Our findings suggest that patients with SCD or SCT may present with a higher mortality and hospitalisation rates due to COVID-19 infection. Funding None.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, School of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Maysa Vilbert
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Isabela Lino Costa
- Department of Medicine, School of Medicine, Federal University of Mineiro Triangle, Uberaba, Brazil
| | | | - Mathias Castonguay
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Thai Hoa Tran
- Division of Paediatric Hematology and Oncology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montréal, Quebec, Canada
| | - Stéphanie Forté
- Division of Hematology and Medical Oncology, Departement of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, Canada
- Division of Hematology and Medical Oncology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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Nelson O, Greenwood E, Simpao AF, Matava CT. Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era. BJA OPEN 2023; 8:100234. [PMID: 37942056 PMCID: PMC10630594 DOI: 10.1016/j.bjao.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.
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Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Eric Greenwood
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan F. Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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69
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Acosta-Mares P, Violante-Soria V, Browne T, Cruz SL. Xylazine potentiates the lethal but not the rewarding effects of fentanyl in mice. Drug Alcohol Depend 2023; 253:110993. [PMID: 37883846 DOI: 10.1016/j.drugalcdep.2023.110993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Fentanyl is commonly laced with xylazine. People who use this combination report heightened effects, but it also increases death risk. Although no medication has been approved to counteract overdoses produced by fentanyl and xylazine, naloxone is frequently used. This paper studies the preclinical rewarding and lethal effects of fentanyl combined with xylazine and the efficacy of yohimbine or naloxone to prevent death. METHODS Male Swiss Webster mice were treated with (in mg/kg, i.p.) xylazine (0.3, 1, 3, or 5.6), fentanyl (0.01, 0.3, or 0.1), or 1 xylazine plus 0.01 (non-effective) or 0.1 (effective) fentanyl doses during the conditioned-place preference (CPP) test. In addition, independent groups received (in mg/kg, i.p.): xylazine (31.6, 60, 74.2, or 100), fentanyl (3.1 or 10), or both substances at two doses: 31.6 xylazine + 3.1 fentanyl, or 60 xylazine + 10 fentanyl to analyze lethal effects. We determined whether yohimbine or naloxone (each medication tested at 10 or 30mg/kg) could prevent the lethality produced by fentanyl/xylazine combinations. Female mice were also tested in key experiments. RESULTS Xylazine neither induced CPP nor altered fentanyl's rewarding effects. In contrast, lethality was potentiated when fentanyl was combined with xylazine. Naloxone, but not yohimbine, effectively prevented the lethality of the fentanyl/xylazine combinations. CONCLUSIONS At the doses tested, xylazine does not increase the rewarding effect of fentanyl on the CPP in male mice but potentiates the risk of fatal overdose in male and female mice. A high naloxone dose prevents death induced by coadministration of fentanyl and xylazine in both sexes.
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Affiliation(s)
- Palmira Acosta-Mares
- Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
| | - Valeria Violante-Soria
- Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico
| | - Thom Browne
- Colombo Plan Secretariat, Drug Advisory Program, Colombo, Sri Lanka
| | - Silvia L Cruz
- Department of Pharmacobiology, Center for Research and Advanced Studies (Cinvestav), Mexico City, Mexico.
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70
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Jou DH, Kim SI, Choi IH, Song SH, Oh TR, Suh SH, Choi HS, Kim CS, Kim SW, Bae EH, Ma SK. Fatal Hypermagnesemia in Patients Taking Magnesium Hydroxide. Electrolyte Blood Press 2023; 21:66-71. [PMID: 38152602 PMCID: PMC10751210 DOI: 10.5049/ebp.2023.21.2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 12/29/2023] Open
Abstract
Hypermagnesemia is a rare but potentially fatal electrolyte disorder often overlooked because of its unfamiliarity. Magnesium is regulated through a balance of bone, intestinal absorption, and renal excretion. Hypermagnesemia typically arises from excessive magnesium intake or reduced renal excretion; however, it also occurs in patients with normal kidney function. Herein, we report two cases of hypermagnesemia in patients taking magnesium hydroxide for constipation. The first case involved an 82-year-old woman with end-stage renal disease who developed metabolic encephalopathy due to hypermagnesemia, after taking 3,000 mg of magnesium hydroxide daily for constipation. Her magnesium level was 9.9 mg/dL. Her treatment involved discontinuing magnesium hydroxide and continuing hemodialysis, which led to her recovery. In the second case, a 50-year-old woman with a history of cerebral hemorrhage and mental retardation developed hypermagnesemia despite having normal renal function. She was also taking magnesium hydroxide for constipation, and her magnesium level was 11.0 mg/dL. She experienced cardiac arrest while preparing for continuous renal replacement therapy (CRRT). After achieving return of spontaneous circulation, CRRT was initiated, and her magnesium level showed a decreasing trend. However, vital signs and lactate levels did not recover, leading to death. These cases highlight the importance of prompt diagnosis and intervention for hypermagnesemia and the need to regularly monitor magnesium levels in individuals receiving magnesium-containing preparations, especially those with impaired kidney function.
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Affiliation(s)
- Da Hye Jou
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su In Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - In Hong Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su Hyun Song
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
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Wang J, Liu Z, Bai Y, Tian G, Hong Y, Chen G, Wan Y, Liang H. Bibliometric and visual analysis of intraoperative hypotension from 2004 to 2022. Front Cardiovasc Med 2023; 10:1270694. [PMID: 38045917 PMCID: PMC10693423 DOI: 10.3389/fcvm.2023.1270694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Intraoperative hypotension (IOH) is a common complication occurring in surgical practice. This study aims to comprehensively review the collaboration and impact of countries, institutions, authors, journals, keywords, and critical papers on intraoperative hypotension from the perspective of bibliometric, and to evaluate the evolution of knowledge structure clustering and identify research hotspots and emerging topics. Methods Articles and reviews related to IOH published from 2004 to 2022 were retrieved from the Web of Science Core Collection. Bibliometric analyses and visualization were conducted on Excel, CiteSpace, VOSviewer, and Bibliometrix (R-Tool of R-Studio). Results A total of 1,784 articles and reviews were included from 2004 to 2022. The number of articles on IOH gradually increased in the past few years, and peaked in 2021. These publications were chiefly from 1,938 institutions in 40 countries, led by America and China in publications. Sessler Daniel I published the most papers and enjoyed the highest number of citations. Analysis of the journals with the most outputs showed that most journals concentrated on perioperative medicine and clinical anesthesiology. Delirium, acute kidney injury and vasoconstrictor agents are the current and developing research hotspots. The keywords "Acute kidney injury", "postoperative complication", "machine learning", "risk factors" and "hemodynamic instability" may also become new trends and focuses of the near future research. Conclusion This study uses bibliometrics and visualization methods to comprehensively review the research on intraoperative hypotension, which is helpful for scholars to better understand the dynamic evolution of IOH and provide directions for future research.
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Affiliation(s)
- Jieyan Wang
- Department of Urology, People's Hospital of Longhua, Shenzhen, China
| | - Zile Liu
- College of Anesthesiology, Southern Medical University, Guangzhou, China
| | - Yawen Bai
- College of Anesthesiology, Southern Medical University, Guangzhou, China
| | - Guijie Tian
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Yinghao Hong
- Guangdong Provincial Key Laboratory of Proteomics, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guo Chen
- Tendon and Injury Department, Sichuan Provincial Orthopedics Hospital, Sichuan, China
| | - Yantong Wan
- Guangdong Provincial Key Laboratory of Proteomics, Department of Pathophysiology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hui Liang
- Department of Urology, People's Hospital of Longhua, Shenzhen, China
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Kempenaers S, Hansen TG, Van de Velde M. Remimazolam and serious adverse events: A scoping review. Eur J Anaesthesiol 2023; 40:841-853. [PMID: 37727906 DOI: 10.1097/eja.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Remimazolam is anticipated to be an interesting anaesthetic and sedative. It combines the pharmacodynamic properties of midazolam with pharmacokinetic properties similar to remifentanil. However, worrisome case reports of anaphylaxis, delayed emergence and re-sedation have emerged recently and necessitate further investigation.PubMed (including MEDLINE) and EMBASE were searched for all studies reporting serious adverse events where remimazolam was administered for sedation or anaesthesia.Thirty-six case reports and 73 trials were identified, involving a total of 6740 patients who received remimazolam. Hypotension was reported in 911 cases, delayed emergence in 68 cases, anaphylaxis in 10 cases and re-sedation in 8 cases. The incidence of hypotension seems to be lower compared with other anaesthetics, even in high-risk patients.Delayed emergence might be related to the metabolism of remimazolam through carboxylesterase 1 (CES1), a tissue esterase predominant in the liver. There is significant interindividual variation, and it is inhibited by flavonoids, fatty acids and alcohol. Individual benzodiazepine sensitivity has also been reported. A higher BMI, older age and low plasma albumin concentration are risk factors for delayed emergence. Anaphylaxis might be related to a non-IgE-mediated effect of the excipient dextran-40 or a partially IgE-mediated reaction to remimazolam itself. Resedation has been reported after flumazenil reversal and is explained by the specific pharmacokinetic properties of flumazenil and remimazolam. Reversal by flumazenil should be reserved for and used carefully in patients with delayed emergence. VISUAL ABSTRACT http://links.lww.com/EJA/A864 .
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Affiliation(s)
- Sander Kempenaers
- From the Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium (SK), Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lorenskog (TGH), Faculty of Medicine, Institute of Clinical Medicine, Oslo University, Oslo, Norway (TGH), Department of Cardiovascular Sciences, KU Leuven (MVdV) and Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium (MVdV)
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Barros M, Carvalho T, Pires AC, Teixeira G, Cardoso H. Effective Postoperative Pain Management in Thoracic Outlet Syndrome Surgery: The Role of the Erector Spinae Plane Block. Cureus 2023; 15:e48944. [PMID: 38106791 PMCID: PMC10725572 DOI: 10.7759/cureus.48944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Thoracic outlet syndrome (TOS) often necessitates surgical intervention to alleviate neurovascular bundle compression, which can result in severe postoperative pain. The myriad of surgical techniques available for TOS treatment, the intricate involvement of diverse sensory pathways, and the limited literature on effective analgesic methods for these specific cases underscore the need for successful approaches. This report introduces an efficacious multimodal analgesic strategy that incorporates the erector spinae plane (ESP) block to enhance postoperative pain management after a supraclavicular surgical approach. By combining this fascial block with a comprehensive rationale for its implementation, this case offers valuable insights into improving the postoperative care of TOS patients, ultimately aiming to enhance their comfort and recovery.
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Affiliation(s)
- Mariana Barros
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Tania Carvalho
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Ana C Pires
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Gabriela Teixeira
- Vascular Surgery, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
| | - Helder Cardoso
- Anesthesiology, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, PRT
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74
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Leal NTB, de Araújo NM, Silva SDO, Cabral MAL, da Silva BVS, Pinheiro TBM, Dantas RAN, Dantas DV. Pain management in the postoperative period of amputation surgeries: A scoping review. J Clin Nurs 2023; 32:7718-7729. [PMID: 37605033 DOI: 10.1111/jocn.16846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pain in the postoperative period of amputation surgeries, when not managed correctly, can have consequences for the patient. PURPOSES AND OBJECTIVES The aim of this study was to map the scientific evidence on pain management in patients in the postoperative period of amputation surgeries. DESIGN Scoping review with elaboration based on the recommendations of the Joanna Briggs Institute, supported by The PAGER framework and guided by the PRISMA-ScR Checklist. METHODS The survey was conducted in August 2022 in 10 data sources. The 3300 publications found were analysed by two independent reviewers, after applying inclusion and exclusion criteria, 16 studies were selected. RESULTS Publications occurred between the years 1997 and 2022 and mainly dealt with the management of residual pain and phantom limb through pharmacological measures with pain assessment made by numerical scales. CONCLUSIONS The literature pointed out strategic uses of analgesics and highlighted technologies for neurostimulation through catheters. The need for new studies with non-pharmacological measures and with designs that can prove their effectiveness is reinforced. RELEVANCE TO CLINICAL PRACTICE The knowledge of these strategies by health professionals allows adequate pain management and patient follow-up for a less traumatic recovery. PATIENT OR PUBLIC CONTRIBUTION To patient or public involvement in this scoping review.
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Lee S, Park J, Kim NH, Hong H, Sohn KH, Kang HY, Kim MK, You AH. Remimazolam Anaphylaxis during Induction of General Anesthesia Confirmed by Provocation Test-A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1915. [PMID: 38003965 PMCID: PMC10673581 DOI: 10.3390/medicina59111915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023]
Abstract
Background: Remimazolam besylate, a newly developed drug, is linked to various anaphylaxis cases. We present a case of remimazolam anaphylaxis confirmed using a provocation test. Case: A 51-year-old female patient was scheduled for humeral pinning. General anesthesia was induced using remimazolam, rocuronium, and remifentanil. After tracheal intubation, the patient experienced decreased blood pressure, increased heart rate, and a systemic rash. Epinephrine was administered repeatedly, and the patient's vital signs stabilized. Acute phase tryptase levels were within normal limits. After four weeks, intradermal test results were negative. When remimazolam was administered intravenously for the provocation test, facial swelling, flushing, and coughing occurred, which improved with epinephrine. The culprit drug was identified as remimazolam using a provocation test. Conclusions: When anaphylaxis occurs during anesthesia induction, remimazolam should not be ruled out as the causative drug. If the skin test result for remimazolam is negative, a provocation test should be considered. The provocation test should be initiated cautiously at a low dose under careful patient monitoring.
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Affiliation(s)
- Sangho Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Joyoung Park
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Na Hei Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Halin Hong
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Kyoung Hee Sohn
- Division of Pulmonary and Allergy, Department of Internal Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Mi Kyeong Kim
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
| | - Ann Hee You
- Department of Anesthesiology and Pain Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea; (S.L.); (J.P.); (N.H.K.); (H.H.); (H.Y.K.); (M.K.K.)
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McCann UG, Park T. Rhabdomyolysis in McArdle disease caused by scuba diving. BMJ Case Rep 2023; 16:e255192. [PMID: 37852664 PMCID: PMC10603480 DOI: 10.1136/bcr-2023-255192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
McArdle disease is a glycogen storage disease that results in rhabdomyolysis during intense exercise. A number of different triggers have been described. We evaluated a patient with McArdle disease who presented with rhabdomyolysis after recreational scuba diving. There was no concern for barotrauma or decompression sickness. His symptoms resolved with standard-of-care management for non-diving-related rhabdomyolysis. Features of his experience provoked questions about the diving-related factors contributing to his presentation. We present the case and explore possible mechanisms of diving-related injury in patients with McArdle disease, including the possible effects of hyperoxia, hyperbaria, hypothermia and strenuous activity.
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Affiliation(s)
- Ulysse George McCann
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Thomas Park
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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77
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Wu B, Tang Q. A sustainable scheduling system for medical equipment: Towards net zero goals for green healthcare. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:18960-18986. [PMID: 38052585 DOI: 10.3934/mbe.2023839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Shortages of medical equipment, growth in medical waste and carbon emissions have increased healthcare pressures and has a huge impact on the environment. An efficient scheduling of medical equipment will effectively reduce the pressure on healthcare and improve the healthcare system's ability to respond to unexpected disasters. A medical equipment scheduling system was established to improve the sustainable utilization of medical equipment within the healthcare network and to reduce the carbon emissions of the healthcare process. First, this paper combines medical equipment information to establish a medical equipment scheduling decision model that considers pollution to filter qualified medical equipment for scheduling. Then, this paper constructs and solves a multi-objective robust optimization model by collecting the patient's travel information and the medical pressure information of each region. In addition, to meet dynamic healthcare needs, a dynamic medical equipment configuration framework was constructed to enhance the flexibility of equipment scheduling and the resilience of the healthcare network. Combined with case studies, the results show that the medical equipment scheduling system can help decision makers make quick scheduling decisions and achieve sustainable use of medical equipment, with a corresponding increase in medical equipment utilization of 12.25% and a reduction in carbon emissions of 26.50%. The study will help enhance healthcare resource utilization and contribute to the net-zero goal of green healthcare.
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Affiliation(s)
- Baotong Wu
- School of management, Shenyang University of Technology, Shenyang, 110870, China
| | - Qi Tang
- School of management, Shenyang University of Technology, Shenyang, 110870, China
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Huang Q, Hua Y, Zhou R, Chen G, Zhu T. Modified anterior approach versus traditional posterior approach for ultrasound-guided superior laryngeal nerve block in awake endotracheal intubation: a randomized non-inferiority clinical trial. Ann Med 2023; 55:2264856. [PMID: 37813093 PMCID: PMC10563619 DOI: 10.1080/07853890.2023.2264856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023] Open
Abstract
STUDY OBJECTIVE This study was undertaken to compare the effect of the modified ultrasound-guided anterior superior laryngeal nerve block (SLNB) with the traditional ultrasound-guided posterior SLNB in providing intubation conditions during awake tracheal intubation (ATI) in patients without difficult airway. DESIGN Randomized, assessor-blind. Registration number: ChiCTR2200058086. SETTING West China Hospital of Sichuan University, Chengdu, China. PATIENTS 104 patients aged 18-65 years, of American Society of Anesthesiologists status I-III, posted for elective general surgery with general endotracheal anesthesia. INTERVENTIONS The patients were randomized into two groups (modified group, n = 52; traditional group, n = 52). Modified anterior SLNB or traditional posterior SLNB was performed under ultrasound guidance. MEASUREMENTS The primary outcome was the proportion of acceptable intubation condition (AIC), which was analyzed in both per-protocol (PP) and intention-to-treat (ITT) populations. The prespecified non-inferiority margin was -4.8%. Secondary outcomes included intubation success rate on the first attempt, hemodynamic parameters during ATI, time taken for airway anesthesia and intubation, recall of intubation, patient perception of comfort, and incidence and severity of postoperative complications. MAIN RESULTS In the PP population, the proportion of AIC in the modified group was 49/49 (100%) and that in the traditional group was 49/49 (100%), absolute difference 0, lower limit of 1-sided 95% CI, -0.3%. In the ITT population, the primary outcomes in the modified and traditional group were 52/52 (100%) and 51/52 (98.1%), respectively, with an absolute difference of 1.9% and a lower limit of 1-sided 95% CI of -1.2%. The non-inferiority of modified ultrasound-guided anterior SLNB was confirmed in both populations. CONCLUSIONS Among adults without difficult airways during videolaryngoscope-assisted ATI, the modified ultrasound-guided anterior SLNB, compared to the traditional posterior approach, showed a statistically non-inferior effect in terms of providing AIC.
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Affiliation(s)
- Qiyuan Huang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yusi Hua
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
- The Research Units of West China (2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
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79
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Sharma R, Damiano J, Al-Saidi I, Dizdarevic A. Chest Wall and Abdominal Blocks for Thoracic and Abdominal Surgeries: A Review. Curr Pain Headache Rep 2023; 27:587-600. [PMID: 37624474 DOI: 10.1007/s11916-023-01158-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of chest wall and abdominal fascial plane blocks in managing perioperative pain. RECENT FINDINGS Clinical evidence suggests that regional anesthesia blocks, including fascial plane blocks, such as pectoralis, serratus, erector spinae, transversus abdominis, and quadratus lumborum blocks, are effective in providing analgesia for various surgical procedures and have more desirable side effect profile when compared to traditional neuraxial techniques. They offer advantages such as reduced opioid consumption, improved pain control, and decreased opioid-related side effects. Further research is needed to establish optimal techniques and indications for these blocks. Presently, they are a vital instrument in a gamut of multimodal analgesia options, especially when there are contraindications to neuraxial or para-neuraxial procedures. Ultimately, clinical judgment and provider skill set determine which blocks-alone or in combination-should be offered to any patient.
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Affiliation(s)
- Richa Sharma
- Department of Anesthesiology, Weill-Cornell Medicine, New York, NY, 10065, USA.
| | - James Damiano
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Ibrahim Al-Saidi
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Anis Dizdarevic
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, 10032, USA
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80
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Kilin M, Kavakli AS, Karaveli A, Sugur T, Kus G, Cagirci G, Arslan S. PECS II block for cardiac implantable electronic device insertion: A pilot study. Pacing Clin Electrophysiol 2023; 46:1251-1257. [PMID: 37665000 DOI: 10.1111/pace.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
AIM Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion. METHODS PECS II blocks were performed on the left side using the ultrasound-guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block-related complications. RESULTS Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4-10 [2.5-12]) mL. Two patients needed additional IV analgesics in the first 24 h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure. CONCLUSIONS PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24 h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.
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Affiliation(s)
- Mustafa Kilin
- Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Arzu Karaveli
- Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Tayfun Sugur
- Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Gorkem Kus
- Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Goksel Cagirci
- Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Sakir Arslan
- Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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Rispoli M, Nespoli MR, Ferrara M, Rosboch GL, Templeton LB, Templeton TW, Massullo D, Fiorelli S, Granell Gil M, Coccia C, Piccioni F. A Practical Guide for Using the EZ-Blocker Endobronchial Blocker: Tips and Tricks After 10 Years of Experience. J Cardiothorac Vasc Anesth 2023; 37:1884-1893. [PMID: 37481398 DOI: 10.1053/j.jvca.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 07/24/2023]
Abstract
The EZ-Blocker (EZB) is a "Y-shaped," semirigid endobronchial blocker used for lung isolation and one-lung ventilation during thoracic surgery. Like many medical tools, initial efforts to use this endobronchial blocker may prove challenging for the uninitiated. However, some tips and tricks can be applied fairly rapidly to aid the clinician in properly placing the device, and, furthermore, may help the clinician get the most out of this innovative device. This article focuses on some of the technical aspects of its placement that the authors have developed over time. Additionally, other facets and potential pitfalls are discussed that relate to intraprocedural issues that may sometimes arise when using this device. The following aspects of the EZB as a lung-isolation device are discussed: standard positioning techniques, alternative positioning techniques, use in pediatric patients, approaches to achieving exceptional lung isolation, advanced uses, and limitations and potential issues. Although some information was taken from the authors' rather extensive experience with using this endobronchial blocker, some of the relevant literature are also reviewed, with the goal of being to improve the reader's knowledge of the device and improve the likelihood of its successful placement. The underlying design of the EZB remains unique among commercially available bronchial blockers in improving positional stability. The Y-shaped conformation, however, can lead to challenges when positioning the device in some patients. Therefore, some very practical tips and tricks are provided to assist the clinician in correctly positioning the device and other hints to improve the quality of lung isolation and surgical conditions.
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Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care Unit, Department of Critical Care, AO dei Colli-Monaldi Hospital, Naples, Italy.
| | - Moana Rossella Nespoli
- Anesthesia and Intensive Care Unit, Department of Critical Care, AO dei Colli-Monaldi Hospital, Naples, Italy
| | - Maurizio Ferrara
- Anesthesia and Intensive Care Unit, ASL Napoli 1, PO San Paolo Hospital, Naples, Italy
| | - Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Domenico Massullo
- Division of Anesthesiology, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Fiorelli
- Anaesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Manuel Granell Gil
- Department of Anesthesiology, Critical Care and Pain Medicine, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Cecilia Coccia
- Istituto di Ricovero e Cura a Carattere Scientifico IFO, Istituto Tumori Regina Elena, Rome, Italy
| | - Federico Piccioni
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy
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Chan WK, Tan KW, Chong KP, Lim ACC, Khalid I. Bilateral External Oblique Intercostal Catheter for Post-operative Analgesia After Open Pancreaticoduodenectomy: A Case Report. Cureus 2023; 15:e47189. [PMID: 38021569 PMCID: PMC10652169 DOI: 10.7759/cureus.47189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Open pancreaticoduodenectomy, also known as Whipple surgery, is a complex and painful procedure that requires a multi-modal analgesic approach for successful post-operative rehabilitation and recovery. While thoracic epidural analgesia (TEA) remains the gold standard for pain relief after open upper abdominal surgery, it carries many risks that may outweigh the potential benefits of the technique. Furthermore, in laparoscopic converted to open pancreaticoduodenectomy cases, post-operative placement of a thoracic epidural catheter is inconvenient to the patient due to pain and positioning. The external oblique intercostal (EOI) block is a novel method that provides somatic analgesia to the upper abdomen. We present a case of bilateral EOI block with catheter insertion for post-operative analgesia in a patient who underwent laparoscopic converted to open Whipple surgery.
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Affiliation(s)
- Weng Ken Chan
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Kok Wang Tan
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Kok Peng Chong
- Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Angelina Chia Chia Lim
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Iskandar Khalid
- Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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83
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Ninan A, Grubb LM, Brenner MJ, Pandian V. Effectiveness of interprofessional tracheostomy teams: A systematic review. J Clin Nurs 2023; 32:6967-6986. [PMID: 37395139 DOI: 10.1111/jocn.16815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/19/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
AIM(S) To systematically locate, evaluate and synthesize evidence regarding effectiveness of interprofessional tracheostomy teams in increasing speaking valve use and decreasing time to speech and decannulation, adverse events, lengths of stay (intensive care unit (ICU) and hospital) and mortality. In addition, to evaluate facilitators and barriers to implementing an interprofessional tracheostomy team in hospital settings. DESIGN Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Johns Hopkins Nursing Evidence-Based Practice Model's guidance. METHODS Our clinical question: Do interprofessional tracheostomy teams increase speaking valve use and decrease time to speech and decannulation, adverse events, lengths of stay and mortality? Primary studies involving adult patients with a tracheostomy were included. Eligible studies were systematically reviewed by two reviewers and verified by another two reviewers. DATA SOURCES MEDLINE, CINAHL and EMBASE. RESULTS Fourteen studies met eligibility criteria; primarily pre-post intervention cohort studies. Percent increase in speaking valve use ranged 14%-275%; percent reduction in median days to speech ranged 33%-73% and median days to decannulation ranged 26%-32%; percent reduction in rate of adverse events ranged 32%-88%; percent reduction in median hospital length of stay days ranged 18-40 days; no significant change in overall ICU length of stay and mortality rates. Facilitators include team education, coverage, rounds, standardization, communication, lead personnel and automation, patient tracking; barrier is financial. CONCLUSION Patients with tracheostomy who received care from a dedicated interprofessional team showed improvements in several clinical outcomes. IMPLICATIONS FOR PATIENT CARE Additional high-quality evidence from rigorous, well-controlled and adequately powered studies are necessary, as are implementation strategies to promote broader adoption of interprofessional tracheostomy team strategies. Interprofessional tracheostomy teams are associated with improved safety and quality of care. IMPACT Evidence from review provides rationale for broader implementation of interprofessional tracheostomy teams. REPORTING METHOD PRISMA and Synthesis Without Meta-analysis (SWiM). PATIENT/PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Ashly Ninan
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Lisa M Grubb
- Department of Nursing Faculty, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
| | - Vinciya Pandian
- Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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Altun D, Canbaz M, Altun D, Sen C, Çamcı E. Airway management during unusual tracheal stenosis: A clinical feasibility trial. Laryngoscope Investig Otolaryngol 2023; 8:1169-1177. [PMID: 37899870 PMCID: PMC10601558 DOI: 10.1002/lio2.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Prolonged intubation is a known risk factor of LTS. LTS related to COVID-19 may result in a different phenotype: pronation affects the location of stenosis and COVID-19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow-controlled ventilation (FCV) in the management of patients with COVID-19-related LTS undergoing laryngeal surgery. Methods 20 patients suffering from COVID-19-related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO2 laser, were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated. Results Median duration of mechanical ventilation during their ICU stay was 17 days, (range, 7-27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons' satisfaction on the view was rated 9 out of 10 (range 7-10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of "respiratory complication." Conclusion This study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics. Level of Evidence IV, non-comparitive prospective clinical trial with 20 patients.
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Affiliation(s)
- Demet Altun
- Istanbul Faculty of Medicine, Department of AnesthesiologyIstanbul UniversityIstanbulTurkey
| | - Mert Canbaz
- Istanbul Faculty of Medicine, Department of AnesthesiologyIstanbul UniversityIstanbulTurkey
| | - Dilek Altun
- Department of Anesthesiology and ReanimationBakırköy Acıbadem HospitalIstanbulTurkey
| | - Cömert Sen
- Istanbul Faculty of Medicine, Department of Otolaryngology&Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Emre Çamcı
- Istanbul Faculty of Medicine, Department of AnesthesiologyIstanbul UniversityIstanbulTurkey
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85
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Fan D, Fisher C, Douglas NM, Hurrell MA, Freeman JT, Jardine DL. A rare case of Streptococcus oralis meningitis in New Zealand. Intern Med J 2023; 53:1931-1933. [PMID: 37859542 DOI: 10.1111/imj.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Dali Fan
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Calum Fisher
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Nicholas M Douglas
- Department of Infectious Diseases, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael A Hurrell
- Department of Radiology, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - Joshua T Freeman
- Department of Microbiology, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
| | - David L Jardine
- Department of General Medicine, Christchurch Hospital, Te Whatu Ora Waitaha, Canterbury, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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86
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Bockholt R, Mirus M. [Principles of the pharmacology of local anesthetics]. Schmerz 2023; 37:389-405. [PMID: 37721599 DOI: 10.1007/s00482-023-00751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023]
Abstract
The development of local anesthetics revolutionized the performance of painful interventions. Local anesthetics have an effect on voltage-gated sodium channels in nerve fibers and modulate the conduction of impulses. With respect to the chemical structure, local anesthetics can be divided into amide and ester types. The structural differences of local anesthetics have an influence on the duration of action, the degradation pathways and specific side effects. Severe adverse events include cardiotoxicity and neurotoxicity. In addition to basic measures, such as the monitoring and securing of vital parameters, lipid infusion represents a treatment option in cases of intoxication. The recent developments of local anesthetics are particularly concerned with the reduction of toxicity and prolonging the duration of action.
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Affiliation(s)
- Rebecca Bockholt
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscher Str. 74, 01307, Dresden, Deutschland.
| | - Martin Mirus
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscher Str. 74, 01307, Dresden, Deutschland
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87
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Radkowski P, Fadrowska-Szleper M, Podhorodecka K, Mieszkowski M. Neurological Complications of Regional Anesthesia: An Updated Review with Clinical Guidelines. Med Sci Monit 2023; 29:e940399. [PMID: 37691286 PMCID: PMC10503399 DOI: 10.12659/msm.940399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 06/07/2023] [Indexed: 09/12/2023] Open
Abstract
The main purpose of this article is to present the neurological complications of regional anesthesia. Our analysis may help clinicians determine when regional anesthesia can be administered safely and in which patients it needs additional precautions. Regional anesthesia has a major role in anesthesia practice. Here, we focus especially on the most common neurological complications: epidural hematoma, post-anesthesia headaches, and peripheral nerve function defect. We investigated risk factors of these states and propose ways of reducing the risks. This work is based on the available literature and the authors' experience. The research process involved using relevant keywords in various electronic databases, resulting in the selection of 32 articles published between 1989 and 2022. This manuscript provides an overview and analysis of the existing literature related to neurological complications of regional anesthesia. We believe that our article provides up-to-date information on the most common regional anesthesia complications, emphasizing differences concerning children and pregnant women and provides important guidance for clinicians in preparing for and performing anesthesia.
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Affiliation(s)
- Paweł Radkowski
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Hospital zum Heiligen Geist in Fritzlar, Fritzlar, Germany
| | | | - Katarzyna Podhorodecka
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland
| | - Marcin Mieszkowski
- Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, Olsztyn, Poland
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Collegium Medicum University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Gaszyński T, Gómez-Ríos MÁ, Serrano-Moraza A, Sastre JA, López T, Ratajczyk P. New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review. Healthcare (Basel) 2023; 11:2468. [PMID: 37761667 PMCID: PMC10650429 DOI: 10.3390/healthcare11182468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.
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Affiliation(s)
- Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
| | - Manuel Ángel Gómez-Ríos
- Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain;
| | | | - José Alfonso Sastre
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Teresa López
- Complejo Asistencial Universitario de Salamanca, 37001 Salamanca, Spain; (J.A.S.); (T.L.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-154 Lodz, Poland;
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89
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Vale A. Poisoning from non-food grade poppy seeds. Clin Toxicol (Phila) 2023; 61:625-628. [PMID: 37988119 DOI: 10.1080/15563650.2023.2274218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Allister Vale
- City Hospital, Birmingham and University of Birmingham, UK
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90
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Biladeau SK, Bocard B, Grell R. Anesthetic Management of an Obstetric Patient With Ehlers-Danlos and Wolff-Parkinson-White Syndromes. Cureus 2023; 15:e45486. [PMID: 37859915 PMCID: PMC10584354 DOI: 10.7759/cureus.45486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
A 31-year-old, primigravida, nullipara (G1P0) female with a past medical history of Ehlers-Danlos Syndrome (EDS), newly diagnosed Wolff-Parkinson-White Syndrome (WPW), and fetal breech presentation initially presented at 36+5 weeks gestation for an external cephalic version (ECV). The patient noted significant symptomatology related to her WPW which had worsened over the course of her pregnancy despite being started on oral metoprolol. Despite joint recommendations from the anesthesia and obstetric teams to combine the ECV with a same-day scheduled induction of labor or cesarean section, the patient declined. An epidural catheter was placed using ultrasound guidance and slowly titrated with 2% lidocaine; however, the ECV was unsuccessful. At 39 weeks gestation, the patient underwent an uncomplicated low transverse cesarean section under combined spinal-epidural anesthesia. The patient was discharged two days later in stable condition with a referral to an electrophysiologist. Here we describe the anesthetic preparation and management for an external cephalic version and subsequent cesarean section in a patient with these two rare conditions.
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Affiliation(s)
- Sara K Biladeau
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Braden Bocard
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Ryan Grell
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
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91
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Goldstein AL, Goldfarb A. We Asked the Experts: Fiberoptic Laryngoscopy Needs to be Included as an Adjunct to Primary Survey (ATLS) After Neck Trauma. World J Surg 2023; 47:2132-2134. [PMID: 37106256 DOI: 10.1007/s00268-023-07025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Adam Lee Goldstein
- General Surgery Department, Trauma Surgery Unit, Edith Wolfson Medical Center, Holon, Israel.
| | - Avi Goldfarb
- Otolaryngology Department, Edith Wolfson Medical Center, Holon, Israel
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92
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Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med 2023; 13:1327. [PMID: 37763095 PMCID: PMC10532647 DOI: 10.3390/jpm13091327] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
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Affiliation(s)
- Sophie A. Saul
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Patrick A. Ward
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Alistair F. McNarry
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
- Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK
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93
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Root ZT, Loomis BD, Smith TJ, Matrka LA. Assessing the concern for airway complications introduced by Wendler's glottoplasty. Laryngoscope Investig Otolaryngol 2023; 8:930-933. [PMID: 37621271 PMCID: PMC10446267 DOI: 10.1002/lio2.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Wendler's glottoplasty (WG) is a pitch-elevating surgery performed by laryngologists providing gender-affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well-described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG. Method A survey of laryngologists assessing opinions on airway considerations in glottoplasty. Results A total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same-day discharge. No long-term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have "major concerns" about future intubations, and only 5.3% thought the immediate risk of airway compromise was a "real concern." 91.9% counsel their patients routinely but briefly on airway concerns. Open-ended comments conveyed themes of concern for post-operative disruption of the web more than of airway compromise. Conclusion Because glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG. Level of Evidence 5.
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Affiliation(s)
- Zachary T. Root
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Bradley D. Loomis
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Thomas J. Smith
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Laura A. Matrka
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
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94
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Karmakar MK, Sivakumar RK, Sheah K, Pangthipampai P, Lönnqvist PA. Quest for the Elusive Mechanism of Action for the Thoracic Paraspinal Nerve Block Techniques. Are We Ignoring the Anatomy of the "Retro Superior Costotransverse Ligament Space?". Anesth Analg 2023; 137:458-465. [PMID: 37450909 DOI: 10.1213/ane.0000000000006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Manoj Kumar Karmakar
- From the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Prince of Wales Hospital, Hong Kong, China
| | - Ranjith Kumar Sivakumar
- From the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Faculty of Medicine, Prince of Wales Hospital, Hong Kong, China
| | - Kenneth Sheah
- Department of Radiology, Orthopedic and Hand MRI (OHM) Novena, Novena Specialist Centre, Singapore
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Mahidol University, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailandand
| | - Per-Arne Lönnqvist
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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95
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Ouyang J, Zhou J, Hei B, Wang B, Liu Z, Liu R. Acute paraplegia after aneurysmal subarachnoid hemorrhage: Case report of a rare complication with a 2‑year follow‑up. Exp Ther Med 2023; 26:339. [PMID: 37383368 PMCID: PMC10294596 DOI: 10.3892/etm.2023.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/04/2023] [Indexed: 06/30/2023] Open
Abstract
The current overall incidence of subarachnoid hemorrhage (SAH) is ~9/100,000 individuals/year and rupture of an intracranial aneurysm is the main cause of SAH, accounting for ~85% of cases. Only a small number of cases of paraplegia after intracranial aneurysmal SAH have so far been reported and its pathogenesis has remained to be fully elucidated. The present study reports the case of a patient with an aneurysm localized in the medial and inferior lateral wall of the C5 segment of the right internal carotid artery that was treated by coil interventional embolization. The muscle strength of both lower extremities of the patient was grade I and grade 0 before and after the operation, respectively. Lumbar and thoracic magnetic resonance imaging examinations revealed slight hematoma in the subarachnoid space below the L2 level. At two weeks after the operation, the muscle strength of both lower extremities was grade II, while the muscle strength was grade III and grade V at 30 and 60 days after the operation, respectively.
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Affiliation(s)
- Jia Ouyang
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Jingru Zhou
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Bo Hei
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Bin Wang
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Zhi Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, P.R. China
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96
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Hughes C, Kearsley R. Position statement from the Editors of Anaesthesia Reports on equity, diversity and inclusion. Anaesth Rep 2023; 11:e12231. [PMID: 37426054 PMCID: PMC10323716 DOI: 10.1002/anr3.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- C. Hughes
- Academic Unit of Anaesthesia, Critical Care and Peri‐Operative MedicineUniversity of GlasgowGlasgowUK
| | - R. Kearsley
- Department of AnaesthesiaThe Rotunda HospitalDublinIreland
- Department of AnaesthesiaMater Misericordiae University HospitalDublinIreland
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97
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Roriz C, Canelas MA, Pereira E. Intracranial Hypotension Syndrome: The Importance of Neurointensive Care. Cureus 2023; 15:e42673. [PMID: 37649930 PMCID: PMC10463094 DOI: 10.7759/cureus.42673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Surgical procedures involving the spine can result in various complications, including vascular, nerve root and dura mater injury, surgical wound infection, and hematoma formation. Unintentional durotomy is a frequent complication of these procedures (up to 17%). Two clinical cases are reported in which the occurrence of epileptiform activity in the form of generalized tonic-clonic seizures after instrumentation of the dorsal and lumbar spine raised suspicion of cerebrospinal fluid (CSF) fistula. In both cases, the diagnostic suspicion and early approach allowed for the adoption of a timely medical and surgical plan, with the aim of reducing the volume of lost CSF as well as the potential neurological dysfunction resulting from this surgical complication.
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Affiliation(s)
- Carolina Roriz
- Intensive Care Unit, Centro Hospitalar de Leiria, Leiria, PRT
| | - Maria Ana Canelas
- Intensive Care Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, PRT
| | - Eduarda Pereira
- Neurocritical Care Unit and Intensive Care, Hospital São João, Porto, PRT
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98
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Morrison S, Van Oostende C, Aerts S, Saldien V. The Tritube: Facilitating Upper Airway Surgery With an Ultrathin Cuffed Airway Device. A A Pract 2023; 17:e01697. [PMID: 37433059 DOI: 10.1213/xaa.0000000000001697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
The Tritube is a narrow-bore cuffed tracheal tube (outer diameter 4.4 mm and inner diameter ~2.4 mm) that permits effective alveolar gas exchange using flow-controlled ventilation. Constant gas flow delivers physiological minute volumes, within preset pressure limits, and applies suction to the airway during expiration. The technique has attracted interest for laryngotracheal microsurgery as it provides superior surgical exposure and avoids many of the complications associated with high-frequency jet ventilation. Cuff inflation protects the lower airway and produces a motionless operating field. We describe the structure of the device, discuss its benefits, and suggest how it should be used clinically.
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Affiliation(s)
- Stuart Morrison
- From the Department of Anesthesiology, Antwerp University Hospital, Edegem, Belgium
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99
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Ormandy D. Comment on 'Utilising 3D printing in assessment of anticipated difficult airways'. Anaesth Rep 2023; 11:e12243. [PMID: 37694101 PMCID: PMC10486320 DOI: 10.1002/anr3.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- D. Ormandy
- East Lancashire Hospitals NHS TrustBlackburnUK
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100
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Türk CÇ, Gediz T, Mutlucan UO, Konak Y, Duman ZN, Sügür T. Unexpected Bradycardia Related to Surgical Manipulation During Thoracolumbar Spinal Surgery. World Neurosurg 2023; 175:e1277-e1282. [PMID: 37146877 DOI: 10.1016/j.wneu.2023.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although spinal surgery can offer pain relief and functional improvements in daily life, it is often associated with various perioperative complications. The incidence of cardiac complications associated with spinal surgery is relatively low. We evaluated frequency and causes for bradycardia incidents in posterior thorocolumbar spinal surgeries. METHODS We retrospectively evaluated posterior thoracolumbar spinal surgeries between 2018-2022 for bradycardic events in our tertiary general hospital. Patients operated for degenerative changes or disk herniations are included, other cases for tumors, trauma, arteriovenous (AV) fistulae or previously operated are excluded. RESULTS The study reached 6 eligible patients (4 female and 2 male) aged between 45-75 years (mean: 63.3) among 550 patients operated between 2018-2022. The rate of bradycardia was 1.09%. Of these, 5 patients (lumbar discectomy: one; posterior stabilization:4) exhibited it following L2 and L3 root manipulation and one presented it following L4-5 discectomy. In each of these cases, bradycardia occurred during surgical manipulation and ceased upon removal of the insult. None of the cases exhibited accompanying hypotension. The patient's heart rates were seen to drop to lowest the of 30 beats/min, and all patients exhibited favorable outcomes and no postoperative cardiac complications over a mean follow-up period of 20 months (range: 10-40 months). CONCLUSIONS The current study examines the occurrence of unexpected bradycardia events associated with thoracolumbar spinal surgery during surgical handling of the dura mater. Awareness of such incidents among surgeons and anesthesiologists can help prevent catastrophic outcomes caused by adverse cardiac events.
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Affiliation(s)
- Cezmi Çağrı Türk
- Department of Neurosurgery, University of Health Sciences, Istanbul, Turkey; Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey.
| | - Tolga Gediz
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Umut Ogün Mutlucan
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Yusuf Konak
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Zeynep Nur Duman
- Antalya Training and Research Hospital, Neurosurgery Clinic, Antalya, Turkey
| | - Tayfun Sügür
- Antalya Training and Research Hospital, Anesthesiology Clinic, Antalya, Turkey
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