251
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Macfarlane AJR, Gitman M, Bornstein KJ, El-Boghdadly K, Weinberg G. Updates in our understanding of local anaesthetic systemic toxicity: a narrative review. Anaesthesia 2021; 76 Suppl 1:27-39. [PMID: 33426662 DOI: 10.1111/anae.15282] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.
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Affiliation(s)
- A J R Macfarlane
- Department of Anaesthesia, Critical Care and Pain Medicine, Glasgow Royal Infirmary, Glasgow, UK.,2University of Glasgow, Glasgow, UK
| | - M Gitman
- Department of Anaesthesia, University of Illinois College of Medicine, Chicago, IL, USA
| | - K J Bornstein
- Department of Medical Education, University of Miami School of Medicine, Miami, FL, USA
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - G Weinberg
- Department of Anaesthesia, University of Illinois College of Medicine, Chicago, IL, USA.,Jesse Brown VA Medical Centre, Chicago, IL, USA
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252
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Shelton CL, Klein AA, Bailey CR, El-Boghdadly K. The Anaesthesia Case Report (ACRE) checklist: a tool to promote high-quality reporting of cases in peri-operative practice. Anaesthesia 2021; 76:1077-1081. [PMID: 33440026 DOI: 10.1111/anae.15391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
Case reports have fulfilled an important role in the development of anaesthesia and continue to be highly relevant to modern practice. Despite this, they are sometimes criticised for being insufficiently rigorous to meaningfully inform clinical practice or research design. Reporting checklists are a useful tool to improve rigour in research and, although case report checklists have previously been developed, no existing checklist focuses on the peri-operative setting. In order to address the need for a case reports checklist that better accommodates peri-operative care, we used an established tool as the basis for developing the 12-item Anaesthesia Case Report checklist. This was refined using an iterative approach through feedback from journal editors with experience of handling case reports, patient and public involvement, and trialling its use on Anaesthesia Reports submissions. The Anaesthesia Case Report checklist differs from existing checklists by aligning with peri-operative practice; it places less emphasis on making diagnoses and focuses on the way in which clinical challenges, for example, related to the patient's comorbidities or operative interventions, are addressed. Adopting a standardised approach to the content of case reports presents clear benefits to authors, editors and peer reviewers through streamlining the processes involved in writing and publication. The Anaesthesia Case Report checklist provides a pragmatic framework for comprehensive and transparent reporting. We hope it will facilitate the authorship of high-quality case reports with the potential to further improve the quality and safety of peri-operative care.
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Affiliation(s)
- C L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Lancaster Medical School, Lancaster University, Lancaster, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - C R Bailey
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Kings College London, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Kings College London, UK
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253
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Khan MF, Shamim F, Slote MU, Salim B, Abbas SA. Combined use of a videolaryngoscope and a flexible bronchoscope for awake tracheal intubation when front-of-neck airway is not an option. Anaesth Rep 2021; 9:12-15. [PMID: 33490953 DOI: 10.1002/anr3.12091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
We report a case of successful tracheal intubation with the combined use of a videolaryngoscope and flexible bronchoscope in a patient with difficult airway when both techniques had individually failed. A 35-year-old man presented with airway obstruction due to massive neck swelling causing hypoxia, stridor and respiratory distress. He had a history of oral cancer which had been resected with bilateral neck dissection and free flap reconstruction 2 months previously. Due to extensive anterior neck swelling, we judged that front-of-neck airway would not be a suitable approach. After unsuccessful attempts at awake tracheal intubation with videolaryngoscopy and flexible bronchoscopy separately, we combined both techniques with a successful outcome. By using a combined technique to address the specific problems presented by this case, a life-threatening emergency was resolved. This case highlights why it is useful for anaesthetists to be familiar with multiple techniques to awake tracheal intubation, both individually and in combination.
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Affiliation(s)
- M F Khan
- Department of Anaesthesiology Aga Khan University Hospital Karachi Pakistan
| | - F Shamim
- Department of Anaesthesiology Aga Khan University Hospital Karachi Pakistan
| | - M U Slote
- Department of Anaesthesiology Aga Khan University Hospital Karachi Pakistan
| | - B Salim
- Department of Anaesthesiology Aga Khan University Hospital Karachi Pakistan
| | - S A Abbas
- Department of Surgery Aga Khan University Hospital Karachi Pakistan
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254
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Kearsley R, Daly Guris R, Miles LF, Shelton CL. Case reports in the COVID-19 pandemic: first responders to an emergency in evidence-based medicine. Anaesth Rep 2021; 9:e12088. [PMID: 33458676 PMCID: PMC7798051 DOI: 10.1002/anr3.12088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- R Kearsley
- Department of Anaesthesia St Mary's Hospital Imperial College Healthcare NHS Trust London UK
| | - R Daly Guris
- Department of Anaesthesia Children's Hospital of Philadelphia Philadelphia USA
| | - L F Miles
- Department of Anaesthesia Austin Health Melbourne Australia.,Centre for Integrated Critical Care The University of Melbourne Melbourne Australia
| | - C L Shelton
- Department of Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK.,Lancaster Medical School Faculty of Health and Medicine Lancaster University Lancaster UK
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255
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Kumar R, Syal R, Chhabra S, Kamal M. Our experience with the mid-point transverse process to pleura block in two patients undergoing modified radical mastectomy. INDIAN JOURNAL OF PAIN 2021. [DOI: 10.4103/ijpn.ijpn_47_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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256
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Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review. Anaesthesia 2021; 76 Suppl 1:110-126. [PMID: 33426660 DOI: 10.1111/anae.15276] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 01/11/2023]
Abstract
Ultrasound-guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high-quality randomised controlled trials focusing on patient-centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.
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Affiliation(s)
- K J Chin
- Department of Anaesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Canada
| | - B Versyck
- Department of Anaesthesia and Pain Medicine, AZ Turnhout, Belgium.,Department of Anaesthesia and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - A Pawa
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
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257
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Pedoto A, Noel J, Park BJ, Amar D. Liposomal Bupivacaine Versus Bupivacaine Hydrochloride for Intercostal Nerve Blockade in Minimally Invasive Thoracic Surgery. J Cardiothorac Vasc Anesth 2020; 35:1393-1398. [PMID: 33376072 DOI: 10.1053/j.jvca.2020.11.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The objective of this study was to compare the effects of liposomal bupivacaine (Lipo-B) and bupivacaine hydrochloride (B-HCl), in the presence of multimodal analgesia, on postoperative analgesia and opioid consumption in minimally invasive thoracic surgery (MITS) lobectomy. DESIGN Retrospective observational cohort study. SETTING Tertiary care cancer center. PARTICIPANTS A total of 60 patients who underwent MITS lobectomy and received intercostal nerve blockade (ICNB) with either 0.66% Lipo-B (n = 29) or 0.5% B-HCl (n = 31). INTERVENTIONS All patients received intravenous patient-controlled analgesia for the first 12 hours postoperatively, followed by opioids and nonsteroidal anti-inflammatory drugs as needed. MEASUREMENTS AND MAIN RESULTS Perioperative opioid and nonopioid consumption and pain scores were compared between groups at 12-hour intervals for the first 72 hours. Between the two groups, there were no statistically significant differences in demographic characteristics, intraoperative (p = 0.46) and postoperative opioid consumption, Richmond Agitation-Sedation Scale scores and pain scores upon postanesthesia care unit arrival and after four hours, length of postanesthesia care unit stay (p = 0.84), or length of hospital stay (p = 0.55). Both groups received intra- and postoperative multimodal analgesia. CONCLUSIONS In this cohort, no differences in opioid consumption or pain scores were observed in the immediate postoperative period following MITS lobectomy between patients given ICNB with Lipo-B and those given ICNB with B-HCl in the presence of multimodal analgesia.
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Affiliation(s)
- Alessia Pedoto
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Jovanka Noel
- Hunter College, City University of New York, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Amar
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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258
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Smith TG, Ahmad I, Takhar A, Surda P, El-Boghdadly K. Unconventional multidisciplinary team strategy for tracheostomy in COVID-19. Anaesth Rep 2020; 8:178-182. [PMID: 33241228 PMCID: PMC7671090 DOI: 10.1002/anr3.12074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- T G Smith
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK.,Centre for Human and Applied Physiological Sciences King's College London London UK
| | - I Ahmad
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK.,King's College London London UK
| | - A Takhar
- Department of Otorhinolaryngology Guy's and St Thomas' NHS Foundation Trust London UK
| | - P Surda
- Department of Otorhinolaryngology Guy's and St Thomas' NHS Foundation Trust London UK
| | - K El-Boghdadly
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust London UK.,King's College London London UK
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259
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Cascella M, Bimonte S, Di Napoli R. Delayed Emergence from Anesthesia: What We Know and How We Act. Local Reg Anesth 2020; 13:195-206. [PMID: 33177867 PMCID: PMC7652217 DOI: 10.2147/lra.s230728] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open
Abstract
The emergence from anesthesia is the stage of general anesthesia featuring the patient’s progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the “active awakening” are reported.
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Affiliation(s)
- Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale, Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale, Naples, Italy
| | - Raffaela Di Napoli
- Department of Anesthesiology, Institut Jules Bordet, Université Libre De Bruxelles, Bruxelles 1000, Belgium
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260
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Raza A, Matloob S, Abdul Rahim NF, Abdul Halim H, Khattak A, Ahmed NH, Nayab DE, Hakeem A, Zubair M. Factors Impeding Health-Care Professionals to Effectively Treat Coronavirus Disease 2019 Patients in Pakistan: A Qualitative Investigation. Front Psychol 2020; 11:572450. [PMID: 33240162 PMCID: PMC7680877 DOI: 10.3389/fpsyg.2020.572450] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, first reported in late December 2019, is regarded as the most significant public health emergency of the century. According to the World Health Organization (WHO), the current outbreak of COVID-19 has affected millions of people and killed hundreds of thousands in more than 200 countries, including Pakistan. Health-care professionals (HCPs) cannot minimize human interactions or isolate themselves from patients due to their jobs and moral duties. Hence, the outbreak needed HCPs to work in adverse and challenging conditions with possible mental health problems. In light of the stated background, this study aims to explore and understand the factors that impede HCPs to effectively treat COVID-19 patients in Karachi, Pakistan. Based on qualitative methods, a phenomenological approach was considered to record the true experiences of HCPs. Twelve doctors and nurses were recruited from five COVID-19 designated hospitals in Karachi, Sindh Province, using purposive and snowball sampling. Semi-structured in-depth telephone interviews were conducted from April 6 to 14, 2020, and analyzed through thematic analysis. The findings suggest that there were two types of constraints, institutional and personal, which were impeding HCPs to treat COVID-19 patients effectively. Institutional constraints include the poor condition of isolation wards, inadequate availability of personal protective equipment (PPE), excessive and uneven workload, and absence of emotional and psychological support in hospitals. Besides, personal constraints include nervousness due to the novel virus, a constant fear of becoming infected, fear of taking virus to family, extreme isolation and loneliness, and feeling of powerlessness. The study found that HCPs in Pakistan have been dealing with a high risk of infection, causing mental health problems such as stress, anxiety, and depressive symptoms. These mental health problems not only affect attention, understanding, and decision-making capacity of HCPs, which could hinder the fight against COVID-19, but they could also have a continuous effect on their overall well-being on a long-term basis. Therefore, the present study outlines important clinical and policy strategies that are needed to support HCPs as the pandemic continues.
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Affiliation(s)
- Ali Raza
- Business Administration Department, Sukkur IBA University, Sukkur, Pakistan
| | - Sheema Matloob
- School of Management, Universiti Sains Malaysia, Penang, Malaysia
| | | | | | | | | | - Durr-e- Nayab
- Department of English, The Women University Multan, Multan, Pakistan
| | - Abdul Hakeem
- Department of Business, National College of Business Administration & Economics, Lahore, Pakistan
| | - Muhammad Zubair
- Ghulam Muhammad Mahar Medical College Teaching Hospital, Sukkur, Pakistan
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261
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Zhang WJ, Luo C, Pu FQ, Zhu JF, Zhu Z. The role and pharmacological characteristics of ATP-gated ionotropic receptor P2X in cancer pain. Pharmacol Res 2020; 161:105106. [DOI: 10.1016/j.phrs.2020.105106] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
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262
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Yeung J, Shelton CL. Back to the future of academic anaesthesia: publication outputs of UK anaesthetists. Anaesthesia 2020; 76:455-459. [PMID: 33080063 DOI: 10.1111/anae.15273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 01/06/2023]
Affiliation(s)
- J Yeung
- Department of Anaesthesia and Critical Care Medicine, University Hospitals Birmingham NHS Trust, Birmingham, UK.,Warwick Medical School, University of Warwick, Warwick, UK
| | - C L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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263
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Ohgoshi Y, Ohtsuka A, Takeda Y. Membrane-mediated paravertebral spread after modified erector spinae plane blocks: A cadaveric study. J Clin Anesth 2020; 65:109880. [DOI: 10.1016/j.jclinane.2020.109880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 11/29/2022]
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264
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Allen M, Spillinger A, Arianpour K, Johnson J, Johnson AP, Folbe AJ, Hotaling J, Svider PF. Tracheal Resection in the Management of Thyroid Cancer: An Evidence-Based Approach. Laryngoscope 2020; 131:932-946. [PMID: 32985692 DOI: 10.1002/lary.29112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer. STUDY DESIGN Systematic review and meta-analysis. METHODS Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random-effects meta-analyses. RESULTS Ninety-six relevant studies encompassing 1,179 patients met inclusion criteria. Meta-analysis pooled rates of complications: 1.7% (confidence interval [CI] 0.8-2.5; P < .001; I2 = 1.85%) airway complications, 2.8% (CI 1.6-3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2-3.1; P < .001; I2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3-19.9; P < .001; I2 = 35.26%), 15% (CI 9.6-20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7-25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4-84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9-32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1-46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7-21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58-96.2; P < .001; I2 = 78.77%) overall survival. CONCLUSION Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope, 131:932-946, 2021.
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Affiliation(s)
- Meredith Allen
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | | | - Jared Johnson
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A
| | - Adam J Folbe
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Jeffrey Hotaling
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Peter F Svider
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
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265
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Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery. Anaesthesist 2020; 69:742-750. [DOI: 10.1007/s00101-020-00848-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/27/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
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266
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Erector spinae block versus serratus anterior block in chest wall trauma, which is better? Am J Emerg Med 2020; 38:2220. [PMID: 32855016 DOI: 10.1016/j.ajem.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
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267
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Aaron L, Welch M, Shah A, Thomas T, McKechnie SR. Recurrent massive pulmonary emboli in a critically ill patient with COVID-19. Anaesth Rep 2020; 8:e12059. [PMID: 32776010 PMCID: PMC7395430 DOI: 10.1002/anr3.12059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
We report the haematological management of a critically ill patient with coronavirus disease 2019 (COVID-19), with recurrent massive pulmonary emboli. A previous healthy 56-year-old man presented to the emergency department with severe hypoxaemic respiratory failure due to suspected COVID-19. He required invasive mechanical ventilation and transfer to the intensive care unit for increasing ventilatory requirements and cardiovascular instability. A computed tomography (CT) pulmonary angiogram demonstrated large bilateral pulmonary emboli with right heart strain, for which he received intravenous systemic thrombolysis followed by therapeutic weight-adjusted anticoagulation with low molecular weight heparin (dalteparin). Two weeks later, following an acute respiratory deterioration, a repeat CT pulmonary angiogram demonstrated a new saddle embolus with right heart strain requiring another regime of intravenous systemic thrombolysis. This occurred despite anti-Xa-guided therapeutic anticoagulation. The dose of therapeutic dalteparin was increased incrementally to an eventual dose of 12,500 units twice daily. A low threshold for radiological imaging should be considered in all COVID-19 patients with acute cardiorespiratory deterioration. Multidisciplinary team discussions highlighted aspects of balancing the risks of bleeding from anticoagulation vs. risk of death from pulmonary embolism. This report highlights the need for further research into the underlying mechanisms and optimal management of thrombotic complications in COVID-19.
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Affiliation(s)
- L Aaron
- Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - M Welch
- Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - A Shah
- Radcliffe Department of Medicine University of Oxford UK
| | - T Thomas
- Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - S R McKechnie
- Adult Intensive Care Unit Oxford University Hospitals NHS Foundation Trust Oxford UK
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268
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Miles LF, Chuen J, Edwards L, Hohmann JD, Williams R, Peyton P, Grayden DB. The design and manufacture of 3D-printed adjuncts for powered air-purifying respirators. Anaesth Rep 2020; 8:e12055. [PMID: 32705085 PMCID: PMC7369400 DOI: 10.1002/anr3.12055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Spurred in part by literature published in the immediate aftermath of the severe acute respiratory syndrome epidemic in 2003, powered air‐purifying respirators have seen increased use worldwide during the COVID‐19 pandemic. Whereas these devices provide excellent protection of the user, there is an added element of risk during doffing and cleaning of the device. An additional layer of barrier protection, in the form of a polypropylene gown, to be worn over the hood and motor belt, can be used to minimise this risk. However, the device entrains air perpendicular to the lie of the gown, resulting in the impermeable material being sucked into the air intake, and partial occlusion of flow. In this report, we describe a clinical‐academic partnership whereby a bespoke filter guard was designed to disrupt airflow and prevent gown entrainment, thereby enabling full barrier protection of both the device and user. This intervention was simple, cheap, scalable and able to be mass produced.
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Affiliation(s)
- L F Miles
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - J Chuen
- 3DMedLab Austin Health Melbourne Vic Australia
| | - L Edwards
- MSD Robotics Lab Melbourne School of Design Melbourne Vic Australia
| | - J D Hohmann
- Technician NExT Lab Melbourne School of Design Melbourne Vic Australia
| | - R Williams
- Melbourne Brain Centre Imaging Unit Melbourne Vic Australia
| | - P Peyton
- Department of Anaesthesia Austin Health Melbourne Vic Australia
| | - D B Grayden
- Department of Biomedical Engineering The University of Melbourne Vic Australia
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269
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Ong S, Lim WY, Ong J, Kam P. Anesthesia guidelines for COVID-19 patients: a narrative review and appraisal. Korean J Anesthesiol 2020; 73:486-502. [PMID: 32668835 PMCID: PMC7714635 DOI: 10.4097/kja.20354] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched for guidelines related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines; the search was expanded to include countries with a high incidence of SARS-CoV. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All the guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were the most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, the rigor of development, and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia, and the lack of auditing of guidelines were identified. Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability.
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Affiliation(s)
- Sharon Ong
- Duke-NUS Medical School, Yong Loo Lin School of Medicine, Singapore.,Department of Surgical Intensive Care, Sengkang General Hospital, Singapore.,Division of Anesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore
| | - Wan Yen Lim
- Division of Anesthesiology and Perioperative Sciences, Singapore General Hospital, Singapore
| | - John Ong
- Department of Engineering, University of Cambridge, Cambridge, UK.,Department of Medicine, National University of Singapore, Singapore
| | - Peter Kam
- Department of Anesthetics, Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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270
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Charlesworth M, Daly Guris RJ, Dalay S. Novel presentations, rare complications and educational content: cases in clinical practice. Anaesth Rep 2020; 8:73-75. [PMID: 32656534 DOI: 10.1002/anr3.12056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Critical Care, Anaesthesia and ECMO Wythenshawe Hospital Manchester UK
| | - R J Daly Guris
- Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia and University of Pennsylvania Philadelphia PA USA
| | - S Dalay
- Department of Anaesthesia Worcestershire Acute Hospitals NHS Trust Worcester UK
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271
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Phipps SJ, Scott AC, Legge CE. Awake tracheal intubation during the COVID-19 pandemic - an aerosol-minimising approach. Anaesth Rep 2020; 8:101. [PMID: 32954351 DOI: 10.1002/anr3.12057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- S J Phipps
- Hawke's Bay District Health Board Hastings New Zealand
| | - A C Scott
- Hawke's Bay District Health Board Hastings New Zealand
| | - C E Legge
- Hawke's Bay District Health Board Hastings New Zealand
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272
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Wloch K, Simpson M, Gowrie-Mohan S. Local anaesthetic resistance in a patient with Ehlers-Danlos syndrome undergoing caesarean section with continuous spinal anaesthesia. Anaesth Rep 2020; 8:56-58. [PMID: 32537613 DOI: 10.1002/anr3.12040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
A patient with a diagnosis of Ehlers-Danlos syndrome was scheduled to undergo elective caesarean section with a combined spinal-epidural anaesthetic technique. The epidural attempt resulted in an inadvertent dural puncture, and we decided subsequently to place an intrathecal catheter. She required high repeated doses of hyperbaric bupivacaine (32.5 mg over 1 h) through the catheter to establish adequate sensory blockade, together with supplemental analgesic techniques. Soon after the procedure, she recovered motor function rapidly and required further supplemental analgesia. We believe this is the first report of possible local anaesthetic resistance with an intrathecal catheter anaesthetic technique for a patient with Ehlers-Danlos syndrome. If there is resistance to the first dose of intrathecal local anaesthetic, a general anaesthetic may be the best option for such patients.
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Affiliation(s)
- K Wloch
- Addenbrookes Hospital Cambridge UK
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273
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A multidisciplinary approach for managing the infraglottic difficult airway in the setting of the Coronavirus pandemic. ACTA ACUST UNITED AC 2020; 31:128-137. [PMID: 32572325 PMCID: PMC7260599 DOI: 10.1016/j.otot.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Management of a difficult airway caused by pathology below the glottis is high-risk and requires a shared approach to airway planning and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible or may preclude surgical access. This work provides a common framework for creating multidisciplinary shared-airway management plans and presents devices and strategies that have in recent years improved airway management safety in this difficult patient group and may prove useful in the setting of the novel Coronavirus Disease 2019 (COVID-19).
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274
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Lemay F, Cooper J, Thompson S, Scott J. Combination of transnasal humidified rapid-insufflation ventilatory exchange with high frequency jet ventilation for shared airway surgery. Can J Anaesth 2020; 67:1264-1265. [PMID: 32207089 DOI: 10.1007/s12630-020-01635-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Francois Lemay
- Département d'anesthésiologie et de soins intensifs, Université Laval, Quebec, Canada. .,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.
| | - Jeremy Cooper
- Green Lane Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Sarah Thompson
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Jeanette Scott
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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275
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Lesser FD, Yakubi M, Rochester S, Evans J, Highgate J. Compartment syndrome of the hand as a complication of prolonged mechanical cardiopulmonary resuscitation. Anaesth Rep 2020; 8:10-13. [PMID: 32154512 PMCID: PMC7052311 DOI: 10.1002/anr3.12025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2019] [Indexed: 12/02/2022] Open
Abstract
A 45‐year‐old man suffered compartment syndrome of the hands as a complication of prolonged cardiopulmonary resuscitation. He was admitted following a hypothermic out‐of‐hospital cardiac arrest due to cold‐water submersion. The patient was in cardiac arrest for 4 h with mechanical cardiopulmonary resuscitation delivered using the Lund University Cardiac Arrest System (Jolife AB, Lund, Sweden). Cardiopulmonary resuscitation along with aggressive rewarming achieved return of spontaneous circulation. He developed compartment syndrome in his left hand which was likely exacerbated by having his arm strapped to the Lund University Cardiac Arrest System device throughout the resuscitation. The compartment syndrome was managed conservatively. Despite preservation of neurological function the patient died of complications from the cardiac arrest after an extended intensive care unit stay. We recommend healthcare providers unstrap patient's hands during prolonged mechanical cardiopulmonary resuscitation.
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Affiliation(s)
| | | | - S Rochester
- Resuscitation Department East Sussex NHS Healthcare Trust UK
| | - J Evans
- Department of Anaesthesia and Intensive Care East Sussex NHS Healthcare Trust UK
| | - J Highgate
- Department of Anaesthesia and Intensive Care East Sussex NHS Healthcare Trust UK
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276
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Albrecht E, Chin KJ. Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia 2020; 75 Suppl 1:e101-e110. [PMID: 31903582 DOI: 10.1111/anae.14868] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/29/2022]
Abstract
Regional anaesthesia has undergone several exciting advances in the past few decades. Ultrasound-guided techniques of peripheral nerve blockade have become the gold standard thanks to the associated improvements in efficacy, ease of performance and safety. This has increased the accessibility and utilisation of regional anaesthesia in the anaesthesia community at large and is timely given the mounting evidence for its potential benefits on various patient-centred outcomes, including major morbidity, cancer recurrence and persistent postoperative pain. Ultrasound guidance has also paved the way for refinement of the technical performance of existing blocks concerning simplicity and safety, as well as the development of new regional anaesthesia techniques. In particular, the emergence of fascial plane blocks has further broadened the application of regional anaesthesia in the management of painful conditions of the thorax and abdomen. The preliminary results of investigations into these fascial plane blocks are promising but require further research to establish their true value and role in clinical care. One of the challenges that remains is how best to prolong regional anaesthesia to maximise its benefits while avoiding undue harm. There is ongoing research into optimising continuous catheter techniques and their management, intravenous and perineural pharmacological adjuncts, and sustained-release local anaesthetic molecules. Finally, there is a growing appreciation for the critical role that regional anaesthesia can play in an overall multimodal anaesthetic strategy. This is especially pertinent given the current focus on eliminating unnecessary peri-operative opioid administration.
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Affiliation(s)
- E Albrecht
- Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland
| | - K J Chin
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
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277
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Swain S, Shajahan N. Managing the airway of acid burn contracture of the neck in a 12-year-old girl. JOURNAL OF THE SCIENTIFIC SOCIETY 2020. [DOI: 10.4103/jss.jss_19_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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278
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Swain S, Acharya S, Sahajan N. Otorhinolaryngological manifestations in COVID-19 infections: An early indicator for isolating the positive cases. JOURNAL OF THE SCIENTIFIC SOCIETY 2020. [DOI: 10.4103/jss.jss_57_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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279
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Charlesworth M, Shelton CL, Dalay S. Airway management, regional anaesthesia and critical incidents: reports in anaesthesia. Anaesth Rep 2020; 8:1-3. [DOI: 10.1002/anr3.12036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- M. Charlesworth
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - C. L. Shelton
- Department of Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust Manchester UK
| | - S. Dalay
- Department of Anaesthesia Worcestershire Acute Hospitals NHS Trust Worcester UK
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280
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Shukla R, Sahu S, Kant S, Dubey KP, Swain A, Uppalapati VK. Emergent airway management in blunt tracheal trauma: A novel use of the mini-tracheostomy kit. J Family Med Prim Care 2020; 9:439-441. [PMID: 32110634 PMCID: PMC7014905 DOI: 10.4103/jfmpc.jfmpc_865_19] [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: 10/08/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
AIM To report and discuss a novel way of managing the airway in a difficult case of anterior tracheal wall disruption caused by blunt trauma to the neck. BACKGROUND Tracheal injury resulting in laceration of the windpipe may present with either one or many of the multitude of problems such as respiratory distress, hoarseness of voice and subcutaneous emphysema. Most often it requires surgical intervention. CASE DESCRIPTION We hereby present the novel use of a mini-tracheostomy kit as an aid in the cannot-intubate-cannot-ventilate situation of a 30-year-old patient presenting with severe features of blunt tracheal injury. The airway was established critically with the use of the mini-tracheostomy kit in a "cannot-intubate-cannot-ventilate" situation during surgical tracheostomy and a potentially disastrous cardiorespiratory arrest situation was averted. CONCLUSION Timely presence of airway equipment, adequate preparation, a willingness to innovate and a team approach are of paramount importance in dealing with difficult airway situations that are presented in myriad and complex ways. CLINICAL SIGNIFICANCE The stylet of mini-tracheostomy kit can be used in emergent airway management especially in clinical situations mimicking ours specifically as a guide for insertion of the standard tracheostomy tube.
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Affiliation(s)
- Rajiv Shukla
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Seelora Sahu
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Shashi Kant
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - K. P. Dubey
- Chief of Medical Indoor Services, Department of Otorhinolaryngology, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Amlan Swain
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Vamsi K. Uppalapati
- Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
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281
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Watton DE, Rose PGD, Abdallah FW, Thompson CP, Maziak DE, Costache I. Midpoint transverse process to pleura catheter placement for postoperative analgesia following video-assisted thoracoscopic surgery. Anaesth Rep 2019; 7:65-68. [PMID: 32051952 PMCID: PMC6931300 DOI: 10.1002/anr3.12018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 01/16/2023] Open
Abstract
The ultrasound-guided midpoint transverse process to pleura block has been described as an alternative end-point for thoracic paravertebral blockade. Although originally described as a single-level block, midpoint transverse process to pleura blockade may cover more than one level when larger volumes of injectate are used. Moreover, a continuous catheter midpoint transverse process to pleura blockade technique was previously thought to be unfeasible. We report three cases where a midpoint transverse process to pleura continuous catheter technique was successfully used for postoperative analgesia following video-assisted thoracoscopic surgery.
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Affiliation(s)
- D. E. Watton
- Department of Anesthesiology and Pain MedicineUniversity of OttawaONCanada
| | - P. G. D. Rose
- Department of Anesthesiology and Pain MedicineUniversity of OttawaONCanada
| | - F. W. Abdallah
- Department of Anesthesiology and Pain MedicineUniversity of OttawaONCanada
| | - C. P. Thompson
- Department of Anesthesiology and Pain MedicineUniversity of OttawaONCanada
| | - D. E. Maziak
- Surgical Oncology Division of Thoracic SurgeryThe Ottawa HospitalUniversity of OttawaONCanada
- University of OttawaONCanada
| | - I. Costache
- Department of Anesthesiology and Pain MedicineUniversity of OttawaONCanada
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282
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McHugh UM, Davies N, Dob DP. Correspondence. Anaesth Rep 2019; 7:69. [PMID: 32051953 PMCID: PMC6931290 DOI: 10.1002/anr3.12020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - D. P. Dob
- Chelsea and Westminster HospitalLondonUK
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283
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Dalay S, Daly Guris RJ, Shelton CL, Charlesworth M. Reports in anaesthesia come of age! Anaesth Rep 2019; 7:61-64. [PMID: 32051951 PMCID: PMC6931304 DOI: 10.1002/anr3.12019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- S. Dalay
- Department of AnaesthesiaWorcestershire Acute Hospitals NHS TrustUK
| | - R. J. Daly Guris
- Children's Hospital of Philadelphia and University of PennsylvaniaUSA
| | - C. L. Shelton
- Department of AnaesthesiaWythenshawe HospitalManchester University Hospitals NHS Foundation TrustManchesterUK
| | - M. Charlesworth
- Department of Cardiothoracic AnaesthesiaWythenshawe HospitalManchester University Hospitals NHS Foundation TrustManchesterUK
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