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Anaesthesia

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https://www.readbyqxmd.com/read/27910094/the-obstetric-difficult-airway-if-we-can-t-predict-it-can-we-prevent-it
#1
EDITORIAL
T Girard, A Palanisamy
No abstract text is available yet for this article.
December 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27900760/choice-of-anaesthesia-for-category-1-caesarean-section-in-women-with-anticipated-difficult-tracheal-intubation-the-use-of-decision-analysis
#2
A J Krom, Y Cohen, J P Miller, T Ezri, S H Halpern, Y Ginosar
A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia...
November 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27897312/the-feasibility-of-micro-ultrasound-as-a-tool-to-image-peripheral-nerves
#3
A Chandra, R Eisma, P Felts, S Munirama, G A Corner, C E M Demore, G McLeod
Despite widespread use of ultrasound imaging to guide needle placement, the incidence of transient and permanent nerve damage as a complication of regional anaesthesia has not changed over the last decade. In view of the controversy surrounding intraneural injection there is a need to understand the structural changes caused by subepineural and subperineural needle penetration. Clinical ultrasound machines do not provide adequate anatomical resolution, and anaesthetists have difficulty judging the precise location of the needle tip relative to the epineurium...
November 29, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27891584/an-observational-study-of-the-macro-and-micro-haemodynamic-implications-of-epidural-anaesthesia-in-children
#4
L Triffterer, P Marhofer, G Lechner, T C Marksz, O Kimberger, W Schmid, D Marhofer
The haemodynamic implications of epidural anaesthesia in children are poorly documented. We report macro- and micro-haemodynamic data from an observational study of 25 children ranging from neonates to six-years old, who underwent surgery conducted with a specific combination of monitoring systems. We analysed 90 min of study-related monitoring after epidural catheterisation, with skin incision taking place after around 30 min. We recorded macrohaemodynamic parameters (monitored using LiDCOrapid) including heart rate, mean arterial pressure, cardiac output, stroke volume, systemic vascular resistance and stroke volume variation...
November 28, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27891579/unexpected-motor-weakness-following-quadratus-lumborum-block-for-gynaecological-laparoscopy
#5
M Wikner
Quadratus lumborum block has recently been described as an effective and long-lasting analgesic strategy for various abdominal operations, including gynaecological laparoscopy. Despite evidence that the analgesic effect is mediated by indirect paravertebral block and that local anaesthetic spreads to the lumbar paravertebral space, there have been no reports to date of lower limb motor weakness. We present a patient with unilateral hip flexion and knee extension weakness leading to unplanned overnight admission following lateral quadratus lumborum block with 20 ml levobupivacaine 0...
November 28, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27891606/putting-the-point-back-into-the-ritual-a-binary-approach-to-difficult-airway-prediction
#6
EDITORIAL
J J Pandit, T Heidegger
No abstract text is available yet for this article.
November 27, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27882541/prediction-of-difficult-mask-ventilation-using-a-systematic-assessment-of-risk-factors-vs-existing-practice-a-cluster-randomised-clinical-trial-in-94-006-patients
#7
A K Nørskov, J Wetterslev, C V Rosenstock, A Afshari, G Astrup, J C Jakobsen, J L Thomsen, L H Lundstrøm
We compared implementation of systematic airway assessment with existing practice of airway assessment on prediction of difficult mask ventilation. Twenty-six departments were cluster-randomised to assess eleven risk factors for difficult airway management (intervention) or to continue with their existing airway assessment (control). In both groups, patients predicted as a difficult mask ventilation and/or difficult intubation were registered in the Danish Anaesthesia Database, with a notational summary of airway management...
November 24, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27882535/evaluation-of-three-unchannelled-videolaryngoscopes-and-the-macintosh-laryngoscope-in-patients-with-a-simulated-difficult-airway-a-randomised-controlled-trial
#8
M Kleine-Brueggeney, M Buttenberg, R Greif, S Nabecker, L Theiler
This prospective randomised, controlled trial compares the performance of three unchannelled videolaryngoscopes (KingVision(™) , Airtraq(™) , A.P. Advance(™) MAC) and the standard Macintosh laryngoscope. With ethics committee approval and written informed consent, 480 patients were included. A difficult airway was created with a cervical collar, limiting mouth opening and neck movement. Primary outcome was first-attempt orotracheal intubation success. Overall success, laryngeal view, intubation difficulty scale, handling, intubation times and side-effects were secondary outcomes...
November 24, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27869303/acute-care-an-important-component-of-the-continuum-of-care-for-hiv-and-tuberculosis-in-developing-countries
#9
EDITORIAL
P Bock, H Cox
No abstract text is available yet for this article.
November 21, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27868190/intensive-care-medicine-in-rural-sub-saharan-africa
#10
M W Dünser, R M Towey, J Amito, M Mer
We undertook an audit in a rural Ugandan hospital that describes the epidemiology and mortality of 5147 patients admitted to the intensive care unit. The most frequent admission diagnoses were postoperative state (including following trauma) (2014/5147; 39.1%), medical conditions (709; 13.8%) and traumatic brain injury (629; 12.2%). Intensive care unit mortality was 27.8%, differing between age groups (p < 0.001). Intensive care unit mortality was highest for neonatal tetanus (29/37; 78.4%) and lowest for foreign body aspiration (4/204; 2...
November 21, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27868189/an-evaluation-of-inpatient-morbidity-and-critical-care-provision-in-zambia
#11
P J Dart, J Kinnear, M D Bould, S L Mwansa, Z Rakhda, D Snell
The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48-h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One-hundred and twenty medical and surgical admissions were studied. Fifty-four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines...
November 21, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27861696/a-cadaver-study-comparing-three-fibreoptic-assisted-techniques-for-converting-a-supraglottic-airway-to-a-cuffed-tracheal-tube
#12
B L Olesnicky, A Rehak, W B Bestic, J T Brock, L Watterson
After rescuing an airway with a supraglottic airway device, a method to convert it to a cuffed tracheal tube is often needed. The best method to do this has never been directly studied. We compared three techniques for conversion of a standard LMA(®) Unique airway to a cuffed endotracheal tube using a fibrescope. The primary endpoint was time to intubation, with secondary endpoints of success rate, perceived difficulty and preferred technique. We also investigated the relationship between level of training and prior training and experience with the techniques on the primary outcome...
November 11, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27858980/classifying-variables
#13
S W Choi, D M H Lam
No abstract text is available yet for this article.
November 11, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27809332/complications-after-emergency-laparotomy-beyond-the-immediate-postoperative-period-a-retrospective-observational-cohort-study-of-1139-patients
#14
L T Tengberg, M Cihoric, N B Foss, M Bay-Nielsen, I Gögenur, R Henriksen, T K Jensen, M-B Tolstrup, L B J Nielsen
Mortality and morbidity occur commonly following emergency laparotomy, and incur a considerable clinical and financial healthcare burden. Limited data have been published describing the postoperative course and temporal pattern of complications after emergency laparotomy. We undertook a retrospective, observational, multicentre study of complications in 1139 patients after emergency laparotomy. A major complication occurred in 537/1139 (47%) of all patients within 30 days of surgery. Unadjusted 30-day mortality was 20...
November 3, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27804117/effects-of-an-alveolar-recruitment-manoeuvre-guided-by-lung-ultrasound-on-anaesthesia-induced-atelectasis-in-infants-a-randomised-controlled-trial
#15
I-K Song, E-H Kim, J-H Lee, S Ro, H-S Kim, J-T Kim
Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia-induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume-controlled ventilation with 5 cmH2 O positive end-expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27804116/the-impact-of-critical-event-checklists-on-medical-management-and-teamwork-during-simulated-crises-in-a-surgical-daycare-facility
#16
T C Everett, P J Morgan, R Brydges, M Kurrek, D Tregunno, L Cunningham, A Chan, D Forde, J Tarshis
Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27804114/helping-experts-and-expert-teams-perform-under-duress-an-agenda-for-cognitive-aid-research
#17
EDITORIAL
S D Marshall
No abstract text is available yet for this article.
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27804113/can-systematic-reviews-with-sparse-data-be-trusted
#18
EDITORIAL
A Afshari, J Wetterslev, A F Smith
No abstract text is available yet for this article.
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27804108/tracheal-extubation-of-the-adult-intensive-care-patient-with-a-predicted-difficult-airway-a-narrative-review
#19
REVIEW
D J Sturgess, K B Greenland, S Senthuran, F A Ajvadi, A van Zundert, M G Irwin
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27797158/the-impact-of-didactic-read-aloud-action-cards-on-the-performance-of-cannula-cricothyroidotomy-in-a-simulated-can-t-intubate-can-t-oxygenate-scenario
#20
R Harvey, L Foulds, T Housden, K A Bennett, D Falzon, A F McNarry, C Graham
Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario...
October 31, 2016: Anaesthesia
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