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Emergancy Anaesthesia

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https://www.readbyqxmd.com/read/27913981/the-challenges-of-anaesthesia-and-pain-relief-in-hip-fracture-care
#1
Rachel Cowan, Jun Hao Lim, Terence Ong, Ashok Kumar, Opinder Sahota
The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia...
December 3, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27909609/emergency-difficult-airway-management-in-a-patient-with-severe-epidermolysis-bullosa
#2
Ahmet Selim Özkan, Gülay Erdoğan Kayhan, Sedat Akbaş, Osman Kaçmaz, Mahmut Durmuş
Epidermolysis bullosa (EB) is a rare disease characterised by vesiculobullous lesions with minimal trauma to the skin and mucous membranes. Bleeding, scar tissue, contractures, oedema and lesions that can spread throughout the body can cause a difficult airway and vascular access in patients with EB. Therefore, anaesthetic management in patients with EB is a major problem even for experienced anaesthesiologists. Herein, we report a case of difficult airway management in a patient diagnosed with severe EB who presented for emergency tracheostomy because of respiratory failure under general anaesthesia...
October 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27908808/emergency-hybrid-approach-to-ruptured-femoral-pseudoaneurysm-in-hiv-positive-intravenous-drug-abusers
#3
Maurizio Domanin, Giovanni Romagnoni, Silvia Romagnoli, Antonio Rolli, Livio Gabrielli
PURPOSE: Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by HIV, can lead to the development of pseudoaneurysms. Rupture of pseudoaneurysm is a dramatic event in such patients and its correction is difficult and controversial. Most of the cases reported describe open surgical elective options, that consist in ligation, repair or substitution of the damaged arterial segment, employing when possible biological grafts...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27904169/lean-umbilical-cord-a-case-report
#4
N Rippinger, M Elsässer, P Sinn, C Sohn, H Fluhr
The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-old women who presented to us at 29 + 4 weeks gestation with vaginal bleeding and cervical incompetence subsequently complicated not only by premature rupture of membranes but also acute placental insufficiency requiring emergency caesarean section under general anaesthesia at 31 + 2 weeks gestation. At surgery no obvious cause for the acute placental insufficiency - such as placental abruption, cord prolapse or true knot of the umbilical cord - was found...
November 2016: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/27896148/plasma-lyte-148-a-clinical-review
#5
Laurence Weinberg, Neil Collins, Kiara Van Mourik, Chong Tan, Rinaldo Bellomo
AIM: To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS: We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: "surgery", "anaesthesia", "anesthesia", "anesthesiology", "anaesthesiology", "fluids", "fluid therapy", "crystalloid", "saline", "plasma-Lyte", "plasmalyte", "hartmann's", "ringers" "acetate", "gluconate", "malate", "lactate"...
November 4, 2016: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27895441/a-retrospective-analysis-of-postoperative-patients-admitted-to-the-intensive-care-unit
#6
S Uzman, Y Yilmaz, M Toptas, I Akkoc, Y G Gul, H Daskaya, Y Toptas
BACKGROUND: The aim of this retrospective study was to evaluate postoperative patients admitted to the intensive care unit (ICU) and to describe their characteristics and outcomes. METHODS: We performed a retrospective chart review of 1,756 postoperative patients admitted to the ICU of a tertiary referral hospital from January 2008 to December 2012. For each patient we recorded: demographic data, reason for admission to the ICU, duration of mechanical ventilation, elective versus emergency surgery, type of anaesthesia, American Society of Anesthesiologists (ASA) physical status, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score (GCS), and outcome...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27892433/efficacy-of-prophylactic-b-lynch-suture-during-lower-segment-caesarian-section-in-high-risk-patients-for-atonic-postpartum-haemorrhage
#7
M Vijayasree
Background Postpartum Haemorrhage causes significant maternal mortality and morbidity all over the world. Active management of the third stage of labour with oxytocics is come into practice. If postpartum haemorrhage is anticipated conservative surgical procedures like B-lynch suture is being applied. Objective To evaluate the effect of elective B-Lynch suture in preventing atonic postpartum haemorrhage during emergency caesarian section with high risk factors for atonicity. Method Forty antenatal women undergoing emergency caesarean section with risk factors for atony of the uterus were selected in our study...
January 2016: Kathmandu University Medical Journal (KUMJ)
https://www.readbyqxmd.com/read/27891405/complete-heart-block-in-pregnancy-a-report-of-emergency-caesarean-section-in-a-parturient-without-pacemaker
#8
Vandana Mohapatra, Aparajita Panda, Satyanarayan Behera, Jagadish Chandra Behera
Management of women with Complete Heart Block (CHB) presenting without pacing, during pregnancy and labour is debatable. Temporary pacemakers have been routinely inserted for labour and birth probably to withstand any haemodynamic variations. However, due to lack of large scale prospective studies, the necessity of this procedure has not been objectively assessed. Also, the most appropriate anaesthetic technique for caesarean section in women with CHB is yet to be clarified. We report herein the case of a pregnant woman with CHB who had uneventful emergency caesarean delivery under spinal anaesthesia without temporary pacing...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27891026/anaesthesia-management-in-craniovertebral-junctional-anomalies
#9
REVIEW
Oswald Mascarenhas
Craniovertebral Junctional (CVJ) anomalies are developmental disorders that affect the skeleton and enclosed neuraxis at the junction of cranium and cervical spine. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardiovascular manifestations poses a high anaesthetic risk to these patients. This article provides a discussion of management of anaesthesia in patients with craniovertebral anomalies, the evaluation of risk factors in these patients and their management, including emergency airway issues...
October 2016: Journal of Craniovertebral Junction and Spine
https://www.readbyqxmd.com/read/27888429/inappropriateness-of-diagnostic-imaging-examinations-in-the-inpatient-setting-a-case-study-research
#10
Ettore Squillaci, Francesca Bolacchi, Jacopo Scaggiante, Francesca Ricci, Luca Pugliese, Alberto Bergamini, Francesco Garaci, Roberto Floris
OBJECTIVE: The purpose of our study was to audit the clinical appropriateness of the prescriptions of whole body CT (WB-CT), PET-CT and chest X-rays (CXRs) performed at Tor Vergata University Hospital in the inpatient setting. MATERIALS AND METHODS: WB-CT, PET-CT and CXRs examinations were retrospectively analysed in the period between January and December 2014. CXR examinations were divided into bedside CXRs and traditional CXRs. The appropriateness of the examinations was defined according the American College of Radiology Appropriateness Criteria...
November 25, 2016: La Radiologia Medica
https://www.readbyqxmd.com/read/27859872/patient-participation-in-postoperative-pain-assessment-after-spine-surgery-in-a-recovery-unit
#11
Kirsten Kaptain, Vibeke Bregnballe, Pia Dreyer
AIMS AND OBJECTIVES: This study aimed to explore how patients undergoing spine surgery participated in postoperative pain assessment in a recovery unit. BACKGROUND: Despite advances in medicine, pharmaceutical and technical knowledge, patients report considerable postoperative pain after spine surgery. Research shows that patients require efficient individual pain treatment and that their participation has a positive effect on pain treatment. DESIGN: This study was based on a phenomenological-hermeneutic design...
November 9, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27844477/videolaryngoscopy-versus-direct-laryngoscopy-for-adult-patients-requiring-tracheal-intubation
#12
REVIEW
Sharon R Lewis, Andrew R Butler, Joshua Parker, Tim M Cook, Andrew F Smith
BACKGROUND: Successful tracheal intubation during general anaesthesia traditionally requires a line of sight to the larynx attained by positioning the head and neck and using a laryngoscope to retract the tongue and soft tissues of the floor of the mouth. Difficulties with intubation commonly arise, and alternative laryngoscopes that use digital and/or fibreoptic technology have been designed to improve visibility when airway difficulty is predicted or encountered. Among these devices, a rigid videolaryngoscope (VLS) uses a blade to retract the soft tissues and transmits a lighted video image to a screen...
November 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27833487/measurement-of-endotracheal-tube-cuff-pressure-instrumental-versus-conventional-method
#13
Mueen Ullah Khan, Rashid Khokar, Sadia Qureshi, Tariq Al Zahrani, Mansoor Aqil, Motasim Shiraz
OBJECTIVE: To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method. STUDY DESIGN: Prospective observational study. PLACE AND DURATION OF STUDY: Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014-July 2014). METHODS: A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27832557/bow-tie-diagrams-for-risk-management-in-anaesthesia
#14
M D Culwick, A F Merry, D M Clarke, K J Taraporewalla, N M Gibbs
Bow-tie analysis is a risk analysis and management tool that has been readily adopted into routine practice in many high reliability industries such as engineering, aviation and emergency services. However, it has received little exposure so far in healthcare. Nevertheless, its simplicity, versatility, and pictorial display may have benefits for the analysis of a range of healthcare risks, including complex and multiple risks and their interactions. Bow-tie diagrams are a combination of a fault tree and an event tree, which when combined take the shape of a bow tie...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27830039/increasing-trend-in-retained-rectal-foreign-bodies
#15
Abraham A Ayantunde, Zynep Unluer
AIM: To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period. METHODS: Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed. Patients' clinical data and yearly case presentation with data relating to hospital episodes were collected. Data analysis was by SPSS Inc. Chicago, IL, United States. RESULTS: Twenty-five patients presented over a 5-year period with a mean age of 39 (17-62) years and M: F ratio of 2:1...
October 27, 2016: World Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/27807964/analgesia-nociception-monitoring-for-opioid-guidance-meta-analysis-of-randomized-clinical-trials
#16
Matthias Gruenewald, Astrid Dempfle
BACKGROUND: The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anaesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anaesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures...
November 3, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27807487/tibiofibula-transposition-in-high-energy-fractures
#17
Peter R Loughenbury, Rebecca A Gledhill, Nick Evans
We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia...
2016: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/27786358/calling-the-patient-s-own-name-facilitates-recovery-from-general-anaesthesia-a-randomised-double-blind-trial
#18
Y S Jung, H Paik, S-H Min, H Choo, M Seo, J-H Bahk, J-H Seo
People can hear and pay attention to familiar terms such as their own name better than general terms, referred to as the cocktail party effect. We performed a prospective, randomised, double-blind trial to investigate whether calling the patient's name compared with a general term facilitated a patient's response and recovery from general anaesthesia. We enrolled women having breast cancer surgery with general anaesthesia using propofol and remifentanil. Patients were randomly allocated into two groups depending on whether the patient's name or a general term was called, followed by the verbal command - 'open your eyes!' - during emergence from anaesthesia; this pre-recorded sentence was played to the patient using headphones...
October 27, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27777355/analgesia-in-the-surgical-intensive-care-unit
#19
REVIEW
Eric Ehieli, Suraj Yalamuri, Charles S Brudney, Srinivas Pyati
Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients...
October 24, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27756210/prevalence-associated-factors-and-treatment-of-post-spinal-shivering-in-a-sub-saharan-tertiary-hospital-a-prospective-observational-study
#20
Tonny Stone Luggya, Richard Nicholas Kabuye, Cephas Mijumbi, Joseph Bahe Tindimwebwa, Andrew Kintu
BACKGROUND: Surgery and anaesthesia cause shivering due to thermal dysregulation as a compensatory mechanism and is worsened by vasodilatation from spinal anaesthesia that redistributes core body heat. Due to paucity of data Mulago Hospital's post spinal shivering burden is unknown yet it causes discomfort and morbidity. METHODS: Ethical approval was obtained to perform the study among consenting mothers due for elective caesarean section from March to May 2011...
October 18, 2016: BMC Anesthesiology
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