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Jason R West, Anthony Scoccimarro, Cody Kramer, Nicholas D Caputo
OBJECTIVES: We sought to examine the physiological impact the apneic period has on the respiratory physiology of patients undergoing intubation in the emergency department and whether DAO, the delivery of 15L oxygen by nasal cannula during apnea, can affect the development of respiratory acidosis. METHODS: This was a prospective observational cohort study conducted at an urban academic level 1 trauma center. A convenience sample of 100 patients was taken. Timed data collection forms were completed during the periintubation period...
April 2, 2017: American Journal of Emergency Medicine
C A Hagberg, R T Connis
No abstract text is available yet for this article.
February 2016: British Journal of Anaesthesia
Laura F Cavallone, Andrea Vannucci
Respiratory complications after tracheal extubation are associated with significant morbidity and mortality, suggesting that process improvements in this clinical area are needed. The decreased rate of respiratory adverse events occurring during tracheal intubation since the implementation of guidelines for difficult airway management supports the value of education and guidelines in advancing clinical practice. Accurate use of terms in defining concepts and describing distinct clinical conditions is paramount to facilitating understanding and fostering education in the treatment of tracheal extubation-related complications...
February 2013: Anesthesia and Analgesia
Jeffrey L Apfelbaum, Carin A Hagberg, Robert A Caplan, Casey D Blitt, Richard T Connis, David G Nickinovich, Carin A Hagberg, Robert A Caplan, Jonathan L Benumof, Frederic A Berry, Casey D Blitt, Robert H Bode, Frederick W Cheney, Richard T Connis, Orin F Guidry, David G Nickinovich, Andranik Ovassapian
No abstract text is available yet for this article.
February 2013: Anesthesiology
M C Mushambi, S M Kinsella, M Popat, H Swales, K K Ramaswamy, A L Winton, A C Quinn
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered...
November 2015: Anaesthesia
M Popat, V Mitchell, R Dravid, A Patel, C Swampillai, A Higgs
Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri-operative practice...
March 2012: Anaesthesia
Carlos A Artime, Carin A Hagberg
Numerous practice guidelines have been developed to assist clinicians in the management of the difficult airway. The nature of difficult airway management, however, does not provide a practical way of comparing different guidelines or algorithms; no evidence supports one set of guidelines over another. Nevertheless they play an important role in patient safety as dissemination of such guidelines encourages airway practitioners to consider their strategies and formulate specific plans for the management of a predicted or unexpected difficult airway...
June 2015: Anesthesiology Clinics
Joe Nemeth, Nisreen Maghraby, Sara Kazim
Patients requiring airway management in the emergency department present an enormous challenge. It requires not only a firm concept of techniques for securing the airway but also of dealing with the potential difficult airway (DA) in which establishing a definite airway is not possible with techniques routinely used. This article highlights the importance of recognition and management of the DA in emergent situations. Both awake and nonawake intubation are discussed, and indications and guidelines are given for the use of nonsurgical and surgical airway interventions...
May 2012: Emergency Medicine Clinics of North America
N Jagannathan, L Sohn, J E Fiadjoe
No abstract text is available yet for this article.
September 2016: British Journal of Anaesthesia
A Pourmand, M Mazer-Amirshahi, C Royall, R Alhawas, R Shesser
There is a need for alternative non-opioid analgesics for the treatment of acute, chronic, and refractory pain in the emergency department (ED). Ketamine is a fast acting N-methyl-d-aspartate (NMDA) receptor antagonist that provides safe and effective analgesia. The use of low dose ketamine (LDK) (<1mg/kg) provides sub-dissociative levels of analgesia and has been studied as an alternative and/or adjunct to opioid analgesics. We reviewed 11 studies using LDK either alone or in combination with opioid analgesics in the ED...
March 2, 2017: American Journal of Emergency Medicine
Takashi Asai
No abstract text is available yet for this article.
March 3, 2017: Journal of Anesthesia
Jeff Riddell, Alexander Tran, Rimon Bengiamin, Gregory W Hendey, Patil Armenian
OBJECTIVE: Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups. METHODS: We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation...
February 13, 2017: American Journal of Emergency Medicine
Kevin James Tierney, Tiffany Murano, Brenda Natal
BACKGROUND: Local anesthetics are commonly used in the emergency department (ED). Overdoses can lead to disastrous complications including cardiac toxicity and arrest. Recognition of local anesthetic systemic toxicity (LAST) is important; however, prevention is even more critical. Knowledge of proper lidocaine dosage can prevent LAST. LAST may be effectively treated with lipid emulsion therapy. Although the mechanism is not well understood, its use may have a profound impact on morbidity and mortality...
January 2016: Journal of Emergency Medicine
Başak Ceyda Meço, Ahmet Onat Bermede, Zekeriyya Alanoğlu, Olcay Yaka, Neslihan Alkış
OBJECTIVE: This prospective, randomized, double-blinded study aimed to compare the effects of three different doses of ketamine or lidocaine on intubating conditions and haemodynamics in a rapid-sequence induction model with 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium. METHODS: A total of 128 ASA I-III patients who were scheduled for elective surgery were randomized in the following five groups: Group 1 (n=24), 1 mg kg(-1) lidocaine+3 mg kg(-1) propofol+0...
February 2016: Turkish Journal of Anaesthesiology and Reanimation
Ghada M N Bashandy
The endothelial glycocalyx is a labile, fine structure coating the luminal membrane of intact healthy vascular endothelium. For many decades, no physiologic importance was linked to this structure. It is crucial for vascular barrier function. There has been an immense interest in recent years for studying this important structure, and research is needed to disclose more information about it. Perioperative damage of the glycocalyx has been demonstrated, and is linked with morbidity and even mortality in surgical patients...
April 2015: Journal of Anesthesia
Ashish Udeshi, Shawn Michael Cantie, Edgar Pierre
Postobstructive pulmonary edema (POPE; also known as negative pressure pulmonary edema) is a potentially life-threatening complication in which pulmonary edema occurs shortly after the relief of an upper airway obstruction. The incidence of POPE has been reported to be as high as 1 in 1000 general anesthetic cases and commonly presents as acute respiratory distress that requires immediate intervention. This review examines the 2 subclasses of POPE and describes the etiologic factors, pathophysiology, clinical manifestations, diagnostic criteria, and treatment strategies associated with each...
September 2010: Journal of Critical Care
Lei Yang, Hui Liu, Hai-Ying Sun, Gui-Rong Li
BACKGROUND: Propofol is widely used clinically for the induction and maintenance of anesthesia. Clinical case reports have shown that propofol has an antiatrial tachycardia/fibrillation effect; however, the related ionic mechanisms are not fully understood. The current study investigates the effects of propofol on human cardiac potassium channels. METHODS: The whole cell patch voltage clamp technique was used to record transient outward potassium current (Ito) and ultrarapidly activating delayed rectifier potassium current (IKur) in human atrial myocytes and hKv1...
March 2015: Anesthesiology
Christopher B Wolff, David W Green
The paper examines the effects of anaesthesia on circulatory physiology and their implications regarding improvement in perioperative anaesthetic management. Changes to current anaesthetic practice, recommended recently, such as the use of flow monitoring in high risk patients, are already beginning to have an impact in reducing complications but not mortality [1]. Better understanding of the patho-physiology should help improve management even further. Analysis of selected individual clinical trials has been used to illustrate particular areas of patho-physiology and how changes in practice have improved outcome...
December 2014: International Journal of Surgery
Martín Cuesta, Christopher Thompson
BACKGROUND: Hyponatraemia is the most common electrolyte disturbance in hospitalized patients. There is an increasing awareness of the impact of hyponatraemia on the perioperative management of surgical patients. METHODS: We performed a literature review. We have included relevant data from different surgical disciplines for analysis. In this review we discuss the differential diagnosis of hyponatraemia, and explain the specific relevance of hyponatraemia to pre-, peri- and post-operative care...
June 2015: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Thomas Schricker, Ralph Lattermann
PURPOSE: This article reviews the pathophysiology, clinical relevance, and therapy of the catabolic response to surgical stress. PRINCIPLE FINDINGS: The key clinical features of perioperative catabolism are hyperglycemia and loss of body protein, both metabolic consequences of impaired insulin function. Muscle weakness and (even moderate) increases in perioperative blood glucose are associated with morbidity after major surgery. Although the optimal glucose concentration for improving clinical outcomes is unknown, most medical associations recommend treatment of random blood glucose > 10 mmol·L(-1)...
February 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
2017-02-21 01:01:51
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