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M Bernhard, S Mohr, M A Weigand, E Martin, A Walther
BACKGROUND: Securing the airway by means of endotracheal intubation (ETI) represents a fundamental skill for anaesthesiologists in emergency situations. This study aimed to evaluate the time needed by first-year anaesthesiology residents to perform 200 ETIs and assessed the associated success rates and number of attempts until successful ETI. METHODS: This prospective single centre study evaluated the number of working days, the success rate, the attempts needed until successful ETI in consecutive blocks of 25 ETI procedures and the related difficulties and complications...
February 2012: Acta Anaesthesiologica Scandinavica
Maya Contreras, Claire Masterson, John G Laffey
PURPOSE OF REVIEW: Hypercapnia is a central component of diverse respiratory disorders, while 'permissive hypercapnia' is frequently used in ventilatory strategies for patients with severe respiratory failure. This review will present data from recent studies relating to hypercapnia, focusing on issues that are of importance to anesthesiologists caring for the surgical and/or critically ill patient. RECENT FINDINGS: Protective ventilatory strategies involving permissive hypercapnia are widely used in patients with severe respiratory failure, particularly in acute respiratory distress syndrome, status asthmaticus, chronic obstructive pulmonary disease and neonatal respiratory failure...
February 2015: Current Opinion in Anaesthesiology
Usharani Nimmagadda, M Ramez Salem, George J Crystal
Preoxygenation before anesthetic induction and tracheal intubation is a widely accepted maneuver, designed to increase the body oxygen stores and thereby delay the onset of arterial hemoglobin desaturation during apnea. Because difficulties with ventilation and intubation are unpredictable, the need for preoxygenation is desirable in all patients. During emergence from anesthesia, residual effects of anesthetics and inadequate reversal of neuromuscular blockade can lead to hypoventilation, hypoxemia, and loss of airway patency...
February 2017: Anesthesia and Analgesia
Marc Garnier, Francis Bonnet
PURPOSE OF REVIEW: Anesthesia outside the operating room is commonly uncomfortable and risky. In this setting, anesthetic emergencies or complications may occur. This review aims to report the most recent updates regarding the management of prehospital anesthesia, anesthesia in the trauma and emergency rooms, and anesthesia for endoscopy and interventional radiology. RECENT FINDINGS: After tracheal intubation failure, airway control of outpatients could be achieved by pharmacologically assisted laryngeal mask insertion...
August 2014: Current Opinion in Anaesthesiology
Nazar Salah, Ismat El Saigh, Niamh Hayes, Conan McCaul
BACKGROUND: Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access. METHODS: Anesthesiologists performed 4 airway access techniques on excised porcine tracheas. The techniques were 1) wire-guided (WGT), 2) trocar (TT), 3) needle cannula (NCT), and 4) surgical-scalpel with endotracheal tube (ST)...
December 2009: Anesthesia and Analgesia
R Flin, R Patey, R Glavin, N Maran
This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia...
July 2010: British Journal of Anaesthesia
T M Cook
Despite being infrequent, complications of airway management remain an important contributor to morbidity and mortality during anaesthesia and care of the critically ill. Developments in the last three decades have made anaesthesia safer, and this has been mirrored in the equipment and techniques available for airway management. Modern technology including novel oxygenation modalities, widespread availability of capnography, second-generation supraglottic airway devices and videolaryngoscopy provide the tools to make airway management safer still...
January 2018: Anaesthesia
Zeping Xu, Wuhua Ma, Douglas L Hester, Yandong Jiang
PURPOSE OF REVIEW: Management of difficult airway is far from optimal despite of continuous progress in science and technology. The purpose of this review is to summarize the current research in the field and bring readers up to date. RECENT FINDINGS: New technologies for intubation make providers more confident to handle difficult airways, but there is lack of evidence indicating the reduction in incidence of 'cannot intubate cannot ventilate (CICV)'. Optimization of mask ventilation should reduce the incidence of difficult mask ventilation but it is greatly underappreciated...
February 2018: Current Opinion in Anaesthesiology
A F McNarry, A Patel
In the last 25 yr, there have been several advances in the safe management of the airway. Videolaryngoscopes and supraglottic airways, now in routine use by new trainees in anaesthesia, have had their genesis in the recent past. The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society published in 2011 a seminal report that has influenced airway management worldwide . Understanding how the report's recommendations were constructed and how clinical guidelines compliment rather than contradict them is important in understanding the tenets of safe airway management...
December 1, 2017: British Journal of Anaesthesia
Robert J Schwartzman, Guillermo M Alexander, John R Grothusen
Complex regional pain syndrome is a neuropathic pain syndrome that is characterized by: severe pain beyond the area of injury; autonomic dysregulation; neurogenic edema; movement disorder; and atrophy and dystrophy. Ketamine is an open-channel NMDA blocker that only acts on those receptors whose Mg(2+) block has been lifted. It is effective in the treatment of the syndrome when standard treatments have failed. Different protocols are utilized depending on the severity of illness. There have been no serious ketamine-induced complications from these protocols, owing to careful psychological screening and the liberal use of midazolam and lorazepam to counter any psychomimetic effects and clonidine to block possible 'Olney's' lesions...
May 2011: Expert Review of Neurotherapeutics
James D Griffiths, Gillian M L Gyte, Shantini Paranjothy, Heather C Brown, Hannah K Broughton, Jane Thomas
BACKGROUND: Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and can also occur in the period following the procedure.  OBJECTIVES: To assess the efficacy of pharmacological and non-pharmacological interventions given prophylactically to prevent nausea and vomiting in women undergoing regional anaesthesia for caesarean section. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 February 2012) and reference lists of identified studies...
September 12, 2012: Cochrane Database of Systematic Reviews
Arsen Uvelin, Jasmina Pejaković, Vesna Mijatović
More than 70% of intensive care unit (ICU) patients experience heart rhythm disturbances, and these patients have correspondingly higher mortality rates. Consequently, one of the standards of care in ICUs is continuous electrocardiography monitoring. One of the potentially preventable dysrhythmic events is the occurrence of torsade de pointes ventricular tachycardia in the setting of acquired prolonged QT interval. This type of ventricular tachycardia can be malignant because it often progresses to ventricular fibrillation...
June 2017: Journal of Anesthesia
N MacDonald, R M Pearse
The approach to i.v. fluid therapy for hypovolaemia may significantly influence outcomes for patients who experience a systemic inflammatory response after sepsis, trauma, or major surgery. Currently, there is no single i.v. fluid agent that meets all the criteria for the ideal treatment for hypovolaemia. The physician must choose the best available agent(s) for each patient, and then decide when and how much to administer. Findings from large randomized trials suggest that some colloid-based fluids, particularly starch-based colloids, may be harmful in some situations, but it is unclear whether they should be withdrawn from use completely...
December 1, 2017: British Journal of Anaesthesia
Douglas E Raines
No abstract text is available yet for this article.
2015: International Anesthesiology Clinics
Tom G Hansen
PURPOSE OF REVIEW: There is a growing medical demand for suitable sedatives and analgesics to support the ongoing progress in diagnostic procedures and imaging techniques. This review provides an update of the pharmacology of the most commonly used drugs used for these procedures and shortly mention new drugs on the horizon. RECENT FINDINGS: There are many drugs available for procedural sedation; however, they all have drawbacks and shortcomings. Multiple adverse effects are associated with the use of these agents, hence monitoring is essential, and emergency equipment should be readily available...
August 2015: Current Opinion in Anaesthesiology
Stuart A Forman
This review focuses on the unique clinical and molecular pharmacologic features of etomidate. Among general anesthesia induction drugs, etomidate is the only imidazole, and it has the most favorable therapeutic index for single-bolus administration. It also produces a unique toxicity among anesthetic drugs: inhibition of adrenal steroid synthesis that far outlasts its hypnotic action and that may reduce survival of critically ill patients. The major molecular targets mediating anesthetic effects of etomidate in the central nervous system are specific γ-aminobutyric acid type A receptor subtypes...
March 2011: Anesthesiology
Flávia Vieira Guimarães Hartmann, Maria Rita Carvalho Garbi Novaes, Marta Rodrigues de Carvalho
BACKGROUND: Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient...
January 2017: Brazilian Journal of Anesthesiology
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...
January 2017: Drugs & Aging
Rhona Flin, Nikki Maran
In this paper, we explain the conceptual background to non-technical skills and show how they can influence job performance in anaesthesia. We then describe the taxonomy of anaesthetists' non-technical skills (ANTS) and related systems, such as ANTS-AP for anaesthetic practitioners. We discuss the training courses that have been designed to teach these non-technical skills, which are called crew resource management (CRM), crisis resource management (CRM) or crisis avoidance resource management (CARMA). Finally, we discuss the application of non-technical skills assessment systems...
March 2015: Best Practice & Research. Clinical Anaesthesiology
Jonathan Ilicki
BACKGROUND: Digital nerve blocks are commonly performed in emergency departments. Health care practitioners are often taught to avoid performing blocks with epinephrine due to a risk of digital necrosis. OBJECTIVE: To review the literature on the safety of epinephrine 1:100,000-200,000 (5-10 μg/mL) with local anesthetics in digital nerve blocks in healthy patients and in patients with risk for poor peripheral circulation. METHODS: PubMed, Web of Science, and the Cochrane Library were searched in June 2014 using the query "digital block AND epinephrine OR digital block AND adrenaline"...
November 2015: Journal of Emergency Medicine
2017-11-09 11:41:37
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