Anaesthesia & Critical Care Medicine Journal最新文献

Propofol for Conscious Sedation for Fibreoptic Nasotracheal Intubation: Comparison with Fentanyl - Midazolam Combination 异丙酚用于纤维气管插管清醒镇静:与芬太尼-咪达唑仑联合应用的比较

Anaesthesia & Critical Care Medicine Journal Pub Date : 2018-06-11 DOI: 10.23880/ACCMJ-16000133

K. Saxena

{"title":"Propofol for Conscious Sedation for Fibreoptic Nasotracheal Intubation: Comparison with Fentanyl - Midazolam Combination","authors":"K. Saxena","doi":"10.23880/ACCMJ-16000133","DOIUrl":"https://doi.org/10.23880/ACCMJ-16000133","url":null,"abstract":"The safest way of doing fibreoptic intubation is with the patient under conscious sedation and maintaining spontaneous respiration. Short acting and easily titrable analgesics are excellent choices for the intensely , but usually brief airway manipulation during fibreoptic nasotracheal intubation .This study was undertaken to evaluate the efficacy of propofol for conscious sedation for FOI and to compare it with a combination of fentanyl and midazolam which is frequently used for this purpose. The parameters studied were, the quality of sedation, intubating conditions, haemodynamic changes, degree of amnesia and global acceptance of the procedure under topical anaesthesia. In our study, we found that in the doses used by us, propofol produced comparable intubating conditions as a combination of midazolam and fentanyl. It produced significantly more sedation but difference between the two groups was significant only at 2 minutes (p value=0.028). Propofol leads to less increase in heart rate when the fiberscope was inserted endotracheally (P value=.007) .As the procedure progressed more boluses of propofol were needed to continue with the procedure. The degree of amnesia for the procedure was less with propofol however; the degree of global acceptance was comparable. To conclude propofol can be used for nasotracheal fibreoptic intubation, however its role in difficult airway and the dose required need more evaluation.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121506635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Paediatric Perioperative Life Support: Safety in the Fast Lane 儿科围手术期生命支持:安全的快车道

Anaesthesia & Critical Care Medicine Journal Pub Date : 2018-06-11 DOI: 10.23880/ACCMJ-16000136

L. Chan

引用次数: 1

Practical Tips in Neuromodulation for Pain 疼痛神经调节的实用技巧

Anaesthesia & Critical Care Medicine Journal Pub Date : 2018-06-11 DOI: 10.23880/ACCMJ-16000134

D. Bendersky

引用次数: 0

Acute Left Ventricular Outflow Tract Obstruction in Non - Mitral Cardiovascular Surgery: A Case Series Analysis 非二尖瓣心血管手术急性左心室流出道阻塞:一个病例系列分析

Anaesthesia & Critical Care Medicine Journal Pub Date : 2018-06-11 DOI: 10.23880/ACCMJ-16000137

L. Krichevskiy

{"title":"Acute Left Ventricular Outflow Tract Obstruction in Non - Mitral Cardiovascular Surgery: A Case Series Analysis","authors":"L. Krichevskiy","doi":"10.23880/ACCMJ-16000137","DOIUrl":"https://doi.org/10.23880/ACCMJ-16000137","url":null,"abstract":"Objective: We aimed to analyze the clinical signs of left ventricular outflow tract obstruction and its management in the perioperative period of major non-mitral cardiovascular procedures. Design. Case series analysis. Methods and Results Thirteen (10 males, 3 females) patients aged 64 (56; 74) y.o. with acutely emerged left ventricular outflow tract obstruction during/after non-mitral cardiovascular procedure between May 2006 and May 2018 were included. Methods: The procedures were as follows: coronary artery bypass grafting – n=11, aortic valve replacement – n=1, abdominal aortic membrane resection (aortic dissection DeBakey type I, acute legs ischemia) – n=1. Left ventricular outflow tract obstruction with systolic anterior motion of anterior leaflet of mitral valve was detected in 0.9% of the total number of perioperative echocardiography examinations. Three variants of its clinical course were described: (1) intracardiac and systemic hemodynamics recovery with a specific therapy (most cases); (2) full resistance to therapy with sustainable systolic anterior motion persistence; (3) termination of systolic anterior motion as a result of the therapy, but the paradoxical persistence of low cardiac output syndrome. Conclusion: Practitioners’ vigilance and Echocardiographic monitoring are needed for early detection of acute left ventricular outflow tract obstruction. Its development can be a marker of the extremely hard concentric left ventricular hypertrophy as a cause of the low cardiac output syndrome.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114894266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

As A Clinical and Radiographic Syndrome Posterior Reversible Encephalopathy Syndrome (PRES) 后可逆性脑病综合征(PRES)作为一种临床和影像学综合征

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000160

A. Sonmezler

引用次数: 0

Direct Percutaneous Tracheostomy from NIV in ICU Patients with Respiratory Failure - A Case Series ICU呼吸衰竭患者直接经皮气管切开术-一个病例系列

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000146

L. Rahman

{"title":"Direct Percutaneous Tracheostomy from NIV in ICU Patients with Respiratory Failure - A Case Series","authors":"L. Rahman","doi":"10.23880/accmj-16000146","DOIUrl":"https://doi.org/10.23880/accmj-16000146","url":null,"abstract":"Nationally thousands of patients every year require endotracheal intubation after failure of non-invasive ventilation for a multitude of pathologies. These pathologies include but are not limited to chest infections, exacerbations of known lung disease, pancreatitis, neuromuscular diseases and acute respiratory distress syndrome (ARDS). Some of these patients may also be severely haemodynamically unstable and therefore intubation may be associated with a high risk of cardiovascular collapse despite the clinician’s best intentions. Patients that will require mechanical ventilation for a prolonged period or be slow to wean off mechanical ventilation can often be accurately predictable. We identified three patients and performed a percutaneous tracheostomy directly from NIV whilst bypassing endotracheal intubation. All 3 of these patients were severely haemodynamically unstable to the extent it was felt that all 3 may completely cardiovascular collapse in the induction or sedative period. However all 3 required invasive ventilation. The procedure was performed under ultrasound guidance, with local anaesthetic infiltration and under light sedation. We describe all three of these patients. The procedure was well tolerated in all 3 cases. Airway care and tracheal suctioning could start immediately after the procedure. As these patients never had to be sedated and ventilated for a prolonged period, no deconditioning occurred. A change to their pre-tracheostomy ventilator settings was not always necessary and weaning could begin promptly. By avoiding the typical 7-10 day period of intubation and deconditioning, it is approximated ITU stay could be cut by up to 7 days. This can have a significant economic impact in both ITU bed days as well as physical capacity. We devised a safety checklist to maintain safety during the procedure, advocating the use of ultrasound whilst remaining aware at all times of the potential urgent need for airway protection.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122665071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perioperative Upper Extremity Peripheral Nerve Injury and Patient Positioning: What Anesthesiologists Need to Know 围手术期上肢周围神经损伤和患者定位:麻醉师需要知道的

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000155

I. Kamel

引用次数: 1

Opinion Piece: Providers - Computers - Patients (Technology Wall in Healthcare) 评论:供应商-计算机-患者(医疗保健领域的技术壁垒)

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000153

Venkatraman Palabindela

引用次数: 0

Acetaminophen Induced Transient Hypothermia in Pediatrics Population Undergoing General Anesthesia; a Double Blinded Randomized Controlled Clinical Trial 对乙酰氨基酚致儿科全麻患者短暂性体温过低一项双盲随机对照临床试验

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000194

Kafrouni Hf

{"title":"Acetaminophen Induced Transient Hypothermia in Pediatrics Population Undergoing General Anesthesia; a Double Blinded Randomized Controlled Clinical Trial","authors":"Kafrouni Hf","doi":"10.23880/accmj-16000194","DOIUrl":"https://doi.org/10.23880/accmj-16000194","url":null,"abstract":"Background: Perioperative hypothermia has been strongly associated with poor outcomes in children undergoing general anesthesia. Methods: This study consisted of a monocentric, block randomized, double blinded, placebo-controlled clinical trial over a period of 3 months at a tertiary referral center. Non-febrile patients with no significant medical history younger than 3 years and having surgery for a minimum duration of one hour under General Anesthesia were chosen. Thirty minutes prior to emergence, patients received either IV Acetaminophen (Group P) or a placebo solution of normal saline (Group N). The temperature was recorded at T0, T15, T30, T45 and T60 intervals. Results: 60 out of 84 patients were enrolled, the sample consisted of 58.3% (n=35) males and 41.7% (n=25) females with a mean age 1.16 ± 0.92 years. When using a t test to compare the mean core temperature, at a 95% Confidence Interval and ±=0.05, data showed that in Group P (35.52 ±0.68 oC < 36°C) and in Group N (36.07 ±0.71 oC > 36°C) were significantly different at T30 (p<0.005). A similar significance was observed at T45 yet not at T60. Conclusion: Acetaminophen seems to have induced a significant transient hypothermia at T30 in the pediatric population, which coincides in this study with the critical time of emergence. At T60, no significant difference was observed, suggesting that patients’ core body temperature values returned to normality. Therefore, it is recommended to administer Acetaminophen at least 60 minutes prior to emergence to avoid a core temperature drop during this critical phase.","PeriodicalId":313122,"journal":{"name":"Anaesthesia & Critical Care Medicine Journal","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134177720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative Fraction of Inspired Oxygen: An Enigma to be Unravelled 术中吸入氧的比例:一个有待解开的谜

Anaesthesia & Critical Care Medicine Journal Pub Date : 1900-01-01 DOI: 10.23880/accmj-16000163

J. Agrawal

引用次数: 1