Anaesthesia reports最新文献

{"title":"Retrodural space: a cadaveric evaluation","authors":"H. Elsharkawy,&nbsp;K. Lebak,&nbsp;A. Crofton,&nbsp;S. E. Pope,&nbsp;P. A. Traxler,&nbsp;S. A. Baraka,&nbsp;L. E. Tollinche","doi":"10.1002/anr3.12323","DOIUrl":"https://doi.org/10.1002/anr3.12323","url":null,"abstract":"<p>The retrodural space is an interfascial tissue plane located between the ligamentum flavum and the interspinous ligament [<span>1-3</span>]. The ligamentum flavum forms a barrier between the retrodural and epidural spaces; however, theoretically normal gaps can allow the spread of medications into the epidural space [<span>4</span>]. Therefore, this space can be a potential location for injecting local anaesthetics, leading to their spread into the dorsal rami, neural foramen and epidural space.</p><p>We investigated this technique in one unembalmed cadaver to determine the distribution of local anaesthetic and dye after injection into the lumbar retrodural space. Anterior–posterior fluoroscopic and ultrasound imaging (a curved array transducer in the transverse window between the L3 and L4 vertebrae) were used to guide the injection. An 18-gauge Tuohy needle was advanced in-plane from lateral to medial (left paramedian approach) (Fig. 1a). Once the needle tip was identified superficial to the ligamentum flavum with ultrasound and increased tactile resistance was noted, 6 ml of lidocaine 1% mixed with 0.5 ml methylene blue and 3.5 ml of iodinated contrast agent was injected (Fig. 1b).</p><p>We observed staining in the tissue plane deep (anterior) to the erector spinae muscles from T12 to L5 (Fig. 2a). The intact facet joints showed dye spread around the capsule (Fig. 2b). The lumbar dorsal root ganglion, the dura and the spinal nerves showed no staining (Fig. 2c).</p><p>This is the first cadaveric study of intentional injection into the retrodural space. This technique may prove useful for posterior truncal wall coverage as it allows the dorsal rami to be blocked.</p><p>The authors state that every effort was made to follow all local and international ethical guidelines and laws pertaining to the use of human cadaveric donors in anatomical research.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An exploration of the cognitive and affective processes for anaesthetists when performing an emergency front of neck airway*","authors":"L. R. Kidd,&nbsp;P. Wegrzynek,&nbsp;C. Newell,&nbsp;E. Wainwright","doi":"10.1002/anr3.12331","DOIUrl":"10.1002/anr3.12331","url":null,"abstract":"<div>\u0000 \u0000 <p>Emergency front of neck airway (eFONA) is a potentially lifesaving but very high-stress procedure. We explored the cognitive and affective processes involved via semi-structured interviews with 17 UK anaesthetists who had attempted eFONA within the previous two years. Thematic analyses generated two meta-themes: ‘Making the decision is the hardest part; the doing is easier’ and ‘What helps make the decision?’. We found concerns around scrutiny, lack of a flat hierarchy, unfamiliarity with the situation and the lack of a model for transitioning to eFONA. Culture change, using a shared mental model, priming and emotional disengagement, assisted with eFONA decision-making. Conclusions and implications for practice are presented.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395666","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}

{"title":"Facial fire with use of high-flow nasal oxygen during laser surgery","authors":"S. Shankla,&nbsp;N. De Zoysa,&nbsp;J. Bird,&nbsp;M. Girgis","doi":"10.1002/anr3.12329","DOIUrl":"10.1002/anr3.12329","url":null,"abstract":"<div>\u0000 \u0000 <p>Use of high-flow nasal oxygen to enable apnoeic oxygenation during tubeless airway surgery is well-established. The use of an ignition source in this oxygen-rich environment increases the risk of surgical fire. We present a case of facial fire secondary to the use of carbon dioxide laser and high-flow nasal oxygen during a surgical procedure for subglottic stenosis. The incident occurred when the laser was being tested near the patient, resulting in superficial burns to the patient's face and neck. The airway was unaffected and the burns were managed conservatively. This case highlights important safety consideration for the use of an ignition source in the presence of high-flow nasal oxygen and the role of human factors and in-built risk mitigation features.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395675","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}

{"title":"A novel application of the Hyperflex™ tracheostomy tube for lung isolation in a patient with airway stoma after laryngectomy","authors":"P. Maurya,&nbsp;N. Gupta,&nbsp;E. Dhamija,&nbsp;V. Kumar","doi":"10.1002/anr3.12328","DOIUrl":"10.1002/anr3.12328","url":null,"abstract":"<div>\u0000 \u0000 <p>In patients who have undergone laryngectomy followed by permanent tracheostomy, managing the airway for one-lung ventilation during lung surgery may present a challenge for anaesthetists. This case report discusses a 45-year-old man with a permanent tracheostomy after a laryngectomy performed for laryngeal carcinoma 5 years ago. He was scheduled to undergo excision of a right bronchial mass for which one-lung ventilation was required. An adjustable Flange Hyperflex™ Tracheostomy tube (Bivona® Silicone Tracheostomy tube, Smiths Medical ASD, Inc., Gary, Indiana, USA) was used for this purpose and the tube was guided into the left main bronchus with a bronchoscope. Appropriate lung isolation was achieved using this technique, and there were no airway-related complications during or after the surgery. This case report shows that a Hyperflex™ tracheostomy tube can be successfully utilised in challenging airway scenarios in patients with a tracheostomy, where other options may not be feasible.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382588","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}

{"title":"The use of surgical sealant to repair intubation-related tracheal injury","authors":"C. Cox,&nbsp;A. Crerar-Gilbert,&nbsp;B. Madden","doi":"10.1002/anr3.12327","DOIUrl":"10.1002/anr3.12327","url":null,"abstract":"<div>\u0000 \u0000 <p>This case study describes the management of a tracheal injury following emergency intubation in a 56-year-old man. After collapsing from heavy alcohol ingestion, intubation was performed using a bougie, leading to a punctate tracheal wound. Initial conservative treatment with antibiotics was followed by bronchoscopy, revealing a tracheal laceration. Rigid bronchoscopy was then performed, and the wound was closed using BioGlue® surgical sealant. The patient made a full recovery, with follow-up bronchoscopy confirming complete healing. This case highlights the effectiveness of BioGlue® as a minimally invasive alternative for tracheal wound closure, reducing the need for more complex interventions.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382590","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}

{"title":"Anaesthetic management of a patient with idiopathic pulmonary arterial hypertension, suprasystemic pulmonary artery pressures and carcinoma of the ascending colon*","authors":"I. Gurajala,&nbsp;G. P. Reddy,&nbsp;K. Vejendla,&nbsp;V. Vanaja,&nbsp;G. S. R. Verma,&nbsp;N. Jonnavithula","doi":"10.1002/anr3.12330","DOIUrl":"10.1002/anr3.12330","url":null,"abstract":"<div>\u0000 \u0000 <p>A 35-year-old woman with severe pulmonary arterial hypertension underwent open hemicolectomy with cholecystectomy under combined general and epidural anaesthesia. Intra-operative pulmonary artery pressure, as measured by Swan-Ganz catheter, was suprasystemic and managed with inodilators. She developed postoperative right ventricular dysfunction requiring inotropes, incremental pulmonary vasodilators and prolonged oxygen supplementation. One year after surgery, she is recurrence-free with oxygen saturations of 88–90% on air. This case highlights that with meticulous care and multidisciplinary team input, patients with severe pulmonary arterial hypertension can have favourable outcomes after major cancer surgery.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382589","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}

{"title":"Internal jugular vein-femoral vein diversion during anterior mediastinal mass resection and superior vena cava replacement","authors":"L. Su,&nbsp;J. Dai","doi":"10.1002/anr3.12326","DOIUrl":"https://doi.org/10.1002/anr3.12326","url":null,"abstract":"<div>\u0000 \u0000 <p>Surgery which involves anterior mediastinal mass resection with artificial replacement of the superior vena cava results in significant disruption to the circulatory system. In this case, a pathway was established to divert blood from the internal jugular to the femoral vein after clamping of the superior vena cava. Blood which would ordinarily return to the right atrium via the superior vena cava was now being returned via the inferior vena cava. The mean arterial pressure was maintained at least 50 mmHg higher than the central venous pressure during clamping of the superior vena cava to avoid cerebral hypoperfusion. The combined use of the above strategies aimed to provide satisfactory surgical conditions and cerebral protection.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245059","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}

{"title":"Peri-operative considerations for a pregnant patient with Werner syndrome and pre-eclampsia","authors":"F. Fallon,&nbsp;B. Byrne,&nbsp;C. Lynch,&nbsp;P. Popivanov","doi":"10.1002/anr3.12325","DOIUrl":"https://doi.org/10.1002/anr3.12325","url":null,"abstract":"&lt;p&gt;Werner syndrome was first described by Otto Werner in 1904 [&lt;span&gt;1&lt;/span&gt;]. It is a rare autosomal recessive syndrome caused by a mutation of the RecQ type DNA/RNA helicase on the &lt;i&gt;WRN&lt;/i&gt; gene resulting in accelerated ageing [&lt;span&gt;1, 2&lt;/span&gt;]. Due to infertility and gonadal failure, the majority of female patients with Werner syndrome do not become pregnant. If pregnancy does occur, it can pose challenges for the anaesthetist.  Typical features include premature greying and hair loss, loss of subcutaneous adipose tissue, muscle wasting of the limbs, central adiposity, a ‘bird-like’ face, short stature and a classic high pitched voice. Age-related systemic disorders include type 2 diabetes mellitus, osteoporosis, atherosclerosis, cataracts, thyroid disease, vocal cord paralysis and malignancy. A full list of features is shown in Table 1. Severe forms of arteriosclerosis and atherosclerosis are common in all patients with Werner syndrome. Myocardial infarction is the leading cause of death, followed by malignancy. Over 50% of patients with Werner syndrome present with myocardial infarction, angina pectoris, stroke or hypertension before the age of 40 [&lt;span&gt;2&lt;/span&gt;]. Case reports describe on-table cardiac arrest secondary to aortic stenosis and severe calcification of coronary vessels during a caesarean birth in a patient with Werner syndrome, and a caesarean birth performed for exacerbation of coronary symptoms and signs of cardiac insufficiency [&lt;span&gt;3, 4&lt;/span&gt;]. Mortality usually occurs in the fourth or fifth decade and the physiological age of a patient with Werner syndrome may be greater than their chronological age. Therefore, consideration should be given to the choice and dose of medications administered. A difficult airway should be anticipated due to the craniofacial abnormalities which affect 98% of patients with Werner syndrome including small mouth, mandibular and maxillary hypoplasia. Difficult intravenous access should also be anticipated due to scleroderma-like skin changes which affect 96% of patients with Werner syndrome [&lt;span&gt;5&lt;/span&gt;]. Anaesthetic techniques for pregnant patients with Werner syndrome should be decided on a case-by-case basis with thorough pre-operative investigations and multidisciplinary team discussion.&lt;/p&gt;&lt;p&gt;A 34-year-old gravida 2, para 0 woman with Werner syndrome was reviewed at the anaesthetic pre-operative assessment clinic at 24-week gestation as part of her antenatal care with the high-risk medical team. She had been diagnosed with Werner syndrome in her 20s, having initially presented with non-alcoholic hepatic steatosis. Genetic studies had confirmed homozygosity for the pathogenic variant &lt;i&gt;c3961C&gt;T&lt;/i&gt; (&lt;i&gt;p.Arg1321Ter&lt;/i&gt;) in the &lt;i&gt;WRN&lt;/i&gt; gene. She had a number of typical features of Werner syndrome (Table 1). Of particular note was her history of dysphonia, a glottic gap, right vocal cord paralysis and partial left vocal cord paralysis. Her regular medications were levothyroxin","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound as a surrogate for transoesophageal echocardiography for intra-operative monitoring of a catheter-related right atrial thrombus during gastrectomy","authors":"D. Nairita,&nbsp;C. Punitha,&nbsp;N. Thirumoorthi,&nbsp;J. Pradeep","doi":"10.1002/anr3.12324","DOIUrl":"https://doi.org/10.1002/anr3.12324","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245047","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}

{"title":"From kitchen to clinic: cherry tomato model for sub-Tenon's block training","authors":"F. Lersch,&nbsp;T. Schweizer,&nbsp;J. M. Berger-Estilita","doi":"10.1002/anr3.12321","DOIUrl":"10.1002/anr3.12321","url":null,"abstract":"&lt;p&gt;Our centre uses a cherry tomato model to simulate the anatomical structures of the vitreous body and surrounding tissues in training for sub-Tenon block administration [&lt;span&gt;1&lt;/span&gt;]. This model provides a hands-on, anatomically accurate simulation that allows trainees to practice and refine their skills under the guidance of experienced instructors. It eliminates the need for training teams to use animal cadaver eyes [&lt;span&gt;2&lt;/span&gt;]. We use a cherry tomato to simulate the vitreous body, surrounded by rubber gloves representing the tissue layers involved in sub-Tenon block administration. A cherry tomato is wrapped in a white rubber glove, simulating the sclera, and then a double layer of coloured gloves simulating the bulbar conjunctiva and Tenon's capsule (Fig. 1a). The pupil and limbus are marked or glued on the outer glove layer helping trainees judge the distance to the incision. The spherical cherry tomato simulates the vitreous body of the eye, allowing trainees to practice manoeuvring around a similarly sized and shaped object. The importance of the coloured double layer (conjunctiva and Tenon's capsule) is stressed in practical training as both layers must be engaged and lifted off the sclera before opening the potential space between the Tenon's capsule and the sclera. Having the contrasting white layer (sclera) appear during practice is essential, as is gliding the cannula behind the eye on the sclera. Identification of the plane and the gliding sensation can be enhanced by positioning a layer of ultrasound jelly between the simulated sclera and the Tenon's capsule (Fig. 1c; grey line). This also enables an ultrasound examination of the model and unequivocally demonstrates the layers (Fig. 1d). Supplementary videos S1 and S2 show the construction and use of the model, respectively.&lt;/p&gt;&lt;p&gt;The training program includes pre-instructional videos and literature (Table 1). Trainees receive instruction during dedicated time without interruptions [&lt;span&gt;3&lt;/span&gt;]. The training involves an explanation of the eye quadrants and the necessity of maintaining a safe distance from the eye muscles. Trainees receive instruction on using forceps and scissors to breach the conjunctiva-Tenon's capsule double layer, ensuring the secure placement of a blunt cannula on the sclera. Instructors also demonstrate the double layer using ultrasound (Fig. 1d). Trainees are encouraged to perform at least five sub-Tenon's blocks on the model using the inferonasal quadrant. Instructors emphasise the layers in the model, provide feedback on the correct use of instruments and emphasise the importance of slowly injecting 2–5 ml of local anaesthetic. By integrating the cherry tomato model into a training package, trainees gain theoretical knowledge and practical skills in sub-Tenon's administration [&lt;span&gt;4&lt;/span&gt;]. Overall, this package provides hands-on, anatomically accurate simulation [&lt;span&gt;5&lt;/span&gt;] which allows trainees to practice and refine their sub-Tenon ","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}