Anaesthesia reports最新文献

{"title":"Peri-operative considerations for a pregnant patient with Werner syndrome and pre-eclampsia","authors":"F. Fallon, B. Byrne, C. Lynch, P. Popivanov","doi":"10.1002/anr3.12325","DOIUrl":"10.1002/anr3.12325","url":null,"abstract":"<p>Werner syndrome was first described by Otto Werner in 1904 [<span>1</span>]. It is a rare autosomal recessive syndrome caused by a mutation of the RecQ type DNA/RNA helicase on the <i>WRN</i> gene resulting in accelerated ageing [<span>1, 2</span>]. 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 [<span>2</span>]. 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 [<span>3, 4</span>]. 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 [<span>5</span>]. 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.</p><p>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 <i>c3961C>T</i> (<i>p.Arg1321Ter</i>) in the <i>WRN</i> 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, C. Punitha, N. Thirumoorthi, J. Pradeep","doi":"10.1002/anr3.12324","DOIUrl":"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, T. Schweizer, J. M. Berger-Estilita","doi":"10.1002/anr3.12321","DOIUrl":"10.1002/anr3.12321","url":null,"abstract":"<p>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 [<span>1</span>]. 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 [<span>2</span>]. 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.</p><p>The training program includes pre-instructional videos and literature (Table 1). Trainees receive instruction during dedicated time without interruptions [<span>3</span>]. 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 [<span>4</span>]. Overall, this package provides hands-on, anatomically accurate simulation [<span>5</span>] 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}

{"title":"Rebound methaemoglobinaemia secondary to intentional sodium nitrite ingestion","authors":"J. Dalziel,&nbsp;D. Urwin,&nbsp;G. Band,&nbsp;S. Dey,&nbsp;T. Barker,&nbsp;R. Frank","doi":"10.1002/anr3.12320","DOIUrl":"10.1002/anr3.12320","url":null,"abstract":"<div>\u0000 \u0000 <p>We report a case of rebounding severe methaemoglobinaemia secondary to sodium nitrite ingestion, despite several administrations of methylene blue. The patient's clinical course was characterised by a series of alternating improvements and deteriorations and proved challenging for treating clinicians. On discussion with poisoning experts, it was hypothesised that a small amount of sodium nitrite remained in the gastrointestinal tract leading to prolonged absorption of the causative agent. Methaemoglobin levels returned to normal following the administration of multi-dose activated charcoal via a nasogastric tube 30 h after the initial presentation to hospital.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142123287","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":"Sternal haematoma infusion catheter: a novel technique for pain management in manubriosternal fractures in the emergency department","authors":"K. Frowde,&nbsp;S. Naeem,&nbsp;A. Alzarrad,&nbsp;D. Abdel-Aziz,&nbsp;O.W. Schofield","doi":"10.1002/anr3.12322","DOIUrl":"10.1002/anr3.12322","url":null,"abstract":"<div>\u0000 \u0000 <p>Sternal fractures are associated with significant morbidity and mortality, with some patients requiring admission for pain management, often through systemic analgesia, which may be ineffective. Regional anaesthetic techniques are more challenging for sternal fractures than rib fractures and require experienced clinicians. Local anaesthetic techniques are becoming recognised as a modality to improve pain control and to reduce complications from opioid use, especially in the elderly. We delivered local anaesthetic via a sternal haematoma infusion catheter for an elderly patient with uncontrolled pain despite the provision of intravenous patient-controlled analgesia. This technique enabled an improvement in pain scores, better engagement with physiotherapy and reduced opioid use. Local anaesthesia has been used previously to manage pain after coronary artery bypass graft surgery. Our experience demonstrated the safety, efficacy and tolerability of this approach to analgesia in sternal fractures.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100428","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":"Recurrent laryngeal nerve block to facilitate rigid bronchoscopy for tracheal stenosis in a patient with extensive burns","authors":"S. Shokohi,&nbsp;M. M. Aghdashi","doi":"10.1002/anr3.12319","DOIUrl":"10.1002/anr3.12319","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141986034","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":"Modified external oblique intercostal plane nerve block for female patients undergoing open donor hepatectomy","authors":"G. Sindwani,&nbsp;R. Nair,&nbsp;G. Manikandan","doi":"10.1002/anr3.12317","DOIUrl":"10.1002/anr3.12317","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908428","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":"Thiopentone-based total intravenous anaesthesia for a patient with carnitine palmitoyltransferase II deficiency and malignant hyperthermia susceptibility","authors":"Z. Essackjee,&nbsp;G. Sloan","doi":"10.1002/anr3.12318","DOIUrl":"10.1002/anr3.12318","url":null,"abstract":"<div>\u0000 \u0000 <p>In this case report, we discuss the use of a thiopentone infusion for the maintenance of anaesthesia in a patient with confirmed malignant hyperthermia susceptibility and carnitine palmitoyltransferase 2 deficiency. The concurrence of both diagnoses precluded the use of both propofol-based total intravenous anaesthesia and volatile inhalational anaesthesia. This patient had been anaesthetised previously with a triple infusion regimen of thiopentone, midazolam and remifentanil and this was a unique opportunity to compare the two instances. Electroencephalogram-based depth of anaesthesia monitoring was in routine use by the time of the second anaesthetic, and thus, the thiopentone infusion could be adjusted accordingly, resulting in a more rapid emergence time. We hope that this case may serve as an example of suitable anaesthetic alternative should both propofol infusion and inhalational anaesthesia not be an option.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908429","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 utility of virtual reality and manikin crisis scenario simulations for anaesthesia trainee education: a randomised crossover pilot study","authors":"L. W. Babus,&nbsp;H. Gurnaney,&nbsp;A. K. Doshi,&nbsp;H. Liu,&nbsp;A. Nishisaki,&nbsp;D. Singh,&nbsp;R. J. Daly Guris,&nbsp;the CHOP Virtual Reality Group","doi":"10.1002/anr3.12316","DOIUrl":"10.1002/anr3.12316","url":null,"abstract":"<div>\u0000 \u0000 <p>Simulation education for anaesthesia trainees is essential to build clinical skills and virtual reality can provide a reproducible, high-fidelity intra-operative training environment. Compared to in-situ manikin-based simulation, this modality has yet to be thoroughly evaluated. Twenty-six second post-graduate year anaesthesiology residents were randomly divided into two groups and participated in both virtual reality and manikin crisis scenarios at sessions six months apart. The exposure order was group A virtual reality followed by manikin and group B manikin followed by virtual reality. Clinical assessments were performed using a standardised checklist. Knowledge assessments were conducted. National Aeronautics and Space Administration Task Load Index and System Usability Scale scores were collected immediately after participation. Clinical scores between groups A and B were not significantly different. Group A had improved post-simulation knowledge scores after both sessions. Task load index scores were lower in mental demand for virtual reality. System usability scores showed less ease of use and more need for support in virtual reality.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891098","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":"Universal C-MAC® videolaryngoscope use in adult patients: a single-centre experience","authors":"R. Penders,&nbsp;F. E. Kelly,&nbsp;T. M. Cook","doi":"10.1002/anr3.12314","DOIUrl":"10.1002/anr3.12314","url":null,"abstract":"<div>\u0000 \u0000 <p>Universal use of Storz C-MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first-pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First-pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non-theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. &gt; 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no-PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non-theatre 7/136, p &lt; 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non-RSI 1/720 (0.1%), p = 0.008).</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891099","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}