European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Ultrasound-aided ipsilateral-dominant epidural block for total hip arthroplasty: a randomised controlled single-blind study.
Lumbar epidural anaesthesia usually affects both legs. The aim was to compare the success rates of ultrasound-aided vs. classical midline epidural catheter insertion for ipsilateral-dominant blocks and analgesia in patients undergoing total hip arthroplasty. ⋯ The use of ultrasound significantly improves the success rate of ipsilateral epidural block compared with the standard midline approach.
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Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the lower respiratory tract. Upon injury, epithelial cells and alveolar macrophages secrete chemical mediators, attracting and activating neutrophils, which in turn release proteases and reactive oxygen species, degrading the alveolocapillary unit. Aspiration can lead to a range of diseases such as infectious pneumonia, chemical pneumonitis or respiratory distress syndrome with significant morbidity and mortality. ⋯ Treatment of acid aspiration is by suctioning after witnessed aspiration; antibiotics are indicated in patients with aspiration pneumonia only. Steroids are not proven to improve outcome or reduce mortality. Patients with acute lung injury requiring mechanical ventilation should be ventilated using lung protective strategies with low tidal volumes and low plateau pressure values, attempting to limit peak lung distension and end-expiratory collapse.
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In 1999, the Swiss Society of Anaesthesiology and Reanimation (SSAR) initiated an analysis of closed malpractice claims filed against anaesthetists in a project intended to improve patient safety. This article discusses the results of a review of closed claims between 1987 and 2008 and filed up to the end of 2009. ⋯ The closed claims analysis project enabled the SSAR to identify areas of high medicolegal risks to gain an insight into the causes of infrequent but potentially harmful events leading to anaesthesia-related injuries and, based on these data, to develop preventive strategies.
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Letter Case Reports
The use of sugammadex in a patient with myotonic dystrophy.