European journal of anaesthesiology
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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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Multicenter Study
Quality of pain management in the emergency department: results of a multicentre prospective study.
The purpose of this study was to evaluate pain management in a large sample of emergency departments (EDs) and identify potential corrective measures. METHOLOGY: A multicentre prospective study was performed in 50 EDs participating in a national quality improvement programme. The rate of inclusion was determined a priori in each ED. Patients were questioned about their pain and pain intensity was assessed by a visual analogue scale. A bivariate and a multivariate analysis were conducted to identify the criteria associated with inadequate pain management. ⋯ This multicentre study conducted on a nationwide scale shows that pain relief can be improved in the ED. Pain intensity is not sufficiently reassessed, analgesics are underutilised, morphine sulfate is rarely used and delay in treatment is common. Reasons for inadequate analgesia were identified in order to identify relevant corrective measures to improve quality of pain management in the ED.
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Randomized Controlled Trial
Use of a temporary forearm tourniquet for intravenous regional anaesthesia: a randomised controlled trial.
To investigate the effect of a temporary, additional mid-forearm tourniquet on the quality of intravenous regional anaesthesia. ⋯ Our results suggest that a temporary mid-forearm tourniquet might speed the onset of intravenous regional anaesthesia. Although the advantage is lost by the time surgery starts, the technique might permit the use of a smaller dose of local anaesthetic and may have safety advantages by more rapid movement of anaesthetic out of the venous bed. The technique merits further investigation.
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Letter Case Reports
The use of sugammadex in a patient with myotonic dystrophy.