Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Pulmonary hypertension impacts negatively on right ventricular function; however, understanding pulmonary vasculature can be difficult. Data from invasive monitoring or traditional echocardiography may not represent the full extent of pulmonary arterial disease. An important element missing from invasive monitoring is the ability to take into account the effects of pulsatile flow; therefore, mean pressures and mean flows are employed in the calculation of pulmonary vascular resistance. ⋯ We show these concepts in a case vignette involving a patient in a low cardiac output state after a complex re-do sternotomy. Additionally, we describe four distinct patterns of PA PWD tracings and illustrate the ability of PA PWD analysis to assess the pulmonary vasculature in both a qualitative and semi-quantitative way. In the critical care setting, it is vital to understand alterations in the pulmonary circulation, and analysis of PA PWD can provide additional information to complement data from other sources.
-
Comparative Study
Less leakage and dislodgement with a catheter-over-needle versus a catheter-through-needle approach for peripheral nerve block: an ex vivo study.
The objective of this study was to compare the catheter-through-needle (CTN) and catheter-over-needle (CON) catheterization techniques ex vivo by measuring leak pressure around the catheter and the catheter's resistance to pulling force. ⋯ In the porcine leg model, CON catheterization provides greater resistance to leakage under high injection pressure and greater holding force in tissue than traditional CTN catheters.
-
This article is a narrative review regarding the usage and effectiveness of introducers or catheters to facilitate tracheal intubation through a supraglottic airway (SGA) as an alternative intubation technique in normal and difficult airway management. ⋯ In failed intubation scenarios, supraglottic airways, such as the LMA Classic™ or LMA ProSeal™ can serve as a conduit for tracheal intubation. A number of techniques using introducers or catheters can facilitate the insertion of an adequately sized endotracheal tube, particularly guided by a bronchoscope. Usage of introducers or catheters through a supraglottic airway may be a useful alternative intubation technique in difficult airway management.