Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study
Laryngoscope manipulation by experienced versus novice laryngoscopists.
During endotracheal intubation using a Macintosh laryngoscope blade, it has been recommended by some that the best laryngeal view is achieved with a laryngoscope handle angle of 45º from horizontal; however, this may be unnecessary. Novices are rarely taught specifically how or where to grip the laryngoscope handle. This study compared the angle and grip of the laryngoscope handle by experienced vs novice laryngoscopists to determine whether basic differences could be identified that might aid in teaching the nuances of skillful laryngoscope manipulation. ⋯ Experienced laryngoscopists used laryngoscope handle angles less than 45º from horizontal for routine intubations. Compared with novices, experts gripped the laryngoscope closer to the hinge and held the laryngoscope more in their fingers vs the palm of their hand. Sharing these important points with novices early in their instruction may improve technique and skill acquisition.
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Case Reports
Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach.
The conventional ultrasound-guided interscalene block targets the C5 and C6 nerve roots at approximately the level of the cricoid cartilage where they lie in the groove between the anterior and middle scalene muscles. This technique, although effective at providing regional anesthesia of the shoulder, is associated with risks of phrenic nerve palsy, injury to the dorsal scapular and long thoracic nerves, and long-term postoperative neurologic symptoms. In this case report, we describe the ultrasound-guided superior trunk block. This procedure targets the C5 and C6 components of the brachial plexus more distally after they unite into the superior trunk but before the suprascapular nerve branches off. ⋯ The enhanced anatomical knowledge provided by ultrasound-guidance has allowed anesthesiologists to devise new block techniques and refine existing ones. The superior trunk block is an example of this refinement and is intended as an alternative to the conventional interscalene block for anesthesia of the shoulder. Further research is planned to confirm the efficacy and safety of the technique.
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Anesthesia technique has been associated with cancer outcomes after radical prostatectomy (RP). These studies are limited by variability in surgeon experience, bias in patient selection, and in some cases, sample size. We evaluated the impact of anesthesia technique for RP on biochemical recurrence (BCR) using a large cohort of patients operated on by a single experienced surgeon. ⋯ We did not find an association between anesthesia technique and disease recurrence in men with prostate cancer treated with RP. Anesthesia technique is unlikely to alter disease recurrence following RP independent of surgical and pathological factors.
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Letter Randomized Controlled Trial
Association between intrapartum fetal head malrotation and motor block by neuraxial analgesia: a randomized trial.
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The purpose of this Continuing Professional Development Module is to review the issues pertinent to one-lung ventilation (OLV) and to propose a management strategy for ventilation before, during, and after lung isolation. ⋯ Optimal perioperative care of the thoracic patient includes a protective ventilation strategy from intubation to extubation and into the immediate postoperative period. Anesthetic goals include the prevention of perioperative hypoxemia and postoperative ALI.