Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Etomidate has a neutral hemodynamic profile which has made it an attractive medication for emergent intubation. Despite theoretical advantages of etomidate administration in the trauma patient, there are incomplete data to support its use. This study examined the association of etomidate use for emergent intubation in traumatic illness with patient mortality. ⋯ The association between use of a single dose of etomidate for emergency tracheal intubation in the trauma patient and mortality is inconclusive. Etomidate administration should be used with caution in trauma patients requiring tracheal intubation. Further data are required to determine the safety and risk-benefit of etomidate use in this patient population.
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Multicenter Study Observational Study
Analgesic, sedative, antipsychotic, and neuromuscular blocker use in Canadian intensive care units: a prospective, multicentre, observational study.
Our aim was to describe analgo-sedation and antipsychotic and neuromuscular blocking drug (NMBD) use in critically ill patients, management strategies, and variables associated with these practice patterns. ⋯ Nearly all MV patients received analgo-sedation. Opioids were used more often than sedatives despite infrequent use of pain scales. Few patients received antipsychotic therapy, but physical restraint was common. Protocol use was poor compared to DSI. Duration of MV predicted the use of either.
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When positioning patients with meningocele and meningomyelocele, it is standard practice to avoid direct pressure on the lesions. That caution is intended to prevent injury to neural elements within the lesion and violation of the cerebrospinal fluid space. We herein report an additional hazard of direct intraoperative pressure on such lesions. An adult patient with a lumbosacral pseudomeningocele sustained a cerebral ischemic injury as a consequence of direct pressure on the lesion during general anesthesia. ⋯ In retrospect, the size and leftward extent of the pseudomeningocele were not appreciated preoperatively, and in spite of the care taken, intraoperative pressure was placed on the lesion. This report cautions that intraoperative pressure related to positioning patients with extra-axial lesions containing cerebrospinal fluid (CSF), e.g., meningoceles and pseudomeningoceles, can result in increases in CSF pressure and thereby a reduction in cerebral perfusion pressure sufficient to result in cerebral ischemia.
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Case Reports
Novel use of a guidewire to facilitate intubation in an obstructing anterior mediastinal mass.
This report describes the management of a life-threatening tracheal obstruction due to a thymoma in the anterior mediastinum and the use of a guidewire to facilitate intubation. ⋯ Confirmed guidewire placement prior to induction enabled intubation in a setting without cardiothoracic backup capabilities.