Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2002
Case ReportsTracheal esophageal combitube: a useful airway for morbidly obese patients who cannot intubate or ventilate.
The tracheal esophageal combitube has been successfully used in many difficult airway circumstances. We report the dramatic case of a morbidly obese patient with a well-known difficult airway who was successfully rescued from a cannot ventilate-cannot intubate situation in our critical care unit by using the tracheal esophageal combitube. Surgical tracheostomy was performed while she was mechanically ventilated through the tracheal esophageal combitube. The tracheal esophageal combitube is a very important device that should be kept available in all cases of morbidly obese airway management.
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Acta Anaesthesiol Scand · Aug 2002
Patients' experiences with multiple stimulation axillary block for fast-track ambulatory hand surgery.
Ambulatory axillary block by multiple nerve stimulation (MNS) is effective and time efficient, but may be rejected by patients because of block pain. This prospective study assessed patients' anxiety and acceptance of this block, identified which of the components of blocking procedure is most painful (i.v. line insertion, repeated needle passes, local anesthetic injection, or electrical stimulation) and recorded patients' anesthetic preferences for the future hand surgery. ⋯ Fear of block pain is diminished after experiencing the blocking procedure. Electrical stimuli was perceived as painful by 53% of patients, and this pain was more intense than with other block components. The majority of our patients would choose axillary block without sedation for future hand surgery and are satisfied with fast-tracking.
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Acta Anaesthesiol Scand · Aug 2002
When is an anesthesiologist needed in a helicopter emergency medical service in northern Norway?
A national air ambulance service, including helicopters and airplanes, was implemented in Norway in 1988. The main intention was to offer advanced medical services when needed. All helicopters are manned by anesthesiologists. Catchment areas for the 11 helicopters span from cities to scarcely populated areas, particularly in the north. Our aim was to assess what proportion of ambulance missions carried out by the rescue helicopter in Bodø, northern Norway, delivered advanced medical treatment needing the skills of an anesthesiologist. ⋯ In our rural area, with a widely scattered population, 95% of patients received medical treatment not requiring an anesthesiologist. A selective use of the anesthesiologist seems indicated.
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Acta Anaesthesiol Scand · Aug 2002
Prehospital advanced life support provided by specially trained physicians: is there a benefit in terms of life years gained?
The benefit of prehospital advanced life support (ALS) is disputed, as is the prehospital use of specially trained, hospital-based physicians. The purpose of the study was to assess the health benefit from an anesthesiologist-manned prehospital emergency medical service (EMS), and to separate the benefit of the anesthesiologist from that of rapid transport. ⋯ The expert panels found LYG in every 14th patient assisted by this anesthesiologist-manned prehospital EMS. There was no difference in LYG between the helicopter and the rapid response car missions. The role of the anesthesiologist was crucial for health benefits.
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Acta Anaesthesiol Scand · Aug 2002
Paramedic helicopter emergency service in rural Finland - do benefits justify the cost?
The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Life Support (ALS) procedures performed on-scene, or due to rapid transport of patients to definitive care. ⋯ A minority of all patients did benefit from HEMS. Benefit was related to early ALS care and the cost per beneficial mission was 28 444.