British journal of anaesthesia
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Review Meta Analysis
Thoracic paravertebral blocks in abdominal surgery - a systematic review of randomized controlled trials.
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as part of a multimodal analgesic strategy for thoracic and breast surgery and have gained popularity with the advent of ultrasound guidance. However, this role is poorly defined in the context of abdominal surgery. We performed a systematic review of randomized controlled trials, to clarify the impact of TPVB on perioperative analgesic outcomes in adult abdominal surgery. ⋯ The reported primary block failure rate was 2.8% and the incidence of complications was 1.2% (6/504); there were no instances of pneumothorax. TPVB therefore appears to be a promising analgesic technique for abdominal surgery in terms of efficacy and safety. But further well-designed and adequately powered studies are needed to confirm its utility, particularly with respect to other regional anaesthesia techniques.
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Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. ⋯ Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
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Multicenter Study
Evaluating the ORSIM® simulator for assessment of anaesthetists' skills in flexible bronchoscopy: aspects of validity and reliability.
Developing expertise in flexible bronchoscopy is limited by inadequate opportunities to train on difficult airways. The new ORSIM bronchoscopy simulator aims to address this by creating virtual patients with difficult airways. This study aims to provide evidence on the validity and reliability of the ORSIM for assessment of subjects on both normal and abnormal airway simulations. ⋯ Our results provide initial evidence on the validity and reliability of the ORSIM bronchoscopy simulator, supporting its potential value in training and assessment.
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Transtracheal jet ventilation (TTJV) is recommended in several airway guidelines as a potentially life-saving procedure during the 'Can't Intubate Can't Oxygenate' (CICO) emergency. Some studies have questioned its effectiveness. ⋯ TTJV is associated with a high risk of device failure and barotrauma in the CICO emergency. Guidelines and recommendations supporting the use of TTJV in CICO should be reconsidered.
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Randomized Controlled Trial Comparative Study
A cadaver study comparing spread of dye and nerve involvement after three different quadratus lumborum blocks.
Posterior variants of abdominal wall block include the quadratus lumborum type I, quadratus lumborum type II and quadratus lumborum transmuscular blocks. Our objectives were to compare the spread of injectate and nerve involvement, after conducting blocks using ultrasound guidance in soft embalmed cadavers. ⋯ Consistent spread to lumbar nerve roots was achieved using the transmuscular approach through the quadratus lumborum.