Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Dec 2018
Observational StudyEffectiveness of regional anaesthesia for treatment of facial and hand wounds by emergency physicians: A 9-month prospective study.
We compared the effectiveness of nerve blocks (regional anaesthesia, [RA]) versus local anaesthesia (LA) to treat face and hand wounds. Emergency physicians who had not previously used nerve blocks administered the anaesthesia based on anatomic landmarks. ⋯ Facial and wrist nerve blocks are easy to administer and as efficient as local infiltrations, plus they require fewer injection sites, and, for facial RA, less anesthetic. Their teaching and use should be more widespread in EDs.
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Anaesth Crit Care Pain Med · Dec 2018
Rescue transtracheal jet ventilation during difficult intubation in patients with upper airway cancer.
The failure rates of intubation and/or mask ventilation are higher in patients with neck or upper airway disease. To ensure oxygenation, rescue trans-tracheal jet ventilation (RTTJV) may be used. In this critical situation, a high rate of complications has been reported. The aim of this study was to report RTTJV performed by a jet ventilator with an end-expiratory pressure control in an experienced institution. ⋯ RTTJV with end-expiratory pressure control allowed oxygenation during difficult intubation, with a low rate of complications.
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Anaesth Crit Care Pain Med · Dec 2018
Observational StudyPostoperative serum levels of Endocan are associated with the duration of norepinephrine support after coronary artery bypass surgery.
Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule-1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB. ⋯ Serum Endocan concentration increases after CABG surgery with CPB until day 1. The norepinephrine support increases the risk of Endocan release, suggesting a relationship between the kinetic of Endocan and the vasoplegic syndrome. At day 3, Endocan concentration decreases slowly but is not normalised at day 5. Further studies should investigate the prognostic value of the magnitude of postoperative Endocan concentration after cardiac surgery.
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Anaesth Crit Care Pain Med · Dec 2018
Application of tourniquet in civilian trauma: Systematic review of the literature.
The effectiveness of a tourniquet (TQ) in case of extremity haemorrhages is well recognised to prevent deaths on the battlefield. However, little is known about the usefulness of TQ in civilian trauma settings, including terrorist attack situations. The aim of this systematic review was to analyse the evidence-based medical literature in order to precise the use of TQ in the management of extremity haemorrhages in civilian setting. ⋯ This systematic review revealed TQ to be an effective tool for the management of extremity haemorrhages in civilian trauma, associated with few complications. Larger studies and dedicated training courses are needed to improve the use of TQ in the civilian standards of care.