Articles: anesthesia.
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Observational Study
The evaluation of endotracheal tube cuff pressure in pediatric patients by subjective inflation techniques: a prospective observational study.
Cuffed endotracheal tubes (ETTs) are commonly used in pediatric patients, with the gold standard for measuring cuff pressure being a cuff pressure manometer. However, this equipment is not always available in every operating room. Subjective inflation techniques, such as the minimal occluding volume (MOV) technique and the stethoscope-guided (Steth) technique, offer convenient and safe alternatives to standard methods but do not provide quantitative measurements. This study aimed to evaluate ETT cuff pressures and volumes of air inflated using the two subjective techniques (MOV and Steth) in pediatric patients. ⋯ Subjective inflation techniques (MOV or Steth) achieve target ETT cuff pressures in less than 50%, and carry the risks of both overinflation and underinflation, even without post-intubation complications.
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Reg Anesth Pain Med · Nov 2024
ReviewNeuraxial pathology and regional anesthesia: an education guide to decision-making.
In current clinical practice, spinal anesthesia and analgesia techniques-including epidural and subarachnoid procedures-are frequently executed without imaging like X-ray or epidurography. Unrecognized spinal pathology has resulted in serious morbidity in the context of performing neuraxial anesthesia. Typically, preoperative consultations incorporate a patient's medical history but lack a detailed spinal examination or consideration of recent MRI or CT scans. ⋯ Such collaborative settings rely on exhaustive clinical history and scrutinization of recent imaging studies, which may influence the decision to proceed with invasive spinal interventions. There are no epidemiological data concerning rates of the different baseline pathologies that would potentially pose morbidity risks from neuraxial procedures, but the most common among these is canal stenosis, which significantly affects almost 20% of people over 60 years of age. This paper aims to elucidate these critical findings and advocate for incorporating meticulous preoperative assessments for individuals slated for spinal anesthesia or analgesia procedures, thereby attempting to mitigate potential risks.
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Anesthesia and analgesia · Nov 2024
Lassen's Cerebral Autoregulation Plot Revisited and Validated 65 Years Later: Impacts of Vasoactive Drug Treatment on Cerebral Blood Flow.
Niels Lassen's seminal 1959 cerebral autoregulation plot, a cornerstone in understanding the relationship between mean arterial pressure (MAP) and cerebral blood flow (CBF), was based on preexisting literature. However, this work has faced criticism for selective data presentation, leading to inaccurate interpretation. This review revisits and validates Lassen's original plot using contemporary data published since 2000. ⋯ Vasopressor treatment results in a greater increase in CBF during volatile than intravenous anesthesia. Modern antihypertensives do not significantly impact CBF based on contemporary data, exerting a smaller impact on CBF compared to historical data. These insights underscore the importance of individualized blood pressure management guided by modern data in the context of cerebral autoregulation across varied patient populations.
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Regional anesthesia (RA) can improve patient outcomes and reduce perioperative complications including deaths. Despite its benefits, RA is less utilised in low-resource settings. The purpose of this study was to assess practice and challenges related to RA in Amhara Regional Hospitals, Northwest-Ethiopia. ⋯ The principal findings indicate that all respondents perform spinal anaesthesia, while the practice of peripheral RA varies. Reported barriers to performing RA are related to knowledge and training, as well as a lack of equipment (there aren't enough regional procedure kits available that include an epidural set, block needle, nerve stimulator, and ultrasound). A more stringent approach with specific requirements, distinguishing between neuraxial and peripheral blocks, enhance training opportunities for peripheral nerve blocks are required in Ethiopia.