Introduction: Sinking skin flap syndrome is a rare complication of craniectomy, which is performed as a treatment of severe intracranial hypertension. Cases Reports: The first case is a 55 year old man. Admitted with Glascow score of 13/15, rapid neurological deterioration was noted with a GCS of 9/15, and then anisocoria. CT scan had objectified hemorrhagic contusions, subdural hematoma measured 11 mm and deviation of the median line. The patient was operated with evacuation of the subdural hematoma through a large decompressive craniectomy. In the second month, he presented a cranial deformation with a deepening of the cutaneous plane, with deterioration of the neurological status and a generalized convulsive crisis. The second case is that of a 32 year old man, admitted to the emergency room with 8/15 of GCS with anisocoria. CT scan was showing an 11 mm right subdural hematoma with a hemorrhagic contusion opposite, a 12 mm midline deviation and diffuse cerebral edema. The patient was operated with Anesth Crit Care 2021; 3 (1): 001-009 DOI: 10.26502/acc.020 Anesthesia and Critical Care 2 evacuation of the subdural hematoma through a large craniectomy. The neurological examination after the extubation showed a GCS of 14. Two days later, the patient presented a depression of the right scalp with an aspect of skin flap syndrome on CT scan without significant neurological deterioration. Conclusion: The role of decompressive craniectomy in neurological improvement in still uncertain, and timing of cranioplasty is more debate: early with unclear neurologic status and preventing the skin flap syndrome or delete after final outcome.
引言:皮瓣下沉综合征是颅骨切除术中一种罕见的并发症，用于治疗严重颅内高压。病例报告:第一位病例为55岁男性。入院时Glascow评分为13/15,GCS为9/15，神经系统迅速恶化，然后是异色。CT扫描显示出血性挫伤，硬膜下血肿11mm，中线偏离。患者通过大减压颅骨切除术清除硬膜下血肿。第二个月，患者出现颅骨变形，皮肤平面加深，神经系统状况恶化，出现全身性抽搐危象。第二个病例是一名32岁的男性，因8/15的GCS和异眼而入院急诊室。CT扫描显示右侧硬膜下11mm血肿伴对面出血性挫伤，中线偏移12mm，弥漫性脑水肿。患者采用Anesth Crit Care 2021进行手术;3 (1): 001-009 DOI: 10.26502/acc.020麻醉与重症监护2大颅骨切除术后硬膜下血肿的清除。拔管后的神经学检查显示GCS为14。两天后，患者在CT扫描上表现为右头皮凹陷，伴有皮瓣综合征，无明显神经功能恶化。结论:减压颅骨切除术在神经系统改善中的作用仍不确定，而颅骨成形术的时机更有争议:早期神经系统状况不清，预防皮瓣综合征或最终结局后的皮瓣删除。
{"title":"Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration","authors":"Touab Rida, Rabii Andaloussi Mohamed, Mohsani Mohamed, Mounir Khalil, Bensghir Mustapha, Balkhi Hicham","doi":"10.26502/acc.020","DOIUrl":"https://doi.org/10.26502/acc.020","url":null,"abstract":"Introduction: Sinking skin flap syndrome is a rare complication of craniectomy, which is performed as a treatment of severe intracranial hypertension. Cases Reports: The first case is a 55 year old man. Admitted with Glascow score of 13/15, rapid neurological deterioration was noted with a GCS of 9/15, and then anisocoria. CT scan had objectified hemorrhagic contusions, subdural hematoma measured 11 mm and deviation of the median line. The patient was operated with evacuation of the subdural hematoma through a large decompressive craniectomy. In the second month, he presented a cranial deformation with a deepening of the cutaneous plane, with deterioration of the neurological status and a generalized convulsive crisis. The second case is that of a 32 year old man, admitted to the emergency room with 8/15 of GCS with anisocoria. CT scan was showing an 11 mm right subdural hematoma with a hemorrhagic contusion opposite, a 12 mm midline deviation and diffuse cerebral edema. The patient was operated with Anesth Crit Care 2021; 3 (1): 001-009 DOI: 10.26502/acc.020 Anesthesia and Critical Care 2 evacuation of the subdural hematoma through a large craniectomy. The neurological examination after the extubation showed a GCS of 14. Two days later, the patient presented a depression of the right scalp with an aspect of skin flap syndrome on CT scan without significant neurological deterioration. Conclusion: The role of decompressive craniectomy in neurological improvement in still uncertain, and timing of cranioplasty is more debate: early with unclear neurologic status and preventing the skin flap syndrome or delete after final outcome.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"12 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80116222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the relationship between mortality and laboratory values that may change with renal function and nutrition, namely creatinine, ALP, albumin, phosphorus and calcium, in patients admitted to the intensive care unit (ICU). Method A total of 2549 patients older than 18 years of age, who were followed up in the ICU of our hospital between 2015-2018, had no history of malignancy or pregnancy, had a length of ICU stay longer than 24 hours, and had laboratory values available at the time of admission to ICU, were included in the study. Results The results of our study showed that advanced age and prolonged length of stay are associated with mortality (p<0.001). Low albumin and calcium values and high creatinine and ALP values at the time Anesth Crit Care 2021; 3 (4): 74-82 DOI: 10.26502/acc.028 Anesthesia and Critical Care 75 of ICU admission were a risk factor for mortality (p<0.001). Phosphorus value was not an important risk factor for mortality (p: 0.753). Conclusion In ICU patients, the relationship between mortality and renal function and laboratory values that may change with renal function and nutrition, namely creatinine, albumin, calcium, and ALP has been shown while no such relationship was observed between phosphorus values and mortality.
目的探讨重症监护病房(ICU)患者死亡率与随肾功能和营养变化的实验室指标肌酐、ALP、白蛋白、磷、钙的关系。方法选取2015-2018年在我院ICU随访的年龄大于18岁、无恶性肿瘤病史、无妊娠史、ICU住院时间大于24小时、入院时有实验室检查结果的2549例患者作为研究对象。结果我们的研究结果显示，高龄和住院时间延长与死亡率相关(p<0.001)。Anesth Crit Care 2021时，低白蛋白和钙值，高肌酐和ALP值;3 (4): 74-82 DOI: 10.26502/acc.028麻醉和重症监护是ICU住院患者死亡的危险因素(p<0.001)。磷值不是死亡率的重要危险因素(p: 0.753)。结论在ICU患者中，死亡率与肾功能的关系以及随肾功能和营养变化的实验室指标肌酐、白蛋白、钙、ALP均有变化，而磷与死亡率无关系。
{"title":"Relationship between Mortality and Albumin, Alkaline Phosphatase, Phosphorus and Calcium Values that May Change with Renal Function and Nutrition in Intensive Care Setting","authors":"A. Sahin Tutak","doi":"10.26502/acc.028","DOIUrl":"https://doi.org/10.26502/acc.028","url":null,"abstract":"Objective To investigate the relationship between mortality and laboratory values that may change with renal function and nutrition, namely creatinine, ALP, albumin, phosphorus and calcium, in patients admitted to the intensive care unit (ICU). Method A total of 2549 patients older than 18 years of age, who were followed up in the ICU of our hospital between 2015-2018, had no history of malignancy or pregnancy, had a length of ICU stay longer than 24 hours, and had laboratory values available at the time of admission to ICU, were included in the study. Results The results of our study showed that advanced age and prolonged length of stay are associated with mortality (p<0.001). Low albumin and calcium values and high creatinine and ALP values at the time Anesth Crit Care 2021; 3 (4): 74-82 DOI: 10.26502/acc.028 Anesthesia and Critical Care 75 of ICU admission were a risk factor for mortality (p<0.001). Phosphorus value was not an important risk factor for mortality (p: 0.753). Conclusion In ICU patients, the relationship between mortality and renal function and laboratory values that may change with renal function and nutrition, namely creatinine, albumin, calcium, and ALP has been shown while no such relationship was observed between phosphorus values and mortality.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"67 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79601169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-07DOI: 10.21203/rs.3.rs-55017/v1
R. Patti, Claudia De Araujo Duarte, Nishil Dalsania, R. Thawani, A. Sinha, Bruno Augusto de Brito Gomes, M. Silver, C. Seneviratne, N. Somal, Yihak Kupfer
Background: High mortality rates are predominant even in COVID-19 patients requiring minimal supportive therapy, with a short-coming of data on COVID-19 patients requiring mechanical ventilation.Objectives/Design: We performed a single-center, retrospective, cohort study at a tertiary care, community-based teaching hospital with patient who required invasive mechanical ventilatory support and were COVID-19 positive. All patients were treated according to the ARDSnet protocol. The primary outcome was overall mortality, and secondary outcome was successful extubation.Results: A total of 72 COVID-19 positive intubated patients were included. Twenty-six (66.6%) patients died within the first 15 days of hospital admission; thirty-eight (52.7%) died within 28 days, and thirty-nine (54.2%) died within 29 days. A total of 22 patients (30.5%) were successfully extubated. 15 patients (20.8%) who required reintubation or could not be extubated further underwent tracheostomy.Conclusions: Mortality of critically ill COVID-19 patients requiring mechanical ventilatory support is high, our observed mortality rate (54.2%) was significantly lower than currently published reports. We believe our rate to be a consequence of early intubation in conjunction with adherence to ARDSnet protocol. We also observed patients with hyperlipidemia, higher CRP, renal failure, or those requiring vasopressor use had worse outcomes.
{"title":"Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn","authors":"R. Patti, Claudia De Araujo Duarte, Nishil Dalsania, R. Thawani, A. Sinha, Bruno Augusto de Brito Gomes, M. Silver, C. Seneviratne, N. Somal, Yihak Kupfer","doi":"10.21203/rs.3.rs-55017/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-55017/v1","url":null,"abstract":"\u0000 Background: High mortality rates are predominant even in COVID-19 patients requiring minimal supportive therapy, with a short-coming of data on COVID-19 patients requiring mechanical ventilation.Objectives/Design: We performed a single-center, retrospective, cohort study at a tertiary care, community-based teaching hospital with patient who required invasive mechanical ventilatory support and were COVID-19 positive. All patients were treated according to the ARDSnet protocol. The primary outcome was overall mortality, and secondary outcome was successful extubation.Results: A total of 72 COVID-19 positive intubated patients were included. Twenty-six (66.6%) patients died within the first 15 days of hospital admission; thirty-eight (52.7%) died within 28 days, and thirty-nine (54.2%) died within 29 days. A total of 22 patients (30.5%) were successfully extubated. 15 patients (20.8%) who required reintubation or could not be extubated further underwent tracheostomy.Conclusions: Mortality of critically ill COVID-19 patients requiring mechanical ventilatory support is high, our observed mortality rate (54.2%) was significantly lower than currently published reports. We believe our rate to be a consequence of early intubation in conjunction with adherence to ARDSnet protocol. We also observed patients with hyperlipidemia, higher CRP, renal failure, or those requiring vasopressor use had worse outcomes.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"41 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86454213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Riley, U. Malla, N. Snels, A. Mitchell, C. Abi-Fares, W. Basson, C. Anstey, L. White
Introduction: Rib fractures are the most common thoracic blunt trauma injury and constitute up to 55% of all thoracic blunt trauma injuries. They are a common cause of hospital admission and are associated with significant morbidity and mortality. Immediate causes of comorbidities and mortality that stem from complications of rib fractures include pneumothorax, haemothorax, pulmonary contusions, flail chest and acute respiratory distress syndrome; whilst more delayed complications include atelectasis, pneumonia, pulmonary embolism, empyema and respiratory failure. The higher the number of rib fractures, the higher the incidence of pulmonary morbidity and mortality. A fundamental contributor to delayed complications is hypoventilation secondary to pain from the facture(s) and thus, a key element in the prevention of post-fracture complications is optimal analgesia. Several neuraxial and regional techniques have been described in relation to systemic opioid analgesia with varying levels of evidence. One such strategy is the use of the Erector Spinae Block (ESB). This technique has never been described in relation to any other technique. The aim of this study will be to compare the ESB to systemic opioid analgesia with the hypothesis that patients receiving Erector Spinae Blocks will have a lower incidence of respiratory complications and thus a shorter length of stay in hospital and reduced mortality rates. Methods and Analysis: A retrospective cohort study with propensity matching will be performed. A retrospective analysis of patients with rib fractures managed by the Sunshine Coast Hospital and Health Service (SCHHS) Acute Pain Service (APS). Each patient’s electronic medical record (EMR) from their hospital admission will be reviewed for age, number of rib fractures, presence of a flail segment, comorbidities at the time of admission, management used (oral medications alone vs. ketamine infusion vs. patient controlled analgesia vs. regional complications (haemothorax/pneumothorax, pneumonia, pulmonary embolism, respiratory failure, requirement ventilatory support or ICU, number of days of ventilatory support, regional block failure or local anaesthetic related adverse effects), length of stay, discharge destination and mortality during admission. Ethics and Dissemination: Ethics approval for the study protocol and data collection has been approved LNR/2018/QPCH/45155). The study findings will be submitted for publication in a peer reviewed journal. Conclusion: There is currently no available literature to support the use of an ESB over other analgesic this cohort study will provide initial exploratory results to guide further randomised controlled trials.
{"title":"Erector Spinae Nerve Block for the Management of Rib Fractures: A Retrospective Propensity Matched Cohort Study Protocol","authors":"B. Riley, U. Malla, N. Snels, A. Mitchell, C. Abi-Fares, W. Basson, C. Anstey, L. White","doi":"10.26502/acc.005","DOIUrl":"https://doi.org/10.26502/acc.005","url":null,"abstract":"Introduction: Rib fractures are the most common thoracic blunt trauma injury and constitute up to 55% of all thoracic blunt trauma injuries. They are a common cause of hospital admission and are associated with significant morbidity and mortality. Immediate causes of comorbidities and mortality that stem from complications of rib fractures include pneumothorax, haemothorax, pulmonary contusions, flail chest and acute respiratory distress syndrome; whilst more delayed complications include atelectasis, pneumonia, pulmonary embolism, empyema and respiratory failure. The higher the number of rib fractures, the higher the incidence of pulmonary morbidity and mortality. A fundamental contributor to delayed complications is hypoventilation secondary to pain from the facture(s) and thus, a key element in the prevention of post-fracture complications is optimal analgesia. Several neuraxial and regional techniques have been described in relation to systemic opioid analgesia with varying levels of evidence. One such strategy is the use of the Erector Spinae Block (ESB). This technique has never been described in relation to any other technique. The aim of this study will be to compare the ESB to systemic opioid analgesia with the hypothesis that patients receiving Erector Spinae Blocks will have a lower incidence of respiratory complications and thus a shorter length of stay in hospital and reduced mortality rates. Methods and Analysis: A retrospective cohort study with propensity matching will be performed. A retrospective analysis of patients with rib fractures managed by the Sunshine Coast Hospital and Health Service (SCHHS) Acute Pain Service (APS). Each patient’s electronic medical record (EMR) from their hospital admission will be reviewed for age, number of rib fractures, presence of a flail segment, comorbidities at the time of admission, management used (oral medications alone vs. ketamine infusion vs. patient controlled analgesia vs. regional complications (haemothorax/pneumothorax, pneumonia, pulmonary embolism, respiratory failure, requirement ventilatory support or ICU, number of days of ventilatory support, regional block failure or local anaesthetic related adverse effects), length of stay, discharge destination and mortality during admission. Ethics and Dissemination: Ethics approval for the study protocol and data collection has been approved LNR/2018/QPCH/45155). The study findings will be submitted for publication in a peer reviewed journal. Conclusion: There is currently no available literature to support the use of an ESB over other analgesic this cohort study will provide initial exploratory results to guide further randomised controlled trials.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"8 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90400082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Čižmárová, B. Hubková, M. Mareková, K. Vladimír, A. Birková
The use of medicinal products is becoming more and more modern. Although little is known about the exact composition and effects of various herbal preparations, their plant and natural origin serve as evidence of their safety. The doctor is rarely notified of their use, while there is increasing body of evidence on the effects, side effects and interactions with synthetically produced drugs.
{"title":"Natural Plant Compounds with Possible Interaction with Anesthetics","authors":"B. Čižmárová, B. Hubková, M. Mareková, K. Vladimír, A. Birková","doi":"10.26502/acc.002","DOIUrl":"https://doi.org/10.26502/acc.002","url":null,"abstract":"The use of medicinal products is becoming more and more modern. Although little is known about the exact composition and effects of various herbal preparations, their plant and natural origin serve as evidence of their safety. The doctor is rarely notified of their use, while there is increasing body of evidence on the effects, side effects and interactions with synthetically produced drugs.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"6 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87902939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. The highest emergency admission proportion was observed in Riga and Pieriga, while the lowest in Latgale - 52 and 38%, respectively. The average proportion of mechanically ventilated patients ranged from 24 to 29% of all admitted patients across the regions. SMR for the total population was 1.44 (95% CI: 1.17- 1.81). In two regions, Riga (1.51; 95% CI: 1.04- 2.14) and Latgale (2.21; 95% CI: 1.9- 3.76), it was significantly higher than 1. Conclusions: We noted excess mortality (SMR >1) in the population of critically ill children in Latvia, 2012-2016; in particular, in patients from two regions - Riga and Latgale.
{"title":"Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia","authors":"Linda Setlere, I. Veģeris, M. Stale, R. Balmaks","doi":"10.26502/acc.003","DOIUrl":"https://doi.org/10.26502/acc.003","url":null,"abstract":"Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. The highest emergency admission proportion was observed in Riga and Pieriga, while the lowest in Latgale - 52 and 38%, respectively. The average proportion of mechanically ventilated patients ranged from 24 to 29% of all admitted patients across the regions. SMR for the total population was 1.44 (95% CI: 1.17- 1.81). In two regions, Riga (1.51; 95% CI: 1.04- 2.14) and Latgale (2.21; 95% CI: 1.9- 3.76), it was significantly higher than 1. Conclusions: We noted excess mortality (SMR >1) in the population of critically ill children in Latvia, 2012-2016; in particular, in patients from two regions - Riga and Latgale.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"113 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87927765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1. Case Report A 33 years old female without systemic disease received laparoscopic ovarian cystectomy and chromotubation. The operation time was 60 minutes. During the surgery, the intraabdominal pressure was limited between 12 and 15 mm Hg. The ETCO2 was about 35 mmHg and the airway pressure was about 22 cm H2O. At the end of operation, TISSEEL [Fibrin Sealant] was delivered by TISSEEL spray set with piped air. The intraabdominal pressure suddenly rose above 20 mmHg, and the peek airway pressure exceeded 40 mmHg. Massive emphysema extending to the face and neck were noted, and bilateral pneumothorax were also found (Figure 1) There were some petechia over her chest. She was transferred to SICU and the condition was relatively stable. She was discharged uneventually after one week.
{"title":"Massive Subcutaneous Emphysema and Bilateral Pneumothorax after TISSEEL Spray in Laparoscopic Surgery","authors":"Weu-Che Hsu, Yu‐Ting Lin","doi":"10.26502/acc.007","DOIUrl":"https://doi.org/10.26502/acc.007","url":null,"abstract":"1. Case Report A 33 years old female without systemic disease received laparoscopic ovarian cystectomy and chromotubation. The operation time was 60 minutes. During the surgery, the intraabdominal pressure was limited between 12 and 15 mm Hg. The ETCO2 was about 35 mmHg and the airway pressure was about 22 cm H2O. At the end of operation, TISSEEL [Fibrin Sealant] was delivered by TISSEEL spray set with piped air. The intraabdominal pressure suddenly rose above 20 mmHg, and the peek airway pressure exceeded 40 mmHg. Massive emphysema extending to the face and neck were noted, and bilateral pneumothorax were also found (Figure 1) There were some petechia over her chest. She was transferred to SICU and the condition was relatively stable. She was discharged uneventually after one week.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"12 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83357346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Edward, Rappaport Rudolf, Kroitoro Simona, B. Michal
Background: Changes of the anatomy of the trachea occur during aging and as a result of a large goiter, cardiac or pulmonary diseases and smoking. These changes may cause difficulties in endotracheal intubation.Methods: In this retrospective study, we analyzed the frequency of acquired deformations, as seen in chest CT scan of 200 adult patients. The radiographic findings were studied, as well as the patients’ demographic variables and co-morbidities.Results: Acquired deformation of the trachea was found only in patients that were older than 50 years. In 117 patients 50 to 90 year-old three types of deformations were found: “S-shape” trachea in 83 patients (71%), horizontal left main bronchus with wide angle main carina in 24 patients (20.5%) and saber-sheath trachea in 10 patients (8.5%). Conclusions: Acquired deformation of the trachea is frequent in patients older than 50. Studying the patient’s chest CT scan may assist the physician in performing endotracheal intubation cautiously and safely.
{"title":"The Frequency of Acquired and Age-Related Tracheal Deformations: a Retrospective Study of CT Scan Findings","authors":"A. Edward, Rappaport Rudolf, Kroitoro Simona, B. Michal","doi":"10.26502/acc.004","DOIUrl":"https://doi.org/10.26502/acc.004","url":null,"abstract":"Background: Changes of the anatomy of the trachea occur during aging and as a result of a large goiter, cardiac or pulmonary diseases and smoking. These changes may cause difficulties in endotracheal intubation.Methods: In this retrospective study, we analyzed the frequency of acquired deformations, as seen in chest CT scan of 200 adult patients. The radiographic findings were studied, as well as the patients’ demographic variables and co-morbidities.Results: Acquired deformation of the trachea was found only in patients that were older than 50 years. In 117 patients 50 to 90 year-old three types of deformations were found: “S-shape” trachea in 83 patients (71%), horizontal left main bronchus with wide angle main carina in 24 patients (20.5%) and saber-sheath trachea in 10 patients (8.5%). Conclusions: Acquired deformation of the trachea is frequent in patients older than 50. Studying the patient’s chest CT scan may assist the physician in performing endotracheal intubation cautiously and safely.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"79 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83240673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Post spinal anaesthesia shivering is a common complication and a leading cause of discomfort to patients under spinal anaesthesia. It follows a decrease in sympathetic tone which results in vasodilatation and redistribution of heat from core to peripheral part of the body. The physiological consequences of shivering include increase in cardiac and systemic energy expenditure, oxygen consumption and carbon dioxide production. Objective: The aim of this study was to compare prophylactic low dose intravenous ketamine with placebo for prevention of post spinal anaesthesia shivering. Methods: Following Institutional Ethical Review committee approval, this randomized, double blind study was conducted on eighty two patients aged ranged 16 to 50 years and ASA I and II who had repair of vesicio-vaginal fistula under spinal anaesthesia. Immediately after the spinal anaesthesia was established; Groups K and S received iv ketamine 0.25 mg/kg diluted to 5 mls and iv normal saline 5mls respectively. Incidence of shivering, haemodynamic parameters and side effects were assessed as primary outcome measures. Results: The incidence of shivering in groups S and K was 46.3% vs 7.3% in Group S compared to Group K respectively. Two (4.8%) patients had hallucination and 1 (2.4%) patient vomited among the group K patients. Similarly, mean arterial blood pressure, heart rates at 5 and 10 minutes after the spinal anaesthesia Group K were significantly higher. Conclusion: The use of prophylactic low dose ketamine significantly reduced spinal anaesthesia-induced shivering.
{"title":"Prophylactic Ketamine for Prevention of Post-Spinal Shivering: Randomised Controlled Trial","authors":"Rabiu Mb, S. Ado, B Chabiya","doi":"10.26502/acc.008","DOIUrl":"https://doi.org/10.26502/acc.008","url":null,"abstract":"Background: Post spinal anaesthesia shivering is a common complication and a leading cause of discomfort to patients under spinal anaesthesia. It follows a decrease in sympathetic tone which results in vasodilatation and redistribution of heat from core to peripheral part of the body. The physiological consequences of shivering include increase in cardiac and systemic energy expenditure, oxygen consumption and carbon dioxide production. Objective: The aim of this study was to compare prophylactic low dose intravenous ketamine with placebo for prevention of post spinal anaesthesia shivering. Methods: Following Institutional Ethical Review committee approval, this randomized, double blind study was conducted on eighty two patients aged ranged 16 to 50 years and ASA I and II who had repair of vesicio-vaginal fistula under spinal anaesthesia. Immediately after the spinal anaesthesia was established; Groups K and S received iv ketamine 0.25 mg/kg diluted to 5 mls and iv normal saline 5mls respectively. Incidence of shivering, haemodynamic parameters and side effects were assessed as primary outcome measures. Results: The incidence of shivering in groups S and K was 46.3% vs 7.3% in Group S compared to Group K respectively. Two (4.8%) patients had hallucination and 1 (2.4%) patient vomited among the group K patients. Similarly, mean arterial blood pressure, heart rates at 5 and 10 minutes after the spinal anaesthesia Group K were significantly higher. Conclusion: The use of prophylactic low dose ketamine significantly reduced spinal anaesthesia-induced shivering.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"5 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81834785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Nausea and/or vomiting following regional anaesthesia in pregnant females undergoing caesarean section is a major clinical problem. This study was conducted to compared the efficacy of metoclopramide, dexamethasone, and their combination for preventing intra operative & post-operative nausea and vomiting (PONV) following spinal anaesthesia given for caesarean section in patients. Materials and Methods: A total of 120 full term pregnant females of ASA I & II grade with uncomplicated pregnancies were included in this prospective randomized double blind study. Patients were randomly allocated to three groups. The group D (n= 40) received 8 mg dexamethasone, group M (n=40) received10 mg of metoclopramide while group D+M (n= 40) received 8 mg dexamethasone along with10 mg of metoclopramide intravenously immediately before administration of spinal anaesthesia. Intraoperative and post operative emetic episodes (nausea, retching, and vomiting) was noted as well as any other adverse effects. Results: During intraoperative period all parturients had PONV score 0. Postoperatively at first hour number of full responders in group D, M and D+M were 29/40 (72.5%), 30/40 (75%), 38/40 (95%) and the difference was statistically significant (Group D Vs Group D+ M, P value -0.013 and Group M Vs Group D+ M, P value-0.025). At 3rd hour postoperatively 9 patients in Group D, 8 patients in Group M and 1 in Group D+ M, had PONV score 1 (Group D Vs Group D+ M, P value -0.014 and Group M Vs Group D+ M, P value-0.029). No patient had any vomiting episodes over the time period of 24 hrs. Conclusion: Combined use of dexamethasone and metoclopramide as a prophylactic antiemetic was significantly better for the prevention of PONV as compared to the use of dexamethasone and metoclopramide alone.
{"title":"Evaluation of Efficacy of Metoclopramide, Dexamethasone and Their Combination for the Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing Cesarean Section","authors":"M. Rasheed, Arindam Sarkar, V. Arora","doi":"10.26502/acc.001","DOIUrl":"https://doi.org/10.26502/acc.001","url":null,"abstract":"Background: Nausea and/or vomiting following regional anaesthesia in pregnant females undergoing caesarean section is a major clinical problem. This study was conducted to compared the efficacy of metoclopramide, dexamethasone, and their combination for preventing intra operative & post-operative nausea and vomiting (PONV) following spinal anaesthesia given for caesarean section in patients. Materials and Methods: A total of 120 full term pregnant females of ASA I & II grade with uncomplicated pregnancies were included in this prospective randomized double blind study. Patients were randomly allocated to three groups. The group D (n= 40) received 8 mg dexamethasone, group M (n=40) received10 mg of metoclopramide while group D+M (n= 40) received 8 mg dexamethasone along with10 mg of metoclopramide intravenously immediately before administration of spinal anaesthesia. Intraoperative and post operative emetic episodes (nausea, retching, and vomiting) was noted as well as any other adverse effects. Results: During intraoperative period all parturients had PONV score 0. Postoperatively at first hour number of full responders in group D, M and D+M were 29/40 (72.5%), 30/40 (75%), 38/40 (95%) and the difference was statistically significant (Group D Vs Group D+ M, P value -0.013 and Group M Vs Group D+ M, P value-0.025). At 3rd hour postoperatively 9 patients in Group D, 8 patients in Group M and 1 in Group D+ M, had PONV score 1 (Group D Vs Group D+ M, P value -0.014 and Group M Vs Group D+ M, P value-0.029). No patient had any vomiting episodes over the time period of 24 hrs. Conclusion: Combined use of dexamethasone and metoclopramide as a prophylactic antiemetic was significantly better for the prevention of PONV as compared to the use of dexamethasone and metoclopramide alone.","PeriodicalId":41147,"journal":{"name":"Pediatric Anesthesia and Critical Care Journal","volume":"93 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76643969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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