Anaesthesia reports最新文献

Tranexamic acid reduces major bleeding events in patients undergoing major surgery without increasing thromboembolic events. In October 2022, the Joint Royal Colleges Tranexamic Acid in Surgery Implementation Group issued recommendations for consideration of tranexamic acid use in all patients having inpatient surgery. National and local audit data shows that a significant portion of eligible patients do not receive tranexamic acid. We designed and implemented a quality improvement project to increase the use of tranexamic acid in patients undergoing major surgery (surgery with the potential for estimated blood loss > 500 ml). Data were collected on baseline tranexamic acid use and stakeholder-reported barriers to tranexamic acid use. This was used to design and implement a sequence of quality improvement interventions. We disseminated Joint Royal Colleges guidance and delivered education sessions to increase understanding of tranexamic acid use. The local World Health Organisation (WHO) surgical checklist was updated to prompt clinical staff to consider the use of tranexamic acid. At baseline tranexamic acid was used in 50 of 100 (50%) major surgical cases. In the third audit cycle, tranexamic acid use had improved to 65 of 96 (68%) cases, with a shift in practice noted on continuous monitoring data indicating sustained improvement. Key factors in successful implementation of this project included stakeholder engagement, widespread dissemination of education and guidance and change of the local WHO surgical checklist.

We report the airway management of an 11-year-old boy with Treacher Collins syndrome. In three instances under general anaesthesia, ventilation via either anaesthesia facemask or supraglottic airway device proved virtually impossible except when the neck was flexed, which runs counter to what is typically observed during routine anaesthetic care. In this report, the impact of neck flexion on the patient's airway is demonstrated with images obtained on videolaryngoscopy and flexible endoscopy. It is prudent to manage airways using validated techniques and established algorithms. Nonetheless, airway management can benefit from atypical measures.

We report the airway management of an 11-year-old boy with Treacher Collins syndrome. In three instances under general anaesthesia, ventilation via either anaesthesia facemask or supraglottic airway device proved virtually impossible except when the neck was flexed, which runs counter to what is typically observed during routine anaesthetic care. In this report, the impact of neck flexion on the patient's airway is demonstrated with images obtained on videolaryngoscopy and flexible endoscopy. It is prudent to manage airways using validated techniques and established algorithms. Nonetheless, airway management can benefit from atypical measures.

A 67-year-old woman with no history of cardiovascular disease, undergoing an elective laparoscopic cholecystectomy, experienced severe bradycardia and cardiac arrest immediately following an alveolar recruitment manoeuvre under general anaesthesia. Prompt cardiopulmonary resuscitation restored cardiac output within 2–3 min. Postoperatively, she remained stable and was discharged following 24 h of monitoring. The cardiac arrest was likely triggered by vagal nerve stimulation and activation of intrinsic cardiac reflexes by the alveolar recruitment manoeuvre. The event emphasises a rare, but significant, risk of the routine management of pulmonary atelectasis.

The retrodural space is an interfascial tissue plane located between the ligamentum flavum and the interspinous ligament [1-3]. The ligamentum flavum forms a barrier between the retrodural and epidural spaces; however, theoretically normal gaps can allow the spread of medications into the epidural space [4]. Therefore, this space can be a potential location for injecting local anaesthetics, leading to their spread into the dorsal rami, neural foramen and epidural space.

We investigated this technique in one unembalmed cadaver to determine the distribution of local anaesthetic and dye after injection into the lumbar retrodural space. Anterior–posterior fluoroscopic and ultrasound imaging (a curved array transducer in the transverse window between the L3 and L4 vertebrae) were used to guide the injection. An 18-gauge Tuohy needle was advanced in-plane from lateral to medial (left paramedian approach) (Fig. 1a). Once the needle tip was identified superficial to the ligamentum flavum with ultrasound and increased tactile resistance was noted, 6 ml of lidocaine 1% mixed with 0.5 ml methylene blue and 3.5 ml of iodinated contrast agent was injected (Fig. 1b).

We observed staining in the tissue plane deep (anterior) to the erector spinae muscles from T12 to L5 (Fig. 2a). The intact facet joints showed dye spread around the capsule (Fig. 2b). The lumbar dorsal root ganglion, the dura and the spinal nerves showed no staining (Fig. 2c).

This is the first cadaveric study of intentional injection into the retrodural space. This technique may prove useful for posterior truncal wall coverage as it allows the dorsal rami to be blocked.

The authors state that every effort was made to follow all local and international ethical guidelines and laws pertaining to the use of human cadaveric donors in anatomical research.