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The use of surgical sealant to repair intubation-related tracheal injury 使用手术密封剂修复与插管相关的气管损伤。
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-10-02 DOI: 10.1002/anr3.12327
C. Cox, A. Crerar-Gilbert, B. Madden

This case study describes the management of a tracheal injury following emergency intubation in a 56-year-old man. After collapsing from heavy alcohol ingestion, intubation was performed using a bougie, leading to a punctate tracheal wound. Initial conservative treatment with antibiotics was followed by bronchoscopy, revealing a tracheal laceration. Rigid bronchoscopy was then performed, and the wound was closed using BioGlue® surgical sealant. The patient made a full recovery, with follow-up bronchoscopy confirming complete healing. This case highlights the effectiveness of BioGlue® as a minimally invasive alternative for tracheal wound closure, reducing the need for more complex interventions.

本病例研究描述了一名 56 岁男子在紧急插管后气管损伤的处理过程。患者因大量饮酒而昏倒,插管时使用了气管插管器,导致气管伤口穿刺。最初使用抗生素进行保守治疗,随后进行支气管镜检查,发现气管裂伤。随后进行了硬质支气管镜检查,并使用 BioGlue® 手术密封胶封闭了伤口。患者完全康复,后续支气管镜检查证实伤口完全愈合。这个病例突出了 BioGlue® 作为气管伤口闭合微创替代方法的有效性,减少了对更复杂干预的需求。
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引用次数: 0
Anaesthetic management of a patient with idiopathic pulmonary arterial hypertension, suprasystemic pulmonary artery pressures and carcinoma of the ascending colon* 对一名患有特发性肺动脉高压、超系统肺动脉压力和升结肠癌的患者的麻醉管理。
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-10-02 DOI: 10.1002/anr3.12330
I. Gurajala, G. P. Reddy, K. Vejendla, V. Vanaja, G. S. R. Verma, N. Jonnavithula

A 35-year-old woman with severe pulmonary arterial hypertension underwent open hemicolectomy with cholecystectomy under combined general and epidural anaesthesia. Intra-operative pulmonary artery pressure, as measured by Swan-Ganz catheter, was suprasystemic and managed with inodilators. She developed postoperative right ventricular dysfunction requiring inotropes, incremental pulmonary vasodilators and prolonged oxygen supplementation. One year after surgery, she is recurrence-free with oxygen saturations of 88–90% on air. This case highlights that with meticulous care and multidisciplinary team input, patients with severe pulmonary arterial hypertension can have favourable outcomes after major cancer surgery.

一名患有严重肺动脉高压的 35 岁女性在全身和硬膜外联合麻醉下接受了开腹半结肠切除术和胆囊切除术。术中通过 Swan-Ganz 导管测得的肺动脉压力为超高压,并使用了增压药。术后她出现了右心室功能障碍,需要使用肌力药物、增量肺血管扩张剂和长时间补氧。术后一年,她的病情没有复发,血氧饱和度达到 88-90%。该病例强调,通过精心护理和多学科团队的参与,严重肺动脉高压患者在接受大型癌症手术后可以获得良好的治疗效果。
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引用次数: 0
Internal jugular vein-femoral vein diversion during anterior mediastinal mass resection and superior vena cava replacement 前纵隔肿块切除术和上腔静脉置换术中的颈内静脉-股静脉转流术
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-09-17 DOI: 10.1002/anr3.12326
L. Su, J. Dai

Surgery which involves anterior mediastinal mass resection with artificial replacement of the superior vena cava results in significant disruption to the circulatory system. In this case, a pathway was established to divert blood from the internal jugular to the femoral vein after clamping of the superior vena cava. Blood which would ordinarily return to the right atrium via the superior vena cava was now being returned via the inferior vena cava. The mean arterial pressure was maintained at least 50 mmHg higher than the central venous pressure during clamping of the superior vena cava to avoid cerebral hypoperfusion. The combined use of the above strategies aimed to provide satisfactory surgical conditions and cerebral protection.

切除前纵隔肿块并人工置换上腔静脉的手术会严重破坏循环系统。在这个病例中,夹闭上腔静脉后,建立了一条将血液从颈内静脉引流到股静脉的通道。通常经上腔静脉回流到右心房的血液现在经下腔静脉回流。在夹闭上腔静脉时,平均动脉压至少要比中心静脉压高出 50 毫米汞柱,以避免脑灌注不足。上述策略的综合使用旨在提供令人满意的手术条件和脑保护。
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引用次数: 0
Peri-operative considerations for a pregnant patient with Werner syndrome and pre-eclampsia 韦纳综合征和先兆子痫孕妇的围手术期注意事项
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-09-17 DOI: 10.1002/anr3.12325
F. Fallon, B. Byrne, C. Lynch, P. Popivanov
<p>Werner syndrome was first described by Otto Werner in 1904 [<span>1</span>]. It is a rare autosomal recessive syndrome caused by a mutation of the RecQ type DNA/RNA helicase on the <i>WRN</i> gene resulting in accelerated ageing [<span>1, 2</span>]. Due to infertility and gonadal failure, the majority of female patients with Werner syndrome do not become pregnant. If pregnancy does occur, it can pose challenges for the anaesthetist.  Typical features include premature greying and hair loss, loss of subcutaneous adipose tissue, muscle wasting of the limbs, central adiposity, a ‘bird-like’ face, short stature and a classic high pitched voice. Age-related systemic disorders include type 2 diabetes mellitus, osteoporosis, atherosclerosis, cataracts, thyroid disease, vocal cord paralysis and malignancy. A full list of features is shown in Table 1. Severe forms of arteriosclerosis and atherosclerosis are common in all patients with Werner syndrome. Myocardial infarction is the leading cause of death, followed by malignancy. Over 50% of patients with Werner syndrome present with myocardial infarction, angina pectoris, stroke or hypertension before the age of 40 [<span>2</span>]. Case reports describe on-table cardiac arrest secondary to aortic stenosis and severe calcification of coronary vessels during a caesarean birth in a patient with Werner syndrome, and a caesarean birth performed for exacerbation of coronary symptoms and signs of cardiac insufficiency [<span>3, 4</span>]. Mortality usually occurs in the fourth or fifth decade and the physiological age of a patient with Werner syndrome may be greater than their chronological age. Therefore, consideration should be given to the choice and dose of medications administered. A difficult airway should be anticipated due to the craniofacial abnormalities which affect 98% of patients with Werner syndrome including small mouth, mandibular and maxillary hypoplasia. Difficult intravenous access should also be anticipated due to scleroderma-like skin changes which affect 96% of patients with Werner syndrome [<span>5</span>]. Anaesthetic techniques for pregnant patients with Werner syndrome should be decided on a case-by-case basis with thorough pre-operative investigations and multidisciplinary team discussion.</p><p>A 34-year-old gravida 2, para 0 woman with Werner syndrome was reviewed at the anaesthetic pre-operative assessment clinic at 24-week gestation as part of her antenatal care with the high-risk medical team. She had been diagnosed with Werner syndrome in her 20s, having initially presented with non-alcoholic hepatic steatosis. Genetic studies had confirmed homozygosity for the pathogenic variant <i>c3961C>T</i> (<i>p.Arg1321Ter</i>) in the <i>WRN</i> gene. She had a number of typical features of Werner syndrome (Table 1). Of particular note was her history of dysphonia, a glottic gap, right vocal cord paralysis and partial left vocal cord paralysis. Her regular medications were levothyroxin
患者观点:'我非常感谢在我怀孕期间所得到的护理。我非常激动,因为生孩子是我长久以来的梦想。剖腹产那天早上,我感到头痛,这让我有点害怕。每个人都围在床边照顾我,我知道我和我的宝宝都被照顾得很好。我还记得我曾担心我的伴侣不能按时进手术室,但幸运的是他做到了。我知道我去了手术室,但之后的很多记忆都模糊了。我只记得我感觉非常非常困。我很高兴一切都很顺利。有时我白天会很累,但对我来说是值得的"。
{"title":"Peri-operative considerations for a pregnant patient with Werner syndrome and pre-eclampsia","authors":"F. Fallon,&nbsp;B. Byrne,&nbsp;C. Lynch,&nbsp;P. Popivanov","doi":"10.1002/anr3.12325","DOIUrl":"https://doi.org/10.1002/anr3.12325","url":null,"abstract":"&lt;p&gt;Werner syndrome was first described by Otto Werner in 1904 [&lt;span&gt;1&lt;/span&gt;]. It is a rare autosomal recessive syndrome caused by a mutation of the RecQ type DNA/RNA helicase on the &lt;i&gt;WRN&lt;/i&gt; gene resulting in accelerated ageing [&lt;span&gt;1, 2&lt;/span&gt;]. Due to infertility and gonadal failure, the majority of female patients with Werner syndrome do not become pregnant. If pregnancy does occur, it can pose challenges for the anaesthetist.  Typical features include premature greying and hair loss, loss of subcutaneous adipose tissue, muscle wasting of the limbs, central adiposity, a ‘bird-like’ face, short stature and a classic high pitched voice. Age-related systemic disorders include type 2 diabetes mellitus, osteoporosis, atherosclerosis, cataracts, thyroid disease, vocal cord paralysis and malignancy. A full list of features is shown in Table 1. Severe forms of arteriosclerosis and atherosclerosis are common in all patients with Werner syndrome. Myocardial infarction is the leading cause of death, followed by malignancy. Over 50% of patients with Werner syndrome present with myocardial infarction, angina pectoris, stroke or hypertension before the age of 40 [&lt;span&gt;2&lt;/span&gt;]. Case reports describe on-table cardiac arrest secondary to aortic stenosis and severe calcification of coronary vessels during a caesarean birth in a patient with Werner syndrome, and a caesarean birth performed for exacerbation of coronary symptoms and signs of cardiac insufficiency [&lt;span&gt;3, 4&lt;/span&gt;]. Mortality usually occurs in the fourth or fifth decade and the physiological age of a patient with Werner syndrome may be greater than their chronological age. Therefore, consideration should be given to the choice and dose of medications administered. A difficult airway should be anticipated due to the craniofacial abnormalities which affect 98% of patients with Werner syndrome including small mouth, mandibular and maxillary hypoplasia. Difficult intravenous access should also be anticipated due to scleroderma-like skin changes which affect 96% of patients with Werner syndrome [&lt;span&gt;5&lt;/span&gt;]. Anaesthetic techniques for pregnant patients with Werner syndrome should be decided on a case-by-case basis with thorough pre-operative investigations and multidisciplinary team discussion.&lt;/p&gt;&lt;p&gt;A 34-year-old gravida 2, para 0 woman with Werner syndrome was reviewed at the anaesthetic pre-operative assessment clinic at 24-week gestation as part of her antenatal care with the high-risk medical team. She had been diagnosed with Werner syndrome in her 20s, having initially presented with non-alcoholic hepatic steatosis. Genetic studies had confirmed homozygosity for the pathogenic variant &lt;i&gt;c3961C&gt;T&lt;/i&gt; (&lt;i&gt;p.Arg1321Ter&lt;/i&gt;) in the &lt;i&gt;WRN&lt;/i&gt; gene. She had a number of typical features of Werner syndrome (Table 1). Of particular note was her history of dysphonia, a glottic gap, right vocal cord paralysis and partial left vocal cord paralysis. Her regular medications were levothyroxin","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 2","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic ultrasound as a surrogate for transoesophageal echocardiography for intra-operative monitoring of a catheter-related right atrial thrombus during gastrectomy 内窥镜超声代替经食道超声心动图术中监测胃切除术中导管相关右心房血栓的情况
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-09-17 DOI: 10.1002/anr3.12324
D. Nairita, C. Punitha, N. Thirumoorthi, J. Pradeep
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引用次数: 0
From kitchen to clinic: cherry tomato model for sub-Tenon's block training 从厨房到诊所:用于亚天农阻滞训练的樱桃番茄模型。
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-09-05 DOI: 10.1002/anr3.12321
F. Lersch, T. Schweizer, J. M. Berger-Estilita
<p>Our centre uses a cherry tomato model to simulate the anatomical structures of the vitreous body and surrounding tissues in training for sub-Tenon block administration [<span>1</span>]. This model provides a hands-on, anatomically accurate simulation that allows trainees to practice and refine their skills under the guidance of experienced instructors. It eliminates the need for training teams to use animal cadaver eyes [<span>2</span>]. We use a cherry tomato to simulate the vitreous body, surrounded by rubber gloves representing the tissue layers involved in sub-Tenon block administration. A cherry tomato is wrapped in a white rubber glove, simulating the sclera, and then a double layer of coloured gloves simulating the bulbar conjunctiva and Tenon's capsule (Fig. 1a). The pupil and limbus are marked or glued on the outer glove layer helping trainees judge the distance to the incision. The spherical cherry tomato simulates the vitreous body of the eye, allowing trainees to practice manoeuvring around a similarly sized and shaped object. The importance of the coloured double layer (conjunctiva and Tenon's capsule) is stressed in practical training as both layers must be engaged and lifted off the sclera before opening the potential space between the Tenon's capsule and the sclera. Having the contrasting white layer (sclera) appear during practice is essential, as is gliding the cannula behind the eye on the sclera. Identification of the plane and the gliding sensation can be enhanced by positioning a layer of ultrasound jelly between the simulated sclera and the Tenon's capsule (Fig. 1c; grey line). This also enables an ultrasound examination of the model and unequivocally demonstrates the layers (Fig. 1d). Supplementary videos S1 and S2 show the construction and use of the model, respectively.</p><p>The training program includes pre-instructional videos and literature (Table 1). Trainees receive instruction during dedicated time without interruptions [<span>3</span>]. The training involves an explanation of the eye quadrants and the necessity of maintaining a safe distance from the eye muscles. Trainees receive instruction on using forceps and scissors to breach the conjunctiva-Tenon's capsule double layer, ensuring the secure placement of a blunt cannula on the sclera. Instructors also demonstrate the double layer using ultrasound (Fig. 1d). Trainees are encouraged to perform at least five sub-Tenon's blocks on the model using the inferonasal quadrant. Instructors emphasise the layers in the model, provide feedback on the correct use of instruments and emphasise the importance of slowly injecting 2–5 ml of local anaesthetic. By integrating the cherry tomato model into a training package, trainees gain theoretical knowledge and practical skills in sub-Tenon's administration [<span>4</span>]. Overall, this package provides hands-on, anatomically accurate simulation [<span>5</span>] which allows trainees to practice and refine their sub-Tenon
我们中心使用樱桃番茄模型模拟玻璃体和周围组织的解剖结构,用于腱膜下阻滞给药培训[1]。该模型提供了一个动手操作、解剖精确的模拟环境,使学员能够在经验丰富的教师指导下练习和提高技能。培训团队无需使用动物尸体眼睛[2]。我们用一个樱桃番茄模拟玻璃体,周围用橡胶手套代表腱膜下阻滞给药所涉及的组织层。用白色橡胶手套包裹樱桃番茄,模拟巩膜,然后用双层彩色手套模拟球结膜和腱膜囊(图 1a)。瞳孔和角膜缘标记或粘在手套外层,帮助受训者判断与切口的距离。球形樱桃番茄模拟眼球玻璃体,让受训者练习围绕类似大小和形状的物体进行操作。在实际训练中强调了彩色双层(结膜和腱膜囊)的重要性,因为在打开腱膜囊和巩膜之间的潜在空间之前,必须将这两层都啮合并抬离巩膜。在练习过程中出现对比鲜明的白色层(巩膜)至关重要,在巩膜上滑动眼球后方的插管也是如此。在模拟巩膜和特农氏囊之间放置一层超声果冻(图 1c;灰线)可增强平面和滑动感觉的识别。这样还能对模型进行超声波检查,并明确显示各层(图 1d)。补充视频 S1 和 S2 分别展示了模型的构建和使用。受训者在专门的时间内不间断地接受指导[3]。培训内容包括解释眼球象限以及与眼肌保持安全距离的必要性。指导受训者使用镊子和剪刀破坏结膜-特农氏囊双层,确保将钝插管安全放置在巩膜上。教员还会使用超声波演示双层结构(图 1d)。鼓励学员使用下鼻象限在模型上进行至少五次Tenon's 下阻滞。导师会强调模型中的层次,反馈正确使用器械的方法,并强调缓慢注射 2-5 毫升局麻药的重要性。通过将樱桃番茄模型整合到培训包中,受训者可以获得噻农下给药的理论知识和实践技能[4]。总之,这套培训教材提供了动手操作、解剖精确的模拟[5],使学员能够在经验丰富的教师指导下练习和提高噻农下给药技能。
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引用次数: 0
Rebound methaemoglobinaemia secondary to intentional sodium nitrite ingestion 因故意摄入亚硝酸钠而引起的反跳性高铁血红蛋白血症
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-09-01 DOI: 10.1002/anr3.12320
J. Dalziel, D. Urwin, G. Band, S. Dey, T. Barker, R. Frank

We report a case of rebounding severe methaemoglobinaemia secondary to sodium nitrite ingestion, despite several administrations of methylene blue. The patient's clinical course was characterised by a series of alternating improvements and deteriorations and proved challenging for treating clinicians. On discussion with poisoning experts, it was hypothesised that a small amount of sodium nitrite remained in the gastrointestinal tract leading to prolonged absorption of the causative agent. Methaemoglobin levels returned to normal following the administration of multi-dose activated charcoal via a nasogastric tube 30 h after the initial presentation to hospital.

我们报告了一例因摄入亚硝酸钠而导致严重高铁血红蛋白血症反弹的病例,尽管患者多次服用亚甲蓝。患者的临床病程表现为一系列好转和恶化的交替出现,这对临床医生的治疗提出了挑战。经与中毒专家讨论,推测少量亚硝酸钠残留在胃肠道中,导致致病因子被长时间吸收。在首次送医 30 小时后,通过鼻胃管给予多剂量活性炭后,甲胎蛋白水平恢复正常。
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引用次数: 0
Sternal haematoma infusion catheter: a novel technique for pain management in manubriosternal fractures in the emergency department 胸骨血肿输液导管:急诊科人胸骨骨折疼痛治疗的新技术
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-08-31 DOI: 10.1002/anr3.12322
K. Frowde, S. Naeem, A. Alzarrad, D. Abdel-Aziz, O.W. Schofield

Sternal fractures are associated with significant morbidity and mortality, with some patients requiring admission for pain management, often through systemic analgesia, which may be ineffective. Regional anaesthetic techniques are more challenging for sternal fractures than rib fractures and require experienced clinicians. Local anaesthetic techniques are becoming recognised as a modality to improve pain control and to reduce complications from opioid use, especially in the elderly. We delivered local anaesthetic via a sternal haematoma infusion catheter for an elderly patient with uncontrolled pain despite the provision of intravenous patient-controlled analgesia. This technique enabled an improvement in pain scores, better engagement with physiotherapy and reduced opioid use. Local anaesthesia has been used previously to manage pain after coronary artery bypass graft surgery. Our experience demonstrated the safety, efficacy and tolerability of this approach to analgesia in sternal fractures.

胸骨骨折的发病率和死亡率都很高,有些患者需要入院接受疼痛治疗,通常需要全身镇痛,但效果可能不佳。与肋骨骨折相比,胸骨骨折的局部麻醉技术更具挑战性,需要经验丰富的临床医生。局部麻醉技术正逐渐被视为一种改善疼痛控制和减少阿片类药物并发症的方法,尤其是在老年人中。我们通过胸骨血肿输注导管为一名疼痛无法控制的老年患者进行局部麻醉,尽管已提供静脉患者自控镇痛。这项技术改善了患者的疼痛评分,使其更好地参与理疗,并减少了阿片类药物的使用。局部麻醉以前曾用于控制冠状动脉旁路移植手术后的疼痛。我们的经验证明了这种镇痛方法在胸骨骨折中的安全性、有效性和耐受性。
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引用次数: 0
Recurrent laryngeal nerve block to facilitate rigid bronchoscopy for tracheal stenosis in a patient with extensive burns 喉返神经阻断术为大面积烧伤患者进行气管狭窄硬质支气管镜检查提供便利
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-08-14 DOI: 10.1002/anr3.12319
S. Shokohi, M. M. Aghdashi
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引用次数: 0
Modified external oblique intercostal plane nerve block for female patients undergoing open donor hepatectomy 为接受开放式供体肝切除术的女性患者提供改良外斜肋间神经阻滞。
IF 0.8 Q3 ANESTHESIOLOGY Pub Date : 2024-08-07 DOI: 10.1002/anr3.12317
G. Sindwani, R. Nair, G. Manikandan
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引用次数: 0
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Anaesthesia reports
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