Anaesthesia reports最新文献

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.

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.

In this case report, we discuss the use of a thiopentone infusion for the maintenance of anaesthesia in a patient with confirmed malignant hyperthermia susceptibility and carnitine palmitoyltransferase 2 deficiency. The concurrence of both diagnoses precluded the use of both propofol-based total intravenous anaesthesia and volatile inhalational anaesthesia. This patient had been anaesthetised previously with a triple infusion regimen of thiopentone, midazolam and remifentanil and this was a unique opportunity to compare the two instances. Electroencephalogram-based depth of anaesthesia monitoring was in routine use by the time of the second anaesthetic, and thus, the thiopentone infusion could be adjusted accordingly, resulting in a more rapid emergence time. We hope that this case may serve as an example of suitable anaesthetic alternative should both propofol infusion and inhalational anaesthesia not be an option.

Simulation education for anaesthesia trainees is essential to build clinical skills and virtual reality can provide a reproducible, high-fidelity intra-operative training environment. Compared to in-situ manikin-based simulation, this modality has yet to be thoroughly evaluated. Twenty-six second post-graduate year anaesthesiology residents were randomly divided into two groups and participated in both virtual reality and manikin crisis scenarios at sessions six months apart. The exposure order was group A virtual reality followed by manikin and group B manikin followed by virtual reality. Clinical assessments were performed using a standardised checklist. Knowledge assessments were conducted. National Aeronautics and Space Administration Task Load Index and System Usability Scale scores were collected immediately after participation. Clinical scores between groups A and B were not significantly different. Group A had improved post-simulation knowledge scores after both sessions. Task load index scores were lower in mental demand for virtual reality. System usability scores showed less ease of use and more need for support in virtual reality.

Universal use of Storz C-MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first-pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First-pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non-theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. > 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no-PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non-theatre 7/136, p < 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non-RSI 1/720 (0.1%), p = 0.008).

Peripheral neuropathy is a well-described side effect of certain chemotherapeutic agents, including taxanes, and often improves in the weeks following treatment. The recurrence of motor and sensory neuropathies after anaesthesia has not yet been described to our knowledge. We present a case of transient recurrence of chemotherapy-induced peripheral neuropathy following general anaesthesia. Although an exact mechanism has not yet been described and is likely multifactorial in nature, anaesthetists should be prepared to address this phenomenon in the growing population of patients on chemotherapeutic agents.