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Airway management of lingual tonsillar hypertrophy: A narrative review. 舌扁桃体肥大的气道管理:叙述回顾。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231196910
Patrick Wong, Jamie W Sleigh

Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.

舌扁桃体肥大在常规气道评估中很少被发现,但可能给气道管理带来困难。我们对舌扁桃体肥大的病例报告进行了叙述性回顾,以检查相关的患者因素,气道管理技术的成功率和并发症。我们检索了有关舌扁桃体肥大病例的麻醉处理的文献。我们在各种病例报告中发现89例患者,从中我们得出92例进行分析。64%的病例被评估为气道正常。口罩通气困难和不可能分别占29.6%和1.4%。插管困难和插管失败分别占89.1%和21.7%。多次插管尝试(多达6次),在直接喉镜下进行第三次插管尝试后没有成功。约16.5%的患者醒来,4.3%的患者需要紧急颈前通道。并发症包括食管插管(10.9%)、出血(9.8%)和严重缺氧(3.2%)。我们的研究结果表明,严重的舌部肥大病例可能导致意想不到的气道困难和严重的并发症,包括缺氧脑损伤和死亡。需要一个健全的气道策略,包括限制喉镜检查的次数,并在必要时尽早启动和执行颈部前方紧急通道。对于已知严重舌扁桃体肥大的患者,应考虑清醒插管。
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引用次数: 0
Response to "What is a case-control study? Comment on 'Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study'". 对“什么是病例对照研究?”对“口服米多卡因不能加速长期血管加压素输注的释放:一项病例对照研究”的评论。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231197692
Alexander Jt Wood, Rashmi Rauniyar, Angela Jacques, Robert N Palmer, Bradley Wibrow, Matthew H Anstey
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引用次数: 0
Preliminary pharmacokinetics and patient experience of jet-injected dexmedetomidine in healthy adults. 健康成人喷射注射右美托咪定的初步药代动力学和患者体验。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-09-15 DOI: 10.1177/0310057X231178841
Nicola M Whittle, Jamie W Sleigh, James W McKeage, Jonathan Termaat, Logan J Voss, Brian J Anderson

Jet injection is a drug delivery system without a needle. A compressed liquid drug formulation pierces the skin, depositing the drug into the subcutaneous or intramuscular tissues. We investigated the pharmacokinetics and patient experience of dexmedetomidine administered using jet injection in six healthy adult study participants. This needleless jet injection device was used to administer dexmedetomidine 0.5 μg/kg to the subcutaneous tissues overlying the deltoid muscle. Serum concentrations of dexmedetomidine were assayed at approximately 5 minutes, 15 minutes, 30 minutes, 1 hour and 4 hours after administration. Pharmacokinetic interrogation of concentration time profiles estimated an absorption half time for jet-injected dexmedetomidine of 21 minutes (coefficient of variation 69.4%) with a relative bioavailability assumed unity. In our samples the measured median peak (range) concentration was 0.164 μg/l (0.011-0.325 μg/l), observed in the sample taken at a median (range) of 13.5 minutes (11-30 minutes). The Richmond agitation sedation scale was used to assess the sedative effect, and scored 0 (alert and calm) or -1 (drowsy) in all participants. Five of the six participants stated they would prefer jet injection to needle injection in the future and one had no preference. The findings suggest that the use of a larger dose (>2 μg/kg) would be required to achieve the clinically relevant target concentration of 1 μg/l necessary to achieve deeper sedation (Richmond agitation sedation scale ≤3).

喷射注射是一种不用针头的给药系统。压缩的液体药物制剂穿透皮肤,将药物注入皮下或肌肉组织。我们以六名健康的成年研究对象为研究对象,调查了使用喷射注射法给药右美托咪定的药代动力学和患者体验。我们使用这种无针喷射注射装置将 0.5 μg/kg 右美托咪定注射到三角肌上的皮下组织。分别在给药后约 5 分钟、15 分钟、30 分钟、1 小时和 4 小时检测右美托咪定的血清浓度。通过对浓度时间曲线进行药代动力学分析,估计喷射注射右美托咪定的吸收半衰期为 21 分钟(变异系数为 69.4%),相对生物利用度假定为 1。在我们的样本中,测得的峰值(范围)浓度中位数为 0.164 微克/升(0.011-0.325 微克/升),取样时间中位数(范围)为 13.5 分钟(11-30 分钟)。里士满躁动镇静量表用于评估镇静效果,所有参与者的评分均为 0(警觉镇静)或-1(昏昏欲睡)。六名参与者中有五人表示,与针头注射相比,他们更愿意在未来使用喷射器注射,一人则表示没有偏好。研究结果表明,需要使用更大的剂量(>2 μg/kg)才能达到与临床相关的目标浓度 1 μg/l,从而实现深度镇静(里士满躁动镇静量表≤3)。
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引用次数: 0
Assessing the impact of COVID-19 on Australian public interest in critical care. 评估COVID-19对澳大利亚重症监护公众利益的影响。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231198258
Rachel H T Yeong, Christopher B Hodge, Premkumar Gunasekaran
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引用次数: 0
Inflammation risk before cardiac surgery and the treatment effect of intraoperative dexamethasone. 心脏手术前炎症风险及术中地塞米松治疗效果分析。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231195098
Andrew J Toner, Tomas B Corcoran, Philip S Vlaskovsky, Arno P Nierich, Chris R Bain, Jan M Dieleman

Patients who exhibit high systemic inflammation after cardiac surgery may benefit most from pre-emptive anti-inflammatory treatments. In this secondary analysis (n = 813) of the randomised, double-blind Intraoperative High-Dose Dexamethasone for Cardiac Surgery trial, we set out to develop an inflammation risk prediction model and assess whether patients at higher risk benefit from a single intraoperative dose of dexamethasone (1 mg/kg). Inflammation risk before surgery was quantified from a linear regression model developed in the placebo arm, relating preoperatively available covariates to peak postoperative C-reactive protein. The primary endpoint was the interaction between inflammation risk and the peak postoperative C-reactive protein reduction associated with dexamethasone treatment. The impact of dexamethasone on the main clinical outcome (a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure within 30 days) was also explored in relation to inflammation risk. Preoperatively available covariates explained a minority of peak postoperative C-reactive protein variation and were not suitable for clinical application (R2 = 0.058, P = 0.012); C-reactive protein before surgery (excluded above 10 mg/L) was the most predictive covariate (P < 0.001). The anti-inflammatory effect of dexamethasone increased as the inflammation risk increased (-0.689 mg/L per unit predicted peak C-reactive protein, P = 0.002 for interaction). No treatment-effect heterogeneity was detected for the main clinical outcome (P = 0.167 for interaction). Overall, risk predictions from a model of inflammation after cardiac surgery were associated with the degree of peak postoperative C-reactive protein reduction derived from dexamethasone treatment. Future work should explore the impact of this phenomenon on clinical outcomes in larger surgical populations.

心脏手术后表现出高度全身性炎症的患者可能从先发制人的抗炎治疗中获益最多。在这项随机、双盲的术中大剂量地塞米松心脏手术试验的二级分析(n = 813)中,我们着手建立一种炎症风险预测模型,并评估高风险患者是否从术中单剂量地塞米松(1mg /kg)中获益。术前炎症风险通过在安慰剂组建立的线性回归模型进行量化,将术前可用协变量与术后c反应蛋白峰值相关。主要终点是炎症风险与地塞米松治疗相关的术后c反应蛋白峰值降低之间的相互作用。地塞米松对主要临床结果(30天内死亡、心肌梗死、中风、肾功能衰竭或呼吸衰竭的综合结果)的影响也与炎症风险有关。术前可用协变量解释了少量术后c反应蛋白峰值变化,不适合临床应用(R2 = 0.058, P = 0.012);术前c反应蛋白(排除高于10 mg/L)是最具预测性的协变量(P < 0.001)。地塞米松的抗炎作用随着炎症风险的增加而增强(预测c反应蛋白峰值为-0.689 mg/L /单位,相互作用P = 0.002)。主要临床结果未发现治疗效果异质性(相互作用P = 0.167)。总体而言,心脏手术后炎症模型的风险预测与地塞米松治疗引起的术后c反应蛋白峰值降低程度相关。未来的工作应该在更大的手术人群中探索这种现象对临床结果的影响。
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引用次数: 0
What is a case-control study? Comment on 'Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study'. 什么是病例对照研究?对“口服米多卡因不能加速长期血管加压素输注的释放:一项病例对照研究”的评论。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231196914
Paul S Myles
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引用次数: 0
Investigation of the HotDog, polymer resistive patient warming device. 调查研究 HotDog 聚合物电阻式病人取暖装置。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-09-17 DOI: 10.1177/0310057X231181405
Teneal E Baxter, Wallace G Grimmett
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引用次数: 0
Publication outcomes among intensive care trainees. 重症监护受训者的出版结果。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231194079
Eddie Shen, Jayesh Dhanani, Elissa M Milford, Vanessa Raileanu, Kevin B Laupland

There is a paucity of literature describing the research productivity among trainees in intensive care medicine. We sought to examine the occurrence and determinants of successful publication outcomes associated with intensive care training. The study cohort consisted of all individuals admitted to fellowship of the College of Intensive Care Medicine of Australia and New Zealand (CICM) from 2012 to 2019. The primary outcome measure of this study was manuscripts indexed on PubMed within one year after and four years prior to admittance to CICM fellowship. Four hundred and eighty-five fellows were identified of whom 216 (45%) had at least one publication; 129 (27%) had one, 34 (7%) had two, 21 (4%) had three and 32 (7%) had four or more publications. Overall 138 (28%) fellows had at least one publication that was likely associated with their mandatory CICM training project for which they were first (n = 110; 80%) and/or corresponding (n = 72; 52%) author in the majority of cases. Overall 107 different senior/mentor authors were identified, with 13 individuals supporting more than one publication. Although gender and location at the time of fellowship award were not associated, location of receipt of medical degree, shorter time period between medical school graduation and fellowship award, more recent year of award, and completion of medical degree/fellowship in the same geographical region were associated with project publication. A minority of CICM fellows have PubMed-indexed publications related to their training. Further efforts are warranted to better define the determinants of successful project publication to optimise future opportunities.

关于重症监护医学培训生的研究生产力的文献描述很少。我们试图检查与重症监护培训相关的成功发表结果的发生和决定因素。该研究队列包括2012年至2019年澳大利亚和新西兰重症监护医学学院(CICM)奖学金录取的所有个体。本研究的主要结局指标是在进入CICM奖学金后一年和进入CICM奖学金前四年在PubMed上索引的手稿。确定了485名研究员,其中216名(45%)至少发表过一篇论文;129人(27%)发表过一篇,34人(7%)发表过两篇,21人(4%)发表过三篇,32人(7%)发表过四篇或更多。总共138名(28%)研究员至少有一篇出版物可能与他们的强制性CICM培训项目有关,他们是第一个(n = 110;80%)和/或相应的(n = 72;52%)作者在大多数情况下。总共确定了107名不同的高级/导师作者,其中13人支持不止一篇论文。虽然颁发研究金时的性别和地点没有关联,但获得医学学位的地点、医学院毕业与颁发研究金之间的时间间隔较短、获奖年份较近以及在同一地理区域完成医学学位/研究金与项目发表有关。少数CICM研究员拥有与他们的培训相关的pubmed索引出版物。有必要进一步努力,更好地确定项目出版成功的决定因素,以尽量利用今后的机会。
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引用次数: 0
The new Diploma of Rural Generalist Anaesthesia: Supporting Australian rural and remote communities. 新的农村全科麻醉学文凭:支持澳大利亚农村和偏远社区。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2024-01-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231196909
Peter T Gilchrist, Neil St M Beaton, Jodie N Atkin, Lindy J Roberts

In 2023, a Diploma of Rural Generalist Anaesthesia (DipRGA) was implemented across Australia. Developed collaboratively by the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), the 12-month qualification is completed during or following ACRRM or RACGP Rural Generalist Fellowship training. Focused on the needs of rural and remote communities for elective and emergency surgery, maternity care, resuscitative care for medical illness or injury, and stabilisation for retrieval, the DipRGA supports rural generalist anaesthetists working within collaborative teams in geographically isolated settings. The goal is a graduate who can anaesthetise American Society of Anesthesiologists physical status class 1, 2 and stable 3 patients for elective surgery, provide obstetric anaesthesia and analgesia, anaesthetise paediatric patients and undertake advanced crisis care within their scope of practice. Crucially, they also recognise both limitations of their skills and local resources available when considering whether to provide care, defer, refer or transfer patients. DipRGA curriculum design commenced by adapting the ANZCA specialist training curriculum with consideration of the training approach of both the ACRRM and the RACGP, particularly the rural and remote context. Curriculum content is addressed in seven entrustable professional activities supported by workplace-based assessments and multisource feedback. Trainees are supervised by rural generalist anaesthetists and specialist anaesthetists, and complete flexible learning activities to accommodate geographical dispersion. Standardised summative assessments include an early test of knowledge and an examination, adapted from the ACRRM structured assessment using multiple patient scenarios.

2023年,农村全科麻醉文凭(DipRGA)在澳大利亚实施。由澳大利亚和新西兰麻醉师学院(ANZCA),澳大利亚农村和远程医学学院(ACRRM)和澳大利亚皇家全科医生学院(RACGP)合作开发,为期12个月的资格认证在ACRRM或RACGP农村全科医生奖学金培训期间或之后完成。该计划的重点是农村和偏远社区对选择性和紧急手术、产妇护理、医疗疾病或损伤的复苏护理以及康复稳定的需求,支持在地理上孤立的环境中在协作小组中工作的农村全科麻醉师。我们的目标是培养一名能够为选择性手术麻醉美国麻醉医师协会身体状态1级、2级和稳定3级患者的毕业生,提供产科麻醉和镇痛,麻醉儿科患者,并在他们的实践范围内承担高级危机护理。至关重要的是,在考虑是否提供护理、推迟、转诊或转移病人时,他们也认识到自己的技能和当地可用资源的局限性。DipRGA的课程设计是在考虑到ACRRM和RACGP的培训方法,特别是农村和偏远地区的情况下,通过调整ANZCA的专家培训课程开始的。课程内容在七个可信赖的专业活动中得到解决,这些活动由基于工作场所的评估和多源反馈支持。受训人员由农村全科麻醉师和专科麻醉师指导,并完成灵活的学习活动,以适应地理分布。标准化总结性评估包括早期知识测试和考试,改编自ACRRM使用多种患者情景的结构化评估。
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引用次数: 0
Ultrasound in peripheral, neuraxial and perineuraxial regional anaesthesia, 1st ed. Switzerland: Published by Springer Nature, 351 pp. Price eBook $189, hardcover $241. ISBN 978-3-031-08803-2 (hardcover), 978-3-031-08804-9 (eBook) 外周、神经和会阴区域麻醉中的超声,第 1 版。瑞士:瑞士:Springer Nature 出版社,351 页。ISBN 978-3-031-08803-2(精装),978-3-031-08804-9(电子书)。
IF 1.5 4区 医学 Q3 ANESTHESIOLOGY Pub Date : 2023-12-02 DOI: 10.1177/0310057x231210009
W. A. Watson
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引用次数: 0
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Anaesthesia and Intensive Care
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