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Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review. 区域麻醉下眼科手术后视网膜动脉闭塞:叙述回顾。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231215826
Alfred Wy Chua, Matthew J Chua, Brian P Harrisberg, Chandra M Kumar

Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.

最近的两例视网膜中央动脉闭塞,在其他情况下并不复杂,导致白内障手术后明显的视力丧失,促使我们对这类病例进行文献回顾。我们确定了97例视网膜动脉闭塞的眼科手术后,在区域麻醉下,没有立即的迹象,阻塞相关的并发症。这些发生在各种眼内(87%)和眼外(13%)手术后,年龄范围广(19-89岁),有(59%)或无(39%)已知危险因素的患者。麻醉技术包括40个球后阻滞,36个球周阻滞,19个球下阻滞,1个局部麻醉和1个未指明的局部麻醉。使用不同剂量的利多卡因、布比卡因、甲哌卡因和罗哌卡因单独使用或以不同的组合使用。麻醉技术的细节在报告中往往不完整,这给比较和分析带来了困难。只有9例患者的病因(视神经鞘损伤)被确定,而其余患者的损伤机制尚不清楚。假设了各种机制;然而,原因可能是多因素的,由于患者,手术和麻醉的危险因素,特别是在那些视网膜循环受损。由于没有确定明确的风险因素,因此无法提出具体建议来避免这种毁灭性的后果。我们提供了一些一般考虑的理由,这可能会降低这种风险,并根据我们的文献综述和我们的个人经验,在必要时对另一只眼睛进行眼科手术时提出麻醉选择。
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引用次数: 0
Bronchial blockers: Has side-by-side fallen by the wayside? Not quite. 支气管阻滞剂:肩并肩已经被淘汰了吗?不完全是。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231202812
Blake J Vorias, Nicholas J Barton, Desmond P McGlade, Naveed Alam
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引用次数: 0
Does gender still matter in the pursuit of a career in anaesthesia? 在追求麻醉学的职业生涯中,性别仍然重要吗?
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231212210
Claire H Stewart, Jane Carter, Natalie Purcell, Maryanne Balkin, Julia Birch, Greta C Pearce, Timothy Makar

A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.

一项发给澳大利亚和新西兰麻醉师学院(ANZCA)研究员的调查旨在记录影响麻醉工作场所性别平等的问题。达到38%的回复率,其中女性占更大比例(64.2%)。平均而言,女性的工作时间比男性短,在公共实践中花费的时间比例更高;然而,男女之间的满意度是相似的。男女薪酬差距不能用工作时数或获得研究金后的年数来解释。在所有性别中,欺凌和骚扰的比例都很高,自1998年斯特兰奇·库尔桑迪(Strange Khursandi)首次进行性别平等调查以来,这一比例在20年里没有改变。妇女认为,她们更有可能受到歧视,特别是在存在其他歧视来源的情况下,并强调麻醉工作场所需要多样化和包容性的重要性。此外,据报告,妇女承担照顾和无偿家务责任的比例更高,这证实,尽管麻醉师的职业地位很高,但他们也不能幸免于影响更广泛社会的因素。总的来说,有一半的女性受访者表示,她们觉得自己的性别是从事麻醉职业的障碍。虽然由于人数少而无法纳入统计,但非二元性别麻醉师做出了回应,并且必须纳入所有未来的工作。这里记录的不平等证明了澳新会性别平等小组委员会必须继续在澳大利亚和新西兰的工作场所促进和实施政策。
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引用次数: 0
Prevention of airway fires during tracheostomy is preferable. Comment on: Simulation training results in performance retention for the management of airway fires: A prospective observational study. 气管造口术期间最好预防气道火灾。评论:模拟训练在气道火灾管理中的成绩保持:一项前瞻性观察性研究。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-10-06 DOI: 10.1177/0310057X231196908
Kar-Soon Lim
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引用次数: 0
The introduction of blood gases into clinical practice. 将血气引入临床实践。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-01-01 DOI: 10.1177/0310057X231212299
Christine M Ball, Peter J Featherstone
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引用次数: 0
Metabolic crisis in maple syrup urine disease: an unusual complication of a rare disease: a case report. 枫糖浆尿病的代谢危机:罕见疾病的罕见并发症:1例报告。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-11-23 DOI: 10.1177/0310057X231183981
Hemang P Doshi, Hemal H Vachharajani, Michael C Tchan, Mohamed A Nasreddine, Kate E Billmore

A 19-year-old woman with known maple syrup urine disease presented to hospital with metabolic crisis in the setting of influenza type A infection and intractable vomiting, rapidly progressing to acute cerebral oedema manifesting as refractory seizures and decreased level of consciousness needing emergency intubation and mechanical ventilation, continuous veno-venous haemodiafiltration and thiopentone coma. A computed tomography scan and magnetic resonance imaging of the brain demonstrated classic signs of cerebral oedema secondary to a metabolic crisis from the metabolic disorder. Her management posed multiple challenges to all teams involved due to lack of familiarity and experience in managing this clinical scenario in the adult intensive care setting.

一名患有枫糖浆尿病的19岁女性在甲型流感感染和难治性呕吐的情况下出现代谢危像,迅速发展为急性脑水肿,表现为难治性癫痫发作和意识水平下降,需要紧急插管和机械通气,持续静脉-静脉血液扩张滤过和硫喷酮昏迷。大脑的计算机断层扫描和磁共振成像显示了代谢紊乱引起的代谢危机继发的脑水肿的典型征象。由于缺乏在成人重症监护环境中管理这种临床场景的熟悉度和经验,她的管理给所有相关团队带来了多重挑战。
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引用次数: 0
Risk factors for mortality in severe COVID-19: Exploring the interplay of immunomodulatory therapy and coinfection. 重症 COVID-19 患者死亡的风险因素:探索免疫调节疗法与合并感染的相互作用。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-09-17 DOI: 10.1177/0310057X231183451
Annaleise R Howard-Jones, Stephen Huang, Sam R Orde, James M Branley

Patients with severe clinical manifestations of coronavirus disease 2019 (COVID-19) present particular diagnostic and management challenges to critical care physicians, including identifying and responding to concurrent bacterial and fungal coinfections. This study evaluates risk factors for in-hospital mortality in patients admitted to the intensive care unit with severe COVID-19 during circulation of the B.1.617.2 (Delta) variant, including the impact of immunomodulators and bacterial and/or fungal coinfection. This retrospective cohort study enrolled patients with severe COVID-19. A Cox proportional hazard ratio analysis identified risk factors for in-hospital mortality. Outcomes were also compared between patients receiving and not receiving immunomodulatory therapy alongside standard care. Ninety patients admitted to the intensive care unit were enrolled. On multivariate analysis, the greatest risk factors for in-hospital mortality were invasive mechanical ventilation (hazard ratio (HR) = 15.27; 95% confidence interval (CI) 3.29-71.0; P < 0.001), elevated body mass index (HR = 1.07 per unit; 95% CI 1.02-1.13; P = 0.007) and older age (HR = 1.53 per decade; 95% CI 1.05-2.24; P = 0.028). Bacterial and/or fungal coinfection occurred at equal frequency in patients receiving and not receiving immunomodulatory therapy. However, in patients receiving immunomodulators, coinfection carried a significantly higher mortality risk (63.0%) compared with those without coinfection (15.4%; P = 0.038). Mortality from severe COVID-19 is significantly higher in older patients and those with elevated body mass index and requiring mechanical ventilation. Immunomodulatory therapy necessitates vigilance towards evolving coinfection in the intensive care setting.

临床表现严重的冠状病毒病2019(COVID-19)患者给重症监护医生带来了特殊的诊断和管理挑战,包括识别和应对并发的细菌和真菌合并感染。本研究评估了在B.1.617.2(Delta)变异体循环期间因重症COVID-19入重症监护病房的患者院内死亡的风险因素,包括免疫调节剂和细菌和/或真菌合并感染的影响。这项回顾性队列研究招募了严重COVID-19患者。Cox比例危险比分析确定了院内死亡率的风险因素。研究还比较了在接受标准护理的同时接受和不接受免疫调节疗法的患者的治疗结果。重症监护室收治的 90 名患者参加了此次研究。通过多变量分析,院内死亡的最大风险因素是侵入性机械通气(危险比 (HR) = 15.27;95% 置信区间 (CI) 3.29-71.0;P = 0.007)和年龄(HR = 每十年 1.53;95% CI 1.05-2.24;P = 0.028)。接受和未接受免疫调节疗法的患者发生细菌和/或真菌合并感染的频率相同。然而,在接受免疫调节剂治疗的患者中,合并感染带来的死亡风险(63.0%)明显高于未合并感染的患者(15.4%;P = 0.038)。在老年患者、体重指数升高和需要机械通气的患者中,严重 COVID-19 的死亡率明显更高。免疫调节疗法需要对重症监护环境中不断演变的合并感染保持警惕。
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引用次数: 0
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 Q2 Medicine 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 Q2 Medicine 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 Q2 Medicine 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
期刊
Anaesthesia and Intensive Care
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