Purpose: An increase of NT-proBNP has been proved to be a predictor for ventilator weaning failure in several medical conditions. However, relation between NT-proBNP and ventilator-weaning outcomes after cardiac surgery has not yet been elucidated. This study was to investigate relationship between blood NT-proBNP and ventilatorweaning outcomes. Methods: A prospective analytical study was at Cardiovascular-thoracic intensive care unit. Cardiac-surgery patients (age 18-80 Y, consented and without exclusion criteria) were included. Blood NT-proBNP was sampling at pre-operation time and at weaning. Early-weaning outcomes were categorized into simple, difficult, and prolong weaning. Late-weaning outcomes were reintubation and suspicious cardiopulmonary compensations. Blood NT-proBNPs were compared among/between early and late-weaning outcomes. Area under the curve and sensitivity/specificity at various cut-off values for poor weaning outcomes were analyzed. Results: A final of 134 patients were analyzed. The mean NT-proBNPs (pre-operation and weaning) were 1,417.8 and 4,532.5 pg/ml, respectively. wide variations of NT-proBNPs were observed. NT-proBNPs were not significantly related to difficult, prolong, and reintubation; but significantly related to suspicious cardiopulmonary compensations. AUC range were 0.43-0.65. Conclusions: NT-proBNP increased 4-5-fold after cardiac surgery. A significant increase was related to sympathetic activation, not weaning-induced LV load. Due to low sensitivity, NT-proBNPs were not good predictors for difficult or prolong weaning and reintubation in post cardiac surgery.
{"title":"N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes","authors":"Sindhvananda Wacharin, Bunpeth Chonlada, Chareonkulnawanun Nuthathai","doi":"10.23937/2377-4630/1410085","DOIUrl":"https://doi.org/10.23937/2377-4630/1410085","url":null,"abstract":"Purpose: An increase of NT-proBNP has been proved to be a predictor for ventilator weaning failure in several medical conditions. However, relation between NT-proBNP and ventilator-weaning outcomes after cardiac surgery has not yet been elucidated. This study was to investigate relationship between blood NT-proBNP and ventilatorweaning outcomes. Methods: A prospective analytical study was at Cardiovascular-thoracic intensive care unit. Cardiac-surgery patients (age 18-80 Y, consented and without exclusion criteria) were included. Blood NT-proBNP was sampling at pre-operation time and at weaning. Early-weaning outcomes were categorized into simple, difficult, and prolong weaning. Late-weaning outcomes were reintubation and suspicious cardiopulmonary compensations. Blood NT-proBNPs were compared among/between early and late-weaning outcomes. Area under the curve and sensitivity/specificity at various cut-off values for poor weaning outcomes were analyzed. Results: A final of 134 patients were analyzed. The mean NT-proBNPs (pre-operation and weaning) were 1,417.8 and 4,532.5 pg/ml, respectively. wide variations of NT-proBNPs were observed. NT-proBNPs were not significantly related to difficult, prolong, and reintubation; but significantly related to suspicious cardiopulmonary compensations. AUC range were 0.43-0.65. Conclusions: NT-proBNP increased 4-5-fold after cardiac surgery. A significant increase was related to sympathetic activation, not weaning-induced LV load. Due to low sensitivity, NT-proBNPs were not good predictors for difficult or prolong weaning and reintubation in post cardiac surgery.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46165715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410080
Saracoglu Ayten, Tetik Sermin
Trauma is still a leading cause of death in the 21st Century mainly due to uncontrolled hemorrhage. Trauma has also an increasing cost of treatment in patients. Recently we have been aware of the importance of complex hemostatic and immunoinflammatory responses in pathogenesis of “Trauma Induced Coagulopathy”. As a result of understanding of changes on coagulation pathway in trauma, different hypotheses put forward explaining the trauma induced coagulopathy. New treatment algorithms also take place in early coagulation management of patients with traumatic coagulopathy. In this review, we aimed to explain pathophysiological determinant of trauma induced coagulopathy and recent evidence-based hemostatic treatment approach for patients with trauma.
{"title":"Hemostatic Coagulation Management in Trauma","authors":"Saracoglu Ayten, Tetik Sermin","doi":"10.23937/2377-4630/1410080","DOIUrl":"https://doi.org/10.23937/2377-4630/1410080","url":null,"abstract":"Trauma is still a leading cause of death in the 21st Century mainly due to uncontrolled hemorrhage. Trauma has also an increasing cost of treatment in patients. Recently we have been aware of the importance of complex hemostatic and immunoinflammatory responses in pathogenesis of “Trauma Induced Coagulopathy”. As a result of understanding of changes on coagulation pathway in trauma, different hypotheses put forward explaining the trauma induced coagulopathy. New treatment algorithms also take place in early coagulation management of patients with traumatic coagulopathy. In this review, we aimed to explain pathophysiological determinant of trauma induced coagulopathy and recent evidence-based hemostatic treatment approach for patients with trauma.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43172463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410079
J. Budzinski
A pneumothorax can arise in a variety of clinical settings in the operating room, from bleb rupture to iatrogenic injury. Should it expand in size and cause increase in intrapleural pressures with resultant diminished venous return, it becomes referred to as a tension pneumothorax. We report a case of a premature infant presenting for repair of congenital pulmonary airway malformation who suffered an iatrogenic tension pneumothorax during lung isolation with fogarty embolectomy catheter used for single lung ventilation in a neonate. via c-section was noticed to have respiratory difficulty shortly after birth. Radiologic investigations revealed a right-sided chest mass with slight mediastinal shift (Figure 1). A diagnosis of CPAM was made, and the child was scheduled for right upper lobectomy. He was otherwise healthy with no abnormal laboratory or clinical findings. The case was discussed with the surgical team, and it was decided to proceed with lung isolation and single-lung ventilation (SLV). Atropine was administered intravenously, and anesthesia was induced with propofol and rocuronium. Mask ventilation was instituted using minimal pressures with 2% sevoflurane and 100% oxygen. Direct laryngoscopy (DL) was performed and a 4 Fr Fogarty embolectomy catheter (FC) easily inserted until resistance was met. An initial attempt with Case RepoRt
{"title":"Occurrence of Tension Pneumothorax following Fogarty Embolectomy Catheter use for Lung Isolation in a Neonate with Congenital Pulmonary Airway Malformation","authors":"J. Budzinski","doi":"10.23937/2377-4630/1410079","DOIUrl":"https://doi.org/10.23937/2377-4630/1410079","url":null,"abstract":"A pneumothorax can arise in a variety of clinical settings in the operating room, from bleb rupture to iatrogenic injury. Should it expand in size and cause increase in intrapleural pressures with resultant diminished venous return, it becomes referred to as a tension pneumothorax. We report a case of a premature infant presenting for repair of congenital pulmonary airway malformation who suffered an iatrogenic tension pneumothorax during lung isolation with fogarty embolectomy catheter used for single lung ventilation in a neonate. via c-section was noticed to have respiratory difficulty shortly after birth. Radiologic investigations revealed a right-sided chest mass with slight mediastinal shift (Figure 1). A diagnosis of CPAM was made, and the child was scheduled for right upper lobectomy. He was otherwise healthy with no abnormal laboratory or clinical findings. The case was discussed with the surgical team, and it was decided to proceed with lung isolation and single-lung ventilation (SLV). Atropine was administered intravenously, and anesthesia was induced with propofol and rocuronium. Mask ventilation was instituted using minimal pressures with 2% sevoflurane and 100% oxygen. Direct laryngoscopy (DL) was performed and a 4 Fr Fogarty embolectomy catheter (FC) easily inserted until resistance was met. An initial attempt with Case RepoRt","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45372500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410072
Q DangAnh, Rozner Marc, L. Nicole, Vachhani Shital
The construction of a coaxial circle breathing circuit encloses the inspiratory limb within the expiratory limb to preserve heat, humidity, anesthetic gas, and oxygen. However, the construction also makes kinks or breaks in the enclosed inspiratory limb difficult to detect. With kinking or disconnection of the central inspiratory limb, the patient may rebreathe expiratory gases, leading to a significant increase in dead space and concomitant respiratory acidosis. We describe a clinical case in which a disconnection in the inner inspiratory limb of a King (King Circuits, Noblesville, IN) coaxial breathing circuit resulted in severe respiratory acidosis 4 hours after induction during a craniotomy for tumor resection. Similar cases have been reported in the literature [1-3], but this one differs in the timing of the rebreathing and respiratory acidosis. Therefore, anesthetic providers who are aware that coaxial circuit failures associated with the inspiratory limb can occur at any time during surgery will be in a position to identify the problem early, thereby limiting the degree of respiratory acidosis that develops and reducing the risk of associated complications.
{"title":"When Equipment Misbehaves: Severe Respiratory Acidosis Resulting from a Compromised Coaxial Circuit","authors":"Q DangAnh, Rozner Marc, L. Nicole, Vachhani Shital","doi":"10.23937/2377-4630/1410072","DOIUrl":"https://doi.org/10.23937/2377-4630/1410072","url":null,"abstract":"The construction of a coaxial circle breathing circuit encloses the inspiratory limb within the expiratory limb to preserve heat, humidity, anesthetic gas, and oxygen. However, the construction also makes kinks or breaks in the enclosed inspiratory limb difficult to detect. With kinking or disconnection of the central inspiratory limb, the patient may rebreathe expiratory gases, leading to a significant increase in dead space and concomitant respiratory acidosis. We describe a clinical case in which a disconnection in the inner inspiratory limb of a King (King Circuits, Noblesville, IN) coaxial breathing circuit resulted in severe respiratory acidosis 4 hours after induction during a craniotomy for tumor resection. Similar cases have been reported in the literature [1-3], but this one differs in the timing of the rebreathing and respiratory acidosis. Therefore, anesthetic providers who are aware that coaxial circuit failures associated with the inspiratory limb can occur at any time during surgery will be in a position to identify the problem early, thereby limiting the degree of respiratory acidosis that develops and reducing the risk of associated complications.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48036417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410077
Hang Dustin, Ellinas Herodotos, Dolinski Sylvia Y
Acute respiratory failure is divided into four categories: hypoxemic (type I), hypercarbic (type II), perioperative (type III) and shock (type IV). We present a case of perioperative respiratory failure in a patient with iatrogenic phrenic nerve injury after mediastinoscopy and the implications for a high index of suspicion as well as appropriate diagnostics.
{"title":"Iatrogenic Nerve Injury Resulting in Respiratory Failure after Mediastinoscopy","authors":"Hang Dustin, Ellinas Herodotos, Dolinski Sylvia Y","doi":"10.23937/2377-4630/1410077","DOIUrl":"https://doi.org/10.23937/2377-4630/1410077","url":null,"abstract":"Acute respiratory failure is divided into four categories: hypoxemic (type I), hypercarbic (type II), perioperative (type III) and shock (type IV). We present a case of perioperative respiratory failure in a patient with iatrogenic phrenic nerve injury after mediastinoscopy and the implications for a high index of suspicion as well as appropriate diagnostics.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41920190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Study objective: Anxiety disorder, which is encountered in surgical patients receiving general anesthesia is a psychological and physical condition, characterized by sudden onset of hazard perception and extensive fear, and may lead to panic disorder. In this study, we aimed to determine anxiety levels of liver transplantation donors via a questionnaire and reveal their quality of life and anxiety status during the 1st postoperative day and month. Design: Prospective observational study. Setting: In the critical care. Patients: Following the Ethics Committee approval, forty subjects of both sexes, between the ages of 18 and 75 years, who were on the list of liver transplant donors were included in the study. Interventions: A 10-item anxiety and quality of life questionnaire was prepared using scales applied to surgical patients, such as the Amsterdam Preoperative Anxiety and Information Scale for preoperative anxiety, the Spielburger State-Trait Anxiety and Inventory and the Profile of Mood States on the 1st postoperative day and month. Measurements: Data regarding the donor’s age, sex, marital status, educational background, history of previous surgeries, the degree of affinity between donor and the recipient, number and age of their children, and duration of patient’s disease were recorded. Main results: On the first day and in the first month, the total score on questions “I am worried about anesthesia” was significantly lower than the total scores on the questions “I am worried about the success of the surgical procedure” and “I am worried about the risk of anesthesia-related mortality” (p = 0.007 and p = 0.001, respectively). Conclusions: Many living donors are motivated to make their decision on this procedure in a short time. We believe that allocating more time to informing patients and donors and holding information meetings on anesthesia and surgical procedures at intervals may be beneficial.
{"title":"Quality of Life and Anxiety Status following Donor Liver Transplantation","authors":"Saracoglu Ayten, Bulutcu Fisun, Oklu Levent, Yentur Ercument, Tokat Yaman, Yuzer Yildiray","doi":"10.23937/2377-4630/1410076","DOIUrl":"https://doi.org/10.23937/2377-4630/1410076","url":null,"abstract":"Study objective: Anxiety disorder, which is encountered in surgical patients receiving general anesthesia is a psychological and physical condition, characterized by sudden onset of hazard perception and extensive fear, and may lead to panic disorder. In this study, we aimed to determine anxiety levels of liver transplantation donors via a questionnaire and reveal their quality of life and anxiety status during the 1st postoperative day and month. Design: Prospective observational study. Setting: In the critical care. Patients: Following the Ethics Committee approval, forty subjects of both sexes, between the ages of 18 and 75 years, who were on the list of liver transplant donors were included in the study. Interventions: A 10-item anxiety and quality of life questionnaire was prepared using scales applied to surgical patients, such as the Amsterdam Preoperative Anxiety and Information Scale for preoperative anxiety, the Spielburger State-Trait Anxiety and Inventory and the Profile of Mood States on the 1st postoperative day and month. Measurements: Data regarding the donor’s age, sex, marital status, educational background, history of previous surgeries, the degree of affinity between donor and the recipient, number and age of their children, and duration of patient’s disease were recorded. Main results: On the first day and in the first month, the total score on questions “I am worried about anesthesia” was significantly lower than the total scores on the questions “I am worried about the success of the surgical procedure” and “I am worried about the risk of anesthesia-related mortality” (p = 0.007 and p = 0.001, respectively). Conclusions: Many living donors are motivated to make their decision on this procedure in a short time. We believe that allocating more time to informing patients and donors and holding information meetings on anesthesia and surgical procedures at intervals may be beneficial.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41986137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410075
A. Abbas, M. Omid, H. Hossein, Shadnia Shahin, Zamani Nasim
Background: Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE). Methods: All OP-poisoned endotracheally intubated patients admitted to poisoning ICU were included. The frequency and time of SE, need for re-intubation, and its impact on hospital stay and outcome were assessed. Results: In fifteen patients (48.4%) SE was reported. Need for re-intubation in these patients was more than those who underwent PE (60.0% vs. 37.5%; P = 0.2). Early unplanned SE significantly correlated with occurrence of pulmonary complications (P = 0.04). The rate of aspiration pneumonia was high (80%) in SE cases. Hospital stay was also significantly prolonged in these patients (14.6 vs. 5.4 days, P = 0.04). Conclusion: Planning for on-time weaning/extubation in OP-poisoned patients can prevent unplanned SE and decrease the occurrence of lung complications.
背景:呼吸衰竭是有机磷中毒患者发病和死亡的最常见原因。我们的目的是评估和比较自我拔管(SE)和计划拔管(PE)患者再次插管的需要和结果。方法:纳入所有经气管插管的op中毒ICU患者。评估SE的频率和时间、再次插管的必要性及其对住院时间和结果的影响。结果:15例患者出现SE，占48.4%。这些患者再次插管的需求高于PE患者(60.0% vs 37.5%;P = 0.2)。早期非计划性SE与肺部并发症的发生有显著相关性(P = 0.04)。SE病例吸入性肺炎发生率高(80%)。住院时间也显著延长(14.6天比5.4天，P = 0.04)。结论:对op中毒患者实施及时脱机拔管计划可预防意外SE的发生，减少肺部并发症的发生。
{"title":"Outcome of Self- and Planned Extubation in Organophosphate-Poisoned Patients","authors":"A. Abbas, M. Omid, H. Hossein, Shadnia Shahin, Zamani Nasim","doi":"10.23937/2377-4630/1410075","DOIUrl":"https://doi.org/10.23937/2377-4630/1410075","url":null,"abstract":"Background: Respiratory failure is the most common cause of morbidity and mortality in organophosphate (OP)-intoxicated patients. We aimed to assess and compare the need for re-intubation and outcome between patients with self-extubation (SE) and planned extubation (PE). Methods: All OP-poisoned endotracheally intubated patients admitted to poisoning ICU were included. The frequency and time of SE, need for re-intubation, and its impact on hospital stay and outcome were assessed. Results: In fifteen patients (48.4%) SE was reported. Need for re-intubation in these patients was more than those who underwent PE (60.0% vs. 37.5%; P = 0.2). Early unplanned SE significantly correlated with occurrence of pulmonary complications (P = 0.04). The rate of aspiration pneumonia was high (80%) in SE cases. Hospital stay was also significantly prolonged in these patients (14.6 vs. 5.4 days, P = 0.04). Conclusion: Planning for on-time weaning/extubation in OP-poisoned patients can prevent unplanned SE and decrease the occurrence of lung complications.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48091556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410082
Paoli Andrea, Lorenzi Marco, Bosco Annalisa, Spagna Andrea, Ori Carlo
Background: Several scientific associations recommend the use of the intraosseous access as a valid alternative to the intravenous route, which is often difficult to find in emergency conditions, as a safe and effective way for drugs and fluids administration and for blood sampling. Aim of the study: The purpose of this study was the evaluation of the use of the EZ-IO® device, by the S.U.E.M. 118 of Padua, in terms of efficacy and safety in obtaining intraosseous vascular access for fluids and drugs infusions in an out-of-hospital emergency setting. Materials and methods: From February 2012 to May 2016, all cases of pre-hospital IO access within the operational areas of the Pre-hospital Emergency Service (SUEM 118) of Padua were prospectively recorded. Data were collected by using a standardized grid and by consulting the online computer server Galileo. Data were then analysed by using the Statgraphics Centurion and Microsoft® Excel software. Results: 89 patients required an intraosseous vascular access. Needles’ placement using the EZ-IO device was successful in 97.75% (87/89). Considering only first attempts, the success rate is 95.51% (85/89). No immediate complications were observed. After one year, one patient was found to have an abscess at the insertion site, but there are insufficient data to establish the cause. Pain was evaluated in 38 patients, after administration of Lidocaine and the Mean value was calculated to be 3 and standard deviation (sd) 2. Only one patient reported unbearable pain (10/10). Conclusions: The high percentage of successful insertions along with low complication rates, shows that the use of intraosseous vascular access should be considered as first line treatment in out-of-hospital emergencies, whenever a rapid and safe vascular access is required, thus it can be used in every situation where a vascular access is impossible to obtain, regardless of the clinical conditions of the patient and the elapsed time.
{"title":"Efficacy and Safety of the Intraosseous Vascular Access in out-of-Hospital Emergencies: A Prospective Study of the Pre-Hospital Emergency Service (SUEM 118) of Padua from 2012 to Today","authors":"Paoli Andrea, Lorenzi Marco, Bosco Annalisa, Spagna Andrea, Ori Carlo","doi":"10.23937/2377-4630/1410082","DOIUrl":"https://doi.org/10.23937/2377-4630/1410082","url":null,"abstract":"Background: Several scientific associations recommend the use of the intraosseous access as a valid alternative to the intravenous route, which is often difficult to find in emergency conditions, as a safe and effective way for drugs and fluids administration and for blood sampling. Aim of the study: The purpose of this study was the evaluation of the use of the EZ-IO® device, by the S.U.E.M. 118 of Padua, in terms of efficacy and safety in obtaining intraosseous vascular access for fluids and drugs infusions in an out-of-hospital emergency setting. Materials and methods: From February 2012 to May 2016, all cases of pre-hospital IO access within the operational areas of the Pre-hospital Emergency Service (SUEM 118) of Padua were prospectively recorded. Data were collected by using a standardized grid and by consulting the online computer server Galileo. Data were then analysed by using the Statgraphics Centurion and Microsoft® Excel software. Results: 89 patients required an intraosseous vascular access. Needles’ placement using the EZ-IO device was successful in 97.75% (87/89). Considering only first attempts, the success rate is 95.51% (85/89). No immediate complications were observed. After one year, one patient was found to have an abscess at the insertion site, but there are insufficient data to establish the cause. Pain was evaluated in 38 patients, after administration of Lidocaine and the Mean value was calculated to be 3 and standard deviation (sd) 2. Only one patient reported unbearable pain (10/10). Conclusions: The high percentage of successful insertions along with low complication rates, shows that the use of intraosseous vascular access should be considered as first line treatment in out-of-hospital emergencies, whenever a rapid and safe vascular access is required, thus it can be used in every situation where a vascular access is impossible to obtain, regardless of the clinical conditions of the patient and the elapsed time.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44628950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/2377-4630/1410071
A. Nazri, Z. Hidayah, M. Suryati, WI Wan Nasrudin, M. Azhar, O. Mazelan, H. N. Ashikin, Z. Fazilawati, M. Maziah, H. Has, S. Puzizer
Succinylcholine is a depolarizing, muscle relaxant, that commonly used to facilitate endotracheal intubation, especially in emergency surgery or patient with difficult intubation. However succinylcholine is associated with severe hyperkalaemia, arrhythmia and cardiac arrest especially in severe burn and neuromuscular disease and renal failure. We report a case of young boy with underlying Obstructive Sleep Apnoea (OSA) presented for bleeding post tonsillectomy, who developed cardiac arrest following administration of succinylcholine. In this case report, we discuss regarding possible mechanism and treatment.
{"title":"Uncommon Complication for Commonly Used Drugs: Cardiac Arrest after Administration of Succinylcholine","authors":"A. Nazri, Z. Hidayah, M. Suryati, WI Wan Nasrudin, M. Azhar, O. Mazelan, H. N. Ashikin, Z. Fazilawati, M. Maziah, H. Has, S. Puzizer","doi":"10.23937/2377-4630/1410071","DOIUrl":"https://doi.org/10.23937/2377-4630/1410071","url":null,"abstract":"Succinylcholine is a depolarizing, muscle relaxant, that commonly used to facilitate endotracheal intubation, especially in emergency surgery or patient with difficult intubation. However succinylcholine is associated with severe hyperkalaemia, arrhythmia and cardiac arrest especially in severe burn and neuromuscular disease and renal failure. We report a case of young boy with underlying Obstructive Sleep Apnoea (OSA) presented for bleeding post tonsillectomy, who developed cardiac arrest following administration of succinylcholine. In this case report, we discuss regarding possible mechanism and treatment.","PeriodicalId":90855,"journal":{"name":"International journal of anesthetics and anesthesiology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46237079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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