Search

Predictors for failure of supraglottic superimposed high-frequency jet ventilation during upper airway surgery in adult patients; a retrospective cohort study of 224 cases Keywords: endoscopic upper airway surgery; obesity; predictor; pulmonary disease; supraglottic superimposed high frequency jet ventilation Positive history of pulmonary pathology (OR = 4.91) and high BMI (OR = 1.15) were found to be significant independent factors for failure of SSHFJV in adult patients undergoing upper airway surgery. The only disadvantage of SSHFJV seems to be obligatory visualisation of the airway through the ventilating laryngoscope during the whole procedure, otherwise the ventilation of the patient is not possible, which makes it not suitable, for instance, for intervention in the hypopharynx. [Extracted from the article]

Summary: Background: Providing supplemental oxygen with a blow‐by method is used to provide additional oxygen to patients who will not tolerate an oxygen delivery device in direct contact with their face. Blow‐by methods are often improvised from parts of standard equipment. The performance is very dependent on the distance to the face and the direction of the gas flow. Blow‐by methods are used by anesthetists during transport but their performance in delivering supplemental oxygen has only been tested in static situations. The aim of this nonclinical study was to determine the performance of different blow‐by methods in the delivery of additional oxygen to pediatric patients during transport. Methods: A manikin of a child with a facemask of appropriate size was transported along a 60 m corridor from the operating theater to the PACU. Oxygen delivery to the face of the manikin was measured during transport. Six blow‐by methods were tested with oxygen flows of 3, 6, and 10 L/min and with the facemask at 0 cm from the face and at 5 cm from the face. The outcome parameter was: blow‐by method reaching and maintaining an FiO2 >50% during transport from the pediatric operating theater to the PACU. Results: At 0 cm from the face, five out of six blow‐by methods maintained a FiO2 >50% with all three flow rates. At 5 cm only two of the blow‐by methods were able to maintain an FiO2 >50% and this only at flow rates of 10 L/min. All other blow‐by methods provided lower FiO2s; in three, the FiO2 decreased to values only marginally above 21%. The decrease in FiO2 typically started within 6‐12 m from the start of the transport. Conclusion: It is concluded that the ability of blow‐by methods to deliver a FiO2 >50% depends on the method used and distance from the face. [ABSTRACT FROM AUTHOR]

Background: Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved.Objective: The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery.Design: Retrospective cohort study.Setting: The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013.Main Outcome Measures: Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications.Results: A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%).Conclusion: Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories. [ABSTRACT FROM AUTHOR]

Background: Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU. Methodology: A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed. Principal Findings: In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management. Conclusions: Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment. [ABSTRACT FROM AUTHOR]

The cover image is based on the Research Report Performance of blow‐by methods in delivering oxygen to pediatric patients during transport: A laboratory study by Clemens R. M. Barends et al., https://doi.org/10.1111/pan.13515. [ABSTRACT FROM AUTHOR]