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Background: Extracorporeally induced whole‐body hyperthermia (eWBH) might be a beneficial treatment in cancer patients. Objectives of this pig study were to assess thermal distribution, (patho‐)physiological effects, and safety of eWBH with a new WBH device. Methods: Fourteen healthy adult pigs were anesthetized, mechanically ventilated, and cannulated; 12 were included in the analysis. Blood was heated in 11 pigs (one pig served as control) using a WBH device (Vithèr Hyperthermia B.V.) containing two separate fluidic circuits and a heat exchanger. Temperature was monitored on nine different sites, including the brain. Core temperature (average of 4 deep probes) was elevated to 42°C for 2 hr. Results: Elevation of core body temperature to 42°C took on average (± standard deviation) 38 ± 8 min. Initially observed temperature spikes diminished after lowering maximal blood temperature to 45°C. Hereafter, brain temperature spikes never exceeded 42.5°C, mean brain temperature was at highest 41.9°C during maintenance. WBH resulted in increased heart rates and decreased mean arterial pressures. The vast amounts of fluids required to counter hypotension tended to be smaller after corticosteroid administration. Hemodialysis was started in three animals (potassium increase prevention in two and hyperkalemia treatment in one). Severe rhabdomyolysis was observed in all pigs (including the control). All animals survived the procedure until planned euthanasia 1, 6, or 24 hr post procedure. Conclusion: Fast induction of eWBH with homogenous thermal distribution is feasible in pigs using the Vithèr WBH device. Severe hemodynamic disturbances, rhabdomyolysis, and hyperkalemia were observed. [ABSTRACT FROM AUTHOR]

Objectives: ENT surgeons and anesthesiologists work closely together in managing challenging airway cases. Sharing knowledge, experiences, and expectations interdisciplinary is essential in order to facilitate decision‐making and adequate management in emergency front‐of‐neck airway cases. Methods: A survey was performed, to analyze level of experience, technique of preference, training, knowledge of material and protocols, and self‐efficacy scores of Dutch ENT surgeons and residents in performing an urgent or emergency front‐of‐neck airway. Results: Within one year (January 2014–2015), 25.7% of the 257 respondents had performed an urgent or emergency front‐of‐neck airway. Of all reported emergency front‐of‐neck airways (N = 30), 80% were managed by tracheotomy. In future emergency front‐of‐neck airway cases, 74% stated cricothyrotomy would be their technique of preference. The majority would choose an uncuffed large‐bore cannula technique. Post‐academic hands‐on training was attended by 42% of respondents. Self‐efficacy scores were highest for surgical tracheotomy, and higher when trained or experienced. In case of an emergency scenario, 8.6% would not perform a front‐of‐neck airway themselves. The main reasons for reluctance to start in general were lack of experience and lack of training. Reported items for improvement were mainly the development of a protocol and training. Conclusion: The chance of encountering an airway emergency scenario requiring front‐of‐neck airway is realistic. There is inconsistency between advised technique, technique of preference and technique actually performed by ENT surgeons. This study shows that there is both a need and desire for improvement in training and organization of care. Interdisciplinary guidelines and education is needed and could eventually safe lives. Level of evidence: 5 [ABSTRACT FROM AUTHOR]

Background: Diagnostic ultrasound is increasingly used by nonradiologists in trauma victims and critically ill patients. In the emergency department, the extended focused assessment with sonography for trauma and Polytrauma Rapid Echo-evaluation Program protocol are often used to assess these patients. Dutch Polytrauma Rapid Echo-evaluation Program-trained Emergency physicians are implementing the use of ultrasound in the emergency department but might encounter barriers to overcome. Objectives: This study aims to explore individual experiences of Dutch emergency physicians. Methods: We performed a qualitative study by conducting semi-structured interviews in Dutch emergency physicians working in a Level 2 emergency department that completed the 2-day Polytrauma Rapid Echo-evaluation Program course at least 1 year before the interviews. Data were analyzed using directed content analysis. Results: Eight emergency physicians employed by eight different hospitals were interviewed. Thirteen categories were identified in the transcribed interviews and these were combined into four general themes: (1) the desire to develop the Emergency Medicine specialty, both nationally and local; (2) incentives to start using ultrasound; (3) exploring practical applications of ultrasound; and (4) barriers faced while implementing emergency physician-performed ultrasound on the emergency department. The interviewees regard the course to be a solid base and are eager to independently perform ultrasound examinations, although challenges are faced. Conclusion: This exploratory study provides essential insight in Dutch emergency physicians implementing ultrasound in their emergency department. It shows that there is a need to develop a quality assurance system and it identified barriers that have to be dealt with. [ABSTRACT FROM AUTHOR]

Introduction The Episure Autodetect syringe, a spring-loaded syringe, is a loss-of-resistance syringe with an internal compression that applies constant pressure on the plunger. As the principle of loss-of-resistance is the same for adult and for pediatric patients, the Episure Autodetect syringe should be able to identify correctly the epidural space also in pediatric patients. Methods A retrospective review was carried out for all pediatric patients, in which the Episure Autodetect syringe was used for locating the epidural space between 2007 and 2011 in our department. Results In 17 pediatric patients (9 months-14 years, 7.5-43 kg weight), the Episure syringe was used. In all 17 patients, the epidural space was correctly identified using the spring-loaded syringe as evidenced by satisfactory analgesia. No accidental dural punctures or false loss-of-resistances were observed. Conclusion The spring-loaded Episure Autodetect syringe might be a potentially useful loss-of-resistance syringe for identification of the epidural space in pediatric patients. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusion To compare the effectiveness of low intra‐abdominal pressure (IAP) facilitated by deep neuromuscular block (NMB) to standard practice in improving the quality of recovery, preserving immune function, and enhancing parietal perfusion during robot‐assisted radical prostatectomy (RARP).In this blinded, randomised controlled trial, 96 patients were randomised to the experimental group with low IAP (8 mmHg) facilitated by deep NMB (post‐tetanic count 1–2) or the control group with standard IAP (14 mmHg) and moderate NMB (train‐of‐four 1–2). Recovery was measured using the 40‐item Quality of Recovery questionnaire and 36‐item Short‐Form Health survey. Immune function was evaluated by plasma damage‐associated molecular patterns, cytokines, and ex vivo lipopolysaccharide‐stimulated cytokine production. Parietal peritoneum perfusion was measured by analysing the recordings of indocyanine‐green injection.Quality of recovery was not superior in the experimental group (n = 46) compared to the control group (n = 50). All clinical outcomes, including pain scores, postoperative nausea and vomiting, and hospital stay were similar. There were no significant differences in postoperative plasma concentrations of damage‐associated molecular patterns, cytokines, and ex vivo cytokine production capacity. The use of low IAP resulted in better parietal peritoneum perfusion.Despite better perfusion of the parietal peritoneum, low IAP facilitated by deep NMB did not improve the quality of recovery or preserve immune function compared to standard practice in patients undergoing RARP. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "What lessons for clinical practice can be learned from systematic reviews of animal studies? The case of anesthetic neurotoxicity," by A. W. Loepke and I. Vutskits in the 2016 issue is presented.