Purpose Safe perioperative care remains a large public healthcare problem in low-and middle-income countries. Anesthesia care provided by trained professionals is one of the essential determinants to address this situation. This article reports the design and implementation of a focused anesthesia educational program for nurses in Chad. Method This program consisted of four full-time courses of one month each, taught in a local hospital. The program included supervised practice in the operating room and post-anesthesia recovery room, skills lab simulation training, high fidelity crisis simulation, theoretical classes, integration sessions, evaluations, and structured feedback sessions. Results Seven male nurses, aged 28-40 yr, were accepted and successfully completed the program. The median [interquartile range] students' global satisfaction with the program was high (86 [85-93]%). Cognitive and skills assessment improved significantly after the program. Students subsequently worked in city and district hospitals performing essential and emergency surgical interventions. Conclusions This is a novel south-south academic cooperation program for nurses in Chad. The program evaluation indicated a high level of satisfaction, effective Electronic supplementary material The online version of this article (https://doi.
BackgroundEpidural waveform analysis (EWA) provides a simple confirmatory adjunct for loss of resistance (LOR): when the needle/catheter tip is correctly positioned inside the epidural space, pressure measurement results in a pulsatile waveform. Epidural waveform analysis can be carried out through the tip of the needle (EWA-N) or the catheter (EWA-C). In this randomized trial, we compared the two methods. We hypothesized that, compared with EWA-C, EWA-N would result in a shorter performance time.MethodsOne hundred and twenty patients undergoing thoracic epidural blocks for thoracic or abdominal surgery were randomized to EWA-N or EWA-C. In the EWA-N group, LOR was confirmed by connecting the epidural needle to a pressure transducer. After obtaining a satisfactory waveform, the epidural catheter was advanced 5 cm beyond the needle tip. In the EWA-C group, the epidural catheter was first advanced 5 cm beyond the needle tip after the occurrence of LOR. Subsequently, the catheter was connected to the pressure transducer to detect the presence of waveforms. In both study groups, the block procedure was repeated at different intervertebral levels until positive waveforms could be obtained (through the needle or catheter as per the allocation) or until a predefined maximum of three intervertebral levels had been reached. Subsequently, the operator administered a 4 mL test dose of lidocaine 2% with epinephrine 5 µg/mL through the catheter. An investigator present during the performance of the block recorded the performance time (defined as the temporal interval between skin infiltration and local anesthetic administration through the epidural catheter). Fifteen minutes after the test dose, a blinded investigator assessed the patient for sensory block to ice. Success was defined as a bilateral block in at least two dermatomes. Furthermore, postoperative pain scores, local anesthetic consumption, and breakthrough analgesic consumption were recorded.ResultsNo intergroup differences were found in terms of performance time, success rate, postoperative pain, local anesthetic requirement, and breakthrough analgesic consumption.ConclusionEWA can be carried out through the needle or through the catheter with similar efficiency (performance time) and efficacy (success rate, postoperative analgesia).Trial registration numberNCT03603574.
Цель. Менингиомы относятся к редким опухолям в детской нейрохирургической практике, а внутрижелудочковое их расположение встречается еще реже. Расположение неоплазмы в полости желудочковой системы создает условия, при которых менингиома может вырастать до очень больших размеров без клинических проявлений. Лечение этой патологии все еще изучается.Методы. В статье представляется краткий обзор данной патологии и опыт нейрохирургического вмешательства при детской внутрижелудочковой менингиоме, аспекты хирургической техники и ее осложнения. Наиболее частыми симптомами этих опухолей при внутрижелудочковом расположении являются симптомы повышения внутричерепного давления за счет развития окклюзионной гидроцефалии. Основным методом лечения менингиом вне зависимости от гистологической формы является нейрохирургическое вмешательство. Роль лучевой и химиотерапии изучается. Результаты. Предоперационная эмболизация опухоли, расположенной внутри желудочковой системы, используется редко в связи с особенностями кровоснабжения, но в случае расположения в полости бокового желудочка и при достижении гигантских размеров по нашему опыту может быть полезна. Важным фактором, позволяющим радикально удалять опухоль и избежать стойкого неврологического дефицита, является выбор хирургического доступа, который осуществляется с обязательным учетом функционально значимых отделов коры головного мозга, проводящих путей белого вещества и сосудов головного мозга. В редких случаях эпидуральная гематома может развиться вдали от хирургического вмешательства.Выводы. Качество жизни является одной из наиболее важных целей при леченииопухоли головного мозга, как и выживание. Правильный выбор подхода позволяет не только радикально удалить опухоль, но и сохранить качество жизни пациента. Purpose. Meningiomas are rare tumors in pediatric neurosurgical practice, and their location inside the ventricular is even less common. The neoplasm located in the cavity of the ventricular system creates conditions under which meningioma can grow to a huge size not having any clinical manifestations. Management of this pathology is being studied.Methods. We present short review of this pathology and our retrospective experience of neurosurgical intervention in pediatric intraventricular meningioma, aspects of surgical technique and its complications. The most common symptoms of these tumors with intraventricular location are symptoms of increased intracranial pressure due to the development of occlusive hydrocephalus. The main method of treating meningiomas, regardless of the histological form, is neurosurgical intervention. The role of radiation and chemotherapy is being studied. Preoperative embolization of a tumor located inside the ventricular system is rarely used due to the peculiarities of blood supply, but in the case of location in the cavity of the lateral ventricle and when reaching gigantic sizes, according to our experience, it can be useful.Results. According to our experience, in the rare case pre-operative embolization may be useful. An important factor that makes it possible to radically remove the tumor and avoid a persistent neurological deficit is selecting a surgical approach with obligatory taking into account eloquent cortex, white matter pathways and cerebral vessels aspects. In rare cases epidural hematoma can develop far from the surgical approach.Conclusions. Quality of the life is the most important goal in treatment brain tumor as is survival. Choosing the correct approach allows not only radical tumor resections but also preservation of patient’s life quality.
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