Ultrasound can not only quickly and effectively identify the suprascapular notch and nerve, but also helps the operator manipulate and advance the needle to a more precise position.
For parturients with labor epidural analgesia needing CS, the use of SA led to shorter anesthetic time and lower postoperative pain scores, with lower morphine doses compared with EA. However, the high failure rate with both neuraxial techniques needs to be addressed.
Background
Fluoroquinolones are first‐line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD in patients with UTIs in the Taiwanese population.
Methods and Results
We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first‐, second‐, or third‐generation cephalosporins. An AA and AD diagnosis within a year constituted the study event. Multivariable analysis with a multiple Cox regression model was applied for comparing the hazard risk of AA and AD between fluoroquinolones and first‐ or second‐generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1 249 944 selected patients with UTIs, 28 568 patients were assigned to each antibiotic group after propensity score matching. The incidence of AA and AD was not significantly different between the fluoroquinolones and first‐ or second‐generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59–1.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04–1.16]).
Conclusions
Compared with first‐ or second‐generation cephalosporins, fluoroquinolones were not associated with increased risk of AA and AD in patients with UTI. However, a significant risk of mortality was still found in patients treated with fluoroquinolones. The priority is to control infections with adequate antibiotics rather than exclude fluoroquinolones considering the risk of AA and AD for patients with UTI.
The GlideScope is used to facilitate exposure of the larynx in both routine and difficult airways. A 38-year-old woman with a flame burn (second/third-degree, 40% total body surface area) and inhalation injury accompanied by acute respiratory failure under mechanical ventilation support presented for wound debridement and split thickness skin grafting. After the surgery, the endotracheal tube was reinserted successfully with a GlideScope because we anticipated a problematic airway. However, direct laryngoscopy revealed the endotracheal tube had pierced through the right palatoglossal arch. Because the consulting otolaryngologist confirmed there was no active bleeding, it was decided that no further management was needed for the wound; the patient was re-intubated under direct laryngoscopy. Postoperatively, she was transferred to the intensive care unit of the burn center under mechanical ventilation. This is a report on a rare complication caused by tracheal intubation associated with the use of the GlideScope. We recommend manipulation of the GlideScope should be performed with care under vigilant surveillance to minimize injury to the oropharyngeal tissues when an endotracheal tube is advanced from the mouth to the pharynx. Potential complications should be always kept in mind when the GlideScope is used for intubation.
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