Anaesthesia in prehospital emergencies and in the emergency room

Paal, Peter; Herff, Holger; Mitterlechner, Thomas; Goedecke, Achim von; Brugger, Hermann; Lindner, Karl H.; Wenzel, Volker

doi:10.1016/j.resuscitation.2009.10.023

Cited by 63 publications

(54 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, SADs such as PLMA or I-gel could be an acceptable alternative to ETI, particularly for novice practitioners or patients with an anticipated difficult airway. Paal and colleagues recommend that less experienced medical staff should ventilate with an alternative SAD [16].…”

Section: Discussionmentioning

confidence: 99%

A comparison of ProSeal laryngeal mask airway, I-gel and endotracheal tube insertion by novices in a simulated difficult airway scenario

et al. 2016

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

A comparison of ProSeal laryngeal mask airway, I-gel and endotracheal tube insertion by novices in a simulated difficult airway scenario

et al. 2016

View full text Add to dashboard Cite

“…It is risky to perform ETI in prehospital settings and most chronicdisease hospitals because of the lack of backup personnel and equipment [22]. Neither a video laryngoscope nor an SGA was available at this rehabilitation facility.…”

Section: Discussionmentioning

confidence: 99%

“…Managing a difficult airway in such a setting is challenging even for an experienced provider [22], and past reports have revealed that both ETI difficulty [23,24] and severe ETI-related complications [25,26] can be increased in such situations. Results of a study by Paal et al [22] suggested that avoiding repeated ETI attempts is much more important in the prehospital setting than in the emergency or operating room. In the present case, manual bag ventilation was possible after removal of the foreign body.…”

Section: Discussionmentioning

confidence: 99%

Massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum after multiple direct laryngoscopies: an autopsy case report

et al. 2015

View full text Add to dashboard Cite

Multiple endotracheal intubation (ETI) attempts increase the risk of airway-related adverse events. However, little is known about autopsy findings after severe ETI-related complications.We present the detailed pathological findings of a case with severe ETI-related complications. A 77-year-old obese male suffered cardiopulmonary arrest after choking at a rehabilitation facility.Spontaneous circulation returned after chest compressions and foreign-body removal. After multiple failed direct laryngoscopies, the patient was transferred to our hospital. He had massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum on admission and died from hypoxic brain injury 15 hours later. Autopsy revealed severe oropharyngeal; laryngeal; and left lung lower lobe injury. The likely mechanisms of diffuse emphysema were: 1) oropharyngeal injury associated with multiple ETI attempts and excessive ventilation pressures and 2) left lung lower lobe injury associated with chest compressions and other resuscitative procedures. Multiple laryngoscopies can cause severe upper-airway injury, worsen respiratory status, and make ETI more difficulta vicious circle that can be prevented by limiting ETI attempts. This is particularly important in unfavorable environments, in which backup devices and personnel are not easily obtained. The pathological findings of our patient caution against repeated attempts at ETI during resuscitation.

show abstract

“…Sugammadeks ile ilgili önemli bir husus da zor havayolu/zor ventilasyon ile karşılaşılan hastalarda kullanımıyla sağladığı hızlı ve etkin dekürarizasyondur. Bu kullanım ile ilgili pek çok olgu sunumu literatürde yer almaktadır ve ilacın yüksek maliyetiyle ilgili kullanım kısıtlanmasına yer bırakmayacak bir endikasyon olarak görülmektedir [15][16]. Benzer şekilde muskuler distrofili hastaların genel anestezi uygulamasında kas gevşetici ajanlarla ilgili yaşanan zorlukların aşılmasında, sugammadeks kullanımıyla olumlu gelişmeler kaydedilmiştir [17][18].…”

Section: Discussionunclassified

Comparison of Sugammadex and Neostigmine in Short Term Surgery

Koç¹

2015

Ann Clin Anal Med

View full text Add to dashboard Cite

ÖzetAmaç: Bu çalışmada kısa süreli elektif cerrahide; rokuronyumla oluşturulan nöromusküler bloğun geri döndürülmesinde sugammadeks ve neostigminin klinik etki ve maliyeti karşılaştırıldı. Gereç ve Yöntem: Yazılı onayları alındık-tan sonra, ASA I-III, öngörülen cerrahi süresi 90 dakikayı aşmayan, 18-65 yaş arası 33 hasta randomize edilerek iki gruba ayrıldı (Grup Sugammadeks, n=16; Grup Neostigmin, n=17). Anestezi indüksiyonunda tüm hastalara fentanil 1-2 µg/kg, tiopental 5-7 mg/kg, rokuronyum 0,6 mg/kg verildi. İdame-de % 50 O2-N2O ve % 1 sevofluran kullanıldı. Nöromusküler blok seviyesi akselomyolografi metoduyla train-o-four (TOF) stimulasyon ile monitorize edildi. Ameliyat sırasında TOF ölçümleri yapılarak TOF 3 olduğunda 0.1-0.2 mg kg ek rokuronyum yapıldı. Cerrahi sonunda TOF 2 olunca Grup S'ye 2 mg/kg sugammadeks yapılırken Grup N'ye 50 µg/kg neostigmin ve 20 µg/ kg atropin uygulandı. Bulgular: Gruplar arasında demografik özellikler benzerdi. TOF oranı 0,9'a ulaşma ve ekstübasyon süreleri Grup S'de ve Grup N'e göre anlamlı olarak kısaydı (2,3±0,9 dk, 9,4±2,7dk ve 6,6±1,6 dk., 12.9±2 dk) (p<0,001). Hasta başına ortalama maliyet Grup S'de, Grup N'e göre anlamlı olarak fazlaydı. (3,13±0,47 TL, 135,36±17,86 TL) (p<0,001). Tartışma: Rokuronyum sonrası nöromusküler fonksiyonların geri dönmesinde TOF oranı 0.9 olması 2 mg/kg sugammadex ile 50 µg/kg neostigmine göre daha hızlı olmakla birlikte sugammadeks neostigminden çok daha pahalıdır. Anahtar KelimelerSugammadeks; Neostigmin; Nöromusküler Blok Abstract Aim: This study compared the efficacy and cost effectivines of sugammadex and neostigmine for reversal of neuromuscular blockade induced by rocuronium for short term elective surgery. Material and Method: After written informed consent, 33 patients aged 18-65, ASA I-III, who were undergoing short term surgery (<90 min) were randomly selected and divided into two groups (Group Sugamadex, n=16; group Neostigmine, n=17). All patients were given 1,5 µg kg-1 fentanyl, 5-7 mgkg-1 thiopental, 0,6 mg kg-1 rocuronium for anaesthesia induction. Anaesthetic maintenance was ensured through 50% O2-N2O and 1% sevoflurane. Neuromuscular blockade was monitored using acceleromyography and a train-of-four (TOF) mode of stimulation. During surgery maintenance doses of 0.1-0.2 mgkg-1 rocuronium were administered according to reappearance of the third response of the TOF. Patients were given sugammadex 2 mg kg_1(group S) or neostigmine 50 µg kg_1 (with atropine 20 µg kg_1) (group N) at reappearance of the second response of the TOF after the last dose of rocuronium in the end of the surgery. Results: Demographic properties were similar in the two groups. Time to recovery of the TOF ratio of 0.9 and extubation time after sugammadex compared with neostigmine were significantly shorter, being 2.3 ± 0.9 versus 9.4 ± 2.7 min and 6.6 ± 1.6 versus 12.9 ± 2 (P<0.001). The costs were higher in group S (71.2 ± 9.8 $ ) than group N (1.7 ± 0.2 $) per patient (p<0.001). Discussion: Recovery of neuromuscular function after rocuronium to a TOF ...

show abstract

Anaesthesia in prehospital emergencies and in the emergency room

Cited by 63 publications

References 84 publications

A comparison of ProSeal laryngeal mask airway, I-gel and endotracheal tube insertion by novices in a simulated difficult airway scenario

A comparison of ProSeal laryngeal mask airway, I-gel and endotracheal tube insertion by novices in a simulated difficult airway scenario

Massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum after multiple direct laryngoscopies: an autopsy case report

Comparison of Sugammadex and Neostigmine in Short Term Surgery

Contact Info

Product

Resources

About