European journal of anaesthesiology
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Continuous interscalene brachial plexus block (ISB) is widely used for arthroscopic shoulder surgery, but the incidence of hemidiaphragmatic paresis (HDP) has been reported to reach 100%. Several methods, including injections distal to the C5-C6 nerve roots, have been attempted to reduce the HDP incidence. However, catheter placement distal to the C5-C6 nerve roots interferes with the surgical site. ⋯ For major shoulder surgery, compared with continuous ISB, continuous PLO-SCB was more sparing of diaphragmatic and respiratory function while providing noninferior analgesia. Catheter placement via the PLO approach is feasible without interfering with the surgical field.
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Practice Guideline
ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation.
In recent years, there has been increasing focus on the use of cardiac biomarkers in patients undergoing noncardiac surgery. ⋯ The ESAIC focused guidelines provide guidance on the perioperative use of cardiac troponin and B-type natriuretic peptides in patients undergoing noncardiac surgery, for three different scopes of application.
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Editorial Comment
A new era for troponins in clinical practice guidelines.