British journal of anaesthesia
-
Septic shock, the most severe complication of sepsis, accounts for approximately 10% of all admissions to intensive care. Our understanding of its complex pathophysiology remains incomplete but clearly involves stimulation of the immune system with subsequent inflammation and microvascular dysfunction. Cardiovascular dysfunction is pronounced and characterized by elements of hypovolaemic, cytotoxic, and distributive shock. ⋯ This review details the myocardial dysfunction observed in adult septic shock, and discusses the underlying pathophysiology. The utility of using the regulatory protein troponin for the detection of myocardial dysfunction is also considered. Finally, options for the management of sepsis-induced LV hypokinesia are discussed, including the use of levosimendan.
-
Case Reports
Pentax-AWS videolaryngoscope for awake nasal intubation in patients with unstable necks.
In patients with unstable necks and at risk of pulmonary aspiration, awake fibreoptic intubation is often appropriate. However, stabilization of the neck can make fibreoptic intubation more difficult. I report the use of awake nasal intubation using the Pentax-Aiway Scope (AWS) in three patients with restricted neck movement, in whom awake fibreoptic intubation had failed. ⋯ Although it was possible to insert a fibreoptic bronchoscope into the trachea while the neck was stabilized with a Halo vest, it was impossible to advance a tube over the fibrescope. Awake nasotracheal intubation using the Pentax-AWS was achieved within 15 s. The Pentax-AWS may be useful for nasotracheal intubation in awake patients with restricted necks.
-
Origin of electrocardiographic (ECG) alterations during intravascular injection of local anaesthetic solutions is controversial. The aim of this study was to elucidate whether epinephrine, bupivacaine or their combination is responsible for ECG alteration. ⋯ This animal model demonstrated that increases in heart rate and T-elevation in the ECG during i.v. application of a common test dose (0.2 ml kg(-1)) of bupivacaine are caused by epinephrine addition. Whether higher doses of bupivacaine alone can cause similar ECG changes or not requires further studies.
-
Cricoid pressure or to be more exact cricoid force (CF) can cause airway obstruction and subsequent difficulty with airway management during an emergency induction. ⋯ Forces well below the recommended value of 30 N will cause significant compression/distortion of the airway in a child.
-
Narrow-bore cricothyrotomy retains a clinical role, due to the availability of its component equipment in acute clinical environments, ease of assembly, and operator preference. However, due to infrequent use, there is a need to model this for research and teaching. We present mathematical and laboratory models. ⋯ We can exploit the contrasting changes in inspiratory and expiratory times with the upper airway resistance to optimize conditions for emergent cannula cricothyrotomy ventilation.