Minerva anestesiologica
-
Minerva anestesiologica · Apr 2020
Randomized Controlled TrialThe Orogastric Tube Guide® as a novel strategy for gastric tube insertion: a prospective, randomized controlled clinical trial.
Gastric tube insertion, either orally or nasally, is daily practice in anesthesia and intensive care. "Blind" insertion represents the common conventional method and is associated with low first-pass success and frequent complications. This trial aimed to evaluate the novel gastric tube guide as a rigid conduit in regard to insertion success rate, time required and associated complications versus the conventional "blind" insertion method. We hypothesized that the insertion success rate is higher using the Orogastric tube guide. ⋯ Our findings suggest that the use of the GTG facilitates and fastens orogastric tube placement in anesthetized patients and thereby constitutes a benefit in clinical routine.
-
Advantages of propofol use in children may include less airway complications, less emergence agitation, and less postoperative behavioral changes. However, needle phobia and the complexity of total intravenous anesthesia set-up, as well as the pharmacokinetic and pharmacodynamic restrictions may limit the wide use of propofol-based anesthesia in the form of total intravenous anesthesia. ⋯ Propofol has earned its place as a valuable choice in pediatric anesthesia. In addition, propofol and inhalation anesthesia should not be looked at as mutually exclusive; a combination of both may sometimes be the best approach to complex clinical dilemmas.
-
Moral distress is a major concern among healthcare professionals (HCPs). In the Intensive Care Unit (ICU), moral distress can result from: 1) disagreements within the ICU team regarding life-sustaining treatments; 2) critical illnesses that result in tragic choices regarding treatment planning; 3) circumstances that require rapid decisions and actions without adequate consideration of all morally meaningful concerns; 4) tensions with administrators; and 5) legal standards that define the decisional authority that should be held by patients and families or which forms of end-of-life care are permissible. An impressive body of research literature has highlighted the prevalence of moral distress among HCPs (including ICU HCPs), health impacts of moral distress, as well as personal and contextual factors that are strong predictors of moral distress. ⋯ This article outlines strategies that could be used to help diminish moral distress, drawing on the available literature. These strategies include: 1) Listen attentively to your colleagues' moral distress; 2) shift the focus from moral distress to moral agency; 3) promote ethically-attuned discussion and education (drawing on discussion models that can help reconcile diverse ethical viewpoints or disagreements); and 4) provide personal supports for HCPs. Research is urgently needed to further examine which strategies are most effective for addressing moral distress in ICU settings as well as other clinical contexts.