Thoracic Regional Anaesthesia and the Impact on Ventilation

2021 ◽  
Author(s):  
Adrian Bosenberg ◽  
Erica Holland
Keyword(s):  
Regional Anaesthesia ◽  
The Impact

The impact of regional anaesthesia on maternal mortality

2000 ◽  
pp. 347-356
Author(s):  
Stephen Morris ◽  
Michael Harmer ◽  
Felicity Reynolds
Keyword(s):  
Maternal Mortality ◽  
Regional Anaesthesia ◽  
The Impact

scholarly journals Point-of-care ultrasound-guided regional anaesthesia in older ED patients with hip fractures: a study to test the feasibility of a training programme and time needed to complete nerve blocks by ED physicians after training

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047113
Author(s):  
Jacques Simon Lee ◽  
Tina Bhandari ◽  
Robert Simard ◽  
Marcel Emond ◽  
Claude Topping ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Regional Anaesthesia ◽  
Point Of Care ◽  
Secondary Outcome ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Stepped Wedge ◽  
Ultrasound Guided ◽  
Cluster Rct ◽  
The Impact

ObjectivesPoint-of-care ultrasound-guided regional anaesthesia (POCUS-GRA) provides safe, rapid analgesia for older people with hip fractures but is rarely performed in the emergency department (ED). Self-perceived inadequate training and time to perform POCUS-GRA are the two most important barriers. Our objective is to assess the feasibility of a proposed multicentre, stepped-wedge cluster randomised clinical trial (RCT) to assess the impact of a knowledge-to-practice (KTP) intervention on delirium.DesignOpen-label feasibility study.SettingAn academic tertiary care Canadian ED (annual visits 60 000).ParticipantsEmergency physicians working at least one ED shift per week, excluding those already performing POCUS-GRA more than four times per year.InterventionA KTP intervention, including 2-hour structured training sessions with procedure bundle and email reminders.Primary and secondary outcome measuresThe primary feasibility outcome is the proportion of eligible physicians that completed training and subsequently performed POCUS-GRA. Secondary outcome is the time needed to complete POCUS-GRA. We also test the feasibility of the enrolment, consent and randomisation processes for the future stepped-wedge cluster RCT (NCT02892968).ResultsOf 36 emergency physicians, 4 (12%) were excluded or declined participation. All remaining 32 emergency physicians completed training and 31 subsequently treated at least one eligible patient. Collectively, 27/31 (87.1%) performed 102 POCUS-GRA blocks (range 1–20 blocks per physician). The median (IQR) time to perform blocks was 15 (10–20) min, and reduction in pain was 6/10 (3–7) following POCUS-GRA. There were no reported complications.ConclusionOur KTP intervention, consent process and randomisation were feasible. The time to perform POCUS-GRA rarely exceeded 30 min, Our findings reinforce the existing data on the safety and effectiveness of POCUS-GRA, mitigate perceived barriers to more widespread adoption and demonstrate the feasibility of trialling this intervention for the proposed stepped-wedge cluster RCT.Trial registration numberClinicaltrials.gov #02892968

scholarly journals The impact of regional anaesthesia on outcome: a patient's perspective

Anaesthesia ◽  
2004 ◽  
Vol 59 (6) ◽  
pp. 613-615 ◽  
Author(s):  
P. B. Cornish ◽  
J. Barton ◽  
A. Deacon
Keyword(s):  
Regional Anaesthesia ◽  
Patient’S Perspective ◽  
The Impact

Anaesthetic choice for hip or knee arthroplasty in New Zealand: Risk of postoperative death and variations in use

2021 ◽  
pp. 0310057X2110509
Author(s):  
Jason K Gurney ◽  
Melissa A McLeod ◽  
Douglas Campbell ◽  
Elizabeth Dennett ◽  
Sarah Jackson ◽  
...  
Keyword(s):  
New Zealand ◽  
Hip Replacement ◽  
Regional Anaesthesia ◽  
Postoperative Mortality ◽  
National Study ◽  
Increased Risk ◽  
Large Joint ◽  
The Impact ◽  
Partial Hip Replacement ◽  
Over Time

Anaesthetic choice for large joint surgery can impact postoperative outcomes, including mortality. The extent to which the impact of anaesthetic choice on postoperative mortality varies within patient populations and the extent to which anaesthetic choice is changing over time remain under-explored both internationally and in the diverse New Zealand context. In a national study of 199,211 hip and knee replacement procedures conducted between 2005 and 2017, we compared postoperative mortality among those receiving general, regional or general plus regional anaesthesia. Focusing on unilateral ( n=86,467) and partial ( n=13,889) hip replacements, we assessed whether some groups within the population are more likely to receive general, regional or general plus regional anaesthesia than others, and whether mortality risk varies depending on anaesthetic choice. We also examined temporal changes in anaesthetic choice over time. Those receiving regional alone or general plus regional for unilateral hip replacement appeared at increased risk of 30-day mortality compared to general anaesthesia alone, even after adjusting for differences in terms of age, ethnicity, deprivation, rurality, comorbidity, American Society of Anesthesiologists physical status score and admission type (e.g. general plus regional: adjusted hazard ratio (adj. HR)=1.94, 95% confidence intervals (CI) 1.32 to 2.84). By contrast, we observed lower 30-day mortality among those receiving regional anaesthesia alone compared to general alone for partial hip replacement (adj. HR=0.86, 95% CI 0.75 to 0.97). The latter observation contrasts with declining temporal trends in the use of regional anaesthesia alone for partial hip replacement procedures. However, we recognise that postoperative mortality is one perioperative factor that drives anaesthetic choice.

scholarly journals Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e020757 ◽  
Author(s):  
Vanisha Patel ◽  
Rita Champaneria ◽  
Janine Dretzke ◽  
Joyce Yeung
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Functional Outcomes ◽  
Regional Anaesthesia ◽  
Postoperative Delirium ◽  
Length Of Hospital Stay ◽  
Hip Fracture Surgery ◽  
Randomised Controlled ◽  
The Impact ◽  
Fracture Surgery

ObjectiveOlder patients with hip fractures who are undergoing surgery are at high risk of significant mortality and morbidity including postoperative delirium. It is unclear whether different types of anaesthesia may reduce the incidence of postoperative delirium. This systematic review will investigate the impact of anaesthetic technique on postoperative delirium. Other outcomes included mortality, length of stay, complications and functional outcomes.DesignSystematic review of randomised controlled trials and non-randomised controlled studies.Data sourcesBibliographic databases were searched from inception to June 2018. Web of Science and ZETOC databases were searched for conference proceedings. Reference lists of relevant articles were checked, and clinical trial registers were searched to identify ongoing trials.Eligibility criteriaStudies were eligible if general and regional anaesthesia were compared in patients (aged 60 and over) undergoing hip fracture surgery, reporting primary outcome of postoperative delirium and secondary outcomes of mortality, length of hospital stay, adverse events, functional outcomes, discharge location and quality of life. Exclusion criteria were anaesthetic technique or drug not considered current standard practice; patients undergoing hip fracture surgery alongside other surgery and uncontrolled studies.ResultsOne hundred and four studies were included. There was no evidence to suggest that anaesthesia type influences postoperative delirium or mortality. Some studies suggested a small reduction in length of hospital stay with regional anaesthesia. There was some evidence to suggest that respiratory complications and intraoperative hypotension were more common with general anaesthesia. Heterogeneity precluded meta-analysis. All findings were described narratively and data were presented where possible in forest plots for illustrative purposes.ConclusionsWhile there was no evidence to suggest that anaesthesia types influence postoperative delirium, the evidence base is lacking. There is a need to ascertain the impact of type of anaesthesia on outcomes with an adequately powered, methodologically rigorous study.PROSPERO registration numberCRD42015020166.

Formation of Lunar Craters and Bright Rays as a Result of Meteorite Impacts

1962 ◽  
Vol 14 ◽  
pp. 415-418
Author(s):  
K. P. Stanyukovich ◽  
V. A. Bronshten
Keyword(s):  
Explosive Charge ◽  
The Moon ◽  
Meteorite Impacts ◽  
The Earth ◽  
Lunar Craters ◽  
The Impact

The phenomena accompanying the impact of large meteorites on the surface of the Moon or of the Earth can be examined on the basis of the theory of explosive phenomena if we assume that, instead of an exploding meteorite moving inside the rock, we have an explosive charge (equivalent in energy), situated at a certain distance under the surface.

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