scholarly journals Applications and Limitations of Neuro-Monitoring in Paediatric Anaesthesia and Intravenous Anaesthesia: A Narrative Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2639
Author(s):  
Chiara Grasso ◽  
Vanessa Marchesini ◽  
Nicola Disma
Keyword(s):  
Hemodynamic Instability ◽  
Favourable Outcome ◽  
Neurotoxic Effect ◽  
Brain Oxygenation ◽  
High Quality ◽  
Neurological Outcomes ◽  
Anaesthetic Agents ◽  
Haemodynamic Stability ◽  
Safe Management ◽  
International Initiative

Safe management of anaesthesia in children has been one of the top areas of research over the last decade. After the large volume of articles which focused on the putative neurotoxic effect of anaesthetic agents on the developing brain, the attention and research efforts shifted toward prevention and treatment of critical events and the importance of peri-anaesthetic haemodynamic stability to prevent negative neurological outcomes. Safetots.org is an international initiative aiming at raising the attention on the relevance of a high-quality anaesthesia in children undergoing surgical and non-surgical procedures to guarantee a favourable outcome. Children might experience hemodynamic instability for many reasons, and how the range of normality within brain autoregulation is maintained is still unknown. Neuro-monitoring can guide anaesthesia providers in delivering optimal anaesthetic drugs dosages and also correcting underling conditions that can negatively affect the neurological outcome. In particular, it is referred to EEG-based monitoring and monitoring for brain oxygenation.

Anaesthesia for non-obstetric surgery

2016 ◽  
Author(s):  
Vegard Dahl ◽  
Ulrich J. Spreng
Keyword(s):  
Pregnant Woman ◽  
Preventive Measure ◽  
Well Being ◽  
Mortality And Morbidity ◽  
Anaesthetic Agents ◽  
Haemodynamic Stability ◽  
Life Threatening ◽  
Short Time ◽  
Obstetric Surgery ◽  
Emergency Diagnostic Imaging

Anaesthesia for non-obstetric reasons is performed in 1–2% of all pregnant women. Although the chances of complications like miscarriage, preterm labour, and abortion are higher when surgery is performed during gestation, careful evaluation, preparation, and a multidisciplinary approach will minimize these risks. There are no methods of anaesthesia that are preferable to others during pregnancy. The most important preventive measure is to maintain maternal haemodynamic stability and normoventilation in order to ensure fetal well-being. Extensive knowledge of the profound anatomical and physiological changes that a pregnancy induces is mandatory for the team when operating on a pregnant woman. Short time exposure to anaesthetic agents in clinically relevant doses during surgery has never been demonstrated to have teratogenic effects. Lately, focus has been made on the possible behavioural teratogenic properties of anaesthesia, especially on the use of NMDA receptor antagonists and GABA receptor agonists. Emergency diagnostic imaging during pregnancy is considered safe and should be performed if necessary. Electroconvulsive therapy for the treatment of serious psychiatric disorders during pregnancy is a possibility that should be considered if necessary. Electric cardioversion seems safe for the fetus if life-threatening arrhythmias occur during pregnancy. Trauma is one of the leading non-obstetric causes of maternal mortality and morbidity. When treating a traumatized pregnant woman one should initially focus on the mother’s safety and haemodynamic stability.

scholarly journals Factors Associated with High-Quality Cardiopulmonary Resuscitation Performed by Bystander

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Hye Ji Park ◽  
Won Jung Jeong ◽  
Hyung Jun Moon ◽  
Gi Woon Kim ◽  
Jin Seong Cho ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Age Groups ◽  
Sudden Cardiac Arrest ◽  
Advanced Life Support ◽  
Fold Increase ◽  
High Quality ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Cpr Quality

Bystander cardiopulmonary dresuscitation (CPR) improves the survival and neurological outcomes of sudden cardiac arrest patients. The rate of bystander CPR is increasing; however, its performance quality has not been evaluated in detail. In this study, emergency medical technicians (EMTs) in the field evaluated bystander CPR quality, and we aimed to investigate the association between bystander information and CPR quality. This retrospective cohort study was based on data included in the Smart Advanced Life Support (SALS) registry between January 2016 and December 2017. We included patients older than 18 years who experienced an out-of-hospital cardiac arrest (OHCA) due to medical causes. Bystander CPR quality was judged to be “high” when the hand positions were appropriate and when compression rates of at least 100/min and compression depths of at least 5 cm were achieved. Among 6,769 eligible patients, 3,799 (58.7%) received bystander CPR, and 6% of bystanders performed high-quality CPR. After adjustment, the occurrence of cardiac arrest at home (adjusted odds ratio (aOR), 95% confidence interval (CI); 0.42, 0.27–0.64), witnessed cardiac arrest (1.45, 1.03–2.06), and younger bystander age all showed associations with one another. High-quality CPR led to a 4.29-fold increase in the chance of neurological recovery. In particular, high-quality CPR in patients aged 60 years showed a significant association compared with other age groups (7.61, 1.41–41.04). The main factor affecting CPR quality in this study was the age of the bystander, and older bystanders found it more difficult to maintain CPR quality. To improve the quality of bystander CPR, training among older bystanders should be the focus.

scholarly journals The Safety Profile of General and Local Anaesthetic Agents: Data Collected during 20 Years of Spontaneous Reporting Activities in the Campania Region (Southern Italy)

2021 ◽  
Vol 14 (12) ◽  
pp. 1261
Author(s):  
Francesca Gargano ◽  
Cristina Scavone ◽  
Gabriella di Mauro ◽  
Alberto Della Corte ◽  
Alice Zoccoli ◽  
...  
Keyword(s):  
Spontaneous Reporting ◽  
Southern Italy ◽  
Descriptive Analysis ◽  
Local Anaesthetics ◽  
Individual Case ◽  
Favourable Outcome ◽  
System Organ Class ◽  
Campania Region ◽  
Anaesthetic Agents ◽  
Pharmacovigilance Database

Background: General and local anaesthetics are widely used during surgery. These drugs have peculiar safety profiles, being commonly associated with mild and reversible local adverse drug reactions (ADRs), but also with more severe and systemic ADRs, including respiratory and cardiovascular depression and anaphylaxis. Methods and Objectives: We carried out a descriptive analysis of Individual Case Safety Reports (ICSRs) sent to the Campania Regional Centre of Pharmacovigilance (Southern Italy) from 2001 to 2021 that reported general or local anaesthetics as suspected drugs, with the aim of describing their overall characteristics, focussing on the ADRs’ seriousness and distribution by System Organ Class (SOC) and Preferred Term (PT). Results: A total of 110 ICSRs documenting general or local anaesthetics were sent to the Italian pharmacovigilance database during 20 years of spontaneous reporting activities in the Campania region. ADRs mainly occurred in patients with a median age of 48 years and in a slightly higher percentage of men. ADRs were more commonly classified as not serious and had a favourable outcome. In terms of ADRs’ distribution by SOC and PT, both general and local anaesthetics were associated with general and cutaneous disorders, with common ADRs that included lack of efficacy, rash, and erythema. In addition, general anaesthetics were associated with the occurrence of respiratory ADRs, while local anaesthetics were associated with the occurrence of nervous ADRs. Conclusion: Even though a limited number of ICSRs documenting anaesthetics-induced ADRs were retrieved from the Italian spontaneous reporting database in the Campania region, we believe that the continuous monitoring of these drugs is highly recommended, especially among the frail population.

EP.FRI.583 Re-Audit of the Quality of Operation Notes

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Orlaith McAuliffe ◽  
Ahmed Aboulela ◽  
Mohamed Mohamed
Keyword(s):  
Blood Loss ◽  
Surgical Patients ◽  
High Quality ◽  
Surgical Practice ◽  
Intraoperative Diagnosis ◽  
Retrospective Audit ◽  
Safe Management ◽  
Audit Data ◽  
Estimated Blood Loss

Abstract Aims High quality operation notes are crucial for the safe management of surgical patients. The Royal College of Surgeons Good Surgical Practice (2014) describes eighteen separate pieces of information that should be included in operation notes. Our aim was to determine whether the quality of operation notes have improved since the introduction in our hospital in 2015 of an electronic proforma to record these notes. Methods We conducted a retrospective audit of operation notes between 28th October and 19th November 2020 based on the RCS guidelines. These results were compared to those of our 2015 audit. Results Of the seventy eight operation notes analysed in this re-audit, twenty eight percent were produced using the electronic proforma compared to forty five percent in 2015. In our re-audit a significantly higher proportion of notes had records of whether operations were elective or emergency (p < 0.01), intraoperative diagnosis (p < 0.01) and estimated blood loss (p < 0.05).Compared to the 2015 audit data there was a significant improvement in recording whether or not the surgery was elective or emergency (p < 0.0001). Conclusion In this audit we noted a disappointing decrease in proportion of operation notes that were produced using the electronic proforma. We also noted that operation notes produced using the electronic proforma were of higher quality compared to those that were not. We need to increase awareness amongst surgeons in our hospital of the benefits of using the electronic proforma to improve the quality of operation notes.

Prehospital osmotherapy in isolated traumatic brain injury: a systematic review

2021 ◽  
Vol 13 (3) ◽  
pp. 114-124
Author(s):  
Gareth Vaughan Williams
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neurological Outcome ◽  
Cerebral Oedema ◽  
Cochrane Library ◽  
Rapid Sequence Intubation ◽  
Secondary Brain Injury ◽  
High Quality ◽  
Neurological Outcomes ◽  
The Impact

Background: Isolated traumatic brain injury (TBI) accounts for 30% of injury-related deaths globally, with significant cost to individual health, lifestyle and the economy. Despite advances in prehospital trauma care, frontline paramedics have limited options to manage cerebral oedema and herniation. Prehospital osmotherapy could limit cerebral oedema and subsequent secondary brain injury, but uncertainties remain of its benefit to patient outcomes. Aim: This study aimed to explore whether prehospital osmotherapy such as hypertonic saline (HTS) could improve mortality and neurological outcomes in adults with severe isolated TBI compared with other products. Methods: Multiple electronic databases (PubMed, MAG Online Library, EMBase and Cochrane Library) were searched to investigate the impact of prehospital osmotherapy on mortality and neurological outcome. Findings: 9005 articles were identified, with six articles fully meeting the research aim. The majority of literature was high quality with an overriding consensus that administration of prehospital HTS or other hyperosmolar products had limited benefit to patient mortality and neurological outcome in isolated TBI. Conclusion: High-quality literature demonstrated that there is no current strong argument to adopt prehospital osmotherapy for isolated TBI. Paramedics should prioritise managing hypoxia and hypotension, which have proven impacts on long-term mortality and neurological outcomes. Future research should focus on the benefits of the expansion of rapid sequence intubation to advanced paramedics and appropriate analgesia (ketamine) for paramedics to enhance isolated TBI management in UK paramedic practice. However, paramedics should not disregard the importance of fundamental basic resuscitation skills in isolated TBI.

scholarly journals Subxiphoid thoracoscopic thymectomy for myasthenia gravis

2021 ◽  
Author(s):  
Yuanyuan Liu ◽  
Jinghao Zhang ◽  
Wenbin Wu ◽  
Hui Zhang ◽  
Chen Zhao ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Fat Tissue ◽  
High Quality ◽  
Neurological Outcomes ◽  
High Quality Evidence ◽  
Quality Evidence

Abstract We investigated the efficacy of subxiphoid thoracoscopic thymectomy in patients with myasthenia gravis. The data of 37 consecutive cases were reviewed. 2 cases of postoperative myasthenia gravis crisis and 4 cases of residual mediastinal fat tissue were recorded. Moreover, 29 patients presented the neurological outcomes, and complete stable remission was achieved in 5 (17.2%) cases. Subxiphoid thymectomy is technically feasible. High-quality evidence is warranted before this approach can be recommended.

Some problems of objective-prism spectra classification

1966 ◽  
Vol 24 ◽  
pp. 51-52
Author(s):  
E. K. Kharadze ◽  
R. A. Bartaya
Keyword(s):  
Short Wave ◽  
High Quality ◽  
Stellar Spectra ◽  
Objective Prism

The unique 70-cm meniscus-type telescope of the Abastumani Astrophysical Observatory supplied with two objective prisms and the seeing conditions characteristic at Mount Kanobili (Abastumani) permit us to obtain stellar spectra of a high quality. No additional design to improve the “climate” immediately around the telescope itself is being applied. The dispersions and photographic magnitude limits are 160 and 660Å/mm, and 12–13, respectively. The short-wave end of spectra reaches 3500–3400Å.

A non-cyanide method of electropolishing silver

1978 ◽  
Vol 36 (1) ◽  
pp. 146-147
Author(s):  
R. L. Lyles ◽  
S. J. Rothman ◽  
W. Jäger
Keyword(s):  
Electron Microscopy ◽  
Sulphuric Acid ◽  
Methyl Alcohol ◽  
Health Hazards ◽  
Silver Alloy ◽  
High Quality ◽  
Silver Alloys ◽  
Free Sample ◽  
Specimen Quality ◽  
Standard Techniques

Standard techniques of electropolishing silver and silver alloys for electron microscopy in most instances have relied on various CN recipes. These methods have been characteristically unsatisfactory due to difficulties in obtaining large electron transparent areas, reproducible results, adequate solution lifetimes, and contamination free sample surfaces. In addition, there are the inherent health hazards associated with the use of CN solutions. Various attempts to develop noncyanic methods of electropolishing specimens for electron microscopy have not been successful in that the specimen quality problems encountered with the CN solutions have also existed in the previously proposed non-cyanic methods.The technique we describe allows us to jet polish high quality silver and silver alloy microscope specimens with consistant reproducibility and without the use of CN salts.The solution is similar to that suggested by Myschoyaev et al. It consists, in order of mixing, 115ml glacial actic acid (CH3CO2H, specific wt 1.04 g/ml), 43ml sulphuric acid (H2SO4, specific wt. g/ml), 350 ml anhydrous methyl alcohol, and 77 g thiourea (NH2CSNH2).

A High Resolution Scanning Microscope

1968 ◽  
Vol 26 ◽  
pp. 356-357
Author(s):  
A. V. Crewe ◽  
J. Wall ◽  
L. M. Welter
Keyword(s):  
High Resolution ◽  
Field Emission ◽  
Spherical Aberration ◽  
Focal Length ◽  
Spot Size ◽  
Emission Source ◽  
Field Of View ◽  
Scanning Microscope ◽  
Magnetic Lens ◽  
High Quality

A scanning microscope using a field emission source has been described elsewhere. This microscope has now been improved by replacing the single magnetic lens with a high quality lens of the type described by Ruska. This lens has a focal length of 1 mm and a spherical aberration coefficient of 0.5 mm. The final spot size, and therefore the microscope resolution, is limited by the aberration of this lens to about 6 Å.The lens has been constructed very carefully, maintaining a tolerance of + 1 μ on all critical surfaces. The gun is prealigned on the lens to form a compact unit. The only mechanical adjustments are those which control the specimen and the tip positions. The microscope can be used in two modes. With the lens off and the gun focused on the specimen, the resolution is 250 Å over an undistorted field of view of 2 mm. With the lens on,the resolution is 20 Å or better over a field of view of 40 microns. The magnification can be accurately varied by attenuating the raster current.

Quantitative defect studies in semiconductor TEM samples prepared by low angle ion milling

1995 ◽  
Vol 53 ◽  
pp. 512-513
Author(s):  
L. Mulestagno ◽  
J.C. Holzer ◽  
P. Fraundorf
Keyword(s):  
Sample Preparation ◽  
Milling Time ◽  
High Density ◽  
Low Density ◽  
Ion Milling ◽  
High Quality ◽  
Variable Angle ◽  
Major Disadvantage ◽  
Induced Defects

Due to the wealth of information, both analytical and structural that can be obtained from it TEM always has been a favorite tool for the analysis of process-induced defects in semiconductor wafers. The only major disadvantage has always been, that the volume under study in the TEM is relatively small, making it difficult to locate low density defects, and sample preparation is a somewhat lengthy procedure. This problem has been somewhat alleviated by the availability of efficient low angle milling.Using a PIPS® variable angle ion -mill, manufactured by Gatan, we have been consistently obtaining planar specimens with a high quality thin area in excess of 5 × 104 μm2 in about half an hour (milling time), which has made it possible to locate defects at lower densities, or, for defects of relatively high density, obtain information which is statistically more significant (table 1).

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