Anesthesia emergency care

Infective endocarditis (IE) remains a rare yet critically severe condition, representing a considerable diagnostic challenge, especially among patients with pre-existing structural heart anomalies. This report details the clinical journal of a 49-year-old male with a known bicuspid aortic valve who initially exhibited nonspecific symptoms, leading to rapid clinical deterioration and the emergence of uncommon complications. The patient experienced an aortic root rupture and pericardial tamponade, necessitating urgent surgical intervention...

The perioperative management of patients undergoing mediastinal mass operations presents a persistent challenge across multiple clinical specialties. General anesthesia administration further increases the risk of perioperative cardiorespiratory decompensation. The interdisciplinary team plays a crucial role in ensuring a safe perioperative period. However, due to the rarity and variability of mediastinal mass syndromes, specific management protocols are lacking. This review aims to outline the multitude of challenges and pitfalls encountered during perioperative management in patients with the mediastinal mass syndrome...

BACKGROUND: Imperforate hymen is the most common congenital defect of the female urogenital tract. The spectrum of clinical manifestations is broad, ranging from mild cases undiagnosed until adolescence to severe cases of giant intraabdominal masses. The most common complication of hydrocolpos is bladder compression, resulting in obstructive uropathy and hydronephrosis. CASE PRESENTATION: We present here the case of a preterm neonate who was admitted to the surgical neonatal intensive care unit for bowel obstruction...

IMPORTANCE: Rib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures. OBJECTIVE: To determine whether the addition of an SAPB to protocolized care bundles increases the likelihood of early favorable analgesic outcomes and reduces opioid requirements in patients with rib fractures...

PURPOSE: Worry is an intuitive sense that goes beyond logical reasoning and is valuable in situations where patients' conditions are rapidly changing or when objective data may not fully capture the complexity of a patient's situation. Nurse anesthetists' subjective reasons for worry are quite vague as they are valued inconsistently and not accurately expressed. This study aimed to identify factors playing a role in the emergence of worry during anesthesia practice to clarify its concept...

No abstract text is available yet for this article.

INTRODUCTION: Victoria, Australia provides a centralised state ECMO service, supported by ambulance retrieval. Equity of access to this service has not been previously described. OBJECTIVE: Describe the characteristics of ECMO recipients and quantify geographical and socioeconomic influence on access. DESIGN: Retrospective observational study with spatial mapping. PARTICIPANTS AND SETTING: Adult (≥18 years) ECMO recipients from July 2016-June 2022...

OBJECTIVES: Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use. DESIGN: We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients...

The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system...

OBJECTIVE: Fluid bolus therapy (FBT) is ubiquitous in intensive care units (ICUs) after cardiac surgery. However, its physiological effects remain unclear. DESIGN: : We performed an electronic health record-based quasi-experimental ICU study after cardiac surgery. We applied propensity score matching and compared the physiological changes after FBT episodes to matched control episodes where despite equivalent physiology no fluid bolus was given. SETTING: The study was conducted in a multidisciplinary ICU of a tertiary-level academic hospital...

OBJECTIVE: To describe the training and accreditation process behind an intensivist-led extracorporeal membrane oxygenation (ECMO) cannulation program, and identify the rate of complications associated with the ECMO cannulation procedure. DESIGN: A narrative review of the accreditation process, and a retrospective review of complications related to cannulation during the first four years of the intensivist program. SETTING: Royal Prince Alfred Hospital, a quaternary referral hospital in Sydney...

OBJECTIVE: To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. DESIGN: Prospective, multicentre observational cohort study. SETTING: Four tertiary medical-surgical ICUs in Australia. PARTICIPANTS: Intubated and non-intubated adult ICU survivors. MAIN OUTCOME MEASURES: Primary outcomes : clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress...

OBJECTIVE: We aimed to describe the characteristics, outcomes and resource utilisation of patients being cared for in an ICU after undergoing elective surgery in Australia and New Zealand (ANZ). METHODS: This was a point prevalence study involving 51 adult ICUs in ANZ in June 2021. Patients met inclusion criteria if they were being treated in a participating ICU on he study dates. Patients were categorised according to whether they had undergone elective surgery, admitted directly from theatre or unplanned from the ward...

[This corrects the article DOI: 10.1016/j.ccrj.2023.06.001.].

OBJECTIVE: Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19. DESIGN SETTING AND PARTICIPANTS: This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS)...

PURPOSE OF REVIEW: To provide an overview of the impact of virtual and augmented reality in contemporary cardiovascular medical practice. RECENT FINDINGS: The utilization of virtual and augmented reality has emerged as an innovative technique in various cardiovascular subspecialties, including interventional adult, pediatric, and adult congenital as well as structural heart disease and heart failure. In particular, electrophysiology has proven valuable for both diagnostic and therapeutic procedures...

BACKGROUND AND AIMS: A Key Performance Indicator (KPI) is a critical metric measuring organizational success or specific activities, reflecting the periodic achievement of operational goals aligned with strategic objectives. MATERIAL AND METHODS: A retrospective cross-sectional study of key quality performance indicators, (CQI-NABH) concerning anesthesia and surgical services was conducted at a tertiary care hospital after taking institutional ethical clearance (AIIMS/IEC/21/150)...

BACKGROUND AND AIMS: Cardiac surgery often necessitates considerable post-operative vasoactive-inotropic support. Given an encouraging literature on the prognostic potential of leucoglycemic index (LGI) [serum glucose (mg/dl) × total leucocytes count (cells/mm3 )/1000], we aimed to evaluate whether intensive care unit (ICU)-admission LGI can predict post-operative vasopressor-inotropic requirements following cardiac surgery on cardio-pulmonary bypass (CPB). MATERIAL AND METHODS: The data of patients undergoing cardiac surgery at our tertiary care center between January 2015 and December 2020 was retrospectively reviewed...

We present a case of an obese 56-year-old male with obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), and pituitary macroadenoma, who underwent nasal endoscopic trans-sphenoidal resection. Surgery was performed under general anesthesia, uneventfully as planned. The patient experienced, however, delayed emergence despite receiving adequate neuromuscular blockade agent reversal. Extubation was performed and the patient was transferred to the recovery room on a Venturi mask (50% fraction of inspired oxygen, FIO2)and 93% saturation...

Purpose: To evaluate the impact of multisensory room (MSR) use on preoperative anxiety and postoperative outcomes in children with autism spectrum disorder (ASD) undergoing dental treatment with general anesthesia. Methods: Forty children, ages six to 17 years, with ASD re- quiring general anesthesia for dental treatment, participated in this study. Participants were randomized to either the control group (standard pre- operative waiting room) or intervention group (MSR) for 20 minutes prior to general anesthesia induction...