Couple honor fallen responders with cross-county 'Move Over' campaign

By Bill Hand Sun Journal HAVELOCK, N.C. — It's the law: slow down and move over. The message, American Towman Magazine believes, should go a long way toward protecting first responders, and it has made the slogan its mission, sending a husband and wife team across the country in a special RV, carrying a symbolic coffin, to remind drivers of what happens when they don't give emergency personnel ...

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Nurse saves cardiac arrest victim in spin class

Heather Fleming, a 34-year-old intensive care nurse, was in a morning spin class when a fellow spinner collapsed and appeared to go into cardiac arrest

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A Novel Technique of Ultrasound-Guided Selective Mandibular Nerve Block With a Lateral Pterygoid Plate Approach: A Cadaveric Study

Background and Objectives We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. Methods Ten soft cadavers were studied. A curved array ultrasound transducer was applied over 1 side of the face of the cadaver, in an open-mouth position. The transducer was placed transversely below the zygomatic arch and tilted in the caudal-to-cranial direction to identify the boundary of the LPP. The needle was inserted in-plane, in an anterior-to-posterior direction, into the posterior border of the uppermost part of the LPP, and 3 mL of methylene blue was injected. Results Mandibular nerve block was successfully performed in all 10 cadavers using an LPP approach under ultrasound guidance. The mandibular nerve and its branches were seen to be stained with methylene blue in all cadaveric specimens. No accidental injection into the facial nerve or maxillary artery was observed. Conclusions This cadaveric study suggests that this novel technique, using an LPP approach under ultrasound guidance, is helpful for selective mandibular nerve block, with high accuracy and feasibility. Further studies are required to establish its safety and efficacy for clinical application. Clinical Trial Registration This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004. Accepted for publication November 20, 2017. Address correspondence to: Wirinaree Kampitak, MD, Department of Anesthesiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society and Faculty of Medicine, Chulalongkorn University, 1873, Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand (e-mail: nutong127@yahoo.com). No external funding was received. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies

Background and Objectives Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31–0.54; P

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Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial

Background and Objectives This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. Methods One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. Results During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. Conclusions Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02415088. Accepted for publication December 30, 2017. Address correspondence to: Björn Stessel, MD, PhD, Department of Anesthesiology and Pain Treatment, Jessa Hospital, Virga-Jesse Campus, Stadsomvaart 11, 3500 Hasselt, Belgium (e-mail: bjornstessel@hotmail.com). This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Province of Limburg, Flemish Government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The authors declare no conflict of interest. Authors' contributions: A.N. was responsible for the study design, data collection, and writing of the paper. B.S. was responsible for the study design, data interpretation, table creation, and writing of the paper. P.F.W. was responsible for the data interpretation and writing of the paper. C.D. was responsible for the study design and the writing of the paper. W.C. provided statistical expertise and was responsible for the statistical analyses and figure creation. J.-P.O., I.A., L.J., and J.D. were responsible for the writing of the paper. D.S. conceived of the study and was responsible for the study design, the literature search, execution of all regional blocks, and writing of the paper. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Clotting-Factor Concentrations 5 Days After Discontinuation of Warfarin

Background The American Society of Regional Anesthesia and Pain Medicine guidelines recommend discontinuation of warfarin and an international normalized ratio (INR) of 1.2 or less before a neuraxial injection. The European and Scandinavian guidelines accept an INR of 1.4 or less. We evaluated INR and levels of clotting factors (CFs) II, VII, IX, and X 5 days after discontinuation of warfarin. Methods Patients who discontinued warfarin for 5 days and had an INR of 1.4 or less had activities of factors II, VII, IX, and X measured. The primary outcome was the frequency of subjects with CF activities of less than 40%. Results Twenty-three patients were studied; 21 (91%) had an INR of 1.2 or less. In these 21 patients, the median (interquartile range) activities of factors II, VII, IX, and X were 66% (52%–80%), 114% (95%–132%), 101% (84%–121%), and 55% (46%–63%), respectively. Ninety-five percent (99% confidence interval, 69%–99%) had CF activities of greater than 40%. The patient who did not CF activities greater than 40% had end-stage renal disease. Two subjects had an INR of greater than 1.2; the activities of factor II, VII, IX, and X were 37% and 46%, 89% and 105%, 66% and 78%, and 20% and 36%, respectively. Neither patient had CF activities of greater than 40%. Conclusions Based on 40% activity of CFs, patients with INRs of 1.2 or less can be considered to have adequate CFs to undergo neuraxial injections. The number of patients with an INR of 1.3 and 1.4 is too small to make conclusions. Accepted for publication January 30, 2018. Address correspondence to: Honorio T. Benzon, MD, Department of Anesthesiology, 251 E. Huron, St, Feinberg Pavilion, 5–704, Chicago, IL 60611 (e-mail: h-benzon@northwestern.edu). L.V. is retired. This work is attributed to the Departments of Anesthesiology and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Funding support for this study was provided by the Department of Anesthesiology, Northwestern University Feinberg School of Medicine (departmental sources only). The study was presented at Anesthesiology 2016, the annual meeting of the American Society of Anesthesiologists, October 22 to 25, 2016, Chicago, IL. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Association of Academic Physiatrists Federal Funding of Disability and Rehabilitation Research Position Statement

The Association of Academic Physiatrists (AAP) seeks to advocate for policies that are supportive of academic rehabilitation, with elected officials, agency leaders, and other policy makers. Accordingly, the AAP's Public Policy Committee identifies policy issues of importance to the organizational mission, conducts background research on those issues, and develops position statements that articulate the organization's position. These position statements require approval by the Board of Trustees and are used to support advocacy efforts by AAP members. Federal funding for disability and rehabilitation research is an important issue for the AAP and its members. This position statement addresses the need for greater federal funding in this area, better coordination of the agencies providing funding, and an appropriate balance of merit-based funding with funding targeted to building capacity in critical rehabilitation-relevant methodology and content areas. This position paper was reviewed by the Association of Academic Physiatrists Public Policy Committee and the Board of Trustees and approved as a position paper of the Association. John Whyte, MD, PhD, Moss Rehabilitation Research Institute, 50 Township Line Road, Elkins Park, PA 19027, email: jwhyte@einstein.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Temporomandibular Joint Ankylosis: "A Pediatric Difficult Airway Management".

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Temporomandibular Joint Ankylosis: "A Pediatric Difficult Airway Management".

Anesth Essays Res. 2018 Jan-Mar;12(1):282-284

Authors: Sharma A, Dwivedi D, Sharma RM

Abstract
Intubating a pediatric patient with temporomandibular joint ankylosis is a daunting task, and it becomes more challenging with limited mouth opening. Fiberoptic nasotracheal intubation technique is considered a gold standard. We describe an improvised technique of securing airway in the absence of appropriate-sized fiberoptic scope. The endotracheal tube inserted in the left nostril for maintaining depth of anesthesia was advanced under vision by the fiberoptic scope inserted into the right nostril, and with external laryngeal manipulation, the airway was secured with no complications.

PMID: 29628599 [PubMed]

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Comparison between lignocaine nebulization and airway nerve block for awake fiberoptic bronchoscopy-guided nasotracheal intubation: a single-blind randomized prospective study.

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Comparison between lignocaine nebulization and airway nerve block for awake fiberoptic bronchoscopy-guided nasotracheal intubation: a single-blind randomized prospective study.

Korean J Anesthesiol. 2018 Apr;71(2):120-126

Authors: Mathur PR, Jain N, Kumar A, Thada B, Mathur V, Garg D

Abstract
BACKGROUND: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy-guided intubation, which requires effective airway anesthesia to ensure patient comfort and acceptance. This randomized single-blind prospective study was conducted to compare lignocaine nebulization and airway nerve block for airway anesthesia prior to awake fiberoptic bronchoscopy-guided intubation.
METHODS: Sixty adult patients scheduled for surgical procedures under general anesthesia were randomly allocated to two groups. Group N received jet nebulization (10 ml of 4% lignocaine) and Group B received bilateral superior laryngeal and transtracheal recurrent laryngeal nerve blocks (each with 2 ml of 2% lignocaine) followed by fiberoptic bronchoscopy-guided nasotracheal intubation. All patients received procedural sedation with dexmedetomidine. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student's t test was used to analyze parametric data, while the Mann-Whitney U test was applied to non-parametric data and Fisher's test to categorical data. P values < 0.05 were considered statistically significant.
RESULTS: The time taken for intubation was significantly shorter in Group B [115.2 (14.7) s compared with Group N [214.0 (22.2) s] (P = 0.029). The intubating conditions and degree of patient comfort were better in Group B compared with Group N. Although all patients were successfully intubated, patient satisfaction was higher in Group B.
CONCLUSIONS: Airway nerve blocks are preferable to lignocaine nebulization as they provide superior-quality airway anesthesia. However, nebulization may be a suitable alternative when a nerve block is not feasible.

PMID: 29619784 [PubMed]

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Jaw Opening Decreases Window to the Deep Parotid Lobe.

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Jaw Opening Decreases Window to the Deep Parotid Lobe.

Otolaryngol Head Neck Surg. 2018 Mar 01;:194599818766317

Authors: Lee YJ, Megwalu U, Melara E, Divi V, Fernandes VT, Sirjani D

Abstract
To describe the relationship between jaw opening and access to the deep parotid window, we identified the following distances in 10 human skulls: symphysis to angle of mandible, mastoid tip to angle of mandible, angle of mandible to condylar process, and mastoid tip to condylar process. With the jaw closed and open, these distances were measured with 1 to 3 wooden blocks, each measuring 1 cm, between the upper and lower incisors. The triangular deep parotid area formed by the last 3 distances was calculated. A repeated measures analysis of variance showed a significant decrease in the deep parotid area with increasing interincisal distance ( P < .01). A generalized estimating equation model demonstrated a statistically significant decreasing area of the deep parotid window with increasing interincisal distance. These results suggest that nasal intubation may improve access to the parotid window.

PMID: 29609515 [PubMed - as supplied by publisher]

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