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6 results

  • 3.13.3 - Traumatic Chest Injuries

  • from Section 3.13 - Severe Trauma and Multiple Injuries
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 402-405

  • Summary

    Key Learning Points

    1. 1. Thoracic trauma accounts for a large proportion of trauma-related mortality, with many patients not even surviving to reach hospital.

    2. 2. Multi-system injuries are common, and as such, a systematic advanced trauma life support assessment must be carried out to ensure nothing is missed.

    3. 3. The location, velocity and type of trauma inflicted (e.g. blunt versus penetrating) are important factors for predicting the extent and severity of an injury.

    4. 4. Bedside investigations through focused echocardiography, invasive monitoring and appropriately timed computed tomography scans are essential in aiding clinicians’ diagnosis of life-threatening injuries.

    5. 5. Effective management involves the presence of a multidisciplinary team, including anaesthetists, intensivists, general surgeons and thoracic surgeons.

  • 6 - The Postcranial Axial Skeleton

  • Timothy D. Smith, Slippery Rock University of Pennsylvania, Valerie B. DeLeon, University of Florida, Christopher J. Vinyard, Jesse W. Young
  • Book:
    Skeletal Anatomy of the Newborn Primate
    Published online:
    23 March 2020
    Print publication:
    28 May 2020, pp 133-162

  • Summary

    In this chapter we discuss the vertebral column, ribs, and sternum from a developmental perspective. The axial skeleton of newborn hominoids (apes and humans) is discussed based on the literature, followed by accounts of osteology in a newly described sample of newborn tarsiers, Old World monkeys, New World monkeys, and strepsirrhines (lemurs and lorises). The neonatal vertebral column is fragmented in skeletonized specimens, because in most vertebrae, actively growing synchondroses connect the right and left neural arches and connect the centrum to the arches. Transverse processes, portions of the articular facets, and the ventral arch of C1 are also cartilaginous in most primates. However, tarsiers and most monkeys have an ossified C1 ventral arch. The chapter ends with a brief discussion of the early postnatal trajectory of axial skeleton ossification in selected primate species based on a comparison of species at different stages (neonatal and older infant), including some at similar known ages.

  • Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery

  • G. De Cosmo, E. Congedo, C. Lai, M. Sgreccia, A. Amato, G. Beccia, P. Aceto
  • Journal:
    European Journal of Anaesthesiology / Volume 25 / Issue 12 / December 2008
    Published online by Cambridge University Press:
    01 December 2008, pp. 1020-1025
    Print publication:
    December 2008
  • Background and objectives

    There are no clinical studies that compare epidural infusion of ropivacaine and levobupivacaine in patients undergoing lung surgery. The aim of this prospective, randomized double-blind study was to evaluate the efficacy and safety of two commercially available solutions of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) when administered by continuous epidural infusion together with sufentanil in patients undergoing lung surgery.

    Methods

    After obtaining informed consent, 54 patients, ASA physical status I–III undergoing lung resection, were enrolled. Patients were randomly assigned to two groups in which analgesia was performed by continuous thoracic epidural infusion of ropivacaine 0.2% w/v (Group R) or levobupivacaine 0.125% w/v (Group L) with or without sufentanil 1 μg mL−1. After a test and a loading dose of each drug for the respective group, continuous epidural infusion, set at 5 mL h−1, began. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia. Visual analogue scale at rest and when coughing, rescue patient-controlled analgesia morphine amount, haemodynamics, sensory and motor block, sedation, nausea and vomiting, patient satisfaction score, were evaluated within 48 h.

    Results

    The two groups were similar regarding patient characteristics, quality of analgesia, level of sensory block, morphine consumption and satisfaction score. Postoperative haemodynamic profile was stable in all the patients. Minor side-effects occurred with a similar incidence. Motor block was not seen.

    Conclusions

    Equivalent volumes of ropivacaine (0.2% w/v) and levobupivacaine (0.125% w/v) provided similar static and dynamic analgesia with similar incidence of minor side-effects after thoracotomy.

  • Unilateral high frequency jet ventilation during one-lung ventilation

  • Y. Dikmen, B. Aykac, H. Erolçay
  • Journal:
    European Journal of Anaesthesiology / Volume 14 / Issue 3 / May 1997
    Published online by Cambridge University Press:
    16 August 2006, pp. 239-243
    Print publication:
    May 1997

  • Fifteen patients undergoing elective thoracic surgery were studied in order to investigate the efficacy of high frequency jet ventilation of the non-dependent lung with respect to arterial oxygenation. During the study PaO2, PaCO2, arterial pressures and heart rate were recorded during ventilation of both lungs in the lateral decubitus position during one-lung ventilation and during high frequency jet ventilation of the non-dependent lung. Mean PaO2 was 28±8.75 kPa and mean PaCO2 was 5.4±0.7 kPa during control. During one-lung ventilation, PaO2 dropped to 10.8±2.57 kPa and PaCO2 rose to 6.3±0.9 kPa. With high frequency jet ventilation to the non-dependent lung, mean PaO2 increased to 25±6.75 kPa and PaCO2 decreased to 5.16±0.9 kPa respectively. Arterial pressures and heart rate remained stable during the study period. In conclusion high frequency jet ventilation of the non-dependent lung was effective in providing arterial normoxaemia and normocapnia during one-lung ventilation.