Compatibility of the Drawover Vaporizer With Military Field Ventilators.

For far-forward resuscitative care for combat trauma casualties, the field anesthesia machine best suited is the Universal Portable Anesthesia Complete (UPAC, Datex Ohmeda, GE Healthcare). However, no provision was made for mechanical ventilation. Historically the Impact Uni-Vent 754 ventilator (Impact Instrumentation, Zoll Medical Corp) was used to provide hands-free ventilation but has limitations. There are 3 other field-capable ventilators that could fill the gap, but no known published research studies exist that examine the compatibility of these ventilators with the UPAC. The research question of this experimental, crossover design study was: Are there operational differences in the Impact 754, Impact Uni-Vent 731, Hamilton-T1 (Hamilton Medical Inc), and second-generation Simplified Automated Ventilator (SAVe II, AutoMedx) ventilators' performance relative to tidal volumes, rates, and inhaled anesthetic concentrations when used with the UPAC? The Impact 754 was most accurate (P<.05), followed by the Impact 731, and Hamilton-T1, and the SAVe II was the least accurate related to minute ventilation comparisons. Each ventilator demonstrated effective inhaled anesthetic delivery (r=0.97-0.99). Data analysis results demonstrated statistical and clinical significance in the reliability of the tested ventilators to deliver set volumes and rates while delivering predictable and accurate amounts of volatile anesthetic.

Tattoos and administration of regional anesthesia: a comprehensive systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The review question is what is the impact of tattoos on the administration of regional anesthesia?The quantitative objective is to identify and quantify the risks to a patient when advancing a needle through tattooed skin for the purpose of administering a regional anesthetic.The qualitative objective is to investigate anesthesia providers' perceptions and experiences when presented with a patient and/or a surgeon requests for a regional anesthetic that would require needle trespass through tattooed skin. An additional qualitative objective is to identify the thoughts, opinions and biases related to the administration of a regional anesthetic through tattooed skin from the perspective of the patient, anesthesia provider, surgeon or other affected parties (e.g. patient families, hospital or clinic administrators or insurance providers).

Effects of humerus intraosseous versus intravenous amiodarone administration in a hypovolemic porcine model.

OBJECTIVE: To compare the effects of amiodarone administration by humerus intraosseous (HIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to maximum concentration (Tmax), maximum plasma drug concentration (Cmax), time to ROSC, and mean concentrations over time in a hypovolemic cardiac arrest model. DESIGN: Prospective, between subjects, randomized experimental design. SETTING: TriService Research Facility. SUBJECTS: Yorkshire-cross swine (n = 28). INTERVENTION: Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, amiodarone 300 mg was administered via the HIO or the IV route. Blood samples were collected over 5 minutes. The samples were analyzed using high-performance liquid chromatography tandem mass spectrometry. MAIN OUTCOME MEASUREMENTS: ROSC, Tmax, Cmax, time to ROSC, and mean concentrations over time. RESULTS: There was no difference in ROSC between the HIO and IV groups; each had five achieve ROSC and two that did not (p = 1). There was no difference in Tmax (p = 0.501) or in Cmax between HIO and IV groups (p = 0.232). Means ± standard deviations in seconds were 94.3 ± 78.3 compared to 115.7 ± 87.3 in the IV versus HIO groups, respectively. The mean ± standard deviation in nanograms per milliliter for the HIO was 49,041 ± 21,107 and 74,258 ± 33,176 for the IV group. There were no significant differences between the HIO and IV groups relative to time to ROSC (p = 0.220). A repeated analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05). CONCLUSION: The humerus intraosseous provides rapid and reliable access to administer life-saving medications during cardiac arrest.