Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit.

This case report describes a patient in the ICU in need of urgent intubation, for whom video laryngoscope-guided intubation had previously failed. The Infrared Red Intubation System (IRRIS) may enhance the chance of successful flexible bronchoscope intubation, especially when performed by non-expert anesthesiologists.

The Importance of the Saphenous Nerve Block for Analgesia Following Major Ankle Surgery: A Randomized, Controlled, Double-Blind Study.

BACKGROUND AND OBJECTIVES: Major ankle surgery causes intense postoperative pain, and whereas the importance of a sciatic nerve block is well established, the clinical significance of a supplemental saphenous nerve block has never been determined in a prospective, randomized, double-blind, placebo-controlled trial. We hypothesized that a saphenous nerve block reduces the proportion of patients experiencing significant clinical pain after major ankle surgery. METHODS: Eighteen patients were enrolled and received a popliteal sciatic nerve block. Patients were randomized to single-injection saphenous nerve block with 10 mL 0.5% bupivacaine with 1:200,000 epinephrine or 10 mL saline (Fig. 1). Primary outcome was the proportion of patients reporting significant clinical pain, defined as a score greater than 3 on the numerical rating scale. Secondary outcomes were maximal pain and analgesia of the cutaneous territory of the infrapatellar branch of the saphenous nerve. RESULTS: Eight of 9 patients in the placebo group reported significant clinical pain versus 1 of 9 patients in the bupivacaine-epinephrine group (P = 0.003). Maximal pain was significantly lower in the active compared with the placebo group (median, 0 [0-0] vs 5 [4-6]; P = 0.001). Breakthrough pain from the saphenous territory began within 30 minutes after surgery in all cases. Sensory testing of the cutaneous territory of the infrapatellar branch of the saphenous nerve showed correlation between pain reported in the anteromedial ankle region and the intensity of cutaneous sensory block in the anteromedial knee region. CONCLUSIONS: The saphenous nerve is an important contributor to postoperative pain after major ankle surgery, with significant clinical pain appearing within 30 minutes after surgery. CLINICAL TRIALS REGISTRATION: This study has been registered at ClinicalTrials.gov, identifier NCT02697955.

Effect of Perineural Dexamethasone on the Duration of Single Injection Saphenous Nerve Block for Analgesia After Major Ankle Surgery: A Randomized, Controlled Study.

BACKGROUND AND OBJECTIVES: Patients undergoing major elective ankle surgery often experience pain from the saphenous nerve territory persisting beyond the duration of a single-injection saphenous nerve block. We hypothesized that perineural dexamethasone as an adjuvant for the saphenous nerve block prolongs the duration of analgesia and postpones as well as reduces opioid-requiring pain. METHODS: Forty patients were included in this prospective, randomized, controlled study. All patients received a continuous sciatic catheter and were randomized to receive a single-injection saphenous nerve block with 10 mL of 0.5% bupivacaine with 1:200,000 epinephrine with addition of 1 mL of saline or 1 mL of 0.4% (ie, 4 mg) dexamethasone. The primary outcome was duration of saphenous nerve block estimated as the time until the first opioid request. Secondary outcomes were opioid consumption and pain. RESULTS: The mean (SD) duration of the saphenous nerve block until first opioid request was 29.4 (8.4) hours in the dexamethasone group and 23.2 (10.3) hours in the control group (P = 0.048). The median opioid consumption [interquartile range] during the first 24 hours was 0 mg [0-0] versus 1.5 mg [0-14.2] in the dexamethasone and control groups, respectively. Nonparametric comparison of opioid consumption from 0 to 24 hours was statistically significant. The opioid consumption was similar in the two groups in the time interval 24 to 48 postoperative hours. CONCLUSION: Perineural dexamethasone as an adjuvant for the single-injection subsartorial saphenous nerve block can prolong analgesia and reduce opioid-requiring pain after major ankle surgery.

Autoresuscitation: A Case and Discussion of the Lazarus Phenomenon.

Lazarus phenomenon or autoresuscitation is a very rare condition defined as delayed unassisted return of spontaneous circulation after cessation of cardiopulmonary resuscitation. Based on a case with a 67-year-old male who came back to life after discontinuation of cardiopulmonary resuscitation, we discuss the background and possible countermeasures related to the Lazarus phenomenon.

[Prehospital treatment of intoxications with euphorizing drugs]. / Præhospital behandling af forgiftninger med euforiserende stoffer.

Acute intoxications are frequently seen in the prehospital setting and are often either a mixture of multiple drugs or supplemented with other drugs such as alcohol or marihuana. In contrast to the in-hospital setting, where intoxications can be detected with blood, sweat or urine tests, the prehospital physician may need to act on the symptomatology rather than the aetiology. Symptoms can be divided into two main groups depending on whether they are promoting or inhibiting vital functions. This article gives an update on management of intoxications with central stimulants in the prehospital setting.

[Sixteen-year-old woman with multiorgan dysfunction after HELLP]. / 16-årig kvinde med ultiorgandysfunktion efter HELLP.

HELLP is a syndrome with haemolysis, elevated liver enzymes and thrombocytopenia. It occurs in 1 to 6 per 1,000 parturient. Approximately 10% of the cases occur post partum. A 16-year-old woman delivered twins in the 34th gestational week. During the following hours, she developed symptoms of hypovolaemic shock. Blood sample values were critical and the patient was diagnosed with HELLP with DIC. She developed liver shock with encephalopathy and acute renal failure. Her condition stabilized on the 8th day of admission and the woman was extubated on the 16th day. She was discharged without complications on the 22 th day.

[Fascia iliaca block performed by emergency department physician trainees in hip fractures]. / Fascia iliaca-blokade anlagt af skadestuevagter ved hoftenaere frakturer.

INTRODUCTION: Patients with hip fractures (HF) may have severe pain on arrival to the emergency department (ED) and have traditionally been treated with systemic opioids. The aim of this study was to investigate the effect of fascia iliaca compartment block (FICB) performed by ED physician trainees in patients with HF. MATERIAL AND METHODS: This prospective study included 102 patients with femoral neck fractures. After arrival to the ED they received a FICB. The block was performed by ED physician trainees who injected a weight-adjusted amount of 5 mg/ml ropivacaine. Pain intensity at rest was registered immediately before the block (T0) and after one hour (T1) using a visual analogue scale (VAS). Adequate pain relief was defined as VAS