REVIEW OF ANAESTHESIA AND ANALGESIA IN THE FIELD WITH EMPHASIS ON AIRBORNE MILITARY OPERATIONS.
Ontology highlight
ABSTRACT:
SUBMITTER: Khanduri KC
PROVIDER: S-EPMC5531871 | biostudies-other | 1999 Jul
REPOSITORIES: biostudies-other
Similar Datasets
Project description:BackgroundProcedural sedation and analgesia (PSA) is used to attenuate the pain and distress that may otherwise be experienced during diagnostic and interventional medical or dental procedures. As the risk of adverse events increases with the depth of sedation induced, frequent monitoring of level of consciousness is recommended. Level of consciousness is usually monitored during PSA with clinical observation. Processed electroencephalogram-based depth of anaesthesia (DoA) monitoring devices provide an alternative method to monitor level of consciousness that can be used in addition to clinical observation. However, there is uncertainty as to whether their routine use in PSA would be justified. Rigorous evaluation of the clinical benefits of DoA monitors during PSA, including comprehensive syntheses of the available evidence, is therefore required. One potential clinical benefit of using DoA monitoring during PSA is that the technology could improve patient safety by reducing sedation-related adverse events, such as death or permanent neurological disability. We hypothesise that earlier identification of lapses into deeper than intended levels of sedation using DoA monitoring leads to more effective titration of sedative and analgesic medications, and results in a reduction in the risk of adverse events caused by the consequences of over-sedation, such as hypoxaemia. The primary objective of this review is to determine whether using DoA monitoring during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO(2)] less than 90 %). Other potential clinical benefits of using DoA monitoring devices during sedation will be assessed as secondary outcomes.Methods/designElectronic databases will be systematically searched for randomized controlled trials comparing the use of depth of anaesthesia monitoring devices with clinical observation of level of consciousness during PSA. Language restrictions will not be imposed. Screening, study selection and data extraction will be performed by two independent reviewers. Disagreements will be resolved by discussion. Meta-analyses will be performed if suitable.DiscussionThis review will synthesise the evidence on an important potential clinical benefit of DoA monitoring during PSA within hospital settings.Systematic review registrationPROSPERO CRD42015017251.
| S-EPMC4465462 | biostudies-literature
Project description:BackgroundTopical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use.MethodsSystematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented.ResultsThere were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels.ConclusionsTopical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.
| S-EPMC9486980 | biostudies-literature
Project description:Does political polarization impact decisions to go to war? This paper explores how differences in casualty sensitivity by political party in the USA may present different incentives to wartime leaders. Using three survey experiments, I assess the relationship between party, ideology, casualty sensitivity and support for war. Results indicate that conservatives are less likely to change their support in response to increases in casualties, while liberals are much more likely to be sensitive to casualties. Further, this result appears to be primarily attributable to ideology, as opposed to partisan preference, generating different incentives regarding war strategy by political party. As polarization increases, these trends are likely to become more pronounced, with significant implications for when and how states fight wars. Supplementary Information The online version contains supplementary material available at 10.1057/s41311-022-00378-9.
| S-EPMC8926088 | biostudies-literature
Project description:Cardiovascular disease (CVD) risk factors can be categorized as non-modifiable and modifiable. Modifiable risk factors include some exogenous and behavioral factors that can be easily modified, whereas endogenous modifiable risk factors, such as hypertension, hyperlipidemia, diabetes, or obesity may be modified to a limited extend. An increased prevalence of CVDs as well as their risk factors have been observed in military personnel, as specific military-related stressors are highly correlated with acute cardiac disorders. Military pilots are a subpopulation with great CVD risk due to an accumulation of different psychological and physical stressors also considered to be CVD risk factors. This review presents data concerning CVD risk in military professionals, with a special emphasis on military pilots and crew members. We also discuss the usefulness of novel indicators related to oxidative stress, inflammation, or hormonal status as well as genetic factors as markers of CVD risk. For a correct and early estimation of CVD risk in asymptomatic soldiers, especially if no environmental risk factors coexist, the scope of performed tests should be increased with novel biomarkers. An indication of risk group among military professional, especially military pilots, enables the implementation the early preventive activities, which will prolong their state of health and military suitability.
| S-EPMC9332217 | biostudies-literature
Project description:Effective prevention of chronic postoperative pain is an important clinical goal, informed by a growing body of studies. Peri-operative regional anaesthesia remains one of the most important tools in the multimodal analgesic toolbox, blocking injury-induced activation and sensitisation of both the peripheral and central nervous system. We review the definition and taxonomy of chronic postoperative pain, its mechanistic basis and the most recent evidence for the preventative potential of multimodal analgesia, with a special focus on regional anaesthesia. While regional anaesthesia targets several important aspects of the mechanistic pathway leading to chronic postoperative pain, evidence for its efficacy is still mixed, possibly owing to the heterogeneity of risk profiles within the surgical patient, but also to variation in techniques and medications reported in the literature.
| S-EPMC8369227 | biostudies-literature
Project description:Dengue is a major cause of illness among travelers and a threat to military troops operating in areas to which it is endemic. Before and during World War II, dengue frequently occurred in US military personnel in Asia and the South Pacific. From the 1960s into the 1990s, dengue often occurred in US troops in Vietnam, the Philippines, Somalia, and Haiti. We found attack rates as high as 80% and periods of convalescence up to 3-1/2 weeks beyond the acute illness. The increase in dengue throughout the world suggests that it will remain a problem for military personnel until an effective vaccine is licensed.
| S-EPMC3309667 | biostudies-literature
Project description:BackgroundEpidural anaesthesia is used extensively for cardiothoracic and vascular surgery in some centres, but not in others, with argument over the safety of the technique in patients who are usually extensively anticoagulated before, during, and after surgery. The principle concern is bleeding in the epidural space, leading to transient or persistent neurological problems.MethodsWe performed an extensive systematic review to find published cohorts of use of epidural catheters during vascular, cardiac, and thoracic surgery, using electronic searching, hand searching, and reference lists of retrieved articles.ResultsTwelve studies included 14,105 patients, of whom 5,026 (36%) had vascular surgery, 4,971 (35%) cardiac surgery, and 4,108 (29%) thoracic surgery. There were no cases of epidural haematoma, giving maximum risks following epidural anaesthesia in cardiac, thoracic, and vascular surgery of 1 in 1,700, 1 in 1,400 and 1 in 1,700 respectively. In all these surgery types combined the maximum expected rate would be 1 in 4,700. In all these patients combined there were eight cases of transient neurological injury, a rate of 1 in 1,700 (95% confidence interval 1 in 3,300 to 1 in 850). There were no cases of persistent neurological injury (maximum expected rate 1 in 4,600).ConclusionThese estimates for cardiothoracic epidural anaesthesia should be the worst case. Limitations are inadequate denominators for different types of surgery in anticoagulated cardiothoracic or vascular patients more at risk of bleeding.
| S-EPMC1586186 | biostudies-literature
Project description:ObjectivesThe objective of this study was to use ambient polycyclic aromatic hydrocarbon (PAH), polychlorinated dibenzo-p-dioxins (PCDD), and polychlorinated dibenzofurans (PCDF) concentrations measured at Joint Base Balad in Iraq in 2007 to identify the sources of these species and their spatial patterns.MethodsThe ratios of the measured species were compared with literature data for likely emission sources. Using the multiple site measurements on specific days, contour maps have been drawn using inverse distance weighting (IDW).ResultsThese analyses suggest multiple sources, including the burn pit (primarily a source of PCDD/PCDFs), the transportation field (primarily as source of PAHs), and other sources of PAHs that include aircraft, space heating, and diesel power generation.ConclusionsThe nature and locations of the sources were identified. PCDD/PCDFs were emitted by the burn pit. Multiple PAH sources exist across the base.
| S-EPMC4978085 | biostudies-literature
Project description:The Hebrew Bible and other ancient Near Eastern texts describe Egyptian, Aramean, Assyrian, and Babylonian military campaigns to the Southern Levant during the 10th to sixth centuries BCE. Indeed, many destruction layers dated to this period have been unearthed in archaeological excavations. Several of these layers are securely linked to specific campaigns and are widely accepted as chronological anchors. However, the dating of many other destruction layers is often debated, challenging the ability to accurately reconstruct the different military campaigns and raising questions regarding the historicity of the biblical narrative. Here, we present a synchronization of the historically dated chronological anchors and other destruction layers and artifacts using the direction and/or intensity of the ancient geomagnetic field recorded in mud bricks from 20 burnt destruction layers and in two ceramic assemblages. During the period in question, the geomagnetic field in this region was extremely anomalous with rapid changes and high-intensity values, including spikes of more than twice the intensity of today's field. The data are useful in the effort to pinpoint these short-term variations on the timescale, and they resolve chronological debates regarding the campaigns against the kingdoms of Israel and Judah, the relationship between the two kingdoms, and their administrations.
| S-EPMC9636932 | biostudies-literature
Project description:BackgroundCertified Swiss farmers are allowed to disbud their goat kids using a standard intramuscularly administered anaesthetic mixture. This mixture, containing xylazine and ketamine, is officially distributed with the goal to provide a painless disbudding. This study aimed to evaluate the quality of analgesia and anaesthesia achieved during disbudding, when performed by Swiss farmers. To assess this, 174 goat kids at 31 different farms were observed and filmed during cautery disbudding.ResultsThe standard anaesthetic mixture (0.05 mg/kg xylazine and 20 mg/kg ketamine) was used only in 71 goat kids. Fifty-eight goat kids were anaesthetised with different dosages of xylazine (median 0.18 mg/kg) and ketamine (median 10 mg/kg), 22 with xylazine only (median 0.61 mg/kg), 20 with xylazine (median 1.84 mg/kg) and perineural lidocaine (median 1.23 mg/kg), three with acepromazine (dosage unknown) and ketamine (10 mg/kg). Based on vocalisation, limb movement and head lifting during disbudding, a general reaction score was attributed to 168 goat kids (six were excluded due to firm restraint): 56.5% were scored zero (no limb movement, no vocalisation), 7.7% one, 17.3% two and 18.5% three (strong movements, vocalisation). Significant risk factors for higher reaction scores were the type of anaesthetic protocol and manipulation by the farmer during induction. Significant risk factors for longer recoveries were use of xylazine alone or xylazine in combination with perineural lidocaine, breed, younger age and recovery underneath heat lamp.ConclusionsThe present study indicates that anaesthesia and analgesia of goat kids disbudded by Swiss farmers is inadequate, as 35.8% of the animals showed moderate to strong behavioural reactions during the procedure. Unexpectedly, only 40.8% of the goat kids were anaesthetised with the standard anaesthetic mixture and several other protocols were used. A refinement of the recommended protocol is urgently needed to guarantee animal welfare.
| S-EPMC6038348 | biostudies-literature