REVIEW OF ANAESTHESIA AND ANALGESIA IN THE FIELD WITH EMPHASIS ON AIRBORNE MILITARY OPERATIONS.
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ABSTRACT:
SUBMITTER: Khanduri KC
PROVIDER: S-EPMC5531871 | biostudies-other | 1999 Jul
REPOSITORIES: biostudies-other
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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