Regional Anaesthesia in the Intensive Care Unit

Numerous regional and local anaesthesia techniques are available for safe use in neonates and can be administered either in combination with general anesthesia or in the awake neonate. Regional anaesthesia provides effective analgesia with reduced drug requirement which is especially beneficial in view of the immature physiology and metabolism in the neonate. The reduced requirement of anaesthetic drugs facilitates stable hemodynamics, faster recovery and a decreased length of stay in the neonatal intensive care unit.

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Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

BMJ Open ◽

10.1136/bmjopen-2019-029245 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029245 ◽

Cited By ~ 8

Author(s):

Eun Jin Ahn ◽

Hyo Jin Kim ◽

Kyung Woo Kim ◽

Hey Ran Choi ◽

Hyun Kang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Insurance ◽

Hip Fracture ◽

Elderly Patients ◽

Regional Anaesthesia ◽

Secondary Outcome ◽

Hip Fracture Surgery ◽

Ventilator Care ◽

Fracture Surgery

ObjectiveTo evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.SettingNationwide National Health Insurance Sharing Service database of Korea.ParticipantsAll patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.InterventionsHip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.Primary and secondary outcome measuresThe primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.ResultsAmong the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI −0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI −0.0024 to 0.023, respectively).ConclusionRA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

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Hypnotic Infusions for Maintenance of Anaesthesia and for Sedation in Regional Anaesthesia and in the Intensive Care Unit

Clinics in Anaesthesiology ◽

10.1016/s0261-9881(21)00193-2 ◽

1984 ◽

Vol 2 (1) ◽

pp. 89-105

Author(s):

M. Morgan ◽

J. Dawson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Regional Anaesthesia

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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