Neuraxial labor analgesia: a focused narrative review of the 2017 literature

Purpose of review Neuraxial labor analgesia remains the most effective and one of the most commonly utilized methods for pain relief during labor. This narrative review article is a summary of the literature published in 2017 on neuraxial analgesia for labor. Recent findings From a total of 41 identified articles, 13 were included in the review. The topics have been structured into three categories: initiation of neuraxial analgesia, maintenance of neuraxial analgesia, and neuraxial analgesia and obstetric outcomes. Maintenance regimens, such as program intermittent epidural bolus (PIEB) techniques, remain a focus of extensive research with the potential to optimize analgesia for each individual patient. In a similar way, the dural puncture epidural technique could improve the quality of labor analgesia with fewer side effects compared with standard epidural and combined spinal epidural (CSE) techniques. Finally, the increased use of modern technology using portable ultrasound devices with automated imaging software to facilitate epidural catheter placement may offer potential advantages to the obstetric anesthesiologist, especially when dealing with technically difficult cases. Summary Recent advances, as well as refinements, of current neuraxial analgesia techniques could improve women's experience of labor. Correspondence to Mitko Kocarev, Anesthesia Department, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. E-mail: mkocarev@hamad.qa Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Paediatric anaesthesia: a rapidly evolving subspecialty

No abstract available

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Wellness in anaesthesia

No abstract available

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Peer support in anesthesia: turning war stories into wellness

Purpose of review Peer support, a method of providing for the well being of healthcare providers following adverse or stressful events, is garnering increased attention in light of the increased prevalence and awareness of burnout, depression and suicidality in physicians. In this review, we will summarize the evolution of the 'second victim,' explore methods of support and examine how new regulatory requirements are changing the peer support landscape. Recent findings As peer support and the second victim are investigated more, themes are emerging regarding the natural history of recovery. As these are delineated, more targeted peer support models are being developed. One major change in 2017 is the institution of new Accreditation Council for Graduate Medical Education's Common Program Requirements, now including topics targeted on well being. Summary Effective and accessible peer support is developing in many departments nationwide and can only be expected to continue, given new regulatory requirements. As these programs develop, and research on their effect continues, best practices will likely emerge. Correspondence to Amy E. Vinson, MD, Boston Children's Hospital, 300 Longwood Avenue - Bader 3, Boston, MA 02115, USA. Tel: +1 401 261 4642; e-mail: amy.vinson@childrens.harvard.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Protective Effect of Punica granatum Extract in Head and Neck Cancer Patients Undergoing Radiotherapy

Abstract

In India, head and neck cancers account for 30–40% cancers of all sites. Due to lack of screening program, wide variation in the availability of infrastructures and expertise, patients present at an advanced stage. The main stay of management of the head and neck tumours is surgery and chemoradiation. Radiation dermatitis and mucositis is one of the most common side effect encountered during the radiotherapy. Aim of our study was to study protective role of pomegranate extract on radiation induced dermatitis and mucositis in head and neck cancer patients. It was a prospective, clinical, double blind, case control study. 60 patients (30 active and controls) undergoing radiotherapy for head and neck cancer were studied for 12 months. Patients in study group were given whole fruit pomegranate extract. Each capsule contained 300 mg of whole fruit extract, each capsule contains 40% polyphenols and 27% punicalagin. Each patient were given 2 capsules every day for a period of 6–7 weeks. The skin and mucosal changes was graded according to the acute radiation morbidity scoring criteria (RTOG) for skin and mucous membrane. The results were statistically significant. Pomegranate extract proved to be radioprotective. Our study is one of the first study in humans to demonstrate the effectiveness of pomegranate extract in preventing radiation dermatitis and mucositis.

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Cumulative risk of skin tumours in patients with Lynch syndrome

Lynch syndrome (LS) is an autosomal-dominant disorder characterized by a predisposition to colorectal cancer and extracolonic malignancies. LS is caused by a germline mutation in one of the four DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6 and PMS2) or loss of expression of MSH2 due to deletion in the EPCAM gene. Muir-Torre syndrome (MTS) is considered a variant of LS, in which patients present with sebaceous neoplasms and/or keratoacanthomas. A few studies and case reports suggest a relation between LS and other benign and (pre)-malignant skin tumours. Currently only patients presenting with sebaceous carcinoma are advised to be referred to a dermatologist for surveillance.

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Percutaneous Dilatational Tracheostomy Using Tube Exchanger

We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope). However, a prospective study is needed to better define its complication rate. Accepted for publication January 22, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Ohad Ronen, MD, Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, POB 21, Nahariya 2210001, Israel. Address e-mail to ohadr@gmc.gov.il. © 2018 International Anesthesia Research Society

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