ABSTRACT
INTRODUCTION: Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures. METHODS: Multidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n=65) and general surgeons (n=36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focussing on the level of neuromuscular blockade. RESULTS: Five recommendations were agreed: 1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), 2) and in obese patients (76.2%); 3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as as immobility or better surgical access (86.1 to 72.3%); 4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally 5) anaesthesiologists/surgeons joint protocols are recommended. CONCLUSIONS: Collaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.
Subject(s)
Neuromuscular Blockade/methods , Adult , Anesthesiology , Contraindications, Procedure , Delayed Emergence from Anesthesia/prevention & control , Delphi Technique , Expert Testimony , Female , General Surgery , Humans , Intraoperative Awareness/prevention & control , Male , Middle Aged , Neuromuscular Blockade/adverse effects , Neuromuscular Blockade/standards , Neuromuscular Blocking Agents/administration & dosage , Neuromuscular Blocking Agents/adverse effects , Neuromuscular Monitoring , Physicians/psychologyABSTRACT
Ewing's Sarcoma (ES) is the most frequent malignant bone tumor of the foot. The radiological picture is characterized, in 14 patients, by a pure osteolytic lesion (9 cases) or by a mixed one (5 cases); the interruption of the cortical bone and swelling of the soft tissues were always present; the periostal reaction was occasional. The radiological aspects cannot be considered typical of the ES and it is suggested that biopsies should always be performed in the presence of a structural alteration of the bone.
Subject(s)
Bone Neoplasms/diagnostic imaging , Foot Diseases/diagnostic imaging , Sarcoma, Ewing/diagnostic imaging , Adolescent , Adult , Child , Female , Humans , Male , RadiographyABSTRACT
The authors present the radiographical features in 8 cases with metastatic tumors to the foot bones. Seven of them have been histologically confirmed. In 4 cases the tumor was monostotic and mainly osteolytic. In the other 4 the neoplasia, having osteolytic or osteoblastic appearance, involved multiple contiguous bones.
