Methods to Reduce the Risk of Exposure to Airborne Pathogens in the Operating Room.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has created many changes and difficulties in healthcare, and the anesthesia specialty is no exception. Both the increased need for personal protective equipment (PPE) and the potential for infection and contamination through respiratory droplets have been sources of much concern. Policies and protocols have been adapted worldwide to help neutralize infection risk and exposure. Transmission of the virus to healthcare workers has been a major concern, and the risk of infection is exceptionally high for Certified Registered Nurse Anesthetists (CRNAs) because of their close contact with infected patients. CRNAs are in a unique position to help decrease exposure for themselves and other members of the healthcare team by taking extra precautions during airway manipulation. A great deal of focus has been placed on reducing risks during intubation, but reports describing methods of reducing contamination and exposure to respiratory droplets during emergence and extubation are scarce. The authors have reviewed techniques to reduce coughing, thereby decreasing the potential of virus exposure through contact with large respiratory droplets and aerosolized particles that may remain suspended in air.

Combat Anesthesia: A Case Report of a Gunshot Wound and New Trauma Protocols.

Revolutionary innovations and technical advances in the disciplines of medicine, surgery, and anesthesia are inextricably connected to military conflict. The demonstrated lifesaving value of these novel approaches in high-acuity trauma has provided the impetus for translation of these elements into injury care in the civilian environment. One element of this battlefield medical revolution is the implementation and refinement of forward surgical care. All US military services have unique configurations of this surgical team to match their expeditionary capacity. The US Army Forward Surgical Team (FST) is a small, mobile surgical unit fielded since the 1990s, but not ubiquitously used until the current contingency operations in southwest Asia. The FST has been used in a variety of ways during the current conflict with or without augmentation by a forward support medical company, Area Support Medical Company, and Brigade Medical Company also known as C-Med. Far forward stand-alone FST have often been emplaced to provide a surgical capability for patients in austere operational environments and to optimize casualty survival in situations of high-risk operations and/or with potential for protracted evacuation.

Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial.

PURPOSE: Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain. METHODS: After institutional review board (IRB) approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (50 mg), magnesium sulfate (0.25 mg), lidocaine (50 mg) plus magnesium sulfate (0.25 mg), or 0.9 % sodium chloride. Following pretreatment, propofol (50 mg) was administered, and subjects were questioned regarding injection site pain and observed for behavioral signs of pain. RESULTS: Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (57 %), followed by those pretreated with placebo (46 %), lidocaine plus magnesium sulfate (41 %), and then lidocaine (29 %; p = 0.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p = 0.031 and p = 0.0003, respectively). CONCLUSIONS: In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.