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Background: During endotracheal intubation, there is a 10% incidence of difficult laryngoscopy, which may result in serious complications. It is important to obtain as much information about the visibility of laryngeal structures before the patient is anaesthetised. Performing awake (video-) laryngoscopy on a patient is uncomfortable and can trigger gagging and coughing reflexes, making visualisation nearly impossible. The objective of this study is to evaluate the effectiveness of a soft mist spray device for airway anaesthesia during awake (video-) laryngoscopy. Methods: Twenty healthy volunteers inhaled through the Trachospray device, which was placed in their mouths. Two 2 mL syringes containing lidocaine at 4% were sprayed into the airway during inspiration. After several minutes, the subjects were asked to perform a videolaryngoscopy on themselves until the glottic structures and the vocal cords were visible. Upon completion of the procedure, all participants were asked to fill out a feedback form. Results: The duration of the videolaryngoscopy to visualisation of the vocal cords averaged 17 ± 13 s. After analysing the data, three distinct groups emerged as follows: Group 1 (70% of participants) showed no response, allowing for easy insertion of the videolaryngoscope. Group 2 (25% of participants) exhibited a light response but still permitted easy insertion and visualisation. One patient demonstrated a clear response with noticeable laryngeal contraction, requiring slightly more effort and discomfort for insertion. In 80% of the participants, the laryngeal structures were visualised according to Cormack–Lehane grade 1. All participants reported a high level of comfort, with an average rating of NRS 8. The anaesthesiologist assessed the level of anaesthesia as good to very good. No adverse events were observed. Conclusions: The Trachospray provided good, reliable, comfortable, and safe topical anaesthesia for awake videolaryngoscopy. This enables a direct visual assessment of the airway and may assist in making decisions regarding airway management for tracheal intubation.

Abstract Background The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using “blind” or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments. We hypothesized that emergency physicians can be effectively trained to safely perform and implement ultrasound-guided femoral nerve blocks, resulting in effective pain relief in patients with proximal femoral fractures. Methods In this prospective observational study, emergency physicians were trained by expert anesthesiologists to perform ultrasound-guided femoral nerve blocks during a single-day course. Femoral nerve blocks were performed on patients with proximal femoral fractures. A system of direct supervision by skilled anesthesiologists and residents was put in place. Results A total of 64 femoral nerve blocks were performed. After 30 min, blocks were effective in 69% of patients, and after 60 min, in 83.3%. The mean reduction in pain scores after 30 and 60 min was 3.84 and 4.77, respectively (both p

Abstract With great interest, we read the study of Line Dussourd et al. concluding that ultrasonography allows better identification of anatomical structures before performing a lumbar puncture. We cannot concur with the conclusions of the study because the authors did not visualize the conus medullaris directly, nor did they assess the individual intervertebral levels. In our commentary, we make some suggestions for improvement using ultrasound to locate the optimal site for a lumbar puncture. We do agree that neuraxial ultrasound is of great benefit for the performance of lumbar punctures. Proper training and applying the correct technique, however, is necessary for obtaining all benefits ultrasonography offers.

During 0.1-0.2% of operations with general anesthesia, patients become aware during surgery. Unfortunately, pharmacologically paralyzed patients cannot seek attention by moving. Their attempted movements may however induce detectable EEG changes over the motor cortex. Here, methods from the area of movement-based brain-computer interfacing are proposed as a novel direction in anesthesia monitoring. Optimal settings for development of such a paradigm are studied to allow for a clinically feasible system. A classifier was trained on recorded EEG data of ten healthy non-anesthetized participants executing 3-second movement tasks. Extensive analysis was performed on this data to obtain an optimal EEG channel set and optimal features for use in a movement detection paradigm. EEG during movement could be distinguished from EEG during non-movement with very high accuracy. After a short calibration session, an average classification rate of 92% was obtained using nine EEG channels over the motor cortex, combined movement and post-movement signals, a frequency resolution of 4 Hz and a frequency range of 8-24 Hz. Using Monte Carlo simulation and a simple decision making paradigm, this translated into a probability of 99% of true positive movement detection within the first two and a half minutes after movement onset. A very low mean false positive rate of

In Jeff VanderMeer’s novel Annihilation and its eponymous 2018 film adaptation directed by Alex Garland, traditional narrative hierarchies and binaries disintegrate, both in thematic material and at the syntactic and (in the film score) musical levels. Words are written with fungus, a bear screams with a human voice, a woman sprouts stems where her veins should be, and a monstrous, flower-like mouth roars humanoid doubles into being. This article applies three lenses to explore this example of narrative genre as a cultural adaptation to the Anthropocene crisis: first, a multispecies perspective of the ‘weird’ storytelling that de-centers the human perspective in order to foreground sensory subjectivities; second, an adaptation studies approach that includes this tradition’s implicit biological connotations; and finally, a musicological analysis of the film score’s unsettling materiality.

Objective. Artefact detection is an essential feature of automatic EEG monitoring systems used in anaesthesia. Clinical experience indicates that Narcotrend monitoring (MonitorTechnik, Bad Bramstedt, Germany, version 4.0) excludes more EEG epochs because of artefacts than bispectral index monitoring (BIS, Aspect Medical Systems, Newton, MA, version XP). Whether this increased exclusion of epochs is justified has not been investigated yet. Methods. Eighteen adult patients undergoing radical prostatectomy were investigated. Induction of anaesthesia was performed with a fentanyl bolus and a propofol infusion. Additionally, following intubation patients received 15 ml bupivacaine 0.5% epidurally. After a waiting period of 45 min depth of anaesthesia was varied two times by increasing and decreasing propofol concentrations. Narcotrend index, BIS values and calculated propofol effect site concentrations were automatically recorded at intervals of 5 s. We tested the hypothesis whether exclusion of artefacts detected by the Narcotrend monitor would possibly improve the prediction probability of the BIS monitor, justifying the necessity of artefact suppression. Results. Simulated propofol effect site concentrations ranged from 2 μ g/ml to 6 μ g/ml. The Narcotrend monitor excluded a significantly higher percentage of epochs because of artefact detection (12.6 ± 1.0%) than the BIS monitor (0.4 ± 0.1%). The performance of BIS as an indicator of predicted propofol effect site concentrations did not differ when including (PK = 0.86 ± 0.05) or excluding (PK = 0.85 ± 0.04) the data pairs where Narcotrend monitor but not BIS monitor indicated an artefact. Artefacts were evenly distributed over the investigated range of propofol effect site concentrations. Conclusion. Exclusion of data pairs that were detected as artefacts by Narcotrend but not by BIS did not change the performance of bispectral index as an indicator of propofol effect site concentration. [ABSTRACT FROM AUTHOR]

The Scandinavian middle classes have been trained in feeling guilty and shameful about their social and economical privileges as well as these privileges in combinations with gender and/or ethnicity. But “eco-guilt” or “eco-shame” has hardly been represented properly in cinema and TV series to this day. In this article, I want to offer a kind of prediction, rather than a description, of what may be an upcoming major theme in Scandinavian visual narratives: eco-guilt and eco-shame. I see signs of this in the recent TV series Jordskott from Sweden, the Norwegian Okkupert and the Danish Bedrag, but my point will be that the ecological issues here are used as a useful background or a dramaturgical starting point rather than as a major theme: as pretexts, in the double sense of the word. The use of ecology as pretext in Scandinavian TV series will be the subject of this article where I intend to focus on the way that the question of eco-guilt seems to be an alluring and tempting as well as repressed thematic, a fact that can be read out of the three series’ paradoxical opening sequences.

Background and Aims: Pain reduction is important for rehabilitation after total knee arthroplasty. Intra- and peri-articular infiltration with local anesthetics may be an alternative to commonly used locoregional techniques. Adding pregabalin orally and s-ketamine intravenously may further reduce postoperative pain. Material and Methods: This prospective, randomized, double-blind, placebo-controlled study compared two methods of perioperative analgesia. Control patients received a standardized multimodal postoperative analgesic regime of paracetamol, diclofenac, and piritramide-patient-controlled analgesia, including ropivacaine knee infiltration during surgery. The study group received pregabalin orally and s-ketamine intravenously as an additional medication to the standard multimodal regimen. The control group received placebo. Results: The study group showed lower piritramide consumption during the first 24 h (P: 0.043), but with more side effects such as diplopia and dizziness. Conclusion: Addition of pregabalin and s-ketamine resulted in lower piritramide consumption during the first 24 h postoperatively. However, more investigation on benefits versus side effects of this medication is required.

Annika Olsson om Margareta Petersson, Globaliseringens ansikten: den indoengelska romanen Stockholm: Carlssons, 2008, 400 s. Mattias Pirholt om Leena Eilittä, Ingeborg Bachmann’s Utopia and Disillusionment: Introduction Helsingfors: Finnish Academy of Science and Letters, 2008, 164 s. Anna Bohlin om Boel Englund & Lena Kåreland, Rätten till ordet: En kollektivbiografi över skrivande Stockholmskvinnor 1880–1920 Stockholm: Carlsson, 2008, 409 s. Örjan Torell om Christer Ekholm och Staffan Thorsson (red.), Främlingskap och främmandegöring: Förhållningssätt till skönlitteratur i universitetsundervisningen Göteborg: Daidalos, 2009, 554 s. Roland Lysell om Johan Sahlin, Om kyrklundheten: Värde, kunskap och skrivande i Willy Kyrklunds Om godheten Lund: ellerströms, 2008, 252 s. (diss. Växjö) Sofi Qvarnström om Peter Forsgren, I vansklighetens land: Genus, genre och modernitet i Elin Wägners smålandsromaner Göteborg: Makadam förlag, 2009, 263 s. Alexandra Borg om Örjan Torell, Den osynliga staden: en gestaltningsmodell hos Olof Högberg, Ludvig Nordström, Bertil Malmberg, Birger Sjödin, Karl Östman, Lars Ahlin och andra svenska författare fram till våra dagar Umeå: Bokförlaget H:ström – Text & Kultur, 2009, 301 s. Jørgen Bruhn om Christer Johansson, Mimetiskt syskonskap: en representationsteoretisk undersökning av relationen fiktionsprosa- fiktionsfilm Stockholm: Acta universitatis stockholmiensis, 2008, 446 s. (diss. Stockholm)