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Background: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions.Methods: Following the 2010 earthquake in Haiti, an emergency physician was trained using the Emergency Physician's General Anesthesia Syllabus (EP GAS) to perform duties similar to those of certified registered nurse anesthetists. The emergency physician then provided anesthesia during surgical mission trips with an orthopaedic team from February 2011 to March 2017, in Milot, Haiti. This is a descriptive overview of this training program and prospectively collected data on the cohort of patients whom the surgical mission teams treated in Haiti during that time frame.Results: A single emergency physician anesthetist provided anesthesia for 71 of the 172 orthopaedic surgical cases, nearly doubling the number of cases that could be performed. This also allowed the anesthesiologists to focus on pediatric and more difficult cases. Both immediately after the surgical procedure and at 1 year, there were no serious adverse events for cases in which the emergency physician provided anesthesia.Conclusions: Given emergency physicians' baseline training in airway management and sedation, well-supervised and focused extra training under the vigilant supervision of a board-certified anesthesiologist may allow emergency physicians to be able to safely administer anesthesia. Using emergency physicians as anesthetists in this closely supervised setting could increase the number of surgical cases that can be performed in a disaster setting. [ABSTRACT FROM AUTHOR]

Background: The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain. Aims: Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction. Settings and Design: A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia. Materials and Methods: Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10. Statistical Analysis: The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions. Results and Conclusions: The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol. [ABSTRACT FROM AUTHOR]

INTRODUCTION How many orthopods does it take to change a light bulb? One - to refer to the medics for 'Darkness ?Cause'. Additionally, anaesthetists and surgeons often disagree on the estimated blood loss during surgery and the estimated procedure duration. We designed this study to compare the ability of orthopaedic surgeons and anaesthetists in: (a) estimating fluid volumes; (b) estimating procedure durations; and (c) changing light bulbs. METHODS Participants had to either be a specialist in anaesthesia or orthopaedic surgery, or a trainee in that specialty for at least two years. Three different fluid specimens were used for volume estimation (44 mL, 88 mL and 144 mL). Two videos of different lengths (140 seconds and 170 seconds), showing the suturing of a banana skin, were used for procedure duration estimation. To determine the ability at changing light bulbs, the participants had to match eight different light sockets to their respective bulbs. RESULTS 30 male anaesthetists and trainees and 31 male orthopaedic surgeons and trainees participated in this study. Orthopaedic surgeons underestimated the three fluid volumes by 3.9% and anaesthetists overestimated by 5.1% (p = 0.925). Anaesthetists and orthopaedic surgeons overestimated the duration of the two procedures by 21.2% and 43.1%, respectively (p = 0.006). Anaesthetists had a faster mean time in changing light bulbs (70.1 seconds vs. 74.1 seconds, p = 0.319). CONCLUSION In an experimental environment, male orthopaedic surgeons are as good as male anaesthetists in estimating fluid volumes (in commonly seen surgical specimens) and in changing light bulbs. Both groups are poor at estimating procedure durations. [ABSTRACT FROM AUTHOR]

Evidence supports the concept that patients undergoing major orthopedic surgery benefit from either thromboprophylaxis or peripheral nerve blocks, especially continuous techniques. A group of anesthesiologists with significant experience in orthopedic anesthesia and peripheral nerve blocks reviewed the literature related to thromboprophylaxis and peripheral nerve blocks and their combination in orthopedics. Major bleeding, including retroperitoneal hematoma, is an established complication of thromboprophylaxis. Major bleeding, including retroperitoneal hematoma, is also an established complication of peripheral nerve blocks. Between 1997 and 2012, only 4 case reports of major bleeding were reported in patients receiving thromboprophylaxis and peripheral nerve blocks. Evidence supports the safety of the combination of thromboprophylaxis and peripheral nerve blocks. This group of experts concluded that currently there is no evidence that the combination of thromboprophylaxis and peripheral nerve block increases the risk of major bleeding compared to either of the treatments alone. [ABSTRACT FROM AUTHOR]

The article discusses a study on the impact of Entropy Module and Bispectral Index (BIS) monitoring on drug consumption and recovery times compared with standard clinical practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia. An experienced anaesthesiologist performed the anaesthesia. The study involved 90 adult patients who received a propofol-remifentanil anaesthesia at the University of Bonn in Germany. Results show Entropy and BIS-monitoring were not superior over standard practice.

Abstract: Orthopaedic surgery is an expanding surgical specialty with a potentially difficult patient population. Regional anaesthesia is becoming increasingly popular as it offers several advantages over general anaesthesia. Consider the following when deciding if a patient is suitable for regional anaesthesia: possible contradictions should be excluded and full consent obtained after an explanation of the intended procedure; the patient''s comfort in a noisy theatre environment for a prolonged period of time; a combination of a regional technique with sedation or a general anaesthetic is possibly indicated; the surgeon''s preference; the patient''s health; the duration of the intended procedure; the practice pattern of the hospital; and the expertise of the anaesthetist. Regional anaesthesia is best done by anaesthetists who are knowledgeable in the anatomy and nerve distribution, and have the dexterity to perform the necessary techniques. For upper limb surgery, interscalene blocks are ideally suited for shoulder and upper arm surgery, suprascapular nerve blocks for upper arm, elbow and radial side of forearm, and the infraclavicular and axillary block for hand, wrist and forearm surgery. Individual nerve blocks are best suited to a localized surgery of the hand, but do not cover tourniquet sites. Lower extremity surgery can be blocked centrally. However, it is associated with significant complications and possible bowel and bladder disturbance and bilateral limb immobility. For hip surgery a lumber plexus block offers many advantages. The three-in-one block is usually ineffective because it does not reliably block the lateral cutaneous nerve or the obturator nerve. For knee replacement surgery both femoral and sciatic nerve blockades are indicated, and the insertion of catheters is becoming more common. This offers much improved analgesia and earlier mobilization. Increased knowledge and practice in regional techniques has the benefit of improving analgesia and mobilization, shortens hospital stay and therefore has many advantageous cost implications as well as improving overall quality of care. [Copyright &y& Elsevier]

A calendar of events for the Association of Anaesthetists of Great Britain and Ireland (AAGBI) for May to June, 2009 is presented which includes the Orthopaedic Anaesthesia seminar on May 5, Human Factors and Team Safety seminar on May 14, and the Ultrasound in Anaesthesia seminar on June 11.

A calendar for the Association of Anaesthetists of Great Britain and Ireland (AAGBI) seminars from April-June 2009 is presented which includes "Leading Job Planning" to be held on April 1, 2009, "Orthopaedic Anaesthesia" to be held on May 5, 2009, and "Anaesthesia for Major Surgery - An Update" to be held on June 18, 2009.