Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists

The Earth’s mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists’ education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.     

Surgery or Conservative Treatment of Forearm in Patients Diagnosed with Pediatric Floating Elbow? Retrospective Analysis of 60 Consecutive Cases

BackgroundThe coexistence of supracondylar humerus fracture and forearm fracture is a rare trauma (3–13%) and it is called floating elbow. The aim of this study is to clinically compare the treatment outcomes of the patients diagnosed with floating elbow who underwent surgical treatment and who were followed up forearm with immobilization with splint.Materials and MethodsWhen scanned retrospectively, 60 patients who were treated with the diagnosis of floating elbow due to traumatic causes and followed up for at least 1 year were included in our study. Surgical treatment was performed on 42 patients for forearm fracture. Eighteen patients followed up with immobilization with a long arm splint. The results were evaluated according to the criteria modified by Templeton and Graham, in comparison with the patient’s intact side.ResultsIn the patients whose forearms were followed up conservatively, the mean age was 5.67 ± 2.25 years, and the mean follow-up period was 62.17 ± 45.91 months. In the patients who underwent surgery for the forearm, the mean age was 8.79 ± 2.01 years, and the mean follow-up was 47.14 ± 34.25 months. Eighteen patients whose forearms followed up conservatively, 12 had excellent and good clinical results and 6 had poor and moderate clinical results. Excellent and good clinical results in 27 patients who underwent surgical treatment for their forearms, moderate and poor clinical results obtained in 15 of them. There was no significant difference between the two groups (p = 0.357).ConclusionsIn conclusion, satisfactory clinical and radiological outcomes can be obtained with immobilization of the forearm fracture with splint, if acceptable reduction can be provided for the forearm following fixation of the supracondylar humerus fracture with the K-wire for treatment of floating elbow injury.     

重型和危重型COVID-19患者实施气管插管的临床经验

目的 对18例实施气管插管的重型和危重型新型冠状病毒肺炎（COVID-19）患者进行临床分析。方法 采用回顾性研究方法，对这18例COVID-19患者的气管插管情况进行分析。记录患者的年龄、性别、插管前意识状态、给氧方式等基本信息。由实施气管插管的麻醉医生评估并记录患者的插管条件。记录患者麻醉诱导前及插管后的基本生命体征变化。结果 患者平均年龄70.39±8.02岁，插管前15例（83.33%）患者进行了无创呼吸机治疗，13例患者（72.22%）插管前意识状态是清醒的。麻醉诱导后，患者的血压、心率有显著下降（P<0.05）。患者气管插管条件的优良率为94.44%，一次插管成功率为100%。目前有死亡5 例，有1例已行气管切开，有12例患者仍在ICU行气管插管机械通气治疗，其中1例患者机械通气效果差，目前已行ECMO辅 助。共16名临床经验丰富的麻醉医生参与了气管插管操作，插管时均采取三级防护，目前尚未发生医务人员感染的情况。结 论 对于有气管插管指征的重型和危重型新冠肺炎患者，建议早期插管，给予有创呼吸支持，增加患者的救治机会。插管过程中需谨慎使用麻醉药物，加强医务人员的防护，最大化保障患者和医务人员的安全。     

中国卒中营养标准化管理专家共识

正脑血管病是世界范围内致残率、致死率最高的疾病之一,也是疾病负担最重的疾病之一~([1-4])。根据最新流行病学研究报道,我国脑血管病的患病率、发病率和死亡率分别为1114.8/10万、246.8/10万和114.8/10万~([5])。脑血管病的发生给患者、家属、社会带来巨大的躯体、精神和经济负担~([3,6])。