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Innovative MAC anesthesia approach to reducing nausea and vomiting!

Patients experience nausea and vomiting 30-50% of surgical recoveries!  There are NO positive reviews from a patient that vomits post-surgery.  PONV is costly in many ways including slowed patient recovery, poor patient experience and in increased staffing needs.  Reducing PONV can help make hospitals and surgery centers become more productive, more pleasant and more profitable and anesthesia providers happier. 

Aromatherapy from the vanilla infused Capnomask O2/CO2 mask is a safe and effective tool for anesthesia to use to reduce PONV, provide oxygen and monitor the patients breathing to assure safe MAC anesthesia. 

The vanilla infused Capnomask offers a drug-free therapy to give anesthesia a proactive way to reduce the chance of a patient experiencing nausea and vomiting.  The Capnomask offers other advantages including:

  • Excellent patient oxygenation of over double the FiO2 of nasal oxygen canula.
  • Capnomask acts as a physical shield or barrier reducing atomization of a patient’s exhalation thus protecting nurses, surgeons and anesthesia by reducing the spread of germs including Covid19.
  • Capnomask comes preassembled with oxygen tubing and 10’ EtCO2 sample line to safely monitor a patient’s breathing to assure no hypoventilation incidents.
  • Vanilla infused scent reduces nausea and vomiting reducing PONV.
  • Low cost of Capnomask compared to cost of DIY or Do It Yourself options of converting a standard oxygen mask with IV catheter and adding an EtCO2 sample line.
  • Reduced anesthesia time to set up DIY version for MAC cases. 

Further benefits of the Capnomask:

  • Reducing Costs
    • Reduced staffing costs and resources used to administer and monitor PONV treatments
    • Reduced drug costs and side effects of nausea prevention drugs
    • Reduced involvement of pharmacy and medication costs
    • Reduced length of recovery time and improved PACU throughput
    • Improved HCAHPS scores with less PONV
  • Adding Value
    • Preventing nausea with the aromatherapy of Capnomask improves patient experience.
    • Satisfaction scores improve with the reduction in PONV
    • Less staff required for PONV intervention if prevented by proactively using Capnomask
    • Capnomask may be considered an added component of ERAS or Enhanced Recovery after Surgery
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No One’s Safe Until Everybody’s Safe

5.4.2021

It’s unclear who first made this comment about the Covid-19 pandemic, but it is being used by health care leaders around the world to encourage their people to get the Covid-19 vaccination. Vaccines have played an important role throughout history in keeping us well.

Evidence exists that early attempts to inoculate people against smallpox were reported in China as early as the 16th Century. Smallpox scabs could be ground up and blown into the recipient’s nostrils or scratched into their skin. The practice, known as “variolation”, came into fashion in Europe in 1721, with the endorsement of English aristocrat Lady Mary Wortley Montagu.

The next development which turned out to be much safer than variolation, originated from the observation that dairy farmers did not catch smallpox. The 18th Century English physician, Edward Jenner, hypothesised that prior infection with cowpox, which is a mild illness spread from cattle, might be responsible for the suspected protection against smallpox.

In 1796, Jenner inoculated an eight-year-old boy by taking pus from the cowpox lesions on a milkmaid’s hands and introducing the fluid into a cut he made in the boy’s arm. Six weeks later, Jenner exposed the boy to smallpox, but he did not develop the infection then, or on 20 subsequent exposures. The origin of the term comes from the Latin for cow or “vacca”.

Edward Jenner vaccinating his child against smallpox; coloured engraving.  Image: Wellcome Library, London (CC BY 4.0)
Edward Jenner vaccinating his child against smallpox; coloured engraving. Image: Wellcome Library, London (CC BY 4.0)

In 1881 French microbiologist Louis Pasteur demonstrated immunisation against anthrax by injecting sheep with a preparation containing forms of the organism that causes the disease. Four years later he developed a protective suspension against rabies. Jenner’s approach was to use a virus similar to, but safer than, smallpox to prevent disease. Pasteur on the other hand developed a weakened or attenuated form of the virus or bacteria to treat the patient.  

This was the birth of vaccinations and heralded a new era in the treatment of diseases around the world using injections containing live, weakened, or killed viruses to produce immunity against an infectious disease. In the early 20th century, we saw the development of vaccines to protect against whooping cough (1914), diphtheria (1926), tetanus (1938), influenza (1945) and mumps (1948). Later vaccines were developed for polio (1955), measles (1963) and rubella (1969) with the world being announced smallpox free in 1980.

Vaccine technology still uses the approaches developed by Jenner and Pasteur but has developed enormously in recent years with a number of new approaches. These include:

  • A subunit vaccine, which is made from proteins found on the surface of infectious agents e.g. Influenza, Hepatitis B.
  • Inactivated toxins of infectious organisms e.g., Tetanus, Diphtheria, Whooping cough.
  • Gene sequencing and editing has allowed the mass production of antigens that are used in vaccines and made the production of attenuated vaccines safer and more effective.
  • Recombinant DNA technology has also been used effectively to develop vaccines e.g., Human papillomavirus.

Today there are around 30 diseases around the world that are treated and controlled by vaccination programmes making us all healthier and allowing us to live longer.

So here we are in 2021 and vaccines will once again help us fight against another highly infectious disease, Covid-19. There are currently 10 vaccines licensed around the world that offer protection against Covid-19. Staggeringly, there are 88 vaccines in clinical development and 184 in pre-clinical development.

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The speed of development of these vaccines has been nothing short of remarkable and their efficacy rates are equally impressive. However, public attitudes to vaccines appears to have shifted markedly to what it was when this type of treatment was introduced. People either trust vaccines or they don’t. Then we have the antivaxxers who believe vaccines are unsafe and infringe their human rights. Antivaxxers also use social media to actively spread misinformation to persuade people to their point of view. Antivaxxers have been pumping out misinformation for a number of years now, so it’s useful to see if they have had any success.

Claims about the Covid-19 vaccine made by the antivaxxer community include:

  • The vaccine alters your DNA.
  • The vaccine causes infertility.
  • Bill Gates is inserting microchips into people.
  • The virus is being used as a ploy to move a country to a “police state”.
  • Don’t be a guinea pig for pharmaceutical companies.

A number of surveys have been conducted assessing public reaction to having a Covid-19 vaccination. The Imperial College London YouGov Covid-19 Behaviour Tracker Data Hub gathers global insights on people’s behaviours in response to COVID-19. Data represents the share of respondents who have not received a COVID-19 vaccine and who agree with the following statement: “If a COVID-19 vaccine were made available to me this week, I would definitely get it.” Respondents were presented with a 1 to 5 scale, ranging from “Strongly agree” (1) to “Strongly disagree” (5). The following chart shows monthly data on the willingness of unvaccinated individuals to receive the COVID-19 vaccine. They asked this question in November 2020 with the following results:

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You can see that in those countries surveyed there is a wide variation in the willingness to be vaccinated ranging from 67% in the U.K. to only 40% in France. A study conducted by Ipsos on behalf of the World Economic forum found similar results.

Is this vaccine hesitancy the result of antivaxxer misinformation? There is no doubt that some of the claims made by antivaxxers will have resonated with some people. However, when you ask people objectively about vaccine hesitancy the reasons are quite straight forward. “Side effects”, “long term effects on health” and “how well the vaccine works” were the top three reasons for reporting negative sentiment towards the vaccine and this was consistent across all population groups. These concerns are not unreasonable. It is important to note that as more and more people are vaccinated, vaccine hesitancy is declining. In fact, in England 95% of the over 50’s have been vaccinated which is way higher than scientists thought could be achieved.

To ensure high rates of vaccination so that a population can gain “herd” immunity, health care leaders need to target vaccine hesitancy messaging very carefully. This is because hesitancy rates vary by population sub-group.

A survey carried out by the Office of National Statistics in the U.K. in early 2021 revealed that vaccine hesitancy was highest in:

  • 16–29 year olds.
  • Black or Black British adults.
  • Parents with child aged 0-4 years.
  • Adults living in the most deprived area.

It’s pretty clear that as vaccine programmes are rolled out around the world, governments and health care workers will have to work hard to ensure the majority of their people are vaccinated. Only then can we stop saying no one’s safe until everybody’s safe and we can start getting back to a normal life and fix some of the other issues this pandemic has caused.

  • We need to be more vigilant against infections, particularly with vulnerable hospitalised patients. That’s why sterile EyePro™ should be the only eyelid cover used to maintain eyelid closure during general anaesthesia or deep sedation.
  • As surgery returns and we start to reduce the huge backlog of patients waiting for routine surgery, hospitals must ensure they deliver a great patient experience by protecting patients’ eyes from trauma by using NoPress™, our foam and rigid plastic shield designed specifically to protect anaesthetised patient’s eyes from externally applied pressure.
  • Enhance the patient experience further, by guarding against dental damage and/or negative pressure oedema through the use of BiteMe™ our purpose designed, air-filled, soft plastic bite block.

So, no one’s safe until everybody’s safe and although vaccines will help the world recover, it’s important we do our utmost to protect patients from infection as well as non Covid-19 complications that can be easily avoided. By using our products, you will optimise your care and ensure your patients have the best experience they can possibly receive.

Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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Corneal Abrasion; problem what problem?

Well, it all depends on which side of the fence you are sitting on. Most medical definitions describe a corneal abrasion as a painful scrape or scratch on the surface of the clear part of the eye. This clear tissue of the eye is known as the cornea, the transparent window covering the iris, the circular coloured portion of the eye. Descriptions also state that in most cases the cornea heals in a couple of days and all symptoms pass.

A patient on the other hand would probably describe a corneal abrasion as painful to say the least. In fact, it may be extremely painful. This is because the cornea has a high concentration of nerve endings, so it is going to be really painful. Alongside the extreme pain they may feel as though there is something in their eye. The eye will look red, vision will be blurred and there will be excessive tearing. They may be sensitive to light but closing the eye may only cause the pain to intensify. There may be vision loss and headaches which will cause concern.

So, this can be an extremely uncomfortable situation for someone to be in and they need treatment immediately to relieve the pain and allow them to see clearly.

How does a corneal abrasion occur? The answer is, quite easily. Minor abrasions can be caused by:

  • Poking your eye with a fingernail, pen, or makeup brush.
  • Rubbing it too hard.
  • Wear poor-fitting or dirty contact lenses or wearing them for too long.
  • Walking into something like a branch of a tree.

More serious abrasions can occur from:

  • Getting chemicals in your eye.
  • Get dirt, sand, sawdust, ash, or some other foreign matter in your eye, especially at work and not wearing eye protection.
  • Play sports or engaging in high-risk physical activity without eye protection.

You may be surprised to learn that a corneal abrasion can occur when you are having an operation and are anaesthetised. How can that possibly happen, you are probably thinking. Again, the answer is quite easily. But before we consider how a corneal abrasion can occur in the operating theatre, we need to look at how the eye behaves when it is anaesthetised, and the steps taken to protect your eyes when you have an operation.

A general anaesthetic can have several effects on your eyes, including:

  • It can cause lagophthalmos which is a failure of the eyelids to fully close. During normal sleep, lid closure is maintained by the tonic contractions of the orbicularis muscle. Lagophthalmos only occurs in about 4% of people during normal sleep. However, under anaesthesia one study demonstrated that 59% of patients failed to have complete eyelid closure.(1)
  • Tear production and stability are significantly reduced which causes the cornea to dry out.
  • Bell’s phenomenon is a protective mechanism that turns the eyes upwards to protect the cornea. It occurs naturally during sleep, but this mechanism is also lost during general anaesthesia.

Therefore, you can see that the eyes are compromised when you are given a general anaesthetic and so must be protected from being damaged. But how common is getting a corneal abrasion in the operating theatre, what causes it and what is done to protect the eyes?

A corneal abrasion is the most frequent ocular complication of general anaesthesia.(2) The American Society of Anaesthesiologists’ closed claims analysis of ocular injuries associated with general anaesthesia, 35% were corneal abrasions, of which 16% resulted in permanent ocular damage.(3)

Because the eyes are compromised during general anaesthesia, almost anything can cause a corneal abrasion. The list is endless. A watch strap, name badge, the anaesthetist’s hands, facemasks, drapes, instruments laryngoscope, skin preparation solutions, or the direct irritant effect of inhalational anaesthetic agents. In recovery the eye may be injured by face masks, the patient’s fingers, or the bed linen. However, most corneal abrasions are caused by the failure of the eyelids to close properly leading to corneal drying.(4) I will return to this point later.

It’s clear that the eyes need some solid protection to prevent them from being damaged. So, what is done in today’s modern, high tech expensive operating theatre? They do this.

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Usually, a theatre technician will use some general-purpose tape that is lying on a trolley or in their pocket and your eyes will be taped shut. Prior to taping a protective ointment or gel may be applied. However, we all know that adhesiveness of tape varies and that used in the operating theatre is no different. Too little stick may not ensure or maintain complete eyelid closure, leading to moisture loss from the eye. Too much stick may cause eyelid bruising, irritation and skin tears or eyelash loss on removal. Tape used is usually opaque making it difficult to tell if the patients’ eyes are completely closed. Frequent removal and reapplication of the tape makes it less sticky and prone to falling off Additionally, the anaesthetist may need to check pupil dilation and the tape needs to be removed and reapplied whilst wearing surgical gloves. Not an easy thing to do!

So, back to our patient. Despite taping the patient’s eyes being taped during an operation, the tape was opaque, and no one spotted that the eyes opened during the operation causing the cornea to dry out. When the patient woke up, they had a really painful and sore red eye. A saline washout of the eye was tried but that didn’t work. In the end an ophthalmologist was called to examine the patient and a corneal abrasion, caused by the eye drying out was diagnosed. This required treatment including pain management, antimicrobial prophylaxis, a pressure patch, and close monitoring meaning the patient was in hospital for an extra day.

Could all this have been avoided? Could the anaesthetist have spotted that the patients’ eyes had opened during the operation and closed them? Could a corneal abrasion have been avoided and the patient not had such a painful experience? Could the hospital have avoided all those extra treatment costs such as consultant time, drugs, and bed usage?

Instead of using opaque general-purpose tape to protect the patients’ eyes, the hospital should have used EyePro™ instead.

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Why should we use EyePro™ instead of tape?  EyePro™ is a unique eyelid cover designed by an anaesthetist to maintain eyelid closure during general anaesthesia.

It ensures rapid, complete, and safe eyelid closure. By sealing around the eye circumferentially, all moisture is retained, thus preventing the eye from drying out. Additionally, a clear central window allows direct observation of eyelid closure.

EyePro™ has a patented dual zone design whereby an inner transparent window allows intra-operative assessment of eyelid closure, while an outer, more rigid, opaque zone allows for easy handling and excellent conformity to the eye socket. The inner window has a gentle adhesive which helps to maintain eyelid closure and reduces eyelid trauma and/or eyelash removal. The outer zone has slightly stronger adhesive that maintains eyelid closure for extended periods. Also, non- adhesive tabs allow for easy handling, application, and removal, even while wearing gloves.

Additionally, each pair of EyePro™ comes packaged together in a sterile wrap to decrease the risk of cross contamination. In a world where we are going to have to live with Covid-19 anything that reduces the risk of infection must be a good thing. But that will be the subject of another article.

EyePro™ is more expensive than tape I hear you say. Yes, it is. That’s because it has been specifically designed for one purpose; to protect the eyes during general anaesthesia. In doing so, EyePro™ provides a superior level of protection against corneal abrasions. And don’t forget those extra treatment costs such as consultant time, drugs, and bed usage. An extra day in hospital would cost approximately $1800/day in the USA, $AUD1000/day in Australia, £400/day in the UK and €600 in the EU.

EyePro™ is a major advance in keeping the patients’ eyes safe during general anaesthesia. Remember, most corneal abrasions are caused by the failure of the eyelids to close properly leading to corneal drying. EyePro™ allows the anaesthetist to ensure the eyes remain closed, thereby reducing the risk of corneal abrasion. This leads to a better patient experience, quicker recovery time and a reduction in the use of valuable hospital resources such as drugs, bed occupancy and clinical time. Additionally, within the overall cost of treating the patient EyePro™ could also save you money. It really is a no brainer!!!

References:

  1. Batra YK & Bali IM. Corneal abrasions during general anaesthesia. Anaesthesia and Analgesia 1977; 56: 363– 5.
  2. Terry TH, Kearns TP, Grafton‐Loue J, Orwell G. Untoward ophthalmic and neurological events of anaesthesia. Surgical Clinics of North America 1965; 45: 927– 9.
  3. Gild WM, Posner KL, Caplan RA, Cheney FW. Eye injuries associated with anaesthesia. Anaesthesiology 1992; 72: 204– 8.
  4. White E, Crosse MM. The aetiology and prevention of peri‐operative corneal abrasions. Anaesthesia, 1998, 53, pages 157–161
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Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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Doctor There’s a Problem in the Recovery Room

The operation had been a long, but it had been a success. The patient had been taken into the recovery room and was being looked after by theatre staff as they were slowly woken up. In theatre the anaesthetist was talking with colleagues about the operation.

Suddenly, a member of staff put their head through the door of the recovery room and looking at the anaesthetist said, “doctor there’s a problem in the recovery room.”

Upon entering the recovery room, the anaesthetist found that the patient, had started to recover but was biting down on the reinforced laryngeal mask airway (LMA). The anaesthetist tried to encourage the patient to stop biting, but that didn’t work. The patient bit right through the LMA and this part was removed from his mouth. Remarkably the patient could still breathe through the bitten off end. A few minutes later the patient had recovered enough to spit the remnants of the LMA out. The photographs below clearly show the aftermath. 

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Thankfully, that was a good outcome both for the patient and the anaesthetist and their team. But there are two other scenarios that could have occurred:

  • The patient could have broken their teeth and suffered dental damage. I wrote about this last year and pointed out the consequences both from a repair perspective and a financial one for the patient and the hospital.
  • Another more serious scenario is that the patient obstructs the lumen of the LMA or the LMA blocks the upper airway. There is a real risk of desaturation and negative pressure pulmonary oedema. This is a dangerous and potentially fatal condition. Negative pressure pulmonary oedema (NPPE) or post obstruction pulmonary oedema (POPE) is a clinical entity of great relevance in anaesthesiology and intensive care. The presentation of NPPE can be immediate or delayed, which therefore necessitates immediate recognition and treatment by anyone directly involved in the perioperative care of a patient.(1)

So, what do we know about negative pressure pulmonary oedema or Post Obstruction Pulmonary Oedema?

There are few studies in the public domain that look at the incidence of NPPE. The incidence of NPPE has been reported to be 0.05%–0.1% of all anaesthetic practices. However, it is suggested that it occurs more commonly than is generally documented. According to one estimate, NPPE develops in 11% of all patients requiring active intervention for acute upper airway obstruction (2) . In a small review of case reports where laryngeal mask is cited, 60% reported that the patient bit through the LMA and of that group ⅔ reported that the patient developed a pulmonary oedema (3) .

The review concluded, ”The vast majority of the papers found are case reports, though a single survey suggests that biting of an unguarded laryngeal mask airway (LMA) is not an uncommon event. Complications of biting include airway obstruction and the development of negative pressure pulmonary oedema, neither of which would be welcome events in the resuscitation area.”

In a U.K. national survey of the use of bite guards and critical incidents involving the laryngeal mask airway (3) a postal questionnaire was sent to 451 anaesthetists with a 42% response rate. 63% of consultants, 45% of SpRs and 43% of recovery staff never used a bite guard in conjunction with a laryngeal mask airway of any sort. However, biting of a laryngeal mask airway by a patient, resulting in airway obstruction, had been experienced by 18 users of the flexible laryngeal mask airway (7.3%) and 71 users of the standard laryngeal mask airway (18.8%).

The recovery staff reported an average of two incidents per month of laryngeal mask airway obstruction. The authors concluded that the use of a bite guard with a laryngeal mask airway is an uncommon practice but the occurrence of airway obstruction with the laryngeal mask airway is high.

An upper airway obstruction is the cause of negative pressure pulmonary oedema. A blocked or broken LMA caused by biting is one cause. Others include hanging, strangulation, upper airway tumours, foreign bodies, croup, choking, migration of Folly’s catheter balloon used to tamponade the nose in epistaxis, near drowning, goitre mononucleosis, big tonsils, hypertrophic adenoids, or a redundant uvula.

Once the upper airway is obstructed a very large, negative, intrathoracic pressure is generated by the patient’s increased effort to breathe. This causes pulmonary oedema or fluid build-up in the lungs resulting in acute respiratory failure. The onset of pulmonary oedema is usually rapid (within a few minutes after signs of upper airway obstruction). The patient will become agitated, may look frightened, will breathe rapidly, may become tachycardic, crackling sounds or rales may be heard with a stethoscope and pulmonary secretions become frothy and pink as progressive oxygen desaturation occurs.

Quick thinking and action are required to remove the blockage causing this emergency. If the blockage were caused by a broken LMA the patient would need to be rapidly re-anaesthetised and paralysed to allow the LMA to be removed. This would also allow reoxygenation to occur if the patient were desaturated. This intervention not only exposes the patient to more drugs but if desaturation carries on for long enough the situation can become an anaesthetic emergency. The Difficult Airway Society Guidelines for the management of tracheal extubation(4) recommend the following for the management of negative pressure oedema.

  1. Treat the cause: relieve the airway obstruction.
  2. Administer 100% O2 with full facial CPAP mask. In addition to relieving upper airway obstruction, CPAP may reduce oedema formation by increasing mean intrathoracic pressure and minimise alveolar collapse by increasing functional residual capacity, improving gas exchange, and reducing the work of breathing.
  3. Nurse the patient sitting upright.
  4. If there is fulminant pulmonary oedema with critical hypoxaemia, tracheal intubation and mechanical ventilation with PEEP are necessary. Less severe hypoxia responds to supplemental oxygen and ⁄ or non-invasive ventilation, or CPAP.
  5. Intravenous opioids may help reduce subjective dyspnoea.
  6. Chest radiography may exclude other complications of difficult airway management and causes of hypoxia (gastric aspiration, pre-existing infection, pneumothorax, barotrauma, pulmonary collapse).
  7. Frank haemoptysis may necessitate direct laryngoscopy and ⁄ or flexible bronchoscopy.
  8. Diuretics are often administered, but their efficacy is unproven.

The Difficult Airway Society also comment,” Post-obstructive pulmonary oedema may be prevented through use of a bite block during emergence.”

And so, let us finally consider the economics of managing a patient who develops negative pressure oedema from biting through their LMA. The first thing to say is that the patient would probably need to spend more time recovering in hospital either in the recovery room, on a ward, HDU or even ICU. Further investigations such as a chest x-ray or blood gas analysis might be needed. Interventions as described in the Difficult airway Society Guidelines may also be required.

Uncovering the daily cost of a hospital bed is not easy and the data is quite old. A stay in a hospital bed without factoring in investigations and/or interventions would cost approximately $1800/day in the USA, $AUD1000/day in Australia and £400/day in the UK. Private healthcare charges would be higher. In most health care systems around the world the daily cost of an ICU bed is in 4 figures. In the USA it is approximately $6000/day, Australia approximately $AUD4000/day and the UK approximately £2000/day. A bite block such as BiteMe™ costs $1.48 per patient and would reduce the incidence of negative pressure pulmonary oedema resulting in fewer patients needing to spend extra time in ICU.

I leave you to make your own mind up when it comes to cost effectiveness.

So, what can we determine from this article?

  • The incidence of NPPE is poorly understood and probably under reported.
  • NPPE can result in acute respiratory failure which is a dangerous and potentially fatal condition.
  • Biting through a laryngeal mask airway (LMA) is not an uncommon event.
  • Despite being recommended by the Difficult Airway Society the use of a bite block with a laryngeal mask airway is not a common practice.
  • Using a bite block in conjunction with an LMA would reduce the incidence of potentially fatal negative pressure pulmonary oedema caused by a patient biting through their LMA.
  • Using a bite block such as BiteMe™ to prevent NPPE caused by the patient biting through the LMA and the upper airway becoming blocked is a more cost-effective option than having the patient spend extra time in ICU.

By using a specifically designed bite block such as BiteMe™. Which is made of a very strong, but soft, plastic that resists the shear forces of a human bite very well reduces the risk of desaturation and/or Negative pressure pulmonary oedema if the patient’s airway device becomes obstructed.

The combination of the soft plastic surrounding a closed air-filled space means that when a patient bites down, there are two forces opposing the bite. This means BiteMe™ has a spongy recoil and therefore reduces the risk of the patient severing the LMA if they start biting during emergence.

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References

  1. Bhaskar B, Fraser JF. Negative pressure pulmonary edema revisited: Pathophysiology and review of management. Saudi J Anaesth. 2011 Jul-Sep; 5(3): 308–313.
  2. Tami TA, Chu F, Wildes TO, Kaplan M. Pulmonary edema and acute upper airway obstruction. Laryngoscope. 1986;96:506–9.
  3. Heptinstall E, Heptinstall L. Should Bite Guards Be Used with Laryngeal Mask Airways In Adults? Best Evidence Topics Database (BestBETS). March 2015.
  4. Popat M (Chairman),Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012, 67, 318–340
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Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

Original Post Here

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LifeFlow Blood and Fluid Infuser: Volume resuscitation when minutes matter!

LifeFlow offers improved resuscitation through earlier and controlled fluid delivery. LifeFlow is a hand operated rapid infuser for critically ill patients who require urgent fluid delivery. 

  • Controlled hand-operated rapid infuser
  • Easy to use, intuitive and safe
  • Four times plus faster than pressure bag delivering 500ml in less than 2 minutes
  • Reverses shock and restores tissue perfusion saving lives
  • Improves outcomes and reduces mortality
  • Easy set up and priming with set up in less than 40 seconds
  • Measured delivery with 10ml delivered with each trigger pull
  • Built in “force reducer” reducing infuser force protecting IV site from blow outs
  • Works with the QinFlow Warrior blood warmer
  • Eliminates “Pull/Push technique for pediatrics
  • Fluids can be delivered through 24 gauge catheter and blood through a 22g. 
  • 5 times faster than pressure bag
  • Great for hypotension
  • Safety system prohibits more than 200PSI pressure delivery

Click to view a short training video

Can be used with Warrior Blood and Fluid Warmer

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The face mask that could end the pandemic

By Keri Enriquez

Updated 10:24 AM ET, Sat January 23, 2021

 (CNN)Getting Americans masked up is a top priority for the Biden administration.

Biden, who calls wearing masks “a patriotic act,” signed an executive order Wednesday — his very first as President — to ask Americans to wear masks of their choice for the first 100 days of the new administration. The executive order also requires mask use on all federal property, though in this case, not just any old mask will do.

On Wednesday, after the inauguration, White House press secretary Jen Psaki showed off her bright white N95 mask in the press briefing room. “I wore it out, of course, here today and will continue to do that,” Psaki said after removing her medical-grade mask and before turning to questions.

CDC reports record number of daily Covid-19 vaccinations as states struggle with supply

N95 masks are considered the gold standard in personal protective equipment because they block 95% of large and small particles utilizing a unique electrostatic filter.

The filter works by trapping neutral particles like bacteria and viruses before they pass through the mask, protecting the wearer and those around them. It’s similar to how socks might get stuck to a blanket in the dryer. The N95 mask, which costs roughly $5, also fits securely to the face, eliminating most of the leakage that may occur with a loose-fitting cloth or paper mask.

Studies have shown that masks significantly decrease the chances of transmitting or contracting the coronavirus. But not all masks provide equal protection. Depending on the fabric and number of layers, homemade and simple cloth masks have a range of effectiveness that can be as low as 26%, which leaves the wearer vulnerable.

Some experts like Brigham and Women’s Hospital and Harvard Medical School physician Dr. Abraar Karan have been advocating for public use of N95 masks from the start of the pandemic. In an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, Karan outlined why N95s are critical at this stage of the pandemic.

“If for four weeks the country essentially wore these masks in those risky settings like that indoors, what kind of difference do you think it would make?” Gupta asked.

“This would stop the epidemic,” Karan responded.

Dr. Gupta on Covid-19: This is the worst it’s ever been 05:46

The quality of protection a face mask can provide is crucial. A respiratory illness like the coronavirus is transmitted through aerosols, tiny particles that waft and hang in the air. Some virus-carrying particles are small enough to travel through or around lower-quality masks, making the wearer vulnerable to inhalation of viral particles.

“We know now that aerosols spread best when there is poor ventilation, crowding and close contact that’s prolonged,” Karan told Gupta in an interview. “So we were arguing that actually in those settings, cloth masks alone are not going to block aerosols.”

Karan is not the only expert who has been vocal in support of better quality masks for the general public. Former US Food and Drug Administration Commissioner Dr. Scott Gottlieb wrote in an op-ed in the Wall Street Journal that “encouraging Americans to wear higher-quality masks is a simple step that might make a difference.”

The biggest problem is lack of supply. This week marked a full year of the coronavirus, and the Biden administration has committed to invoking the Defense Production Act more often to boost manufacture of N95 masks and other critical supplies. Experts hope manufacturing will hit a speed to be able to sufficiently supply the population.

“An N95 that’s well-fitted clearly is the best that you can do,” National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci told CNN Friday. “You could get production of that at a much higher rate now.”

Karan believes N95 masks could be an essential asset in reopening the economy as the vaccine rollout remains sluggish and quarantine fatigue soars.

The huge stakes of Biden’s new Covid-19 plan

“If we have better personal protection for people, they can more safely go back to work. They can more safely re-engage, especially if testing and tracing is not where we need it to be,” Karan said.

“This was going to be one way to get people back in and get the economy back up.”

Some European countries are already taking that step to prevent coronavirus spread within their borders. Earlier this week, Germany and France mandated that all citizens wear high filtration masks like the N95 in all public places.

After months of treating coronavirus patients, Karan says it’s time to invest in making sure masks people wear are even more effective. “Focus on getting better masks to as many people as possible, focus on the messaging around masks, be consistent with your messaging, make masks part of American culture to stop the epidemic.”

The key here is to always wear a mask whenever you’re in public. One study in Lancet Digital Health found that a 10% increase in mask-wearing could lead to a three-fold increase in the odds of maintaining control over virus transmission in a community. The ability to control the spread of the coronavirus is in our hands — and on our faces.

Original Article Viewed Here

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Novaerus Defend 1050 air purifier approved by FDA as 510(k) Class II Medical Device

Novaerus Defend 1050 cleared by FDA as 510(k) Class II Medical Device to inactivate and filter out airborne virus and bacteria for medical purposes

Defend 1050 uses patented NanoStrike® technology to damage and inactivate airborne micro-organisms.

Dublin, Ireland and Stamford, CT – Novaerus, a WellAir company that delivers clean air solutions to help prevent the spread of infectious outbreaks, announced today that the U.S. Food and Drug Administration (FDA) cleared the Novaerus Defend 1050 (NV 1050) as a 510(k) Class II Medical Device to inactivate and filter out micro-organisms, including virus and bacteria, for medical purposes. The Novaerus Defend 1050 is the first system that uses NanoStrike®, a patented plasma generating technology, to receive FDA 510(k) clearance.

The Novaerus Defend 1050 is a free-standing, portable recirculating air cleaning system designed for additional frontline protection in healthcare settings such as operating rooms, intensive care units, in vitro fertilization labs, emergency rooms, waiting and treatment areas, neonatal units, and other critical environments including those performing aerosol-generating medical procedures (AGMP).

The Defend 1050’s NanoStrike technology uses a plasma field that rapidly inactivates micro-organisms at the molecular level. Within 15 minutes, the Defend 1050 has demonstrated a 4-log (99.99%) reduction of the MS2 bacteriophage RNA virus, an accepted surrogate for SARS-CoV-2. The Defend 1050 also showed a 4-log (99.99%) reduction in Bacillus Globigii endospores (bacterial spores) within 15 minutes, which was maintained over the prolonged operation (24 hours).

The Defend 1050 is currently used in hospitals and healthcare settings worldwide. Given the rapid spread of COVID-19, WellAir moved quickly to understand how this device could potentially combat the virus while moving it through a thorough FDA medical device clearance process. Additionally, the Defend 1050 meets relevant performance criteria in the FDA Guidance, which provides non-binding recommendations that may reduce the risk of viral exposure for patients and healthcare providers during the current public health emergency.

“Our team of outstanding engineers and scientists have been focused on delivering innovative and powerful airborne infection control devices. The FDA clearance on the Defend 1050 is a critical milestone for our company, validating our work to deliver a safe and effective medical device,” said Dr Kevin Devlin, WellAir CEO. “The Defend 1050 has demonstrated tremendous efficacy in third party testing against viruses, bacteria, VOCs, and particulate matter, which makes it an ideal solution for hospitals and healthcare settings. As we continue to see an alarming rise in the number of COVID-19 cases, we have moved quickly to make the device readily available.”

Defend 1050 utilizes multiple stages to reduce airborne micro-organisms. The first stage is a general air pre-filter that captures particles between 4 and 10 microns from the input airflow. This filtered air passes through a series of NanoStrike coils (plasma generators) that damage and inactivate micro-organisms on contact, including viruses and bacteria. The resulting inactive particulates are trapped by a HEPA (High-efficiency Particulate Air) filter. In a final cleaning stage, an activated carbon filter traps VOCs in the airstream before the air is released into the environment.

The Defend 1050 system is delivered complete with all components necessary for immediate use. It can be wheeled easily by a single person to the desired point of use and plugs into standard outlets. Five airflow speed settings enable optimization to each healthcare environment. The only routine maintenance required is a calendar-based filter change schedule.

If you are a medical or healthcare facility interested in learning more about the Novaerus Defend 1050 or other Novaerus products, additional information can be found here, or please contact us

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Xavant Technology Announces First Dual-Sensor Neuromuscular Patient Monitor

The Stimpod NMS450X NMT monitor for Anesthesia first to feature both AMG and EMG modalities in one single, portable patient monitoring system.  

Pretoria, South Africa, October. 15, 2019 – Xavant Technology, a pioneer in neuromuscular monitoring and innovative neuromodulation modalities, announced an addition to the company’s newest generation of Stimpod neuromuscular transmission monitor – the capability of utilizing either of the two most industry prominent types of monitoring sensors, AMG and EMG. The new Stimpod system and EMG sensor accessory will be exhibited at the American Society of Anesthesia (ASA) Annual Meeting, October 19-21 in Orlando, Florida alongside the company’s entire Stimpod portfolio for anesthesia.

“We are excited to announce the EMG modality to our Stimpod line of monitors,” stated Corlius Birkill, CEO of Xavant Technology. “By offering, for the first time, anesthesiologists and clinicians a choice in using either AMG or EMG, we can give them unparalleled clinical and budgetary benefits.” Mr. Birkill continued, “We believe quantitative or objective monitoring of patients who are undergoing neuromuscular block for surgery should be the standard of care. Our goal is to provide physicians with the most optimal and efficient tools to achieve that standard.”

The latest update to the AMG-based Stimpod NMS450X monitor series will enable the use for the first time ever, a dual sensor objective neuromuscular transmission monitor that enables anesthesiologists the choice of using either acceleromyography (AMG) with a reusable sensor or electromyography (EMG) with a disposable sensor to manage patients undergoing neuromuscular block during surgery or while being cared for in the intensive care unit.

By adding an EMG sensor accessory to the Stimpod, clinician opportunities in monitoring will be maximized. Being able to choose either AMG or EMG at site of service, hospitals can perform cost-effective entire-surgery monitoring with the platform that is optimal for that specific case. While AMG is a proven, accurate and cost-effective technology, the EMG sensor will simplify how clinicians monitor patients in more restrictive surgical cases, such as robotic surgery where restricting the hands is common. The EMG accessory is pending FDA clearance.

“The Stimpod NMT monitor is simple and economical way for hospitals to drive patient safety, Operating room, PACU, and ICU efficiency, and manage their very expensive paralytic and recovery drug budgets,” stated Xavant Chairman Roche van Rensburg. “We believe the data is fairly conclusive that hospitals can enhance safety outcomes related to residual neuromuscular block by utilizing objective NMT monitoring. But also important is the power to more effectively manage the time and cost-of-care efficacy for the hospital – we believe the Stimpod system can make a tremendous positive difference on both fronts,” added Mr. van Rensburg.

About Xavant Technology

By Xavant Technology October 17, 2019