Chest compressions are a fundamental component of modern day cardiopulmonary resuscitation techniques. While their value is indisputable, they are not without fault, being responsible for an extensive list of iatrogenic complications, one of the most frequent being injuries to the skeletal component of the chest wall. In this work, an extensive literature review was performed, in order to determine the incidence and the patterns of skeletal chest wall injuries following successful cardiopulmonary resuscitation. This process was succeeded by careful study and analysis of the regional anesthesia techniques available for the pain management of these injuries and the selection of four of them for the experimental portion of the study. They are as follows: sternal periosteal infusion, parasternal PECS block, PECS II block and the Serratus Anterior Nerve block. The aim of this study is to determine the regional anesthesia technique of choice in these patients through a cadaveric study. Firstly, each cadaver will be intubated and ventilated using volume controlled ventilation at a rate of 13 breaths per minute and a volume of 6 ml/kg. Each cadaver will undergo one type of nerve block, according to their standard procedural technique, and a bolus of methylene blue dye will be injected, followed by continuous infusion for three hours. All blocks will be carried out under ultrasound guidance. Finally, each cadaver will undergo dissection by the pathological anatomist in order to determine the spread of the dye according to each technique. This study takes a particular interest in documenting whether the anterior collateral cutaneous branches and the lateral cutaneous branches of the intercostal nerves have been successfully reached
Lesioni toraciche scheletriche indotte dalla rianimazione cardiopolmonare:Quale tecnica di anestesia regionale per la gestione del dolore? Protocollo di uno studio cadaverico. Le compressioni toraciche sono una componente fondamentale delle tecniche moderne di rianimazione cardiopolmonare. Sebbene il loro valore sia indiscutibile, non sono senza difetti, essendo responsabili per un ampio elenco di complicanze iatrogene. Una delle più frequenti è la lesione della componente scheletrica della parete toracica. In questo lavoro, è stata eseguita un'ampia revisione della letteratura, al fine di determinare l'incidenza e i modelli di lesioni della parete toracica scheletrica a seguito di rianimazionecardiopolmonare. Questo processo è stato seguito da un'attenta analisi delle tecniche dianestesia regionale disponibili per la gestione del dolore di queste lesioni e dalla selezione diquattro di esse per la parte sperimentale dello studio. Sono i seguenti: infusione periostale sternale, blocco PECS parasternale, blocco PECS II e blocco del nervo serrato anteriore. Lo scopo di questo studio è determinare la tecnica di anestesia regionale ideale in questi pazienti attraverso uno studio cadaverico. In primo luogo, ogni cadavere verrà intubato e ventilato utilizzando una ventilazione a volumecontrollato a una velocità di 13 respiri al minuto e un volume di 6 ml/kg. Ogni cadavere subirà un tipo di blocco nervoso, secondo la loro tecnica procedurale standard, e verrà iniettato un bolo di colorante blu di metilene, seguito da un'infusione continua per tre ore. Tutti i blocchi saranno eseguiti sotto guida ecografica. Infine, ogni cadavere sarà sottoposto a dissezione da parte dell'anatomista patologico al fine di determinare la diffusione del colorante secondo ciascuna tecnica. Questo studio ha un particolare interesse nel documentare se i rami cutanei collaterali anteriori ei rami cutanei laterali dei nervi intercostali sono stati raggiunti con successo.
Cardiopulmonary Resuscitation-Induced Skeletal Chest Injuries:Which Regional Anaesthesia Technique for Pain Management? Protocol of a cadaveric study.
DOS SANTOS DRAGHI, ISABELLA
2022/2023
Abstract
Chest compressions are a fundamental component of modern day cardiopulmonary resuscitation techniques. While their value is indisputable, they are not without fault, being responsible for an extensive list of iatrogenic complications, one of the most frequent being injuries to the skeletal component of the chest wall. In this work, an extensive literature review was performed, in order to determine the incidence and the patterns of skeletal chest wall injuries following successful cardiopulmonary resuscitation. This process was succeeded by careful study and analysis of the regional anesthesia techniques available for the pain management of these injuries and the selection of four of them for the experimental portion of the study. They are as follows: sternal periosteal infusion, parasternal PECS block, PECS II block and the Serratus Anterior Nerve block. The aim of this study is to determine the regional anesthesia technique of choice in these patients through a cadaveric study. Firstly, each cadaver will be intubated and ventilated using volume controlled ventilation at a rate of 13 breaths per minute and a volume of 6 ml/kg. Each cadaver will undergo one type of nerve block, according to their standard procedural technique, and a bolus of methylene blue dye will be injected, followed by continuous infusion for three hours. All blocks will be carried out under ultrasound guidance. Finally, each cadaver will undergo dissection by the pathological anatomist in order to determine the spread of the dye according to each technique. This study takes a particular interest in documenting whether the anterior collateral cutaneous branches and the lateral cutaneous branches of the intercostal nerves have been successfully reachedÈ consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/16013