Securing an airway enables the oxygenation and ventilation of the lungs and is a potentially life-saving medical procedure. Adverse and critical events are common during airway management, particularly in neonates and infants. The multifactorial reasons for this include patient-dependent, user-dependent and also external factors. The recently published joint ESAIC/BJA international guidelines on airway management in neonates and infants are summarized with a focus on the clinical application. The original publication of the guidelines focussed on naming formal recommendations based on systematically documented evidence, whereas this summary focusses particularly on the practicability of their implementation.
UNASSIGNED: Die Sicherung der Atemwege ermöglicht die Oxygenierung und Ventilation der Lungen und stellt eine potenziell lebensrettende medizinische Maßnahme dar. Insbesondere bei Neugeborenen und Säuglingen kommt es gehäuft zu unerwünschten und kritischen Ereignissen während des Atemwegsmanagements. Die multifaktoriellen Gründe dafür umfassen patientenabhängige, anwenderabhängige, aber auch externe Faktoren. Im Folgenden wird die neu erschienene internationale Leitlinie zur Atemwegssicherung bei Neugeborenen und Säuglingen fokussierend auf die klinische Anwendung zusammengefasst. Während die Originalpublikation der Leitlinie darauf fokussiert, auf Basis der systematisch erfassten Evidenz formale Empfehlungen zu benennen, stellt diese Zusammenfassung v. a. die Praktikabilität ihrer Umsetzung in den Fokus.

BACKGROUND: Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures.
METHODS: Multidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n=65) and general surgeons (n=36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focussing on the level of neuromuscular blockade.
RESULTS: Five recommendations were agreed: 1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), 2) and in obese patients (76.2%); 3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as as immobility or better surgical access (86.1 to 72.3%); 4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally 5) anaesthesiologists/surgeons joint protocols are recommended.
CONCLUSIONS: Collaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.

Neuromuscular blocking agents, although not commonly used in veterinary practice, should be considered when muscle relaxation is needed to facilitate surgical exposure and minimize tissue trauma. These drugs should be administered only once respiration has been controlled and anesthetic agents have been administered to induce unconsciousness and analgesia. Following administration of neuromuscular blocking drugs, neuromuscular and cardiovascular function must be monitored.

This article is a review of the literature on cervical traction. The various mechanical factors most relevant to cervical traction are organized and discussed. The factors presented are 1) neck position, 2) traction force, 3) duration of traction, 4) angle of pull, and 5) position of the patient. Treatment guidelines are suggested based on interpretation of the literature.