Ultrasound‐guided out‐of‐plane obturator nerve block
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‘microbial broth’, and we note that only the antibacterial effects of SaniCloth CHG 2% on E. coli and MRSA were measured. With input from the Medicines and Healthcare products Regulatory Agency’s Microbiology Advisory Committee, the AAGBI guidelines on infection control in anaesthesia [2] risk-stratify devices and methods of decontamination into high/intermediate/low, depending on the penetration of skin and mucous membranes. Bougies, along with other airway devices, are highly likely to be in contact with mucous membranes, and to become contaminated, and are therefore designated intermediate-risk. As such, they require high-level disinfection which would not be achieved with chlorhexidine 2%/alcohol 70% alone. It follows that low-level disinfection of reusable bougies is inadequate to prevent transmission of the majority of bacteria, viruses, fungi and spores. Perhaps more importantly, the authors have not commented on the prevention of transmission of prion proteins, such as those causing variant Creutzfeldt-Jakob disease (vCJD) [3]. Sani-Cloth CHG 2% disinfection would be insufficient to minimise the risk of transmission of vCJD adequately, and it is predominantly for this reason that disposable airway devices are recommended.
[1] V. Howell,et al. Chlorhexidine cleaning of re‐usable bougies , 2013, Anaesthesia.
[2] A. Taha. Brief reports: ultrasound-guided obturator nerve block: a proximal interfascial technique. , 2012, Anesthesia and analgesia.
[3] T. Saranteas,et al. Identification of the obturator nerve divisions and subdivisions in the inguinal region: a study with ultrasound , 2007, Acta anaesthesiologica Scandinavica.
[4] H. Gerbershagen,et al. Nerve blocks , 2020, Don't Forget The Bubbles.