Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 6 Articles
Background: The Laryngeal Tube Suction Disposable (LTS-D) and the Supreme Laryngeal Mask Airway (SLMA) are\nsecond generation supraglottic airway devices (SADs) with an added channel to allow gastric drainage. We studied\nthe efficacy of these devices when using pressure controlled mechanical ventilation during general anesthesia for\nshort and medium duration surgical procedures and compared the oropharyngeal seal pressure in different head\nand-neck positions.\nMethods: Eighty patients in each group had either LTS-D or SLMA for airway management. The patients were\nrecruited in two different institutions. Primary outcome variables were the oropharyngeal seal pressures in neutral,\nflexion, extension, right and left head-neck position. Secondary outcome variables were time to achieve an effective\nairway, ease of insertion, number of attempts, maneuvers necessary during insertion, ventilatory parameters, success\nof gastric tube insertion and incidence of complications.\nResults: The oropharyngeal seal pressure achieved with the LTS-D was higher than the SLMA in, (extension (p=0.0150)\nand right position (p=0.0268 at 60 cm H2O intracuff pressures and nearly significant in neutral position (p = 0.0571). The\noropharyngeal seal pressure was significantly higher with the LTS-D during neck extension as compared to\nSLMA (p= 0.015). Similar oropharyngeal seal pressures were detected in all other positions with each device. The\nsecondary outcomes were comparable between both groups. Patients ventilated with LTS-D had higher\nincidence of sore throat (p = 0.527). No major complications occurred.\nConclusions: Better oropharyngeal seal pressure was achieved with the LTS-D in head-neck right and extension\npositions , although it did not appear to have significance in alteration of management using pressure control\nmechanical ventilation in neutral position. The fiberoptic view was better with the SLMA. The post-operative\nsore throat incidence was higher in the LTS-D....
The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous\ndysplasia, caf�©-au lait skin pigmentations and endocrine hyperfunction. Those\npatients with bone issues could have various surgeries under general anesthesia.\nAirway abnormality and various endocrine abnormalities should be considered during\ngeneral anesthesia for McCune-Albright syndrome patients. A 15-year-old male\nwith McCune-Albright syndrome was admitted with complaint of right nasal obstruction\noriginated from fibrous dysplasia. Endoscopic resection of nasal cavity lesion\nwas scheduled under navigation system guidance. Difficult airway could be anticipated\ndue to protrusion of maxilla and right nostril. Awake fiberoptic intubation\nwas performed by spray-as-you-go technique. When an anesthesiologist expects to\ntake care of the patient with the McCune-Albright syndrome, the most appropriate\nanesthetic induction and tracheal intubation technique should be selected, and multiple\nbackup instruments such as supraglottic device, video laryngoscope and fiberoptic\nbronchoscopy should be prepared....
Introduction.The aim of the study was to assess changes of regional ventilation distribution at the level of the 3rd intercostal space in\nthe lungs ofmorbidly obese patients as a result of general anaesthesia and laparoscopic surgery aswell as the relation of these changes\nto lung mechanics.We also wanted to determine if positive end-expiratory pressure of 10 cm H2O prevents the expected atelectasis\nin themorbidly obese patients during general anaesthesia. Materials and Methods. 49 patients completed the examination and were\nrandomized to 2 groups: ventilated without positive end-expiratory pressure (PEEP 0) and with PEEP of 10 cm H2O (PEEP 10)\npreceded by a recruitment maneuver with peak inspiratory pressure of 40 cm H2O. Impedance Ratio (IR) was utilized to examine\nventilation distribution changes as a result of anaesthesia, pneumoperitoneum, and change of body position. We also analyzed\nintraoperative respiratory mechanics and pulse oximetry values. Results. In both groups general anaesthesia caused a ventilation\nshift towards the nondependent lungs which was not further intensified after pneumoperitoneum. Reverse Trendelenburg position\npromoted homogeneous ventilation distribution. Respiratory system compliance was reduced after insufflation and improved\nafter exsufflation of pneumoperitoneum. There were no statistically significant differences in ventilation distribution between the\nexamined groups. Respiratory system compliance, plateau pressure, and pulse oximetry values were higher in PEEP 10. Conclusions.\nChanges of ventilation distribution in the obese do occur at cranial lung regions. During pneumoperitoneum alterations of\nventilation distribution may not follow the direction of the changes of lung mechanics. In the obese patients PEEP level of 10 cm\nH2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis\ninduced by general anaesthesia....
Background: The present study aimed to compare the intravenous bolus effect of oxycodone and fentanyl\non hemodynamic response after endotracheal intubation and postoperative pain in patients undergoing\nclosed reduction of nasal bone fracture.\nMethods: In this prospective randomized double-blinded study, 64 patients undergoing closed reduction of\nnasal bone fracture were randomized into one of two groups: the fentanyl group (Group F) or the oxycodone\ngroup (Group O). Each drug (fentanyl 2 mcg/kg in Group F and oxycodone 0.2 mg/kg in Group O) was administered\nprior to the induction of general anesthesia. Hemodynamic changes after endotracheal intubation and postoperative\npain were then measured in both groups.\nResults: There was no significant difference in the change in mean arterial pressure and heart rate between\npre-induction and post-intubation in both Groups F and O (P > 0.05). Postoperative pain in Group O was\nmilder than that in Group F (P < 0.001); however, time to awakening from the end of operation was shorter\nin Group F (P = 0.012).\nConclusion: In patients undergoing closed reduction of nasal bone fracture, oxycodone attenuates hemodynamic\nresponse to endotracheal intubation similar to fentanyl. However, oxycodone is more effective than fentanyl\nin improving postoperative pain....
Background: Remifentanil is an effective drug for protecting against adverse haemodynamic responses to tracheal\nintubation. We compared the haemodynamic responses during anaesthesia induction between continuous\nintravenous (IV) infusion and two bolus injections of remifentanil.\nMethods: This prospective, randomised, open-label, single-centre study included patients with American Society of\nAnesthesiologists physical status I-II, scheduled to undergo elective surgery under general anaesthesia. Patients\nwere randomised into two groups based on remifentanil administration type: the continuous IV infusion group\n(Group C) receiving a 0.3-�¼g/kg/min remifentanil infusion for 5 min followed by a 0.1-�¼g/kg/min remifentanil\ninfusion, and the IV bolus group (Group B) receiving a combination of two bolus injections of remifentanil (first\nbolus of 0.4 �¼g/kg and second bolus of 0.6 �¼g/kg after 3 min) and 0.1 �¼g/kg/min remifentanil. General anaesthesia\nwas induced with 1 mg/kg propofol and 0.6 mg/kg rocuronium 3 min after remifentanil infusion (Group C) or\nimmediately after the first bolus of remifentanil (Group B). Tracheal intubation was performed 4 min after the\ninjection of propofol and rocuronium. Heart rate and non-invasive blood pressure were recorded at 1-min intervals\nfrom baseline (i.e., before induction) to 5 min after tracheal intubation.\nResults: A total of 107 patients were enrolled (Group C, 55; Group B, 52). Normotensive patients with no history of\nantihypertensive medication use were assigned to the normotensive subgroup (41 each in both groups), while\nthose with hypertension but without a history of antihypertensive medication use were assigned to the untreated\nhypertensive subgroup (Group C vs. B, n = 7 vs. 4). Finally, patients with a history of antihypertensive medication use\nwere assigned to the treated hypertensive subgroup (7 each in both Groups C and B). No differences in heart rate\nand blood pressure were observed between Groups C and B within each subgroup.\nConclusions: Haemodynamic responses during anaesthesia induction were similar between continuous infusion and\ntwo bolus injections of remifentanil within both normotensive and hypertensive patients with or without medication....
Background: General anesthesia does not block central nervous processing of auditive information. Therefore,\npositive suggestions even given during surgery might have the potential to encourage well-being and recovery of\npatients.\nAim of this review was to summarize the evidence on the efficacy of therapeutic suggestions under general\nanesthesia in adults undergoing surgery compared to an attention control (i.e. white noise).\nMethods: We included randomized controlled trials that investigated therapeutic suggestions presented during\ngeneral anesthesia to adult patients undergoing surgery or medical procedures. Outcomes on pain intensity, mental\ndistress, recovery, use of medication, measured postoperatively within hospitalization were considered. Electronic\nsearches were carried out in the following databases (last search February 23, 2015): MEDLINE, CENTRAL, Web of\nScience, PsycINFO, ProQuest Dissertations and Theses.\nResults: Thirty-two eligible randomized controlled trials were included, comprising a total of 2102 patients. All\nstudies used taped suggestions. Random effects meta-analyses revealed no effects on pain intensity (Hedgesââ?¬â?¢ g = 0.\n04, CI 95% [âË?â??0.04; 0.12], number needed to treat [NNT] = 44.3) and mental distress (g = 0.03, CI 95% [âË?â??0.11; 0.16],\nNNT = 68.2). In contrast, we found small but significant positive effects on use of medication (g = 0.19, CI 95% [0.09;\n0.29], NNT = 9.2) and on recovery (g = 0.14, CI 95% [0.03; 0.25], NNT = 13.0). All effects were homogeneous and\nrobust.\nConclusions: Even though effects were small, our results provide indications that intraoperative suggestions can\nhave the potential to reduce the need for medication and enhance recovery. Further high quality trials are needed\nto strengthen the promising evidence on the efficacy of therapeutic suggestions under general anesthesia for\npatients undergoing surgery....
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