scholarly journals Mediastinal Masses, Anesthetic Interventions, and Airway Compression in Adults: A Prospective Observational Study

2021 ◽  
Author(s):  
Philip M. Hartigan ◽  
Sergey Karamnov ◽  
Ritu R. Gill ◽  
Ju-Mei Ng ◽  
Stephanie Yacoubian ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Positive Pressure Ventilation ◽  
Spontaneous Ventilation ◽  
Positive Pressure ◽  
Airway Patency ◽  
Mediastinal Masses ◽  
Airway Collapse ◽  
The Mean ◽  
Central Airway

Background Central airway occlusion is a feared complication of general anesthesia in patients with mediastinal masses. Maintenance of spontaneous ventilation and avoiding neuromuscular blockade are recommended to reduce this risk. Physiologic arguments supporting these recommendations are controversial and direct evidence is lacking. The authors hypothesized that, in adult patients with moderate to severe mediastinal mass–mediated tracheobronchial compression, anesthetic interventions including positive pressure ventilation and neuromuscular blockade could be instituted without compromising central airway patency. Methods Seventeen adult patients with large mediastinal masses requiring general anesthesia underwent awake intubation followed by continuous video bronchoscopy recordings of the compromised portion of the airway during staged induction. Assessments of changes in anterior–posterior airway diameter relative to baseline (awake, spontaneous ventilation) were performed using the following patency scores: unchanged = 0; 25 to 50% larger = +1; more than 50% larger = +2; 25 to 50% smaller = −1; more than 50% smaller = −2. Assessments were made by seven experienced bronchoscopists in side-by-side blinded and scrambled comparisons between (1) baseline awake, spontaneous breathing; (2) anesthetized with spontaneous ventilation; (3) anesthetized with positive pressure ventilation; and (4) anesthetized with positive pressure ventilation and neuromuscular blockade. Tidal volumes, respiratory rate, and inspiratory/expiratory ratio were similar between phases. Results No significant change from baseline was observed in the mean airway patency scores after the induction of general anesthesia (0 [95% CI, 0 to 0]; P = 0.953). The mean airway patency score increased with the addition of positive pressure ventilation (0 [95% CI, 0 to 1]; P = 0.024) and neuromuscular blockade (1 [95% CI, 0 to 1]; P < 0.001). No patient suffered airway collapse or difficult ventilation during any anesthetic phase. Conclusions These observations suggest a need to reassess prevailing assumptions regarding positive pressure ventilation and/or paralysis and mediastinal mass–mediated airway collapse, but do not prove that conventional (nonstaged) inductions are safe for such patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

2019 ◽  
Vol 35 (6) ◽  
Author(s):  
Nadia Ishfaq ◽  
Naheed Gul ◽  
Neelum Zaka
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Early Use ◽  
The Mean

Objective: To determine the outcome of early use of non-invasive positive pressure ventilation (NIPPV) in Pakistani patients with acute exacerbation of chronic obstructive pulmonary disease. Methods: This descriptive study was conducted at Shifa International Hospital Islamabad from April 2015 to January 2017. A total of 120 patients with acute exacerbation of chronic obstructive pulmonary disease receiving NIPPV alongside standard therapy were included in the study. The patients were clinically assessed before starting on NIPPV. The parameters of respiratory rate, pH and paCO2 were monitored and NIPPV was given for six hours to evaluate clinical outcomes and analyze the factors predicting failure (requirement of mechanical ventilation and mortality). Frequency and percentages were calculated for qualitative variables while Mean and Standard Deviation for quantitative variables. Chi-square and t-test were used to see differences in pre and post NIPPV arterial blood gases. Results: Patients’ mean age was 58.88±10.09 years. Males were 88 (73.3%) and females were 32 (26.7%). The mean respiratory rate was 24±1.45 per minute before and 17.96±1.35 per minute after NIPPV (p < 0.00001). The mean pH before NIPPV was 7.27±0.04 and afterwards 7.38±0.02 (p < 0.00001). The mean pCO2 was 61.87±9.60 mm of Hg before and 57.46±6.79 mm of Hg after NIPPV (P < 0.0003). Twenty Four (20%) patients required invasive ventilation of which 19 (15.8%) patients could not survive. Conclusions: There was remarkable improvement in the arterial blood gases after NIPPV. However, the high mortality rate and significant number of COPD patients requiring mechanical ventilation necessitates further investigation into our population. doi: https://doi.org/10.12669/pjms.35.6.857 How to cite this:Ishfaq N, Gul N, Zaka N. Outcome of early use of non-invasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease. Pak J Med Sci. 2019;35(6):1488-1492. doi: https://doi.org/10.12669/pjms.35.6.857 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

2018 ◽  
Vol 104 (1) ◽  
pp. F57-F62 ◽  
Author(s):  
Qaasim Mian ◽  
Po-Yin Cheung ◽  
Megan O’Reilly ◽  
Samantha K Barton ◽  
Graeme R Polglase ◽  
...  
Keyword(s):  
Brain Injury ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Positive Pressure Ventilation ◽  
Intraventricular Haemorrhage ◽  
Delivery Room ◽  
Positive Pressure ◽  
Reference Ranges ◽  
The Mean ◽  
Spontaneously Breathing

Background and objectivesDelivery of inadvertent high tidal volume (VT) during positive pressure ventilation (PPV) in the delivery room is common. High VT delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if VT delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks’ gestation.MethodsA flow-sensor was placed between the mask and the ventilation device. VT values were compared with recently described reference ranges for VT in spontaneously breathing preterm infants at birth. Infants were divided into two groups: VT<6  mL/kg or VT>6 mL/kg (normal and high VT, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.ResultsA total of 165 preterm infants were included, 124 (75%) had high VT and 41 (25%) normal VT. The mean (SD) gestational age and birth weight in high and normal VT group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high VT group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal VT group (P=0.008).Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high VT group and 2/41 (6%) in the normal VT group (P=0.01).ConclusionsHigh VT delivery during mask PPV at birth was associated with brain injury. Strategies to limit VT delivery during mask PPV should be used to prevent high VT delivery.

Atelectatic lobe blood flow: open vs. closed chest, positive pressure vs. spontaneous ventilation

1981 ◽  
Vol 50 (5) ◽  
pp. 1022-1026 ◽  
Author(s):  
A. F. Pirlo ◽  
J. L. Benumof ◽  
F. R. Trousdale
Keyword(s):  
Blood Flow ◽  
Positive Pressure Ventilation ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Transpulmonary Pressure ◽  
Spontaneous Ventilation ◽  
Positive Pressure ◽  
Closed Chest ◽  
Pulmonary Vasoconstriction ◽  
Anesthetized Dogs ◽  
Percent Decrease

We measured lobar hypoxic pulmonary vasoconstriction (HPV) caused by both absorption atelectasis (AA) and nitrogen ventilation (N2) during conditions of a) open chest and positive-pressure ventilation (PPV), b) closed chest ad PPV, and c) closed chest and spontaneous ventilation (SV) and compared conditions a with b and b with c. In eight pentobarbital-anesthetized dogs we found that selective hypoxia of the left lower loe (LLL) caused by either AA or N2 resulted in the same percent decrease in the electromagnetically measured LLL blood flow whether the ches was open or closed to whether ventilation was by PPV or SV (range 58.3-65.0%). Whether the chest was open or closed and whether ventilation was by PPV or SV, reexpansion and ventilation of LLL AA with LLL N2 did not change LLL blood flow and indicated that there were no mechanical forces responsible for the decreased LLL AA blood flow. Differences in the degree of hypoxia, magnitude of transpulmonary pressure, and absolute pulmonary vascular pressure between LLL AA and N2 were considered to be minor. We conclude that the mechanism of decreased blood flow to an atelectatic lobe, whether the chest is open or closed and whether ventilation is by PPV or SV, is entirely due to HPV.

scholarly journals A Meta-Analysis on the Effect of Dexamethasone on the Sugammadex Reversal of Rocuronium-Induced Neuromuscular Block

2020 ◽  
Vol 9 (4) ◽  
pp. 1240
Author(s):  
Chang-Hoon Koo ◽  
Jin-Young Hwang ◽  
Seong-Won Min ◽  
Jung-Hee Ryu
Keyword(s):  
General Anesthesia ◽  
Neuromuscular Blockade ◽  
Primary Outcome ◽  
Elective Surgery ◽  
Neuromuscular Block ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Continuous Variables ◽  
Train Of Four ◽  
The Mean

Sugammadex reverses the rocuronium-induced neuromuscular block by trapping the cyclopentanoperhydrophenanthrene ring of rocuronium. Dexamethasone shares the same steroidal structure with rocuronium. The purpose of this study was to evaluate the influence of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. Electronic databases were searched to identify all trials investigating the effect of dexamethasone on neuromuscular reversal of sugammadex after general anesthesia. The primary outcome was time for neuromuscular reversal, defined as the time to reach a Train-of-Four (TOF) ratio of 0.9 after sugammadex administration. The secondary outcome was the time to extubation after sugammadex administration. The mean difference (MD) and 95% CI were used for these continuous variables. Six trials were identified; a total of 329 patients were included. The analyses indicated that dexamethasone did not influence the time for neuromuscular reversal of sugammadex (MD −3.28, 95% CI −36.56 to 29.99, p = 0.847) and time to extubation (MD 25.99, 95% CI −4.32 to 56.31, p = 0.093) after general anesthesia. The results indicate that dexamethasone did not influence the neuromuscular reversal of sugammadex in patients after general anesthesia. Therefore, the dexamethasone does not appear to interfere with reversal of neuromuscular blockade with sugammadex in patients undergoing general anesthesia for elective surgery.

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