Rigid Laryngoscope-assisted Insertion of Transesophageal Echocardiography Probe Reduces Oropharyngeal Mucosal Injury in Anesthetized Patients

Background Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury. Methods Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed. Results There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group. Conclusion Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.

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A comparative study between i-gel and classical laryngeal mask airway in elective surgery under general anaesthesia

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20163110 ◽

2016 ◽

Vol 2 (9) ◽

pp. 227

Author(s):

Smita R. Engineer ◽

Digant B. Jansari ◽

Saumya Saxena ◽

Rahul D. Patel

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Elective Surgery ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Hemodynamic Parameters ◽

Randomized Clinical Study ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference

Background: Supraglottic airway devices have been widely used as an alternative to tracheal intubation during general anesthesia both in adults and children. This study was carried out to compare classical laryngeal mask airway (LMA) and i-gel, regarding ease of insertion, adequate placement of device, ability to maintain ETCO2 and SPO2, perioperative hemodynamic parameters and intra operative and postoperative complication.Methods: This prospective, randomized clinical study was done on 100 patients of either sex, age between 5 to 60 years, ASA grade I-III who underwent different surgical procedures under general anesthesia in supine position. After giving premedication, induction of anesthesia was done with inj. Propofol 2-3 mg/kg and inj. Succnylcoline 1.5-2 mg/kg. In “sniffing air” position, airway was secured with either LMA or i-gel. An effective placement of device was checked by a square wave capnography, normal chest expansion, SPO2 >95%, and absence of audible leak. Patients were observed for time and ease of insertion, number of attempts, perioperative hemodynamic changes and complications.Results: No statistically significant difference was reported between both the groups, regarding heart rate, BP, SPO2 and ETCO2. Duration of insertion was more in group LMA. Insertion was easy and was possible in first attempt in 88% of patients without much manipulation in group i-gel.Conclusions: I-gel is a better alternative supraglottic airway device than LMA in view of ease of insertion with minimal manipulations and minimal complications. Hemodynamic parameters, SPO2 and ETCO2 were maintained in both the groups.

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Propofol-dexmedetomidine Versus Propofol-ketamine for Anesthesia of Endoscopic Retrograde Cholangiopancreatography (ERCP)

QJM ◽

10.1093/qjmed/hcab086.073 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Sidky Mahmoud Zaki ◽

Sameh Salem Hanafy Taha ◽

Fady Adib Abd Elmalek Morkos ◽

Mohammed Ayman Abd El-Aziz Salama

Keyword(s):

General Anesthesia ◽

Outcome Measures ◽

Anesthetic Management ◽

Duodenal Perforation ◽

Probability Method ◽

Hemodynamic Parameters ◽

Syringe Pump ◽

Group I ◽

Significant Difference ◽

Procedural Complications

Abstract Background The ideal method for anesthetic management during ERCP varied between deep sedation and general anesthesia with preference for general anesthesia over sedation. Aim of the study Primary aim: The aim of this study will to compare the effects of propofoldexmedetomidine and propofol-ketamine combinations for anesthesia in patients undergoing ERCP regarding the following outcome measures: Hemodynamic changes. Respiratory parameters changes. Propofol requirements. The recovery criteria. Post-operative pain. Secondary aim: To assess the rate of other anesthetic and procedural complications regarding the following outcome measures: Anesthetic complications: Post-procedural nausea and vomiting. Post-procedural cognitive dysfunction or hallucinations. Procedural complications: Bleeding: may occur by sphincterotomy. Duodenal perforation; it is a serious condition but it has a rare incidence and usually requires surgical intervention. Material and methods Patients ERCP, aged 20-50ys old, ASA І-II-III, were randomly allocated in two groups each of which was 25 by a probability method in the form of sequentially numbered, opaque, sealed envelopes (SNOSE) that will be divided in 2 groups (25 envelopes for each group) with random selection for each patient for an envelope. Group-I received dexmedetomidine loading 1µg/kg slow IV over 15min then infused at a rate of 0.5µg/kg/h by syringe pump. Group II received Ketamine 1mg/kg slow IV over 15min then infused at a rate of 0.5mg/kg/h by syringe pump. Both groups received propofol; 1-2mg/kg induction – then 5mg/kg/h IV infusion, 0.5mg/kg boluses guided by hemodynamic parameters, atracurium 0.5mg/kg intubating dose followed by 0.1mg/kg every 20min. Cuffed ETT was inserted and CMV. By the end of the procedure, patients turned supine and reversed by administration of neostigmine (0.05mg/kg) + atropine (0.01mg/kg). Extubation was performed after fulfillment of the criteria of extubation. Conclusion Dexmedetomidine-propofol combination was better than ketamine-propofol combination as regard; hemodynamic parameters (intra- and post-procedural), PONV, cognitive functions and recovery time. Incidence of pain had no clinical significant value between both groups. Total propofol consumption had no clinical significant difference between both groups. Recommendation Dexmedetomidine - propofol combination as TIVA technique for ERCP requires further studies with recommendation to include; different types of patients; geriatric, critically ill and increasing the sample size of patients.

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General Anesthesia for Cesarean Section in a Pregnant Woman with Truncus Arteriosus Intraoperatively Monitored by Transesophageal Echocardiography

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2021799 ◽

2021 ◽

Author(s):

Sumidtra Prathep ◽

Suttasinee Petsakul ◽

Natticha Chainarong ◽

Sirichai Cheewatanakornkul ◽

Jutarat Tanasansuttiporn

Keyword(s):

General Anesthesia ◽

Transesophageal Echocardiography ◽

Hemodynamic Instability ◽

Great Artery ◽

Truncus Arteriosus ◽

High Morbidity ◽

Cardiovascular Malformation ◽

Intraoperative Transesophageal Echocardiography ◽

A New Technique ◽

Systemic Arteries

Truncus arteriosus (TA) is defined as a congenital cardiovascular malformation in which one great artery arises from the base of the heart and gives origin to the pulmonary and systemic arteries. TA patients who become pregnant have high morbidity and mortality rates because physiologic changes during pregnancy can worsen the cardiopulmonary balance causing cardiopulmonary decompensation. In this case report we report a successful general anesthesia in a truncus arteriosus patient with severe pulmonary hypertension (Eisenmenger syndrome) who underwent a full-term pregnancy delivery monitored by intraoperative transesophageal echocardiography, a new technique to assist physicians in dealing with patients with hemodynamic instability during both cardiac and noncardiac surgery.

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Opioid-Free General Anesthesia with Dexmedetomidine-Esketamine-Lidocaine Versus Opioid-Based General Anesthesia with Sufentanil-Remifentanil for Breast Benign Patients Undergoing Lumpectomy

10.21203/rs.3.rs-900446/v1 ◽

2021 ◽

Author(s):

Xiali Qian ◽

Hongmei Yuan ◽

Lin Zhao ◽

Shanwu Feng ◽

Yajie Chen ◽

...

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Postoperative Nausea ◽

Recovery Time ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Hemodynamic Parameters ◽

Rescue Analgesia ◽

Surgical Incision ◽

Significant Difference

Abstract Background: Opioid-free anesthesia (OFA) is being implemented in breast benign lumpectomy due to increased awareness of opioid adverse effects and the national opioid crisis. The objective of this study was to examine the effect of Dexmedetomidine-Esketamine-Lidocaine OFA technique in breast benign lumpectomy and assess its impact on subjective pain, intraoperative hemodynamic parameters, adverse events versus standard opioid-based technique (OA).Methods: In this prospective, randomized study, sixty breast benign patients, aging from 20 to 60 years with American Society of Anesthesiologists physical status I or II, were scheduled to undergo lumpectomy. The patients were randomized to receive either OFA (OFA group) or opioid-based (OA group) anesthesia. Dexmedetomidine-Esketamine-Lidocaine or Sufentanil-Remifentanil was administered for induction and maintenance in OFA group or OA group, respectively. Intravenous flurbiprofen axate 50 mg was administered 10 minutes before the end of surgery, and dezocine 5 mg was given to patient showing visual analog scale (VAS) pain score≥4 at any point of time for postoperative rescue analgesia in both groups. Intraoperative hemodynamic parameters at the time points of entering operating room (T0), immediately after induction of anesthesia (T1), immediately after intubation (T2), 1 minute after surgical incision (T3), 5 minutes after surgical incision (T4), and 10 minutes after surgical incision (T5), number of vasoactive drugs required, awakening time and recovery time of orientation, postoperative pain VAS at 2 h, 12 h, and 24 h after recovery, number of postoperative rescue dezocine analgesia required, and incidence of adverse events were recorded.Results: The mean arterial pressure and heart rate at T1, T2, T3, T4, T5 were significantly lower in OA group than OFA group. The incidences of application of rescue ephedrine (1 of 30 [3.3%] versus 12 of 30 [40%], P=0.001) and rescue atropine (2 of 30 [6.7%] versus 6 of 30 [20%], P=0.038) were significantly lower in OFA group compared with OA group. The pain VAS scores at 2 h, 12 h, and 24 h after surgery and number of rescuing dezocine analgesia required (0 of 30 [0%] versus 0 of 30 [0%]) had no statistically significant difference between the two groups. Postoperative nausea and vomiting (3 of 30 [10%] versus 16 of 30 [53%], P=0.001) and application of rescue ondansetron (1 of 30 [3.3%] versus 10 of 30 [33%], P=0.003) were both less in the OFA group compared to those in OA group. However, compared with OA group, patients in OFA group had more delayed awakening time ([7.27±2.85] min versus [4.47±1.11] min, P=0.000) and prolonged recovery time of orientation. ([11.97±3.19] min versus [6.93±1.17] min, P=0.000).Conclusions: The combination of Dexmedetomidine-Esketamine-Lidocaine OFA technique may be an alternative anesthesia for breast benign lumpectomy as better hemodynamic stability, lower incidence of postoperative nausea and vomiting, and adequate postoperative analgesia compared with OA, although longer awakening time and longer recovery time of orientation.Trial registration number: ChiCTR2100044230 (http://www.chictr.org.cn/)

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Hemodynamic Changes during Hepatic Vascular Exclusion: Use of Intraoperative Transesophageal Echocardiography a Case Series

ISRN Anesthesiology ◽

10.5402/2011/278545 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Franco Marinangeli ◽

Alessandra Ciccozzi ◽

Chiara Angeletti ◽

Cristiana Guetti ◽

Tommaso Aloisio ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Index ◽

Transesophageal Echocardiography ◽

Diastolic Pressure ◽

Case Series ◽

Left Ventricular ◽

Vascular Exclusion ◽

Significant Difference ◽

Hepatic Vascular Exclusion ◽

Intraoperative Transesophageal Echocardiography

The aim of this clinical observation was to compare intraoperative transesophageal echocardiography (TEE) and pulmonary artery catheterization (PAC) during hepatic vascular exclusion (HEV). Five non-cirrhotic patients to undergo HVE for major liver resection have been observed. Hemodynamic parameters: pulmonary arterial wedge pressure (PCWP), cardiac index (CI), cardiac output (CO), and systemic vascular resistance (SVR) have been monitored by PAC. Left ventricular end-diastolic area (LVEDA), left ventricular end-systolic area (LVESA), left ventricular end-diastolic pressure (LVEDP), cardiac index (CI), cardiac output (CO), and fractional area changes (FAC) have been monitored by TEE. Hemodynamic variables were assessed before clamping (), at 5 and 30 minutes after clamping (, ) and 15 minutes after unclamping (). No significant difference between PCWP and LVEDP was found. LVEDP significantly decreased at and compared to (); PCWP showed the same trend. A correlation was found between SV and LVEDP (, ) as well as CI (, ). Data confirm that intraoperative TEE may be a reliable method for hemodynamic monitoring during major liver resections.

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Faculty of 1000 evaluation for Complications of intraoperative transesophageal echocardiography in adult cardiac surgical patients - experience of two institutions in Taiwan.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.1880962.1428060 ◽

2010 ◽

Author(s):

John Augoustides ◽

Thomas Gentilcore

Keyword(s):

Transesophageal Echocardiography ◽

Surgical Patients ◽

Intraoperative Transesophageal Echocardiography ◽

Patients Experience

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Effect of Levetiracetam on Cognitive Function and Clonic Seizure Frequency in Children with Epilepsy

Current Molecular Medicine ◽

10.2174/1566524019666190729113321 ◽

2019 ◽

Vol 19 (9) ◽

pp. 699-703

Author(s):

Shihao Zhou ◽

Qiong Zhan ◽

Xiaomei Wu

Keyword(s):

Cognitive Function ◽

Effective Rate ◽

Clonic Seizure ◽

Conventional Group ◽

Significant Difference ◽

Random Number Table ◽

Clonic Seizures ◽

The Difference ◽

Experimental Group ◽

Executive Ability

Background: This study aimed to explore the clinical effect of levetiracetam in the treatment of children with epilepsy. Methods: 136 children with epilepsy were selected from January 2017 to December 2017. According to the random number table method, they were divided into the experimental group and the conventional group, with 68 cases in each group. The conventional group was treated with valproate, while the experimental group was treated with levetiracetam. The effective rate, the cognitive function and the frequency of clonic seizures in the two groups were compared. Results: There was no significant difference in the total effective rate between the two groups (P>0.05). There was no significant difference in attention, executive ability, abstract and orientation scores between the two groups before treatment (P>0.05). After treatment, the focus of attention (106.54±6.56), executive ability (105.76±6.77), abstract and directional score (106.65±6.57) were significantly higher than that of the conventional group. The difference in the two groups was statistically significant (P<0.05). After 3 months of treatment, the frequency of myoclonic seizures (9.22±0.95) and the frequency of tonic-clonic seizures (11.68±1.36) were found to be significantly lower than those of the conventional group, and the difference between the two groups was statistically significant (P<0.05). Conclusion: Levetiracetam is effective in the treatment of children with epilepsy. It can effectively improve the cognitive function of the patients, reduce the frequency of myoclonic seizures and tonic-clonic seizures, and has a high promotion value.

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Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1403-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Yuan-Wei Zhang ◽

Xin Xiao ◽

Wen-Cheng Gao ◽

Yan Xiao ◽

Su-Li Zhang ◽

...

Keyword(s):

3D Printing ◽

Blood Loss ◽

Three Dimensional ◽

Operation Time ◽

Varus Deformity ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Cubitus Varus ◽

Guide Plate ◽

Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

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