Predictors of Difficult Airway Intubation A Prospective Observational Study of 202 Patients Undergoing General Anesthesia

Abstract Background Respiratory compromise (RC) including hypoxia and hypoventilation is likely to be missed in the postoperative period. Integrated pulmonary index (IPI) is a comprehensive respiratory parameter evaluating ventilation and oxygenation. It is calculated from four parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO2), and pulse rate. We hypothesized that IPI monitoring can help predict the occurrence of RC in patients at high-risk of hypoventilation in post-anesthesia care units (PACUs). Methods This prospective observational study was conducted in two centers and included older adults (≥ 75-year-old) or obese (body mass index ≥ 28) patients who were at high-risk of hypoventilation. Monitoring was started on admission to the PACU after elective surgery under general anesthesia. We investigated the onset of RC defined as respiratory events with prolonged stay in the PACU or transfer to the intensive care units; airway narrowing, hypoxemia, hypercapnia, wheezing, apnea, and any other events that were judged to require interventions. We evaluated the relationship between several initial parameters in the PACU and the occurrence of RC. Additionally, we analyzed the relationship between IPI fluctuation during PACU stay and the occurrences of RC using individual standard deviations of the IPI every five minutes (IPI-SDs). Results In total, 288 patients were included (199 elderly, 66 obese, and 23 elderly and obese). Among them, 18 patients (6.3 %) developed RC. The initial IPI and SpO2 values in the PACU in the RC group were significantly lower than those in the non-RC group (6.7 ± 2.5 vs. 9.0 ± 1.3, p < 0.001 and 95.9 ± 4.2 % vs. 98.3 ± 1.9 %, p = 0.040, respectively). We used the area under the receiver operating characteristic curves (AUC) to evaluate their ability to predict RC. The AUCs of the IPI and SpO2 were 0.80 (0.69–0.91) and 0.64 (0.48–0.80), respectively. The IPI-SD, evaluating fluctuation, was significantly greater in the RC group than in the non-RC group (1.47 ± 0.74 vs. 0.93 ± 0.74, p = 0.002). Conclusions Our study showed that low value of the initial IPI and the fluctuating IPI after admission to the PACU predict the occurrence of RC. The IPI might be useful for respiratory monitoring in PACUs and ICUs after general anesthesia.

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Patient factors associated with difficult flexible bronchoscopic intubation under general anesthesia: a prospective observational study

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-020-01568-w ◽

2020 ◽

Vol 67 (6) ◽

pp. 706-714

Author(s):

Taher Touré ◽

Stephan R. Williams ◽

Mahmoud Kerouch ◽

Monique Ruel

Keyword(s):

Observational Study ◽

General Anesthesia ◽

Prospective Observational Study ◽

Patient Factors ◽

Factors Associated

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Ultrasound assessment of gastric emptying time after intake of clear fluids in children scheduled for general anesthesia—A prospective observational study

Pediatric Anesthesia ◽

10.1111/pan.14029 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1384-1389

Author(s):

Christiane E. Beck ◽

Thurgkai Chandrakumar ◽

Robert Sümpelmann ◽

Katja Nickel ◽

Oliver Keil ◽

...

Keyword(s):

Gastric Emptying ◽

Observational Study ◽

General Anesthesia ◽

Prospective Observational Study ◽

Gastric Emptying Time ◽

Ultrasound Assessment ◽

Emptying Time

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Faculty Opinions recommendation of Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia: A Prospective Observational Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735578298.793566155 ◽

2019 ◽

Author(s):

Yoshinori Nakata

Keyword(s):

Blood Pressure ◽

Observational Study ◽

General Anesthesia ◽

Ambulatory Blood Pressure ◽

Prospective Observational Study ◽

Noncardiac Surgery ◽

Pressure Measurements ◽

Intraoperative Hypotension ◽

Ambulatory Blood Pressure Measurements

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Evaluation of pH in Double-Lumen Tubes Removed After General Anesthesia: A Prospective Observational Study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.03.142 ◽

2016 ◽

Vol 30 (5) ◽

pp. e46-e47

Author(s):

Shiho Deguchi ◽

Nobuyasu Komasawa ◽

Tomoki Yamasaki ◽

Michi Omori ◽

Toshiaki Minami

Keyword(s):

Observational Study ◽

General Anesthesia ◽

Prospective Observational Study ◽

Double Lumen

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Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

Journal of Anesthesia ◽

10.1007/s00540-020-02805-8 ◽

2020 ◽

Vol 34 (5) ◽

pp. 675-687

Author(s):

Yan Zhang ◽

Shu-Ting He ◽

Bin Nie ◽

Xue-Ying Li ◽

Dong-Xin Wang

Keyword(s):

Observational Study ◽

General Anesthesia ◽

Postoperative Delirium ◽

Prospective Observational Study ◽

Confusion Assessment Method ◽

Assessment Method ◽

Emergence Delirium ◽

Confusion Assessment ◽

Increased Risk ◽

Pacu Stay

Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

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Feasibility of Anesthesiologist-Performed Preoperative Echocardiography for the Prediction of Postinduction Hypotension: A Prospective Observational Study

Anesthesiology Research and Practice ◽

10.1155/2020/1375741 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Babar Fiza ◽

Neal Duggal ◽

Caitlin E. McMillan ◽

Graciela Mentz ◽

Michael D. Maile

Keyword(s):

Body Mass Index ◽

Observational Study ◽

General Anesthesia ◽

Body Mass ◽

Prospective Observational Study ◽

Medical Center ◽

Academic Medical Center ◽

Vena Cava ◽

Left Ventricular ◽

Point Of Care Ultrasound

Purpose. To determine if left ventricular or inferior vena cava (IVC) measurements are easier to obtain on point-of-care ultrasound by anesthesiologists in preoperative patients, and to assess the relationship between preoperative cardiac dimensions and hypotension with the induction of general anesthesia. Methods. This prospective observational study was conducted at a large academic medical center. Sixty-three patients undergoing noncardiac surgeries under general anesthesia were enrolled. Ultrasound examinations were performed by anesthesiologists in the preoperative area. To ensure that hypotension represented both a relative and absolute decrease in blood pressure, both a mean arterial pressure (MAP) < 65 mmHg and a MAP decrease of >30% from preoperative value defined this outcome. Results. Left ventricular measurements were more likely to be acquired than IVC measurements (97% vs. 79%). Subjects without adequate images to assess IVC collapsibility tended to have a higher body mass index (33.6 ± 5.5 vs. 28.5 ± 4.5, p = 0.001 ). While high left ventricular end-diastolic diameter values were associated with a decreased odds of MAP < 65 mmHg (OR: 0.24, 95% CI: 0.07–0.83, p = 0.023 ) or a MAP decrease of >30% from baseline alone (OR: 0.25, 95% CI: 0.07–0.83, p = 0.023 ), the primary endpoint of both relative and absolute hypotension was not associated with preoperative left ventricular dimensions. Conclusions. Preoperative cardiac ultrasound may be a more reliable way for anesthesiologists to assess patients’ volume status compared to ultrasound of the IVC, particularly for patients with a higher body mass index.

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