Informative Supraglottic Airway versus Endotracheal Tube During Interventional Pulmonary Procedures – A Retrospective Study

Abstract Background As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

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Supraglottic Airway versus Endotracheal Tube During Interventional Pulmonary Procedures – A Retrospective Study

10.21203/rs.2.256/v3 ◽

2019 ◽

Author(s):

Kyle M Behrens ◽

Richard E Galgon

Keyword(s):

Airway Management ◽

General Anesthesia ◽

Endotracheal Tube ◽

Anesthetic Management ◽

Pulmonary Complications ◽

Neuromuscular Blocking ◽

Supraglottic Airway ◽

Lung Pathology ◽

Anesthetic Agents ◽

Increased Risk

Abstract Background: As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods: From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results: Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions: In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

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Informative Supraglottic Airway versus Endotracheal Tube During Interventional Pulmonary Procedures – A Retrospective Study

10.21203/rs.2.256/v2 ◽

2019 ◽

Author(s):

Kyle M Behrens ◽

Richard E Galgon

Keyword(s):

Airway Management ◽

General Anesthesia ◽

Endotracheal Tube ◽

Anesthetic Management ◽

Pulmonary Complications ◽

Neuromuscular Blocking ◽

Supraglottic Airway ◽

Lung Pathology ◽

Anesthetic Agents ◽

Increased Risk

Abstract Background: As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods: From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results: Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions: In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

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Informative Supraglottic Airway versus Endotracheal Tube During Interventional Pulmonary Procedures – A Retrospective Study

10.21203/rs.2.256/v1 ◽

2019 ◽

Author(s):

Kyle M Behrens ◽

Richard E Galgon

Keyword(s):

Airway Management ◽

General Anesthesia ◽

Endotracheal Tube ◽

Anesthetic Management ◽

Pulmonary Complications ◽

Neuromuscular Blocking ◽

Supraglottic Airway ◽

Lung Pathology ◽

Interventional Pulmonology ◽

Increased Risk

Abstract Background: As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution. Methods: From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed. Results: Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use. Conclusions: In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation. Keywords: Supraglottic airway, endotracheal tube, airway maintenance, interventional pulmonology, neuromuscular blocking

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General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00454-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuji Suzuki ◽

Matsuyuki Doi ◽

Yoshiki Nakajima

Keyword(s):

Lactic Acidosis ◽

General Anesthesia ◽

Mitochondrial Disease ◽

Muscle Relaxation ◽

Anesthetic Management ◽

Perioperative Period ◽

Mitochondrial Encephalomyopathy ◽

Anesthesia Induction ◽

General Anesthetic ◽

Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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Pharyngeal Function and Breathing Pattern during Partial Neuromuscular Block in the Elderly

Anesthesiology ◽

10.1097/aln.0000000000000043 ◽

2014 ◽

Vol 120 (2) ◽

pp. 312-325 ◽

Cited By ~ 37

Author(s):

Anna I. Hårdemark Cedborg ◽

Eva Sundman ◽

Katarina Bodén ◽

Hanne Witt Hedström ◽

Richard Kuylenstierna ◽

...

Keyword(s):

Neuromuscular Block ◽

The Elderly ◽

Pulmonary Complications ◽

Neuromuscular Blocking ◽

Residual Effects ◽

Airway Protection ◽

Healthy Elderly ◽

Increased Risk ◽

Train Of Four ◽

Pharyngeal Function

Abstract Background: Intact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr. Methods: Pharyngeal function and coordination of breathing and swallowing were assessed by manometry and videoradiography in 17 volunteers, mean age 73.5 yr. After control recordings, rocuronium was administered to obtain steady-state train-of-four ratios of 0.70 and 0.80 followed by spontaneous recovery to greater than 0.90. Results: Pharyngeal dysfunction increased significantly at train-of-four ratios 0.70 and 0.80 to 67 and 71%, respectively, compared with 37% at control recordings, and swallowing showed a more severe degree of dysfunction during partial neuromuscular block. After recovery to train-of-four ratio of greater than 0.90, pharyngeal dysfunction was not significantly different from the control state. Resting pressure in the upper esophageal sphincter was lower at all levels of partial neuromuscular block compared with control recordings. The authors were unable to demonstrate impaired coordination of breathing and swallowing. Conclusion: Partial neuromuscular block in healthy elderly individuals causes an increased incidence of pharyngeal dysfunction from 37 to 71%, with impaired ability to protect the airway; however, the authors were unable to detect an effect of partial neuromuscular block on coordination of breathing and swallowing.

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Intraoperative Tracheal Obstruction Management among Patients with Anterior Mediastinal Masses

Case Reports in Medicine ◽

10.1155/2018/4895263 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

H. Kafrouni ◽

Joelle Saroufim ◽

Myriam Abdel Massih

Keyword(s):

Case Report ◽

Airway Obstruction ◽

General Anesthesia ◽

Intraoperative Complications ◽

Anesthetic Management ◽

Preoperative Assessment ◽

Anterior Mediastinal Mass ◽

Tracheal Obstruction ◽

Mediastinal Masses ◽

Increased Risk

Background. Patients suffering from undiagnosed obstruction of the central airways: the trachea and main stem bronchi are at increased risk for perioperative and postoperative complications, especially if general anesthesia is performed. Case Description. This report discusses a 30-year-old asymptomatic Caucasian female who faced recurrent distal airway collapse during mediastinoscopy for biopsy of an anterior mediastinal mass, which led to the inability to extubate her. This case examines the necessity of a thorough preoperative assessment especially in patients with undiagnosed tracheal obstruction and a precise coordination between anesthesiologist and surgeon in being able to perform a safe and smooth anesthesia, in order to avoid life-threatening complications and to reduce further morbidity. Methods. The scope of this case report is restricted to publications in all surgical and anesthesiological specialties among adult patient population. Main search key words were as follows: “tracheal obstruction,” “general anesthesia,” “mediastinum,” and “tumors” Results. The literature supports an increased perioperative risk of airway obstruction with the use of general anesthesia in patients with anterior mediastinal masses. This case report suggests a perioperative anesthetic management modality for patients presenting with anterior mediastinal masses and who are at high risk of cardiovascular compression and tracheal obstruction. Thus, it is highly important to note that evidence-based recommendations are not available in the literature. Conclusions. This case report suggests perioperative management modalities performed by anesthesiologists in order to minimize the risk of airway obstruction among patients having anterior mediastinal masses and shed the lights on the importance of proper anesthetic and surgical planning in order to prevent intraoperative complications and improve the quality of healthcare provided to patients presenting critical cases.

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Analysis of clinico-demographic risk factors for postoperative pulmonary complications following gastrointestinal surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20195950 ◽

2019 ◽

Vol 7 (1) ◽

pp. 93

Author(s):

Vijay Sinouvassan ◽

Hemalatha Dayalane ◽

Subalakshmi Balagurunathan ◽

Ashok Kumar Sahoo ◽

Vishnu Kanth ◽

...

Keyword(s):

Risk Factors ◽

Serum Albumin ◽

Gastrointestinal Surgery ◽

Pulmonary Complications ◽

Lung Pathology ◽

Postoperative Pulmonary Complications ◽

Increased Risk ◽

Education Status ◽

Demographic Risk ◽

Demographic Risk Factors

Background: Postoperative pulmonary complications (PPC) are one of the commonest complications following gastrointestinal surgery. They lead to increased mortality, increased length of intensive care unit (ICU) stay, and higher cost of treatment. Identifying the risk factors of PPC helps in predicting its occurrence and to develop preventive measures. The objectives of the present study were to study the clinical and demographic risk factors for PPC following gastrointestinal surgery.Methods: The study was designed as an observational descriptive analytic study. All the patients ≥18 years of age undergoing gastrointestinal surgery were included. The patients with preoperative lung pathology requiring ICU care or ventilatory support and patients with lung metastasis were excluded. The demographic and clinical parameters at admission were recorded. The details of pulmonary complications like the time of occurrence after surgery and the mode of treatment for pulmonary complications were noted. The risk association was assessed for statistical significance.Results: A total of 100 patients were underwent various gastrointestinal surgeries during the study period. The incidence of PPC was 34% in our study. Age, education status, smoking, and presence of comorbidities were found to be positively associated with an increased incidence of PPCs. The serum albumin of less than 3.5gm and the haemoglobin of less than 8 gm were also associated with an increased incidence of PPC. Pleural effusion was the commonest PPC seen in 15 (44.1%) patients followed by pneumonia in 9 (26.5%).Conclusions: Age, smoking, education status, serum albumin, haemoglobin, emergency surgery, elective postoperative ventilation, nasogastric intubation and blood loss in the intraoperative period were found to associated with increased risk of PPCs.

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Airway Management Devices

The Physics, Clinical Measurement and Equipment of Anaesthetic Practice for the FRCA ◽

10.1093/oso/9780199595150.003.0027 ◽

2011 ◽

Author(s):

Patrick Magee ◽

Mark Tooley

Keyword(s):

Airway Management ◽

Endotracheal Tube ◽

Breathing System ◽

Supraglottic Airway ◽

Artificial Airway ◽

Oropharyngeal Airway ◽

Equipment Availability ◽

The Many ◽

Deep Anaesthesia ◽

Almost All

The most important interface between the breathing system and the patient’s lungs is an airway management device (AMD). Post-operatively it can be considered to be a means of delivering oxygen enriched air to the patient. Intraoperatively it is intended to secure the patient’s airway, which might otherwise obstruct due to deep anaesthesia, to provide a reasonably gas tight seal to ensure accurate delivery of anaesthetic gases and, if necessary, to protect the lungs against aspiration of gastric contents. Postoperatively, the AMD can be nasal prongs or a variable performance mask, whose efficiencies may not be predictable [Wagstaff et al. 2007]. Intraoperatively it might be an artificial airway with a facemask, a supraglottic airway of one of the many types now available or an endotracheal tube (ETT). A supraglottic airway is one that sits in the pharynx or larynx above the vocal cords and these days is usually a laryngeal mask airway (LMA) of the numerous types now available, a cuffed oropharyngeal airway (COPA), or a Combitube. The LMA types available consist of: the classical LMA; the flexible (reinforced) LMA with a flexible tube to the breathing system; the ‘Proseal’, which has a gastric drainage tube as well as a gas transport tube; the intubating LMA, a device with a rigid right angled tube that acts as a ventilation conduit in the usual way, but through which an endotracheal tube may also be blindly introduced into the trachea; the ‘I-gel’ which has a gastric and a respiratory port as does the Proseal, but is less bulky, and whose bowl does not require inflation with air, but is filled with a gel that expands with body heat to form a seal. These days, almost all devices are made of material that excludes latex, but care should be taken to ensure this is indeed the case when there is a latex sensitive patient. Depending on the exact surgical and anaesthetic circumstances, the anaesthetist’s experience and equipment availability, a choice is made between these devices to secure the airway for a given operation. Additionally, there are other devices available to assist in securing the airway, such as the laryngoscope, the fibre optic bronchoscope and the cricothyrotomy tube.

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A Comparasion of Laboratory and Cardiopulmonary Effects of Desflurane, Detomidine and Medetomidine Anaesthetic Combinations in Horses

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.80799 ◽

2017 ◽

Vol 45 (1) ◽

pp. 9

Author(s):

Hanifi Erol ◽

Mustafa Arıcan

Keyword(s):

General Anesthesia ◽

Respiratory Rate ◽

Endotracheal Tube ◽

Venous Blood ◽

Blood Parameters ◽

Group Iv ◽

Clinical Effects ◽

Anesthetic Agents ◽

Group I ◽

Balanced Anesthesia

Background: Equine anesthesia morbidity and mortality rates are greater than in other domestic animals because of hypotension and hypoventilation. The important features desired in general anesthesia for horses are a rapid effect, rapid emergence and balanced anesthesia. The long duration of action of currently used anesthetic agents cause various complications in horses. The aim of the present study was to compare the clinical effects of combination of the anesthetics desflurane, detomidine and medetomidine in horses.Materials, Methods & Results: Eight healthy mixed-breed horses (four males and four females) with weighing 275 ± 56 kg [mean ± standard deviation (SD)] and aged 6.8 ± 5 years [(mean ± SD)] were used for this study. The horses were placed into one of four groups: group I (detomidine-desflurane), group II (detomidine-desflurane-atipamezole), group III (medetomidinedesflurane), or group IV (medetomidine-desflurane-atipamezole). Horses were rested for 15 days before each group starts to study. Intravenous detomidine (25 µg/kg) was used for premedication in groups I and II, and intravenous medetomidine (7 µg/ kg) was used for premedication in groups III and IV. Ketamine hydrocholoride (2 mg/kg) and midazolam (0.03 mg/kg) were intravenously administered in the same syringe to induce anesthesia. After induction of anesthesia, horses were placed in the left lateral recumbent position, and the trachea was intubated with a cuffed endotracheal tube with an internal diameter of 28 mm. The endotracheal tube was attached to a large animal circle breathing system anesthesia machine, and anesthesia was maintained with desflurane for 90 min. The initial dosage of desflurane was 14% + 4 L O2/min, and was reduced by 2% every 10 min over the first 30 min of anesthesia. After 30 min, the desflurane dose was changed to 8% + 4 L, which was maintained until the end of anesthesia (90 min). After 90 min, the administration of desflurane was discontinued, and all animals were supported by O2, with groups II and IV receiving 0.06 mg/kg atipamezole in addition to oxygen. Anaesthetic action times, hematological parameters, blood gas levels, electrolyte levels, biochemical values, electrocardiography values and end-tidal carbon dioxide volume were measured before, during, at the end of, and 24 h after anesthesia.Discussion: In this study, medetomidine (7 µg/kg) and detomidine (25 µg/kg) were intravenously administered, which was adequate and suitable for sedating horses. At the end of anesthesia, 0.06 mg/kg atipamezole was intravenously administered in groups II and IV. However, atipamezole did not affect the clinical parameters. Stress, excitement, fear, catecholamine exchange in blood circulation, hyperglycemia, and hypoxia can all cause changes in venous blood parameters. These are potential reasons for the changes in venous blood parameters (i.e., WBC and Hb) observed at the beginning of and during anesthesia in the present study. During and after the anesthetic period, serum biochemical values can be different from baseline values. They are dependent on the effects of anesthetic agents. During anesthesia, the decrease and increase of biochemical values stabilize the changes in the enzyme system that develops because of the effects of anesthetic agents. In the present study, it was considered that the changes in the biochemical values aimed to stabilize the changes induced by anesthesia. Regarding the electrolyte parameters evaluated in the study, there was a statistical difference detected in Na values between 90 min after induction of anesthesia and 24 h after induction of anesthesia in group IV. However, in previous studies, the changes in Na values did not influence the cardiac pressure during general anesthesia. In our study, significant changes were not seen in any electrolyte parameters except Na, and atrioventricular block was not detected in ECG traces. Generally, decreased ETCO2 levels are evidence of lung perfusion deficiency. It depends on the effects of anesthetic agents on the cardiopulmonary, cardiovascular, and respiratory systems. In particular, the higher pressure and dose of desflurane supress respiratory system. Oxygen supplementation in general anesthesia increases respiratory rate, but a-2 agonists and ketamine-midazolam effects can eliminate the increasing respiratory rate in general anesthesia.

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