scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

scholarly journals Incidence of airway complications associated with deep extubation in adults

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). Conclusions The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Important Determinant ◽  
Physical Status ◽  
Respiratory Complications ◽  
Airway Assessment ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults.Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.

scholarly journals Incidence of Airway Complications Associated with Deep Extubation in Adults

2020 ◽  
Author(s):  
Jeremy Juang ◽  
Martha Cordoba ◽  
Alex Ciaramella ◽  
Mark Xiao ◽  
Jeremy Goldfarb ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Respiratory Complications ◽  
Probability Of Success ◽  
Intracranial Pressures ◽  
Eye Opening ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Endotracheal Extubation

Abstract Background: Endotracheal extubation is the most crucial step during emergence from general anesthesia. In the vast majority of cases, this is carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. This smooth emergence is particularly important for procedures that require maintenance of stable levels of intraocular and intracranial pressures, such as in neurologic, ophthalmic, and head-and-neck surgery [1]. Reluctance to performing deep extubation in adults, even in appropriate circumstances, is common and likely derives both from concerns for potential respiratory complications [2] and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods: In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results: Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p<0.05). Conclusions: The complication rate during deep extubation in adults was low and all easily reversible. And patient factors and extubation conditions may influence probability of success in deep extubation.

Comparative Hemodynamic Depression of Sevoflurane versus Halothane in Infants 

1997 ◽  
Vol 87 (4) ◽  
pp. 795-800 ◽  
Author(s):  
Eric Wodey ◽  
Patrick Pladys ◽  
Catherine Copin ◽  
Marie Madeleine Lucas ◽  
Andre Chaumont ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Index ◽  
Elective Surgery ◽  
Physical Status ◽  
Inhalation Induction ◽  
Cardiovascular Side Effects ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background The cardiovascular side effects of volatile anesthetics are one of the chief causes of postoperative complications in children, and infants seem to be at the greatest risk for this. This study compared cardiovascular changes at equipotent concentrations of sevoflurane and halothane in infants. Methods Thirty infants classified as American Society of Anesthesiologists physical status I or II who required elective surgery were randomized to receive either halothane or sevoflurane for inhalation induction. Cardiovascular and echocardiographic data were recorded in both groups at baseline and at end-tidal concentrations of 1 and 1.5 minimum alveolar concentration (MAC). Results Sevoflurane did not alter heart rate or cardiac index at all concentrations compared with awake values. Sevoflurane significantly decreased blood pressure and systemic vascular resistance compared with awake values at all concentrations. Shortening fraction and rate-corrected velocity of circumferential fiber shortening decreased at 1.5 but not at 1 MAC. Myocardial contractility assessed by stress-velocity index and stress-shortening index decreased significantly at all concentrations, but did not fall into the abnormal range at any concentration. Halothane caused a greater decrease in heart rate, shortening fraction, stress-shortening index, velocity of circumferential fiber shortening, stress-velocity index, and cardiac index at all concentrations than did sevoflurane. Conclusion Sevoflurane causes a lesser decrease in cardiac output than does halothane in infants.

scholarly journals Evaluation of Differences between PaCO2 and ETCO2 by Age as Measured during General Anesthesia with Patients in a Supine Position

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Kenichi Satoh ◽  
Ayako Ohashi ◽  
Miho Kumagai ◽  
Masahito Sato ◽  
Akiyoshi Kuji ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Pressure Gradient ◽  
Partial Pressure ◽  
General Anesthesia ◽  
Supine Position ◽  
Physical Status ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists

Objective. The aim of this study was to evaluate the arterial to end-tidal partial pressure gradient of carbon dioxide according to age in the supine position during general anesthesia. Methods. From January 2001 to December 2013, we evaluated 596 patients aged ≥16 years who underwent general anesthesia in the supine position. The anesthetic charts of these 596 patients, all classified as American Society of Anesthesiologists physical status I or II, were retrospectively reviewed to investigate the accuracy of PaCO2 and ETCO2. Results. The a-ETCO2 was 3.0 ± 2.1 mmHg for patients aged 16 to <65 years and 4.1±3.1 mmHg for patients ≥65 years. The a-ETCO2 was 2.4±3.1 mmHg for patients aged 16 to 25 years, 3.1±2.2 mmHg for patients aged 26 to 35 years, 3.0±2.2 mmHg for patients aged 36 to 45 years, 3.4±2.0 mmHg for patients aged 46 to 55 years, 3.2±2.0 mmHg for patients aged 56 to 64 years, 4.3±3.2 mmHg for patients aged 65 to 74 years, and 3.7±2.8 mmHg for patients aged 75 to 84 years. Conclusion. The arterial to end-tidal partial pressure gradient of carbon dioxide tended to increase with increasing age.

Changes of Electroencephalographic Bicoherence during Isoflurane Anesthesia Combined with Epidural Anesthesia

2002 ◽  
Vol 97 (6) ◽  
pp. 1409-1415 ◽  
Author(s):  
Satoshi Hagihira ◽  
Masaki Takashina ◽  
Takahiko Mori ◽  
Takashi Mashimo ◽  
Ikuto Yoshiya
Keyword(s):  
Epidural Anesthesia ◽  
Physical Status ◽  
Isoflurane Concentration ◽  
Frequency Space ◽  
Isoflurane Anesthesia ◽  
Restricted Region ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Two Peaks

Background The authors previously reported that, during isoflurane anesthesia, electroencephalographic bicoherence values changed in a fairly restricted region of frequency versus frequency space. The aim of the current study was to clarify the relation between electroencephalographic bicoherence and the isoflurane concentration. Methods Thirty elective abdominal surgery patients (male and female, aged 34-77 yr, American Society of Anesthesiologists physical status I-II) were enrolled. After electroencephalogram recording with patients in an awake state, anesthesia was induced with 3 mg/kg thiopental and maintained with oxygen and isoflurane. Continuous epidural anesthesia with 80-100 mg/kg 1% lidocaine was also administered. Using software they developed, the authors continuously recorded the FP1-A1 lead of the electroencephalographic signal and expired isoflurane concentration to an IBM-PC compatible computer. After confirming the steady state of each isoflurane (end-tidal concentration at 0.3, 0.5, 0.7, 0.9, 1.1, 1.3, and 1.5%), electroencephalographic bicoherence values were calculated. Results In a light anesthetic state, electroencephalographic bicoherence values were low (generally &lt; or = 15.0%). At increased concentrations of isoflurane, two peaks of electroencephalographic bicoherence emerged along the diagonal line (f1=f2). The peak emerged at around 4.0 Hz and grew higher as isoflurane concentration increased until it reached a plateau (43.8 +/- 3.5%, mean +/- SD) at isoflurane 0.9%. The other peak, at about 10.0 Hz, also became significantly higher and reached a plateau (32.6 +/- 9.2%) at isoflurane 0.9%; at isoflurane 1.3%, however, this peak slightly decreased. Conclusion Changes in the height of two electroencephalographic bicoherence peaks correlated well with isoflurane concentration.

Association of Ethnicity with the Minimum Alveolar Concentration of Sevoflurane

2007 ◽  
Vol 107 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Tiberiu Ezri ◽  
Daniel Sessler ◽  
Marian Weisenberg ◽  
Gleb Muzikant ◽  
Michael Protianov ◽  
...  
Keyword(s):  
Selective Breeding ◽  
Minimum Alveolar Concentration ◽  
Skin Incision ◽  
Physical Status ◽  
The Caucasus ◽  
Lifestyle Choices ◽  
American Society ◽  
End Tidal ◽  
American Society Of Anesthesiologists ◽  
Animal Strains

Abstract Background: Selective breeding produces animal strains with varying anesthetic sensitivity. It thus seems unlikely that various human ethnicities have identical anesthetic requirements. Therefore, the authors tested the hypothesis that the minimum alveolar concentration of sevoflurane differs significantly as a function of ethnicity. Methods: The authors recruited 90 American Society of Anesthesiologists physical status I and II adult patients belonging to three Jewish ethnic groups: European, Oriental, and Caucasian (from the Caucasus Mountain region). All were scheduled to undergo surgery requiring a skin incision exceeding 3 cm. Without premedication, anesthesia was induced with 6–8% sevoflurane in 100% oxygen, and tracheal intubation was facilitated with succinylcholine. The skin incision was made after a predetermined end-tidal concentration of sevoflurane of 2.0% was maintained for at least 10 min in the first patient in each group. Blinded investigators observed the patient for movement during the subsequent minute. The concentration in the next patient was increased by 0.2% when patients moved, or decreased by the same amount when they did not. Results are presented as means [95% confidence intervals]. Results: Morphometric and demographic characteristics were similar among the groups; however, mean arterial pressure was slightly greater in European Jews. Minimum alveolar concentration for sevoflurane was greatest in Caucasian Jews (2.32% [2.27–2.41%]), less in Oriental Jews (2.14% [2.06–2.22%]), and still less in European Jews (1.9% [1.82–1.99%]) (P &lt; 0.001). Conclusions: The results suggest that minimum alveolar concentration varies as a function of ethnicity. However, the extent to which confounding characteristics contribute, including lifestyle choices and environmental factors, remains unknown.

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