AIRWAY SUPPORT FOR ENDOSCOPIC ENDONASAL SURGERY IN GERONTOLOGY

Поддержание проходимости дыхательных путей при вмешательствах на ЛОР-органах в условиях общей анестезии является важной задачей. Управление степенью интраоперационного кровотечения играет ведущую роль в улучшении видимости операционного поля и снижении риска развития осложнений. Выбор способа обеспечения проходимости дыхательных путей может влиять на выраженность интраоперационного кровотечения. Показано, что применение надгортанного воздуховода при эндоскопической эндоназальной риносинусохирургии у геронтологических больных в условиях общей анестезии снижает частоту развития вазопрессорных реакций, выражающихся в подъеме ЧСС, уровня среднего АД, уровня интраоперационного кровотечения, и уменьшает риск оперативного вмешательства. Airway patency during ENT surgery in general anesthesia is a serious problem. It is important to manage the degree of intraoperative bleeding to improve the visibility of the surgical site and reduce the risk of complications. Airway management may affect the severity of intraoperative bleeding. We have shown that the use of a laryngeal mask during endoscopic endonasal rhinosinus surgery during general anesthesia reduces the severity of the hemodynamic response, which is expressed in an increase in heart rate, mean arterial pressure and intraoperative bleeding, and also reduces the risk of surgery.

Download Full-text

Observation of the clinical efficacy of dexmedetomidine in flexible bronchoscopy under general anesthesia: clinical case experience exchange

Journal of International Medical Research ◽

10.1177/0300060519880763 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6215-6222 ◽

Cited By ~ 2

Author(s):

Hongtu Li ◽

Na Zhang ◽

Ke Zhang ◽

Yanhua Wei

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Adverse Events ◽

Arterial Pressure ◽

General Anesthesia ◽

Recovery Time ◽

Flexible Bronchoscopy ◽

Stress Indices ◽

Group A ◽

Group B

Object To investigate the clinical efficacy and safety of dexmedetomidine in flexible bronchoscopy under general anesthesia. Methods A total of 114 patients were randomly divided into intervention group A and control group B. Group A received dexmedetomidine, fentanyl, and propofol as anesthesia, while Group B received fentanyl and propofol only. Changes in heart rate, mean arterial pressure, pulse oxygen saturation, stress indices (blood cortisol, adrenaline, and norepinephrine levels), incidence of adverse events, anesthesia dose, duration of procedure, and recovery time were compared between the groups at specific time points T0, T1, and T2 during bronchoscopy. Results There was no statistical difference between the groups at T0. At T1 and T2, pulse oxygen saturation, mean arterial pressure, heart rate, and stress indices in group A were significantly more favorable than those in group B. The incidence of adverse events (5.26%) in group A was significantly lower than that in group B (17.54%), and patients in group A required less propofol and had a faster recovery time than patients in group B. Conclusion Dexmedetomidine use in flexible bronchoscopy under general anesthesia is safe and effective and decreases the stress response in synergy with propofol to provide hemodynamic stability.

Download Full-text

A randomized comparative study of preloading with Ringers lactate and intravenous Ephedrine for the prevention of hypotension due to propofol during induction of general anesthesia

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v3i1.14653 ◽

2016 ◽

Vol 3 (1) ◽

pp. 22-27 ◽

Cited By ~ 1

Author(s):

Manisha Pradhan ◽

Brahma Dev Jha

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

General Anesthesia ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Physical Status ◽

Volume Loading

Background: The ideal method to prevent hypotension due to intravenous propofol for induction of anesthesia is still debatable. The aim of the study was to compare the hemodynamic response of ephedrine and volume loading with ringer lactate in preventing the hypotension caused by propofol as inducing agent in patients scheduled for elective surgeries requiring general anesthesia with endotracheal intubation.Methods: This was prospective randomized study conducted in 40 patients of ASA physical status I, aged 20-50 years, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation. Group I received intravenous ephedrine sulphate (70 mcg/kg) just before induction of anaesthesia, and patients assigned to Group II received preloading with Ringer's lactate (12 ml/kg) over the 10-15 minutes before the administration of propofol. The variables compared were heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure following induction of anesthesia till 10 minutes after intubation of trachea.Results: We found that there were increase in systolic blood pressure, diastolic blood pressure and mean arterial pressure after induction in both the groups but the difference between the groups was not significant. The increase in heart rate was found to be significantly higher in ephedrine group in comparison to volume loading group.Conclusion: Our study showed that both the methods used were equally effective in preventing hypotension induced by propofol in the adult ASA physical status I patients requiring general anesthesia with endotracheal intubation. However, the heart rate was significantly higher in patients receiving ephedrine in comparison to volume loading group.

Download Full-text

Dexmedetomidine as a Single Bolus Dose in Laparoscopic Cholecystectomy under General Anesthesia – A Comparison of Different Doses

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i2.31415 ◽

2020 ◽

Vol 5 (2) ◽

pp. 1045-1049

Author(s):

Kumud Pyakurel ◽

Lalit Kumar Rajbanshi ◽

Chitra Thapa ◽

Gunjan Regmi

Keyword(s):

Heart Rate ◽

Laparoscopic Cholecystectomy ◽

Mean Arterial Pressure ◽

Adverse Events ◽

Arterial Pressure ◽

General Anesthesia ◽

Induction Dose ◽

Pharmacodynamic Profile ◽

Duration Of Surgery ◽

Sedation Scores

Introduction: Dexmedetomidine has an ideal pharmacodynamic profile for attenuation of stress response during general anesthesia for laparoscopic cholecystectomy. Since, the value of dexmedetomidine as a single premedication dose remains largely unexplored, this study compared dexmedetomidine in 0.5μg/kg and 1μg/kg dose for laparoscopic cholecystectomy under general anesthesia. Objectives: The primary objective of this study was to compare dexmedetomidine in a single premedication dose of 0.5μg/kg and 1μg/kg in terms of hemodynamic (heart rate and mean arterial pressure) changes to critical incidences such as laryngoscopy, endotracheal intubation, pneumoperitoneum and extubation. The secondary objectives were to compare induction dose of propofol required, sedation scores in the immediate post anesthesia period and adverse events such as bradycardia and hypotension. Methodology: This was a prospective double blind study. Ninety-two patients aged 18-55 years of either gender of American Society of Anesthesiologists physical status I-II were randomly allocated into two groups to receive either Dexmedetomidine 1μg/kg or 0.5μg/kg slowly IV over 10 minutes as a premedication before induction. Heart rate, Mean arterial pressure, induction dose of propofol, sedation scores, and adverse events were compared. Results: The patient characteristics, Fentanyl consumption, duration of surgery and anesthesia in both groups were comparable. There was comparable attenuation of hemodynamics in both groups during laryngoscopy and intubation. Dexmedetomidine in 1μg/kg compared to 0.5μg/kg had significantly better attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum. After 40 minutes, there was no attenuation in either group. The post anesthesia sedation scores were comparable. The induction dose of propofol was significantly less and the incidence of bradycardia was significantly higher with dexmedetomidine 1μg/kg. Conclusion This study demonstrates that a premedication dose of Dexmedetomidine in 1μg/kg compared to 0.5μg/kg has significantly betier attenuation of hemodynamics from 1 minute to 40 minutes of pneumoperitoneum.

Download Full-text

Dexmedetomidine vs Fentanyl in Attenuating the Sympathetic Surge During Endotracheal Intubation: A Scoping Review

10.21007/con.dnp.2021.0007 ◽

2021 ◽

Author(s):

Alexandra Schwieger ◽

Kaelee Shrewsbury ◽

Paul Shaver

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Systolic Blood Pressure ◽

General Anesthesia ◽

Diastolic Blood Pressure ◽

Endotracheal Intubation ◽

Scoping Review ◽

Hemodynamic Stability

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 adrenergic agonist, can decrease the release of norepinephrine, has analgesic properties, and can lower the heart rate. Methods In this scoping review, studies published between 2009 and 2021 that compared fentanyl and dexmedetomidine during general anesthesia induction and endotracheal intubation of surgical patients over the age of 18 were included. Full text, peer-reviewed studies in English were included with no limit on country of study. The outcomes included post-operative reviews of decrease in pain medication usage and hemodynamic stability. Studies that were included focused on hemodynamic variables such as systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and use of opioids post-surgery. Result Of 2,114 results from our search, 10 articles were selected based on multiple eligibility criteria of age greater than 18, patients undergoing endotracheal intubation after induction of general anesthesia, and required either a dose of dexmedetomidine or fentanyl to be given prior to intubation. Dexmedetomidine was shown to effectively attenuate the sympathetic surge during intubation over fentanyl. Dexmedetomidine showed a greater reduction in heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure than fentanyl, causing better hemodynamic stability in patients undergoing elective surgery.Implications for Nursing Practice Findings during this scoping review indicate that dexmedetomidine is a safe and effective alternative to fentanyl during induction of general anesthesia and endotracheal intubation in attenuating the hemodynamic response. It is also a safe choice for opioid-free anesthesia.

Download Full-text

AN OBSERVATIONAL STUDY TO EVALUATE THE HAEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND LARYNGEAL MASK AIRWAY INSERTION

10.36106/ijsr/0729114 ◽

2021 ◽

pp. 56-58

Author(s):

Rahul Kumar ◽

Anant Prakash ◽

Chandeshwar Choudhary ◽

Debarshi Jana

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mean Arterial Pressure ◽

Laryngeal Mask Airway ◽

Observational Study ◽

Arterial Pressure ◽

Airway Management ◽

Endotracheal Intubation ◽

Laryngeal Mask ◽

Laryngeal Mask Airway Insertion

Introduction: Airway management is a crucial skill for the clinical anaesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. The laryngeal mask airways (LMA) have become popular in airway management as a missing link between facemask and tracheal tube in terms of both anatomical position and degree of invasiveness. Haemodynamic stability is an important aspect to the anaesthesiologist for the benet of the patients especially during intubations, laryngeal mask insertion. Laryngoscopy and endotracheal intubation can cause striking changes in Haemodynamics as result of intense stimulation of sympathetic nervous system. The aim of this study was to evaluate the hemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Material And Methods: This was a prospective observational study on 46 patients of ASA I-II status divided into 2 groups of 23 each. In the ETT (Endotracheal tube) group endotracheal intubation was done using Macintosh laryngoscope by using portex cuffed endotracheal while in LMA (Laryngeal mask airway) group laryngeal mask airway was inserted according to the standard recommendation. Heart rate, Systolic, Diastolic and Mean arterial pressure and dysrhythmias were monitored. Results: The two groups were comparable in terms of demographic data as there were no signicant differences between the 2 groups in terms of age, sex, duration of surgery, ASA grades and MPC classication. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure(DBP), Mean arterial pressure (MAP) remains on higher side in ETT group than LMA group which was statistically signicant. P<0.05. Dysrhythmias were noted in 2 patients of ETT group while LMA group did not notice any dysrhythmias. Conclusion: This study demonstrated that there is a haemodynamic response consisting of an increase in Heart rate, SBP, DBP and MAP that comes with ETT insertion as well as with LMA insertion. However, the response caused by ETT insertion is signicantly greater than that caused by LMA insertion.

Download Full-text