Evaluation of Pressure of Arterial Oxygen by Age in Supine Position during General Anesthesia

Abstract Background Acute onset paraplegia after endovascular aneurysm repair (EVAR) is a rare but well-known complication. We here show a 79-year-old woman with paraplegia caused by static and dynamic spinal cord insult not by ischemia after EVAR. Case presentation The patient underwent EVAR for abdominal aortic aneurism under general anesthesia in the supine position. She had a medical history of lumbar canal stenosis. After the surgery, we recognized severe paraplegia and sensory disorder of lower limbs. Although the possibility of spinal cord ischemia was considered at that time, postoperative magnetic resonance imaging (MRI) revealed burst fracture of vertebra and compressed spinal cord. Conclusions Patients with spinal canal stenosis can cause extrinsic spinal cord injury even with weak external forces. Thus, even after EVAR, it is important to consider extrinsic factors as the cause of paraplegia.

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Prone position results in enhanced pressor response to ephedrine compared with supine position during general anesthesia

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2016.01.023 ◽

2016 ◽

Vol 31 ◽

pp. 94-100 ◽

Cited By ~ 1

Author(s):

Jiangyan Xia ◽

Jing Yuan ◽

Xinjian Lu ◽

Ning Yin

Keyword(s):

General Anesthesia ◽

Prone Position ◽

Supine Position ◽

Pressor Response

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Arterial Oxygen Saturation following Endotracheal Intubation, Extubation and Suction during General Anesthesia

Korean Journal of Anesthesiology ◽

10.4097/kjae.1968.1.1.31 ◽

1968 ◽

Vol 1 (1) ◽

pp. 31

Author(s):

Dong Ho Park ◽

Choon Hee Lee ◽

Hung Kun Oh

Keyword(s):

Oxygen Saturation ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen

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Prone Versus Supine Position in Intubated COVID-19 Patients With ARDS: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-820756/v1 ◽

2021 ◽

Author(s):

Dita Aditianingsih ◽

Adhrie Sugiarto ◽

Sidharta Kusuma Manggala ◽

Hansen Angkasa ◽

Ahmad Pasha Natanegara

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Partial Pressure ◽

Prone Position ◽

Supine Position ◽

Meta Analysis ◽

Arterial Oxygen ◽

Icu Discharge ◽

Significant Difference ◽

Position Group

Abstract BackgroundThis review determined the effect of prone positioning in changes of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, partial pressure of carbon dioxide (PaCO2), mortality rate, ICU length of stay and duration of mechanical ventilation in intubated COVID-19 patients with severe ARDS.MethodsA computer-aided comprehensive electronic bibliographic search from MEDLINE, EMBASE, and Science Direct were conducted. The search comprised the articles written in English and intubated adults (≥ 18 years old) patients with COVID-19. The primary outcome was comparing PaO2/FiO2 ratio between prone and supine position group. Secondary outcomes were PaCO2, ICU discharge, and mortality rate. Review Manager version 5.4 (The Cochrane Collaboration) was used for statistical analyses of the included studies.ResultsA total of 7 articles were determined to be eligible, consisting of 1403 intubated COVID-19 patients with ARDS that showed prone position was associated with a higher PaO2/FiO2 ratio compared to supine position (MD 60.17, 95% CI 46.86 - 73.47; p < 0.00001). Four studies reported the PaCO2 measurement and showed no significant difference between prone and supine position (MD 2.07, 95% CI -2.79 - 6.92; p <0.40). Only two studies reported mortalities, one study had 262 deaths out of 648 patients (40.4%) and one study lost 11 out of 20 patients (55%). One study reported median ICU stay and mechanical ventilation duration (16 days) were significantly longer in prone position group.ConclusionThis meta-analysis showed that prone position improved PaO2/FiO2 ratio in intubated COVID-19 patients with ARDS.

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The Use of Oxygen Reserve Index in One-Lung Ventilation and Its Impact On Peripheral Oxygen Saturation, Perfusion Index and Pleth Variability Index

10.21203/rs.3.rs-990585/v1 ◽

2021 ◽

Author(s):

Gonul Sagiroglu ◽

Ayse Baysal ◽

Yekta Altemur Karamustafaoglu

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

General Anesthesia ◽

Supine Position ◽

Lung Ventilation ◽

Anesthesia Induction ◽

Pleth Variability Index ◽

One Lung Ventilation ◽

Peripheral Oxygen Saturation ◽

Variability Index

Abstract Background: Our goal is to investigate the use of the Oxygen Reserve Index (ORi) and its relation with peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV).Methods: Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. During general anesthesia induction, propofol, fentanyl, and rocuronium at appropriate doses were administered intravenously. All patients required OLV after a left-sided double-lumen tube insertion during intubation. Hypoxemia during OLV was defined as peripheral oxygen saturation (SpO2) value of less than 95% when the inspired oxygen fraction (FiO2) is above 60% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi equals zero in different anesthesia time points to predict hypoxemia. At Clinicaltrials.gov registry, the Registration ID is NCT05050552.Results: The accuracy for predicting hypoxemia during anesthesia induction at ORi value equals zero at five minutes after intubation in the supine position (DS5) showed a sensitivity of 92.3% (95% CI 84.9-99.6), specificity of 81.1% (95% CI 70.2-91.9), and an accuracy of 84.0% (95% CI 73.8- 94.2). ORi and SpO2 correlation was found at DS5 (p = 0.044), 5 minutes after lateral position with two-lung ventilation (DL5) (p = 0.039), and at 10 minutes after OLV (OLV10)(p = 0.011).Conclusions: ORi equals zero at the time point of five minutes after tracheal intubation in the supine position (DS5) showed high sensitivity and specificity for predicting hypoxemia at a less than 95% value.

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Contributions of Anesthesiology to the Surgical Treatment of Cerebrovascular Disease

Anesthesiology ◽

10.1097/aln.0b013e3181672648 ◽

2008 ◽

Vol 108 (4) ◽

pp. 756-758 ◽

Cited By ~ 2

Author(s):

Charles D. Collard ◽

James M. Anton ◽

John R. Cooper ◽

N Martin Giesecke ◽

David S. Warner

Keyword(s):

Cerebral Ischemia ◽

General Anesthesia ◽

Carotid Endarterectomy ◽

Local Anesthesia ◽

Collateral Circulation ◽

Carotid Arteries ◽

Arterial Oxygen Tension ◽

Carotid Occlusion ◽

Arterial Oxygen ◽

Cerebral Metabolic Rate

Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. By B. A. Wells, A. S. Keats, and D. A. Cooley. Surgery 1963; 54:216-23. Local anesthesia with little or no preoperative sedation is currently recommended as the anesthetic of choice for temporary carotid occlusion during carotid endarterectomy. Purported advantages include minimal circulatory and respiratory changes from the local anesthetic, and constant verbal contact can be maintained with the patient so that neurologic changes are promptly recognized. However, local anesthesia may not be satisfactory in uncooperative or semiconscious patients. We therefore undertook a trial of general anesthesia in 56 consecutive patients undergoing carotid endarterectomy. Patients were induced in standardized fashion using intravenous thiopental (100-400 mg), atropine (0.2 mg), and succinylcholine (40-80 mg). Cyclopropane, along with deliberate hypercapnia and hypertension, was used for anesthesia maintenance. All patients tolerated carotid occlusion for periods of up to 30 min during general anesthesia without shunt, bypass, or hypothermia. Except for one patient, electroencephalogram evidence of cerebral ischemia was not apparent during occlusion, and no patient suffered postoperative neurologic sequela. Twenty percent of patients who had their carotid arteries occluded preoperatively for 30-60 s without general anesthesia suffered convulsions. These data suggest that general anesthesia increased the tolerance to cerebral ischemia. Potential mechanisms involved might include: 1) decreased cerebral metabolic rate for oxygen; 2) increased cerebral blood flow from hypercapnia; 3) increased arterial oxygen tension; and 4) recruitment of new routes of collateral circulation.

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Nasopharyngeal Airway Versus Laryngeal Mask Airway During Diagnostic Flexible Fiber-Optic Bronchoscope in Children

The Open Anesthesia Journal ◽

10.2174/2589645801812010001 ◽

2018 ◽

Vol 12 (1) ◽

pp. 1-7

Author(s):

Aktham Adel Shoukry ◽

Amr Gaber Sayed Sharaf

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Total Dose ◽

Recovery Time ◽

Arterial Oxygen Saturation ◽

Laryngeal Mask ◽

Fibreoptic Bronchoscopy ◽

Arterial Oxygen ◽

Significant Difference ◽

Nasopharyngeal Airway

Background: Pediatric fibreoptic diagnostic bronchoscope under general anesthesia using Supraglottic devices as Laryngeal Mask Airway (LMA) and nasopharyngeal airway (NPA) are one of the variable techniques used for patient’s ventilation during this procedure. Objective: We studied the effect of both devices on hypoxemia, the duration of the procedure, recovery time and the overall propofol consumption. Methods: Ninety patients of both sexes, aged 5-10 years, American society of Anesthesiology class I & II scheduled for diagnostic fibreoptic bronchoscope under general anesthesia were divided randomly into two equal groups; LMA group & NPA group, during the procedure: heart rate, non invasive blood pressure, peripheral arterial oxygen saturation (SpO2), arterial partial pressure of carbon dioxide(PaCO2), time of procedure, recovery time and total dose of propofol were measured and compared for each patient in both groups. Results: Hypoxemia & desaturation incidence was more in LMA group than NPA group with high significant difference (p-value 0.005). Also the duration of procedure, recovery time in PACU, and total dose of propofol consumed were significantly less in the NPA group (p< 0.001). With no difference in hemodynamic status and PaCO2. Conclusion: The use of NPA as supraglottic ventilating device for children undergoing diagnostic flexible fibreoptic bronchoscopy is considered a good alternative for shortening the bronchoscopy time with less incidence of hypoxemia and better recovery time compared to LMA.

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Comparison of Intra and Post-operative Sedation efficacy of Dexmedetomidine-Midazolam and Dexmedetomidine-Propofol for Major Abdominal Surgery

Current Drug Metabolism ◽

10.2174/1389200222666211103121832 ◽

2021 ◽

Vol 22 ◽

Author(s):

Yuanyuan Gao ◽

Fei Yan

Keyword(s):

Clinical Trial ◽

Abdominal Surgery ◽

Oxygen Saturation ◽

General Anesthesia ◽

Arterial Oxygen Saturation ◽

Carbon Dioxide Tension ◽

Major Abdominal Surgery ◽

Arterial Oxygen ◽

Anesthesia Induction ◽

Significant Difference

Background: The effectiveness and side effects of dexmedetomidine (DEX) in combination with midazolam and propofol have not been comparatively studied in a single clinical trial as sedative agents to general anesthesia before. Objective: The objective of this study is to compare intra and post-operative sedation between DEX-Midazolam and DEX-Propofol in patients who underwent major abdominal surgery on the duration of general anesthesia, hemodynamic and sedation effect. Method: This prospective, randomized, double-blinded clinical trial included 50 patients who were 20 to 60 years of age and admitted for major abdominal surgery. The patients were randomly assigned by a computer-generated random numbers table to sedation with DEX plus midazolam (DM group) (n=25) or DEX plus propofol (DP group) (n=25). In the DM group, patients received a bolus dose of 0.1 mg/kg of midazolam and immediately initiated the intravenous (i.v.) infusion of DEX 1 µg/kg over a 10 min and 0.5 µg/kg/hr by continuous i.v. infusion within operation period. In the DP group, patients received pre-anesthetic i.v. DEX 1 µg/kg over 15 min before anesthesia induction and 0.2-1 µg/kg/hr by continuous i.v. infusion during the operative period. After preoxygenation for at least 2 min, during the surgery, patients received propofol infusion dose of 250 μg/kg/min for 15 min then a basal infusion dose of 50 μg/kg/min. The bispectral index (BIS) value, as well as mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), percutaneous arterial oxygen saturation (SpO2) and end-tidal carbon dioxide tension (ETCO2) were recorded before anesthesia (T0), during anesthesia (at 15-min intervals throughout the surgical procedure), by a blinded observer. Evidence of apnea, hypotension, hypertension and hypoxemia were recorded during surgery. Results: The hemodynamic changes, including HR, MAP, BIS, VT, SaO2, and RR had a downward tendency with time, but no significant difference was observed between the groups (P>0.05). However, the two groups showed no significant differences in ETCO2 and SPO2 values in any of the assessed interval (P>0.05). In this study, the two groups showed no significant differences in the incidence of nausea, vomiting, coughing, apnea, hypotension, hypertension, bradycardia and hypoxemia (P>0.05). Respiratory depression and Conclusion: Our study showed no significant differences between the groups in hemodynamic and respiratory changes in each of the time intervals. There were also no significant differences between the two groups in the incidence of complication intra and post-operative. Further investigations are required to specify the optimum doses of using drugs which provide safety in cardiovascular and respiratory system without adverse disturbance during surgery.

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Can the Tomographic Aspect Characteristics of Patients Presenting with Acute Respiratory Distress Syndrome Predict Improvement in Oxygenation-related Response to the Prone Position?

Anesthesiology ◽

10.1097/00000542-200209000-00013 ◽

2002 ◽

Vol 97 (3) ◽

pp. 599-607 ◽

Cited By ~ 30

Author(s):

Laurent Papazian ◽

Marie-Héléne Paladini ◽

Fabienne Bregeon ◽

Xavier Thirion ◽

Olivier Durieux ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Prone Position ◽

Supine Position ◽

Distress Syndrome ◽

Arterial Oxygen ◽

Computed Tomographic ◽

Computed Tomographic Scan ◽

A Prospective Study

Background In some patients with acute respiratory distress syndrome, the prone position is able to improve oxygenation, whereas in others it is not. It could be hypothesized that the more opacities that are present in dependent regions of the lung when the patient is in the supine position, the better the improvement in oxygenation is observed when the patients are turned prone. Therefore, we conducted a prospective study to identify computed tomographic scan aspects that could accurately predict who will respond to the prone position. Methods We included 46 patients with acute respiratory distress syndrome (31 responders and 15 nonresponders). Computed tomographic scan was performed in the 6-h period preceding prone position. Blood gas analyses were performed before and at the end of the first 6-h period of prone position. Results Arterial oxygen partial pressure/fraction of inspired oxygen increased from 117 +/- 42 (mean +/- SD) in the supine position to 200 +/- 76 mmHg in the prone position (P < 0.001). There were 31 responders and 15 nonresponders. There was a vertebral predominance of the opacities (P < 0.0001). However, there was no difference between responders and nonresponders. When only the amount of consolidated lung located under the heart was evaluated, there was more consolidated tissue under the heart relative to total lung area in nonresponders than in responders (P = 0.01). Conclusions There are no distinctive morphologic features in the pattern of lung disease measured by computed tomographic scanning performed with the patient in the supine position that can predict response to the prone position.

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