Analysis of modern anesthetic approaches in endoscopic phthisiosurgery

Objective — to analyze modern anesthetic approaches and their use in endoscopic phthisiosurgery. Materials and methods. During 2008—2021, we performed 133 VATS lung resections in patients with tuberculosis. The following VATS operations were performed: atypical segmentectomy — 29 (21.6 %), typical segmentectomy — 49 (36.9 %), lobectomy — 49 (36.9 %) cases, bilobectomy — 2 (1.5 %), pulmonectomy — 4 (3.1 %) observations.The number of patients diagnosed with newly diagnosed tuberculosis was 62 (46.3 %), with multidrug­resistant tuberculosis 45 (34.4 %) and extensively drug-resistant tuberculosis 26 (19 3 %). One-pulmonary ventilation, which was carried out by endobronchial intubation of the main bronchus of the contralateral lung using a double-lumen tube (DLT) in 115 (86.4 %) patients, in 15 (11.3 %) cases, endobronchial intubation was performed with a single-lumen tube (SLT) and in 3 (3.1 %) tracheal intubation. Results and discussion. The use of a DLT for intubation made it possible to reduce the duration of surgery by 20—25 % compared with the use of a SLT or tracheal intubation. When using a DLT, a more stable, faster and better collapse of the lungs was achieved, which in turn gave a decrease in trauma to its parenchyma due to the fact that additional instrumental actions were not required on the part of surgeons to achieve it.Intraoperative blood loss with DLT was (75.4 ± 38.7) and (112.6 ± 51.8) ml with SLT in experiments with intubation of the main bronchus of the contralateral lung and (184.3 ± 89.8) ml in tracheal intubation, largely due to visualization and comfort working conditions of the surgical team.In the recovery of costs, we adhere to restrictive infusion approaches, which allows avoiding overloading the pulmonary circulation, and therefore reducing the number of pulmonary complications. The qualitative composition of the intraoperative infusion program included crystalloid and colloidal solutions. The quantitative ratio during the intubation of DLT was 3 : 0.5, with SLT 3 : 1. The need for transfusion of blood components was only during tracheal intubation. Conclusions. The most important task of modern anesthesiology in endoscopic phthisiosurgery is to improve patient safety during surgery. The defining technologies of anesthetic protection in this case should be the following categories: means and methods of general anesthesia, methods of respiratory provision and technical means of their application; full intraoperative monitoring of vital functions.

Prospective observational study of the endotracheal intubation complications in Emergency Department

Endotracheal intubation is the gold standard intervention for emergency airway management. Complications related to endotracheal intubation are numerous and frequent. Complications were identified as being related to endotracheal intubation in our study: hypoxia, hypotension, dysrhythmia, cardiac arrest, hypertension, tachycardia, bradycardia, regurgitation and aspiration of stomach contents, endobronchial intubation, and incorrect positioning of the endotracheal tube in either the esophagus or hypopharynx. The study included 186 patients that were over 18 and intubated. The complication rate associated with endotracheal intubation was found to be over 50%. Patients included in our prospective, observational study were all initially evaluated in our ED. A survey was filled out at a time as soon as possible after intubation to record the personnel in charge of intubation, details of the procedure, and hemodynamic changes and complications. Our study found that the following factors were associated with increased rates of complication in intubated patients: history of acute renal failure, history of cancer, GCS < 8, midazolam use during intubation, history of trauma, crash intubation, history of shock, history of cardiac arrest, resident with <1 year of experience carrying out the intubation, residents with 2+ years of experience and specialists carrying out the intubation, history of respiratory failure, and patient age <65. To better understand which patients were likely to be affected by complications associated with intubation, as well as to understand which precautions to take, this study aims to investigate the aggravating factors and complication rates of endotracheal intubation.

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

BackgroundEmergency tracheal intubation during major trauma resuscitation may be associated with unrecognised endobronchial intubation. The risk factors and outcomes associated with this issue have not previously been fully defined.MethodsWe retrospectively analysed adult patients admitted directly from the scene to the ED of a single level 1 trauma centre, who received either prehospital or ED tracheal intubation prior to initial whole-body CT from January 2008 to December 2019. Our objectives were to describe tube-to-carina distances (TCDs) via CT and to assess the risk factors and outcomes (mortality, length of intensive care unit stay and mechanical ventilation) of patients with endobronchial intubation (TCD <0 cm) using a multivariable model.ResultsWe included 616 patients and discovered 26 (4.2%) cases of endobronchial intubation identified on CT. Factors associated with an increased risk of endobronchial intubations were short body height (OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94; p≤0.001), a high body mass index (OR 1.14; 95% CI 1.04 to 1.25; p=0.005) and ED intubation (OR 3.62; 95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases underwent tube thoracostomy, four of whom had no evidence of underlying chest injury on CT. There was no statistically significant difference in mortality or length of stay although the absolute number of endobronchial intubations was small.ConclusionsShort body height and high body mass index were associated with endobronchial intubation. Before considering tube thoracostomy in intubated major trauma patients suspected of pneumothorax, the possibility of unrecognised endobronchial intubation should be considered.

Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula

Introduction: Intubation mistakes, such as ETT malposition, will result in serious complications. Endobronchial intubation can cause pneumothorax and contralateral lung collapse (atelectasis). On the contrary, superficial ETT could increase the risk of being released easily, leading to desaturation or even cardiac arrest. A shallow ETT position could cause the compression of the vocal cord and laryngeal nerve by ETT's cuff. An optimal position can be reached if the cuff position is 1.5-2.5 cm under the vocal cord and the tip is 3-5 cm above the carina. Several methods of ETT depth measurement based on airway length data can be an alternative, especially during the COVID-19 era, where the use of a stethoscope to check ETT depth is limited. Objectives: To analyze the accuracy of ETT depth placement using Chula and MSJ formula. Methods and Material: We conducted the prospective comparative analytic research on 50 patients who had elective surgery in GBPT operating room at Dr. Soetomo Hospital Surabaya. The research data during the intubation and FOL (Fyber Optic Laryngoscope) from each patient were height, MSJ length, initial ETT length, the distance of carina-ETT tip, the distance of cuff-vocal cord, and final ETT length. Result and Discussion: In the Chula formula group, the average patients' height was 160.60cm ± 9.738 for men and 157.76 cm ± 8.604 for women. The average MSJ length was 20.28 cm. The application of the Chula formula is more accurate because ETT revision was carried out in only 8.0% of the samples, with an average revision is 0.04. On the other hand, the ETT revision with an average of 0.868 on the MSJ formula group was conducted in 84% of the samples. This research also found a linear correlation between increasing ETT depth and body height. Conclusion: Applying the Chula formula to measure the ETT depth for Indonesian (Javanese) people is more appropriate than the MSJ formula.

Management of Bronchial Hydatid Cyst with Endobronchial Intubation along with Patient Positioning and Bougie: A New Approach

The article's abstract is no available.

The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study of Endobronchial Intubation: An Analysis of 2,000 Incident Reports

Background: The Royal College of Anesthesiologists of Thailand hosted a multicentered project, namely the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study. Objective: The aims of the present study were to investigate incidences, contributing factors and suggested preventive strategies of anesthesia-related complications particularly the endobronchial intubation (EBI). Materials and Methods: The PAAd Thai study was a collaborative incident report among 22 hospitals across Thailand. After approval by the Institutional Ethical Committee, the structured incident report together with open ended data record form of anesthesia-related complications such as cardiac arrest, death within 24 hours, and respiratory complications including EBI were requested to be sent to the data management center together with monthly statistics of anesthesia service in each hospital for 12 months (between January 2015 and December 2015) on an anonymous and voluntary basis. The EBI reports were reviewed by three anesthesiologists. Any discretion was discussed to achieve a consensus. Descriptive statistics were used. Results: Among the first 2,000 incident reports, there were 23 EBIs, at the rate of 1.06:10,000 (95% CI 0.62 to 1.49) or 1.15% of all reports. Two-thirds of the incidents occurred in patients with age less than 5 years old and more than 60 years old, and in elective cases. The common sites of surgery were trunk, head and neck, and laparoscopic procedures. EBIs were diagnosed by pulse oximeter (13 cases, 54.0%), increased airway pressure (four cases, 17.2%) and clinical monitoring (four cases 17.2%). Common phases of detection were pre-induction (one case, 4.3%), induction (nine cases, 39.2%), maintenance (12 cases, 52.2%), and emergence (one case, 4.3%). Contributing factors were lack of knowledge, inexperience, and haste, while factors minimizing the incidents were having experience and vigilance. Suggested preventive strategies were additional training, including simulation, practice guidelines, improvement of supervision, and communication. Conclusion: The authors have found that EBI was uncommon, but it is one of the serious anesthesia-related adverse events. It can happen anytime during the entire course of anesthesia. Under these circumstances, careful monitoring and vigilance of the anesthesiologists is essential. Keywords: Anesthesia, Complication, Endobronchial intubation, Intubation, Hypoxia

Airway

This chapter covers the guidelines for airway emergencies in anaesthesia. Strategies, checklists, and flowcharts are presented for the management of unexpected difficult mask ventilation and difficult intubation, e.g. ‘Cannot intubate, cannot oxygenate’ (CICO) and front of neck airway (FONA), partial airway obstruction, rapid sequence induction, laryngospasm, endobronchial intubation, oesophageal intubation, aspiration, airway fire, and difficult tracheal extubation. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations (e.g. paediatric implications) for each airway-related situation are covered. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.