Safety and efficacy of high-flow nasal oxygen for pre-oxygenation before anesthesia induction: a meta-analysis / 中华麻醉学杂志

Objective:To systematically review and evaluate the safety and efficacy of high-flow nasal oxygen (HFNO) for pre-oxygenation before anesthesia induction.Methods:Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and China Biomedical Literature Database were searched from inception to March 2022.All randomized controlled trials comparing HFNO and facemask ventilation for pre-oxygenation before anesthesia induction were collected.Two researchers independently assessed the quality of trials and extracted data.The primary outcome was the safe apnea time, the secondary outcomes were the lowest SpO 2 during intubation, oxygenation-related complications, patient comfort, PaO 2 and PaCO 2 before and after pre-oxygenation and after intubation.Meta-analysis was performed using RevMan 5.4 software. Results:Seventeen randomized controlled trials involving 843 patients were included in this meta-analysis.The results of meta-analysis showed that the safe apnea time was significantly longer ( MD=67.61, 95% CI 5.94-129.28, P=0.03), the lowest SpO 2 was higher during tracheal intubation ( MD=3.27, 95% CI 2.25-4.29, P<0.01), and PaO 2 was higher after pre-oxygenation ( MD=54.39, 95% CI 9.32-99.46, P=0.02) in the patients using HFNO than those using facemask ventilation.There were no statistically significant differences in the other outcomes ( P>0.05). Conclusions:HFNO for pre-oxygenation before anesthesia induction can significantly prolong the safe apnea time, increase the lowest SpO 2 during tracheal intubation, and improve the levels of PaO 2 after pre-oxygenation, and HFNO does not affect the patient′s comfort or increase the development of preoxygenation-related complications when compared with facemask ventilation.

Unanticipated Difficult Mask Ventilation: Cystic Swelling- The Culprit

Introduction: Difficulty in mask ventilation is quitechallenging to an anaesthesiologist because mask ventilation isthe primary technique of ventilation and the rescue techniqueif the tracheal intubation fails. Unanticipated difficulty in maskventilation is even more challenging to the anaesthesiologist.Case report: Here we report a case of unanticipated difficultmask ventilation due to cystic swelling on left side ofepiglottis.Conclusion: Prudent and cautious corrective measures takenat the right time, ensures patient safety

The effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement / 中华急诊医学杂志

Objective To investigate the effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement. Methods Based on the national database of emergency cardiac arrest treatment, patients treated with advanced airway placement during cardiopulmonary resuscitation (CPR) were enrolled in PUMCH Emergency Department from December 2013 to June 2018. The physiological parameters, such as electrocardiograph waveform, pulse oximetry plethysmographic waveform and capnography, were recorded at least 18 minutes. The demographic data and resuscitation parameters were collected. Waveform capnography was used for calculating ventilation rate (VR) and the VR between 8 to 12 breaths/min was defined as the qualified ventilation rate (QVR). According to the ventilation modes, patients were divided into the bag-mask group (BMG) and mechanical ventilation group (MVG). According to the VR, patients in the mechanical ventilation group were divided into two subgroups, the high-frequency ventilation subgroup (HFV subgroup) with the VR more than 20 breaths/min and the low-frequency VR subgroup (LFV subgroup) with the VR less than 20 breaths/min. VR, the qualified ventilation rate ratio (QVRR), the return of spontaneous circulation (ROSC), and 24-h and 7-day survival were compared between the two groups and subgroups. Result A total of 90 patients were enrolled in the analysis with 22 patients in the bag-mask group and 68 patients in the mechanical ventilation group. The total rate of ROSC was 35.6％, 24-h survival was 1.1％ and 7-day survival was 0. The first 18 minutes ventilation data were collected and added up to 1620 min. The median VR was 16.5 (12.0, 26.0) breaths/min and the QVRR was 30％. Compared with the mechanical ventilation group, the VR in the bag-mask group were lower (10 breaths/min vs 21 breaths/min) and the QVRR was higher (88.9％ vs 11.5％). The ROSC, 24-h survival and 7-day survival had no statistical differences between the two groups. In the mechanical ventilation group, the ratio of VR more than 20 breaths/min was 52.6％. Between the two subgroups, there was no statistical difference in ROSC, 24-h survival and 7-day survival. Conclusions Compared with the mechanical ventilation during CPR, the VR is lower with bag-mask ventilation, and the QVRR is higher. But there was no statistical difference on the outcomes. There was no difference on the outcomes between the two mechanical ventilation subgroups.

Bilateral mandibular nerve injury following mask ventilation: a case report / Lesão do nervo mandibular bilateral após ventilação com máscara: um relato de caso

Abstract Background and objectives Nerve injury following mask ventilation is a rare but serious anesthetic complication. The majority of reported cases are associated with excessive pressure applied to the face mask, long duration of mask ventilation, excessive digital pressure behind the mandible to relieve airway obstruction and pressure exerted by the plastic oropharyngeal airway. Case report We present a case of bilateral mandibular nerve injury following mask ventilation with short duration, most likely due to a semi-silicone facemask with an over-inflated cushion. Conclusion An over-inflated sealing cushion of a facemask may trigger difficult mask ventilation leading to mandibular nerve injury following mask ventilation. Alternative airway management techniques such as laryngeal mask airway should be considered when airway maintenance can only be achieved with strong pressure applied to the facemask and/or mandible.

Resumo Justificativa e objetivos A lesão nervosa após ventilação com máscara é uma complicação anestésica rara, mas grave. A maioria dos casos relatados está associada à pressão excessiva aplicada à máscara facial, ao tempo prolongado de ventilação, à pressão digital excessiva atrás da mandíbula para aliviar a obstrução das vias aéreas e à pressão exercida pela cânula orofaríngea. Relato de caso Apresentamos um caso de lesão do nervo mandibular bilateral após uma ventilação de curta duração via máscara, provavelmente devido ao uso de uma máscara facial (de semissilicone) com insuflação excessiva da almofada. Conclusão A insuflação excessiva da almofada de uma máscara facial pode desencadear uma ventilação com máscara difícil, levando à lesão do nervo mandibular após a ventilação. Técnicas alternativas de manejo das vias aéreas, como o uso de máscara laríngea, devem ser consideradas quando a manutenção das vias aéreas só pode ser obtida com forte pressão aplicada à máscara facial e/ou mandíbula.

Nondepolarizing muscle relaxant improves direct laryngoscopy view with no effect on face mask ventilation / Relaxantes musculares não despolarizantes melhoram a visibilidade em laringoscopia direta sem efeito sobre a ventilação via máscara facial

Abstract Background: Difficult or impossible face mask ventilation complicated with difficult tracheal intubation during anesthesia induction occurs in 0.4% of adult anesthesia cases, possibly leading to life-threatening complications. Because of such catastrophes, muscle relaxants have been recommended to be administered after confirming adequate face mask ventilation without a solid scientific validation of this principal. Methods: In this observational study, the ease of ventilation and the scores of direct laryngoscopy views before and after administration of cisatracurium were assessed in ninety young healthy adults, without anesthetic risks and without foreseen difficult intubation and who were scheduled for general elective surgeries. Results: Before muscle relaxation, 43 patients (48%) were Cormack Grade I, while the remaining 47 patients (52%) were either Cormack Grade II (28 patients, 31%) or Cormack Grade II (19 patients, 21%). Following muscle relaxation with cisatracurium, the number of patients with Cormack Grade I significantly increased from 43 patients (48%) to 65 patients (72%) (p = 0.0013). Only 1 patient out of 19 patients (5%) improved his Cormack grade from Grade III to Grade I while 16 out 19 patients (84%) improved their Cormack grade from Grade III to Grade II after the use of cisatracurium. The quality of face mask ventilation did not differ with and without muscle relaxants in all patients. Conclusion: The use of cisatracurium in healthy young adults undergoing general elective surgeries with no anticipated difficult endotracheal intubation had no effect on the quality of face mask ventilation despite resulting in a quantifiable improvement in the laryngeal view.

Resumo Justificativa: A ventilação difícil ou impossível via máscara facial complicada pela intubação traqueal difícil durante a indução da anestesia ocorre em 0,4% dos casos de anestesia em adultos, possivelmente leva a complicações fatais. Devido a tais catástrofes, recomendou-se que a administração de relaxantes musculares seja feita após a confirmação de ventilação adequada via máscara facial, sem uma validação científica sólida dessa conduta. Métodos: Neste estudo observacional, a facilidade de ventilação e os escores de visibilidade em laringoscopia direta antes e após a administração de cisatracúrio foram avaliados em 90 adultos jovens e saudáveis, sem riscos anestésicos e sem intubação difícil prevista, agendados para cirurgias eletivas gerais. Resultados: Antes do relaxamento muscular, 43 pacientes (48%) eram Cormack Grau I, enquanto os 47 (52%) restantes eram ou Cormack Grau II (28, 31%) ou Cormack Grade III (19, 21%). Após o relaxamento muscular com cisatracúrio, o número de pacientes com Cormack Grau I aumentou significativamente de 43 (48%) para 65 (72%) (p = 0,0013). Apenas um paciente (5%) dos 19 melhorou sua classificação de Cormack do Grau III para o Grau I, enquanto 16 dos 19 (84%) melhoraram suas classificações de Cormack do Grau III para o grau II após o uso de cisatracúrio. A qualidade da ventilação via máscara facial não diferiu com ou sem relaxantes musculares em todos os pacientes. Conclusão: O uso de cisatracúrio em adultos jovens saudáveis submetidos a cirurgias eletivas gerais sem intubação traqueal difícil prevista não teve efeito sobre a qualidade da ventilação via máscara facial, mesmo resultando em melhora quantificável da visibilidade da laringe.

Awake intubation in a patient with huge orocutaneous fistula: a case report

Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.

Caracterización clínica y epidemiológica de pacientes en ventilación manual asistida / Clinical and epidemiological characterization of patients in assisted manual ventilation

Antecedentes: No hay estudios publicados de pacientes ventilados manualmente, solo algunos reportes de caso. Metodología: Se realizó un estudio descriptivo retrospectivo de diecinueve casos de pacientes con intubación endotraqueal y ventilados manualmente con el objetivo de determinar sus características clínicas, de febrero a mayo 2015 en el Hospital Roosevelt. Resultados: Trece de 19 (63%) eran mujeres, con rango de edad entre 19 y 78 años (promedio 49 años). Se ventilaron 12/19 (63%) en la emergencia, 6/19 (32%) en encamamiento. El motivo de consulta más frecuente fue insuficiencia respiratoria con 7 casos. Las enfermedades de base más frecuentes fueron hipertensión arterial y diabetes mellitus con 8 y 5 casos respectivamente. El 19% de los pacientes que fueron extubados volvieron a ser intubado. Diez de 19 (53%) falleció, 6/19 (32%) egresaron vivos, 2/19 (10%) continuaron hospitalizados y 1/19 (5%) tubo egreso contraindicado. Una escala de Glasgow menor a 8 puntos fue un factor de riesgo para morir (P 0.0063, OR27). Conclusiones: La mortalidad asociada a ventilación manual fue de 58%. Un Glasgow menos a 8 puntos representa 26 veces mayor riesgo a morir...(AU)

Background: There are no published studies of patients ventilated manually, only a few case reports. Methodology: A retrospective study of nineteen cases of patients with endotracheal intubation was performed manually ventilated in order to determine their clinical characteristics, from February to May 2015 in the Roosevelt Hospital. Results: Thirteen of 19 (63%) were females, with ages ranging from 19 to 78 years (mean 49 years), 12/19 (63%) were ventilated in emergency, 6/19 (32%) in bedridden. The most frequent reason for consultation was respiratory failure in 7 cases. Diseases were more frequent basis hypertension and diabetes mellitus with 8 and 5 cases respectively. 19% of patients were extubated again be intubated. Ten of 19 (53%) died, 6/19 (32%) discharged alive, 2/19 (10%) remained hospitalized and 1/19 (5%) contraindicated discharge tube. A smaller scale Glasgow 8 points was a risk factor for death (P 0.0063, OR 27). Conclusions: The mortality associated with manual ventilation was 58%. A Glasgow least 8 points represents 26 times more likely to die...(AU)

Acute unilateral anesthesia mumps after hysteroscopic surgery under general anesthesia: a case report / 대한마취과학회지

Acute unilateral parotid gland swelling after general anesthesia, anesthesia mumps is rare and when occurred, it is associated with the patient's position and with long-lasting surgery. The exact mechanism or etiology has not been fully established but stasis of gland secretion, blockage of Stensen's duct by direct compression, or retrograde flow of air by increased the oral cavity pressure are suspicious reasons. We experienced a case of soft tissue swelling in the left preauricular and submandibular regions in a 40-year-old female patient after short-lasting, hysteroscopic myomectomy performed in the lithotomy position with no suspicious predisposing factor. It is required to pay attention on the fact that even with the usual face mask ventilation can lead to the development of anesthesia mumps.

Study of a Modified Two-person Cardiopulmonary Resuscitation Method to Provide Effective Ventilation: Analysis Based on a Rescuer's Training Proficiency

PURPOSE: The purpose of this study is to compare the modified two-person cardiopulmonary resuscitation method (MM) (the first resuscitator performs chest compressions and squeezes the bag of bag-valve-mask (BVM) during pauses of compression, and the second resuscitator uses two hands to provide an open airway) using the conventional two-person cardiopulmonary resuscitation method (CM). METHODS: This simulation study used a manikin and a cross-over execution design and included 102 participants. After practice of CM and MM, participants were randomly assigned a partner. Each pair of participants performed the 2-CPR for five cycles using both methods alternately at random. All data were recorded in a personal computer and analyzed. RESULTS: Data from 510 cycles each of the CM and MM were analyzed. The MM generated a higher mean tidal volume (TV) (791.2 ml versus 563.8 ml, P<0.001) and more frequent visible chest ventilation (92.1% versus 64.7%, P<0.001). For the inexpert resuscitator group (50; 49%), the MM generated more frequent visible chest ventilation (88.6% versus 34.0%, P<0.001) and ventilation with an adequate TV (43.6% versus 32.0%, P<0.001). No significant difference in compression rate, depth, hand position, and release, and minimal difference of hands off time (0.5s) were observed between the two methods. CONCLUSION: The CM could not easily provide sufficient visible chest rise and might be a poor ventilation option for inexpert BVM resuscitators. The MM can be useful as an alternative method and preferable to the CM for inexpert BVM resuscitators.

Comparative study of bag-valne-mask ventilation and endotracheal intubation in the first aid / 中国基层医药

Objective To compare the effect of bag-valne-mask ventilation(BVM)and endotracheal intubation in the first aid.Methods 50 cases of sudden cardiac arrest(SCA)patients who received first aid were selected and divided into two groups by the breathing methods.The average time of intubations oxygen saturation and the restoration of spontaneous circulation(ROSC)were recorded.Results The rate of ROSC in two groups was not statistically significant.But the BVM group's breathing building time was much faster than the other group.Conclusion There was no difference of successful rate between two cardiopulmonary resuscitation methods in first aid of cardiac arrest.

Closed Reduction of Nasal Bone Fracture Under the Mask Ventilation Anesthesia Using Oral Airway

PURPOSE: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. METHODS: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. RESULTS: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. CONCLUSION: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.