ABSTRACT
La neumonía COVID-19, puede condicir a insuficiencia respiratoria aguda, en pacientes críticos se requiera de la intubación orotraqueal con la finalidad de aislar la vía aérea y permitir la protección y el con¬trol o asistencia de la ventilación, siendo la secuencia rápida una alternativa para garantizar el éxito terapéutico y seguridad del personal. Bajo estudio prospectivo de cohorte, desde junio a diciembre de 2020, en pacientes con diagnóstico confirmado de SARS-CoV2, ingresados en la Unidad de Cuidados Intensivos, se incluyeron 72, 45 fueron masculino (62,50%) y 27 femeninos (37,50%), con un rango de edad entre 27 a 64 años, siendo el grupo mas vulnerable de 55 a 64 años con un 59,72% (43/72). La maniobra fue excelente en 47 ocasiones (65,28+12,28%), buena en 25 (31,94+6,04%) y en dos oportuniddes imposible, la secuencia de Fentanilo-propofol succinilcolina para la inducción rápida se ejecuto en el 50,00%, con efectividad de 100,00%; sin embargo, no hubo diferencia con las otras secuencias. Antes de proceder a la inducción farmacológica de la inconsciencia y del bloqueo neuromuscular, es necesario evaluar minuciosamente ciertos aspectos de la historia clínica y del examen físico del paciente(AU)
COVID-19 pneumonia can lead to acute respiratory failure, in critical patients orotracheal intubation is required in order to isolate the airway and allow protection and control or assistance of ventilation, the rapid sequence being an alternative to guarantee therapeutic success and staff safety. Under a prospective cohort study, from June to December 2020, in patients with a confirmed diagnosis of SARS-CoV2, admitted to the Intensive Care Unit, 72 were included, 45 were male (62.50%) and 27 were female (37, 50%), with an age range between 27 to 64 years, the most vulnerable group being 55 to 64 years with 59.72% (43/72). The maneuver was excellent on 47 occasions (65.28 + 12.28%), good on 25 (31.94 + 6.04%) and on two occasions impossible, the Fentanyl-propofol succinylcholine sequence for rapid induction was performed in 50.00%, with effectiveness of 100.00%; however, there was no difference with the other sequences. Before proceeding with the pharmacological induction of unconsciousness and neuromuscular blockade, it is necessary to carefully evaluate certain aspects of the patient's medical history and physical examination(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , COVID-19/complications , LidocaineABSTRACT
RESUMEN La COVID-19 es una afección que puede evolucionar hacia la gravedad y el paciente presentar insuficiencia respiratoria aguda, síndrome de distréss respiratorio agudo secundario a proceso neumónico desencadenado por esta afección, en el curso de la cual se puede requerir un procedimiento anestésico-quirúrgico y, como consecuencia de las condiciones anteriormente descritas, una intubación de secuencia rápida. Este trabajo está dirigido a ofrecer un grupo de consideraciones válidas en el nuevo contexto, relacionado con la aparición de la COVID-19, realizando precisiones en el manejo de la vía aérea en estos pacientes. Se detallan los pasos a seguir para la realización de la intubación de secuencia rápida, considerando los fármacos a utilizar y las medidas de bioseguridad a tener presentes, además se exponen las recomendaciones para el manejo posterior al procedimiento anestésico-quirúrgico en pacientes con COVID-19.
ABSTRACT COVID-19 is a condition that may evolve towards severity and the patient may presents acute respiratory failure, acute respiratory distress syndrome secondary to the pneumonic process triggered by this condition, in the course of which an anesthetic-surgical procedure may be required, and , as a consequence of the conditions described above, a rapid sequence intubation.This work is aimed at offering a group of valid considerations in the new context, related to the appearance of COVID-19, providing details on the management of these patients´ airway. The steps to follow for performing rapid sequence intubation are detailed, considering the drugs to be used and the biosecurity measures to be taken into account, as well as the recommendations for subsequent management of the anesthetic-surgical procedure in patients with COVID-19.
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BACKGROUND@# We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction (RSI) among trauma patients.@*METHODS@# A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating specialties.@*RESULTS@#A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol (74.5%) and Etomidate (50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients (P=0.001). Emergency physicians preferred Etomidate (63.6%) and Ketamine (20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium (55.6% vs. 27.7%, P=0.01) in stable as well as unstable (43.4 % vs. 27.7%, P=0.08) patients.@*CONCLUSION@# There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.
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Postpartum hemorrhagic complication is a critical situation for an anesthesiologist. This situation requires timely and skilful anesthetic management. A massive postpartum bleeding leading to severe hypovolemic shock may result in life-threatening cardiopulmonary arrest. The treatment of postpartum hemorrhage (PPH) has two components: First, resuscitation and control of bleeding and second, identification and management of underlying cause. Here is a case report of a 20-year-old with atonic PPH resulting in hypovolemic shock and impending cardiac arrest and successful anesthetic management for emergency peripartum hysterectomy to save the life of the patient.
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Objective To investigate the effects of dexmedetomidine on hemodynamics and tra-cheal intubation facility in general anesthetized patients.Methods Forty gynecological patients of se-lective operation under general anesthesia were randomly arranged into 2 groups:group D and group C.With high flow mask oxygen inhalation(5 L/min),dexmedetomidine was intravenously pumped in-to the patients in group D at 0.6μg/kg in 10 minutes while in group C saline were given instead.Both groups were then proceeded with rapid sequence induction (RSI)immediately.The values of MAP, HR,PaO2 and PaCO2 were recorded every minute from pumping start till 15 minutes,the bucking, intubation time and glottis exposure were evaluated as well.Results No significant differences were found in intubation time or glottis exposure between these two groups.After tracheal intubation group D showed higher MAP value than group C at 14,15 minutes,and a lower HR value (P <0.05).Even no significant differences were found in values of SpO2 and PaO2 ,the group D showed less bucking than the group C (P<0.05).Conclusion Dexmedetomidine administration at 0.6μg/kg in RSI can diminish the variation in hemodynamics and facilitate the tracheal intubation by less buc-king,but no affect the oxygen reserve.
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@#BACKGROUND: Rapid sequence induction and intubation (RSII) is an emergency airway management technique for patients with a risk of pulmonary aspiration. It involves preoxygenation, administration of predetermined doses of induction and paralytic drugs, avoidance of mask ventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied till endotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessed the incidence of oxygen desaturation during RSII. METHODS: An institution-based observational study was conducted from March 3 to May 4, 2014 in our hospital. All patients who were operated upon under general anesthesia with RSII during the study period were included. A checklist was prepared for data collection. RESULTS: A total of 153 patients were included in this study with a response rate of 91.6%. Appropriate drugs for RSII, equipments for RSII, equipments for difficult intubation, suction machine with a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41 (26.8%), 50 (32.7%), 51 (33.3%), 38 (24.8%) and 25 (16.3%) patients respectively. Cricoid pressure was not applied at all for 17 (11.1%) patients and 53 (34.6%) patients were ventilated after induction of anesthesia but before intubation and endotracheal cuff inflation. A total of 55 (35.9%) patients desaturated during RSII (SPO2<95%). The minimum, maximum and mean oxygen desaturations were 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of <50%, 50%–64%, 65%–74%, 75%–84%, 85%–89 % and 90%–94% for 6 (3.9%), 7 (4.6%), 5 (3.3%), 10 (6.5%), 13 (8.5%) and 14 (9.2%) patients respectively. CONCLUSION: The incidence of oxygen desaturation during RSII was high in our hospital. Preoperative patient optimization and training about the techniques of RSII should be emphasized.
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A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.
Subject(s)
Adult , Anesthesia/methods , Cardiac Tamponade/complications , Chest Pain/epidemiology , Chest Pain/etiology , Gastrointestinal Contents , Humans , Ketamine/therapeutic use , Male , Midazolam/therapeutic use , Sternotomy/methods , Succinylcholine/therapeutic use , Ventricular Septal Rupture/complicationsABSTRACT
BACKGROUND: We have investigated the possibility of rocuronium 0.6 mg/kg and timing principle application with the same dose for rapid sequence induction (RSI) in 65 children, aged 4-8 yr. METHODS: Sixty five patients were randomly assigned to one of two groups; Group A (n = 31, timing principle application) received rocuronium (0.6 mg/kg) followed by administration of propofol (2.5 mg/kg), and group B (n = 36) received rocuronium (0.6 mg/kg) after administration of propofol. Intubation was assessed at 60 seconds just after administration of last injectants. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. RESULTS: Excellent intubation conditions were obtained in 87% in group A and 61% in group B. However, clinically acceptable intubation conditions which means excellent and good did not show any significant difference as 100% (group A) and 99% (group B). CONCLUSIONS: In cases of pediatiric patients undergoing elective surgery, RSI was possible irrespective of the use of timing principle.
Subject(s)
Aged , Child , Humans , Androstanols , Intubation , Propofol , Relaxation , Vocal CordsABSTRACT
BACKGROUND: We investigated whether the intubating condition change acoording to the methods of administration of propofol and rocuronium. METHODS: Ninety adult patients (ASA physical status I or II) undergoing elective surgery were randomly assigned to one of three groups; Group I (n = 30) received rocuronium (0.6 mg/kg) after administration of propofol (2 mg/kg), Group II (n = 30) received propofol and rocuronium simultaneously via different intravenous routes, and Group III (n = 30) received a mixture of propofol and rocuronium via same intravenous route. Intubation was attempted at 60 seconds after administration of rocuronium. Hemodynamic parameters (mean blood pressure, heart rate) were measured before and after propofol administration with 20 seconds interval. Intubating conditions (jaw relaxation, vocal cord movement, and response to tracheal intubation) were evaluated as excellent, good, fair and poor. Train of four counts were recorded at 60 seconds after administration of rocuronium. RESULTS: Excellent intubating conditions were obtained in 13% in group I, 60% in group II, 77% in group III. Mean train of four counts were 3.7 in group I, 3.4 in group II, and 3.5 in group III. Mean blood pressures were decreased gradually after propofol administration in all groups. However, heart rates were not changed in all groups. CONCLUSIONS: At induction of anesthesia, simultaneous or mixed administration of propofol and rocuronium provides excellent or good intubating conditions 60 seconds after rocuronium administration. It could be an effective alternative to succinylcholine for rapid sequence induction of anesthesia.
Subject(s)
Adult , Humans , Androstanols , Anesthesia , Blood Pressure , Heart , Heart Rate , Hemodynamics , Intubation , Propofol , Relaxation , Succinylcholine , Vocal CordsABSTRACT
BACKGROUND: This study evaluated the effects of remifentanil on hemodynamic changes in endotracheal intubation during rapid sequence induction using thiopental or propofol and succinylcholine. METHODS: One hundred and twenty patients were divided into 4 groups (30 patients in each group).Anesthesia was induced with propofol 2 mg/kg or thiopental 5 mg/kg and succinylcholine 1 mg/kg followed by remifetanil 0.5microgram/kg (group PR), remifentanil 1microgram/kg (group TR) or normal saline as control (group PC, group TC).An endotracheal intubation was performed 90 s later, and vecuronium 0.08 mg/kg was given for neuromuscular block.Anesthesia was maintained using 1-3 vol% enflurane with 2 L/min N2O and 2 L/min O2.Arterial blood pressure (ABP) and heart rate (HR) were recorded before induction, just before intubation, and at 1 min intervals for 5 min after intubation.The incidence of hypertension, hypotension, tachycardia, and bradycardia were recorded. RESULTS: ABP in group PR was lower than in group TR, but HR was not different.The incidence of hypotension in group PR was higher than group TR or group PC.ABP in groups using remifentanil was lower than in control groups.The incidence of hypertension and tachycardia in groups using remifentanil were lower than control groups. CONCLUSIONS: During administration of propofol or thiopental and succinylcholine, remifentanil as a bolus for rapid sequence induction attenuated cardiovascular responses to endotracheal intubation effectively, but with a higher incidence of hypotension following propofol.
Subject(s)
Humans , Blood Pressure , Bradycardia , Enflurane , Heart Rate , Hemodynamics , Hypertension , Hypotension , Incidence , Intubation , Intubation, Intratracheal , Piperidines , Propofol , Succinylcholine , Tachycardia , Thiopental , Vecuronium BromideABSTRACT
The circulatory stimulation accompanying laryngoscopy and tracheal intubation and its attendant potential hazards are well recognized. This study was perfomed to compare cardiovascular effects of rapid sequence induction with slow induction during induction of anesthesia and following tracheal intubation with laryngoscope. Eighty six adult patients ASA class I or II, ages 20-55, with no previous history of hypertension and pulmonary diseases that undergoing elective surgery requiring intubation, were admitted to the study. These patients were randomly divided into four groups. Group 1. Rapid sequence induction (n=20) Group 2. Slow induction for 7min. (n=20) Group 3. Slow induction for 10min. (n=21) Group 4. Slow induction for 15min. (n=25) Anesthesia was induced with lidocaine 1.5mg/kg and thiopental sodium 5mg/kg i.v. in a rapid sequence induction in group 1. Tracheal intubation with laryngoscope was facilitated with succinylcholine chloride 1mg/kg iv. Thereafter 50% nitrous oxide in oxygen, 2.0 vol% enflurane, and vecuronium bromide 0.1mg/kg was administered. Group 2, 3, 4 patients received thiopental sodium 5mg/kg iv, vecuronium bromide 0.1mg/kg iv, 2.0 vol% enflurane and 5096 nitrous oxide in oxygen with mask ventilation for 7 min, 10 min and 15 min before intubation with laryngoscope, respectively. After tracheal intubation inhalation of the anesthetic gases were administered. Blood pressure and heart rate measurements and electrocardiography were obtained throughout the study period. Slow induction (Group 2, 3, 4) significantly blunted the increase in heart rate and blood pressure caused by laryngoscopy and endotracheal intubation than rapid sequence induction (group 1). Less unwanted effects were observed in group 2 and 3. Therefore, the author suggests that 7-10 minute of slow induction with volatile anesthetics following thiopental sodium injection is more effective in attenuating cardiovascular responses to tracheal intubation and laryngoscopy.