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Objective:To explore the effect of spontaneous breathing during induction of general anesthesia on atelectasis in patients undergoing laparoscopic resection of gastrointestinal tumors.Methods:A total of 60 patients aged 18-60 years scheduled for laparoscopic resection of gastrointestinal tumors under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to August 2022 were selected. The body mass index was 18.5-28.0 kg/m 2 and the American Society of Anesthesiology grade wasⅠ-Ⅱ. All patients were divided into the spontaneous breathing group (group S, 30 cases) and the controlled breathing group (group C, 30 cases) according to the random number table method. Patients in group S received 0.2-0.3 mg/kg etomidate (pumping at the speed of 200 ml/h) and 2 μg/kg remifentanil (slowly injected more than 30 s) for anesthesia induction; patients in group C received 0.2-0.3 mg/kg etomidate and 2 μg/kg remifentanil (slowly injected more than 30 s) and 0.2 mg/kg cisatracurium. After bispectral index (BIS) decreased to 80, the patients had no response to the language stimulation; and then the mask was used to closely fit the face and maintain spontaneous breathing in group S; patients in group C received manual positive pressure ventilation. Atelectasis scores were collected immediately after endotracheal intubation (T 1) and 15 min after transferring to the recovery room (T 3), and oxygenation index (OI) was collected 5 min after endotracheal intubation (T 2) and at T 3. The postoperative pulmonary complication (PPC) on the 3rd day after the operation was recorded. Results:A total of 56 patients were finally enrolled, 27 cases in group S and 29 cases in groups C. Compared with group C, the atelectasis score of group S at T 1 and T 3 decreased [T 1: (2.4±0.8) scores vs. (4.2±0.7) scores, t = -9.12, P < 0.001; T 3: (8.2±1.8) scores vs. (10.5±1.6) scores, t = -4.96, P < 0.001]. The OI increased at T 2 and T 3 in group S [T 2: (334±11) mmHg (1 mmHg = 0.133 kPa) vs. (323±13) mmHg, t = 3.45, P = 0.001; T 3: (362±23) mmHg vs. (347±25) mmHg, t = 2.31, P = 0.025]. The incidence of PPC was 20.7% (6/29) and 18.5% (5/27), respectively in group C and group S on the 3rd day after the operation, and the difference was statistically significant ( χ2 = 0.04, P = 0.838). Conclusions:Maintaining spontaneous breathing during induction of general anesthesia can reduce atelectasis caused by general anesthesia and improve oxygenation for patients undergoing laparoscopic resection of gastrointestinal tumors.
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Abstract Introduction: Currently, transesophageal echodopplercardiography is frequently performed under sedation on an outpatient basis. Sedation is related with increase in incidents on airways. Bearing in mind this scenario, we developed a new double lumen oropharyngeal cannula aimed at keeping airway patency, in addition to reducing risks to patients during endoscopy procedures performed under sedation. The main objective of our study was to assess the incidence of oxygen desaturation in a series of cases of adult patients submitted to outpatient transesophageal echo exam, under sedation and using the oropharyngeal cannula. Method: 30 patients under sedation with intravenous midazolam and propofol were assessed. After loss of consciousness, the cannula was placed and patients were maintained on spontaneous breathing. Oxygen saturation, capnometry, heart rate and non-invasive arterial blood pressure, in addition to subjective data: airway patency, handling of cannula insertion and, comfort of examiner were analyzed. Results: The incidence of mild desaturation was 23.3%, and there was no severe desaturation in any of the cases. The insertion of the oropharyngeal cannula was considered easy for 29 patients (96.6%), and transesophageal echo probe handling was appropriate in 93.33% of exams performed. Conclusions: Transesophageal echo exams under sedation aided by the double-lumen oropharyngeal cannula presented a low incidence of desaturation in patients assessed, and allowed analysis of expired CO2 during the exams.
Resumo Introdução: Nos dias atuais, exames de ecocardiografia transesofágica (ETE) são realizados de forma frequente sob sedação em regime ambulatorial. A sedação está relacionada com aumento de intercorrências nas vias aéreas. Dentro desse contexto, desenvolvemos uma cânula orofaríngea de duplo-lúmen com finalidade de manutenção da via aérea pérvia, reduzindo riscos aos pacientes durante procedimentos endoscópicos sob sedação. O principal objetivo do nosso estudo foi avaliar a incidência de dessaturação em uma série de casos de pacientes adultos submetidos a ETE ambulatorial sob sedação com o uso da cânula orofaríngea. Métodos: Foram avaliados 30 pacientes sedados com midazolam e propofol intravenoso. A cânula foi inserida após perda da consciência e os pacientes foram mantidos com ventilação espontânea. Analisados saturação de oxigênio, capnometria, frequência cardíaca e pressão arterial não invasiva, além de dados subjetivos: patência das vias aéreas, manuseio e inserção da cânula e conforto ao examinador. Resultados: A incidência de dessaturação leve foi de 23.3% e não houve dessaturação grave em nenhum caso. A inserção da cânula orotraqueal foi considerada fácil em 29 pacientes (96,6%) e o manuseio da sonda de ETE foi adequada em 93,33% dos exames realizados. Conclusões: A realização dos exames de ETE sob sedação com auxílio da cânula orofaríngea de duplo lúmen apresentou baixa incidência de dessaturação nos pacientes avaliados, além de permitir análise do CO2 expirado durante a realização dos exames.
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Echocardiography , Cannula , Anesthesia and Analgesia , Conscious SedationABSTRACT
INTRODUCTION@#Children with an anterior mediastinal mass (AMM) need general anaesthesia (GA) or deep sedation for diagnostic procedures more often than adult patients. Anaesthetic management to prevent such complications includes maintenance of spontaneous ventilation (SV) and prebiopsy corticosteroids/radiotherapy.@*METHODS@#We reviewed the medical records of children with AMM who were brought to the operating theatre for diagnostic procedures (prior to chemotherapy) between 2001 and 2013. Our aim was to describe the clinical features, radiological findings and anaesthetic management, as well as determine any association with complications.@*RESULTS@#25 patients (age range 10 months-14 years) were identified during the study period. Corticosteroid therapy was started before the biopsy for one patient. All 25 patients had GA/sedation. A senior paediatric anaesthesiologist was involved in all procedures. Among 13 high-risk patients, SV was maintained in 11 (84.6%) patients, ketamine was used as the main anaesthetic in 8 (61.5%) patients, 6 (46.2%) patients were in a sitting position and no airway adjunct was used for 7 (53.8%) patients. There were 3 (12.0%) minor complications.@*CONCLUSION@#Based on our results, we propose a simplified workflow, wherein airway compression of any degree is considered high risk. For patients with high-risk features, multidisciplinary input should be sought to decide whether the child would be fit for a procedure under GA/sedation or considered unfit for any procedure. Recommendations include the use of less invasive methods, involving experienced anaesthesiologists to plan the anaesthetic technique and maintaining SV.
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@#Objective To compare the feasibility and safety of video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation. Methods A total of 80 patients undergoing VATS (48 wedge resections, 8 sympathectomies, 24 pleural biopsies) between January 2015 and June 2017 were included. Those patients were randomized into two groups. The 40 patients were enrolled as a treatment group (19 males and 21 females at age of 23.3±10.2 years) and received surgery under non-intubated intravenous anesthesia with spontaneous ventilation. And the other 40 patients were enrolled as a control group (21 males and 19 females at age of 22.2±9.9 years) and received surgery under routine intravenous anesthesia with intubated ventilation. Results Comparing with the control group, the patients of the treatment group had lower white blood cell count (5.8×109±2.4×109 vs. 7.3×109±3.6×109, P<0.001), lower gastrointestinal adverse reaction rate (7.5% vs. 27.5%, P=0.002), lower sore throat rate (5.0% vs. 30.0%, P<0.001), lower cough grade (0.9±0.3 vs 2.1±0.5, P<0.050), shorter drainage time (1.8±1.6 d vs. 3.7±1.8 d, P<0.050) and shorter hospital stay (2.3±1.8 d vs. 5.8±2.3 d, P<0.050). Conclusion Video-assisted thoracoscopic surgery under non-intubated, intravenous anesthesia with spontaneous ventilation is safe and feasible, which also has certain advantages in reducing the postoperative complications and promoting patients' quick recovery from surgery.
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We present a case of severe tracheobronchial compression from a complex aorto‑subclavian aneurysm in a patient with Turner’s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.
Subject(s)
Adult , Airway Obstruction/complications , Anesthesiology/methods , Anesthetics, Inhalation , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/surgery , Bronchial Diseases/complications , Cardiopulmonary Bypass/methods , Catheterization, Swan-Ganz/methods , Circulatory Arrest, Deep Hypothermia Induced/methods , Constriction, Pathologic/complications , Echocardiography, Transesophageal/methods , Female , Humans , Methyl Ethers , Positive-Pressure Respiration/methods , Subclavian Artery/abnormalities , Subclavian Artery/surgery , Tracheal Stenosis/complications , Turner Syndrome/surgeryABSTRACT
Objective To investigate the effects of different infusion rates of remifentanil infusion on spontaneous ventilation in children received sevoflurane anesthesia. Methods A total of 120 children underwent strabismus surgery were randomly assigned to four groups: C group (administration of saline), L group (remifentanil 0.03 μg · kg-1 · min-1), M group (remifentanil 0.06μg · kg-1 · min-1) and H group (remifentanil 0.09μg · kg-1 · min-1). The mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), tidal volume (VT), minute ventilation (MV), endtidal CO2 [p(CO2)] and endtidal SEV were recorded after laryngeal mask insertion (T1), an initial bolus dose of remifentanil (T2),10 mins after remifentanil infu-sion (T3),15 mins after remifentanil infusion (T4) and laryngeal mask remove (T5) respectively. The adverse events and time of induction, maintenance and emergence were also recoded. Results There were no significant differences in patient age, body mass index, anesthesia time, operation time, HR and MBP at different time points between four groups. No body movement and hypoxemia were observed. The values of RR and MV at T3, T4 and T5 were significantly lower in H group than those of other three groups (P <0.05). Values of p(CO2)at T3 and T4 were significantly higher in H group than those of other three groups (P<0.05). The values of RR at T3, T4 and T5 were significantly lower in L group and M group than those of C group. The values of MV at T3 and T4 were significantly lower in L group and M group than those of C group. p(CO2)at T4 was significantly higher in L group and M group than that of C group(P<0.05), but no significant difference was found be-tween L group and M group. There was no significant difference in value of VT between four groups. Conclusion Remifent-anil infusion at a rate of 0.03~0.09μg·kg-1·min-1 could depress spontaneous ventilation in children received sevoflurane an-esthesia. The respiratory depression effect is mainly manifested by reduction of RR. It is a good option to choose 0.03~0.06μg · kg-1 · min-1 infusion to keep spontaneous ventilation and avoid severe respiratory depression according to the demand of operations in children.
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Compararam-se os efeitos da ventilação espontânea (V E) e controlada (V C) em equinos submetidos à mudança de decúbito durante anestesia. Dezesseis animais foram equitativamente divididos em dois grupos: V E e V C. Os procedimentos cirúrgicos foram iniciados com os animais em decúbito lateral esquerdo (DLE) e, após 75 minutos, os animais foram reposicionados em decúbito lateral direito (DLD). Análises hemogasométricas do sangue arterial foram realizadas após 30 e 75 minutos com os animais posicionados em cada decúbito (M1 e M2 no DLE e M3 e M4 no DLD, respectivamente). Durante a V E, observaram-se hipercapnia (PaCO2 >45mmHg), acidose respiratória (pH <7,35), redução significativa da oxigenação sanguínea após 75min da mudança de decúbito (M4: 205,8±124,7mmHg) em relação aos valores de PaO2 observados antes da mudança de posicionamento (M1: 271,8±84,8mmHg). A Vc foi associada a valores de PaCO2 e pH mais próximos da normalidade bem como resultou em valores de PaO2 significativamente maiores (52 a 96 por cento de elevação nos valores médios) que a V E. Conclui-se que a mudança de decúbito, em equinos anestesiados com halotano e mantidos sob V E, resulta em hipercapnia, acidose respiratória e diminuição dos valores de PaO2. A instituição de V C, desde o início da anestesia, previne a acidose respiratória, além de resultar em valores de PaO2 mais próximos do ideal para animais respirando O2 a 100 por cento.
The effects of spontaneous (SV) and controlled ventilation (CV) were compared in horses undergoing changes in body position during anesthesia. Sixteen animals were equally distributed in two groups: SV and CV. All surgical procedures were commenced on left lateral recumbency (LLR) and 75 minutes later the animals were repositioned on right lateral recumbency (RLR). Arterial blood gas analyses were performed at 30 and 75 minutes after each recumbency (M1 and M2 for LLR and M3 and M4 for RLR). Hypercapnia (PaCO2 >45mmHg), respiratory acidosis (pH <7.35), and significant decrease in PaO2 after 75min of change in body position (M4: 205.8±124.7mmHg) in comparison to PaO2 values before the change of position (M1: 271.8±84.8mmHg) were observed during SV. When compared to the SV group, CV resulted in significantly higher PaO2 levels (52 to 96 percent increase). It was concluded that the change in the body position in spontaneously ventilating halothane-anesthetized horses causes impairment in arterial oxygenation. The use of CV since the beginning of anesthesia prevents the respiratory acidosis and maintains arterial oxygen levels that are closer to values expected during the use of 100 percent O2.
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Animals , Anesthesia, Inhalation , Posture , Pulmonary Ventilation , Respiration, Artificial , Anesthesiology , Horses/bloodABSTRACT
General anesthesia for the removal of a large mediastinal mass has been associated with life-threatening airway obstruction. We present a case of general anesthesia for a patient with superior posterior mediastinal mass and critical airway compression who was allowed to maintain spontaneous ventilation throughout general anesthesia for a thoracotomy. The patient was a 5-year-old boy complaining of productive cough and intermittent fever for 3 weeks. His chest radiograph and magnetic resonance imaging(MRI) film demonstrated a critically narrowed and deviated trachea at the level of the thoracic inlet to the proximal portion of the right bronchus. We can secure the airway by spontaneous ventilation without muscle relaxation and allowing the patient to breathe spontaneously and insertion of endotracheal tube distal to the narrowed portion of trachea.