Subject(s)
Brachial Plexus Block/methods , Brachial Plexus/drug effects , Fracture Fixation, Internal/adverse effects , Pacemaker, Artificial/adverse effects , Radius Fractures/surgery , Adult , Anesthetics, Local/administration & dosage , Arrhythmia, Sinus/therapy , Humans , Male , Ultrasonography, Interventional/methodsABSTRACT
Abstract Background Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. Results Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. Conclusion Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.
Resumo Justificativa A inserção de sonda nasogástrica (NG) pode ser difícil em pacientes anestesiados e intubados com a cabeça em posição neutra. Há várias técnicas para a inserção bem-sucedida de sonda NG. O objetivo primário deste estudo foi investigar a diferença da taxa de sucesso na primeira tentativa de diferentes técnicas para inserção de sonda NG. O objetivo secundário foi investigar a diferença do tempo de inserção com o uso da técnica selecionada e as complicações durante a inserção (dobradura da sonda e sangramento da mucosa). Material e métodos 200 pacientes adultos que receberam anestesia geral para cirurgias abdominais eletivas que exigiam inserção de sonda NG foram randomicamente distribuídos em quatro grupos: grupo convencional (Grupo C), grupo com a cabeça posicionada lateralmente (Grupo L), grupo com assistência de tubo traqueal (Grupo TE) e grupo com videolaringoscópio McGrath (grupo MG). As taxas de sucesso, os tempos de inserção e as complicações foram registrados. Resultados As taxas de sucesso de inserção da sonda NG na primeira tentativa e em geral foram menores no Grupo C do que nos grupos TE e MG. As durações e os tempos totais de inserção bem-sucedida da sonda NG na primeira tentativa foram significativamente maiores no Grupo TE. Dobradura foi maior no Grupo C. Sangramento da mucosa foi estatisticamente menor no Grupo MG. Conclusão O uso de videolaringoscópio e de TE durante a inserção de sonda NG comparado com o uso da técnica convencional aumentou a taxa de sucesso e reduziu a dobradura da sonda em pacientes adultos anestesiados e intubados. O uso de videolaringoscópio durante a inserção de sonda NG em comparação com outras técnicas reduz o sangramento da mucosa em pacientes adultos anestesiados e intubados.
Subject(s)
Humans , Male , Female , Intubation, Gastrointestinal/methods , Anesthesia , Intubation, Gastrointestinal/adverse effects , Intubation, Intratracheal , Laryngoscopy , Middle AgedABSTRACT
BACKGROUND: Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. MATERIAL AND METHODS: 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. RESULTS: Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. CONCLUSION: Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.
Subject(s)
Anesthesia , Intubation, Gastrointestinal/methods , Female , Humans , Intubation, Gastrointestinal/adverse effects , Intubation, Intratracheal , Laryngoscopy , Male , Middle AgedABSTRACT
OBJECTIVES: Various minimally invasive surgical approaches have been used in mitral valve (MV) surgery. The transapical off-pump mitral valve intervention with NeoChord implantation (TOP-MINI) is a minimally invasive, alternative procedure for the treatment of degenerative mitral regurgitation. There are several special considerations for the anesthesiologist during the TOP-MINI procedure. The main purpose of this study was to present the anesthetic management of the TOP-MINI procedure. DESIGN: An observational study. SETTING: Training and research hospital. PARTICIPANTS: Adult patients who underwent MV repair with the NeoChord DS1000 system (NeoChord Inc, St Louis Park, MN). INTERVENTIONS: The study included 12 consecutive patients who underwent MV repair with the NeoChord DS1000 system at the Antalya Training and Research Hospital, Antalya, Turkey, between June 2014 and December 2015. A record was made of preoperative demographic details, comorbidities, preoperative and postoperative mitral regurgitation severity, preoperative and postoperative forced expiratory volume in 1 second values, use of blood products and vasoactive drugs, surgical times, mechanical ventilation times, intensive care unit (ICU) and hospital length of stay, visual analog scale scores, analgesic requirement in ICU and perioperative complications. MEASUREMENTS AND MAIN RESULTS: TOP-MINI was performed completely off-pump in 12 patients. Intraoperative salvaged blood via cell-saver was 660±196 mL. Patients required 0.8±0.7 U of red blood cells and 2.0±0.9 U of fresh frozen plasma in the ICU. Inotropic support was used in 5 patients. There was a significant decline in mean arterial pressure from before surgery to during implantation (70.9±4.5 mmHg v 51.7±5.8 mmHg, respectively). A statistically significant increase was demonstrated in mean arterial pressure from during implantation to postimplantation (51.7±5.8 mmHg v 67.0±6.8 mmHg, respectively). There were no significant differences in preoperative and postoperative forced expiratory volume in 1âsecond values. Defibrillation was required in 1 patient, and temporary atrial fibrillation was observed in 1 patient during the procedure. Atelectasis occurred in the postoperative period in 1 patient. The mean visual analog scale score was 3.6±1.4, and the mean tramadol consumption was 77±39 mg in the ICU. Extubation time and the mean length of stay in the ICU and hospital were 2.6±0.5 hours, 19.8±2.7 hours, 5±1 days, respectively. CONCLUSIONS: The TOP-MINI procedure requires complex anesthetic management. Transesophageal echocardiographic guidance is essential for this procedure. One-lung ventilation, fluid administration, avoidance of hypothermia, and pain management are the bases for anesthetic management.
