Evaluation of continuous aspiration of subglottic secretions in prevention of microaspiration during general anesthesia: a randomized controlled pilot study.

AIM: To assess the difference between endotracheal tubes (ETT) with continuous suction of subglottic secretions (CASS) and standard ETT in preventing secretions movement from the pharynx into the trachea, past the inflated cuff during general anesthesia. METHODS: This randomized, controlled trial enrolled 50 patients who underwent general anesthesia for elective abdominal surgery lasting longer than two hours. They received either ETT with CASS: Teleflex ISIS HVT (GISIS, n=17) or Mallinckrodt TaperGuard Evac (GEvac, n=17), or ETT without suction: Mallinckrodt Intermediate Hi-Lo (GStand, n=16). Methylene blue dye solution (10 mL) was delivered into the hypopharynx every 60 minutes. Subglottic secretions were continuously suctioned. Fiberoptic bronchoscopy was performed every 20 minutes and during tracheal extubation to evaluate the dye location. RESULTS: The groups did not differ in age, sex, body mass index, race, American Society of Anesthesiologists status, and surgery type. Dye migrated past the inflated cuff into the distal trachea in no patient with ETT with CASS and in 13% of patients with standard ETT. On tracheal extubation, dye migrated into the distal trachea more often in the GStand group (56%), compared with the GEvac (13%) and GISIS group (29%) (P=0.045). The GISIS group had 26±19 mL of secretions suctioned from above the inflated cuff, while the GEvac group had 13±10 mL (P=0.05). CONCLUSION: Compared with standard ETT, ETT with CASS efficiently removed secretions during general anesthesia, prevented secretions from migrating past the inflated cuff, and significantly reduced the amount of secretions that reached the distal airways on tracheal extubation.

Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy.

Inherited pseudocholinesterase deficiency refers to an uncommon defect in the butyrylcholinesterase enzyme which can result in prolonged muscle paralysis due to delayed breakdown of choline ester paralytic anaesthetic agents. We describe a 25-year-old woman receiving electroconvulsive therapy (ECT) for treatment of depression in whom motor function did not recover adequately after administration of succinylcholine. Investigated post-ECT, she was found to have severe pseudocholinesterase deficiency. Implications of pseudocholinesterase deficiency for ECT treatment and anaesthetic strategies are discussed.

Spinal agents for acute pain management.

This article describes the current and investigational agents for use in the treatment of acute pain. The use of spinal and epidural routes also are discussed.