Airway Group Research Articles

The application of intravenous general anesthesia under nasopharyngeal airway assisted ventilation undergoing ureteroscopic holmium laser lithotripsy: A prospective, single-center, controlled trial

Abstract To observe the effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation on patients undergoing ureteroscopic holmium laser lithotripsy. One hundred and twenty patients who underwent ureteroscopic holmium laser lithotripsy in our hospital were selected and randomly divided into nasopharyngeal airway group (research group) and laryngeal mask group (control group). These patients, respectively, received intravenous anesthesia under nasopharyngeal airway and laryngeal mask-assisted ventilation. The following evaluation indexes were compared and analyzed between the two groups, including anesthetic effect, hemodynamics, stress response, postoperative recovery, adverse reactions, etc. There were no significant differences in Visual Analog Scale, hemodynamics, and stress response between the two groups at each time point (P > 0.05). There were no significant differences in residence time and postoperative recovery time between the two groups (P > 0.05). The difference in airway establishment time between the two groups was statistically significant (P < 0.05), and cases with blood in the research group was significantly lower than those in the control group (P < 0.05). Patient satisfaction in research group was significantly higher than those in the control group (P < 0.05). The clinical effect of intravenous general anesthesia under nasopharyngeal airway-assisted ventilation in ureteroscopic holmium laser lithotripsy is significant, which helps to stabilize patients’ hemodynamics, reduce their stress response and adverse reactions, and improve the satisfaction rate of patient.

Perbedaan Tingkat Nyeri Tenggorokan Pasca Ekstubasi Endotracheal Tube (ETT) dan Laryngeal Mask Airway (LMA) di RSUD Dr. Soedirman Kebumen

General anesthesia is a condition in which the patient loses consciousness completely after taking certain medications. Sore throat is a common complication in postoperative patients with general anesthesia after extubation with laryngeal mask airway or endotracheal tube. The aim of this study was to compare the level of throat pain after extubation using an endotracheal tube versus a laryngeal mask airway. Methods: A quantitative cross-sectional approach was utilized, with accidental sampling as the technique. The study sample comprised 78 respondents who underwent surgery and were extubated with either an endotracheal tube or a laryngeal mask airway at Dr. Soedirman Hospital, Kebumen. Data analysis was conducted using the Mann-Whitney test. Results: Each group, consisting of endotracheal tube and laryngeal mask airway users, had 39 respondents. Throat pain was reported by 34 respondents (84.6%) in the endotracheal tube group and 27 respondents (69.2%) in the laryngeal mask airway group. The Mann-Whitney test yielded a p-value of 0.022, which is less than 0.05. Conclusion: There is a significant difference in the level of sore throat in postoperative patients with the laryngeal extubation technique with the laryngeal mask air way extubation technique and the endotracheal tube extubation technique at dr. Soedirman Kebumen Hospital.

Application of combined anesthesia with spontaneous breathing in the surgery of intertrochanteric fracture of femur in elderly patients.

This study aims to investigate the feasibility and safety of combined anesthesia with spontaneous breathing in the operation of intertrochanteric fracture of femur in the elderly. Between January 2020 and January 2023, a total of 141 elderly patients (45 males, 96 females; mean age: 72.5±6.8 years; range, 65 to 87 years) who underwent proximal femoral nail anti-rotation (PFNA) surgery for intertrochanteric fracture of femur were included in this single-blind, prospective, randomized-controlled study. The patients were randomly divided into three groups. Group A (experimental group) was a general anesthesia with laryngeal mask airway (LMA) group preserving spontaneous breathing, Group B (control group 1) was a general anesthesia with LMA group for mechanical ventilation, and Group C (control group 2) was a tracheal intubation anesthesia group for mechanical ventilation. The differences of related indexes among the three groups were compared. The mean onset time of anesthesia (6.23±1.45 vs. 12.78±2.78 vs. 13.73±2.43 min), postoperative recovery time of consciousness (8.13±0.83 vs. 11.34±0.89 vs. 12.45±0.86 min), and postoperative complete awakening time (10.45±2.34 vs. 18.87±2.56 vs. 19.62±2.93 min) were significantly shorter in Group A than in Groups B and C (p<0.05). The duration of analgesic effect was longer in Group A than in Groups B and C (p<0.05). After anesthesia, the Ramsay Sedation Scale and Visual Analog Scale (VAS) scores were significantly lower in Group A than the other groups (p<0.05). The mean Mini-Mental State Examination (MMS) scores were significantly higher in Group A than in Groups B and C (p<0.05). Hemodynamic parameters showed that blood pressure, heart rate, cardiac output, and cardiac index (CI) levels were significantly higher in Group A than the other groups (p<0.05). Our study results indicate that combined anesthesia preserving spontaneous breathing is safe and feasible in the operation of intertrochanteric fracture of femur in the elderly, with faster anesthesia recovery than the mechanical ventilation group.

Comparative Case Series on LMA-Assisted Flexible Fiberoptic Bronchoscopy

ABSTRACT Fiberoptic bronchoscopy in children requires sedation, while routinely employed techniques for oxygenation under sedation don’t provide airway protection.LMA during FOB can provide safer ventilation with good operative views.Although the use of laryngeal mask airway for FOB was described in 1982, its application has not been established in pediatric patients. The aim of our study was to compare the safety and efficacy of LMA-assisted bronchoscopy compared to nasal airway with oxygenation-assisted bronchoscopy. The study was conducted on 12 patients, 6 in each group. Data collected includes monitoring of oxygen saturation, hemodynamics, ETCO2, and complications. LMA group children had lower episodes of desaturation as compared to nasal airway group. ETCO2 values were maintained and rate of complications were less in LMA group. Hemodynamic stability in both groups were comparable. Hence the use of LMA allows better airway conduit, with stable O2 saturation and ETCO2 values than nasal airway-assisted bronchoscopy.

Neuromedin-U Mediates Rapid Activation of Airway Group 2 Innate Lymphoid Cells in Mild Asthma.

Rationale: In asthma, sputum group 2 innate lymphoid cells (ILC2s) are activated within 7 hours after allergen challenge. Neuroimmune interactions mediate rapid host responses at mucosal interfaces. In murine models of asthma, lung ILC2s colocalize to sensory neuronal termini expressing the neuropeptide neuromedin U (NMU), which stimulates type 2 (T2) cytokine secretion by ILC2s, with additive effects to alarmins invitro. Objectives: To investigate the effect of the NMU/NMUR1 (NMU receptor 1) axis on early activation of ILC2s in asthma. Methods: Subjects with mild asthma (n = 8) were enrolled in a diluent-controlled allergen inhalation challenge study. Sputum ILC2 expression of NMUR1 and T2 cytokines was enumerated by flow cytometry, and airway NMU levels were assessed by ELISA. This was compared with samples from subjects with moderate to severe asthma (n = 9). Flow sort-purified and ex vivo-expanded ILC2s were used for functional assays and transcriptomic analyses. Measurements and Main Results: Significant increases in sputum ILC2s expressing NMUR1 were detected 7 hours after allergen versus diluent challenge whereby the majority of NMUR1+ ILC2s expressed IL-5/IL-13. Sputum NMUR1+ ILC2 counts were significantly greater in mild versus moderate to severe asthma, and NMUR1+ ILC2s correlated inversely with the dose of inhaled corticosteroid in the latter group. Coculturing with alarmins upregulated NMUR1 in ILC2s, which was attenuated by dexamethasone. NMU-stimulated T2 cytokine expression by ILC2s, maximal at 6 hours, was abrogated by dexamethasone or specific signaling inhibitors for mitogen-activated protein kinase 1/2 and phosphoinositol 3-kinase but not the IL-33 signaling moiety MyD88 invitro. Conclusions: The NMU/NMUR1 axis stimulates rapid effects on ILC2s and may be an important early activator of these cells in eosinophilic inflammatory responses in asthma.

Evaluation of Ultrasonography with Conventional Clinical Parameters for Predicting Difficult Laryngoscopy

Background: Unanticipated difficult intubation poses a challenge in routine practice for anaesthesiologists. A preoperative airway evaluation helps in the identification of a difficult airway. Airway assessment with ultrasound is a modality recently being used to predict difficult airway. In this study we evaluate ultrasonography parameters with conventional clinical parameters for predicting difficult airway in adults undergoing elective surgeries.&#x0D; Methods: This cross sectional randomised clinical trial analyses ASA class 1 and 2 adults requiring endotracheal intubation for surgeries under general anaesthesia were enrolled following which Modified Mallampatti score and thyromental distance as well as ultrasound distance to epiglottis (DSE) and distance to hyoid bone (DSHB) were measured and based on Cormack Lehane grading they were categorised into easy and difficult airway groups.&#x0D; Results: DSE had the highest sensitivity of 90.48% whereas Modified Mallampatti grading had least sensitivity of 66.67%.&#x0D; Conclusion: The results of this study showed that ultrasonographic measurements at the thyrohyoid and hyoid level have higher sensitivity and specificity than the clinical parameters for airway assessment.

ASSESSMENT OF THE RATE OF CHANGE IN THE RAPID SHALLOW BREATHING INDEX AND ITS IMPACT ON EXTUBATION OUTCOMES IN MECHANICALLY VENTILATED PATIENTS

Mechanical ventilation is a crucial intervention in critical care, but weaning and extubation can be complex. Extubation failure poses significant risks, including increased morbidity and mortality. The Rapid Shallow Breathing Index (RSBI) has been explored to predict extubation outcomes. Still, recent research suggests that assessing the rate of change of RSBI over time (ΔRSBI) could enhance prediction accuracy. In this prospective observational study, we analyzed data from patients with respiratory failure, including those with airway diseases and those without documented respiratory conditions. RSBI was measured at the 5th and 120th minutes of spontaneous breathing trials (SBT), and the ΔRSBI was calculated. Patients were categorized into extubation failure and success groups based on their post-extubation outcomes. Receiver-operating characteristic (ROC) curves were generated to determine optimal RSBI thresholds for predicting extubation failure. Out of 119 patients, 23 were excluded due to intolerance to the 120-minute SBT. The remaining 96 patients were divided into normal and airway groups. In the overall analysis, ΔRSBI had an AUC of 0.943, with a threshold of 26% ΔRSBI predicting extubation failure (sensitivity 96%, specificity 91%, overall accuracy 89%). RSBI 120 had an AUC of 0.837, with an optimal threshold of 71 (sensitivity 86%, specificity 78%, overall accuracy 82%). In the normal group, ΔRSBI (AUC 0.785) with a threshold of 24% (sensitivity 86%, specificity 92%, overall accuracy 88%) outperformed RSBI-120 (AUC 0.931) with a threshold of 70 (sensitivity 86%, specificity 91%, overall accuracy 86%). In the airway group, ΔRSBI (AUC 0.893) with a threshold of 26% ΔRSBI (sensitivity 88%, specificity 84%, overall accuracy 88%) and RSBI 120 (AUC 0.863) with a threshold of 76 (sensitivity 88%, specificity 84%, overall accuracy 84%) showed strong predictive capabilities.&#x0D; Assessing the rate of change of RSBI during a 120-minute SBT offers superior predictive value for extubation outcomes compared to a single RSBI measurement. This approach is particularly valuable in patients with airway diseases. Accurate extubation prediction can reduce reintubation rates and associated complications, ultimately improving patient care.

Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients.

Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5th and the 120th minutes of SBT. The rate of change of RSBI (RSBI 5-120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5-120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. The RSBI 5-120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5-120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5-120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5-120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). The rate of change of RSBI between the 5th and 120th minutes was moderately more accurate than the single value of RSBI measured at the 120th minute in predicting extubation outcome.

Prediction of the difficult airway by pre-operative ultrasound-based measurement of airway parameters: A prospective observational study.

Ultrasonography has emerged as a new airway assessment tool. However, its role in predicting difficult airways needs to be explored. This study aimed to evaluate the accuracy of pre-operative ultrasound assessment of the neck in predicting difficult airways in patients undergoing elective surgery under general anaesthesia. One hundred and fourteen adult patients undergoing elective surgeries under general anaesthesia were enrolled in this study. In the pre-operative room, upper airway ultrasound measurements of the neck were obtained, namely, distance from skin to the hyoid bone, distance from skin to the thyroid isthmus and thickness of the base of the tongue. Clinical airway assessment details were noted from the pre-anaesthetic evaluation form. The airway management technique was noted. Receiver operating characteristic curves were used to assess the diagnostic value of these upper airway ultrasound measurements in predicting difficult airways. The distance from the skin to the thyroid isthmus in the difficult airway group (0.37 ± 0.133 cm) was significantly higher than in the non-difficult group (P = 0.007). It appeared to be a better predictor of difficult airways and correlated better with clinical tests among the measured ultrasound parameters. The body mass index was significantly higher in the difficult airway group (P = 0.009). Considering the difference in means between the two groups, distance from the skin to the thyroid isthmus should be explored as a potential predictor of a difficult airway in studies with a larger sample size.

Gastric Inflation in Prehospital Cardiopulmonary Resuscitation: Aspiration Pneumonia and Resuscitation Outcomes.

Gastric inflation (GI) can induce gastric regurgitation and subsequent aspiration pneumonia, which can prolong intensive care unit stay. However, it has not been verified in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the incidence of GI during prehospital resuscitation and its effect on aspiration pneumonia and resuscitation outcomes in patients with out-of-hospital cardiac arrest. This was a multicenter, retrospective, observational study. Patients with non-traumatic OHCA aged 19 years who had been admitted to the emergency department were enrolled. Patients who received mouth-to-mouth ventilation during bystander cardiopulmonary resuscitation (CPR) were excluded from the evaluation owing to the possibility of GI following bystander CPR. Patients who experienced cardiac arrest during transportation to the hospital who were treated by the emergency medical service (EMS) personnel, and those with a nasogastric tube at the time of chest or abdominal radiography were also excluded. Radiologists independently reviewed plain chest or abdominal radiographs immediately after resuscitation to identify GI. Chest computed tomography performed within 24 h after return of spontaneous circulation was also reviewed to identify aspiration pneumonia. Of 499 patients included in our analysis, GI occurred in approximately 57% during the prehospital resuscitation process, and its frequency was higher in a bag-valve mask ventilation group (n = 70, 69.3%) than in the chest compression-only cardiopulmonary resuscitation (n = 31, 55.4%), supraglottic airway (n = 180, 53.9%), and endotracheal intubation groups (n = 3, 37.5%) (p = 0.031). GI was inversely associated with initial shockable rhythm (adjusted odds ratio [OR] 0.53; 95% confidence interval [CI]: 0.30-0.94). Aspiration pneumonia was not associated with GI. Survival to hospital discharge and favorable neurologic outcomes were not associated with GI during prehospital resuscitation. GI in patients with OHCA was not associated with the use of different airway management techniques.

Effect of Laryngeal Mask Airway on Image Quality in Pediatric Patients Undergoing Brain Magnetic Resonance Imaging: A Randomized Controlled Trial.

Magnetic resonance imaging (MRI) is highly sensitive to motion, resulting in artifacts and lowering image quality. Laryngeal mask airway (LMA) provides numerous advantages over endotracheal tubes as it reduces laryngospasm, coughing, and the risk of postoperative desaturation. We aimed to compare LMA with oral airway for airway management during brain MRI in terms of reducing motion artifacts, which can improve image quality. This randomized, controlled, double-blind trial was carried out on 40 pediatrics aged 1 - 18 years, American Society of Anesthesiologists (ASA) physical status І and П undergoing brain MRI. Patients were randomized into two equal groups according to the airway method, the control (Guedel oral airway) group and the LMA group. A compatible anesthesia machine was used to provide O2 and sevoflurane 2% - 4%. The mean MRI image quality score was significantly higher in the LMA group than in the control group (26.10 ± 3.97 versus 18.60 ± 5.30, P < 0.001). Mean arterial blood pressure and heart rate were significantly lower in the LMA group than in the control group at all study times except at baseline and immediate post-extubation (P < 0.05). Cough was significantly lower in LMA than in the control group (15% vs. 50%, P = 0.040). Airway complications (sore throat, laryngeal spasm, and bronchospasm), nausea, and vomiting did not have a significantly different between the two groups. Compared to Guedel oral airway, using LMA for airway management in pediatrics undergoing MRI scans improved the image quality with less cough and better hemodynamics.

Comparison of Upper Airway Ultrasonography With End-Tidal Capnography for the Confirmation of Endotracheal Tube Placement in Patients Requiring General Anesthesia

Introduction End-tidal capnography (EtCO2)has been the gold standard method for confirmation of endotracheal intubation.Upper airway ultrasonography (USG) is a new promising method for confirming endotracheal tube (ETT) placement and has the potential to become the first-line non-invasive airway assessment tool in the future thanks to widespread POCUS knowledge, greater technology improvements, portability, and availability of ultrasound in the majority of essential areas. Hence our study aimed to compare upper airway USGand EtCO2 for the confirmation of ETTplacement in patients undergoing general anesthesia. Aim To compare the upper airway USG with EtCO2for confirmation of ETTplacement in patients requiring general anesthesia for elective surgical procedures.The objectives of the study were to compare the time taken for confirmation, and the number of correct identification of tracheal and esophageal intubation by both upper airway USG and EtCO2. Materials and methods After obtaining institutional ethical committee (IEC) approval, a prospective randomized comparative study involving 150 patients under American Society of Anesthesiologists (ASA) grade I and II requiring endotracheal intubation for elective surgeries under general anesthesia was randomized into two groups, Group U-upper airway USG and Group E-EtCO2with 75 patients in each group. ETT placement confirmation was done by upper airway USG in Group U andby EtCO2in Group E and the time taken for confirmation of ETT placement and correct identification of esophageal and tracheal intubation by USG and EtCO2was noted. Results The demographic details among both groupswere statistically insignificant. Upper airway USG had a faster average confirmation time of 16.41 seconds when compared to EtCO2 which took an average confirmation time of 23.56 seconds. In our study, upper airway USG was able to identify esophageal intubation with 100% specificity. Conclusion Upper airway USG can be a reliable method and can be employed as a standard method for confirmation of ETT location in patients undergoing elective surgeries under general anesthesia when compared to EtCO2.

Comparison of Oropharyngeal Oxygen Pooling and Suctioning During Intubated and Nonintubated Dental Office-Based Anesthesia.

The risk of a spontaneous surgical fire increases as oxygen concentrations surrounding the surgical site rise above the normal atmospheric level of 21%. Previously published in vitro findings imply this phenomenon (termed oxygen pooling) occurs during dental procedures under sedation and general anesthesia; however, it has not been clinically documented. Thirty-one children classified as American Society of Anesthesiologists I and II between 2 and 6 years of age undergoing office-based general anesthesia for complete dental rehabilitation were monitored for intraoral ambient oxygen concentration, end-tidal CO2, and respiratory rate changes immediately following nasotracheal intubation or insertion of nasopharyngeal airways, followed by high-speed suctioning of the oral cavity during simulated dental treatment. Mean ambient intraoral oxygen concentrations ranging from 46.9% to 72.1%, levels consistent with oxygen pooling, occurred in the nasopharyngeal airway group prior to the introduction of high-speed oral suctioning. However, 1 minute of suctioning reversed the oxygen pooling to 31.2%. Oropharyngeal ambient oxygen concentrations in patients with uncuffed endotracheal tubes ranged from 24.1% to 26.6% prior to high-speed suctioning, which reversed the pooling to 21.1% after 1 minute. This study demonstrated significant oxygen pooling with nasopharyngeal airway use before and after high-speed suctioning. Uncuffed endotracheal intubation showed minimal pooling, which was reversed to room air ambient oxygen concentrations after 1 minute of suctioning.

Accuracy of airway ultrasound parameters to predict difficult airway using the LEMON criteria as a reference: A cross-sectional diagnostic accuracy study.

Ultrasound (US) airway indexes were frequently compared with other scoring systems such as Mallampati score and Cormack - Lehane classification system, but to the best of our knowledge never with LEMON. Here, in this study, we evaluated the accuracy of some recommended airway US parameters in terms of screening difficult airway using the LEMON criteria as a reference. This was a cross-sectional diagnostic accuracy study in which people with at least 18 years old coming to the emergency departments for any reason who had consent for participation, were enrolled with the simple random sampling method. Hyo-mental distance (HMD), skin to epiglottis distance (EP), and peri-epiglottic space to epiglottis to vocal cord ratio (PEP/E. VC) were the US indexes that were calculated in all participants. Using a preprepared checklist, measured US parameters were recorded. For each participant, the LEMON score variables were also assessed and recorded, and the cutoff point for considering as a difficult airway case, based on LEMON score, was 2. Demographic characteristics of the participants were also registered. A total of 299 cases with a mean age of 41.1 years (95% confidence interval [CI]: 39.3-42.9), were participated. Based on LEMON score ≥2, 20 participants (6.7%) were categorized in difficult airway group. Comparison of the PEP/E. VC (P = 0.007) and EP distance (P = 0.049) of the participants based on LEMON score showed a statistically significant difference; but comparison of the means of HMD in the two groups was not statistically significant (P = 0.144). The median of EP of the participants was 7.70 mm (interquartile range [IQR]: 6.70-9.40). The best cutoff point of EP distance for evaluating a difficult airway was 12.27 mm and more with the sensitivity of 35% and the specificity of 86.96% (accuracy = 0.614; 95% CI: 0.492-0.736). The median of PEP/E. VC was 1.01(IQR: 0.79-1.23). The best cutoff point of PEP/E. VC for evaluating a difficult airway was 0.88 and less with the sensitivity of 70% and the specificity of 67.38% (accuracy = 0.701; 95% CI: 0.583-0.818). As per our results, PEP/E. VC and EP distance measured with sonography can be used in distinguishing the difficult airway, using the LEMON criteria as the reference. However, further studies are needed to use PEP/E. VC and EP distance as a part of reliable indexes.

Effects of General Anesthesia on the Results of Cardiac Catheterization in Pediatric Patients with Ventricular Septal Defect

<b>Background:</b> There is no gold standard sedation method for pediatric cardiac catheterization. In congenital heart diseases with intracardiac shunts, hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics, although few studies have examined these effects. The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters. <b>Methods:</b> This study retrospectively evaluated consecutive patients with ventricular septal defect (VSD) below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center, who were divided into age- and VSD diameter-matched general anesthesia (GA) and monitored anesthesia care (MAC) under the natural airway groups (<i></i>n = 40 each), for comparison of hemodynamic parameters. <b>Results:</b> In the GA group, arterial blood pH and arterial partial pressure of oxygen were significantly higher (<i>p</i> < 0.01), whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group (<i>p</i> < 0.01). Mean pulmonary artery pressure (<i>p</i> < 0.05) and systemic blood pressure (<i>p</i> < 0.01) were lower in the GA group. Pulmonary vascular resistance index (<i>p</i> < 0.01) and systemic vascular resistance index (<i>p</i> < 0.01) were also significantly lower in the GA group than the MAC group. There were no significant differences in pulmonary blood flow index, systemic blood flow index, and pulmonary/systemic blood flow ratio between the two groups. <b>Conclusions:</b> Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC. In particular, when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management, consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.

Sevoflurane consumption pattern by individual anaesthesiologists varies widely despite using the same high-end workstations in the same hospital.

Volatile anaesthetics are potent greenhouse gasses but contemporary workstations enable considerable savings while improving patient safety. Institutions may provide this technology to reduce the ecological footprint but proper training and motivation is required to maximize their ecologic and financial benefit. This study aims to compare the sevoflurane consumption of 22 anaesthesiologists in a medium sized hospital 4years after flow-i workstations (Getinge, Sweden) entered into service, in three airway approaches: intubated patients, laryngeal mask ventilation, and mask anaesthesia. Typical sevoflurane consumption for each anaesthesiologist was defined as the mean cumulative consumption in the chronologically first 50 cases meeting the inclusion criteria for each airway group in 2019. The potential savings, if everyone were to adopt the approach of the more economical anaesthesiologists (15th percentile), was calculated. The CO2 equivalent emissions were calculated using a GWP20 of 702 and a GWP100 of 195. The median [range] consumption after 45min was 10.9 [7.5-18.4] ml in intubated patients and 9.0 [7.4-15.3] ml in patients with laryngeal mask, and 9.9 [3.4-20.9] ml after 8min with mask ventilation. This corresponds to a double to six fold consumption between the least and most wasteful approach. The typical CO2 equivalent emissions (GWP20) per anaesthesiologist varied between 8.0 and 19.6kg/45min in intubated airways, between 7.9 and 16.3kg/45min in LMA, and between 3.6 and 22.3kg/8min in mask ventilation. Despite using the same workstations in the same hospital, the typical sevoflurane consumption differed dramatically between 22 anaesthesiologists. In addition to providing advanced workstations, proper education is required to achieve the behavior change needed to reduce the pollution and financial waste associated with volatile anaesthetics.

Which one is the most preferred anesthesia type in dental treatments of patients with special needs: sedation or general anesthesia?

Aim: Patients with special needs, who have mental, physical or medical disabilities, were reported to have worse oral hygiene than their healthy peers. Disabled patients are usually uncooperated, and dental treatments of these patients are completed under several anesthesia types. Our aim was to compare anesthesia types in dental treatments of patients with special needs. Material and Method: The study included review of uncooperated patients, who had physical or mental disabilities, between June 1, 2021 and June 1, 2022. Patients were divided into three groups due to their anesthesia types; sedation (Group S), laryngeal mask airway (LMA) (Group L), and nasotracheal intubation (Group N). Results: In total 80 patients were analyzed; 4 patients excluded, 45 patients were in Group S, 19 patients were in Group L, and 12 patients were in Group N. Anesthesia times were significantly different between groups; 20 min in Group S, 25 min in Group L, and 45 min in Group N. Propofol use was significantly low (p&amp;lt;0.001) and ketamine use was significantly high in Group S (p=0.002). Number of tooth extractions was not significantly different between groups, but number of filling tooth was significantly high in Group N (p=0.002). Conclusion: Sedation was the most preferred anesthesia type in dental treatment of patients with special needs. Although all three types of anesthesia can be used safely in dental treatments, we suggest that sedation can be considered as the first choice in tooth extraction in patients deemed appropriate by the anesthesiologist and dentist.

S667 Outcomes of Difficult Airway (DA) Patients Presenting With Upper Gastrointestinal Bleed (UGIB): 4-Year Retrospective Study Using National Inpatient Sample (2016 – 2019)

Introduction: Difficult airway patients presenting with upper gastrointestinal bleeding present unique challenge due to increased risk of respiratory complications such as from aspiration or from airway obstruction during anesthesia for urgent upper endoscopy. Limited data are available regarding clinical outcomes in difficult airway patients presenting with Upper gastrointestinal bleed. Methods: Using National Inpatient Sample databases from 2016 to 2019, we identified patients presenting with Upper gastrointestinal bleed, the population were then divided based on the presence and absence of difficult airway using appropriate ICD-10-CM/PCS codes. STATA 17.0 software (3) was used for the analysis. Pearson’s Chi-Square test was used to analyze categorical variable, whereas the student t-test was used to analyze continuous variables. Univariate and multivariate logistic regression was used to adjust for potential confounders. Primary outcome was in hospital mortality due to upper gastrointestinal bleed in patients with and without difficult airway. Results: Amongst total of 1555580 patients admitted with upper gastrointestinal bleed, 140 patients had diagnosis of difficult airway and 1555440 patients did not have difficult airway diagnosis, male gender and white ethnicity was predominant in both populations. The mean LOS was 6.035±5.02 days in difficult airway group, 4.288±4.45 in non-airway group, this result was statistically significant. The mean total hospitalization charges in difficult airway group were 27111$, in the non-difficult airway group were 13183$ and this was found to be statistically significant. There were 45(32.14%) and 36708(2.36%) mortality in patients with and without difficult airway diagnosis. The difference is statistically significant with OR:5.06, 95% CI: 1.62-15.81, and p < 0.001. Odds of using IR intervention and ICU admissions were higher and EGD were lower in difficult airway group, found to be statistically significant. (Table) Conclusion: Patient with diagnosis of difficult airway presenting with upper gastrointestinal bleed symptoms were younger, had higher healthcare utilization and were associated with higher inpatient mortality and complications. Table 1. - In Patient Outcomes of the difficult intubation group presenting with upper gastrointestinal bleed Variables Odds ratio 95% CI P-value In-patient mortality 5.06 1.62-15.81 < 0.001 ALL EGD 0.425 0.131-1.378 <0.001 IR intervention 1.23 0.206-7.31 <0.001 ICU Stay 34.641 13.61-88.11 <0.001 Blood Products Transfusion 0.935 0.408-2.14 <0.001 Blakemore tube insertion 0.95 0.373-2.458 <0.001

Interactive effect of multi-tier response and advanced airway management on clinical outcomes after out-of-hospital cardiac arrest: a nationwide population-based observational study.

ObjectiveWe hypothesized that a multi-tier response (MTR) will provide high-quality cardiopulmonary resuscitation including airway management. However, the type of tier response system and airway management will have different interactive effects resulting in varying outcomes following out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the advanced airway management method has an effect on OHCA outcomes and to compare the size of the effect across MTR types.MethodsThis is a retrospective population-based observational study using the Korea OHCA Registry. Airway management methods were categorized into endotracheal intubation (ETI) and supraglottic airway (SGA) groups. The tier system was categorized into single-tier response (STR) or two types of MTR: ambulance-ambulance MTR or fire engine-ambulance MTR.ResultsIn total, 45,264 patients were analyzed among the 89,087 emergency medical service assessed OHCAs. The SGA group was significantly associated with a lower prehospital return of spontaneous circulation (ROSC) rate compared to the ETI group (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.72–0.88). Both MTR with an ambulance or fire engine were significantly associated with higher prehospital ROSC rates compared to STR (STR vs. MTR with an ambulance: aOR, 1.33; 95% CI, 1.21–1.47; STR vs. MTR with a fire engine: aOR, 1.43; 95% CI, 1.20–1.71). Prehospital SGA was significantly associated with poor neurological outcomes in MTR with fire engine (aOR, 0.71; 95% CI, 0.53–0.96).ConclusionIn this nationwide observational study, we observed that MTR was associated with higher prehospital ROSC than STR. Moreover, SGA is associated with a lower prehospital ROSC rate regardless of tier response type compared to ETI.

Contrast of Laryngeal Mask Airway Versus Endotracheal Tube for Early Postoperative Recovery Following Laparoscopic Cholecystectomy

Aim: To assess the difference between laryngeal mask airway versus endotracheal tube for early postoperative recovery following laparoscopic cholecystectomy Study design: A randomized controlled trial Place and Duration: This study was conducted in Liaquat National Hospital and Medical College Karachi from June 2020 to June 2021 Methodology: Overall, 60 individuals were assigned to airway management utilizing either the laryngeal mask airway(LMA) group or endotracheal tube (ETT) group. All the patients went under sevoflurane-based general anesthesia and all of them had a laparoscopic cholecystectomy. Three things were recorded before and after carbo peritoneum that was blood pressure, heart rate and peak airway pressure. The first hour after surgery and the first postoperative day were used to assess postoperative pain and analgesic needs, as well as hoarseness, nausea, sore throat, and dysphonia. Results: Two attempts were made to have a successful Laryngeal mask airway or endotracheal tube placement. During carbo peritoneum, both of the groups, LMA and ETT had similar highest average peak airway pressure (LMA: 17.8 [2.9], ETT: 18.2 [4.1], with a p-value of 0.159). The incidence of bradycardia and elevated systolic blood pressure was higher in the LMA group. The LMA group had lower pain scores one hour postoperatively and on a postoperative day 1 than the ETT group (LMA: 3.9 [2.0], ETT: 5.4 [2.3], with a p-value of 0.017 and LMA: 5.6 [1.9], ETT: 6.7 [1.7], with a p-value of 0.042). Both the groups had the same analgesic requirements. Until postoperative day 1, the LMA group had a lower incidence of nausea than the ETT group (LMA: 4/28 [14%], ETT: 12/28 [43%], with a p-value of 0.032). Conclusion: The Laryngeal Mask Airway Protector proved to be a successful ventilator device which showed lesser intraoperative hemodynamic stress responses. It also enhanced the early recovery standard following laparoscopic cholecystectomy. Keywords: Endotracheal tube, laparoscopic cholecystectomy, Laryngeal mask airway