Anesthetic Airway Management Research Articles

Torrential intraoral bleed in a mandibular arteriovenous malformation: Resuscitation under nonoperating room settings

Arteriovenous malformation (AVM) of the head and neck, though rare, can present significant clinical challenges, particularly during dental procedures. This case report details the acute management of a 7-year-old girl with an AVM in the right mandible, with sudden, severe, torrential intraoral hemorrhage during an angioembolization procedure, necessitating immediate airway management and hemodynamic stabilization in a nonoperating room anesthesia (NORA) setting. Persistent bleeding led to a multidisciplinary intervention, including external carotid artery ligation and right hemimandibulectomy, achieving hemostasis. The case underscores the importance of meticulous planning, readiness with resuscitation and airway management equipment, and coordinated efforts among anesthesia and surgical teams in NORA settings to manage such critical situations effectively.

Comparison Of Outcome Between Conventional And Video Laryngoscope In Predicted Difficult Intubation

Background: Endotracheal intubation is the mainstay of airway management in general anaesthesia. Failure to intubate the trachea, often known as difficult intubation, is always a possibility. To overcome difficult intubation, different methods of instrumental support were developed. Some authors. Methods: From March 2018 to September 2019, a comparative cross-sectional study was conducted at BSMMU, Dhaka in the department of anesthesia, analgesia, and intensive care medicine. A total of 60 patients with predicted difficult intubation who were scheduled for elective surgery under general anaesthesia with endotracheal intubation were selected for the study. Prediction of difficult intubation was assessed by modified Mallampati class III and IV or thyromental height. Results: Time taken from visualization of glottis for insertion of ETT was 12.8±2.3 sec in conventional laryngoscope which was significantly lower in video laryngoscope (15.0±3.6) (p =0.006). Time taken to visualize the glottis was 13.2±1.7 sec in conventional laryngoscope and 13.2±4.0 sec in video laryngoscope (p>0.05). Total time for tracheal intubation was 49.0±6.4 sec in conventional laryngoscope and 53.2±9.9 sec in video laryngoscope (p>0.05). Intubation with first attempt by video laryngoscope was (30/30; 100%) as compared with conventional laryngoscope (27/30; 90%) (p>0.05). Conclusion: It is evident from the study that intubation with video laryngoscope in comparison to conventional laryngoscope might provide better outcome in terms of ease of intubation and number of attempts during intubation for patients undergoing elective surgery under general anaesthesia. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 7-13

Epidemiology of adverse events attributed to airway management in paediatric anaesthesia: protocol for the prospective, multicentre, registry-based, cross-sectional Japan Pediatric Difficult Airway in Anesthesia study (J-PEDIA)

IntroductionFailure to secure an airway during general anaesthesia is a major cause of adverse events (AEs) in children. The safety of paediatric anaesthesia may be improved by identifying the incidence...

Achieving Successful Extubation and Cost-Effective Recovery Following Anesthetic Airway Management in Supracarinal Tracheal Reconstruction Surgeries: A Retrospective Analysis.

Introduction From an anesthesiologist's perspective, perioperative concerns related to supracarinal tracheal reconstruction surgery include having uninterrupted smooth ventilation without any laryngeal edema, glottic dysfunction, and airway leak. Surgical concerns comprise various kinds of anastomotic dissections, fistulas to innominate arteries, and the esophagus. The most serious complication following tracheal surgery is anastomotic separation, which might manifest modestly as stridor, respiratory distress, and extremis. To avoid dire repercussions, prompt management and securing the airway are necessary.Against this background,we wanted tohighlight the importance of early extubation and discharge of supracarinal tracheal reconstruction patients from hospitals without any postoperative complications and with the least expenses possible, since mostof these patients have already undergone postintubation tracheal stenosis and prolonged intensive care unit stay, and have experienced significant financialburden incurring from preceding events. Methodology Medical records of allpatients admitted for tracheal reconstruction during the period from March 2019 toApril 2022(four years)were reviewed to collect patient demographic details, surgical descriptions, anesthesia data, records of pre-anesthetic evaluations, and postoperative details up until the hospital discharge. Results The most common reason for tracheal stenosis among our patients was post-intubation tracheal stenosis (PITS), which was seen in 8/13 patients (61.53%);4/13patients (30.76%)had stridorat rest and underwent emergency tracheostomy preoperatively immediately following admission to the hospital.The stenosis was situated at a median distance of 3 cm [interquartilerange (IQR): 0.5-7] from the true vocal cords or 7 cm (IQR: 3-9) from the carina. The median length of tracheal resection was 2 cm(IQR: 1-4).Weobserved that the mode ofinductionfor airway management was tracheostomytubein four patients (with 90% tracheal stenosis), placement of laryngeal mask airway (LMA) with spontaneous ventilationin four patients (with 75% tracheal stenosis), andsmall-size (#5-7.5sizes) endotracheal tube (ETT) placement in five patients (with less than 75% tracheal stenosis).The postoperative complicationnoted was bleeding from the operative site in 1/13 patients (7.6%); a 0% mortality rate was noted during the hospital stay and up until six months post-discharge. We noted that the median duration of postoperative hospitalizationwas five days (IQR: 2-15), and the total cost incurred by each patientwas less thanINR 85,000 (USD 1,000). Conclusion Our analysis revealed that all our patients were extubated in the operative room andshifted to the ward. In the "open airway phase",standard distal tracheal intubation and cross-field ventilation techniques, and tracheal suturing were facilitated by the apnoea-ventilation-apnoea technique. Both the techniques along with the emergency tracheostomies done in severe tracheal obstruction preoperatively and intraoperative anesthesia management with the insertion of LMA Supreme,maintained with spontaneous breathing techniques, offered potential advantages in the management ofsupracarinal tracheal reconstruction surgeries. The multidisciplinary teamwork along with close communication and good rapport with the surgical team was found to be the key factor in the fast-track extubation and recovery of these patients.

Comparison of Normal Saline and Alkalinized 2% Lignocaine to Reduce Emergence Phenomenon and Post-Intubation Morbidities: A Prospective, Double-Blind, Randomized Study.

Endotracheal intubation for airway management in general anesthesia is associated with post-intubation morbidities due to tracheal mucosa injury caused by endotracheal tube (ETT) cuff. Nitrous oxide (N2O) diffuses into tracheal tube cuffs filled with air. The rate of diffusion of N2O through the membrane is proportional to its concentration gradient. High-volume low-pressure cuffs expand with only a slight increase in pressure until fully inflated. At this point, owing to the inelasticity of the material, the cuff pressure rises rapidly. This increased pressure can damage the tracheal mucosa. This phenomenon can be avoided, if we inflate the cuff with either a liquid or a gas mixture identical to the inspired gas and monitor the cuff pressure and volume at regular intervals. When lignocaine is used to inflate the ETT cuff, it diffuses to the underlying tracheal mucosa. Thus reducing local irritation and inflammation of the airway through its local anesthetic action. Alkalinization of lignocaine increases its rate of diffusion across the ETT cuff. It also reduces the dose of local anesthetic required to achieve the desired result. We sought to determine the benefits of filling the ETT cuff with alkalinized lignocaine 2% over normal saline, to prevent ETT-induced emergence phenomenon and reduce the incidence of post-intubation morbidities like sore throat, hoarseness, and nausea. This prospective, randomized, double-blind, and comparative study was done at a multispecialty hospital. A total of 120 individuals ofAmerican Society of Anesthesiologists (ASA) physical status 1 and 2, posted for surgery under general anesthesia, were randomly selected and divided into two groups: alkalinized 2% lignocaine group (group L) and normal saline group (group S). After induction of general anesthesia, the airway was secured with appropriate-sized ETT. The ETT cuff was inflated with either of the study media. Continuous cuff pressure monitoring was done to keep cuff pressure below 30 centimeters of water (cm of H2O), at all times. At extubation, the response was evaluated in terms of percentage change in heart rate (HR) and blood pressure from baseline, coughing, bucking, and restlessness. All the surgeries lasted more than two hours. Post-operatively, the patients were evaluated for sore throat and hoarseness, at regular intervals of up to 24 hours. ETT cuff pressure was initially less in group S, which rose to a significantly higher level at extubation, compared to group L (p <0.001). At extubation, there was a significant increase in HR and systolic blood pressure (SBP) from baseline, in group S than in group L (p <0.001 and p=0.001, respectively).The incidence of cough and restlessness was less in group L, compared to group S (p<0.001 and p=0.002, respectively). Mean extubation time and emergence time was more in group S than in group L (p<0.001). Post-operatively, the incidence and severity of sore throat were significantly higher in group S than in group L (p<0.001). Meanwhile, the incidence of hoarseness and nausea was comparable in the two groups. Continuous ETT cuff pressure monitoring helps to keep cuff pressure below tracheal mucosa capillary occlusion pressure. Filling the ETT cuff with alkalinized lignocaine further reduces extubation response and post-intubation morbidities.

A view on pediatric airway management: a cross sectional survey study.

This survey aimed to investigate routine practices and approaches of clinicians on pediatric airway in anesthesia and intensive care medicine. A 20-question multiple-choice questionnaire with the possibility to provide open text answers was developed and sent. The survey was sent to the members of European Airway Management Society via a web-based platform. Responses were analyzed thematically. Only the answers from one representative of the pediatric service of each hospital was included into the analysis. Among the members, 143 physicians responded the survey, being anesthesiologists (83.2%), intensivists (11.9%), emergency medicine physicians (2.1%), and (2.8%) pain medicine practitioners. A straight blade was preferred by 115 participants (80.4%) in newborns, whereas in infants 86 (60.1%) indicated a curved blade and 55 (38.5%) a straight blade. Uncuffed tracheal tube were preferred by 115 participants (80.4%) in newborns, whereas 24 (16.8%) used cuffed tubes. Approximately 2/3 of the participants (89, 62.2%) reported not to use routinely a cuff manometer in their clinical practice, whereas 54 participants (37.8%) use it routinely in pediatric patients. Direct laryngoscopy for routine pediatric tracheal intubation was reported by 127 participants (88.8%), while 16 (11.2%) reported using videolaryngoscopes routinely. Interestingly, 39 (27.3%) had never performed neither videolaryngoscopy nor flexible bronchoscopy in children. These results were significantly less in hospitals with a dedicated pediatric anesthesiologist. This survey on airway management in pediatric anesthesia revealed that the use of cuffed tubes and the routine monitoring of cuff pressure are rare. In addition, the rate of videolaryngoscopy or flexible optical intubation was low for expected difficult intubation. Our survey highlights the need for properly trained pediatric anesthesiologists working in-line with updated scientific evidence.

Successful airway management in a patient with left parapharyngeal and retropharyngeal abscess with mediastinal extension during COVID-19 pandemic

Acute airway compromise caused by a deep neck space abscess significantly contributes to the morbidity and mortality, and it requires quick identification and rapid treatment.1 Parapharyngeal and retropharyngeal abscesses affect 2.64 persons out of 100,000 population. The incidence in males and females is 3.34 and 1.94 per 100,000 people, respectively.2 Of note, the abscess might increase the patient’s susceptibility to COVID-19 infection. In order to limit COVID-19 transmission in such patients, an advanced treatment plan is required.3 We share the anesthetic airway management of a high-risk airway case during the current COVID-19 pandemic.&#x0D; Key words: airway management; COVID-19; abscess, parapharyngeal; abscess, retropharyngeal; video-assisted thoracoscopy; Surgery, thoracic&#x0D; Citation: Hehsan MR, Shukeri WFWM, Chettiar RSRMS, Abidin HZ. Successful airway management in a patient with left parapharyngeal and retropharyngeal abscess with mediastinal extension during COVID-19 pandemic. Anaesth. pain intensive care 2021;26(1):128-129.&#x0D; DOI: 10.35975/apic.v26i1.1784

Abstract No.: ABS1016: Comparison of clinical performance of I-GEL and LMA blockbuster in adult patient during general anaesthesia: a comparative randomised trial

Background & Aims:LMA BLOCKBUSTER is relatively newer second generation supraglottic device.There are various meta analysis comparing I-GEL and LMA SUPREME.However we conducted this study to compare clinical performance of I-GEL and LMA BLOCKBUSTER regarding oropharyngeal leak pressure and time for successful insertion.Methods:After getting approval from institutional ethical committee and getting CTRI registered, a total of 62 adult patients of American Society of Anesthesiologists physical status I/II between 20-60 years undergoing procedures for whichsupraglottic devices are used routinely, were included in this prospective randomised controlled trial and randomised into 2 groups by a computer generated random number sequence (Group I receiving I-GEL and Group L receiving LMABLOCKBUSTER) of 32 cases in each group. We compared oropharyngeal leak pressure and time for successful insertion onfirst attempt by visible end-tidal carbon dioxide (EtCO2) graph on the monitor.Results:Patients of both groups were comparable with each other in baseline demographic profile. Oropharyngeal leak pressure ofpatients of Group L (24.59±2.76 cmH2O) was found to be significantly higher as compared to Group I (20.60±2.33cmH2O) with p value <0.001. Whereas mean time of insertion of device was lesser in Group I (13.50±2.62 seconds) thanthat of Group L (14.09±2.01 seconds) yet this difference was not found to be statistically significant (p value=0.319)Conclusion:Both I-GEL and LMA BLOCKBUSTER can be used safely and effectively in terms of airway management in adult patientsundergoing general anaesthesia. Compared with commonly used supraglottic device I-GEL, LMA BLOCKBUSTER has higher oropharyngeal leak pressure and therefore provides high quality of airway sealing, but with lesser mean time of insertion for I-GEL.

Preliminary evaluation of SaCoVLM\u2122 video laryngeal mask airway in airway management for general anesthesia

BackgroundTo preliminary evaluate the application of SaCoVLM™ video laryngeal mask airway in airway management of general anesthesia.MethodsWe recruited 100 adult patients (ages 18–78 years, male 19, female 81, weight 48–90 kg) with normal predicted airway (Mallampati I ~ II, unrestricted mouth opening, normal head and neck mobility) and ASA I-II who required general anaesthesia. The SaCoVLM™ was inserted after anesthesia induction and connected with the anesthesia machine for ventilation. Our primary outcome was glottic visualization grades. Secondary outcomes included seal pressure, success rate of insertion, intraoperative findings (gastric reflux and contraposition), gastric drainage and 24-h complications after operation.ResultsThe laryngeal inlet was exposed in all the patients and shown on the video after SaCoVLM™ insertion. The status of glottic visualization was classified: grade 1 in 55 cases, grade 2 in 23 cases, grade 3 in 14 cases and grade 4 in 8 cases. The first-time success rate of SaCoVLM™ insertion was 95% (95% CI = 0.887 to 0.984), and the total success rate was 96% (95% CI = 0.901 to 0.989). The sealing pressure of SaCoVLM™ was 34.1 ± 6.2 cmH2O and the gastric drainage were smooth. Only a small number of patients developed mild complications after SaCoVLM™ was removed (such as blood stains on SaCoVLM™ and sore throat).ConclusionsThe SaCoVLM™ can visualize partial or whole laryngeal inlets during the surgery, with a high success rate, a high sealing pressure and smooth gastroesophageal drainage. SaCoVLM™ could be a promise new effective supraglottic device to airway management during general anesthesia.Trial registrationChiCTR,ChiCTR2000028802.Registered 4 January 2020.

Airway management in general anesthesia for endovascular treatment of cerebral arteriovenous malformation: a retrospective observational study

Background and objectiveThis retrospective and observational study aimed to retrospectively evaluate the use of the endotracheal tube (ETT) and the Laryngeal Mask Airway (LMA) for the airway management with respect to airway safety, hemodynamic stability, adverse respiratory events, and recovery characteristics in patients who underwent endovascular treatment (EVT) for cerebrovascular arteriovenous malformation under general anesthesia between 2011 and 2018. MethodsThe study included data from the patient's electronic medical records and anesthesia files. The primary outcome measure was the incidence of hemodynamic disturbances and respiratory adverse events during airway management. The secondary outcome measure was the comparison of recovery characteristics. ResultsThe airway was secured using ETT in 41 patients and LMA in 39 patients. Airway safety was established in all patients without a complication throughout the procedure. Mean arterial blood pressure and heart rate were increased to > 20% of baseline levels at intubation and extubation periods in more patients in the ETT group than the LMA group (27 vs. 3; p = 0.07, and 11 vs. 2; p = 0.021). Respiratory adverse events including straining and coughing were observed in ten patients in the ETT group but only in one patient in the LMA group (p = 0.013). Time to extubation, to neurological assessment, and to discharge from the angiography unit were similar (p > 0.05). ConclusionIt was concluded that LMA provided sufficient airway safety as with ETT and may be used as an alternative to ETT for EVTs under general anesthesia.

Development of a Novel Anesthesia Airway Management Robot.

Non-invasive positive pressure ventilation has attracted increasing attention for air management in general anesthesia. This work proposes a novel robot equipped with two snake arms and a mask-fastening mechanism to facilitate trachea airway management for anesthesia as well as deep sedation and to improve surgical outcomes. The two snake arms with supporting terminals have been designed to lift a patient’s jaw with design optimization, and the mask-fastening mechanism has been utilized to fasten the mask onto a patient’s face. The control unit has been developed to implement lifting and fastening force control with safety and robustness. Loading experiments on the snake arm and tension experiments on the mask-fastening mechanism have been performed to investigate and validate the performances of the proposed anesthesia airway management robot. Experiments on a mock person have also been employed to further verify the effectiveness and reliability of the developed robot system. As an early study of an anesthesia airway management robot, it was verified as a valid attempt to perform mask non-invasive positive pressure ventilation technology by taking advantage of a robotic system.

Comparative Evaluation of Dexmeditomidine Fentanyl in Terms of Cardiovascular Stress Response During Anesthetic Airway Management in Major Surgical Procedures

Background- airway management both in operation theatre and during emergencies remains challenge because of cardiovascular stress response &amp; inflammatory mediators during procedure exhilarating the stress response itself leading to catastrophic events. This study is aimed to evaluate comparative efficacy of dexmedetomidine over fentanyl because of it have not only as sympatholytic also as anti-inflammatory properties. Study was orchestrated at tertiary care centre in western India after approval of institutional scientific &amp; ethical committee. Methodology Study group include 50 patients of either sex aged between 18 to 55 years who were admitted for major surgical procedure and given consent for inclusion. Study group divided in two group for record &amp; statistical analysis of parameters like heartrate, mean arterial pressure at various interval during surgery to ascertain the superiority of dexmedetomidine vs fentanyl in stabilizing cardiovascular stress response.

Simulation and evaluation of the protective barrier enclosure for cardiopulmonary resuscitation

IntroductionThe COVID-19 pandemic has presented a significant challenge for infection prevention and control during airway management in anaesthesia and critical care. The protective barrier enclosure has been described and studied particularly for perioperative anaesthesia use. The potential use of the protective barrier enclosure during cardiopulmonary resuscitation has been poorly explored in the current literature. This work aims to demonstrate the potential of protective barrier enclosure in limiting aerosol dispersion during cardiopulmonary resuscitation delivery. MethodsA proof-of-concept simulation study was conducted to evaluate the protective properties of the protective barrier enclosure during cardiopulmonary resuscitation. Aerosol was simulated using a fluorescent dye trapped within the manikin. Three different methods of cardiopulmonary resuscitation delivery with a protective barrier enclosure applied over the manikin’s head were conducted. The first method simulated a chest compression only cardiopulmonary resuscitation, the second method also used chest compressions only, with a face mask fitted on the victim, while the third method, the victim was given chest compression and bag-valve-mask ventilation by two rescuers. ResultsIn the first method, release of aerosol from the manikin’s mouth was observed during chest compression, while in second method, most of the aerosol was trapped within the face mask, with only minor leaking. However, when bag-valve-mask ventilation was delivered, the aerosol leaked out at high speed around the bag-valve-mask seal. No aerosol condensation was found outside of the protective barrier enclosure in all scenes. ConclusionProtective barrier enclosure may reduce aerosol exposure to the rescuers during out-of-hospital cardiac arrest.

Current practice of thoracic anaesthesia in Europe \u2013 a survey by the European Society of Anaesthesiology Part I \u2013 airway management and regional anaesthesia techniques

BackgroundThe scientific working group for “Anaesthesia in thoracic surgery” of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) has performed an online survey to assess the current standards of care and structural properties of anaesthesia workstations in thoracic surgery.MethodsAll members of the European Society of Anaesthesiology (ESA) were invited to participate in the study.ResultsThoracic anaesthesia was most commonly performed by specialists/board-certified anaesthetists and/or senior/attending physicians. Across Europe, the double lumen tube (DLT) was most commonly chosen as the primary device for lung separation (461/ 97.3%). Bronchial blockers were chosen less frequently (9/ 1.9%).Throughout Europe, bronchoscopy was not consistently used to confirm correct double lumen tube positioning. Respondents from Eastern Europe (32/ 57.1%) frequently stated that there were not enough bronchoscopes available for every intrathoracic operation. A specific algorithm for difficult airway management in thoracic anaesthesia was available to only 18.6% (n = 88) of the respondents. Thoracic epidural analgesia (TEA) is the most commonly used form of regional analgesia for thoracic surgery in Europe. Ultrasonography was widely available 93,8% (n = 412) throughout Europe and was predominantly used for central line placement and lung diagnostics.ConclusionsWhile certain „gold standards “are widely met, there are also aspects of care requiring substantial improvement in thoracic anaesthesia throughout Europe.Our data suggest that algorithms and standard operating procedures for difficult airway management in thoracic anaesthesia need to be established. A European recommendation for the basic requirements of an anaesthesia workstation for thoracic anaesthesia is expedient and desirable, to improve structural quality and patient safety.

Perioperative airway complications in infants and children with Crouzon and Pfeiffer syndromes: A single-center experience.

Crouzon and Pfeiffer syndromes are rare genetic disorders characterized by craniosynostosis, exorbitism, and maxillary hypoplasia. Patients with these syndromes frequently require general anesthesia for various diagnostic and surgical procedures and may present a challenge to anesthetists with regard to airway management. The primary aim of this study was to determine the incidence, timing, and management of perioperative upper airway obstruction in infants and children with Crouzon and Pfeiffer syndromes. The secondary aim was to determine the degree of difficulty in performing endotracheal intubation. A retrospective review of 812 anesthetic encounters in 67 patients was conducted. The following were recorded: timing and management of episodes of perioperative upper airway obstruction, from induction of anesthesia to discharge from recovery, degree of difficulty with laryngoscopy using the Cormack-Lehane grading system and number of intubation attempts required, patient demographics, respiratory comorbidity, surgical procedure, and anesthetic airway management techniques. Upper airway obstruction at induction of anesthesia was very common, with an incidence of 31% (167/542 anesthetic encounters affecting 54 patients). In a quarter of these incidents, bag-valve-mask ventilation was challenging, but a laryngeal mask airway was almost always effective. Upper airway obstruction on emergence from anesthesia was less common, with an incidence of 2.7% (14/515 anesthetic encounters affecting 10 patients). Contributing factors included patient comorbidity (obstructive sleep apnea, nasal stenosis) and the nature of surgery (craniofacial or airway procedures). Intubation was rarely difficult in this cohort, with 85% of laryngoscopies rated Cormack-Lehane grade 1 or 2 (n=373), and 89% of intubations successful on the first attempt (n=306). Upper airway obstruction at induction of anesthesia is common in patients with Crouzon and Pfeiffer syndrome. These patients are likely to present some difficulties with perioperative airway management, especially bag-valve-mask ventilation, but rarely endotracheal intubation.

Intracuff alkalinized lignocaine improves endotracheal tube induced emergence phenomenon

Background: Endotracheal intubation for airway management in general anaesthesia is associated with post intubation morbidities due to prolonged inflation of the ETT cuff with air. Lidocaine by instillation in the ETT cuff and its diffusion through semipermeable membrane causes reduction in mucosal irritation and inflammation. Objectives To compare the endotracheal tube (ETT) cuff pressure inflated with air or alkalinized lignocaine during anaesthesia and evaluate clinical symptoms such as coughing and sore throat (postoperative sore throat [POST]) following tracheal extubation. Material and Methods: This was a prospective randomized controlled study conducted over a period of 6 months. We included 60 patients in age group of 18–55 years posted for elective laparoscopic operative gynecological surgeries of duration more than 90 min under general anaesthesia with N2O‑O2 mixture. Patients were randomized using computer‑generated randomization table into air and lignocaine group. The ETT cuff was inflated with air or alkalinized lignocaine (2% lignocaine with 7.5% sodium bicarbonate, in the proportions of 19.0:1.0 ml) to the volume that prevented air leak using cuff pressure manometer. After extubation, an independent observer blinded to study group recorded the presence or absence of coughing and POST at immediately, 1,6,12h and 24 h postoperatively. Results: Demographic data, baseline characteristics (American Society of Anaesthesiologists grade, intracuff volume/cuff pressure at start of surgery), and duration of anaesthesia were comparable among study groups (P>0.05). Cuff pressure and volume achieved in the end of surgery were much noteworthy higher in air group as compared to lignocaine group (P < 0.0001). Incidence of coughing and POST at immediately, 1,6,12h and 24 h postoperatively was significantly higher in air group compared to lignocaine group. Conclusion: This study showed the significance of use of alkalinized 2% lignocaine in prevention of rise of cuff pressure and incidence of coughing and POST.

From expert opinion recommendations to tailored airway management in thoracic anesthesia

From expert opinion recommendations to tailored airway management in thoracic anesthesia

Regional anesthesia in coronavirus disease 2019 pandemic.

Purpose of reviewCoronavirus disease 19 (COVID-19) has presented numerous challenges to healthcare systems worldwide. The virus is highly contagious and infectious since transmission can occur via multiple routes. General measures to prevent viral transmission to patients and healthcare personnel, such as a reduction in clinical load and routine testing, must be coupled with multiple additional safety measures in perioperative services.Recent findingsRegional anesthesia preserves respiratory function and reduces aerosol-generating procedures typically associated with airway management in general anesthesia, making it the first choice for a suspected or confirmed COVID-19 patient in need of surgery with anesthesia. A well thought out regional anesthetic plan, implementation of hygiene and (personal) safety measures are necessary to ensure the best possible outcome for both the patient and the healthcare staff.SummaryThe present review addresses both practical and recommended measures for performing regional anesthesia in the pandemic, to ensure patient and staff safety, and equipment protection. Further research and evidence-based guidelines are necessary to devise an established standard of care during the current COVID-19 and possible future pandemics.

Anesthesia airway management for tracheal resection and reconstruction: a single-center case series.

Anesthesia airway management is challenging during tracheal resection and reconstruction as these surgical procedures involve the airway. This case series describes four approaches to airway management in patients undergoing tracheal resection and reconstruction and discusses their advantages and disadvantages. Thirteen patients underwent 1 of the following 4 kinds of airway management techniques during tracheal resection and reconstruction between 2013 and 2019: intubation, intubation with high frequency jet ventilation (HFJV), non-intubation, and venovenous extracorporeal membrane oxygenation (VV-ECMO). Intraoperative variables and postoperative outcomes were compared for the techniques based on our institution's medical electronic database. Intraoperative oxygenation management involved VV-ECMO in 8 patients, intubation in 2 patients, intubation with HFJV in 2 patients, or non-intubation in 1 patient. The lowest peripheral oxygen saturation (SpO2) in 4 patients was below 90%. Three patients were extubated in the operation room after complete recovery of spontaneous respiration. Most patients were admitted to the intensive care unit for further postoperative treatment, except 1 patient who received laryngeal mask airway management without tracheal intubation during surgery. Two patients died, 1 due to severe anastomotic leakage and the other from acute respiratory distress syndrome. In addition, another patient showed complications with oozing from the wound. Our clinical experience suggests that there is no single airway strategy universally suitable for all tracheal surgeries. The choice of airway management strategy is best determined by multifactorial assessment of advantages and disadvantages according to preoperative comorbidities, unique features of the obstructive mass, surgical experience, and patient preference.

A quantitative evaluation of aerosol generation during tracheal intubation and extubation.

SummaryThe potential aerosolised transmission of severe acute respiratory syndrome coronavirus‐2 is of global concern. Airborne precaution personal protective equipment and preventative measures are universally mandated for medical procedures deemed to be aerosol generating. The implementation of these measures is having a huge impact on healthcare provision. There is currently a lack of quantitative evidence on the number and size of airborne particles produced during aerosol‐generating procedures to inform risk assessments. To address this evidence gap, we conducted real‐time, high‐resolution environmental monitoring in ultraclean ventilation operating theatres during tracheal intubation and extubation sequences. Continuous sampling with an optical particle sizer allowed characterisation of aerosol generation within the zone between the patient and anaesthetist. Aerosol monitoring showed a very low background particle count (0.4 particles.l−1) allowing resolution of transient increases in airborne particles associated with airway management. As a positive reference control, we quantitated the aerosol produced in the same setting by a volitional cough (average concentration, 732 (418) particles.l−1, n = 38). Tracheal intubation including facemask ventilation produced very low quantities of aerosolised particles (average concentration, 1.4 (1.4) particles.l−1, n = 14, p < 0.0001 vs. cough). Tracheal extubation, particularly when the patient coughed, produced a detectable aerosol (21 (18) l−1, n = 10) which was 15‐fold greater than intubation (p = 0.0004) but 35‐fold less than a volitional cough (p < 0.0001). The study does not support the designation of elective tracheal intubation as an aerosol‐generating procedure. Extubation generates more detectable aerosol than intubation but falls below the current criterion for designation as a high‐risk aerosol‐generating procedure. These novel findings from real‐time aerosol detection in a routine healthcare setting provide a quantitative methodology for risk assessment that can be extended to other airway management techniques and clinical settings. They also indicate the need for reappraisal of what constitutes an aerosol‐generating procedure and the associated precautions for routine anaesthetic airway management.