Anesthesia Intubation Research Articles

Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children

BackgroundsTo preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children.MethodsOne hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation.ResultsThe first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04–1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03–1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia.ConclusionThe SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management.Trial registrationThis study was approved by the University’s Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn. Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Mediastinal emphysema caused by tracheal tube replacement during the operation of laryngeal cancer complicated with tracheal diverticulum: a case report

The incidence of the tracheal diverticulum is low, and its risk to surgery and anesthesia has not been emphasized. This article reports a case of laryngeal cancer complicated with tracheal diverticulum, which was successfully rescued after mediastinal emphysema caused by the intraoperative replacement of a tracheal catheter. Operations such as anesthesia intubation may lead to severe complications such as pneumothorax due to diverticulum rupture, and the surgical team should pay more attention to the tracheal diverticulum.

Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial

BackgroundCiprofol is a novel 2, 6-disubstituted phenolic derivative anesthetic that binds to the gamma-aminobutyric acid-A receptor.AimTo determine the equally potent dose of ciprofol compared with propofol as an induction agent for general anesthesia in patients undergoing selective surgery, and to assess its safety.MethodA total of 109 patients undergoing selective non-emergency, non-cardiothoracic or non-neurosurgical surgery requiring tracheal intubation for general anesthesia were enrolled. Ten patients per group were assigned to ciprofol-0.3, 0.4 and 0.5 mg/kg, and propofol-2.0 or 2.5 mg/kg groups, respectively to receive an intravenous bolus dose. An additional 20 patients were enrolled in the ciprofol-0.3, 0.5 or propofol-2.0 mg/kg groups. The primary outcome was the success rate of induction defined as a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) ≤ 1 after the initial bolus dose. The secondary outcomes included the time to reach MOAA/S ≤ 1, the time to loss of the eyelash reflex, the incidences and severity of adverse events (AEs).ResultsThe success rates were 100% for all 5 groups. The mean time to MOAA/S ≤ 1 and the time to loss of the eyelash reflex were not different among the 5 groups, regardless of whether a top-up dose was needed. There were no significant differences in the incidences and severity of AEs in the dose ranges investigated of ciprofol vs. propofol.ConclusionThe efficacy and safety of a single bolus dose of ciprofol-0.5 mg/kg for the general anesthesia induction in selective surgery patients was comparable to that of propofol-2.0 mg/kg.Trial registrationClinicaltrials.gov, NCT03698617, retrospectively registered.

Ciprofol: A Novel Alternative to Propofol in Clinical Intravenous Anesthesia?

Ciprofol is a novel compound that was independently developed in China. According to the Chinese product instructions approved by the China National Medical Products Administration and the information of official website, indications for ciprofol include sedation and anesthesia during the surgical/procedure of nontracheal intubation, induction and maintenance of general anesthesia, and sedation during intensive care. Ciprofol is a short-acting intravenous sedative based on the structural modification of propofol. Ciprofol has high efficacy, good selectivity, and fewer adverse reactions, indicating good clinical application potential. A series of clinical studies have been conducted to evaluate the sedative effect of ciprofol in various procedures and settings, including gastroscopy and colonoscopy, fiber-optic bronchoscopy, general anesthesia in elective surgeries, and mechanical ventilation in intensive care units. This review summarizes the chemical structure, pharmacodynamics, and pharmacokinetic properties of ciprofol. We also assessed the efficacy and safety of ciprofol by synthesizing the relevant clinical trial data.

Retracted: Implementation of Evidence in Preventing Postoperative Sore Throat of Patients Undergoing General Anesthesia Intubation Using the i-PARIHS Framework.

[This retracts the article DOI: 10.1155/2022/3151423.].

A Comparison of Air-Q and I-Gel in Terms of Insertion Conditions and as Intubating Aids for Elective Surgeries under General Anaesthesia

BACKGROUND
 Supraglottic airway devices (SAD) like air Q and I-Gel are widely used in place of tracheal intubation for general anaesthesia. The present study was undertaken to compare the insertion conditions of these two supraglottic airway devices and as conduits for endotracheal tube (ETT) insertion in adult patients undergoing elective surgeries.
 METHODS
 100 patients belonging to American Society of Anaesthesiologists (ASA) grade 1 and 2 between 18 to 70 years were randomly divided into 2 groups of 50 each. In group A, Air-Q was used and in group B, I-gel. The following parameters were compared while inserting SAD and endotracheal tube (ETT): number of insertion attempts, insertion time, ease of insertion, intraoperative and postoperative complications.
 RESULTS
 Insertion in first attempt was 90 % in air- Q and 72 % in I-gel. The mean time of insertion for air-Q was 7.28 1.46 seconds which was shorter as compared to I-gel which was 8.46 2.18 seconds (p = 0.002). Air Q was easy to insert in 93 % cases and I-Gel in 52 % cases. ETT insertion through Air-Q was easy when compared to I-Gel .Complications occurred in some patients in both the groups.
 CONCLUSIONS
 We concluded that Air-Q has better efficacy than I-gel in terms of insertion conditions and as a conduit for endotracheal intubation.

Eight-year single-center experience with transcatheter aortic valve implantation (TAVI)

The first TAVI implantation was performed in 2002 by Cribier and colleagues. From then, we have seen significant progress in technology, with the appearance of new generations – lower-profile, longer-lasting and more stable during positioning TAVI prostheses. The present publication presents single-center results and experience with TAVI procedures over an eight-year period. During the period 2013 – November 2022 a total of 354 TAVI procedures were performed in Acibadem City Clinical Cardiovascular Center. Two operating strategies are used – standard and minimalist approach. From the first procedure in 2013 until mid-2018 the standard approach (surgical vascular access, general anesthesia, direct valve implantation where possible) was mostly used. Then, the minimalist approach (percutaneous access, no intubation anesthesia, mandatory valve predilation and use of rapid pacing) was introduced as a standard approach in the center.

Comparison of two techniques of airway anaesthesia for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway

Introduction: The success of awake fibreoptic assisted intubation often depends on the adequacy of anaesthesia of the airway and patient comfort for the procedure. Aim: To compare the standard technique (nerve block) of airway anaesthesia with simple aspiration of lignocaine. Methods: Thirty patients in whom difficult airway was anticipated were randomly allocated into either Group A (Aspiration) and Group B (Nerve block). In Group A, 0.2 mL/kg of 1.5% lignocaine was trickled on to the dorsum of the tongue while the patient was encouraged to breathe through the mouth. In Group B, superior laryngeal nerve block and intratracheal injection of lignocaine was used. Fibreoptic bronchoscopy was then carried out by a consultant anaesthesiologist, who was blinded to the local anaesthetic technique used. The patient responses to instrumentation of pharynx, glottis and trachea, and tolerance of the endotracheal tube were noted. Results: Two cases were excluded from the study because of bleeding resulting in subsequent loss of visualisation of glottis through bronchoscope. There was no statistical or clinical difference in the patient responses between the two groups (P > 0.05) due to fibreoptic bronchoscope in the pharynx, larynx and endotracheal tube in the trachea or with regard to the use of rescue medications. Conclusions: Aspiration of 1.5% lignocaine (0.2 mL/kg) provides clinically comparable conditions for intubation as the nerve block technique for awake fibreoptic nasotracheal intubation in patients with anticipated difficult airway.

The short-term outcomes of nonintubated anesthesia compared with intubated anesthesia in single-port video-assisted lung surgery in enhanced recovery after thoracic surgery: results from a single-center retrospective study.

Nonintubated anesthesia avoids invasive tracheal intubation operations and reduces trauma. in addition, it has advantages in lung surgery in some patients with poor lung function, in line with the concept of rapid recovery. However, few studies have discussed the clinical significance of Enhanced recovery after surgery (ERAS) combined with nonintubated anesthesia in single-port video-assisted thoracoscopic surgery (VATS). We conducted a retrospective study to examine the safety and availability of nonintubated anesthesia single-port video-assisted lung surgery (NI-SP-VALS) combined with ERAS programs in patients. This was a single-center retrospective study. All patients were preoperatively diagnosed with lung nodules and underwent NI-SP-VALS or intubated anesthesia SP-VALS (I-SP-VALS) combined with ERAS programs between July 2021 and March 2022. Short-term postoperative outcomes were compared in 2 cohorts. In total, 272 patients were included. Among them, 91 patients received NI-SP-VALS combined with ERAS programs (observation group), and 181 underwent intubation anesthesia (control group). Baseline data were statistically different between the two groups, and 1:1 propensity score matching (PSM) matching was used. A total of 73 patients remained in each group after PSM, and baseline characteristics were not significantly different between the 2 cohorts. The time of hospital stay [4.00 (4.00-5.00) vs. 44.50 (0.00-5.75) d; P=0.029] and catheter stay [0.50 (0.20-2.00) vs. 2.00 (2.00-2.00) d; P<0.001] were significantly shorter, the white blood cell count (WBC) [9.45 (8.08-11.30) vs. 11 (8.50-12.80)/L; P=0.009] and the lowest SpO2 in operation [96.00 (94.00-97.50) vs. 97.00 (95.00-98.50); P=0.035] were also lower in the nonintubated group than those of the intubated group. No differences were observed in variables of intraoperation, other routine blood indexes, postoperative drainage, postoperative medicine use, postoperative symptoms, complications, hospitalization expenses, postoperative follow-up index, or self-assessment of anxiety. The data after PSM shows that compared with intubated anesthesia, NI-SP-VALS combined with ERAS programs is safe and effective. Nonintubated anesthesia promotes rapid recovery of patients and reduces postoperative inflammatory reactions. Hence, nonintubated anesthesia may conform to the idea of ERAS and has application value in thoracic surgery.

Electroacupuncture as an effective therapy for Tapia’s syndrome after transoral intubation for general anesthesia: a case report and review of the literature

BackgroundTapia’s syndrome is a rare complication of airway manipulation under general anesthesia. Injuries to the vagus nerve (X) and hypoglossal nerve (XII) during transoral intubation are the primary cause of the disease. The typical symptoms include hoarseness, dysarthria, dysphagia, tongue muscle atrophy, and tongue deviation toward the affected side. We report a case of Tapia’s syndrome treated with electroacupuncture to accelerate the recovery process, and discuss the potential mechanism behind our findings based on previous research.Case presentationIn this report, we describe a 57-year-old Chinese man who suffered Tapia’s syndrome after craniotomy evacuation of hematoma with general anesthesia and transoral intubation. After 52 days of electroacupuncture therapy along with standard swallowing training, the patient achieved significant improvement in deglutition and speech function.ConclusionElectroacupuncture is effective and safe for Tapia’s syndrome. It can shorten the recovery time when combined with routine swallowing rehabilitation.

A Comparison of the Effectiveness of Videolaryngoscopy and Macintosh Laryngoscopy in Intubation Attempts on Adult Patients.

This study aimed to compare the effectiveness of videolaryngoscopy and Macintosh laryngoscopy on adult patients who were scheduled for elective surgery under general anaesthesia. Of the 200 adult patients who were scheduled to undergo general anaesthesia, 100 were intubated with a videolaryngoscope and 100 with a Macintosh laryngoscope. The patients' age, sex, American Society of Anesthesiologists score, height, weight, body mass index, smoking and alcohol habits, comorbidity, and neck circumference were recorded. Their El-Ganzouri Risk Index score, which considers the parameters of mouth opening, thyromental distance, Mallampati score, neck movement, propensity for prognathism, body weight, and history of difficult intubation, was also calculated and recorded. The time to achieve intubation was then recorded. The number of intubation attempts, number of cases of difficult intubation, Cormack-Lehane scores, and incidences of trauma or complication were also evaluated. The mean intubation time was found to be significantly lower in the videolaryngoscope group compared to the Macintosh laryngoscope group. Although the number of patients with difficult intubation was high in the videolaryngoscope group, when we evaluated their glottic view, the Cormack-Lehane score was found to be significantly lower. The number and ratio of complications due to intubation were lower in the videolaryngoscope group compared to the Macintosh laryngoscopy group. In patients undergoing endotracheal intubation for general anaesthesia, it was concluded that videolaryngoscopy is superior to Macintosh laryngoscopy as it enlarges the glottic view, shortens the time to achieve intubation, facilitates intubation, and has less risk of complications.

Surgical therapy of congenital nevi using power-stretching technique on the forehead.

Surgical therapy of congenital nevi using power-stretching technique on the forehead.

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

ObjectivesTo study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations.MethodsThis research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence.ResultsThis bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately.ConclusionIt is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

Retrospectively analyze and compare the efficacy and safety of thoracoscopic-assisted Nuss repair of pectus excavatum under intubation anesthesia and non-intubation anesthesia

Thoracoscopic-assisted Nuss repair is a commonly used method for treating pectus excavatum, which has always been performed under tracheal intubation and general anesthesia. However, general anesthesia with endotracheal intubation can produce intubation and anesthetic drug related complications. In non-intubation anesthesia, laryngeal mask is used instead of tracheal intubation without muscle relaxants and small doses of sedative and analgesic drugs. Therefore, non-intubation anesthesia can reduce complications and speed up postoperative recovery. This study retrospectively analyzed the clinical impact of these two anesthesia methods on thoracoscopic-assisted Nuss repair for the treatment of pectus excavatum. A total of 115 pectus excavatum patients who underwent thoracoscopic-assisted Nuss procedure repair in the Department of Thoracic Surgery of Yunnan First People's Hospital from January 2017 to January 2022 were included. All subjects in this study underwent thoracoscopic assisted Nuss repair in the same thoracic surgical team. According to different anesthesia methods, they were divided into non-intubation anesthesia group (n=62) and intubation anesthesia group (n=53). The intubation time, intraoperative mean heart rate, postoperative complications, postoperative first oral food intake, water intake, ambulation, defecation time, postoperative blood drawing results, postoperative hospital stay and total hospitalization cost were compared between the two groups. There were no significant differences in clinical characteristics and preoperative examination indexes between the two groups, which were comparable. Compared with the intubation anesthesia group, the non-intubation anesthesia group had less anesthesia intubation time, lower intraoperative mean heart rate, less postoperative complications, such as pneumothorax, pleural effusion, and lung infection. In the non-intubation anesthesia group, the first time to eat, drink, get out of bed, and defecate were all earlier. Routine blood results 24 h after surgery indicated that the non-intubation anesthesia group had lower white blood cell, neutrophil and lymphocyte, an earlier postoperative discharge time, and lower total hospitalization expenses. Non-intubation anesthesia in thoracoscopic-assisted Nuss procedure for the repair of pectus excavatum can make the postoperative recovery of patients faster and has better safety and efficacy.

Application and Research Progress of Video Double-lumen Tube in Thoracic Surgery

以电视辅助胸腔镜技术为代表的微创胸外科，已逐步取代传统胸外科技术成为肺部结节包括早期肺癌等在内治疗的首要选择方式。随着双腔支气管导管在临床的应用，实现患侧肺隔离技术，不仅为胸外科微创手术的普及提供了坚实的麻醉基础，也为手术快速而平稳的实施提供了保障。然而，相较于单腔管而言，双腔支气管导管的管径更粗，管身较硬且难以塑形，给麻醉插管带来了不便；此外，由于双腔支气管导管的左、右支气管结构不同，麻醉插管过程中错位的发生率也很高。随着可视双腔支气管导管（video double-lumen tube, VDLT）在临床上逐渐使用，近年来成为胸科手术中的关注热点。本文就VDLT在胸外科手术中的应用和研究进展做一综述。

Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry.

Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia. This study used data from an international observational registry, the Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways. The use of sedation versus general anesthesia for tracheal intubation were compared. The primary outcome was the first-attempt success of tracheal intubation. Secondary outcomes included the number of intubation attempts and nonsevere and severe complications. Propensity score matching was used with a matching ratio up to 1:15 to reduce bias due to measured confounders. Between 2017 and 2020, 34 hospitals submitted 1,839 anticipated difficult airway cases that met inclusion criteria for the study. Of these, 75 patients received sedation, and 1,764 patients received general anesthesia. Propensity score matching resulted in 58 patients in the sedation group and 522 patients in the general anesthesia group. The rate of first-attempt success of tracheal intubation was 28 of 58 (48.3%) in the sedation group and 250 of 522 (47.9%) in the general anesthesia group (odds ratio, 1.06; 95% CI, 0.60 to 1.87; P = 0.846). The median number of intubations attempts was 2 (interquartile range, 1 to 3) in the sedation group and 2 (interquartile range, 1, 2) in the general anesthesia group. The general anesthesia group had 6 of 522 (1.1%) intubation failures versus 0 of 58 in the sedation group. However, 16 of 58 (27.6%) sedation cases had to be converted to general anesthesia for successful tracheal intubation. Complications were similar between the groups, and the rate of severe complications was low. Sedation and general anesthesia had a similar rate of first-attempt success of tracheal intubation in children with difficult airways; however, 27.6% of the sedation cases needed to be converted to general anesthesia to complete tracheal intubation. Complications overall were similar between the groups, and the rate of severe complications was low.

Implementation of Evidence in Preventing Postoperative Sore Throat of Patients Undergoing General Anesthesia Intubation Using the i-PARIHS Framework.

Objective The aim of the study was to assess the effectiveness of the implementation of the best evidence in preventing postoperative sore throat in patients undergoing general anesthesia intubation. Methods The related topics of the postoperative sore throat of patients undergoing general anesthesia intubation were systematically searched in the database and evaluated using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Combined with clinical needs and evidence-based professional judgment, 20 pieces of evidence and 6 examination standards on the management process and evidence implementation plan for the prevention of postoperative sore throat in patients with general anesthesia intubation are summarized, implementing the best evidence into clinical practice in anesthesiology, general surgery, orthopedics, thoracic surgery, and gynecology. Results Nurses' knowledge scores and evidence compliance significantly improved after the implementation of the best evidence (P < 0.05); the incidence of the postoperative sore throat in patients undergoing general anesthesia intubation decreased from 41.7% to 28.1%. Conclusion The i-PARIHS framework effectively prevents postoperative sore throat in patients, providing an effective case for translating evidence into practice based on the i-PARIHS framework.

Diagnostic Accuracy of Mallampati Score in Patients under General Anesthesia Effect: A Cross Sectional Study.

Introduction: Difficult airway management has been linked to significant morbidityand death, and it is a fundamental and important problem for anesthesiologists.Traditional clinical predictors are used to examine the airway prior to surgery.Objectives: To compare the diagnostic accuracy of Mallampati score at both positions (supine and upright) with phonation to predict difficult laryngoscopy and intubation in patients after anesthesia administration.Methodology: This cross-sectional study was conducted at Department of Anesthesia, Dow University of Health Sciences/Civil Hospital Karachi from July 2019 to January 2020. Patients on list for elective surgeries (like ENT surgery, general surgery,ophthalmologic, neurosurgery, obstetric surgery, bypass surgery and orthopedicsurgery) under general anesthesia were selected. Mallampati score was estimatedwith certain conditions like full extension of head, wide open mouth and extrudedtongue with phonation at two positions i.e., supine position and upright position.Easy or difficult laryngoscopy and intubation was noted at both positions using Mallampati test.Results: Enrolled patients are of age between 20-80 years and of both genders i.e.,male and female. Sensitivity, specificity, negative predicted value, positive predictedvalue, and overall diagnostic accuracy of the Mallampati score at upright positionwas found to be 79%, 100%, 94%, 98% and 98% respectively. Sensitivity, specificity,negative predicted value, positive predicted value, and overall diagnostic accuracyof the Mallampati score at supine position was found to be 22%, 97%, 36%, 95%and 92% respectively.Conclusion: Patients with difficult laryngoscopy and intubation for general anesthesia have higher diagnostic accuracy of Mallampati score in upright position as compared to supine position with phonation.&#x0D; Keywords: Mallampati score, supine versus upright position with phonation, laryngoscopy, intubation.

Comparison of blind and endoscopic-guided orotracheal intubation on laryngeal and tracheal damage in domestic rabbits (Oryctolagus cuniculus)

ObjectiveTo compare blind and endoscopic-guided techniques for orotracheal intubation in rabbits and the number of intubation attempts with laryngeal/tracheal damage. Study designProspective, randomized experimental study. AnimalsA total of 24 healthy, intact female New Zealand White rabbits, weighing 2.2 ± 0.2 kg (mean ± standard deviation). MethodsRabbits were randomly assigned to blind (group B) or endoscopic-guided (group E) orotracheal intubation with a 2.0 mm internal diameter uncuffed tube. Intramuscular (IM) alfaxalone (7 mg kg–1), hydromorphone (0.1 mg kg–1) and dexmedetomidine (0.005 mg kg–1) were administered, and additional IM alfaxalone (3–5 mg kg–1) and dexmedetomidine (0.025 mg kg–1) were administered to rabbits with strong jaw tone. An intubation attempt was defined as the advancement of the endotracheal tube from the incisors to the laryngeal entrance. Tracheal intubation was confirmed via capnography and anesthesia was maintained with isoflurane for 2 hours. Following euthanasia, laryngeal and tracheal tissues were submitted for histopathology. Quality of anesthesia for orotracheal intubation, intubation procedure and tissue damage were numerically scored. Data were analyzed using Poisson regression, Spearman’s correlation, t test, mixed anova, Mann–Whitney U test, Friedman and Chi square tests as appropriate. ResultsMedian (range) intubation attempts were 2 (1–8) and 1 (1–3) for groups B and E, respectively. More rabbits in group E (91.6%) required additional alfaxalone and dexmedetomidine than in group B (16.7%). Median (range) cumulative histopathology scores were 6 (3–10) and 6 (2–9) for groups B and E, respectively. Scores were highest in the cranial trachea, but there was no difference between groups and no correlation between laryngeal/tracheal damage and the number of intubation attempts. Conclusions and clinical relevanceBoth orotracheal intubation techniques were associated with laryngeal/tracheal damage. Although blind orotracheal intubation was associated with a higher number of attempts, the tissue damage was similar between groups.

Avoidance of routine endotracheal intubation and general anesthesia for primary closure of gastroschisis: a systematic review and meta-analysis.

Over the last few decades, several articles have examined the feasibility of attempting primary reduction and closure of gastroschisis without general anesthesia (GA). We aimed to systematically evaluate the impact of forgoing routine intubation and GA during primary bedside reduction and closure of gastroschisis. The primary outcome was closure success. Secondary outcomes were mortality, time to enteral feeding, and length of hospital stay. 12 studies were included: 5 comparative studies totalling 192 patients and 7 descriptive case studies totalling 56 patients. Primary closure success was statistically equivalent between the two groups, but trended toward improved success with GA/intubation (RR = 0.86, CI 0.70-1.03, p = 0.08). Mortality was equivalent between groups (RR = 1.26, CI 0.26-6.08, p = 0.65). With respect to time to enteral feeds and length of hospital stay, outcomes were either equivalent between the two groups or favored the group that underwent primary closure without intubation and GA. There are few comparative studies examining the impact of performing primary bedside closure of gastroschisis without GA. A meta-analysis of the available data found no statistically significant difference when forgoing intubation and GA. Foregoing GA also did not negatively impact time to enteral feeds, length of hospital stay, or mortality.