Intubation Research Articles

Application of Submandibular Intubation as Alternative to Elective Short-Term Tracheotomy for Particular Cases of Oral and Maxillofacial Tumors Resection and Defects Reconstruction

Objective: To describe the cases of oral and maxillofacial tumors (OMFT) resection and defects reconstruction under submandibular intubation (SMI) performed in our institution; secondly, to systematically review and analyze the characteristics of studies about SMI in oral and maxillofacial surgery to estimate the incidence rate of complication. Method: Data related to all 6 patients included in this study were prospectively collected from November 2016 to November 2023. The tract for endotracheal tube was created by bluntly dissection from the submandibular area to the floor of mouth. We performed an exhaustive search for studies about SMI using Pubmed, Embase, Proquest, and Chinese Biomedical Literature Database. Meta-analysis of the incidence rate of complication and infection was performed using STATA 14.1. Results: There was a male predominance (87.3%); the mean age was 47.8±16.8 years; squamous cell carcinoma (SCC) was the most frequent diagnosis (33.3%); the mean time of the operation was 237.0±65.2 minutes; the SMI procedure mean time was 5.5±0.9 minutes; and the mean time to extubation 133.3±12.5 minutes. No accident or complication was observed intraoperatively and postoperatively. The systematic review included 22 out of 234 studies screened. The meta-analysis showed an overall complication rate and superficial infection rate of 5.7% and 3.7% in the last 15 years versus 20.2% and 10.6% in over 15 years ago. Conclusion: Submandibular intubation was found technically easy, safe, and effective alternative of elective short-term tracheotomy, orotracheal and nasotracheal intubations in our series of OMFT resection and defects reconstruction.

Improvement of the Endotracheal Intubation Skill of Nurse Anesthesia Students Using Visual Self-evaluation in Iran: A Randomized Controlled Study

Background: One of the feedback methods is visual self-evaluation, which is a type of immediate feedback provided after a task. It is at the level of self-regulation. Mastery in learning requires accurate evaluation of clinical skills, and visual self-evaluation can help learners to master the stages of skill implementation. Objectives: The present study investigated the effect of visual self-evaluation on the endotracheal intubation skill of nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Methods: This randomized controlled study was conducted in April and May of 2023. 63 second- and third-year nurse anesthesia students were allocated to the intervention (visual self-evaluation) and control (conventional methods) groups according to the academic year, using stratified random sampling. The skill of endotracheal intubation was taught using visual self-evaluation method in the intervention group while the same skill was taught in the control group based on the conventional methods, i.e. lecture, practical training, and practice on the mannequin under the supervision of the instructor. Visual self-evaluation and conventional teaching methods were compared in terms of learning outcomes. The endotracheal intubation skill evaluation checklist developed by hart was used to evaluate endotracheal intubation skill. The students of the intervention group also completed a questionnaire to measure their satisfaction with the visual self-evaluation method. Results: The students with a mean age of 21.53 ± 3.65 years, participated in this study. About 73% of the participants were women. The mean scores of students in the post-test compared to the pre-test in both intervention (23.56 ± 2.68 at baseline and increased to 28.87 ± 4.80) and control (24.03 ± 2.22 at baseline and increased to 25.19 ± 2.46) groups increased significantly (P < 0.001), but the mean post-test scores of the intervention group were significantly higher than those of the control group (P < 0.001). Also, the mean satisfaction score in the intervention group was 40.79 ± 1.22 out of a maximum of 50, which indicates a very high satisfaction with the adoption of visual self-evaluation method in clinical education. Conclusions: The use of visual self-evaluation not only had a significant effect on improving the clinical skill of nurse anesthesia students but also was effective in helping them learn self-regulation and achieve mastery and independence. This method is recommended as a low-cost and effective method to be used along with other educational methods.

Airway management in pediatrics: improving safety

AbstractAirway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.

Prevalence of Atypical Bacteria in Patients from Different Paediatric Age Groups Diagnosed with a Respiratory Disease

Atypical bacterial pathogens present the ability to induce pulmonary damage. At present, there are no available phenotypic diagnosis tests that achieve up to 100% reliability. Therefore, clinicians must utilise molecular techniques for the detection and identification of these pathogens. The main objective of this research was to evaluate the prevalence of atypical bacteria in paediatric patients from different age groups. A total of 609 clinical samples were collected from paediatric patients who presented with an adverse respiratory condition during the period from March 2021 to February 2024. DNA was extracted from the samples, and end-point PCR was performed to detect atypical bacteria. Statistical analyses were performed to evaluate the bacterial prevalence and assess clinical data from newborns and mothers that could be related to RDS. A total of 139 patients exhibited at least one atypical organism (22.82%). Ureaplasma parvum was more prevalent in neonates, while M. pneumoniae and C. pneumoniae were more prevalent in older infants. Atypical bacteria can be present in all seasons of the year, but their prevalence increases during hot weather. Mixed infections due to atypical bacteria may occur. The risk factors related to the development of RDS are prematurity, low weight, and orotracheal intubation.

Efficacy and safety of remimazolam vs. propofol for general anesthesia with tracheal intubation: Systematic review and meta‑analysis

Efficacy and safety of remimazolam vs. propofol for general anesthesia with tracheal intubation: Systematic review and meta‑analysis

Practice and outcomes of endotracheal intubation in the emergency department: a retrospective observational study at a single institution in Bhutan

Abstract Background Airway management is a critical skill required in the Emergency Department (ED). We conducted an observational airway registry-based study to report the practice and outcome of endotracheal intubations in the ED at the national referral hospital in Thimphu. Methods All patients who were intubated in the ED and recorded on the registry data form between May 2020 to November 2022 were studied. Variables such as indications, type of physician performing intubations, success rate, complications, medications, and disposition were captured. Descriptive analysis was presented in frequency and proportions. Results There were a total of 336 intubations during the study period. First pass success rate was 87.80% and complication rate was 19.64%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt. Most intubations were performed by emergency medicine (EM) residents (54.17%), followed by medical officers (37.8%). Emergency Physician (EP) performed the least number of intubations, 27 (8.04%). During preoxygenation, 64.5% (n = 217) patients received positive pressure ventilations and 119 (35.42%) did not. Conclusion Physicians working in the ED are the primary airway provider. First pass success rate was 87.80%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt.

Comparison of dexmedetomidine, fentanyl, ketamine nebulization as an adjuvant to lignocaine for awake fibreoptic intubation: A randomised control trial

Comparison of dexmedetomidine, fentanyl, ketamine nebulization as an adjuvant to lignocaine for awake fibreoptic intubation: A randomised control trial

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation

Inadvertent kinking of a flexometallic endotracheal tube

Inadvertent kinking of a flexometallic endotracheal tube

Microbiological comparison of the disinfecting efficacy of small and large cotton swabs in nasotracheal intubation: a randomized trial.

Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy. Patients classified as American Society of Anesthesiologists-physical status (ASA-PS) class 1 or 2 scheduled for general anesthesia with NTI were randomly assigned to either a large cotton swabs (LCS) or fine cotton swabs (FCS) group in this randomized controlled trial (RCT)." After anesthesia, a fine cotton swab was inserted into the inferior nasal meatus in both groups to collect bacteria (sample A). Next, the nasal cavity was disinfected with LCS or FCS according to the patient group. Bacteria were collected by inserting a fine cotton swab into the inferior nasal meatus (sample B). After surgery, bacteria were collected from the endotracheal tube tip using a fine cotton swab in both groups (sample C). The samples were cultured for 24 hours, and the colonies from samples A-C were counted. The changes in bacteria count between samples A and B and samples A and C were determined. Nasal bleeding from cotton swab insertion was assessed as a secondary outcome. Student's t-tests, a chi-square independence test, and Mann-Whitney U tests were used for the statistical analysis. The statistical significance level was set at p < 0.05. Between samples A and B, the change in bacteria count was 7.2% (1.4-26.1%) (median[interquartile range]) in the LCS group and 6.9% (0.9-22%) in the FCS group (p = 0.90). Between samples A and C, the change in bacteria count was 7.5% (0.2-44%) in the LCS group and 8.3% (0.3-39%) in the FCS group (p = 0.55). We examined 62 subjects in each group (LCS and FCS), and samples A, B, and C were collected from all participants in both groups. Nasal bleeding occurred in 42/62 in the LCS group and 22/62 in the FCS group (p < 0.01). Cotton swab thickness did not impact disinfection efficacy, but large swabs increased the risk of nasal bleeding. We recommend FCS for nasal disinfection prior to NTI in ASA 1-2 patients, as they reduce bleeding risk without compromising disinfection. UMIN-CTR (registration no. UMIN000051495), June 30, 2023.

Early physiologic changes after awake prone positioning predict clinical outcomes in patients with acute hypoxemic respiratory failure.

The optimal physiologic parameters to monitor after a session of awake prone positioning in patients with acute respiratory failure are not well understood. This study aimed to identify which early physiologic changes after the first session of awake prone positioning are linked to the need for invasive mechanical ventilation or death in patients with acute respiratory failure. We performed a secondary analysis of a prospective cohort study of adult patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) treated with awake prone positioning. We assessed the association between relative changes in physiological variables (oxygenation, respiratory rate, pCO2 and respiratory rate-oxygenation [ROX] index) within the first 6h of the first awake prone positioning session with treatment failure, defined as endotracheal intubation and/or death within 7days. 244 patients [70 female (29%), mean age 60 (standard deviation [SD] 13) years] were included. Seventy-one (29%) patients experienced awake prone positioning failure. ROX index was the main physiologic predictor. Patients with treatment failure had lower mean [SD] ROX index at baseline [5 (1.4) versus 6.6 (2.2), p < 0.0001] and within 6h of prone positioning [5.6 (1.7) versus 8.7 (2.8), p < 0.0001]. After adjusting for baseline characteristics and severity, a relative increase of the ROX index compared to baseline was associated with lower odds of failure [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.25-0.54 every 25% increase]. Relative changes in the ROX index within 6h of the first awake prone positioning session along with other known predictive factors are associated with intubation and mortality at day 7.

Efficacy and safety of remimazolam tosylate for patients undergoing off-pump coronary artery bypass grafting: a study protocol for a non-inferiority randomised controlled trial in China

IntroductionMaintaining haemodynamic stability is crucial but challenging during the induction and maintenance of general anaesthesia (GA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Remimazolam tosylate is a novel...

Nasal Fiber-optic Intubation Training for Nurse Anesthesia Students Incorporating Deliberate Practice and Summative Assessment

Introduction Managing difficult airways and adverse respiratory events is critical for anesthesia providers. Fiber-optic intubation (FOI) is a strategic management approach in difficult airway situations. Clinical exposure to FOI can be limited, posing challenges for skill development. Simulation-based medical education offers a safe alternative for training. This study aims to evaluate the effectiveness of a simulation-based FOI training program for student registered nurse anesthetists (SRNAs) in an educational context. Methods A repeated measure study was conducted during the Pediatric Anesthesia Simulation for Student Nurse Anesthetists course at the Peter M. Winter Institute for Simulation, Education, and Research. One hundred twenty-three SRNAs participated in the FOI simulation program. For the analysis, students were stratified into 2 groups based on their performance in the summative testing of nasal FOI time. Baseline characteristics and the students' performance during the simulation were analyzed. Results Among the participants, 58 were categorized as “above median time” (AMT) and 65 as “below median time” (BMT) for FOI testing. No significant differences were observed in baseline characteristics. The AMT group exhibited longer mean times for summative testing FOI (50 vs. 26 seconds), first FOI attempt (97 vs. 78 seconds), and subsequent sets (third: 374 vs. 325 seconds, fourth: 323 vs. 268 seconds). Both groups showed performance improvement across training sets with reduced variability. Conclusions The simulation-based FOI training program effectively enhanced SRNA skill, with performance improvement during the training period. This study underscores the importance of simulation in anesthesia education, offering a safe and structured environment for skill development in FOI.

Changes of endotracheal tube cuff pressure and its indicators in laparoscopic resection of colorectal neoplasms: an observational prospective clinical trial.

Laparoscopic surgery is a popular alternative for resection of colorectal neoplasms. Carbon dioxide pneumoperitoneum and Trendelenburg positioning in procedure can significantly increase airway pressure, when endotracheal tube cuff pressure is not monitored. This prospective observational study aimed to evaluate indicators, changes and its correlation factors of endotracheal tube cuff pressure during laparoscopic resection of colorectal neoplasms. 122 patients scheduled for laparoscopic resection of colorectal neoplasms under propofol/remifentanil total intravenous anesthesia with orotracheal intubation were included. Tracheal tube cuff pressure was monitored continuously by calibrated pressure transducers. The ability of several predictors to predict out-of-range tracheal tube cuff pressure at different time points and its correlation factors were assessed. ROC analysis showed that waist-to-hip ratio has the highest AUC for predicting out-of-range tracheal cuff pressure (AUC: 0.86 [95% CI: 0.77-0.95]); Tracheal tube cuff pressure provided by palpation was 41.0 (29.0-53.3) cmH20. Cuff pressure was 33.7 ± 2.9 cmH20 at 15min and comparable at 30 and 45min after insufflation, all values were significantly higher than 25 cmH20 (p < 0.001). Multiple linear regression showed tracheal tube cuff pressure was associated with peak airway pressure (p < 0.001). Patients with normal BMI undergoing laparoscopic resection of colorectal neoplasms require continuous monitoring and timely adjustments of tracheal tube cuff pressure. Compared with BMI, waist-to-hip ratio is a better predictor of out-of-range tracheal tube cuff pressure. Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

BN SO46 - PANDORA's BOX- When anatomy trumps the pathology

Abstract Background Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible. Method After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure. Results Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh. Conclusion Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.

A rare case of endotracheal tube cuff leakage with no detectable decrease in cuff pressure.

Common causes of air leakage around an endotracheal tube include insufficient endotracheal tube cuff inflation and damage to the cuff, while damage to the pilot balloon or pilot balloon tubing is relatively rare. A 74-year-old female with vertebral osteomyelitis was scheduled for an extreme lateral interbody fusion followed posterior fixation. A fiber-optic light was utilized as part of the surgical illuminator. A sudden decrease in tidal volume and airway pressure was noted intraoperatively. We suspected leakage around the endotracheal tube cuff; however, no decrease in cuff pressure was detected. Despite the normal cuff pressure, we decided to inject a small amount of air which led to a significant increase in the cuff pressure. Upon careful inspection of the endotracheal tube, we discovered that the pilot balloon tubing was damaged as a result of thermal energy emitted by the fiber-optic light, which had ignited the surgical drape. The pilot balloon tubing was partially severed in which the section proximal to the endotracheal tube cuff was burned and punctured, causing the cuff leak. Meanwhile, the section proximal to the pilot balloon had melted and occluded the lumen, resulting in a falsely normal cuff pressure reading followed by an elevated cuff pressure when a small amount of air was injected into the pilot balloon during troubleshooting. Appropriate ventilation was resumed after extubation and re-intubation with a new endotracheal tube. We experienced an endotracheal tube cuff leakage caused by a damaged pilot balloon tubing due to thermal energy of the fiber-optic light. Our case report emphasizes the importance of suspecting damage to the endotracheal tube cuff and inflation system despite a normal cuff pressure reading, given that the measurement may be falsely elevated depending on the specific location of the damage. In addition, all operating personnel should be familiarized with safety warnings and cautions related to handling.

Predictors of adverse outcomes in patients with chronic obstructive pulmonary disease and pulmonary embolism and the predictive value of the simplified pulmonary embolism severity index

Objective: To explore the relevant factors associated with poor prognosis in patients suffering from chronic obstructive pulmonary disease (COPD) combined with pulmonary embolism (PE), and investigate the predictive value of the simplified pulmonary embolism severity index (sPESI) score on adverse outcomes in these patients. Methods: A total of 168 patients with COPD and PE who were treated at West China Hospital of Sichuan University from January 1, 2018, to December 30, 2020 were retrospectively included. Patients were divided into adverse outcome group and control group based on the occurrence of adverse outcomes [any of the following events: in-hospital death, intensive care unit (ICU) admission, and endotracheal intubation]. Correlation factors for poor prognosis were explored using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was employed to assess the predictive value of the sPESI score for adverse outcomes in COPD patients with PE. Results: A total of 168 patients were studied, with an age of (73.4±10.4) years and 119 male (70.8%). In the adverse outcome group, there were 18 cases (10.7%), including 12 in-hospital deaths, 6 ICU admission, and 1 endotracheal intubation. The control group comprised 150 cases (89.3%). Statistically significant differences were observed between two groups regarding the proportion of patients with diabetes, nephrotic syndrome, severe pneumonia, respiratory failure and lower extremity edema, and the pulse, diastolic blood pressure, pulse oxygen saturation, lactate dehydrogenase and cholesterol levels (all P<0.05). Multivariate logistic regression analysis revealed that severe pneumonia, respiratory failure, lower extremity edema, and diastolic blood pressure<60 mmHg (1 mmHg=0.133 kPa) are correlative factors of adverse outcomes in patients with COPD complicated by PE [OR (95%CI) were 7.363 (1.053-51.772), 4.077 (1.030-16.133), 4.490 (1.131-17.832), and 8.060 (1.209-53.918), respectively, all P<0.05]. The sPESI score in the adverse outcome group was higher than that in the control group [M (Q1, Q3), 2 (2, 2) vs 1 (1, 2) score, P=0.006]; the optimal cutoff value for sPESI score was 2 score, the sensitivity was 77.8%, the specificity was 54.0%, and the area under the curve (AUC) and 95%CI were 0.681 (0.554-0.809) based on the ROC curve analysis. Patients with sPESI≥2 score exhibited a 4.109-fold (95%CI: 1.292-13.063, P=0.017) increased risk of adverse prognosis compared to those with sPESI<2 score. Conclusions: Patients with COPD combined with PE have a higher incidence of adverse prognostic outcomes. Severe pneumonia, respiratory failure, lower limb edema, and diastolic pressure<60 mmHg are associated factors for poor prognosis. The sPESI score has some value in predicting adverse outcomes in COPD patients with PE.

Abstract 4144517: Feasibility of Deep Sedation for Catheter Ablation of Atrial Fibrillation Using Pulsed Field Ablation

Introduction: General anesthesia is commonly utilized during catheter ablation of atrial fibrillation (AF) in the United States, providing patient immobility and permitting esophageal temperature management for radiofrequency ablation. Pulsed field ablation (PFA) is associated with shorter procedure time, less risk of esophageal injury, and less dependence on catheter stability compared with radiofrequency ablation. There are limited data available on performing the procedure with deep sedation as an alternative to general anesthesia with endotracheal intubation. Methods: Consecutive patients who underwent catheter ablation of AF at Endeavor Health (Chicago, IL) using pulsed field ablation (Farapulse, Boston Scientific, Marlborough, MA or PulseSelect, Medtronic, Minneapolis, MN) and deep sedation between March and May 2024 were retrospectively included in this study. Deep sedation (monitored anesthesia care) was administered by a certified registered nurse anesthetist and attending anesthesiologist, consisting of bolus and infusion dosing of propofol, dexmedetomidine, fentanyl, and midazolam at the discretion of the practitioner with continuous monitoring of vital signs and end-tidal CO2. The primary endpoint was the rate of airway complications or requirement for conversion to general anesthesia. Secondary endpoints were the rate of acute procedural success (all pulmonary veins isolated), total time in the EP lab, procedure time (from lidocaine to removal of sheaths), and non-procedure time (difference between total time in lab and procedure time). Results: A total of 40 patients (mean age 70.4 ± 13.6 years, BMI 30.2 ± 7.4, 60% females) were included in the analysis. There were no instances of airway complications or conversion from deep sedation to general anesthesia. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 156.6 ± 41.5 minutes; consisting of a mean procedure time of 107.1 ± 39.7 minutes and non-procedure time 49.5 ± 10.3 minutes. Conclusions: In this initial experience at a single center, deep sedation (monitored anesthesia care) for PFA was associated with no instances of airway complications. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases. Although patients generally were amnestic to the procedure, larger studies incorporating patient-reported outcomes are needed, as well as data regarding long-term clinical outcomes and cost.

Abstract 4119744: Evaluation of Neuropsychological development and Factors Affecting it in Children With Cyanotic and Acyanotic Congenital Cardiac Disease After Surgical Treatment

Objective: To evaluate neuropsychological development in children with cyanotic and acyanotic congenital heart diseases (CHDs) after surgical treatment and analyze the risk factors. Methods: 89 children who received follow-up in Fuwai Hospital after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into cyanotic CHDs group and acyanotic CHDs group. Neuropsychological development was assessed according to Pediatric-psychological mental test scale and statistical analysis was employed. Results: The acyanotic CHDs group achieved better distribution of development quotient than cyanotic CHDs group (p &lt; 0.05) but worse than the normal control group (p = 0.004). The proportion in cyanotic CHDs group with developmental quotient below the moderate level was higher than that of the normal control group (p &lt; 0.001), but there was no significant difference between the cyanotic CHDs group and acyanotic CHDs group (p = 0.055). Multivariate regression analysis indicated that for cyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower preoperative blood glucose level, lower BIS level, and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale (p &lt; 0.05); for acyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower temperature during surgery and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale(p &lt; 0.05). Conclusion: Distinct neuropsychological impairment could be present in children with cyanotic CHDs. Younger age at cardiac surgery, body mass, preoperative blood glucose level, BIS level during surgery, temperature during surgery and duration of tracheal intubation after surgery were perioperative factors that could influence long-time neuropsychological development in children with CHDs.