General Anesthesia In Adults Research Articles

Propofol‐induced moderate–deep sedation modulates pediatric neural activity: A functional connectivity study

AbstractBackgroundPrevious studies have demonstrated the underlying neurophysiologic mechanism during general anesthesia in adults. However, the mechanism of propofol‐induced moderate–deep sedation (PMDS) in modulating pediatric neural activity remains unknown, which therefore was investigated in the present study based on functional magnetic resonance imaging (fMRI).MethodsA total of 41 children (5.10 ± 1.14 years, male/female 21/20) with fMRI were employed to construct the functional connectivity network (FCN). The network communication, graph‐theoretic properties, and network hub identification were statistically analyzed (t test and Bonferroni correction) between sedation (21 children) and awake (20 children) groups. All involved analyses were established on the whole‐brain FCN and seven sub‐networks, which included the default mode network (DMN), dorsal attentional network (DAN), salience network (SAN), auditory network (AUD), visual network (VIS), subcortical network (SUB), and other networks (Other).ResultsUnder PMDS, significant decreases in network communication were observed between SUB‐VIS, SUB‐DAN, and VIS‐DAN, and between brain regions from the temporal lobe, limbic system, and subcortical tissues. However, no significant decrease in thalamus‐related communication was observed. Most graph‐theoretic properties were significantly decreased in the sedation group, and all graphical features of the DMN showed significant group differences. The superior parietal cortex with different neurological functions was identified as a network hub that was not greatly affected.ConclusionsAlthough the children had a depressed level of neural activity under PMDS, the crucial thalamus‐related communication was maintained, and the network hub superior parietal cortex stayed active, which highlighted clinical practices that the human body under PMDS is still perceptible to external stimuli and can be awakened by sound or touch.

Influence of Pre- and Intraoperative Local Anaesthetic in Strabismus Surgery under General Anaesthesia in Adults.

As studies have shown a reduction in the occurrence of the oculocardiac reflex with the addition of local anaesthesia, we changed our care regime accordingly a few years ago. To promote and establish better patient care, we retrospectively analysed the files of our patients who underwent strabismus surgery from 2013 to 2021 in order to compare strabismus surgery under general anaesthesia with and without local anaesthetics in a routine clinical setting. Data from 238 adult patients who had undergone strabismus surgery could be extracted from the files: G1: n = 102, only general anaesthesia; G2: n = 136, preoperative application of tetracaine eye drops and intraoperative subtenon lidocaine/levobupivacaine in addition to general anaesthesia. We compared the two groups in regard to the frequency of oculocardiac reflex, the amount of atropine needed to treat, as well as the amount of antiemetic and analgesic medication given, and time spent in the recovery room. Mean age of G1 was 50 years and 52 years in G2. There was no significant difference between the kind of surgeries (recessions/resections), the number of patients who had undergone a reoperation, or the duration of the operations. Adding local anaesthetics resulted in significantly less occurrence of oculocardiac reflex (p = 0.009), a reduction in the need for atropine, analgesic, or antiemetic medication, as well as reduced time in the recovery room. As this increases patient safety and comfort and is cost-effective (less time in the recovery room), we recommend adding perioperative local anaesthesia to strabismus surgery performed under general anaesthesia.

A comparative study of intraoperative analgesic consumption and recovery profile between sevoflurane- and propofol-based general anesthesia in adults

Background: Many researches were performed in the past to compare propofol and sevoflurane as sole anesthetics. While some studies have reported the advantages of propofol regarding better recovery profile and post-operative analgesic sparing effect, the contrast reporting does exist. Hence, there is a further need of research to explore recovery characteristics. Whether either of these two as sole anesthetics can yield any benefit regarding intraoperative analgesics consumption has not been evaluated. Aims and Objectives: The study primarily aimed at determining total analgesic consumption in the intraoperative period (primary outcome), between those receiving either sevoflurane or propofol for induction as well as maintenance of anesthesia. In addition, intraoperative hemodynamics (heart rate and mean arterial pressure) and recovery profile were compared. Materials and Methods: Total of 168 patients, aged 18–60 years, the American Society of Anesthesiologists’ physical status I/II, undergoing elective and emergency surgeries under general anesthesia for 2–3 h finally recruited. Patients were randomly allocated to receive either sevoflurane (group S, n=84) or propofol (group P, n=84) for both induction and maintenance. Anesthetics were titrated to achieve bispectral index (BIS) value of 60. For both the groups, additional fentanyl was considered aliquots of 25 mcg whenever the hemodynamics changes occurred despite maintaining BIS value in the above-mentioned range. Results: The total intraoperative analgesic consumption was found comparable in both groups of patients. Induction time (38 vs. 59 s) and emergence time (8 vs. 10 s, P<0.001) were found shorter in the propofol group than in sevoflurane. Aldrete score >9 was achieved earlier with propofol compared with sevoflurane (8.5 vs. 12 min). Conclusion: Propofol-based shows no advantage over sevoflurane in view of intraoperative consumption of analgesics and intraoperative hemodynamic stability. However, the use of propofol was associated with faster induction as well as quicker emergence from anesthesia.

Effects of intra-operative administration of intravenous dexmedetomidine on incidence of emergence phenomenon after general anaesthesia in adults; An observational study

Background: The occurrence of emergence agitation (EA) is the most common and practical problem faced in the immediate post-operative period during the process of Extubation under General Anaesthesia. Dexmedetomidine, an α2 adrenoceptor agonist is an excellent drug that has been shown effective to decrease the preoperative anxiety and smooth induction and emergence. Aims and Objectives: To assess the effect of intravenous dexmedetomidine primarily on EA and other complications that may occur during emergence from general anesthesia. Materials and Methods: 80 patients of either gender aged 18–65 years with ASA status I and II, undergoing various elective general and urological surgeries under general anesthesia were included in the study. Patients receiving adjuvant drug dexmedetomidine, were labelled as Group D (n=40) and those who didn’t receive any adjuvant were labelled as group C (n=40). Dexmedetomidine was given at 1 μg/kg and then maintained at infusion of 0.4 μg/kg/h till the end of the surgery for group D. The hemodynamic parameters and SpO2 were measured during the intraoperative period at various intervals of time till the end of surgery and also on arrival to the recovery room till patient was discharged from post-anesthesia care unit in both the groups. Results: The use of IV dexmedetomidine has proved significantly effective in prevention of incidence of EA with the overall incidence of agitation of 7.5% in Group D as compared to 42.5% in group C. Conclusion: Intraoperative administration of intravenous dexmedetomidine decreased the incidence of EA and other emergence phenomena like cough, pain and PONV with stable hemodynamics, safety profile, good analgesic properties and opioids sparing side effects.

A Case of General Anaesthesia Using an I-gel Airway for MRI of an Adult Patient With Athetoid Cerebral Palsy

Patients with athetoid cerebral palsy may develop cervical myelopathy owing to repetitive involuntary motion. In these patients, MRI evaluation is required; involuntary motion is problematic, and general anaesthesiaand immobilisation may be necessary. However, MRI studies requiring muscle relaxation and general anesthesia in adults are rare. A 65-year-old man with a history of athetoid cerebral palsy required an MRI of the cervical spine under general anaesthesia. General anaesthesia was administered with 5 mg of midazolam and 50 mg of rocuronium in a room adjacent to the MRI room. The airway was secured using an i-gel airway, and the patient was ventilated using a Jackson-Rees circuit. As the only MRI-compatible monitoring method available at our institution was SpO2 monitoring,blood pressure was monitored by palpation of the dorsal pedal artery, and ventilation was monitored visually by an anaesthesiologist in the MRI room. The MRI was uneventful. After scanning, the patient awoke promptly and was returned to the ward. An MRI scan under general anaesthesia requires monitoring of the patient, securing of the airway and ventilation, and careful selection of suitable anaesthetic agents. Although MRI scans requiring general anaesthesia are rare, anaesthesiologists should be prepared for this eventuality.

A case of monosomy 21 presented with difficult tracheal intubation

BackgroundMonosomy 21 is a rare chromosomal abnormality. It is mainly associated with mental retardation, intellectual disability, growth retardation, microcephaly, and characteristic facial features. General anesthesia in adults with this disease has not been reported. We report difficult airway management of an adult patient with monosomy 21.Case descriptionA 30-year-old female was scheduled for laparoscopic gynecological surgery. She was diagnosed with monosomy 21 at birth and accompanied with mental retardation. Preoperative examination revealed limited mouth opening with Mallampati score of IV, but no abnormal laboratory test or chest X-P. Anesthesia was performed using general anesthesia with epidural analgesia. Although bag-mask ventilation was improved by a muscle relaxant, mouth opening was further restricted, and laryngoscope insertion was impossible. Tracheal intubation was achieved using a bronchofiberscope. The operation procedure was completed, and the patient was discharged from the hospital without any major postoperative complications.ConclusionsIn this patient, mouth opening was further reduced after induction of general anesthesia with a muscle relaxant. Preoperative evaluation and adequate preparation of airway management are important for general anesthesia in an adult patient with monosomy 21.

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis.

BackgroundPatients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients.ObjectiveThe aim is to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization.MethodsWe will search electronic bibliographic databases (MEDLINE, EMBASE, the seven databases in Evidence-Based Medicine Reviews, medRxiv, bioRxiv, and Google Scholar), review papers identified during the search, and included article bibliographies. We will include randomized and nonrandomized studies comparing the use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate the risk of bias. The primary outcome will be short-term (in-hospital or 30-day) mortality. Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, renal, and limb events; delirium; deep vein thrombosis or pulmonary embolism; neuraxial or regional anesthesia–related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios (ORs) and standardized mean differences (SMDs) using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using the Begg and Egger tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to make an overall rating of the quality of evidence in our effect estimates.ResultsThe protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We executed the peer-reviewed search strategy on March 2, 2021. We completed the review of titles and abstracts on July 30, 2021, and plan to complete the review of full-text papers by September 30, 2021. We will complete full-text study data extraction and the risk-of-bias assessment by November 15, 2021, and conduct qualitative and then quantitative data synthesis and GRADE assessment of results by January 1, 2022, before drafting the manuscript. We anticipate that we will be able to submit the manuscript for peer review by the end of February 2022.ConclusionsThis study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial.Trial RegistrationProspero CRD42021237060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=237060International Registered Report Identifier (IRRID)PRR1-10.2196/32170

Outcomes after Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis

We sought to determine whether the receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery results in differences in health outcomes and length of hospital stay.

Risk Factors for Fentanyl-Induced Cough Following General Anesthesia in Adults: A Retrospective Study from a Single Center in China.

BackgroundFentanyl-induced cough (FIC) during general anesthesia induction and postoperative nausea and vomiting are common complications, yet the risk factors for FIC remain controversial. This retrospective study was conducted at a single center in China and aimed to investigate the risk factors for fentanyl-induced cough following general anesthesia in adults.Material/MethodsA total of 601 adult patients undergoing elective surgery were enrolled, and the incidence of FIC during general anesthesia induction and postoperative adverse events were recorded. The risk factors for FIC during general anesthesia induction and postoperative nausea and vomiting were assessed using multivariate logistic regression analysis.ResultsThe incidence of FIC, nausea, and vomiting were 21.8%, 6.3%, and 4.5%, respectively. The results of multivariate logistic regression analysis indicated that pharyngitis history was associated with an increased risk of FIC during general anesthesia induction (odds ratio [OR]: 2.852; 95% confidence interval [CI]: 1.698–4.792; P<0.001), whereas use of lidocaine could protect against FIC risk (OR: 0.649; 95% CI: 0.557–0.757; P<0.001). However, the characteristics of patients were not associated with the risk of postoperative nausea and vomiting.ConclusionsThe findings from this study showed that a history of pharyngitis increased the risk of FIC, while the use of lidocaine was associated with a reduced risk of FIC. The risk of postoperative nausea and vomiting was not affected by fentanyl use or patient characteristics.

Effect of amino acid infusion on perioperative thermoregulation in newborn surgery

Objectives: Decreased drug metabolism, coagulation disorders, wound infections, and cardiac arrhythmias are the most important and well-known results of intraoperative hypothermia. Perioperative amino acid infusion is known to prevent intraoperative hypothermia during general anesthesia in adults. In this study, we aimed to demonstrate the effect of perioperative amino acid infusion on the prevention of hypothermia during general anesthesia in newborn surgery. Methods: Twenty surgical newborns, aged 1-30 days, were enrolled in this prospective randomized controlled study. Newborns were assigned randomly into two groups: the amino acid/dextrose (AAD) group and the dextrose (D) group. The core temperatures of the newborns were measured from the distal esophagus in the first minute of the induction once and every fifteen minutes thereafter. The core body temperature changes in each group during the operation and the differences between the two groups were analyzed. Results: The surgical operations in each group were similar. The mean operating room temperatures of AAD and D groups were 25.4 ± 0.2°C and 25.3 ± 0.3°C, respectively. There were no significant differences in the general characteristics of the two groups. The mean core temperatures began to decrease after the induction of anesthesia in both groups and continued to decrease during the course of the surgery. There was no significant difference between the two groups. Conclusions: Hypothermia develops in all neonates when surgical time exceeds one hour, even in warmer ambient temperatures. Although it seems effective in adults, amino acid-induced thermoregulation does not seem effective in newborns during general anesthesia.

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

BackgroundWe examined the association between emergent postoperative tracheal intubation and the use of supraglottic airway devices (SGAs) vs tracheal tubes. MethodsWe included data from adult noncardiac surgical cases under general anaesthesia between 2008 and 2018. We only included cases (n=59 991) in which both airways were deemed to be feasible options. Multivariable logistic regression, instrumental variable analysis, propensity matching, and mediation analysis were used. ResultsUse of a tracheal tube was associated with a higher risk of emergent postoperative intubation (adjusted absolute risk difference [ARD]=0.80%; 95% confidence interval (CI), 0.64–0.97; P<0.001), and a higher risk of post-extubation hypoxaemia (ARD=3.9%; 95% CI, 3.4–4.4; P<0.001). The effect was modified by the use of non-depolarising neuromuscular blocking agents (NMBAs); mediation analyses revealed that 28.9% (95% CI, 14.4–43.4%; P<0.001) of the main effect was attributable to NMBA. Airway management modified the association of NMBA and risk of emergent postoperative intubation (Pinteraction=0.02). Patients managed with an SGA had higher odds of NMBA-associated reintubation compared to patients managed with a tracheal tube (adjusted odds ratio [aOR]=3.65, 95% CI, 1.99–6.67 vs aOR=1.68, 95% CI, 1.29–2.18 [P<0.001], respectively). ConclusionsIn patients undergoing procedures under general anaesthesia that could be managed with either SGA or tracheal tube, use of an SGA was associated with lower risk of emergent postoperative intubation. The effect can partly be explained by use of NMBAs. Use of NMBAs in patients with an SGA appears to increase the risk of emergent postoperative intubation.

Extraction of airway foreign bodies with bronchoscopy under general anesthesia in adults: an analysis of 38 cases

BackgroundTo explore the efficacy and safety of extracting airway foreign bodies with bronchoscopy under general anesthesia in adults.MethodsAltogether, 38 adult patients who underwent airway foreign body extraction with bronchoscopy under general anesthesia in the Pneumology Department of Beijing Tiantan Hospital, Capital Medical University, from January 2005 to December 2014 were included in the study and retrospectively analyzed concerning the extraction methods and complications. The indications and experience and lessons were summarized.ResultsIn 38 patients with general anesthesia who had foreign bodies removed by bronchoscopy, 1 case failed to be removed, and 37 cases were successfully removed, with a success rate of 97.4%. One of the patients failed to remove the foreign body due to massive hemorrhage during the resection of the right middle bronchial stone, and the operation was interrupted. Blood loss was analyzed in all patients, 4 patients (10.5%) lost blood greater than 10 mL, and 1 patient (2.63%) lost blood greater than 300 mL. To analyze the status of airway injury, 3 patients (7.9%) had local airway mucosal tearing, and 1 patient had mild glottis edema. All the patients in this group had silent portal injury, severe hypoxemia or asphyxia, and no complications such as pneumothorax, mediastinal emphysema or pulmonary edema occurred.ConclusionsExtraction of airway foreign bodies with bronchoscopy under general anesthesia in adults is safe and effective and can avoid surgical treatment in some patients.

Streamlined percutaneous atrial septal defect closure in adults

Objectives: The aim of the study to evaluate the safety and efficacy of the transthoracic echocardiography (TTE) guided secundum atrial septal defect (ASD) closure without balloon sizing, sedation or general anesthesia in adults. Methods: We retrospectively evaluated 200 secundum ASD closure patients in the tertiary cardiology center. Transesophageal echocardiography (TEE) was performed to all the patients at least one day before the intervention by the procedure operators. The patients who were closed with a cribriform device, using more than one device, with insufficient rim (&amp;lt;5 mm) (other than the anterior superior rim (aortic rim)), totally flail, and complex interatrial septum anatomy were excluded from the analysis.The size of the ASD closure device was chosen according to the largest diameter measured by TEE. ASD device was selected as 4 mm larger in patients without anterior superior rim and 2 mm larger in other patients than the largest diameter measured in 2D-TEE. Results: In the remaining 166 patients, the procedure was performed with TTE and fluoroscopy guidance without balloon sizing, sedation or general anesthesia. The procedure was performed through right femoral vein. The patients age: 38.56 ± 14.72, gender: 57 male, 109 female, ASD size: 18.88 ± 5.99 mm, anterior superior rim: 5.30 ± 4.04 mm, anterior inferior rim: 14.22 ± 6.46 mm, posterior superior rim: 17.16 ± 4.96 mm, posterior inferior rim: 16.67 ± 7.48 mm. ASD device size: 23.74 ± 6.59 mm. The procedure success rate was 98.1% (163 patients). The complications; 1 patient device embolised, 2 patients device was not placed in the correct position by TTE. Conclusions: TTE and fluoroscopy-guided secundum ASD closure without balloon sizing, sedation or general anesthesia by experienced operators is a safe and effective procedure.

Bispectral index for improving intraoperative awareness and early postoperative recovery in adults.

Bispectral index for improving intraoperative awareness and early postoperative recovery in adults.

Effects of peri-operative intravenous administration of dexmedetomidine on emergence agitation after general anesthesia in adults: a meta-analysis of randomized controlled trials.

ObjectiveThe aim of the current meta-analysis was to assess the effect of dexmedetomidine on emergence agitation (EA) and the recovery outcomes after general anesthesia in adults.MethodsWe searched the PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science and clinicaltrials.gov for relevant randomized controlled trials (RCTs) investigating the effects of dexmedetomidine on the EA in adults after general anesthesia compared with placebo. The primary outcome was the incidence of EA. Secondary outcomes included other recovery outcomes after general anesthesia.ResultsTwelve RCTs (842 participants) met the eligibility criteria. A conventional random-effects meta-analysis demonstrated that peri-operative intravenous dexmedetomidine could be effective for the prevention of EA [risk ratio (RR) 0.49, Trial Sequential Analysis (TSA)-adjusted 95% confidence interval (CI) 0.35–0.68, P<0.00001]. In addition, the TSA indicated that the meta-analysis for the incidence of EA reached the required information size (370). Lower number of patients receiving dexmedetomidine required analgesia (P=0.0009). Extubation time was longer (P=0.03) and hypotension (P=0.03) was more common with dexmedetomidine. Moreover, no difference was found in the other outcomes.ConclusionDexmedetomidine was shown to effectively decrease the incidence of EA and to reduce postoperative analgesic requirements. Yet, other recovery outcomes including extubation time, length of PACU stay, postoperative residual sedation, hypotension, bradycardia as well as postoperative nausea and vomiting provided no data that could be used to form final conclusions.

Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12\xa0years

ObjectivesSpecial needs patients are prone to insufficient oral care and subsequent caries or periodontitis. The aim of this retrospective study was the assessment of demand for restorative therapy and tooth extractions under general anesthesia in adults with intellectual and/or physical disablement (IPD) or psychiatric disorders (PDs) with inherent dentist phobia at the University Hospital of Innsbruck with regard to demographic factors.Materials and methodsA total of 444 consecutive cases of scheduled dental general anesthesia (DGA) in adults from 2003 to 2014 were included. From patient files, demographic data, the presence of either IPD or a PD, attested by a mandatory certificate, and restorative therapy and tooth extractions performed under DGA were obtained. Data analysis was carried out by means of descriptive and comparative statistics.ResultsFour hundred two cases (mean age 37.5 ± 13.87 years) assigned to 283 individuals with IPD and 42 cases (mean age 36.09 ± 13.03 years) assigned to 39 individuals with PDs arose in the observed period. Patients with PDs required significantly more restorations (in 7.98 ± 5.4 versus 5.34 ± 4.41 teeth; p = 0.002; Mann-Whitney U test) and extractions (of 4.86 ± 4.51 versus 2.6 ± 3.96 teeth; p < 0.001; Mann-Whitney U test) than patients with IPD.ConclusionsDemand for dental treatment was high in the collective of special needs patients. Oral health status was worse in patients with PDs than in patients suffering IPD.Clinical relevanceWhile in patients with severe disablement, DGA presents the only treatment option, specific preventive programs should be implemented for patients with minor disablement or dentist phobia. In these patients, alternative approaches should be promoted.

How does processed electroencephalography (EEG) compare with clinical signs for guiding general anesthesia in adults undergoing elective non-cardiac or non-neurological elective surgery?

How does processed electroencephalography (EEG) compare with clinical signs for guiding general anesthesia in adults undergoing elective non-cardiac or non-neurological elective surgery?

Preventive strategies for postoperative sore throat following endotracheal intubation under general anesthesia in adults

Background Postoperative sore throat (POST) is a common complication following endotracheal intubation under general anesthesia. Although it is self-limiting, it greatly reduces postoperative comfortableness and satisfaction. Thus, in recent years, this issue has attracted much attention from anesthesiologists. Objective To summarize the pharmacological and non-pharmacological strategies for the prevention and treatment of POST in order to provide references for anesthesiologist to improve prognosis of patients undergoing endotracheal intubation. Content The currently available medications used for the intervention and treatment of POST include lidocaine, steroids, non-steroidal anti-inflammatory drugs, and others. There are some non-pharmacological methods being applied postoperatively, such as, capsule management, core application, and tracheal catheter softening. The efficacy of these methods to reduce the incidence of POST in patients underwent endotracheal intubation are individually summarized in this article. Trend Appropriate combination of pharmacological and non-pharmacological methods could minimize the distress of endotracheal intubation and prevent POST. Key words: Endotracheal intubation; Postoperative sore throat; Prevention

Tracheal extubation with suction vs. positive pressure during emergence from general anaesthesia in adults: A randomised controlled trial

BackgroundAfter general anaesthesia (GA) in adults, the optimal tracheal extubation technique (positive pressure or suctioning) remains debated. The primary endpoint of this study was to assess the effects of these techniques on onset time of desaturation (SpO2<92%). MethodsSixty-nine patients with a body mass index<30 scheduled for elective orthopaedic surgery were allocated to positive pressure (PP) or suctioning (SUC) group. GA was standardised with propofol and remifentanil via target-controlled infusion. A morphine bolus of 0.15mg/kg was administered 20–30mins before the end of surgery. The effect of extubation technique on onset time of desaturation (T92) was assessed during the first 10mins after extubation during the spontaneous air breathing. Secondary endpoints included: frequency of desaturation, respiratory complications, need to use oxygen therapy and SpO2 at the end of the first hour while breathing in air (ClinicalTrials.gov identifier: NCT01323049). ResultsBaseline patient characteristics and intraoperative management data for the 68 patients included had no relevant clinical difference between groups. T92 (sec) after tracheal extubation was 214 (168) vs. 248 (148) in the PP and SUC groups, respectively (P=0.44). In the PP and SUC groups, 50 and 43% reached a SpO2<92% within the first 10mins after extubation respectively (P=0.73). There were no statistically significant differences between groups for any secondary endpoints. ConclusionsPositive pressure extubation as compared with suctioning extubation did not seem to delay onset time of desaturation after GA in standard weight adult patients.

Can alpha-2 adrenergic agonists help to prevent shivering following general anesthesia in adults?

Can alpha-2 adrenergic agonists help to prevent shivering following general anesthesia in adults?