Intratracheal Anesthesia Research Articles

Association Between Receipt of General Anesthesia During Childhood and Attention Deficit Hyperactive Disorder and Neurodevelopment.

There are inconsistent reports regarding the association between general anesthesia and adverse neurodevelopmental and behavioral disorders in children. This nationwide administrative cohort study included children born in Korea between 2008 and 2009, and followed until December 31, 2017. The cohort included 93,717 participants who received general anesthesia with endotracheal intubation (ETI) who were matched to unexposed subjects in a 1:1 ratio. General anesthesia was defined by National Health Insurance Service treatment codes with intratracheal anesthesia, and the index date was the first event of general anesthesia. The primary outcome was attention deficit hyperactive disorder (ADHD), which was defined as at least a principal diagnosis of 10th revision of the International Classification of Diseases code F90.X after the age of 72 months. Neurodevelopment, which was assessed using a developmental screening test (Korean-Ages and Stages Questionnaire [K-ASQ]), was a secondary outcome. The K-ASQ is performed annually from 1 to 6 years of age and consists of 5 domains. The association between general anesthesia and ADHD was estimated using a Cox hazard model, and its association with neurodevelopment was estimated using a generalized estimation equation, with control for multiple risk factors beyond 1 year after the index date. The median age at the index date was 3.8 (95% confidence interval [CI], 1.7-5.8) years, and there were 57,625 (61.5%) men. During a mean follow-up period of 5 years, the incidence rate of ADHD was 42.6 and 27.7 per 10,000 person-years (PY) in the exposed and unexposed groups, respectively (absolute rate difference 14.9 [95% CI, 12.5-17.3] per 10,000 PY). Compared to the unexposed group, the exposed group had an increased risk of ADHD (adjusted hazard ratio, 1.41 [95% CI, 1.30-1.52]). In addition, a longer duration of anesthesia with ETI and more general anesthesia procedures with ETI were associated with greater risk of ADHD. General anesthesia with ETI was also associated with poorer results in the K-ASQ. Administration of general anesthesia with ETI to children is associated with an increased risk of ADHD and poor results in a neurodevelopmental screening test.

Video-assisted thoracoscopic pacemaker lead placement in children with atrioventricular block.

Background:The pacemaker lead placement is presented as one of the most appropriate procedures in children with a complete atrioventricular block (AVB). Despite the fact that video-assisted thoracic surgery (VATS) for epicardial lead placement has demonstrated positive results as to the feasibility, safety, and efficacy in adults, its role in pacemaker implantation in children remains unclear.Aim:This study sought to assess the intermediate-term outcomes of video-assisted thoracoscopic pacemaker lead placement in children with complete AVBMaterials and Methods:From May 2017 to November 2019, five children with complete AVB underwent minimally invasive left ventricular (LV) lead placements via thoracoscopic video assistance approach. The procedure was performed under complex intratracheal anesthesia with single-lung ventilation, all pacing parameters were evaluated in perioperative and follow-up periods.Results:The median age of children at implantation was 3 years (range: 2 to 4 years), the median weight was 13 kg (range: 12–15 kg). All procedures were completed successfully, pacing thresholds for the active lead measured 0.3-1.1V, with R-wave amplitude of 8-18 mV and impedance of 560-1478 Ohm.Conclusion:Thoracoscopic pacemaker lead placement may provide a potential alternative to the transthoracic approach of epicardial lead placement in children with AVB.

P512New approaches to pacing in children with atrioventricular block

Abstract Introduction The placement of permanent pacemaker is presented as one of the most appropriate procedures in patients with congenital complete atrioventricular block (AVB). Despite video-assisted thoracic surgery (VATS) for epicardial lead placement has demonstrated positive results concerning the feasibility and freedom of complications in adults, its role in pacemaker implantation in children remains unclear. The study aimed to assess the intermediate-term outcomes of video-assisted thoracic pacing in children with congenital complete AVB. Methods From May 2017 to November 2018, six children with complete idiopathic AVB underwent minimally invasive left ventricular lead placements via thoracoscopic video assistance. The procedure was performed under complex intratracheal anesthesia with single-lung ventilation, median operation time was 180 minutes (120–240). Four incisions were made, three of them were used to place the lead on the left ventricular, and one was needed to place the device. All pacing parameters were evaluated in perioperative and follow-up periods. Results Median age at implantation was 3 years (2 to 15 years), median weight 13 kg (12–46 kg). All procedures were completed successfully, pacing thresholds for the active lead measured 0.5-1.1V, with R-wave amplitude of 8-18 mV and impedance of 404-1478 Ohm. Increasing pacing thresholds in the third month after pacemaker implantation occurred in one patient, so anti-inflammatory therapy was assigned. Satisfactory thresholds and impedances with no significant difference with initial values were obtained at the median follow-up of 21 months (range: 10–28 months). Conclusion Video-assisted thoracic pacing may provide a potential alternative to the transthoracic approach of epicardial lead placement in children with congenital AVB.

MS21.01 Surgery and its Evolution

MS21.01 Surgery and its Evolution

DOMESTIC ANESTHESIOLOGY IN THE FIRST HALF OF THE XX CENTURY: SCIENTIFIC PRIORITIES

The article notes that the problems of anesthesia in the first half of the XX century were developed by joint efforts of surgeons and anaesthesiologists, who distinguished their discipline as a narrow specialty from clinical medicine. Local anesthesia by the method of creeping infiltrate, anatomically developed and physiologically grounded prof. A.V. Vishnevsky, has become very popular not only in our country, but also abroad. It is shown that many other surgeons began to perform under local anesthesia surgical interventions on the organs of the thoracic cavity, esophagus, lungs, and heart. About 90% of lung operations for tumors, bronchiectasis, tuberculosis were performed using the creeping infiltrate method under local anesthesia. It was stressed that in the 50s of the 20th century it became evident that in many cases of severe and deeply traumatic surgery, especially on the chest cavity, only protection against pathological reflexes in the field of intervention achieved by the Novocaine blockade is insufficient, since it was necessary to preserve and maintain the function of the whole organism. The use of barbiturates in surgery has received a lot of attention, and a technique has been developed that made it possible to carry out large operations lasting up to 2 hours or more (under the action of hexenal). It was shown that hexenal anesthesia was not injected and almost all of it was abandoned. In the post-war period, intratracheal ether-oxygen anesthesia began to be used in surgical practice. It was noted that the absence of vomiting, the patient’s open face, bronchial tamponade, the ability to increase intrabronchial pressure, spread the lungs, provide artificial ventilation and maintain a high oxygen content in the blood - all this contributed to the spread of this method. Consequently, anesthesia in surgical interventions, the use of modern pharmacological agents and anesthesia at that time, turned into special problems, the solution of which became practiced by doctors specially trained in the field of therapy, physiology, pharmacology and pathological physiology. Thus, a new discipline arose, anesthesiology, and all preparation for surgery, anesthesia during surgery and an early postoperative period is transferred to the direct management of anesthesiologists.

Professor of the Military Medical Academy – Milij Nikolaevich Anichkov

Briefly highlights the life path of the graduate of the Military Medical Academy of Kirov Anichkova Milya Nikolaevich. Little-known facts from his life are established. Described are the front-line meetings of M.N. Anichkov with outstanding people of his time. Yudin, A.A. Vishnevsky, A.N. Bakilev. At the Leningrad front, he worked as a military surgeon, being subordinated to the chief surgeon of the front, Major General of the Medical Service, Professor Pyotr Andreevich Kupriyanov. I got great experience as a field surgeon. The role and place of M.N. Anichkov in the accumulation of the Russian experience of intratracheal anesthesia in operations with pneumothorax. Together with M.S. Grigoriev M.N. Anichkov published the first monograph in Russia dedicated to muscle relaxants. Many years of research in the academic anatomical theater in conjunction with Professor ID. Leo led to the publication of the first in Russia anatomical atlas devoted to operations on the aorta. Knowing the perfect German language, Milya Nikolaevich translates into Russian the manual on abdominal surgery Imre Littmann. For a long time M.N. Anichkov conducted friendly correspondence with the famous American surgeon with Michael Ellis Debakey. Foreign students delivered lectures in French.

Application of laryngeal mask airway anesthesia combined with sacral canal block in pediatric surgery

Objective To observe differences between the application of laryngeal mask anesthesia combined with sacral canal block and single intratracheal anesthesia in African pediatric surgery and provide references for child anaesthesia. Methods Sixty 4-6 year-old children for lower abdominal or lower limb surgerywere randomly divided into two groups(n=30): laryngeal mask airway anaesthesia combined with sacral canal block group(group A) and single intratracheal anaesthesia group(group B). MAP, HR and SpO2 were recorded before induction of anaesthesia(T0), before and after intubation of laryngeal mask airway or tracheal tube (T1, T2) and after removal of laryngeal mask airway or tracheal tube(T3). The waking-up time, VAS pain scores and adverse reaction were recorded after surgery. Results There were no significant differences in MAP, HR and SpO2 between the two groups at T0 and T1 (P>0.05). The MAP and HR [(68±10) mmHg(1 mmHg=0.133 kPa), (108±17) bpm] values in group A were significantly lower than the MAP and HR [(91±8) mmHg, (139±18) bpm] values in group B at T2(P<0.05). The MAP and HR [(67±9) mmHg, (121±16) bpm] values in the group A were also significantly lower than the MAP and HR [(85 ± 9) mmHg, (141 ± 17) bpm] values in the group B at T3(P<0.05). The postoperative VAS values (1.5±0.5) in groups A were significantly lower than values (6.5±1.5) in the group B (P<0.05). The waking-up time [(5.8±2.4) min] in group A was significantly shorter than the time [(12.2±2.8) min] in group B (P<0.05). There are only 4 cases of postoperative agitation in group A which was significantly lower than that in group B (P<0.05). The frequencies of postoperative cry and cough in group A were significantly lower than that in group B. Conclusions The general anesthesia via laryngeal mask airway combined with sacral canal block in children during the induction and the waking-up time guaranteed more stable hemodynamics and significantly reduce postoperative pain, the waking-up time significantly shorten, significantly reduce the incidence of postoperative mania ,so it is an more ideal anesthesia methed in lower abdominal or lower limb surgery. Key words: Laryngeal mask airway; Anesthesia, general; Sacral canal block; African child

Ciężki uraz okolicy twarzoczaszki i szyi połączony z wniknięciem ciał obcych podczas obróbki drewna

IntroductionThe aim of this work was to describe the patient with severe injury within the splanchnocranium and neck connected with the penetration of large foreign bodies in his wood processing activity, and their impaction in soft tissues and life-threatening localisation. Material and methodsThe authors describe the case of a 37-year-old male patient whose splanchnocranium and neck were injured while he was processing the wood with a mechanical saw. Two enormous wooden strips staved in his face while one was boring towards the nose and paranasal sinuses and the other was penetrating through the soft tissues of the cheek and neck from side of the oral cavity, with a visible prominent ending at the nape. ResultsOn diagnostic tests, the patient underwent tracheotomy media under neuroleptoanalgesia and infiltration anaesthesia, then, under intratracheal anaesthesia, he was intubated through tracheostomy. The two foreign bodies (enormous wooden strips) were removed by a multispecialty team of surgeons. Further, repositioning and osteosynthesis of the fractured ramus of the mandible on the left side were performed. The minititanium plate, 5 holes, 8 holes and 3 holes, was used. The wound within the nasal passages, maxillary sinuses and anterior surface of the maxilla was cleaned from fragments and chips of wood. The reconstruction of the tissues and repositioning of the bony fragments were conducted. The Redon drainage tube was implemented in the postoperative cavity, anterior and posterior nasal tamponade (Bellocq type) was required, the wounds in the left cheek and neck were debrided. The patient was discharged in general good condition 7 days on surgery. ConclusionsThe patients with severe injuries within the splanchnocranium and the neck, connected with the penetration of foreign bodies huge in size, should be treated in specialist centres by a multispecialty team of surgeons according to therapeutic standards.

Zastosowanie wideolaryngostroboskopii w diagnostyce oraz ocenie wyników leczenia u chorych ze zmianami organicznymi krtani

The aim of the work was to evaluate effects of the surgical treatment and postoperative rehabilitation of the patients with organic lesions of the larynx using laryngostroboscopy. A group of 110 patients of both sex was covered by the studies, aged 19-65, who underwent surgical treatment due to organic lesion in the larynx. The voice was assessed using the perceptive GRBAS scale and the laryngostroboscopic examination following and preceding the surgical treatment and foniatric rehabilitation (30 days after the operation). Direct microlaryngoscopic procedures were performed under local intratracheal anaesthesia, whereas the CO2 laser was used in the surgery in 18.2% cases and the other cases (81.8%) had the traditional technique applied. RESULTS OF THE STUDIES: In the studied material the following was found: chronic hypertrophic laryngitis in 46.4% of the patients, Reincke's laryngeal oedema in 29.1% of the patients, vocal cord polyp in 22.7% of the patients and laryngeal papilloma in 1.8% of the patients. The voice evaluation based on the GRBAS scale indicated that better voice improvement after the treatment and rehabilitation was found in the patients with Reincke's oedema and vocal fold polyp rather than in those with chronic laryngeal hypertrophy. The majority showed the degree of hoarseness, rough voice, blowing voice, weak and tight voice in the scale of either 0 or 1, contrary to the evaluation preceding the surgery. No better voice improvement was achieved in the GRBAS scale in the patients with laryngeal papilloma. On the grounds of the laryngostroboscopic examination it was found that the best voice improvement occurred after the surgical treatment and rehabilitation of the patients suffering from Reincke's oedema and vocal cord polyps. On the basis of the GRBAS scale and laryngostroboscopic examination of the patients after their surgical treatment and rehabilitation the best results in the voice quality were found in the patients with laryngeal polyps and Reincke's oedema whereas the worst results occurred in the patients with laryngeal papilloma.

Tidal Volume Perception in a CI-C2 Tétraplégie Subject is Blocked by Airway Anesthesia

We administered lidocaine aerosol intratracheal anesthesia to a ventilator-dependent, tracheostomized C1-C2 tétraplégie subject to determine its effect on her ability to detect small changes in tidal volume. A psychophysical test of volume detection was given before and immediately after a 20 percent lidocaine aerosol was delivered through the subject’s cuffed tracheostomy tube. On each of three occasions, she reliably (p<.001) detected changes in tidal volume during a control period; on two of these occasions she could not detect the same volume after inhaling the anesthetic. On one occasion the anesthetic had no effect on volume perception, possibly because copious airway secretions interfered with lidocaine uptake. Subject-blinded control tests with saline aerosol inhalation did not affect detection. We concluded that this subject’s tidal volume perception depended on mechanoreceptors in the lungs and thoracic airways and that local anesthetic interrupted these sensory signals when airway secretions were not excessive.

Recent Progress in Treating Patients with Cleft Palate

Over the last 4 decades remarkable progress has been made in the treatment of cleft palate: the rate of attaining normal or nearly normal speech after surgery has risen from about 65% 40 years ago to nearly 90% or more nowadays. One of the main factors is intratracheal intubation anesthesia that has made the surgery much safer and easier. Improved surgical technique and speech therapy also played a great role. This paper deals with two problems: (1) Slight velopharyngeal incompetence: The combined use of fiberscopy and fluorovideoscopy can provide useful information as to: (a) the exact place of the faulty articulation, (b) the detailed pattern of inconsistent velopharyngeal function, (c) changes in articulation induced by speech therapy, and (d) the relation between velopharyngeal function and faulty articulation. All the above information greatly facilitates speech therapy for cleft palate speech. It should be done with utmost care though due to possible adverse effects of radiation. (2) Analysis of faulty articulation. It was revealed that faulty articulations such as laryngeal fricative and affricates, pharyngeal stop, and glottal stop in cleft palate speech, secondary to velopharyngeal incompetence, were produced by articulation in the larynx at various sites such as the epiglottis, arytenoids, aryepiglottic folds and vocal folds. These faulty articulation points were located lower than supposed on the basis of auditory perception.

Dr. Samuel James Meltzer and intratracheal anesthesia

Dr. Samuel James Meltzer and intratracheal anesthesia

Historical notes on lung cancer before and after Graham's successful pneumonectomy in 1933

Lung cancer, known by its external appearance as “cerebriform” disease in the 16th century, was finally called carcinoma 3 centuries later with the advent of cellular pathologic analysis. The evolution of pulmonary resection was slow. The introduction of intratracheal anesthesia in the 20th century made possible mass ligation lobectomy and multiple staged pneumonectomy in 1931 and 1932. However, attempts at the excision of lung cancer were not successful until 1933 when Evarts A. Graham performed the first successful one-stage pneumonectomy, demonstrating that the main pulmonary artery could be occluded without reflex changes similar to those caused by massive pulmonary embolism. The fact that his physician-patient not only survived the operation but also lived to a ripe old age practicing medicine showed that surgical cure was possible for the patient with carcinoma of the lung. After this operation, individual ligation techniques for pneumonectomy, segmental resection, lower lobe, and upper lobe lobectomy were introduced. Closure of the bronchus was improved by a virtually leak-proof bronchial closure. This was followed by effective methods of managing the large pleural dead space occurring after lobectomy. Pulmonary resection remains the best method of treatment of lung cancer, so that my classification, which facilitates early diagnosis, can lead to improved results. Because of careful preoperative staging there have been fewer exploratory thoracotomies and longer survival after surgery. The location, size, and extent of the carcinoma are important factors in prognosis. The American Joint Committee classification system has aided in standardizing the reporting of cases. Because of possible occult spread in surgical cases, adjuvant therapy must be considered in postresection cases. Future improvements in long-term postsurgical results will depend more on the advances in adjuvant therapy than on refinements in surgical technique. The development of surgery for lung cancer has been a very absorbing commitment for me for over 40 years. I am grateful for the opportunity to include my interests and contributions in the history of the diagnosis and treatment of this challenging disease.

Surgical correction of familial diaphragmatic hernia of morgagni in the golden lion tamarin

The Golden Lion Tamarin (Leontopithecus rosalia) is an endangered species of primate indigenous to the coastal rain forest of Brazil. Since 1971 a propagation and behavioral research program has been carried out on a colony of these monkeys at the Zoological Park. Several related animals have died and at necropsy have shown absence of the anterior portion of the diaphragm with a variety of abdominal viscera in the thorax. Diagnostic studies undertaken on the living members of the colony include plain chest radiographs and gastrointestinal series. Four of the animals have been found to have major diaphragmatic defects with the liver, stomach, spleen, colon, and portions of the intestine in the chest. In three of the animals so affected clinical signs of failure-to-thrive were clearly manifest, although one female born in 1968 has reproduced successfully for 8 yr with no deleterious clinical effects from the hernia. Surgical repair of the diaphragm with relocation of the abdominal viscera has been carried out in three of the animals under a combination of intravenous and intra-tracheal anesthesia. The monkeys weighed 550, 685, and 710 g, respectively. All three Tamarins have survived the operative procedure, and subsequently have shown improved clinical status. These cases have been instructive from the genetic point of view, the major anatomical defect, the type of repair necessary, and the postoperative care in small vigorous mammals. Additionally this study documents a familial factor in diaphragmatic defects in higher mammals.

Regional anesthesia today--possibilities and limits: introduction (author's transl)

The various procedures of regional anesthesia were widely used before the introduction of intratracheal anesthesia; thereafter, it was replaced by the today commonly used general anesthesia. Regional anesthesia nonetheless plays an important role, primarily in outpatient treatment, because a large number of surgical departments still have no anesthesiologist on the staff. Often the surgeon is responsible for both the operation and the anesthesia. Indications, risks, and complications including legal problems related to regional anesthesia are discussed.

Laryngotracheal Damage during Intratracheal Anesthesia

Laryngotracheal Damage during Intratracheal Anesthesia

Sterilization of Anesthesia Apparatus

THE INCREASING use of intratracheal anesthesia has introduced a new possibility for producing infection in a patient undergoing prolonged surgery in a clean field. An example in otolaryngology is the transtemporal bone microsurgical removal of acoustic neuromas where postoperative meningitis and pneumonitis are potential serious complications. Sterilization of anesthesia equipment presents a rather difficult problem, since bulky rubber items do not easily lend themselves to usual sterilizing techniques. In the<i>Journal of the American Medical Association</i>, Meeks et al consider the problem. Two methods of sterilizing face masks, breathing tubes, rebreathing bags and endotracheal tubes and correctors were utilized, with cultures made before and after sterilization. The first method included thorough washing (and brushing where this could be done) with hexachlorophene and water followed by rinsing and soaking in buffered glutaraldehyde for ten minutes. After the first method (alcohol soaking after washing in hexachlorophene) there was only a slight decrease

Effect of blocking the central cholinergic synaptic systems on resistance of the cerebral cortex to asphyxia and ischemia

Sixty six experiments were staged on cats by a specially elaborated method under intratracheal automatic ether-air anesthesia with controlled breathing. Out of this number 44 experiments were done with asphyxia (in 10 experiments of this series the ether supply was switched off) and 22 with ischemia (occlusion of the ascending aorta). EEG, ECG and arterial blood pressure were recorded. Metamysil block of the central muscarine-like cholinergic synaptic systems increased the resistance of the cortex to asphyxia and ischemia. The effect of nicotine-like cholinolytics (difacil, gangleron) structures by nivalin, an anticholinesterase agent, inhibited the restoration of the bioelectric activity of the cerebral cortex following prolonged asphyxia or ischemia.

A Case of Neurilemmoma Arising Primary in the Laryx

Neurilemmoma is rare occurence as a benign tumor arising primary in the larynx.A 27 years old man who visited the hospital with complaint of dyspnea and hoareseness, was found to have a large tumor in the larynx which occupied most cavity of the larynx.The tumor was extracted after a trachotomy and intratracheal anesthesia with chinning laryngoscopy, and it was found that the tumor has sprung from the aryepiglottic fold.The tumor was smooth, elastic, hard and 22.52cm. largest and the histological examination showed that it was neurinoma, that is to say, neurilemmoma.The patient maintained a normal laryngeal function without disturbance in swallowing after a few days of the operation.

On Auriculo-Veatricular Interference Dissociauon Recognized during Intratracheal Anesthesia

On Auriculo-Veatricular Interference Dissociauon Recognized during Intratracheal Anesthesia