Anesthesia Intubation Research Articles

Clinical study on effect of wrist-ankle acupuncture on incidence of hypertension after intubation during induction of general anesthesia

ABSTRACT Objective To observe the effect of wrist-ankle acupuncture on the incidence of hypertension after tracheal intubation during induction of general anesthesia. Methods 200 patients receiving selective surgery under tracheal intubation and general anesthesia in our Hospital were selected and divided into control group and wrist-ankle acupuncture group using the random number table method, with 100 patients in each group. Sufentanil, cisatracurium besilate, remifentanil, etomidate and lidocaine hydrochloride were used for anesthesia induction, and intravenously injected according to the onset time of drugs, successively. The wrist-ankle acupuncture group was needled in bilateral upper 1, 2 and 3 areas, while the control group was treated with false acupuncture.Blood pressure and related blood biochemical indexes were measured and observed at different stages in each group. Result The incidence of blood pressure exceeding 20% and 30% of basal blood pressure within 5 minutes after intubation was as follows:wrist-ankle acupuncture group 11.83% and 6.45%; control group 29.79% and 22.34%, The incidence in the study group was lower than that in the control group. Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that before induction (P < .05), and plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05). The plasma Norepinephrine concentration in the wrist-ankle acupuncture group was significantly lower than that in the control group after intubation (P < .05) Conclusion wrist-ankle acupuncture can prevent hypertension after intubation during anesthesia induction. Moreover, it is safe, effective, minimally invasive. Therefore, it is easy to be popularized in clinical practice.

Prospective Elective Neurosurgical Theater Utilization Audit in Pakistan: Problems in a Public Tertiary Care Hospital and Proposed Solutions from Lower-Middle-Income Country.

Background In lower-middle-income countries such as Pakistan, public hospitals provide free healthcare but suffer from poor management and misgovernance, negatively impacting service provision. One aspect of this is operating theater time (OTT) utilization. In a 1,600-bed hospital with a 22 million catchment population, we noticed significant delays and inadequate OTT efficiency at the neurosurgery department of Jinnah Hospital, Lahore, Punjab, Pakistan. This audit aimed to analyze the neurosurgical OTT utilization, identify delays, and highlight managerial deficiencies and areas for improvement while comparing our workflow with contemporary international literature. Materials and Methods We prospectively audited OTT utilization at the neurosurgical department. All elective surgeries from January to April 2021 were included to identify delays concerning patient transfer, anesthesia team arrival, preparation and intubation time, operative time, and anesthesia extubation time. Results Fifty-six per cent of OTT was utilized operating. Sources of delay included the delayed arrival of anesthesia team (4.7%) and the delay in transferring patients to OT (9.7%). Anesthesia intubation and preparation time accounted for 23% of OT utilization and was significantly longer than the comparable international studies. Extubation time accounted for 5.7% of OT utilization. The issues surrounding transfer delays and prolonged anesthesia time were discussed, with strategies to address them developed with close vital input from our anesthesia colleagues and ward staff. Conclusion Gross delays relatively simple in nature were identified due to poor management and less than ideal interspecialty coordination. Most delays were avoidable and can be addressed by proper planning, optimization of patient transfer and resources, and, most importantly, improved communication between surgeons, anesthetists, and ward staff. This can ensure optimal use of theater time and benefit all specialties, including ancillary staff, and, most importantly, the patient. A reaudit is warranted to assess the impact of interventions on OTT utilization.

Difficult and failed intubation in Caesarean general anaesthesia: a four-year retrospective review.

General anaesthesia is associated with higher maternal morbidity and mortality when compared with regional anaesthesia, related mainly to failure of intubation, hypoxia and aspiration. The aim of this retrospective review was to define the incidence of failed and difficult intubation in parturients undergoing general anaesthesia for Caesarean delivery at a high-volume obstetric hospital in Singapore. All parturients who underwent Caesarean delivery under general anaesthesia from 2013 to 2016 were identified and their medical records were reviewed to extract pertinent data. Difficult intubation was defined as 'requiring more than one attempt at intubation or documented as such, based on the opinion of the anaesthetist'. A failed intubation was defined as 'inability to intubate the trachea, with subsequent abandonment of intubation as a means of airway management'. Records of 660 Caesarean sections under general anaesthesia were extracted. The mean age of the parturients was 32.1 ± 5.5 years and the median body mass index was 27.5 (interquartile range 24.6-31.1) kg/m2. Rapid sequence induction with cricoid pressure was employed for all patients, with thiopentone and succinylcholine being administered for 91.2% and 98.1% of patients, respectively. There were 33 difficult intubations among 660 patients, yielding an incidence of 5.0%. Junior trainees performed about 90% of all intubations and 28 (84.8%) out of 33 difficult intubations. Repeat intubations were performed by senior residents/fellows (57.1%) and consultants (14.3%). No instance of failed intubation was reported. The local incidence of difficult obstetric intubation was one in 20. No failure of intubation was observed.

Non-intubated Thoracoscopic Surgery to Minimize Contamination From Airway Secretions During the COVID-19 Pandemic

BackgroundGeneral anesthesia and tracheal intubation potentially pose a high risk to health care workers (HCWs) managing surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Non-intubated anesthesia is a rational way of managing patients undergoing thoracoscopic surgery that avoids tracheal intubation and minimizes the aerosols generated during airway instrumentation. The purpose of this study was to determine whether non-intubated anesthesia in combination with a face mask is safe and feasible in patients undergoing thoracoscopic surgery.MethodsA total of 18 patients who underwent non-intubated thoracoscopic surgery with a face mask during the perioperative period between March 9, 2020 and April 6, 2020 were included. The main outcomes were anesthetic management and postoperative results.ResultsThe 18 patients had a mean age of 64 years and a body mass index of 22.9 kg/m2. All patients wore a mask during induction of anesthesia and throughout surgery. Three patients underwent lobectomy, four segmentectomy, ten wedge resection, and one underwent anterior mediastinal tumor resection. No patient developed cough or vomiting during the perioperative period. All patients were transferred to the postoperative recovery unit within 15 min of the end of surgery (average 7.2 min). No patient required conversion to tracheal intubation or conversion to thoracotomy.ConclusionNon-intubated anesthesia with a mask was safe and feasible in patients undergoing thoracoscopic surgery. Avoidance of intubated general anesthesia and use of a lung separation device may reduce the risk to HCWs of contamination by airway secretions, thereby conserving personal protective equipment, especially during the COVID-19 pandemic.

Comparison of the Incidence of Sore Throat After General Anaesthesia and Endotracheal Intubation in Early Post-Operatively Period for Abdominal Surgeries who are Given Normal Saline and Dexamethasone

Aim: To compare the incidence of sore throat in the initial postoperative period in patients experiencing general anaesthesia and endotracheal intubation for surgery of the abdomen using normal saline and dexamethasone. Study design: A Randomized-Controlled trial Place and Duration: In the Department of Anaesthesiology, Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six months duration from June 2021 to November 2021. Methodology: 110 patients enduring planned for abdominal surgery under general anaesthesia were included. They 2 groups of the patients were made with equal number of patients. Group I were given 8 mg (2 ml) of dexamethasone I.V before surgery, and 2 ml of saline I.V was given in group II before surgery. The two groups pain comparison was done with chi-square test. The sore throat grading was done with visual analogue scale (VAS). ≤ 4 VAS score was accepted as no sore-throat and a VAS score&gt; 4 as sore-throat. Results: The incidence of postoperative sore throat was lower in group (I) than in control group (II) after the first 24 hours after GA and endotracheal intubation. In this study, nine (16.4%) patients out of 55 who received pre-operative doses of I.V dexamethasone had sore throat post-operatively compared to the control group, i.e., 30 (54.5%) subjects, and the variance was statistically significant (p &lt;0.01). Conclusions: Preoperative usage of dexamethasone was related with a lower frequency of postoperative sore-throat. Keywords: General anaesthesia, visual analogue scale (VAS) and postoperative sore-throat,

Трудная ларингоскопия в плановой анестезиологии

Введение. Обеспечение проходимости дыхательных путей — одна из ключевых задач плановой анестезиологии. Почти треть всех случаев анестезиологической смертности связана с трудностями при вентиляции пациентов после индукции в наркоз. Причем большинство из них обусловлены непосредственно интубацией трахеи и трудностями последующей вентиляции. Причиной 80 % закрытых исков Американской ассоциации анестезиологов по поводу повреждения гортани были повторные попытки интубации трахеи во время плановой анестезии. Цель исследования: повышение эффективности и уменьшение частоты осложнений обеспечения проходимости дыхательных путей при трудной ларингоскопии в плановой анестезиологии. Материалы и методы исследования. Нами проанализированы результаты 66 случаев трудной ларингоскопии при плановых оперативных вмешательствах на базе Полтавской областной клинической больницы за 2013–2015 годы. У всех пациентов во время прямой ларингоскопии на фоне миоплегии голосовая щель не визуализировалась. Пациентам I группы применялся клинический протокол оказания медицинской помощи больным с трудной интубацией трахеи, пациентам II группы после неудачной попытки интубации сразу устанавливалась ларингеальная маска соответствующего размера. Исследовалась частота удачных попыток восстановления проходимости дыхательных путей методом интубации трахеи и с помощью ларингеальной маски, частота и причины осложнений. Результаты исследования. У пациентов I группы вторая попытка интубации трахеи была удачной в 43,8 % случаев. Со следующими попытками интубации трахеи эффективность манипуляции прогрессивно уменьшалась до 6,2 % с четвертой попытки. Эффективность последующего использования ларингеальной маски составила 45,4 %; причины несостоятельности: травматизация слизистой, гиперсаливация, бронхорея, ларинго- и бронхоспазм. У пациентов II группы в 91,2 % случаев постановка ларингеальной маски обеспечила герметичность дыхательного контура и адекватную вентиляцию во время оперативного вмешательства. Осложнений практически не наблюдалось. Выводы. Использование клинического протокола оказания медицинской помощи больным с трудной интубацией трахеи в плановой анестезиологии менее эффективно и имеет высокую частоту осложнений, связанных с прямой ларингоскопией, по сравнению с единственной попыткой интубации трахеи и последующим использованием ларингеальной маски.

Профілактика і лікування пресорних гемодинамічних реакцій на етапі ввідного наркозу та інтубації трахеї в пацієнтів похилого віку

Ця робота присвячена оцінці вираженості пресорних гемодинамічних реакцій на етапі ввідного наркозу та інтубації трахеї в пацієнтів похилого віку, їх профілактиці та способам купірування. У дослідження було включено 47 пацієнтів з ішемічною хворобою серця, яким була виконана операція аортокоронарного шунтування в умовах штучного кровообігу. Середній вік обстежених становив 69,3 ± 4,5 року, середня маса тіла — 82,5 ± 7,4 кг. Залежно від способу профілактики й лікування пресорних реакцій, що виникали у пацієнтів на етапі інтубації трахеї, всі пацієнти були розділені на три групи. У першу групу (n = 12) увійшли пацієнти, у яких був використаний 2% розчин лідокаїну (100 мг), яким зрошували голосові зв’язки перед введенням інтубаційної трубки. Другу групу (n = 18) становили пацієнти, яким на етапі ларингоскопії вводився урапідил у дозі 15–20 мг. У третій групі обстежених (n = 17) проводилося поглиблення анестезії у вигляді додаткового введення фентанілу й пропофолу. У всіх обстежених пацієнтів на етапі ларингоскопії артеріальний тиск (АТ) збільшувався на 23,6 ± 3,2 % відносно вихідного рівня. Безпосередньо після інтубації в першій і третій групах спостерігалося подальше підвищення систолічного АТ, при цьому у другій групі, у якій використовувалося профілактичне введення урапідилу, АТ був у середньому на 27,4 ± 2,6 % менше порівняно зі значеннями АТ, що фіксувалися в першій і третій групах. Отже, пацієнти з артеріальною гіпертензією на етапі ларингоскопії та інтубації трахеї схильні до виражених пресорних гемодинамічних реакцій, для профілактики і лікування яких найбільш ефективним методом є внутрішньовенне введення урапідилу.

Asystole due to vagal reflex in a patient with obstructive sleep apnea during anesthesia intubation with laryngoscope

Obstructive sleep apnea (OSA) is a serious sleep disorder. The complications of OSA are respiratory and cardiovascular events, including bradycardia, tachycardia, and even cardiac arrest. A 57-year-old female with OSA was vulnerable to vagal stimulation, developing severe bradycardia and asystole during general anesthesia while undergoing intubation with a conventional direct laryngoscope. This asystole case highlights the fact that anesthetized patients with OSA may experience increased parasympathetic activity (vagal tone) and vagal stimulation with consequent severe bradycardia and asystole. Atropine is recommended to resolve such conditions.

PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery. Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.

Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study.

Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study.

Effect of Air versus 1% Lignocaine used for Endotracheal Tube Cuff Inflation on Laryngotracheal Morbidity after Laparoscopic Surgery- A Randomised Clinical Study

Introduction: Endotracheal intubation in general anaesthesia is associated with post intubation morbidity due to prolonged inflation of Endotracheal Tube (ETT) cuff with air. During laparoscopic surgery their incidence increases further. Lignocaine is likely to diffuse through ETT cuff when instilled into it. As a result, it decreases coughing, sore throat and hoarseness by reducing local irritation and inflammation of the airway. Aim: To compare the effect of air and 1% lignocaine used for ETT cuff inflation on postoperative sore throat, hoarseness of voice and coughing in patients undergoing laparoscopic surgeries. Materials and Methods: This double-blinded randomised clinical study was conducted at Shree Krishna Hospital, Karamsad, Gujarat, India, between September 2021 to March 2022. Total of 54 patients were randomly divided into two groups with 27 in each; group A (air) and group X (1% lignocaine= 2% lignocaine and equal volume of normal saline). Postextubation patients were assessed for Postoperative Sore Throat (POST), hoarseness and coughing at 2 hours and 18-24 hours. Fisher’s-exact test was used to find association between categorical variables in both the groups. A p-value &lt;0.05 was considered statistically significant. Results: The mean age in group A was 46.04±10.26 years, and in group X was 48.59±10.92 years. At 2 hours, in group X 11% (n=3) of patients had postoperative sore throat as compared to group A where nine patients (33%) reported postoperative sore throat (p-value=0.099). Group X showed a significantly reduced incidence of postoperative sore throat at 18-24 hours, hoarseness of voice, coughing at 2 hours and at 18-24 hours as compared to group A. Conclusion: The use of 1% lignocaine for ETT cuff inflation in laparoscopic surgeries was associated with reduced incidence of postoperative sore throat, hoarseness of voice and coughing as compared to air.

Comparison between Standard Technique versus Reverse Manoeuvre of Airtraq Insertion for Tracheal Intubation in Lean versus Obese Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Obese patients pose challenge to anaesthesiologist in terms of securing airway due to large tongue and anatomical variations, need a novel tracheal intubation technique to quickly secure airway in obese individuals. The airtraq laryngoscope with reverse technique of insertion is used to secure airway without classical sniffing position. Aim: To compare the two techniques of airtraq insertion, standard and reverse manoeuvre, in lean versus obese patients undergoing surgery under general anaesthesia. Materials and Methods: This randomised clinical study was conducted from July 2012 to January 2014 at Seth GS Medical College and KEM Hospital, Mumbai, Maharasthra, India in a total of 200 American Society of Anaesthesiologists (ASA) I-III undergoing surgery under general anaesthesia. Both lean and obese patients were randomly allocated to each technique. After induction of anaesthesia intubation was performed by an expert anaesthesiologist with each technique (three attempts) were used to intubate trachea. If there was a failure, switch over technique was applied. All the groups were analysed for intubation time, number of attempts, ease of intubation Visual Analogue Scale (VAS), haemodynamics, and complications. Results: Both lean and obese groups were comparable in the airway and demographic characteristics. In lean patients there was no significant difference between intubation time with both standard and reverse manoeuvre. While in obese patients reverse manoeuvre (11.84±1.99 seconds) significantly reduced exposure time by 13 seconds as compared to standard technique (24.02±6.94 seconds), thereby reducing total duration of intubation (26.08±1.16 seconds) as compared to total duration of intubation with standard technique (39.62±8.95 seconds). Lean group were comparable in number of attempts with standard technique (47 1st /3 2nd attempt) and reverse manoeuvre (49 1st /1 2nd attempt). Obese group with reverse manoeuvre all were intubated with first attempt (50 1st) with standard technique (46 1st /1 2nd attempt) and there was switch over from standard to reverse technique in three patients. Both lean and obese groups were comparable in complications with both technique. Conclusion: Reverse manoeuvre proved beneficial in obese patients as it reduced intubation time as compared to standard technique, while lean patients showed no difference.

LAPAROLIFTING IN PERFORMING LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH COVID-19

Starting in March 2020, when doctors faced the onset of the coronavirus disease (SARS-CoV-2) pandemic, the surgical service faced new challenges: the growth in abdominal emergencies and the presence of the COVID-19 as a concomitant disease. Respiratory infection requires finding ways to improve the performance of surgical laparoscopic interventions, since all patients have respiratory disorders. One method that can help is laparolifting or "gasless laparoscopy." The aim of the study was to investigate the efficacy and safety of the gasless laparoscopy (laparolifting) method for endoscopic cholecystectomy in patients with COVID-19 co-infection. We analyzed the clinical data of patients with acute destructive cholecystitis and COVID-19 co-infection who underwent laparoscopic cholecystectomy by applying a laparolifting device and compared them with standard surgery by using carboxy-peritoneum. According to the data obtained, we can suggest that the use of "gasless laparoscopy" method in the presence of respiratory distress syndrome in patients with COVID-19 reduces the need to increase the peak inspiratory pressure during intubation anesthesia, and over the postoperative period this method has a positive effect on the patients’ need in oxygen to achieve the good saturation. Having analyzed laboratory parameters, we can conclude that both methods are comparable and do not cause critical shifts in the body's homeostasis. According to our study, laparolifting is a safe technique that also reduces pain syndrome intensity after surgery and does not seriously restrain the patient's activity. Therefore, we can recommend the use of laparolifting when performing laparoscopic cholecystectomy in patients with COVID-19.

Academician Evgeniy Nikolaevich Meshalkin (1916–1997) (on the 105th anniversary of his birth)

The outstanding cardiologist and cardiac surgeon Evgeny Nikolaevich Meshalkin was born on February 25, 1916 in the city of Yekaterinoslav, now Dnepropetrovsk. In 1918, the Meshalkin family moved to Rostov-on-Don, and in 1928 to Moscow, where Evgeny graduated from school in 1930, and then studied at the factory school at the Sickle and Hammer factory. In 1941, Evgeny Nikolaevich graduated from the 2nd Moscow Medical Institute and from August 1941 to May 1945 was a participant of the Great Patriotic War permanently in the field army. After demobilization from the army, E. N. Meshalkin worked from 1946 to 1956 at the department and at the clinic of Faculty Surgery of the 2nd Moscow State Medical Institute, headed by Academician of the USSR Academy of Medical Sciences A. N. Bakulev. In 1950, he defended his PhD thesis «Intubation anesthesia», and in 1953, his first monograph «Intubation anesthesia Technique» was published. Evgeny Nikolaevich is rightfully considered one of the founders of the Russian anesthesiology. In 1953, E. N. Meshalkin defended his doctoral dissertation «Probing and contrast study of the heart and major vessels». In conditions of moderate nonperfusion hypothermia, Yevgeny Nikolaevich successfully operated on complex heart defects, performed the insertion of mechanical prostheses for mitral and aortic insufficiency. From January 1956 to 1960, he was the head of the Department of Thoracic Surgery and Anesthesiology of the Central Institute of Advanced Medical Training (now the Russian Medical Academy of Postgraduate Education). E.N.Meshalkin owns 47 copyright certificates and patents, which are implemented not only in the Research Institute of Circulatory Pathology, but also in other cardiac surgery centers in Russia. Honorary citizen of Novosibirsk Evgeny Nikolaevich Meshalkin passed away on March 8, 1997 and was buried in Novosibirsk at the Southern Cemetery. In memory of the outstanding scientist, the Novosibirsk Research Institute of Circulatory Pathology was named after Academician E. N. Meshalkin.

Pharmacology of Cisatracurium Besylate

Background: In routine anesthesia practice, a variety of neuromuscular blocking agents are used. Cisatracurium besylate is a nondepolarizing neuromuscular blocking agent with an intermediate duration of action. Because of the high molecular weight and polarity, the volume of distribution is small. Cisatracurium besylate undergoes Hofmann elimination, making it an excellent choice for patients suffering from organ failure.&#x0D; Methodology: This review article was prepared after a thorough study of the literature using data search engines such as Scopus, Pubmed, Web of Science, and Google Scholar. This article referred to prior Cisatracurium observational studies and case reports.&#x0D; Review Findings: After learning pharmacology, uses, contraindications of Cisatracurium and reviewing the previous observational studies and case reports about Cisatracurium, this drug is used as a muscle relaxant during general anesthesia for tracheal intubation. It has been used successfully in critical care settings where patients were placed on mechanical ventilation and required complete skeletal muscle paralysis. Systemic or cutaneous release of histamine is not caused by cisatracurium.&#x0D; Conclusion: Cisatracurium is a relatively new intermediate-onset, long-lasting skeletal muscle relaxant. This medication can be used safely in patients with hepatorenal impairment. It, like other muscle relaxants, can be used during elective surgical repair under general anaesthesia as well as in patients undergoing prolonged controlled mechanical ventilation. The only concern could be the cost effectiveness in comparison to other skeletal muscle relaxants on the market.

Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia.

BACKGROUNDGastroesophageal reflux (GER) affects up to 20% of the adult population and is defined as troublesome and frequent symptoms of heartburn or regurgitation. GER produces significantly harmful impacts on quality of life and precipitates poor mental well-being. However, the potential risk factors for the incidence and extent of GER in adults undergoing general anesthesia remain unclear.AIMTo explore independent risk factors for the incidence and extent of GER during general anesthesia induction. METHODSA retrospective study was conducted, and 601 adult patients received general anesthesia intubation or laryngeal mask surgery between July 2016 and January 2019 in Shanghai General Hospital of Nanjing Medical University. This study recruited a total of 601 adult patients undergoing general anesthesia, and the characteristics of patients and the incidence or extent of GER were recorded. The potential risk factors for the incidence of GER were explored using multivariate logistic regression, and the risk factors for the extent of GER were evaluated using multivariate linear regression.RESULTSThe current study included 601 adult patients, 82 patients with GER and 519 patients without GER. Overall, we noted significant differences between GER and non-GER for pharyngitis, history of GER, other digestive tract diseases, history of asthma, and the use of sufentanil (P < 0.05), while no significant differences between groups were observed for sex, age, type of surgery, operative time, body mass index, intraoperative blood loss, smoking status, alcohol intake, hypertension, diabetes mellitus, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, palliative strategies, propofol, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05). The results of multivariate logistic regression indicated that female sex [odds ratio (OR): 2.702; 95% confidence interval (CI): 1.144-6.378; P = 0.023], increased age (OR: 1.031; 95%CI: 1.008-1.056; P = 0.009), pharyngitis (OR: 31.388; 95%CI: 15.709-62.715; P < 0.001), and history of GER (OR: 11.925; 95%CI: 4.184-33.989; P < 0.001) were associated with an increased risk of GER, whereas the use of propofol could protect against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Finally, age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017) were significantly associated with GER time.CONCLUSIONThis study identified the risk factors for GER in patients undergoing general anesthesia including female sex, increased age, pharyngitis, and history of GER.

Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy

Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity.&#x0D; Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable.&#x0D; Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia.

BackgroundNon-intubated anesthesia thoracoscopic surgery is an evolving form of minimally invasive thoracic surgery. It has had encouraging results in the treatment of lung cancer, and the current concept of enhanced recovery after surgery has become indispensable to surgical treatment. Our center retrospectively evaluated the clinical effect of rapid postoperative rehabilitation in patients who underwent thoracoscopic lung surgery under non-intubated anesthesia.MethodsThe clinical data of 192 patients undergoing video-assisted thoracoscopic surgery (VATS) at the Department of Thoracic Surgery of The First People’s Hospital of Yunnan Province were retrospectively analyzed. Among them, 75 received double-lumen endotracheal intubation anesthesia, and 117 received a laryngeal mask instead of endotracheal intubated anesthesia. Comparing the intra-and post-operative indicators difference of these 2 groups.ResultsThere were no significant differences in the postoperative complications, length of hospital stay, hemoglobin counts and platelet count 24 h after surgery between the non-intubated anesthesia and intubated anesthesia groups (P>0.05). In terms of the postoperative rehabilitation indicators of the VATS patients, the non-intubated anesthesia group had an earlier recovery in terms of water (food) intake, out-of-bed activity, and defecation (exhaust) times (P<0.001), less postoperative complications and adverse throat reactions (P<0.05), and higher levels of satisfaction (P<0.05) than the intubated anesthesia group. Compared to the intubated anesthesia group, the non-intubated anesthesia group had fewer changes of white blood cell counts, neutrophil percentages and lymphocytes percentages 24 h postoperatively (9.25×109 vs. 7.67×109, P=0.045; 7.06 vs. 5.53, P=0.039; 1.45 vs. 1.27, P=0.017), significant reduction pleural drainage after restoring oral intake in postoperative 24 and 48 h (198.43 vs. 131.07 and 114.04 vs. 57.47 mL, P<0.001), shorter postoperative thoracic tube drainage times (3.73 vs. 3.13 d, P<0.001). Notably, there was no difference between the smoking history and previous medical history of the patients in the 2 groups.ConclusionsCompared to intubation by general anesthesia, non-intubated thoracoscopic anesthesia is a safe and effective option. Patients who undergo non-intubated thoracoscopic lung surgery have a rapid recovery after surgery. Thus, it is worthy of promotion in clinical surgery settings.

Repair of a three-way congenital bronchoesophageal fistula in an adult patient: a case report

BackgroundThe incidence of congenital bronchoesophageal fistulas in adults is rare. Most fistulas discovered in adulthood are often small and can be repaired with a simple one-step method.Case presentationA 46-year-old female patient complained of a 2-month history of chocking, coughing, and a 12 kg drop in weight. The bronchofiberscopy and gastroscopy showed a large fistula, which extended from the esophagus to the main bronchus on both sides, thus forming a special three-way channel which has never been reported. This case was challenging both to the anesthetists and surgeons. The patient was intubated with a sengstaken-blakemore tube, and then received segmental esophageal resection, anastomotic reconstruction, and double-flap repair with esophagus segment in situ.ConclusionWhen the fistula in BEF is large or complicated, appropriate surgical methods should be meticulously designed according to the condition of the patient. The problem of anesthesia intubation should be solved first, to allow a smooth operation. Secondly, a double-layer repair of the airway fistula by using esophageal wall tissues as patch materials is proposed.

Clinical application of preserving spontaneous breathing non-intubation anesthesia in thoracoscopic surgery for lung cancer under ERAS concept.

To explore the safety and feasibility of thoracoscopic surgery in patients with lung cancer under non-intubation anesthesia, and to evaluate the advantages of the non-intubation anesthesia compared with intubation anesthesia on enhanced recovery after surgery (ERAS). A retrospective cohort study was conducted in which 100 patients who underwent thoracoscopic lung cancer surgery from January 2020 to February 2021 in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University were included and divided into non-intubation group (n=50) and intubation group (n=50). The primary outcome was the comparison of intra- and postoperative parameters. Secondary outcomes included inflammatory response indicators and intra- and postoperative complications. There was no significant difference between the two groups in anesthesia effect score, blood loss, lowest pulse oxygen saturation, operation time, postoperative chest tube indwelling time (P>0.05). Non-intubation group had less intraoperative remifentanil dosage, less change of blood pressure and heart rate, lower postoperative pain numerical score(NRS), less medical costs, smaller incidence rate of throat discomfort (P<0.05). The non-intubation group was also associated with less extubation time, postanesthesia care unit recovery time, ambulation time, food intake time, postoperative antibiotic use time, and hospital stay (P<0.05). The increase of C-reactive protein in the non-intubation group was lower than that in the intubation group (P<0.05). Non-intubation anesthesia for thoracoscopic lung cancer surgery is safe and feasible. Compared with the intubation anesthesia, it has advantages in ERAS and reducing medical costs.