General Anesthesia Intubation Research Articles

Comparative evaluation of lignocaine nebulization with and without dexmedetomidine for flexible videoendoscopic guided awake nasal intubation for general anaesthesia.

Awake fibreoptic intubation is considered a safe approach in airway management of a patient with difficult airway. Awake fibreoptic endoscopy needs appropriate anaesthesia of airway to suppress airway reflexes and prevent discomfort. We planned this study to evaluate effect of adding dexmedetomidine to lignocaine nebulization on conditions for awake videoendoscopic intubation. In this prospective randomized double blind controlled study, ninety six ASA grade I, II patients of either gender, aged 18-65 years, scheduled for elective surgeries under general anaesthesia, were randomly allocated into two groups, Group D and L to receive nebulization with 4% Lignocaine 5 ml + Dexmedetomidine 2 mcg/kg and 4% Lignocaine alone respectively, 20 min before procedure. Time taken to intubate the patient, ease of intubation assessed by cough severity score, patient comfort score, post-intubation patient satisfaction and hemodynamic changes were recorded and compared. Group D and L had comparable intubation time (196.8 ± 61.2 s) and (205.8 ± 52.2 s) (p = 0.437). Cough severity, patient comfort and quality of procedure with post intubation patient satisfaction score were significantly better in Group D. Haemodynamics parameters were better post nebulization in group D as compared to group L. Addition of Dexmedetomidine 2 mcg/kg with 4% Lignocaine during nebulization improves intubating conditions during awake flexible videoendoscopy in terms of ease of intubation, cough severity, patients comfort and satisfaction along with providing stable Haemodynamics profile.

Analysis of the 3D printing open-source video laryngoscope for orotracheal intubation

Introduction Orotracheal intubation becomes a challenge for the anesthesiologist when the glottis is not visualized with direct laryngoscopy. Videolaryngoscopes emerged as an alternative in these situations, but the costs of these devices restrict their popularization. Doubts remain as to whether low-cost devices would be safe and effective, such as the 3D printing Open-Source video laryngoscope. Aim To analyze the 3D printing Open-Source video laryngoscope for orotracheal intubation for general anesthesia in its the rate of achieving, glottis visualization time, intubation time and its correlation with the order of execution. Methods Clinical, prospective, analytical study of a questionnaire carried out after the procedure. Statistical analysis was performed using Spearman’s correlation, Kruskal-Wallis test, and chi-square test. Results There was a total of 64 uncomplicated orotracheal intubation procedures with an overall success rate of 93.8%. Mean time for viewing the glottis (16.4”), mean times of endotracheal intubation with Mallampati I (26.5”), ll (33.7”), lll (57.3”), lV (38.5”) were obtained with no statistical significance (P 0.170) and overall mean time of orotracheal intubation (36.4”) with a moderate negative correlation of –0.36 across the orotracheal intubation execution order. Conclusion In the analysis of endotracheal intubation with the 3D printing Open-Source video laryngoscope a high success rate was demonstrated without any complications. The time to obtain endotracheal intubation tends to reduce with subsequent experiences and learning, but it is more than twice the time required to adequately visualize the glottis and the Mallampati classification was not a relevant time predictor. Keywords Orotracheal intubation; Videolaryngoscopy, Airway management

Airway assessment: Predictors for difficult intubation – A prospective observational study

Airway management remains an important challenge in the contemporary practice of anaesthesia and preoperative airway assessment facilitates appropriate preparation when difficulty with intubation or ventilation is anticipated prior to induction of anaesthesia.: Aim: To study the important predictors for difficult laryngeal intubation. To determine the predictors of difficult laryngeal intubation. Secondary: To determine the most significant predictor for difficult intubation and to determine the incidence of unanticipated difficult intubation.This single centre prospective observational study done in Bangalore Baptist hospital (after obtaining clearance from ethical committee) included adult patients posted for elective surgeries who received general anaesthesia. Patients of either gender in the 18 – 65 year age group, with an American Society of Anaesthesiologists physical status classification of I or II, who required endotracheal intubation for general anaesthesia. The sample size was 413 with confidence level 95%. In our study the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Mallampati class were found to be 75.8%, 78.06%, 37.90%, 94.80% respectively. The sensitivity, specificity, PPV and NPV of mouth opening were found to be 33.87%, 81.19%, 24.13%, 87.42% respectively. The sensitivity, specificity, PPV and NPV of upper lip bite test found to be 27.41%, 96.29%, 56.66%, 88.25% respectively. The sensitivity, specificity, PPV and NPV of neck extension found to be 54.83%, 92.59%, 56.66%, 92.06% respectively. The sensitivity, specificity, PPV and NPV of BMI found to be 53.22%, 75.49%, 27.73%, 90.13% respectively. The incidence of difficult intubation was 15%.:In conclusion, no single predictor is sufficient for prediction of difficult intubation on its own. All the studied bedside tests are poor to moderate predictors of difficult intubation. All the tests showed poor positive predictive values and high negative predictive values which suggests that they can be more useful predictors of easy intubation than difficult intubation.

Effect of electroacupuncture on haemodynamic changes during intubation for general anaesthesia is mediated by nitric oxide synthase‑3 via the regulation of microRNA‑155, microRNA‑335 and microRNA‑383.

Intubation for general anaesthesia is a life‑threatening risk because it can cause haemodynamic changes. Electroacupuncture (EA) has been reported to alleviate the risk of intubation. In the present study, haemodynamic changes were measured at different time points before and after EA. Reverse transcription‑quantitative PCR was performed to measure the expression of micro (mi)RNAs and endothelial NO synthase (eNOS) mRNA. Western blotting was performed to evaluate the expression of eNOS protein. A luciferase assay was used to explore the inhibitory role of miRNAs in eNOS expression. The transfection of miRNA precursors and antagomirs was performed to assess their effect on eNOS expression. The systolic blood pressure, diastolic blood pressure and mean arterial pressure of patients were significantly decreased by EA, while the heart rate of patients was markedly increased. The expression of micro RNA (miR)‑155, miR‑335 and miR‑383 was effectively inhibited by EA in the plasma and peripheral blood monocytes of patients, whereas eNOS expression and NOS production were markedly elevated by EA. The luciferase activity of the eNOS vector was significantly inhibited by miR‑155, miR‑335 and miR‑383 mimics but activated by miR‑155, miR‑335 and miR‑383 antagomirs. miR‑155, miR‑335 and miR‑383 precursors suppressed the expression of eNOS, while miR‑155, miR‑335 and miR‑383 antagomirs enhanced the expression of eNOS. The present study demonstrated that EA may exert a vasodilative effect during intubation for general anaesthesia by promoting NO production and upregulating eNOS expression. The effect of EA on upregulating eNOS expression may be mediated by its inhibitory effect on the expression of miRNA‑155, miRNA‑335 and miRNA‑383.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Effect of supraglottic airway devices versus endotracheal intubation general anesthesia on outcomes in patients undergoing mechanical thrombectomy: A prospective randomized clinical trial.

Background:There are still controversies about the optimal anesthesia protocol for patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). The aim of this study was to explore the effect of supraglottic airway device (SAD) versus endotracheal intubation (EI) general anesthesia on clinical and angiographic outcomes in patients with AIS undergoing MT.Methods:One hundred sixteen patients with large-vessel occlusion stroke were randomized to receive either SAD or EI general anesthesia. The primary outcome was the rate of occurrence of >20% fall in mean arterial pressure (MAP). Secondary outcomes included hemodynamics, successful recanalization, time metrics, satisfaction score of neurointerventionalist, number of passes performed, the conversion rate from SAD to EI, the National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score before and 24 hours after surgery, length of stay in the stroke unit and hospital, complications and functional independence at discharge, and 90 days after stroke.Results:Both the lowest systolic blood pressure and lowest diastolic blood pressure were significantly lower in the EI group (P = .001). The consumption of vasoactive agents, the occurrence of >20% reduction in MAP and time spent with >20% fall in MAP were significantly higher in the EI group (P < .05). Compared with the EI group, the time for door-to-puncture was significantly shorter in the SAD group (P = .015). There were no significant differences with respect to puncture-to-reperfusion time, number of passes performed, rates of successful recanalization, National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT Score 24 hours after surgery. The satisfaction score of neurointerventionalist was significantly lower in the EI group (P = .043). Conversion rate from SAD to EI was 7.41%. There were no significant differences with respect to complications, mortality, and mean Modified Rankin Scale scores both at discharge and 90-day after stroke. However, length of stroke unit and hospital stays were significantly shorter in the SAD group (P < .05).Conclusion:AIS patients undergoing MT with SAD general anesthesia led to more stable hemodynamics, higher satisfaction score of neurointerventionalist, shorter door-to-puncture time, length of stroke unit, and hospital stay. However, there were no significant differences between the 2 groups on the angiographic and functional outcomes both at discharge and 90 days after stroke.

The incidence and causes of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia

Objective: To observe the incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia and to explore the risk factors for its occurrence. Methods: The data of patients suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia from June 2018 to May 2021 were retrospectively reviewed. The type of procedure, surgeon, age and gender were selected as matching factors, 4 patients without Tapia syndrome were selected as control group for each case. The radiological parameters including mandibular-vertebral distance, thyroid-vertebral distance, thyroid cartilage-vertebral distance, and C2-C7 lordotic Cobb angle were measured on lateral radiographs of the cervical spine. The above parameters were measured on neutral, over-flexion and over-extension radiographs. The difference between the Tapia group and the control group were analyzed. Results: There were 9 patients (0.37%) suffered from Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia in 2 431 patients, and it happened in 0.67 days (0-2 days) after the operation. There were 3 males and 6 females with a mean age of (61±5) years. The clinical manifestations was tongue extension deviation in 8 cases (88.9%), dysarthria in 6 cases (66.7%), dysphagia in 3 cases (33.3%), tongue stiffness in 3 cases (33.3%), hoarseness in voice and pharyngeal discomfort in 1 case (11.1%). All of the symptoms were relieved in all patients at 3 months postoperative follow-up. In neutral position, the mandibular-vertebral distance was (7.19±3.96) mm in the control group and it was (3.98±3.01) mm in Tapia group (P<0.05). From neutral position to hyperflexion position, the distance between mandible and vertebral body was reduced from 3.98 mm to 1.95 mm in the Tapia group and decreased for 51.0%, and it decreased from 7.19 mm for 31.8% to 4.90 mm in the control group. Conclusions: The incidence of Tapia syndrome after posterior cervical spine surgery under oral tracheal intubation general anesthesia is low. A smaller mandibular-vertebral distance on pre-operative cervical spine lateral view radiograph maybe a risk factor for Tapia syndrome after posterior cervical surgery under oral tracheal intubation general anesthesia.

Effect of Entropy Index-Targeted Dextromeetomidine on Postoperative Neurocognitive Function in Elderly Patients with Gastrointestinal Tumors

Objective: To investigate the effect of entropy index targeted monitoring combined with dexmedetomidine infusion on cognitive function after thoracic and abdominal surgery in elderly patients. Methods: 60 elderly patients undergoing abdominal surgery in our hospital on October ~2017 and October 2019 were selected, ASAⅡ~ grade III, and the random digital table method was divided into 3 groups ,20 cases in each group. entropy index monitoring combined with dexmedetomidine group (D1 group), entropy index monitoring combined with dexmedetomidine group (D2 group) and dexmedetomidine monitoring combined with saline group (D0 group). All patients were subjected to sequential rapid induction of endotracheal intubation general anesthesia. D1, D2, the group was injected with 0.5μg/kg dexmedetomidine hydrochloride intravenously in the first 15 min of induction, followed by a 0.3μg•kg-1•h-1, 0.6μg•kg-1•h-1 maintenance pump until 30 minutes before the end of operation, respectively. The D0 group was injected with the same amount of saline intravenously before induction, and then maintained with the same amount of saline. D1 and D2 groups were calibrated at 40~60. preoperative (T1), tracheal intubation immediate (T2),30 min after operation (T3) and extubation immediate (T4) M after operation were compared in 3 groups AP (mmhg), hr (sub/ min), blood oxygen saturation (SpO2) and intraoperative anesthetic dosage, vasoactive drug use, and postoperative recovery status; simple intelligent mental state examination scale (MMSE) test was completed 1 day before ,1 day after ,3 days after and 7 days after operation to record the incidence of perioperative neurocognitive disorders (PND). To detect the necrosis factor-α(TNF-α) and C-reactive protein (CRP) of the above-mentioned concurrent serum tumors; Results Compared with D0 group, the MAP of D1 group and D2 group decreased significantly and the HR slowed down significantly (P&lt;0.05), The MAP, HR of T3, T4 in D2 group was significantly decreased compared with that in the D1 group (P&lt;0.05), but the difference was not significant at all time points (0.05);The respiratory recovery time (min), dialling time (min) and restoring directional force time (min) were significantly shortened compared with the D0 group and the D2 group, and the consumption of propofol and sufentanil during the operation was significantly decreased. Compared with the D2 group, the use of vasoactive drugs in the D1 group was significantly decreased (P&lt;0.05). The TNF-α, CRP of patients in the first day and the third day were higher than those in the first day of operation, but the TNF-α, CRP of D1 group and D2 group were lower than those in the D0 group (0.05). The MMSE scores of l days and 3 days after operation in D1 and D2 groups were higher than those in D0 groups. Significantly decreased (P&lt;0.05), and there was no significant difference between the groups 7 days after operation (P&gt;0.05): Conclusion entropy index targeted monitoring combined with dexmedetomidine infusion (0.3μg/kg/h) in the elderly patients during surgery can improve the intraoperative and postoperative hemodynamic stability, can improve the perioperative neurocognitive disorders of patients, worthy of clinical promotion.

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.

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.

Effect of Different Anesthesia Methods on Emergence Agitation and Related Complications in Postoperative Patients with Osteosarcoma.

Purpose To explore the effect of different anesthesia methods on emergence agitation (EA) and related complications in postoperative patients with osteosarcoma. Methods According to the order of admission, 115 patients requiring osteosarcoma surgery treated in our hospital from January 2018 to December 2020 were selected as the research object and randomly divided into the control group (n = 57, accepted the general anesthesia with tracheal intubation) and the experimental group (n = 58, accepted the combined spinal-epidural anesthesia) to compare their anesthesia effect, incidence rates of agitation and complications, and other indexes. Results In terms of the hemodynamic indexes (MAP, HR, and CVP values), both groups had lower ones at T1 than at T0, but the decline of the experimental group was generally lesser than that of the control group; at T2, no statistical difference was shown within the experimental group's indexes when comparing with those at T1, but the control group obtained a significant increase; at T3 and T4, both groups had their hemodynamic indexes increased, but such increase within the experimental group showed no statistical difference when comparing with those at T0, while the control group achieved obviously higher values at T4 than at T0 (before the anesthesia); and the between-group difference in the hemodynamic indexes at T1 and T4 was significant. Compared with the control group, the experimental group achieved better VAS scores and anesthesia indexes and lower incidence rates of EA and complications such as the hypoxemia, cardiovascular response, delayed recovery, and headache. In addition, the differences in the incidence rates of hypotension and cognitive dysfunction between the two groups were not statistically significant. Conclusion When comparing with tracheal intubation general anesthesia, the combined spinal-epidural anesthesia has a better effect in osteosarcoma surgery, with less hemodynamics influence on patients, reduced postoperative pain and stress reaction, and lowered incidence rates of postoperative EA and complications, which is worthy of wide application in clinical treatment.

Effect of Magnesium Sulphate Nebulization on the Incidence of Postoperative Sore Throat in Patients Requiring Endotracheal Intubation for General Anesthesia

Background: Post-operative sore throat (POST) is one of the most common anesthesia related complication. It is one of the undesirable post-operative events. Several Non pharmacological and pharmacological methods tried to reduce POST. we planned to study the efficacy of magnsesium sulphate nebulization in reduction of post operative sore throat.&#x0D; Study Design: Prospective, comparative observational study.&#x0D; Place and Duration of Study: Department of anesthesiology, AVBRH, from June 2020 to November 2020.&#x0D; Materials and Methods: observational study of 60 cases divided into two equal groups. Patients included in the study were of either gender belonging to American Society of Anesthesiologists (ASA) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation. Patients in Group N were nebulized with 3 ml of normal saline and the patients in Group M were nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min. The incidence of POST at rest and on swallowing at 0, 2, 4,12 and 24 h in the postoperative period were evaluated.&#x0D; Results: No significant difference in postoperative sorethroat was observed on swallowing in between magnesium sulphate and normal saline at zero and 2nd hour. significant difference was observed at 4th,12th and 24th hour between magnesium sulphate and normal saline in reducing the incidence of post-operative sore throat.&#x0D; Conclusion: MgSO4 significantly reduces the incidence of POST compared to normal saline.

ANESTHESIA MANAGEMENT OF PATIENTS UNDERGOING PERCUTANEOUS PULMONARY VALVE IMPLANTATION

Introduction To investigate the perioperative anesthesia management of percutaneous pulmonary valve implantation (PPVI). Methods Clinical data of 6 patients undergoing PPVI operation were retrospectively analyzed in children's heart center of Henan Provincial People's Hospital from December 2017 to January 2020, including 3 males and 3 females with mean age (16.3±5.4) years,weight 41.2±12.3Kg. All patients received endotracheal intubation under general anesthesia. Systolic blood pressure (SBP) and diastolic blood pressure (DBP),heart rate(HR),central venous pressure(CVP),pulse oxygen saturation(SPO2) were recorded before anesthesia induction (T1),after anesthesia induction (T2),before surgery (T3),before percutaneous pulmonary valve implantation (T4),during percutaneous pulmonary valve implantation (T5),after percutaneous pulmonary valve implantation (T6) and out of the operating room (T7). Right ventricular systolic (SRVP) and right ventricular diastolic (DRVP), pulmonary artery systolic (SPAP) and diastolic (DPAP) were recorded before T4 and after T6. Intraoperative complications were recorded. The time of tracheal catheter removal was recorded. The time of stay in ICU and the time of discharge was recorded. Results Compared with T1,T2,T3,T4,T6,T7,SBP,DBP,HR and SPO2 was significantly reduced at T5 (P Discussion Tracheal intubation general anesthesia is suitable for percutaneous PPVI surgery. Hemodynamic monitoring should be strengthened during pulmonary valve implantation to maintain circulatory stability.

Difference between remimazolam toluenesulfonic acid and propofol in waking quality and conscious state after general anesthesia.

To explore the difference of anesthesia recovery and postoperative conscious state between remimazolam toluenesulfonic acid and propofol after induction and maintenance of general anesthesia. 104 patients undergoing elective tracheal intubation general anesthesia in our hospital were randomly divided into 2 groups: Remimazolam Toluenesulfonic acid group (Group R) and Propofol group (Group P). MOAA/S score, the modified Aldrete score, recovery index, time point, a state of consciousness, interpretative vital signs and adverse events were monitored at different time. Compared with the Group P, the extubation time and orientation recovery time of the Group R were significantly shorter. When the operation time was less than 1 hour, the MOAA/S score of the Group R was shorter than that of Group P at 5min and 15min after the operation. To compare with the Group P, the score of MOAA/S in the Group R increased at 5min, 20min and 30min after the operation. When the operation time was less than or equal to 1h, the modified Aldrete score in the Group R was slightly higher than that in the Group P at 30min after extubation. There was no injection pain in the the Group R, and the incidence of hypotension was lower than that of propofol. Compared with Propofol, when the operation time of general anesthesia is more than 1 hour, recovery time of Remimazolam Toluenesulfonic acid is shorter, with more complete and higher-quality recovery.