Removal Of Tracheal Tube Research Articles

Effect of continuous measurement and adjustment of endotracheal tube cuff pressure on postoperative sore throat in patients undergoing gynecological laparoscopic surgery: a randomized controlled trial.

Postoperative sore throat (POST) is a common complication following endotracheal tube removal, and effective preventive strategies remain elusive. This trial aimed to determine whether actively regulating intraoperative cuff pressure below the tracheal capillary perfusion pressure threshold could effectively reduce POST incidence in patients undergoing gynecological laparoscopic procedures. This single-center, randomized controlled superiority trial allocated 60 patients scheduled for elective gynecological laparoscopic procedures into two groups: one designated for cuff pressure measurement and adjustment (CPMA) group, and a control group where only cuff pressure measurement was conducted without any subsequent adjustments. The primary outcome was POST incidence at rest within 24h post-extubation. Secondary outcomes included cough, hoarseness, postoperative nausea and vomiting (PONV) incidence, and post-extubation pain severity. The incidence of sore throat at rest within 24h after extubation in the CPMA group was lower than in the control group, meeting the criteria for statistically significant superiority based on a one-sided test (3.3% vs. 26.7%, P < 0.025). No statistically significant differences were observed in cough, hoarseness, or pain scores within 24h post-extubation between the two groups. However, the CPMA group had a higher incidence of PONV compared to the control group. Additionally, the control group reported higher sore throat severity scores within 24h post-extubation. Continuous monitoring and maintenance of tracheal tube cuff pressure at 18 mmHg were superior to merely monitoring without adjustment, effectively reducing the incidence of POST during quiet within 24h after tracheal tube removal in gynecological laparoscopic surgery patients. The study was registered at www.chictr.org.cn (ChiCTR2200064792) on 18/10/2022.

Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

BackgroundDeep neuromuscular block (NMB) has been shown to improve surgical conditions and alleviate post-operative pain in bariatric surgery compared with moderate NMB. We hypothesized that deep NMB could also improve the quality of early recovery after laparoscopic sleeve gastrectomy (LSG).MethodsEighty patients were randomized to receive either deep (post-tetanic count 1–3) or moderate (train-of-four count 1–3) NMB. The QoR-15 questionnaire was used to evaluate the quality of early recovery at 1 day before surgery (T0), 24 and 48 h after surgery (T2, T3). Additionally, we recorded diaphragm excursion (DE), postoperative pain, surgical condition, cumulative dose of analgesics, time of first flatus and ambulation, post-operative nausea and vomiting, time of tracheal tube removal and hospitalization time.Main resultsThe quality of recovery was significantly better 24 h after surgery in patients who received a deep versus moderate block (114.4 ± 12.9 versus 102.1 ± 18.1). Diaphragm excursion was significantly greater in the deep NMB group when patients performed maximal inspiration at T2 and T3 (P < 0.05). Patients who underwent deep NMB reported lower visceral pain scores 40 min after surgery; additionally, these patients experienced lower pain during movement at T3 (P < 0.05). Optimal surgical conditions were rated in 87.5% and 64.6% of all measurements during deep and moderate NMB respectively (P < 0.001). The time to tracheal tube removal was significantly longer in the deep NMB group (P = 0.001). There were no differences in other outcomes.ConclusionIn obese patients receiving deep NMB during LSG, we observed improved QoR-15 scores, greater diaphragmatic excursions, improved surgical conditions, and visceral pain scores were lower. More evidence is needed to determine the effects of deep NMB on these outcomes.Trial registrationChiCTR2200065919. Date of retrospectively registered: 18/11/2022.

Cognitive and psychological outcomes and follow-up in severely affected COVID-19 survivors admitted to a rehabilitation hospital.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) represents the most recent severe pandemic resulting in coronavirus disease 2019 (COVID-19). COVID-19 can damage the central nervous system, requiring admission to intensive care units (ICU) and aggressive treatments (long-term ventilatory assistance and sedation) to stabilize vitals. Most post-COVID-19 patients experience cognitive impairments and mood or stress disorders. We aimed to study the frequency of cognitive deficits in COVID-19 survivors, the relationship between clinical factors in the acute phase and cognitive outcomes, affective states, and quality of life. We explored cognitive reserve (CR) role, as a post-COVID-19 resilience factor. Twenty-nine COVID-19 inpatients were assessed using a neuropsychological battery, mood scales, quality of life, and social integration questionnaires. Twenty-five were retained through telephone follow-up to monitor cognitive sequelae, affective states, and reintegration levels roughly 8months after hospital discharge. We administered the Cognitive Reserve Index questionnaire. We found most patients display no cognitive deficits. When they did, multi-domain impairment occurred most frequently, especially involving executive functions. Results revealed a significant correlation between depression levels and the interval between ICU admission and tracheal tube removal. We found increased levels of depression and anxiety at follow-up, a significant relationship between resuming daily life activities, high CR, and executive functions. These findings suggest the importance of psychological support in the long term and the modulating role of cognitive reserve in quality of life after infection.

Impact of Tracheostomy Timing on Outcomes After Cardiovascular Surgery

This study aimed to investigate whether tracheostomy timing in patients undergoing cardiac surgery had an impact on outcomes. Retrospective, observational study. Single-center university hospital. Patients requiring tracheostomy among a total of 961 patients who underwent cardiovascular surgery via a median sternotomy from January 2014 to March 2021. Early versus late tracheostomy. During the study period, tracheostomy was performed in 28 patients (2.9%). According to tracheostomy timing, postoperative day seven was chosen as the cutoff to define early (≤seven days) and late (>seven days) tracheostomy. Patients in the early-tracheostomy group had a significantly shorter ventilation time after tracheostomy compared with the late-tracheostomy group (p=0.039), and early tracheostomy resulted in a reduction in total ventilation time (p=0.001). The incidence of pressure ulcers was significantly lower in the early-tracheostomy group compared with the late- tracheostomy group. There was a higher tracheal tube removal rate in the early-tracheostomy group compared with the late-tracheostomy group (p=0.0007). The one-year survival rate in the early- and late-tracheostomy groups was 65% and 31%, respectively. The long-term mortality rate was significantly lower in the early-tracheostomy group compared with the late- tracheostomy group (p=0.04). Early tracheostomy (<seven days) may provide better clinical outcomes, with lower mortality and morbidity rates, when patients are judged to require at least seven days of ventilation after cardiovascular surgery.

The Value of Combined Application of Oxycodone Hydrochloride Injection and Dexmedetomidine in Anesthesia for LC for Patients with Gallbladder Lesions.

Objective To analyze the effect of combined application of oxycodone hydrochloride injection and dexmedetomidine in anesthesia for laparoscopic cholecystectomy (LC) for patients with gallbladder lesions. Method 93 patients with gallbladder lesions in our hospital were divided into 2 groups by the random number table method. 46 patients in the control group applied oxycodone hydrochloride injection in anesthesia, and 47 patients in the observation group applied oxycodone hydrochloride injection combined with dexmedetomidine in anesthesia. Result The T1 and T2 MAP levels in the observation group were lower than those in the control group (P < 0.05), and the difference between T3 and the control group was not significantly significant (P > 0.05). The T1 to T3 HR level in the observation group were lower than those in the control group (P < 0.05). The rate of excessive sedation (10.64%) and sedation inefficiency (12.77%) in the observation group was lower than that in the control group (28.26% and 30.43%), and the rate of satisfactory sedation (76.60%) was higher than that in the control group (41.30%) (P < 0.05). The postoperative awakening, tracheal tube removal, and first anal venting time were shorter in the observation group than in the control group (P < 0.05). The WHO scores of incisional pain at 6, 12, 24, and 48 hours after the operation were lower in the observation group than in the control group (P < 0.05). The T2 SOD level in the observation group was higher than that in the control group, and the ROS and MDA levels were lower than those in the control group (P < 0.05). The incidence of side effects of anesthetic in the observation group was 17.02%, which was not statistically different from the control group of 13.04% (P > 0.05). Conclusion The combined application of oxycodone hydrochloride injection and dexmedetomidine in anesthesia for LC for patients with gallbladder lesions can achieve better sedation and analgesia effect, accelerate postoperative awakening and recovery, and control oxidative stress and fluctuations in signs, without increasing anesthesia-related side effects.

Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery

Postoperative delirium is a frequent disorder for patients undergoing surgery and is associated with poor outcomes. Delirium may occur in the immediate period after anesthesia administration and surgery. Tropisetron, which is frequently administrated for postoperative nausea and vomiting, is also a partial agonist of α7 nicotinic acetylcholine receptors associated with neuroprotective effects. Tropisetron may be the potential pharmacological treatment to decrease delirium after noncardiac surgery. To perform a randomized clinical trial to determine the efficacy and safety of tropisetron for prevention of emergence delirium in patients undergoing noncardiac surgery. This single-center, 2-arm randomized, double-blind, placebo-controlled trial will include 1508 patients undergoing noncardiac surgery. The intervention group will receive 5 mg of intravenous tropisetron before anesthesia induction, and patients in the control group will receive a placebo. The primary end point is the incidence of emergence delirium within 1 hour after tracheal tube removal, measured by the Confusion Assessment Method for the Intensive Care Unit score. The main secondary outcome is the incidence of postoperative delirium measured at 3 days of follow-up. An intention-to-treat principle will be used for all analyses. Delirium remains the most common neuropsychiatric complication for patients after surgery. This will be the first randomized clinical study to evaluate whether tropisetron is effective in preventing emergence delirium. Results from this study will provide evidence for alteration of daily practice. ClinicalTrials.gov Identifier: NCT04027751.

Emergence Delirium in Elderly Patients as a Potential Predictor of Subsequent Postoperative Delirium: A Descriptive Correlational Study

PurposeThis study aimed to investigate the incidence of emergence delirium (ED) in elderly patients under general anesthesia and to determine the correlation between ED and delirium at five subsequent postoperative days. DesignThis research is a descriptive correlational study. MethodsA total of 168 aged patients undergoing elective general anesthesia were recruited from a comprehensive tertiary teaching hospital with 2,400 beds in Southern China from April 2018 to September 2018. The Nursing Delirium Screening Scale was used to assess delirium at 30 and 60 minutes after extubation or on discharge from the postanesthesia care unit. Patients were assessed for delirium at postoperative days one through five using the same method. Patients' demographic information, including cognitive function, were collected. FindingsAmong the 168 aged patients, 58 suffered from ED (34.5%), including the 79.3% for the 46 patients who experienced postoperative delirium (POD). A positive correlation existed between ED and POD (χ2 = 111.744; P < .01). Logistic regression analysis included seven variables: age, preoperative Mini-Mental State Examination score, underlying diseases, American Society of Anesthesiologists grade, surgery duration, postoperative complications, and the presence of ED. Age and ED were concluded to be independent predictive factors of POD. ConclusionsED in the first hour after tracheal tube removal is a predictor of delirium at five subsequent postoperative days. Accurate and timely assessment of recovery period can effectively guide the treatment and rehabilitation of POD and maximize prevention of adverse consequences.

The Effects of Preoperative Oral Carbohydrate on Frequency of T and NK Cells in Patients with Cervical Cancer Treated Using Neoadjuvant Chemotherapy and Surgery: A Prospective Cohort Study.

Background Immune dysfunction can occur after neoadjuvant chemotherapy (NAC) and surgery for cancer. We investigated whether preoperative oral carbohydrate affected the postoperative percentages of T cells (CD4+ and CD8+) and natural killer (NK) cells in patients with cervical cancer treated with NAC and surgery. Methods This prospective cohort study enrolled consecutive patients with cervical cancer treated by radical hysterectomy with PLND at the Gynecologic Oncology Department of Fujian Provincial Cancer Hospital (China) between January 2018 and December 2018. Patients were divided into three groups according to the treatment method: NAC (two cycles, surgery 1 month later), NAC+CHO (chemotherapy and surgical methods same as with the NAC group but with 300 mL of oral carbohydrate administered 2 h before surgery), and non-NAC (surgery alone). Percentages of NK, CD3+, CD4+, and CD8+ cells were evaluated by flow cytometry the day after the first admission, just before surgery, immediately after tracheal tube removal, and the day after surgery. This trial is registered with NCT03872635 at clinicaltrials.com. Results The final analysis included 77 patients (non-NAC group, n = 26; NAC group, n = 25; and NAC-CHO group, n = 26). Baseline characteristics and preoperative NK, CD3+, CD4+, and CD8+ cell percentages were similar between groups. Postoperatively, all groups exhibited reductions in NK, CD3+, and CD4+ cell percentages and increases in CD8+ cell percentages (all P < 0.05). The changes in NK, CD3+, CD4+, and CD8+ cell percentages were attenuated in the NAC-CHO group (P < 0.05 vs. both other groups). Conclusion Preoperative oral carbohydrate can improve the postoperative populations of NK and T cells after the treatment of cervical cancer by NAC and surgery.

Obstructive sleep apnea in patients with laryngeal cancer after supracricoid or vertical partial laryngectomy

ObjectiveTo investigate whether partial laryngectomy is a risk factor for obstructive sleep apnea (OSA) and the effect of different partial laryngectomy methods on OSA.MethodA prospective study was carried out involving 40 patients who underwent supracricoid partial laryngectomy (SCPL) (24) or vertical partial laryngectomy (VPL) (16) for carcinoma of the larynx. Apnea-hypopnea index (AHI) and oxygen saturation determined by polysomnography (PSG), Epworth sleepiness scale (ESS) score, and body mass index (BMI) were evaluated in patients before surgery, on the day of tracheal tube removal and three months later. In patients who developed apnea, laryngoscopy, Muller’s test, computer tomography (CT) and dynamic sleep magnetic resonance imaging (MRI) were performed to assess the location of airway stenosis and collapse.ResultsThe AHI (P<0.001) increased and the lowest oxygen saturation (P<0.001), ESS score (P<0.001) and BMI (P=0.017) decreased after extubation compared with before surgery. Three months after extubation, the same changes were found in AHI (P<0.001) and the lowest oxygen saturation (P<0.001), but the ESS score (P<0.001) increased compared with that preoperatively. The AHI in the SCPL group was significantly higher than that in the VPL group post-operatively (P=0.010), while the miniSpO2 in the SCPL group was lower than that of the VPL group (P=0.022). Laryngoscopy showed that the patients with partial excision of the larynx had a narrowed retropalatal and retrolingual space post-operatively. Muller's test showed the collapse of the retropalatal and retrolingual space, and the CT scan showed that the tongue root was positioned lower in the SCPL group. Compared with the retropalatal and retrolingual space in the expiratory phase according to dynamic sleep MRI, the space in the inspiratory phase was clearly decreased.ConclusionLaryngeal function preservation surgery for laryngeal cancer results in the occurrence of OSA by altering the anatomical structure of the larynx and pharynx. OSA was more severe in patients undergoing SCPL than in patients undergoing VPL. The effect of partial laryngectomy on OSA may be related to the surgical method used.

Meta analysis on effectiveness of epidermal growth factor in treating patients with inhalation injury

Objective: To systematically evaluate the effectiveness of epidermal growth factor (EGF) in treating patients with inhalation injury by meta analysis. Methods: Databases including PubMed, Cochrance Library, and Embase were searched using key words " inhalation injury, smoke inhalation injury, epidermal growth factor, and EGF" , and Chinese Journals Full-text Database, China Biology Medicine disc, VIP Database, and Wanfang Database were searched using key words in Chinese version "," to obtain the randomized controlled trails about EGF published publicly in the treatment of patients with inhalation injury from the establishment of each database to December 2017. The measurement indexes included content of total protein and albumin, colloid osmotic pressure (COP), the number of total cells, percentages of neutrophils, lymphocytes, and fibroblasts in bronchoalveolar lavage fluid (BALF), the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, the time of removal of tracheal tube, the amount of respiratory secretions, and the incidence of lung infection. Meta-analysis was conducted by RevMan 5.3 statistical software. Results: A total of 6 trials involving 375 patients were included, with 182 patients in group EGF who received EGF treatment and 173 patients in conventional treatment group who received conventional treatment. All of the 6 trails had unclear risk of bias. The content of total protein and albumin and COP in BALF of patients in group EGF were lower than those in conventional treatment group, with standardized mean differences (SMDs) respectively -9.37, -26.77 , and -8.13 [with 95% confidence intervals (CIs) respectively -14.11--4.63, -41.85--11.69, -9.54--6.73, P<0.001]. The number of total cells and percentages of neutrophils and lymphocytes in BALF of patients in group EGF were lower than those in conventional treatment group, while the percentage of fibroblasts in BALF of patients in group EGF was higher than that in conventional treatment group, with SMDs respectively -20.22, -13.08, -12.28, 2.99 (with 95% CIs respectively -22.27--17.66 , -14.76--11.40, -13.86--10.70, 2.48-3.50, P<0.001). The time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube of patients in group EGF were shorter than those in conventional treatment group, with SMDs respectively -1.05, -1.22 , -1.11 (with 95% CIs respectively -1.36--0.74, -1.54--0.91, -1.39--0.82, P<0.001). The amount of respiratory secretions of patients in group EGF was lower than that in conventional treatment group, with SMD -1.44 (with 95% CI -1.90--0.98, P<0.001). The incidence rate of pulmonary infection of patients in group EGF was lower than that in conventional treatment group, with relative risk 0.46 (with 95% CI 0.24-0.89, P<0.05). There may be publication bias in the content of total protein, albumin, and COP in BALF (P<0.05), while the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube showed no significant publication bias (P>0.05). Conclusions: Conventional treatment combined with EGF therapy can reduce respiratory inflammation of inhalation injury, promote restoration of respiratory epithelium, shorten the time of removal of tracheal tube, reduce the incidence of pulmonary infection of patients, and therefore has good effect on inhalation injury.

Protocol for an observational study of delirium in the post-anaesthesia care unit (PACU) as a potential predictor of subsequent postoperative delirium

IntroductionPostoperative delirium can be a serious consequence of major surgery, associated with longer hospital stays, readmission, cognitive and functional deterioration and mortality. Delirium is an acute, reversible disorder characterised by...

Comparing the efficacy and safety of laryngeal mask airway, streamlined liner of the pharyngeal airway and I-gel following tracheal extubation.

Adverse events following surgical operations are common complications due to removal of tracheal tube in contrast to the tracheal intubation. Awareness about the new methods and strategies for tracheal tube extubation is necessary for a safe and successful extubation. Therefore, we aimed to assess the safety and efficacy of laryngeal mask airway (LMA), streamlined liner of the pharyngeal airway (SLIPA) and I-gel in extubation time of tracheal tube. A one-single randomized clinical trial was conducted in 105 eligible patients in three groups including LMA, SLIPA and I-gel. The patients were under surgery after general anesthesia with propofol (2–3 mg/kg) and fentanyl (1–2 μg/kg). Hemodynamic responses and extubation consequences including coughing rate, laryngospasm, airway obstruction, apnea, breath holding and straining of patients, vomiting, and need for re-intubation were recorded every 5 minutes since inserting of supraglottic airway devices (SADs) until patients restore consciousness. Analysis of data was conducted in SPSS software by analysis of variance (ANOVA) and ANOVA for repeated measurements tests. The overall successful insertion was 100% for LMA and I-Gel and this rate was 97.1% for SLIPA method. A significant decrease was observed in trend of hemodynamic responses in all three groups. Nevertheless, the MBP was lower in LMA group and lower HR was observed in I-Gel and higher HR occurred in SLIPA (P < 0.05). Three groups was same statistically regarding sore throat, vomiting, coughing, breath holding, apnea, laryngospasm, and re-intubation need (P > 0.05). However, the incidence rate of apnea, and laryngospasm, as well as re-intubation need in SLIPA group was 2.9%, respectively. LMA, I-GEL and SLIPA could be considered as useful and safe devices for ventilation control after tracheal tube removal at the end of operation. Three devices were same regarding to sore throat, vomiting, coughing, and breath holding. However, LMA showed lower side effects while SLIPA was related to more occurrences of apnea, laryngospasm, and re-intubation need.

Difficult extubation after large tongue swelling in intensive care unit.

Sir, A 65-year-old female patient presented with respiratory distress due to left ventricular failure. The patient was intubated by the attending doctor in view of hypoxia. During laryngoscopy and intubation, the posterior pharyngeal wall was lacerated. After placing the endotracheal tube, the posterior pharynx was packed to control the bleeding. On the second day of ventilation, the pack was removed gently; however the patient developed a large tongue swelling [Figure 1]. Even though patient's hemodynamics and oxygenation parameters were stabilized, extubation was therefore not attempted. Pieces of soft gauze were wrapped around the tongue to protect it from teeth bite. Tongue swelling gradually subsided permitting extubation on day 4. Subsequently, the patient could maintain airway patency. Figure 1 Post intubation large tongue swelling Tongue edema is mainly documented as a consequence of vascular compromise, lymphatic drainage obstruction, thromboembolism of lingual artery and compression due to hard bite block or in other situations such as a tight throat pack.[1] Other mechanisms of tongue swelling are trauma, allergy, infection and massive post-operative fluid loading.[2] In the present case, tight throat packing at the base of tongue in the posterior pharynx might have compromised lingual venous drainage leading to edema. Massive lingual swelling contributes to airway compromise. It may worsen after tracheal tube removal, leading to partial or complete airway obstruction.[3] Tracheal reintubation may prove difficult or impossible.[4]

Risk factors for postoperative mortality and morbidities in emergency surgeries

Emergency surgery itself induces high risk for postoperative mortality and morbidities; however, it remains unknown which concomitant pathological conditions of emergency surgeries are causative factors of deteriorating outcomes. This study examined the causal factors of postoperative mortality and morbidity in cases of emergency surgery. Patients undergoing emergency surgery from January to December 2007 were enrolled in this retrospective cohort study. Causal relationships were analyzed by stepwise multivariate logistic regression analysis between possible independent factors (sex, age, kind of surgical department, timing of surgery, duration of surgery, blood transfusion, deteriorated consciousness level, shock state, abnormal coagulate state, and history of hypertension, diabetes, ischemic heart disease, chronic obstructive pulmonary disease, renal failure, and anemia) and postoperative mortality or morbidities (failure of removal of tracheal tube after operation, tracheotomy, cerebral infarction, massive hemorrhage, severe hypotension, severe hypoxemia, and severe arrhythmia during or after surgery). Shock, deteriorated consciousness level, chronic obstructive lung disease, and ischemic heart disease were significant risk factors for mortality (OR 14.2, 7.9, 6.4, and 3.8, respectively), and deteriorated consciousness level, blood transfusion, shock, chronic obstructive lung disease, diabetes, cardiovascular surgery, and operation longer than 2 h were significant risk factors for morbidity (OR 19.1, 3.3, 3.0, 2.5, 2.4, 2.4, and 1.8, respectively). State of shock, deteriorated consciousness level, chronic obstructive lung disease, ischemic heart disease, hemorrhage requiring blood transfusion, age over 80 years, cardiovascular surgery, surgeries at night, and surgeries of duration more than 2 h cause patients to be strongly susceptible to postoperative mortality or morbidity in emergency surgeries.

A12 Ischemic Heart Disease and Weaning from Mechanical Ventilation, how efficient Esmolol can be when Extubation is unsuccessful?

Background and Goal of Study: Patients with ischemic heart disease are known to tolerate hemodynamic stress poorly. As a consequence of their coronary artery disease, ischemic episodes may develop during, or shortly after tracheal tube removal. We describe a case with coronary artery disease that developed repeated episodes of pulmonary oedema each time extubation was attempted. We describe a case of patient with ischemic heart disease and the difficulties in weaning and extubation. Methods: A 70 year old male was submitted urgently because of an abdominal aneurysm. The patient was hemodynamically stable throughout the intervention that lasted 4 hours and on ICU admission, (Heart rate 100/min, and blood pressure 130/65mmHg). Despite trying twice the patient did not achieve successful extubation, in both instances, after extubation, he presented with a rapid shallow breathing and low arterial oxygen saturation. On auscultation, he presented crepitations in middle zones of both lung fields and the chest X-ray was indicative for pulmonary oedema. A trans-thoracic echo that was performed showed normal systolic ventricular function and diastolic dysfunction with abnormal relaxation, patient was therefore given initially esmolol 500 μg/kg/min (iv.) followed by an infusion of 50 μg/kg/min. Sedation was gradually decreased and infusion rate of esmolol was increased. Patient was extubated successfully under 100 μg/kg/min and was discharged from the ICU two days later. Results: Extubation stress in patients with coronary artery disease cause excessive increases in myocardial oxygen consumption thereby altering the supply/demand ratio. Our patient was experiencing ischemic left ventricular dysfunction during weaning, secondary to catecholamine release due to upper airway stimulation by the tracheal tube. This was manifested as hypertension, tachycardia and episodes of pulmonary oedema, which were rapidly resolved with sedation. Conclusions: Using esmolol, a short/acting beta/blocker, allowed successful extubation of patient who developed repeated episodes of pulmonary oedema each time extubation was attempted.

Confirmation of tracheal tube placement and tracheal tube removal practice following unsuccessful resuscitation

Confirmation of tracheal tube placement and tracheal tube removal practice following unsuccessful resuscitation

Noninvasive positive-pressure ventilation avoids recannulation and facilitates early weaning from tracheotomy in children*

To show that noninvasive positive-pressure ventilation by means of a nasal mask may avoid recannulation after decannulation and facilitate early decannulation. Retrospective cohort study. Ear-nose-and-throat and pulmonary department of a pediatric university hospital. The data from 15 patients (age = 2-12 yrs) who needed a tracheotomy for upper airway obstruction (n = 13), congenital diaphragmatic hypoplasia (n = 1), or lung disease (n = 1) were analyzed. Four patients received also nocturnal invasive ventilatory support for associated lung disease (n = 3) or congenital diaphragmatic hypoplasia (n = 1). Decannulation was proposed in all patients because endoscopic evaluation showed sufficient upper airway patency and normal nocturnal gas exchange with a small size closed tracheal tube, but obstructive airway symptoms occurred either immediately or with delay after decannulation without noninvasive positive-pressure ventilation. In nine patients, noninvasive positive-pressure ventilation was started after recurrence of obstructive symptoms after a delay of 1 to 48 mos after a successful immediate decannulation. Noninvasive positive-pressure ventilation was anticipated in six patients who failed repeated decannulation trials because of poor clinical tolerance of tracheal tube removal or tube closure during sleep. After noninvasive positive-pressure ventilation acclimatization, decannulation was performed with success in all patients. Noninvasive positive-pressure ventilation was associated with an improvement in nocturnal gas exchange and marked clinical improvement in their obstructive sleep apnea symptoms. None of the 15 patients needed tracheal recannulation. Noninvasive positive-pressure ventilation could be withdrawn in six patients after 2 yrs to 8.5 yrs. The other nine patients still receive noninvasive positive-pressure ventilation after 1 yr to 6 yrs. In selected patients with upper airway obstruction or lung disease, noninvasive positive-pressure ventilation may represent a valuable tool to treat the recurrence of obstructive symptoms after decannulation and may facilitate early weaning from tracheotomy in children who failed repeated decannulation trials.

Optimally fitted tracheal tubes decrease the probability of postextubation adverse events in children undergoing general anesthesia

The air leak test is recommended for assessing the appropriate size of an uncuffed tracheal tube (TT) in children. Our objectives were to determine whether there is a certain threshold air leak value beyond which a higher risk for adverse events after removal of TT can be predicted and to define other risk factors related to extubation. We enrolled 234 cases ranging from newborn to 9 years of age requiring tracheal intubation for elective or emergency surgery. General anesthesia was induced by a mask or intravenously. The TT size was calculated using the formula: [age (years)/4] + 4.5. After the induction of anesthesia, the patient's trachea was intubated and the correct position was confirmed. The attending anesthetist assessed the leak pressure. Incidences of adverse events (prolonged or barking cough, obstructed or prolonged inspiration or expiration, subcostal and sternal retractions, arterial desaturation, or laryngospasm) were recorded after removal of TT. Ten patients were excluded from the study. A total of 218 children underwent 224 operations under general anesthesia. Children who had an absent air leak at 25 cmH(2)O pressure had 2.8 times more adverse events during emergence from anesthesia than those with an audible air leak. Adverse events after the removal of TT were 3.7 times more likely to occur in children whose anesthesia was provided by a less experienced anesthesia trainee. Adverse events after removal of TT were more likely to occur in children with an absent air leak at 25 cmH(2)O pressure and in children whose anesthesia was provided by a less experienced anesthetist.

Postmortem removal of tracheal tube

Postmortem removal of tracheal tube

Postmortem removal of tracheal tube

Postmortem removal of tracheal tube