Frontiers in Anesthesiology最新文献

{"title":"The application of classic laryngeal mask airway combined with a self-created adaptor in interventional bronchoscopy for pediatric patients: A case series and literature review","authors":"Xuesong Song, Na Yan, Zhuang Zhao, Zhiwen Li","doi":"10.3389/fanes.2022.992072","DOIUrl":"https://doi.org/10.3389/fanes.2022.992072","url":null,"abstract":"Purpose To verify the feasibility of classic laryngeal mask airways (cLMA) combined with self-created adaptors in the interventional bronchoscopy of subglottic lesions for pediatric patients. Methods Three children who were diagnosed with upper airway lesions, subglottic stenosis (scar hyperplasia), and congenital laryngomalacia were respectively subjected to fiberoptic bronchoscopy (FOB) and therapeutic interventions. A classic laryngeal mask airway combined with a self-created adaptor was applied during the FOB procedures. Results In our cases, the vocal cord, glottis, trachea, and lesions were easily exposed, which provided an effective ventilation or oxygenation for the patients. Furthermore, both surgeons and patients were comfortable with the technique. Vital signs were stable during the procedures, including blood pressure, heart rate, and the saturation of pulse oximetry. Conclusion By retaining spontaneous breathing, the application of a classic laryngeal mask airway combined with a self-created adaptor is a feasible alternative method of airway management during FOB interventional procedures for pediatric patients.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125665997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea","authors":"K. Fischer, Dominik P. Guensch, N. Shie, G. Nadeshalingham, J. Lebel, M. Friedrich","doi":"10.3389/fanes.2022.997836","DOIUrl":"https://doi.org/10.3389/fanes.2022.997836","url":null,"abstract":"Purpose Arterial blood gases change frequently during anesthesia and intensive care. Apnea can occur during diagnostic exams and airway and surgical interventions. While the impact of blood gas levels on coronary blood flow is established, their confounding effect on coronary vasoreactivity in response to an apneic stimulus, especially in coronary artery disease, is not known. Methods Six anesthetized control swine and eleven swine with coronary artery stenosis were examined. Nine different blood gas levels from a combination of arterial partial pressure of oxygen (70, 100, and 300 mmHg) and carbon dioxide (30, 40, and 50 mmHg) were targeted. Apnea was induced by halting controlled positive pressure ventilation for 3–30s, while the left descending coronary artery flow was measured and reported relative to apnea duration, and at the adjusted mean (12s). Results At normoxemic-normocapnic blood gas levels, apnea increased coronary blood flow in proportion to the duration of apnea in the control (r = 0.533, p < 0.001) and stenosed groups (r = 0.566, p < 0.001). This culminated in a 42% (95% CI: 27–58) increase in controls (p < 0.001) and, to a lesser extent, 27% (15–40) in the presence of coronary artery stenosis (p < 0.001). Vasoreactivity was augmented by mild-hypoxemic levels [81% (65–97), and 66% (53–79) increase in flow respectively, p < 0.001 vs. normoxemia], but markedly reduced during hyperoxia (7.5% (−8.2–23) and 0.3% (−12–13), respectively, p < 0.001 vs. normoxemia). Conclusion Alterations of blood oxygen and carbon dioxide affect coronary vascular reactivity induced by apnea in swine, which was attenuated further in the presence of coronary stenosis. Especially hyperoxia significantly reduces coronary blood flow and blunts coronary vascular reactivity.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"286 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116854359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of ultrasound-guided serratus anterior plane block for postoperative analgesia in thoracic surgery and breast surgery: A systematic review and meta-analysis of randomized controlled studies","authors":"Wenfu Zhang, Yingting Wu, Rongrong Liu, Z. Qiu, Ruipeng Zhong, Qinghai Lan, Yufei Wang, Jinlong Liu, Maolin Zhong, Shuhui Hu, Weidong Liang","doi":"10.3389/fanes.2022.980483","DOIUrl":"https://doi.org/10.3389/fanes.2022.980483","url":null,"abstract":"Objective Serratus anterior plane block (SAPB) is a new perioperative analgesia for patients undergoing thoracic and breast surgery. The primary purpose of this systematic review and meta-analysis was to investigate whether ultrasound-guided SAPB combined with general anesthesia provides safer and more effective postoperative analgesia than general anesthesia alone or general anesthesia combined with incisional local infiltration anesthesia in patients receiving thoracic and breast surgery. Methods We systematically searched PubMed, Embase, Web of Science and the Cochrane Library databases for clinical randomized controlled trials (RCTs) of SAPB for postoperative analgesia in thoracic and breast surgery. The primary outcome was the postoperative pain score. Secondary outcomes included intraoperative opioid consumption, 24-h postoperative opioid consumption, time to first use of analgesics, number of patients requiring urgent additional analgesics, opioid complications (postoperative nausea, vomiting, respiratory depression, constipation, dizziness, sedation) and length of hospital stay. The risk of bias was assessed using the Cochrane method and Jadad score. Results A total of 29 RCTs with 1,978 patients were included. Twelve studies included thoracic surgery, and 17 studies included breast surgery. The results of the meta-analysis showed that the rest or movement pain scores of the SAPB group were significantly lower than those of the control group at each postoperative time point. In addition, morphine consumption was significantly reduced in the SAPB group at 24 h postoperatively (standardized mean differences [SMD], −2.77; 95% confidence interval [CI], −3.56 to −1.97; P < 0.01). Intraoperative opioid consumption was significantly reduced in the SAPB group (SMD, −0.66; 95% CI, −1.03 to −0.28; P < 0.01); and the number of patients requiring urgent additional pain medication postoperatively (risk ratio [RR], 0.34; 95% CI,0.27 to 0.42; P < 0.01) was significantly lower; and the time to first use of analgesics was significantly longer (SMD, 3.49; 95% CI, 2.23 to 4.74; P < 0.01); and the incidence of postoperative nausea and vomiting (PONV) (RR, 0.43; 95% CI, 0.34 to 0.54; P < 0.01), constipation (RR, 0.12; 95% CI, 0.03 to 0.52; P < 0.01; I2 = 0), dizziness (RR, 0.24; 95% CI, 0.06 to 0.92; P < 0.05; I2 = 0) and sedation (RR, 0.07; 95% CI, 0.01 to 0.52; P < 0.01; I2 = 0) were significantly lower; the length of hospital stay was significantly shorter (SMD, −0.28; 95% CI, −0.46 to −0.09; P < 0.01) and the SAPB group have a significantly reduced the incidence of postoperative pain syndrome at 3 months. Conclusions Compared with no SAPB block, ultrasound-guided SAPB provides superior postoperative analgesia by reducing postoperative pain scores, the incidence of postoperative pain syndrome at 3 months and perioperative opioid consumption in patients after thoracic and breast surgery. At the same time, SAPB reduces the incidence of side effects of opioid","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115262634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway management with novel intubating laryngeal tubes has no influence on cerebral oxygenation in cardiac surgery patients: A prospective observational study","authors":"M. Kriege, R. Rissel, F. Heid, T. Ott, H. E. Beyrouti, Eric Hotz","doi":"10.3389/fanes.2022.990391","DOIUrl":"https://doi.org/10.3389/fanes.2022.990391","url":null,"abstract":"Background A laryngeal tube is often used as an alternative to intubation with direct laryngoscopy during cardiopulmonary resuscitation. However, in a study with piglets undergoing simulated cardiac arrest, reduced carotid artery blood flow was associated with the insertion of different supraglottic airway devices, such as a laryngeal tube. Limited by its construction, secondary tracheal intubation through a laryngeal tube was difficult or impossible in contrast to a second generation laryngeal mask. The new disposable intubating laryngeal tube with suction (iLTS-D®) seems to facilitate tracheal intubation. We hypothesized that iLTS-D, when inflated to the recommended air volume, does not reduce cerebral oxygenation in patients with cardiovascular diseases undergoing elective cardiac surgery. Methods This single-center prospective, controlled observational study was approved by the local ethics committee (Ethical Committee No. 2018-13716). Forty adult patients undergoing elective cardiac surgery requiring tracheal intubation were included in this study. The exclusion criteria were age <18 years and a high risk of aspiration, inability to consent, height <155 cm, or pregnancy. Prior to insufflation and deflation of the cuffs, we performed cerebral oximetry via near-infrared spectroscopy. The primary outcome was a significant reduction in NIRS in the context of the preinduction baseline value after inflation of the cuffs with the recommended air volume, defined as a ≥25% decrease from baseline or an absolute value ≤ 50%. The secondary endpoints were differences in time points, insertion success rates, and complications. Results There was no significant reduction in cerebral oximetry after inflation with the recommended cuff volume and an initially measured cuff pressure of >120 cmH2O. Overall, tracheal intubation was achieved in a median of 20 s [interquartile range 15-23 s] and enabled sufficient ventilation and tracheal intubation through the iLTS-D in all patients. Traces of blood on the cuffs (after removing the iLTS-D) and a sore throat (evaluated 2 h after removing the tracheal tube) were observed in one patient. Conclusion Our results showed no association between the insertion of the iLTS-D and reduced cerebral oxygenation in patients undergoing elective cardiac surgery. Trial registration ClinicalTrials.gov, NCT03942809.","PeriodicalId":314147,"journal":{"name":"Frontiers in Anesthesiology","volume":"326 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116215612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}