Trends in Anaesthesia and Critical Care最新文献

{"title":"Nebulization of a combination of low dose dexmedetomidine and ketamine versus dexmedetomidine alone as a premedication for children undergoing cleft palate repair surgeries: A prospective randomized clinical trial","authors":"Fatma Nabil ,&nbsp;Samar A. Abdellah ,&nbsp;Deiaaeldin M. Tamer ,&nbsp;Mohamed El-Shazly ,&nbsp;Mohamed Galal Aly ,&nbsp;Hany M. Osman","doi":"10.1016/j.tacc.2026.101639","DOIUrl":"10.1016/j.tacc.2026.101639","url":null,"abstract":"<div><h3>Background</h3><div>Sedation for young children who have cleft palate is challenging as poorly titrated sedation may result in respiratory depression, airway obstruction, or desaturation. The aim of this trial was to evaluate whether a nebulized combination of ketamine and low dose dexmedetomidine provides more effective preoperative sedation than dexmedetomidine alone in a higher dose for children undergoing cleft palate repair surgeries.</div></div><div><h3>Methods</h3><div>Fifty-six children, aged 1-4 years, who underwent cleft palate repair surgeries under general anesthesia were randomly assigned to receive preoperative sedation via nebulization either with a mixture of dexmedetomidine (1 µg/kg) and ketamine (2 mg/kg) in group DK (n = 28) or dexmedetomidine (2 µg/kg) alone in group D (n = 28). The primary outcome was the level of sedation after 30 minutes of completion of the nebulization. The secondary outcomes included assessment of parental separation, anesthesia mask acceptance, postoperative emergence delirium, postoperative pain, and any adverse events.</div></div><div><h3>Results</h3><div>The median (Q1-Q3) University of Michigan Sedation Scale score after 30 minutes of completion of the nebulization was 2 (1.3-2) in group DK versus 1 (1-2) in group D (<em>P</em> = 0.013). Furthermore, group DK showed more accepted parental separation anxiety scores and more satisfactory mask acceptance scores than group D (<em>P</em> = 0.005 and 0.018 respectively).</div></div><div><h3>Conclusions</h3><div>As a premedication for children undergoing cleft palate repair surgeries, a nebulized combination of ketamine and low dose dexmedetomidine appeared to be more effective than dexmedetomidine alone in a higher dose. This combination was also associated with better parental separation and acceptance of the anesthesia mask.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101639"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189130","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":"Toward a physiological approach to airway management in the critically ill: The utility of the ABCDE framework","authors":"R. Albillos-Almaraz ,&nbsp;S. Balboa-Palomino ,&nbsp;J. Fanjul-Cuesta","doi":"10.1016/j.tacc.2026.101631","DOIUrl":"10.1016/j.tacc.2026.101631","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101631"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038375","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":"Density spectral array emergence pattern during TIVA: Neurophysiological and clinical implications","authors":"Carolina Frederico Avendaño ,&nbsp;Sarah Saxena ,&nbsp;Joana Berger-Estilita","doi":"10.1016/j.tacc.2026.101633","DOIUrl":"10.1016/j.tacc.2026.101633","url":null,"abstract":"<div><div>Emergence from anesthesia involves structured cortical transitions that are visible on the density spectral array (DSA). The “open crocodile upper jaw” pattern, defined by the separation of slow delta and re-emerging beta-gamma activity, has gained attention as a physiological marker and a teaching tool. Here, we contextualize this visual mnemonic phenomenon within established neurophysiology and emphasize its importance in understanding recovery from general anesthesia. This article provides new value by formally contextualizing an informal EEG teaching cue within established neurophysiology and translating it into a practical, clinically interpretable framework.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101633"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038374","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":"Novel dual-port technique using fogarty balloon catheter for life-threatening rice silo aspiration: A case report","authors":"Kanwaljit Singh ,&nbsp;Eshaan Kaushik ,&nbsp;Ankush Nayyar","doi":"10.1016/j.tacc.2025.101621","DOIUrl":"10.1016/j.tacc.2025.101621","url":null,"abstract":"<div><div>Airway obstruction from foreign bodies in the aerodigestive tract is a common emergency, but massive aspiration of fine particulate matter can present unique challenges. Conventional tools such as rigid bronchoscopy or standard forceps may be insufficient in such cases. We report a rare case of a male patient who suffered massive rice particle aspiration, presenting with acute respiratory failure. The patient was successfully managed using a novel dual-port technique involving a Fogarty balloon catheter and a pediatric endotracheal tube during flexible bronchoscopy. This approach allowed effective foreign body extraction while minimizing airway trauma. This case highlights the potential of innovative, minimally invasive techniques in complex airway management and expands the applications of flexible bronchoscopy when standard interventions are inadequate.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101621"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145904026","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":"A sudden “can't ventilate–can't intubate” crisis: The hidden pathology behind a silent airway","authors":"Catarina Cruz Chaves,&nbsp;Francisca Santos","doi":"10.1016/j.tacc.2026.101635","DOIUrl":"10.1016/j.tacc.2026.101635","url":null,"abstract":"<div><div>Unanticipated difficult airway remains a major cause of anaesthetic morbidity, often arising abruptly during seemingly routine inductions. Contemporary difficult airway frameworks emphasize early declaration of difficulty, minimization of repeated attempts, prioritisation of oxygenation, and restoration of spontaneous ventilation whenever feasible. We report the case of a 71-year-old man scheduled for urgent transurethral resection of a bladder tumour who developed a sudden “can't ventilate–can't intubate” (CVCI) event immediately after an apparently straightforward induction, despite the absence of major predictors of a difficult airway. Failure of both supraglottic airway ventilation and face-mask ventilation rapidly transformed a routine induction into a critical airway emergency, necessitating awakening of the patient to restore spontaneous ventilation. Subsequent ear, nose and throat assessment revealed a previously undiagnosed infiltrative supraglottic mass. Definitive airway management was later achieved under preserved spontaneous ventilation using videolaryngoscopy. This case illustrates a scenario uncomfortably familiar to experienced anaesthetists, in which a familiar clinical pathway suddenly diverges into a life-threatening airway crisis. It underscores the importance of early recognition of failed ventilation, consideration of occult laryngeal pathology in CVCI situations, and adherence to contemporary difficult airway principles.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101635"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038368","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":"Letter To The Editor Regarding “Comparative efficacy of ciprofol and propofol for sedation in patients undergoing colonoscopy: A systematic review, meta-analysis and trial sequential analysis of randomized controlled trials”","authors":"Saul Dominici ,&nbsp;Italo C. Martins ,&nbsp;Breno Dias L. Ribeiro ,&nbsp;Victor Arthur Ohannesian ,&nbsp;Brunno Braga Sauaia ,&nbsp;Caio Márcio Barros de Oliveira ,&nbsp;Plínio da Cunha Leal","doi":"10.1016/j.tacc.2026.101630","DOIUrl":"10.1016/j.tacc.2026.101630","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101630"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979784","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":"Video-assisted fiberoptic intubation (VAFI) in patients undergoing general anesthesia for ENT surgery: Use of a videolaryngoscope with guide channel vs. without channel","authors":"Mariagrazia Cicala ,&nbsp;Debora Felicetti ,&nbsp;Leonardo Emberti-Gialloreti ,&nbsp;Francesco Pugliese ,&nbsp;Costantino Eugenio Buonopane","doi":"10.1016/j.tacc.2026.101641","DOIUrl":"10.1016/j.tacc.2026.101641","url":null,"abstract":"<div><h3>Purpose</h3><div>Airway management is a critical aspect of anesthesia, as failed intubation is associated with severe morbidity. The combination of a videolaryngoscope (VL) with a flexible endoscope (FOB), known as video-assisted fiberoptic intubation (VAFI), improves glottic visualisation and endotracheal tube placement. However, evidence comparing VAFI performed with channeled versus non-channeled VLs is limited. This study aimed to compare the effectiveness of these two approaches in a controlled elective setting.</div></div><div><h3>Methods</h3><div>This prospective observational comparative study was conducted at Policlinico Umberto I University Hospital in Rome. Adult patients (ASA I–II) undergoing elective ENT surgery under general anesthesia were enrolled and allocated to two groups according to device availability: Group A (Airtraq channeled VL + FOB) and Group B (C-MAC D Blade non-channeled VL + FOB). The primary outcomes were total intubation time and first-attempt success. Secondary outcomes included intubation difficulty parameters.</div></div><div><h3>Results</h3><div>Thirty-seven patients were included (18 in Group A and 19 in Group B). Baseline characteristics were comparable between groups. Median total intubation time was 52 s in Group A and 44 s in Group B. First-attempt success was achieved in 78% and 79% of patients, respectively (p = 0.999). No statistically significant differences were observed in total intubation times or first-attempt success.</div></div><div><h3>Conclusion</h3><div>Within the limits of this prospective observational study, channeled or non-channeled videolaryngoscopes used as part of a VAFI strategy showed comparable intubation times and first-attempt success rates. When appropriate expertise and resources are available, device selection may reasonably be guided by operator familiarity and equipment availability.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101641"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146189128","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":"Navigating the swollen airway: Awake videolaryngoscopy as a rescue strategy after failed awake fibreoptic intubation in severe supraglottic edema – A case report","authors":"Maria Carvalho ,&nbsp;Gonçalo Pinto ,&nbsp;Marta Afonso ,&nbsp;Ana Belinha ,&nbsp;Helena Barbosa ,&nbsp;Ana Isabel Pereira","doi":"10.1016/j.tacc.2026.101634","DOIUrl":"10.1016/j.tacc.2026.101634","url":null,"abstract":"<div><div>Acute supraglottic edema can rapidly progress to airway obstruction and awake fibreoptic intubation is often considered first-line approach. We report a case of life-threatening supraglottic swelling where awake fibreoptic intubation failed due to marked edema and airway reactivity. Awake videolaryngoscopy enabled successful tracheal intubation, securing the airway while preserving spontaneous ventilation. This case highlights the importance of flexibility in airway strategy selection, the value of videolaryngoscopy as a rescue technique and the essential role of multidisciplinary coordination in upper airway emergencies.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101634"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038371","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":"Face mask ventilation – to paralyze or not to paralyze, is that the question?","authors":"Pavel Michalek ,&nbsp;Manuel Á. Gómez-Ríos ,&nbsp;Ana Isabel Pereira ,&nbsp;Tomasz Gaszynski","doi":"10.1016/j.tacc.2026.101637","DOIUrl":"10.1016/j.tacc.2026.101637","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101637"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078877","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":"Awake fibreoptic intubation in a rapidly deteriorating airway following blunt trauma to an advanced tongue carcinoma","authors":"J. Orankiewicz ,&nbsp;B. Sadownik ,&nbsp;P. Andruszkiewicz","doi":"10.1016/j.tacc.2026.101632","DOIUrl":"10.1016/j.tacc.2026.101632","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"67 ","pages":"Article 101632"},"PeriodicalIF":0.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038373","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}