Trends in Anaesthesia and Critical Care最新文献

{"title":"Vasoactive drugs for the management of maternal arterial hypotension after spinal anesthesia for cesarean section. An updated integrative narrative review","authors":"Martín Astete B ,&nbsp;Lorena Basso V ,&nbsp;Héctor J. Lacassie","doi":"10.1016/j.tacc.2024.101491","DOIUrl":"10.1016/j.tacc.2024.101491","url":null,"abstract":"<div><div>Spinal neuraxial anesthesia remains the technique of choice due to its large number of maternal-fetal advantages over general anesthesia. However, its adverse effects, such as hypotension, nausea and vomiting continue to represent an important source of morbimortality and a challenge for anesthesiologists. Currently, there are different strategies for its prevention and management, vasoactive drugs being one of the mainstay treatments. In recent years different pharmacological alternatives and administration schemes have emerged in hopes of finding the ideal one and ending this dilemma. The objective of this integrative narrative review is to provide an update on vasoactive drugs used in cesarean section with the latest available evidence. To date, norepinephrine seems to achieve hemodynamic stability with a lower rate of maternal-fetal complications in patients without other associated complications.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101491"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532123","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":"Direct laryngoscopy versus videolaryngoscopy for neonatal tracheal intubation: An updated systematic review and meta-analysis","authors":"Carlos Henrique de Oliveira Ferreira ,&nbsp;Bruno FM. Wegner ,&nbsp;Gustavo RM. Wegner ,&nbsp;João Victor de Oliveira Ramos ,&nbsp;Gabrielle de Lacerda Dantas Henrique ,&nbsp;Henrique Santana Cumming ,&nbsp;Naieli Machado Andrade ,&nbsp;Heidi Cordeiro ,&nbsp;Tatiana Souza do Nascimento","doi":"10.1016/j.tacc.2024.101494","DOIUrl":"10.1016/j.tacc.2024.101494","url":null,"abstract":"<div><h3>Introduction</h3><div>The potential benefits and risks of Videolaryngoscopy (VL) over Direct Laryngoscopy (DL) in neonates undergoing tracheal intubation are unclear.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis of randomized clinical trial (RCT) data comparing VL to DL in neonate patients following tracheal intubation, regarding the success rate of the first intubation attempt, mean number of intubation attempts, time to intubate, oxygen desaturation, bradycardia, airway trauma or bleeding and cardiopulmonary resuscitation.</div></div><div><h3>Results</h3><div>Seven studies comprising 897 patients undergoing tracheal intubation were included. Of the participants studied, 450 (50,2 %) used VL and 447 (49,8 %) utilized DL. Overall, VL was associated with a higher first intubation success rate (RR: 1.18; p = 0.02; I² = 67 %) and fewer episodes of oxygen desaturation &lt;90 % (RR: 0.84; p = 0.008; I² = 0 %). No differences were found in mean attempts to intubate (MD: 0.25; p = 0.188; I² = 99 %), time to intubate (MD: 1.327; p = 0.81; I² = 97 %), airway trauma or bleeding (RR: 0.69; p = 0.372; I² = 16 %), bradycardia &lt;100 bpm (RR: 1.05; p = 0.81; I² = 0 %), and cardiopulmonary resuscitation (RR: 0.61; p = 0.447; I² = 74 %). Sub Analyses of first attempt intubation success rate in the intensive care unit (ICU) (RR: 1.48; p = 0.003; I² = 35 %) showed an advantage for VL. However, in bradycardia &lt;60 bpm (RR: 0.89; p = 0.769; I² = 0 %) and oxygen desaturation &lt;80 % (RR: 0.85; p = 0.066; I² = 0 %), VL and DL were equivalent.</div></div><div><h3>Conclusion</h3><div>Despite the equivalence in some outcomes, in general, VL was superior to DL. This superiority was seen most clearly in the success rate of the first intubation and in the reduction in episodes of hypoxemia.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101494"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653278","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":"The advantages of “closed” type management in intensive care units","authors":"Mehdi Nematbakhsh","doi":"10.1016/j.tacc.2024.101487","DOIUrl":"10.1016/j.tacc.2024.101487","url":null,"abstract":"<div><h3>Background</h3><div>The intensive care units (ICUs) are responsible for treating the most complex and sensitive patients in the clinic, and it often is stated that the types of management in intensive care units are associated with patient's clinical outcomes. Among the types of management in ICUs, two types are more common and more important— the “open” type and “closed” type —while each type of management has its own supportive and critics. In recent years, efforts have been made to defend each type of management in ICUs based on patients' vital indicators, such as mortality rate and length of stay in the ICU. Therefore, an important question arises regarding which type of ICU management is suitable for meeting treatment goals.</div></div><div><h3>Method</h3><div>The literature review was obtained using information sources such as Web of Sciences, PubMed, PMC, Google Scholar and Scopus. All articles that were published until 2024 were considered, and the English original or review publications evaluating “open” and “closed” types of ICUs management were selected. Finally, an overview was provided on patient's mortality rate and length of stay in “open” and “closed” types of ICUs.</div></div><div><h3>Conclusion</h3><div>Most of the findings support a “closed” type of ICU with trained intensivist supervision. However, to achieve a standard “closed” type of ICU under the supervision of trained intensivists, the necessary conditions must be performed. These necessary conditions were discussed, and a model was presented.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101487"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427684","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":"Evaluation of changes in Mallampati grading in patients undergoing elective urological procedures in prone and lithotomy positions- A prospective observational study","authors":"Sharmila Chaganti,&nbsp;Nirmala Jonnavithula,&nbsp;Indira Gurajala,&nbsp;Harshini Muthyala,&nbsp;Hareesh Peetha","doi":"10.1016/j.tacc.2024.101492","DOIUrl":"10.1016/j.tacc.2024.101492","url":null,"abstract":"<div><div>Intubation often results in airway edema, which can lead to reintubation following planned extubation in the post-anesthesia care unit. In urological procedures like percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL), the use of irrigation fluids may exacerbate these airway changes. This study aims to assess alterations in Mallampati grading in patients undergoing elective urological procedures, particularly in prone and lithotomy positions.</div><div>This prospective observational study was conducted at a tertiary care hospital from May 2021 to September 2021. Sixty patients with ASA I and II classifications scheduled for elective PCNL in the prone position and URSL in the lithotomy position, with 30 patients in each group, were enrolled. We assessed the Modified Mallampati Grading (MPG) before the procedure and at postoperative intervals of 4 h, 8 h, 12 h, 24 h, and 48 h, noting any changes and the time required to return to the baseline. We also recorded the number of irrigation fluids used, intravenous (IV) fluids administered, surgery duration, and estimated blood loss to explore potential associations.</div><div>MPG changed by at least one class in 36.6 % of patients in the prone position and 20 % of patients in the lithotomy position. Furthermore, MPG changed by two classes in 20 % of patients in the prone position and 3.3 % of patients in the lithotomy position. The absorption of irrigation fluids was identified as a potential cause of airway edema, with a significant p-value of 0.0001, leading to worsening of the MPG. Fortunately, in most patients, the changes in MPG returned to baseline values within 24 h.</div><div>In conclusion, our study confirms that Mallampati grading may experience at least a one-class increase in both prone and lithotomy positions in most patients, and it typically reverts to baseline in about 24 h for most patients. These airway changes should be considered when re-intubating patients in the postoperative period.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101492"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553254","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":"“Distribution of pulmonary ventilation in the lateral decubitus position of healthy adults under Non-Invasive Mechanical Ventilation: a pilot study”","authors":"Konstantinos Grigoriadis ,&nbsp;Anna Grigoriadou ,&nbsp;Frantzeska Frantzeskaki ,&nbsp;Ioannis Efstathiou ,&nbsp;Iraklis Tsangaris","doi":"10.1016/j.tacc.2024.101499","DOIUrl":"10.1016/j.tacc.2024.101499","url":null,"abstract":"<div><h3>Objective</h3><div>In the lateral decubitus position, the largest percentage of pulmonary ventilation in non-sedated subjects is distributed mainly in the dependent lung.</div></div><div><h3>Methods</h3><div>We aimed to investigate, via impedance tomography, the distribution of pulmonary ventilation in the lateral position under the effect of different Continuous Positive Airway Pressure (CPAP) levels (0, 5, 10 cm H₂O) in healthy subjects. The volunteers were noninvasively ventilated in both lateral positions and supine positions at the beginning and end of the process.</div></div><div><h3>Results</h3><div>A statistically significant difference between the percentage distribution of lung ventilation in different CPAP levels in the right and left lateral decubitus body positions was observed.</div></div><div><h3>Conclusion</h3><div>We concluded that in the lateral position, as positive pressure increases, ventilation of the dependent lung increases, while, conversely, pulmonary ventilation of the non-dependent lung decreases.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101499"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653277","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":"Is pre-extubation fasting in ICU justified? Insights from a prospective observational study using gastric ultrasound","authors":"Mohd Saif Khan ,&nbsp;Barun Ram ,&nbsp;Amit Kumar ,&nbsp;Kamel Bousselmi ,&nbsp;Priyesh Kumar ,&nbsp;Dumini Soren ,&nbsp;Priyanka Shrivastava ,&nbsp;Naveen Kumar","doi":"10.1016/j.tacc.2024.101497","DOIUrl":"10.1016/j.tacc.2024.101497","url":null,"abstract":"<div><h3>Background</h3><div>In order to mitigate the risk of aspiration pneumonia, it is common practice to recommend fasting for critically ill patients who are undergoing elective tracheal extubation. This clinical investigation seeks to question and reassess this standard fasting protocol.</div></div><div><h3>Aims &amp; objectives</h3><div>This study aimed to determine the role of gastric ultrasound in critically ill patients before a planned tracheal extubation. Main objectives of this study were to assess prevalence of at-risk stomach (full stomach) and the rates of safe extubation in fasted and non-fasted patients.</div></div><div><h3>Methods</h3><div>Gastric ultrasound was performed on 60 critically ill patients prior to tracheal extubation to assess cross-sectional area (CSA) and calculate gastric volume. Patients with a volume exceeding 1.5 mL/kg or thick fluid were classified as ‘at-risk’ for aspiration (full stomach). All patients were monitored for aspiration pneumonitis during the 24 h following extubation.</div></div><div><h3>Results</h3><div>The overall prevalence of at-risk stomachs (full stomach) was 40 %, showing no difference between fasted and non-fasted groups (50 % vs. 30 %; p = 0.114). Calculated gastric volumes were also similar across both groups (0.95 ± 0.58 vs. 0.86 ± 0.48 mL/kg; p = 0.574). The safe extubation rate did not significantly differ between fasted and non-fasted groups (86.7 % vs. 93.3 %; p = 0.39). Ongoing opioid use was identified as an independent predictor of at-risk stomach (adjusted odds ratio, 5.54; p = 0.016).</div></div><div><h3>Conclusions</h3><div>The prevalence of at-risk stomach (full stomach) was high in our cohort. Pre-extubation fasting did not decrease gastric volumes, as assessed by ultrasound, while ongoing opioid use was an independent predictor of an ‘at-risk’ stomach.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101497"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653276","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 knife to the neck; An airway challenge for the Anesthesiologist: A case report","authors":"Roaa Suleiman ,&nbsp;Ayten Saracoglu ,&nbsp;Redouane Mecharnia ,&nbsp;Bushra M. Abdallah ,&nbsp;Layla J.M. Kily ,&nbsp;Loubna Zabat ,&nbsp;Sana Saleem ,&nbsp;Kemal Tolga Saracoglu","doi":"10.1016/j.tacc.2024.101490","DOIUrl":"10.1016/j.tacc.2024.101490","url":null,"abstract":"<div><div>Penetrating neck injuries are potentially life-threatening emergencies that can pose significant airway difficulties. There is a lack of evidence regarding the best practice for airway management in these patients. We aimed to describe a multistep approach to airway management in a 36-year-old patient with a 3 cm deep penetrating neck stab wound. A combined technique of videolaryngoscope and fiberoptic scope was utilized to secure the airway, considering the patient's stability and cooperation. In conclusion, D blade-assisted tracheal intubation following rapid sequence induction can be considered as a safe alternative to awake intubation with a high success rate in selected patients with penetrating neck injuries.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101490"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532124","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":"The hidden pouch: Anesthetic challenges in tracheal diverticula management – A case report","authors":"José Moreira ,&nbsp;Patrícia Lima ,&nbsp;Sérgio Pinto ,&nbsp;Hélder Pereira ,&nbsp;Patrícia Santos","doi":"10.1016/j.tacc.2024.101495","DOIUrl":"10.1016/j.tacc.2024.101495","url":null,"abstract":"<div><div>Tracheal diverticula are uncommon anatomical anomalies characterized by air-filled outpouchings of the tracheal wall. While typically asymptomatic and incidentally discovered, tracheal diverticula can pose significant challenges in airway management during anesthesia.</div><div>We present the case of a 58-year-old female scheduled for microsurgical resection of meningioma. Preoperative imaging revealed a sizable tracheal diverticulum on the posterior tracheal wall, measuring 65 by 26 mm. An awake fiberoptic intubation approach was regarded as the safest approach for airway management. Several anatomical anomalies were identified during flexible bronchoscopy, including tracheomalacia and vascular malformations. Despite these challenges, successful intubation and anesthesia management were achieved without complications.</div><div>This case highlights the importance of thorough preoperative evaluation and careful planning in patients with tracheal diverticula, in order to prevent a crisis from difficult intubation, difficult ventilation or even rupture of the diverticulum.</div></div>","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"58 ","pages":"Article 101495"},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653279","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":"57 Failure to Ventilate through LMA During Surgery: Switching to Unanticipated Difficult Intubation due to Mass in the Upper Airway in an Adult","authors":"Pınar Ozdemir Yasar,&nbsp;Bengisu Koc,&nbsp;Irem Bengisu Ciflikli Salkımlı,&nbsp;Filiz Uzumcugil","doi":"10.1016/j.tacc.2024.101431","DOIUrl":"10.1016/j.tacc.2024.101431","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"57 ","pages":"Article 101431"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327688","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":"23 A Proposal for Airway Workshops Utilizing Simulation","authors":"Anna Tchorzewska,&nbsp;Ajeesh Karthikeyan","doi":"10.1016/j.tacc.2024.101442","DOIUrl":"10.1016/j.tacc.2024.101442","url":null,"abstract":"","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"57 ","pages":"Article 101442"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326912","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}