Anesthesia progress最新文献

{"title":"Curious Case of the Pretracheal Stethoscope.","authors":"Kyle J Kramer","doi":"10.2344/anpr-68-04-07","DOIUrl":"https://doi.org/10.2344/anpr-68-04-07","url":null,"abstract":"","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"191-192"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674854/pdf/i0003-3006-68-4-191.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerated Idioventricular Rhythm Following Intraoral Local Anesthetic Injection During General Anesthesia.","authors":"Kenichi Sato, Yoshihisa Miyamae, Miwako Kan, Shu Sato, Motoi Yaegashi, Wakana Sakanoue, Hiroyuki Sakai, Souhei Sakamoto, Kazuki Vaba","doi":"10.2344/anpr-68-03-09","DOIUrl":"10.2344/anpr-68-03-09","url":null,"abstract":"<p><p>Some anesthetic agents or adjunct medications administered during general anesthesia can cause an accelerated idioventricular rhythm (AIVR), which is associated with higher vagal tone and lower sympathetic activity. We encountered AIVR induced by vagal response to injection-related pain following local anesthetic infiltration into the oral mucosa during general anesthesia. A 48-year-old woman underwent extraction of a residual tooth root from the left maxillary sinus under general anesthesia. Routine preoperative electrocardiogram (ECG) was otherwise normal. Eight milliliters of 1% lidocaine (80 mg) with 1:100,000 epinephrine (80 μg) was infiltrated around the left maxillary molars over 20 seconds using a 23-gauge needle and firm pressure. Widened QRS complexes consistent with AIVR were observed for ∼60 seconds, followed by an atrioventricular junctional rhythm and the return of normal sinus rhythm. A cardiology consultation and 12-lead ECG in the operating room produced no additional concerns, so the operation continued with no complications. AIVR was presumably caused by activation of the trigeminocardiac reflex triggered by intense pain following rapid local anesthetic infiltration with a large gauge needle and firm pressure. Administration of local anesthetic should be performed cautiously when using a large gauge needle and avoid excessive pressure.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"230-234"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674851/pdf/i0003-3006-68-4-230.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Current Literature of Interest to the Office-Based Anesthesiologist.","authors":"Mark A Saxen","doi":"10.2344/0003-3006-68.4.245","DOIUrl":"https://doi.org/10.2344/0003-3006-68.4.245","url":null,"abstract":"Perioperative pulmonary aspiration of gastric contents has been, and continues to be, associated with severe morbidity and death despite recent advances in relevant guidelines and airway management. In this closed claim analysis, 115 cases of pulmonary aspiration were retrieved from the Anesthesia Closed Claims Database for the period between 2000 and 2015. Anesthesia malpractice claims associated with surgical, procedural, or obstetric anesthesia care were included, whereas claims associated with acute or chronic pain management were excluded. Death occurred in 57% of the claims and severe permanent injury occurred in another 14%. Risk factors that occurred in 10% ormore of cases included emergency procedure, gastrointestinal obstruction or other acute intra-abdominal process, body mass index . 35 kg/m, gastroesophageal reflux disease, diabetes mellitus, and recent oral intake (defined as more recent than standard nil per os recommendations). The presence of at least 1 aspiration risk factor was identified in 93% of the claims. Of the patients identified within the claims, 61% had either gastrointestinal obstruction or another intraabdominal process. Management of the aspiration event was judged to be substandard in 59% of the 115 claims. Comment: The findings from this study failed to confirm the application of cricoid pressure and rapid sequence induction as strategies for preventing aspiration. The authors note that although pregnancy and delivery have historically been considered major aspiration risk factors, only 3 of 115 patients in this series were pregnant. Because no definitive treatment for aspiration has been described to date, the best strategy for prevention is to avoid known risk factors.","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"245-247"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674850/pdf/i0003-3006-68-4-245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation Technology in Anesthesiology.","authors":"Morton Rosenberg","doi":"10.2344/0003-3006-68.4.238","DOIUrl":"https://doi.org/10.2344/0003-3006-68.4.238","url":null,"abstract":"A simulator is a device or software program that is gy.7-9 Nursing and other medical personnel such as car1id designed to reproduce or represent effects simudiac perfusionists are utilizing simulation technologies in lating phenomena likely to occur in reality. Perhaps the their curricula.10,11 Anesthesiology, which has often used most familiar simulator is the flight simulator, which acthe aviation model in the discussion of critical incidents, curately replicates the look and feel of an airplane cockhas been a driving force in the medical community in pit. Using a flight simulator, a pilot may practice takeintroducing realistic, complex simulation concepts.12 offs, landings, navigation procedures, and critical inciDental sedation/anesthesia practice, with its emphadents without risk to passengers, crew, or expensive airsis on perioperative critical event training, the treatment craft. Simulation technology has become an important of the complex emergency patient, and the developeducational tool in many complex, high-risk, dynamic ment of emergency algorithms, may greatly benefit environments such as the nuclear power and petroleum from the inclusion of simulation technology in training industries, the military, law enforcement, and especially, programs as well as part of continuing education initiain aviation, automotive, and space travel.' Simulators tive for oral and maxillofacial surgeons and dentist anreduce the financial cost of testing and training personesthesiologists. nel and reduce the risk to human life. With production pressures in medical/dental education that limit instruction time and patient availability, the expanding algoBACKGROUND rithms for patient diagnosis and management, and the major advances in computer and simulation technology, the~ ~ ~~~~~~. meia edcto comnt'sbginn orc No matter what type of simulator technology is emognize thed potentialufcsiation co neptsnad t rechployed, two important concepts must be strictly adhered ognize he potential of s mulation concepts an tech . 2 to in order for the experience to be valid and relevantSimulation strategies span the entire gamut of medithe fidelity and the presentation of the simulation. Ficldaofmimulation laboratore to strengten delity is how closely the simulation actually replicates the medical student skills in patient examination3 tothe deactual clinical event. The higher the fidelity of a simuvelopment and implementation of standardized patients lation, the more the simulator mirrors reality. The repused as simulators to assess clinical performance by the resentation of the simulator is the summation of its outEducational Commission for Foreign Medical Graduputs and is what actually constitutes the simulated event. ates.4 Simulation technology is at the forefront in introRepresentation may be accomplished via computerducing and expanding revolutionary endoscopic and based simulators with data presented on the screen or laproscopic surgical techniques.5'6 Many medical ","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"238-241"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674847/pdf/i0003-3006-68-4-238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a Patient With Tracheal Stenosis After Previous Tracheotomy.","authors":"Kazumi Takaishi,&nbsp;Shinji Kawahito,&nbsp;Hiroshi Kitahata","doi":"10.2344/anpr-68-03-08","DOIUrl":"https://doi.org/10.2344/anpr-68-03-08","url":null,"abstract":"<p><p>Tracheal stenosis after tracheotomy can cause difficult airway management and respiratory complications. It is difficult to predict tracheal stenosis after tracheotomy based on a patient's symptoms as the symptoms of tracheal stenosis appear only after they become severe. In patients with a history of previous tracheotomy, it is important to consider the risk factors for tracheal stenosis. Detailed preoperative evaluation of patients with a history of previous tracheotomy is essential and should include 3-dimensional assessment of the airway. We report the preoperative assessment and perioperative management of an 83-year-old woman at high risk for tracheal stenosis due to a previous emergency tracheotomy who was scheduled to undergo general anesthesia for a right maxillectomy for squamous cell carcinoma. Preoperative anteroposterior chest radiograph revealed findings indicative of tracheal stenosis. Additional detailed examinations of the stenotic area were conducted with computed tomography imaging and bronchofiberscopy. General anesthesia with nasotracheal intubation was performed, and although there were no adverse intraoperative events, stridor after extubation was observed. Nebulized epinephrine was administered via an ultrasound nebulizer and effectively improved the patient's postoperative transient dyspnea.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"224-229"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674855/pdf/i0003-3006-68-4-224.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39727909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway Complications in Intubated Versus Laryngeal Mask Airway-Managed Dentistry: A Meta-Analysis.","authors":"Jordan Prince,&nbsp;Cameron Goertzen,&nbsp;Maryam Zanjir,&nbsp;Michelle Wong,&nbsp;Amir Azarpazhooh","doi":"10.2344/anpr-68-04-02","DOIUrl":"https://doi.org/10.2344/anpr-68-04-02","url":null,"abstract":"<p><strong>Objective: </strong>Serious airway complications can occur with inadequate airway management during general anesthesia (GA). This meta-analysis investigated randomized controlled trials that compared perioperative technique failures and airway complications, including hypoxia, during GA for dentistry using endotracheal intubation or a laryngeal mask airway (LMA) for airway management.</p><p><strong>Methods: </strong>A systematic search of electronic databases and gray literature was completed. Independent reviewers assessed eligibility, performed data extraction, completed risk of bias assessment, and judged the quality of results through Grading of Recommendations, Assessment, Development, and Evaluation. Risk ratios (RRs) for airway complications, with 95% CIs, were calculated. Heterogeneity was quantified using the I2 statistic. Sensitivity and age-subgroup analyses were explored.</p><p><strong>Results: </strong>Six trials were deemed eligible from a total of 9076 identified reports. The airway management intervention for these trials was LMA. Technique failures or effect differences in airway complications were not detected except for postoperative hypoxia, where LMA use had a decreased risk (RR, 0.22; 95% CI, 0.06-0.77; I2 = 0%; moderate quality). A similar effect was seen in the pediatric analysis (RR, 0.10; 95% CI, 0.01-0.84; I2 = 0%; moderate quality). Additionally, LMA use reduced pediatric sore throat risk (RR, 0.08; 95% CI, 0.04-0.15; I2 = 0%; moderate quality).</p><p><strong>Conclusion: </strong>Use of an LMA in dentistry may have the potential to reduce the risk of postoperative hypoxia, particularly in pediatric patients, although further study is required.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"193-205"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674849/pdf/i0003-3006-68-4-193.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39727911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients.","authors":"Kelly Lipp,&nbsp;Paul Casamassimo,&nbsp;Ann Griffen,&nbsp;Megann Smiley,&nbsp;Jason Bryant,&nbsp;John Draper,&nbsp;Ashok Kumar","doi":"10.2344/anpr-68-02-06","DOIUrl":"https://doi.org/10.2344/anpr-68-02-06","url":null,"abstract":"<p><strong>Objective: </strong>This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods.</p><p><strong>Methods: </strong>Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88).</p><p><strong>Results: </strong>The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence.</p><p><strong>Conclusion: </strong>Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"206-213"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674845/pdf/i0003-3006-68-4-206.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39727910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HISTORICAL SELECTION: Rosenberg MB. Simulation technology in anesthesiology. Anesth Prog. 2000;47(1):8-11.","authors":"Joel M Weaver","doi":"10.2344/anpr-68-04-05","DOIUrl":"https://doi.org/10.2344/anpr-68-04-05","url":null,"abstract":"","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"242-244"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674852/pdf/i0003-3006-68-4-242.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Nasal Mucosa Cautery With Reintubation Under Pharyngeal Suction for Massive Epistaxis After Extubation.","authors":"Yukiko Arai,&nbsp;Akari Hasegawa,&nbsp;Aki Kameda,&nbsp;Saki Mitani,&nbsp;Takuya Uchida,&nbsp;Yasuhiko Kato,&nbsp;Yozo Manabe,&nbsp;Yoshihiro Momota","doi":"10.2344/anpr-68-03-04","DOIUrl":"https://doi.org/10.2344/anpr-68-03-04","url":null,"abstract":"<p><p>We describe a case of massive epistaxis that occurred after removal of a nasal endotracheal tube, prompting emergent reintubation. Mask ventilation could not be performed because the nasal cavity was packed with gauze and the airway was being evacuated with a suction catheter. Therefore, instead of inhalational anesthetics and muscle relaxants, boluses of midazolam and remifentanil were administered, and reintubation was promptly performed. Sedation was maintained with dexmedetomidine infusion and midazolam. Nasal cautery was performed near the left sphenopalatine foramen. The patient was extubated without agitation or additional hemorrhage. Immediate recognition of the potential for airway loss, sufficient control of active bleeding, and drug selection in accordance with the emergent circumstances enabled prompt resecuring of the airway without pulmonary aspiration of blood.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 4","pages":"235-237"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8674848/pdf/i0003-3006-68-4-235.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39816909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management of a Patient With Citrullinemia Type I During Dental Treatment.","authors":"Makiko Shibuya,&nbsp;Rie Iwamoto,&nbsp;Yukifumi Kimura,&nbsp;Nobuhito Kamekura,&nbsp;Toshiaki Fujisawa","doi":"10.2344/anpr-68-02-04","DOIUrl":"https://doi.org/10.2344/anpr-68-02-04","url":null,"abstract":"<p><p>We report a case involving intravenous sedation for third molar extractions in a 32-year-old man with citrullinemia type I (CTLN1), a genetic disorder that affects the urea cycle. The patient was diagnosed with CTLN1 after he exhibited seizures soon after birth and was intellectually disabled because of persistent hyperammonemia, although his recent serum ammonia levels were fairly well controlled. We planned to minimize his preoperative fasting, continue his routine oral medications, and monitor his serum ammonia levels at least twice. Sedation with midazolam and a propofol infusion was planned to suppress his gag reflex and reduce protein hypercatabolism due to stress. Epinephrine-containing local anesthetics, which enhance protein catabolism, were avoided, replaced by plain lidocaine for blocks and prilocaine with felypressin for infiltration anesthesia. No significant elevation in ammonia levels was observed. In patients with CTLN1, sedation can be useful for preventing hyperammonemia. Patients who develop symptomatic hyperammonemia may require urgent/emergent treatment involving other medical specialists. Therefore, preoperative endocrinology consultation, perioperative monitoring of serum ammonia levels, and preemptively coordinating for appropriate care in the event hyperammonemia occurs should all be considered.</p>","PeriodicalId":7818,"journal":{"name":"Anesthesia progress","volume":"68 3","pages":"158-162"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500320/pdf/i0003-3006-68-3-158.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39484337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}