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Abstract
Gastric ultrasound (US) is a growing modality within the point-of-care ultrasound (POCUS) field. It provides the ability to directly measure an individual patient's gastric content and has potential use as both a clinical and a research tool. Here, we review the historical development of current gastric US models and their clinical application within the field of general anesthesia, describe the US findings and technique for using POCUS to assess gastric content, and discuss the current and potential applications of gastric POCUS within the emergency department.
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352
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Young CD, Walker AM, Weber BA, Spencer AO. Quality improvement assessment of a bianchi-technique pediatric orchiopexy perioperative pain management pathway. J Pediatr Urol 2020; 16:461.e1-461.e9. [PMID: 32698984 DOI: 10.1016/j.jpurol.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/30/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical correction of undescended testes is a common surgical procedure which can be performed via a two-incision technique or a single high scrotal incision (Bianchi technique). The Bianchi technique requires less surgical time and may be associated with less pain in the initial postoperative period, however it has been adopted slowly due to a lack of familiarity and perceived technical challenges of the technique. Traditionally postoperative orchiopexy pain is managed with a caudal or ilioinguinal/iliohypogastric nerve block. As urologists at our site adopted the Bianchi technique, the anesthesiologists stopped performing caudals or ilioinguinal/iliohypogastric nerve blocks as local infiltration appeared sufficient. Therefore, this quality improvement (QI) project endeavoured to assess Alberta Children's Hospital's care pathway in its effectiveness to control pain in the first 24 h following pediatric orchiopexy using the Bianchi technique. METHODS We completed a prospective QI project examining a care pathway for patients undergoing orchiopexy using the Bianchi technique. Eligible patients were healthy and aged 6 months to 12 years. A multimodal analgesic approach including local anesthetic surgical infiltration was used. Pain scores (FLACC) were recorded for up to 2 h postoperatively and a PPPM was completed at 24 h postoperatively. RESULTS Sixty-four patients were included in the final analysis. The median discharge FLACC score was 0 (range 0-2) (Table 2). Median intraoperative morphine administered was 0.09 mg/kg with no significant correlations between the amount of morphine administered and postoperative pain measures. Median PPPM scores were 4 and 3.5 for unilateral and bilateral procedures, respectively. CONCLUSIONS We have demonstrated that orchiopexies repaired using the Bianchi technique following the care pathway established at Alberta Children's Hospital are associated with minimal pain scores. Our QI project suggests that combining a Bianchi technique with a simple multimodal analgesic approach including local infiltration, negates the need for regional anesthesia techniques, yet still provides adequate analgesia.
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Affiliation(s)
- Christopher D Young
- Department of Anaesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, Foothills Medical Centre, Calgary, Canada.
| | - Andrew M Walker
- Department of Anaesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, Foothills Medical Centre, Calgary, Canada
| | - Bryce A Weber
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adam O Spencer
- Department of Paediatric Anaesthesia, Cumming School of Medicine, University of Calgary, Calgary, Canada
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353
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Garg H, Podder S, Bala I, Gulati A. Comparison of fasting gastric volume using ultrasound in diabetic and non-diabetic patients in elective surgery: An observational study. Indian J Anaesth 2020; 64:391-396. [PMID: 32724247 PMCID: PMC7286410 DOI: 10.4103/ija.ija_796_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/16/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Abstract
Background and Aims: Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non-diabetic patients scheduled for elective surgery using USG. Methods: This prospective observational study included 53 diabetic and 50 non-diabetic patients aged >18 years, American Society of Anesthesiologists' physical status I-III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross-sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. Results: In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm2 and 3.73 ± 1.61 cm2 in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm2 and 2.30 ± 1.18 cm2 of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group. Conclusion: Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients.
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Affiliation(s)
- Heena Garg
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subrata Podder
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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354
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Reed LaSala V, Morgan ME, Bradburn EH, Vernon TM, Maish GO. The Effects of Fasting Status on the Relative Risk of Pulmonary Aspiration in Acute Care Surgery Patients. Am Surg 2020; 86:837-840. [PMID: 32705882 DOI: 10.1177/0003134820940257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute care surgery patients are often unfasted at the time of surgery, presenting a unique opportunity to study the effects of fasting on the risk of pulmonary aspiration. We aimed to determine the relative risk of aspiration in patients who were fasted at the time of surgery according to guidelines versus those in an unfasted state. METHODS A retrospective chart review of 100 patients who underwent appendectomy (n = 76) or exploratory laparotomy (n = 24) was conducted at a single institution in 2016-2017. Using the American Society of Anesthesiologists (ASA) Practice Guidelines for Preoperative Fasting, patients were stratified into study and control groups according to whether they were unfasted (nothing by mouth for <8 hours prior to surgery) or fasted (nothing by mouth for >8 hours prior to surgery). Data controlled for patients' age, sex, body mass index (BMI), most recent hemoglobin A1c, presence of gastroesophageal reflux disease (GERD), and presence of hiatal hernia. RESULTS Of the 76 patients who underwent appendectomy, 15% were unfasted with a total of 0 aspiration events (P < .001). Of the 24 patients who underwent exploratory laparotomy, 42% were unfasted with a total of 0 aspiration events (P < .001). This yields a relative risk of pulmonary aspiration of 1.0 (absolute risk of 0) in both the study and control groups. DISCUSSION In an acute care surgery population including patients who were not fasted according to guidelines, there was no increase in the risk of pulmonary aspiration. LEVEL OF EVIDENCE Epidemiological study; Level III.
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Affiliation(s)
- V Reed LaSala
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Madison E Morgan
- Trauma Services, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Eric H Bradburn
- Trauma Services, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Tawnya M Vernon
- Trauma Services, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - George O Maish
- Trauma Services, Penn Medicine Lancaster General Health, Lancaster, PA, USA
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355
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Abstract
PURPOSE OF REVIEW This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. RECENT FINDINGS Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation. SUMMARY NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.
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356
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Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care. Clin Nutr 2020; 39:2014-2024. [DOI: 10.1016/j.clnu.2019.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
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357
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High-flow nasal oxygen does not increase the volume of gastric secretions during spontaneous ventilation. Br J Anaesth 2020; 125:e75-e80. [DOI: 10.1016/j.bja.2020.02.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/29/2020] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
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358
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Greenidge E, Krieves M, Solorzano R. Global Anesthesia in Oral and Maxillofacial Surgery. Oral Maxillofac Surg Clin North Am 2020; 32:427-436. [PMID: 32507355 DOI: 10.1016/j.coms.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anesthesia for oral and maxillofacial procedures during volunteer surgical missions requires careful planning of personnel, equipment, supplies, and coordination with the host medical institution. Cleft lip and palate repair are the most common oral and maxillofacial surgeries performed, and can be performed safely in low-resource environments when proper care and planning is taken.
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Affiliation(s)
| | - Michael Krieves
- Smile Bangladesh; Private Practice, Grand Junction, CO, USA.
| | - Rene Solorzano
- Smile Bangladesh; Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
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359
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Jacomelli M, Margotto SS, Demarzo SE, Scordamaglio PR, Cardoso PFG, Palomino ALM, Figueiredo VR. Early complications in flexible bronchoscopy at a university hospital. J Bras Pneumol 2020; 46:e20180125. [PMID: 32490906 PMCID: PMC7567622 DOI: 10.36416/1806-3756/e20180125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: To analyze the complications related to flexible bronchoscopy (FB) and its collection procedures in outpatients and inpatients with various lung and airway diseases treated at a university hospital. Methods: This was a retrospective analysis of complications occurring during or within 2 h after FB performed between January of 2012 and December of 2013, as recorded in the database of the respiratory endoscopy department of a hospital complex in the city of São Paulo, Brazil. Results: We analyzed 3,473 FBs. Complications occurred in 185 procedures (5.3%): moderate to severe bleeding, in 2.2%; pneumothorax, in 0.7%; severe bronchospasm, in 0.8%; general complications (hypoxemia, psychomotor agitation, arrhythmias, vomiting, or hypotension), in 1.6%; and cardiopulmonary arrest, in 0.03%. There were no deaths related to the procedures. Specifically, among the 1,728 patients undergoing biopsy, bronchial brushing, or fine-needle aspiration biopsy, bleeding occurred in 75 (4.3%). Among the 1,191 patients undergoing transbronchial biopsy, severe pneumothorax (requiring chest tube drainage) occurred in 24 (2.0%). Conclusions: In our patient sample, FB proved to be a safe method with a low rate of complications. Appropriate continuing training of specialist doctors and nursing staff, as well as the development of standardized care protocols, are important for maintaining those standards.
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Affiliation(s)
- Marcia Jacomelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sergio Eduardo Demarzo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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360
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Carvalho CALDB, Carvalho AAD, Preza ADG, Nogueira PLB, Mendes KBV, Dock-Nascimento DB, Aguilar-Nascimento JE. Metabolic and Inflammatory Benefits of Reducing Preoperative Fasting Time in Pediatric Surgery. Rev Col Bras Cir 2020; 47:e20202353. [PMID: 32578813 DOI: 10.1590/0100-6991e-20202353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate the metabolic/inflammatory impact of reducing the preoperative fasting time in preschool children. METHODS Forty children were randomly assigned to a fasting group (absolute fasting after 00:00) and a carbohydrate (CHO) group (allowed to ingest, two hours before surgery, a carbohydrate-rich beverage). Blood samples were collected right before and after surgery to quantify the levels of albumin, interleukin-6, glucose, insulin, C-reactive protein and to calculate insulin resistance by the HOMA-IR index. RESULTS Preoperative fasting time in the CHO group were shorter than in the fasting group (2.49h vs. 11.24h, p <0.001). Pre- and post-surgical CRP levels were significantly lower in the CHO group (p = 0.05 and p = 0.02, respectively). The preoperative CRP/albumin ratios in the CHO group were lower than in the fasting group (p = 0.03). Four patients (21%) in the fasting group but none in the CHO group were hyperglycemic before surgery (p = 0.04). The two groups had similar levels of albumin, interleukin-6, insulin and HOMA index. There were no adverse events. CONCLUSION Reducing the preoperative fasting time with carbohydrate-rich beverages improves the perioperative metabolic and inflammatory responses of preschool children undergoing inguinal hernia surgery.
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361
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Suvvari P, Mishra S, Bhatnagar S, Garg R, Bharati SJ, Gupta N, Kumar V, Khan M. Comparison of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedication for Level of Sedation in Children Undergoing Radiation Therapy: A Prospective, Randomised, Double-Blind Study. Turk J Anaesthesiol Reanim 2020; 48:215-222. [PMID: 32551449 PMCID: PMC7279870 DOI: 10.5152/tjar.2019.45087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Radiation therapy is indicated in many solid tumours in children. Absolute immobility is required to precisely position children for optimal delivery of radiation energy to the target tissues, improve success rate and reduce the damage to nearby normal tissues. Intranasal (IN) administration of drugs is well tolerated, effective and fast acting. The primary aim of the present study was to evaluate the effectiveness of IN ketamine and dexmedetomidine for providing sedation in children before shifting to the radiotherapy suite. The secondary objective was to assess the requirement of propofol dosage in these patients. METHODS A total of 243 children aged between 1 and 5 years scheduled to undergo external beam radiotherapy were randomised to receive 5 mg kg-1 ketamine (group K, n=80), 2.5 μg kg-1 dexmedetomidine (group D, n=85) or 0.5 ml of saline (group S, n=78) in each nostril. After 45 min, sedation score was measured according to the modified Ramsay score (MRS) at the time of shifting for radiation. Time to awakening and time to discharge after the procedure were also noted. RESULTS A significantly higher proportion of children in group D (84.7%) achieved an MRS score ≥3 as compared to group K (36.2%) and group S (3.84%). The total propofol dose (mg kg-1) required was significantly less in group D (p<0.01). The patients in group D required more time to awakening, but this difference was not clinically significant. CONCLUSION The present study demonstrated that IN dexmedetomidine is superior to IN ketamine to provide procedural sedation for radiotherapy in children.
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Affiliation(s)
- Praneeth Suvvari
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia & Palliative Medicine, Dr BRA-Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - M.A. Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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362
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Pfaff KE, Tumin D, Miller R, Beltran RJ, Tobias JD, Uffman JC. Perioperative aspiration events in children: A report from the Wake Up Safe Collaborative. Paediatr Anaesth 2020; 30:660-666. [PMID: 32319164 DOI: 10.1111/pan.13893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Perioperative aspiration, while rare, is a serious complication of anesthetic care. Consequences of aspiration may include physical obstruction, wheezing, and pneumonia, resulting in mild to severe hypoxemia and even death. AIM We used a multi-institutional registry of pediatric patients to identify factors that influence the rate and resulting harm of perioperative pulmonary aspiration. METHODS The Wake Up Safe registry was queried for all severe adverse events reported from 29 institutions from 2010 to 2017. Aspiration events were identified through the "respiratory adverse event" data entry form or through free text search. Multivariable regression was used to predict aspiration events, and contributory factors were identified by reviewing free text case comments. RESULTS Analysis included 2 440 810 anesthetics administered involving patients ≤18 years of age. There were 135 pulmonary aspiration events, for an incidence of 0.006%. Within these 135 cases, 110 cases (82%) resulted in escalation of care and 51 (38%) resulted in patient harm, including 2 deaths (1.5%). In multivariable analysis, patients undergoing emergency surgery (OR 2.0 [1.2-3.5]) or with higher ASA status were more likely to experience aspiration (ASA 3 (OR 5.0 [2.6-9.1]); ASA ≥ 4 (OR 5.5 [3.8-16.8])). Noted causes of aspiration included gastrointestinal comorbid conditions (19%), postcoughing event or laryngospasm (14%), nil per os (NPO) violation (11%), blood or secretions in the airway following or during the procedure (6%), and oral premedication reaction (3%). CONCLUSION Although infrequent, death was reported as a consequence of perioperative aspiration in two patients. The frequency with which NPO violations were identified as a potential cause of aspiration highlights the struggles institutions face with adherence to NPO regulations, as these cases may be preventable. Furthermore, preventive measures may be needed to address other common causes of aspiration, such as gastrointestinal comorbid conditions.
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Affiliation(s)
- Kayla E Pfaff
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Brody School of Medicine East Carolina University, Greenville, NC, USA
| | - Rebecca Miller
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ralph J Beltran
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua C Uffman
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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363
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Abstract
Preoperative evaluation before thoracic surgery aims to separate those patients who will tolerate surgery and those who are not surgical candidates. Predicted postoperative pulmonary function testing helps make this distinction. The preoperative period represents a time for patient engagement and physical optimization to improve postoperative outcomes.
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Affiliation(s)
- Theofilos Matheos
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical School, UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA.
| | - Lakshmi Ram
- Department of Anesthesiology, Division of Critical Care, UMass Memorial Medical Center, Worcester, MA, USA
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364
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Kamran M, Wallace AN, Adewumi A. Interventional Management of Head and Neck Tumors. Semin Intervent Radiol 2020; 37:157-165. [PMID: 32419728 DOI: 10.1055/s-0040-1709157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Advancements in medical imaging and device technology allow minimal invasive procedures for the diagnosis and treatment of various disorders. For the management of tumors in head and neck region, these image-guided interventions play essential role in the often used multidisciplinary approach. Tissue sampling under ultrasound or computed tomography guidance is generally the first step to reach a pathological diagnosis. For head and neck tumors with high vascularity, embolization using particulate matter, liquid embolic agents, or coils is used to achieve successful tumor resection with minimal blood loss. Hemorrhage related to head and neck tumors can be evaluated and managed with endovascular techniques with minimal morbidity and mortality. Intra-arterial chemotherapy, radiofrequency ablation, and cryotherapy are new techniques for the management of advanced head and neck cancer which may serve as an alternative to achieve locoregional control and survival when curative resection may not be feasible.
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Affiliation(s)
- Mudassar Kamran
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
| | - Adam N Wallace
- Department of Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| | - Amole Adewumi
- Department of Radiology, UAMS College of Medicine, Little Rock, Arkansas
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365
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Yoon SB, Ji SH, Jang YE, Lee JH, Kim EH, Kim JT, Kim HS. Effects of prone positioning with neck extension on intracranial pressure according to optic nerve sheath diameter measured using ultrasound in children. Childs Nerv Syst 2020; 36:1001-1007. [PMID: 31797072 DOI: 10.1007/s00381-019-04442-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Optic nerve sheath diameter has been used for measure of intracranial pressure. The aim of this study was to evaluate the effect of prone positioning with neck extension on intracranial pressure in infants undergoing craniosynostosis surgery and to determine precautions using optic nerve sheath diameter measurement. METHODS We enrolled 30 infants who were scheduled for correction of craniosynostosis in which planning included the prone position with neck extension. Optic nerve sheath diameter (anterior/lateral transbulbar approach) was measured 5 times in each eyeball at the following time points: 15 min after intubation in supine position as the baseline value (supine 1); 10 min after final surgical position before skin incision (prone); and 10 min after returning to supine position at the conclusion of surgery (supine 2). Hemodynamic parameters, airway peak pressure, oxygen saturation, and ETCO2 were monitored. Data were analyzed using repeated-measures multivariate analysis of variance to evaluate the effect of different positions under anesthesia on changes in using optic nerve sheath diameter and P < 0.05 was considered to be statistically significant. RESULTS There was no difference in optic nerve sheath diameter after prone position with neck extension in all the measure. After surgery, optic nerve sheath diameter was decreased compared with the preoperative baseline values (Rt anterior/lateral 5.6/5.5: 5.4/5.2; Lt anterior/lateral 5.6/5.5: 5.4/5.3, P < 0.05, respectively). CONCLUSIONS In conclusion, prone positioning with head extension did not further increase intracranial pressure, although the surgical procedure could reduce intracranial pressure in the immediate postoperative period in infants undergoing craniosynostosis surgery.
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Affiliation(s)
- Soo-Bin Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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366
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Zhang YL, Li H, Zeng H, Li Q, Qiu LP, Dai RP. Ultrasonographic evaluation of gastric emptying after ingesting carbohydrate-rich drink in young children: A randomized crossover study. Paediatr Anaesth 2020; 30:599-606. [PMID: 32162448 DOI: 10.1111/pan.13853] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND A recent consensus statement in Europe has suggested that the fasting time for clear liquid in children can be shortened to 1 hour before a surgery. However, the study to show that 1-hour fasting time for clear fluids is safe in young children is still lacking. This study aimed to investigate the gastric emptying time for carbohydrate-rich drink and regular 5% glucose solution in children aged 3-7 years. METHODS After overnight fasting, individuals were randomly assigned to ingest 5 mL kg-1 of either carbohydrate-rich drink or 5% glucose solution. One week later, the same subjects were asked to ingest the other one. Ultrasonography was performed to examine the gastric contents. Gastric antral cross-sectional area was measured, and the gastric fluid volume was calculated before and after fluid ingestion within 120 minutes. The primary outcome was the gastric emptying time for both the clear fluids calculated using the antral cross-sectional area and logarithms of gastric fluid volume. The degrees of thirst and hunger of two drinks were evaluated using a visual analogue scale as the secondary outcomes. RESULTS Data from 16 individuals were analyzed. In the glucose solution group, the antral cross-sectional area and logarithms of gastric fluid volume returned to baseline at 30 minutes after ingestion. However, in the carbohydrate-rich drink group, the median [interquartile range; range] antral cross-sectional area (3.69 [2.64-5.15; 1.83-8.93] cm2 vs 2.41 [2.10-2.96; 1.81-4.37] cm2 , P < .001) and mean (95% confidence interval) logarithms of gastric fluid volume (2.54 [2.30-2.79] mL vs 2.12 [1.94-2.30] mL, P = .048) were still higher than at 60 minutes and returned to the baseline values at 90 minutes after ingestion, respectively. The degree of thirst was lower in the glucose solution group than that in the carbohydrate-rich drink group. CONCLUSIONS Gastric emptying of carbohydrate-rich drink is slower than that of 5% glucose solution but the residual gastric fluid volume is low one hour after ingestion of 5 mL kg-1 of either fluid.
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Affiliation(s)
- Yan-Ling Zhang
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hua Zeng
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiao Li
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li-Ping Qiu
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ru-Ping Dai
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, China.,Anesthesia Medical Research Centre, Central South University, Changsha, China
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367
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Löser B, Recio Ariza O, Saugel B, Reuter DA, Zöllner C, Werner YB, Rösch T, Petzoldt M. Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures. Anesth Analg 2020; 130:1331-1340. [DOI: 10.1213/ane.0000000000004420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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368
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Meier I, Vogt AP, Meineri M, Kaiser HA, Luedi MM, Braun M. Point-of-care ultrasound in the preoperative setting. Best Pract Res Clin Anaesthesiol 2020; 34:315-324. [PMID: 32711837 DOI: 10.1016/j.bpa.2020.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/24/2022]
Abstract
Point-of-care ultrasound (POCUS) is a widely used diagnostic tool, especially in emergency and critical care medicine, and it is increasingly being used in the perioperative setting. Its specific role in preoperative assessment of patients, however, has not yet been defined. While some data show innovative use of the technique in the preoperative setting, higher-level evidence to underscore potential advantages is still limited. We review and discuss a range of POCUS examinations which can potentially help anaesthesiologists in the preoperative clinic decide whether to perform additional testing, can assist in selecting the best anaesthetic approach, and can support perioperative and postoperative monitoring.
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Affiliation(s)
- Isabella Meier
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Andreas P Vogt
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | | | - Heiko A Kaiser
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
| | - Matthias Braun
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland.
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369
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Ultrasound assessment of gastric content in fasted patients before elective laparoscopic cholecystectomy: a prospective observational single-cohort study. Can J Anaesth 2020; 67:810-816. [DOI: 10.1007/s12630-020-01668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
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370
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Denkyi L. An exploration of pre-operative fasting practices in adult patients having elective surgery. ACTA ACUST UNITED AC 2020; 29:436-441. [DOI: 10.12968/bjon.2020.29.7.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Patients fast routinely before elective surgery in order to reduce gastric volume and acidity. The standard fasting time is ‘nil by mouth’ from midnight before surgery. In recent years, new guidelines have recommended that patients remain nil by mouth from clear fluids for 2 hours and from solids for 6 hours. This literature review explored preoperative fasting practices in adult patients from an international perspective. Methods: A literature search was undertaken of databases, including CINAHL Plus, PubMed, Medline, the Cochrane Central Register of Controlled Trials, Science Direct, Sage Journals and Embase. Results: Anaesthetists were found to possess greater knowledge of reduced preoperative fasting than other health professionals including nurses. Conclusion: Actual fasting time was found to be relatively longer than prescribed fasting times.
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Affiliation(s)
- Lovejoy Denkyi
- MSC Clinical Leadership Capstone Project, Kingston University, London
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371
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Abstract
A moderately liberal IV fluid regimen, using a balanced crystalloid, and consideration of the use of an advanced hemodynamic monitor in a setting of an enhanced recovery pathway are recommended for major surgery.
Supplemental Digital Content is available in the text.
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372
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373
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Hewson DW, Moppett I. Preoperative fasting and prevention of pulmonary aspiration in adults: research feast, quality improvement famine. Br J Anaesth 2020; 124:361-363. [PMID: 31980163 DOI: 10.1016/j.bja.2019.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- David W Hewson
- Anaesthesia and Critical Care, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Iain Moppett
- Anaesthesia and Critical Care, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
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374
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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375
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Gurm HS. A Complementary Approach for Preventing Contrast-Induced Acute Kidney Injury. JACC Cardiovasc Interv 2020; 13:843-845. [DOI: 10.1016/j.jcin.2019.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
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376
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Li L, Yong RJ, Kaye AD, Urman RD. Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview. Curr Pain Headache Rep 2020; 24:20. [DOI: 10.1007/s11916-020-0847-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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377
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Dharmawardana N, Woods C, Watson DI, Yazbeck R, Ooi EH. A review of breath analysis techniques in head and neck cancer. Oral Oncol 2020; 104:104654. [PMID: 32200303 DOI: 10.1016/j.oraloncology.2020.104654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 02/01/2023]
Abstract
Cancers of the head and neck region are a severely disabling group of diseases with no method for early detection. Analysis of exhaled breath volatile organic compounds shows promise as biomarkers for early detection and disease monitoring. This article reviews breath analysis in the setting of head and neck cancer, with a practical focus on breath sampling techniques, detection technologies and valid data analysis methods. Title and abstract keyword searches were conducted on PubMed and Embase databases to identify English language studies without a time-period limitation. The main inclusion criteria were human studies comparing head and neck cancer patients to healthy controls using exhaled breath analysis. Multiple breath collection techniques, three major detection technologies and multiple data analysis methods were identified. However, the variability in techniques and lack of methodological standardization does not allow for adequate study replication or data pooling. Twenty-two volatile organic compounds identified in five studies have been reported to discriminate head and neck cancer patients from healthy controls. Breath analysis for detection of head and neck cancer shows promise as a non-invasive detection tool. However, methodological standardization is paramount for future research study design to provide the potential for translating these techniques into routine clinical use.
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Affiliation(s)
- Nuwan Dharmawardana
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia.
| | - Charmaine Woods
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Roger Yazbeck
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Eng H Ooi
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Otorhinolaryngology-Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia
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378
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Valero Castañer H, Vendrell Jordà M, Sala Blanch X, Valero R. Preoperative bedside ultrasound assessment of gastric volume and evaluation of predisposing factors for delayed gastric emptying: a case-control observational study. J Clin Monit Comput 2020; 35:483-489. [PMID: 32124149 DOI: 10.1007/s10877-020-00489-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022]
Abstract
Perioperative pulmonary aspiration of gastric content is a serious complication. Fasting guidelines try to ensure an empty stomach before intervention. Certain medications or pathologies may cause delayed gastric emptying. Bedside ultrasonography is a useful tool when gastric content status is unclear or in emergency situations where fasting is not feasible. The aim of this prospective case-control observational study was to assess differences in gastric fluid volume between fasted patients with or without predisposing factors for delayed gastric emptying. Patients were preoperatively scanned. Antral cross-sectional area was measured by two tracing methods and total gastric clear fluid volumes were calculated. Data was recorded from September 2018 to March 2019 in a university hospital setting in Barcelona, Spain. Fifty-three patients were enrolled, 23 with delayed gastric emptying predisposing factors (DGEF) and 30 without non-DGEF. Ultrasound-estimated gastric clear fluid volume was 35.21 ± 32.69 mL in the DGEF versus 53.50 ± 30.72 mL in the non-DGEF group (p = 0.08). Average volume per unit of weight was 0.61 ± 0.46 mL/kg. Only 1 patient in the DGEF group had a volume that posed a higher risk of aspiration (1.57 mL/kg). Perfect correlation (R = 0.91; p < 0.01) and concordance (0.91; 95% CI 0.83; 0.95) was found between tracing methods. Minimal gastric content was observed in scheduled surgery in spite of predisposing factors for delayed gastric emptying. Ultrasound clear gastric volume estimation was useful to assess preoperative bedside gastric content.
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Affiliation(s)
| | - Marina Vendrell Jordà
- Anesthesiology Department, Hospital Clinic Barcelona, Villaroel 170, Esc 4-3, Barcelona, Spain.
| | - Xavier Sala Blanch
- Anesthesiology Department, Hospital Clinic Barcelona, Villaroel 170, Esc 4-3, Barcelona, Spain
| | - Ricard Valero
- Anesthesiology Department, Hospital Clinic Barcelona, Villaroel 170, Esc 4-3, Barcelona, Spain
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379
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Abstract
Obesity is considered a major comorbidity, and it is imperative for an anesthesiologist to put increased emphasis on preoperative evaluation and perioperative management. A multidisciplinary team approach is the key for a successful outcome. This article encompasses basic tenets like pathophysiology and pharmacology pertaining to obesity. The authors also talk about important aspects of anesthesia care starting from preoperative assessment and optimization, intraoperative challenges and care, to recovery and discharge of these patients.
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Affiliation(s)
- Surangama Sharma
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6417-JCP, Iowa City, IA 52242, USA.
| | - Lovkesh Arora
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 6413-JCP, Iowa City, IA 52242, USA
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380
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Ashok A, Niyogi D, Ranganathan P, Tandon S, Bhaskar M, Karimundackal G, Jiwnani S, Shetmahajan M, Pramesh CS. The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection. Surg Today 2020; 50:323-334. [PMID: 32048046 PMCID: PMC7098920 DOI: 10.1007/s00595-020-01956-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and
mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra- and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.
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Affiliation(s)
- Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India
| | - Devayani Niyogi
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India
| | - Priya Ranganathan
- Division of Thoracic Surgery, Department of Anesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sandeep Tandon
- Division of Thoracic Surgery, Department of Pulmonary Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maheema Bhaskar
- Division of Thoracic Surgery, Department of Pulmonary Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - George Karimundackal
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India
| | - Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India
| | - Madhavi Shetmahajan
- Division of Thoracic Surgery, Department of Anesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India.
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381
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Al Hillan A, Curras-Martin D, Carson M, Gor S, Ezeume A, Gupta V, Copcaalvarez A, Beri G, Bermann M, Asif A. Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics. Cureus 2020; 12:e6894. [PMID: 32064217 PMCID: PMC7003722 DOI: 10.7759/cureus.6894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Anesthesia guidelines recommend fasting for at least two hours to minimize aspiration risk related to endoscopic procedures, and the American Society for Gastrointestinal Endoscopy (ASGE) states that the final oral preparation liquid can be administered three to eight hours before the procedure. We have observed the cancellation of endoscopy procedures if liquids were consumed within four, six, or eight hours of the start time. Objectively, documenting gastric transit time via a review of pill endoscopy data could address clinician concerns, prevent delays in patient care, and improve the rate at which our clinicians practice within national guidelines. The objective was to utilize capsule endoscopy data from our center to report the relationship between patient factors that could affect gastric transit time (GTT) and small bowel transit time (SBTT) such as chronic kidney disease (CKD), diabetes mellitus (DM), nutritional status, and obesity. Methods This retrospective review obtained data on adult pill endoscopy (PillCam™ SB 3) (Medtronic, Minneapolis MN) studies on in- and outpatients. Past medical history and laboratory data were abstracted from electronic medical records. Mean GTT and SBTT are reported in minutes + standard deviation (SD) and times were compared accounting for conditions that could prolong transit, such as diabetes mellitus or chronic kidney disease (CKD). Results One hundred and sixty-three records reviewed. Four patients were excluded as the pill did not pass out of the stomach. The mean age was 66 years, 57% were female, and 26% were evaluated for gastrointestinal (GI) bleeding. The mean GTT for all patients (n = 159) was 35 + 49 with a median of 19 minutes. There were no statistically significant differences in GTT between the following subgroups: CKD0 (n = 100) 40 + 58 versus CKD5 (n = 11) 35 + 39, albumin > 3.0 (n = 123) 37 + 53 versus albumin < 3.0 (n = 36) 27 + 30, diabetes mellitus (DM) (n = 40) 51 + 71 vs. non-DM (n = 119) 42 + 79, body mass index (BMI) > 30, or aspirin use. The SBTT results in all patients (n = 124) was 238 + 88 minutes. Similarly, there was no relation between SBTT and albumin, any CKD, CKD0 versus CKD5, DM status, or BMI. The patients with the capsule stuck in the stomach did not have any other clinical history to explain this occurrence. Conclusions This analysis of objective data regarding pill endoscopy found that the mean GTT was 44 minutes, and it was < 60 minutes for 85% of the cohort. Patient factors were not associated with longer transit times, and this is the first report to document PillCam times in relation to CKD. These data support recommendations that endoscopic procedures, in accordance with anesthesia and ASGE guidelines, can be safely conducted in the majority of patients within 60 minutes of ingesting liquids.
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Affiliation(s)
- Alsadiq Al Hillan
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | | | - Michael Carson
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Shreya Gor
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Adaeze Ezeume
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Varsha Gupta
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | | | - Gagan Beri
- Gastroenterology, Jersey Shore University Medical Center, Neptune, USA
| | - Mordechai Bermann
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
| | - Arif Asif
- Internal Medicine, Jersey Shore University Medical Center, Neptune, USA
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382
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Elliott EM, Isserman RS, Stricker P, Yaddanapudi S, Subramanyam R. Fasting for anaesthesia: Less is more! Indian J Anaesth 2020; 64:87-89. [PMID: 32139924 PMCID: PMC7017675 DOI: 10.4103/ija.ija_936_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Elizabeth M Elliott
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Rebecca S Isserman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Paul Stricker
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
| | - Sandhya Yaddanapudi
- Department of Anesthesia and Critical Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Subramanyam
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. E-mail:
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383
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Zorio V, Lebreton T, Desgranges FP, Bochaton T, Desebbe O, Chassard D, Jacquet-Lagrèze M, Lilot M. Does a two-minute mini-fluid challenge predict fluid responsiveness in pediatric patients under general anesthesia? Paediatr Anaesth 2020; 30:161-167. [PMID: 31858641 DOI: 10.1111/pan.13793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Very little evidence for predictive markers of fluid responsiveness has been reported in children as compared to adults. The impact of hypovolemia or hypervolemia on morbidity has driven interest in the fluid challenge titration strategy. AIM The objective of this study was to explore the ability of a 3 mL kg-1 mini-fluid challenge over 2 minutes to predict fluid responsiveness in children under controlled ventilation. METHODS Children scheduled for surgery under general anesthesia were included and received a fluid challenge of 15 mL kg-1 of crystalloid prior to incision administered over 10 minutes in two steps: 3 mL kg-1 over 2 minutes then 12 mL kg-1 over 8 minutes. Fluid responsiveness was defined as a change of ≥10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as measured by transthoracic ultrasound before and after the fluid challenge of 15 mL kg-1 . RESULTS Of the 55 patients included in the analysis, 43 were fluid responders. The increase in the VTI after the mini-fluid challenge (ΔVTIminiFC ) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77; 95% CI (0.63-0.87), P = .004. Considering the least significant change which was 7.9%; 95% CI (6-10), the threshold was 8% with a sensitivity of 53%; 95% CI (38-68); and a specificity of 77%; 95% CI (54-100). CONCLUSION ΔVTIminiFC weakly predicted the effects of a fluid challenge of 15 mL kg-1 of crystalloid in anesthetized children under controlled mechanical ventilation.
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Affiliation(s)
- Violette Zorio
- Department of Anesthesia and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibault Lebreton
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - Thomas Bochaton
- Cardiac Intensive Care Unit, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Olivier Desebbe
- Department of Anesthesia and Intensive Care, Ramsay Generale de Sante, Sauvegarde Clinic, Lyon, France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France
| | - Matthias Jacquet-Lagrèze
- Department of Anesthesia and Intensive Care, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - Marc Lilot
- Department of Anesthesia and Intensive Care, The Hospital Femme-Mère-Enfant (Woman-Mother-Child), Hospices Civils de Lyon, Bron, France.,Health Services and Performance Research laboratory (EA 7425 HESPER), Claude Bernard Lyon 1 University, Lyon, France
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384
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Galvez JA, Wu L, Simpao AF, Tan J, Muhly W, Masino A, Sutherland T, Wasey JO, Nelson O, Lin E, Fiadjoe JE, Stricker P. Duration of preoperative clear fluid fasting and peripheral intravenous catheterization in children: A single-center observational cohort study of 9693 patients. Paediatr Anaesth 2020; 30:137-146. [PMID: 31785039 DOI: 10.1111/pan.13777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Children routinely undergo inhalational induction of general anesthesia. Intravenous line placement typically occurs after induction of anesthesia and can be challenging, particularly in infants and young children. AIMS We conducted a retrospective observational study to determine whether there was an association between clear liquid fasting time and the number of peripheral intravenous catheter insertion attempts in anesthetized children. The secondary aim was to identify factors associated with multiple attempts to insert intravenous lines. METHODS After institutional research board approval, we retrieved a data set of all children between 0 months and 18 years who received general anesthesia at our hospital between January 1, 2016, and September 30, 2017. Data included age, gender, weight, race, ASA status, gestational age, number of peripheral intravenous catheter insertion attempts, any assistive device for insertion, and insertion site. Inclusion criteria were mask induction, ASA status 1 or 2, nonemergency, ambulatory surgical procedures, and placement of a single intravenous line during the anesthetic. RESULTS A total of 9693 patients were included in the study. Of which 8869 patients required one insertion attempt and 824 underwent multiple insertion attempts. 50% of patients in the single insertion attempt group had clear liquid fasting time <6.9 hours compared to 51.8% of patients requiring multiple attempts. Logistic regression model adjusted for age, ASA status, gender, and BMI did not find an association between duration of clear liquid fasting time and rate of multiple insertion attempts for intravenous catheters (OR: 0.99, 95% CI: 0.98-1.01, P = .47). CONCLUSION Clear liquid fasting time was not associated with multiple insertion attempts for intravenous line insertion in children receiving general anesthesia. Factors such as patient age, ethnicity, time of day of induction of anesthesia, and American Society of Anesthesiologists Physical Status classification show a greater association with the risk of multiple intravenous line insertion attempts.
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Affiliation(s)
- Jorge A Galvez
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lezhou Wu
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allan F Simpao
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan Tan
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wallis Muhly
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Aaron Masino
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Tori Sutherland
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jack O Wasey
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Olivia Nelson
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elaina Lin
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John E Fiadjoe
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Stricker
- Department of Anesthesia & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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385
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Pai SL, Bojaxhi E, Logvinov II, Porter S, Feinglass NG, Robards CB, Torp KD. Gastric emptying of "clear liquid drinks" assessed with gastric ultrasonography: a blinded, randomized pilot study. Minerva Anestesiol 2020; 86. [DOI: 10.23736/s0375-9393.19.13822-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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386
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Nascimento LAD, Garcia AKA, Conchon MF, Aroni P, Pierotti I, Martins PR, Nakaya TG, Fonseca LF. Advances in the Management of Perioperative Patients' Thirst. AORN J 2020; 111:165-179. [DOI: 10.1002/aorn.12931] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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387
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Altman AD, Helpman L, McGee J, Samouëlian V, Auclair MH, Brar H, Nelson GS. Enhanced recovery after surgery: implementing a new standard of surgical care. CMAJ 2020; 191:E469-E475. [PMID: 31036609 DOI: 10.1503/cmaj.180635] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta.
| | - Limor Helpman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Jacob McGee
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Vanessa Samouëlian
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Marie-Hélène Auclair
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Harinder Brar
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Gregg S Nelson
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
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388
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Li C, Shao H, Huang S, Zhang T, Su X, Zhu S. Effects of an Individualized Fasting Program on Fasting Time and Comfort in Infants and Young Children During the Perioperative Period. J Perianesth Nurs 2020; 35:326-330. [PMID: 31973960 DOI: 10.1016/j.jopan.2019.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/17/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The study was designed to evaluate the effect of an individualized fasting program on fasting time and comfort in infants and young children during the perioperative period. DESIGN A quasiexperimental design was used. METHODS The study included 675 children (intervention = 353, control = 322). Data collection tools included Characteristics of Children Form and the Infant Hunger Rating Scale. The fasting program included individualized fasting education and fasting in batches. On the day of the operation, clear liquids were fed 2 hours before surgery and refed after the patient woke after surgery. FINDINGS The duration of perioperative fasting and the time to refeeding were shorter, the hunger scores were lower in the intervention group than those in the control group (P < .05). There was no difference in the incidence of vomiting between the two groups (P > .05), and no coughing and bloating occurred. CONCLUSIONS The fasting program for infants and young children can shorten the duration of fasting and can reduce the degree of hunger. This program is safe and feasible.
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Affiliation(s)
- Canping Li
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China.
| | - Hanqing Shao
- Department of Respiratory, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Shoujiang Huang
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Tingting Zhang
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Xiaohua Su
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Shuangping Zhu
- Department of Day Surgery, The Children's Hospital School of Medicine Zhejiang University, Hangzhou, China
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389
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Kothekar AT, Kulkarni AP. Gastrointestinal Tract: A Neglected Guardian Angel? Indian J Crit Care Med 2020; 24:S146-S151. [PMID: 33354032 PMCID: PMC7724944 DOI: 10.5005/jp-journals-10071-23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Role of the gastrointestinal (GI) system is not limited to the digestion of food and absorption of water and nutrients. Gastrointestinal mucosa forms a barrier preventing translocation of microbes into the blood. Upper GI tract performs important function of swallowing and prevention of aspiration, failure of which mandates enteral tube feeding. Rate of gastric emptying depends on gastric volume and contents and delayed emptying is observed both in solid and in fatty food. Cricoid pressure during intubation is an important intervention for prevention of aspiration in critically ill patients who are considered as full stomach. To utilize mucosal barrier function optimally, hemodynamically stable patients should preferably receive enteral nutrition even if they are on small doses of vasopressors. Post-pyloric feeds may reduce risk of aspiration and hence are recommended for patients who are deemed to have high risk for aspiration. Bowel sounds have poor reproducibility, sensitivity, specificity, accuracy, and interobserver agreement, and absent bowel sounds should not be considered as a contraindication to enteral feeding. How to cite this article: Kothekar AT, Kulkarni AP. Gastrointestinal Tract: A Neglected Guardian Angel? Indian J Crit Care Med 2020;24(Suppl 4):S146–S151.
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Affiliation(s)
- Amol T Kothekar
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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390
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Rabie A, Ghoneim T, Saad El-Rouby A. Single-shot thoracic epidural analgesia for neonates undergoing thoracotomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1848009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Aliaa Rabie
- Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tamer Ghoneim
- Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Saad El-Rouby
- Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
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391
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Ali SA, Aweke Z, Jemal B. Evidence based guideline on use of ketofol (Ketamine and Propofol admixture) for procedural sedation and analgesia (PSA) in pediatrics surgery: Review article. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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392
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Rabie A, Ghoneim T, El-Rouby A. Paravertebral versus single shot epidural blockade for neonates undergoing thoracotomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2020. [DOI: 10.1080/11101849.2020.1804816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Aliaa Rabie
- Lecturer of Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Tamer Ghoneim
- Lecturer of Anesthesia, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ahmed El-Rouby
- Lecturer of Pediatric Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
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393
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Li YY, Zeng YS, Chen JY, Wang KF, Hsing CH, Wu WJ, Wang JJ, Feng PH, Chu CC. Prophylactic diphenhydramine attenuates postoperative catheter-related bladder discomfort in patients undergoing gynecologic laparoscopic surgery: a randomized double-blind clinical study. J Anesth 2019; 34:232-237. [DOI: 10.1007/s00540-019-02724-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
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394
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Bouvet L, Chassard D. Ultrasound assessment of gastric contents in emergency patients examined in the full supine position: an appropriate composite ultrasound grading scale can finally be proposed. J Clin Monit Comput 2019; 34:865-868. [DOI: 10.1007/s10877-019-00452-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
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395
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Goudra B, Singh PM. Critical Analysis of Guidelines for Providing Sedation to Patients Undergoing Gastrointestinal Endoscopy Procedures. Anesth Essays Res 2019; 13:601-607. [PMID: 32009702 PMCID: PMC6937897 DOI: 10.4103/aer.aer_135_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022] Open
Abstract
In spite of growing numbers of gastrointestinal endoscopic procedures performed under deep sedation, guidelines are lacking. Hypoxemia and aspiration continue to be the main source of morbidity. Anesthesia providers have tried to address these concerns by modifying their technique and employing newer or improvised devices. In addition, preprocedural evaluation poses many challenges. In many centers, workload pressures determine the time available to perform such an evaluation. A comprehensive history and examination similar to a major surgical procedure is often not possible. As a result, a focused history and examination is essential. This should be followed by an appropriate explanation of risks before obtaining consent. A plan should be in place to manage complications such as aspiration. This paper provides a succinct review of the above aspects.
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Affiliation(s)
- Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University in Saint Louis, St. Louis, Missouri, USA
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396
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Gao Y, Wang C, Wang G, Cui X, Yang G, Lou H, Zhang L. Benefits of Enhanced Recovery After Surgery in Patients Undergoing Endoscopic Sinus Surgery. Am J Rhinol Allergy 2019; 34:280-289. [PMID: 31799861 DOI: 10.1177/1945892419892834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Although enhanced recovery after surgery (ERAS) protocols have been widely applied during perioperative periods for different diseases, there are few reports of ERAS in patients undergoing endoscopic sinus surgery (ESS). This study therefore aimed to evaluate the benefits of ERAS protocol compared to traditional care following ESS. Methods A total of 55 patients with chronic rhinosinusitis undergoing ESS were prospectively assigned to 1 of 5 treatment groups; ERAS groups with postoperative intravenous Flubiprofen Axetil or analgesia pump, traditional care with Flubiprofen Axetil or analgesia pump (NERAS groups), or traditional care without postoperative intravenous analgesia group (control). All patients completed the Kolcaba General Comfort Questionnaire, Medical Outcomes Study Sleep Scale, and Self-rating Anxiety Scale at admission and before discharge. Pain scores were recorded at 2, 6, 24, and 48 hours postsurgery and adverse reactions to analgesics were noted. Results Patients in ERAS group demonstrated significantly higher general comfort scores and lower self-rating anxiety scores compared to patients in NERAS and control groups. Compared to control patients, patients in ERAS group reported significantly lower pain scores at 6, 24, and 48 hours. Moreover, pain alleviated from 6 hours postsurgery in ERAS group compared to 48 hours in NERAS group. Patients using opioids experienced more adverse nausea events than patients using only nonsteroidal anti-inflammatory drugs (NSAIDs). Conclusions The use of patient-tailored ERAS programs following ESS may help to attain higher general comfort and to alleviate perioperative anxiety compared with traditional perioperative care. Adequate postoperative analgesia with NSAIDs in ERAS protocol may alleviate pain earlier with fewer adverse reactions.
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Affiliation(s)
- Yunbo Gao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Guang Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China *These authors contributed equally in this work
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397
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Green SM, Leroy PL, Roback MG, Irwin MG, Andolfatto G, Babl FE, Barbi E, Costa LR, Absalom A, Carlson DW, Krauss BS, Roelofse J, Yuen VM, Alcaino E, Costa PS, Mason KP. An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children. Anaesthesia 2019; 75:374-385. [PMID: 31792941 PMCID: PMC7064977 DOI: 10.1111/anae.14892] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/29/2023]
Abstract
The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
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Affiliation(s)
- S M Green
- Department of Emergency Medicine, Loma Linda University, Loma Linda, CA, USA
| | - P L Leroy
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M G Roback
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - G Andolfatto
- University of British, Columbia Department of Emergency Medicine, Lions Gate Hospital, North Vancouver, BC, Canada
| | - F E Babl
- Department of Emergency Medicine, Royal Children's Hospital, Parkville, Vic., Australia
| | - E Barbi
- Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy
| | - L R Costa
- Department of Pediatric Dentistry, Federal University of Goias, Goiania-Goias, Brazil
| | - A Absalom
- Department of Anaesthesia, University of Groningen, University Medical Center Groningen, the Netherlands
| | - D W Carlson
- Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - B S Krauss
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - J Roelofse
- Departments of Anaesthesia, University of the Western Cape, Stellenbosch University, Tygerberg, Republic of South Africa
| | - V M Yuen
- Department of Anaesthesiology, Hong Kong Children's Hospital and Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - E Alcaino
- Department of Paediatric Dentistry, University of Sydney, Westmead Centre for Oral Health, Sydney, NSW, Australia
| | - P S Costa
- Department of Pediatrics, Federal University of Goias, Goiania-Goias, Brazil
| | - K P Mason
- Department of Anesthesia, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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Miao YM, Wang J, Liu JE, Li L. Nutritional management of patients undergoing laparoscopic surgery for gastric cancer based on the concept of rapid rehabilitation. Shijie Huaren Xiaohua Zazhi 2019; 27:1349-1355. [DOI: 10.11569/wcjd.v27.i22.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a common malignant tumor, patients with gastric cancer (GC) are prone to malnutrition during the development and treatment of the disease. Fast track surgery (FTS), as a perioperative medical concept based on evidence-based medicine, plays an important role in nutrition management, including preoperative malnutrition screening and treatment, preoperative nutritional management, postoperative early oral feeding, accelerated promotion of gastrointestinal function recovery, and nutritional support. Based on a series of small sample studies, the safety and importance of FTS in laparoscopic nutrition management of GC are gradually emerging, but clinical implementation is difficult. This article will review the research progress of FTS in the field of laparoscopic nutrition management of GC in the past decade.
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Affiliation(s)
- Ying-Ming Miao
- Department of Nursing, Second Affiliated Hospital of Hainan Medical College, Haikou 570100, Hainan Province, China
| | - Jie Wang
- Department of Nursing, Second Affiliated Hospital of Hainan Medical College, Haikou 570100, Hainan Province, China
| | - Jun-Er Liu
- Department of Nursing, Second Affiliated Hospital of Hainan Medical College, Haikou 570100, Hainan Province, China
| | - Long Li
- Department of Nursing, Second Affiliated Hospital of Hainan Medical College, Haikou 570100, Hainan Province, China
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Duggan E, Chen Y. Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy. Curr Diab Rep 2019; 19:134. [PMID: 31749027 DOI: 10.1007/s11892-019-1277-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review provides a literature update and practical outline for the management of diabetes and stress hyperglycemia for adult surgical patients in the pre- and intraoperative settings. RECENT FINDINGS Hyperglycemia in surgical patients has been associated with increased risk of complication in both diabetic and non-diabetic patients in the perioperative setting. While current recommended perioperative blood glucose target is < 180 mg/dL (10 mmol/L), optimal outcomes may require different treatment targets for diabetic versus non-diabetic patients. Hemoglobin A1C level is associated with elevated risk of hyperglycemia and adverse outcomes, but there is insufficient evidence to recommend routine preoperative testing or optimal values in elective surgical patients. Day of surgery blood glucose testing and treatment are recommended in the perioperative period, and anesthetic management includes appropriate patient selection for use of subcutaneous insulin, intravenous insulin infusions, and insulin pumps. Additionally, administration of both intravenous and perineural dexamethasone is associated with increased blood glucose levels and clinicians should consider the risk benefit ratio in surgical patients. For enhanced recovery after surgery protocols, further evidence is needed to support routine use of carbohydrate loading in diabetic patients. Optimal perioperative care includes screening at-risk patients, use of preoperative oral hypoglycemics and home insulin, anesthetic type and medication selection, blood glucose testing, and treatment for hyperglycemia in the operating room. Partnerships with surgery and endocrinology teams aid optimal postoperative management and discharge planning.
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Affiliation(s)
- Elizabeth Duggan
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA.
| | - York Chen
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA
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