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Li X, Wei J, Shen N, Lu T, Xing J, Mai K, Li J, Hei Z, Chen C. Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials. Anesth Analg 2023; 137:859-869. [PMID: 37010960 DOI: 10.1213/ane.0000000000006447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND We aimed to determine the preventive and therapeutic efficacy of modified manual chest compression (MMCC), a novel noninvasive and device-independent method, in reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation. METHODS A total of 584 outpatients who underwent deep sedation during upper gastrointestinal endoscopy were enrolled. In the preventive cohort, 440 patients were randomized to the MMCC group (patients received MMCC when their eyelash reflex disappeared, M1 group) or control group (C1 group). In the therapeutic cohort, 144 patients with oxygen desaturation of a Sp o2 < 95% were randomized to MMCC group (patients who subsequently received MMCC, M2 group) or the conventional treatment group (C2 group). The primary outcomes were the incidence of desaturation episodes with an Sp o2 < 95% for the preventive cohort and the time spent below 95% Sp o2 for the therapeutic cohort. Secondary outcomes included the incidence of gastroscopy withdrawal and diaphragmatic pause. RESULTS In the preventive cohort, MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37-0.815; P = .002), gastroscopy withdrawal (0% vs 2.29%; P = .008), and diaphragmatic pause at 30 seconds after propofol injection (74.5% vs 88.1%; RR, 0.846; 95% CI, 0.772-0.928; P < .001). In the therapeutic cohort, patients who received MMCC had a significantly shorter time spent below 95% Sp o2 (40 [20-69] seconds vs 91 [33-152] seconds, median difference [95% CI], -39 [-57 to -16] seconds, P < .001), a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018), and more enhanced diaphragmatic movement at 30 seconds after Sp o2 <95% (1.11 [0.93-1.4] cm vs 1.03 [0.7-1.24] cm; median difference [95% confidence interval], 0.16 [0.02-0.32] cm; P = .015). CONCLUSIONS MMCC may exert preventive and therapeutic effects against oxygen desaturation events during upper gastrointestinal endoscopy.
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Affiliation(s)
- Xiaoyun Li
- From the Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Wilson‐Baig N, Walker R. Relief of laryngospasm with gentle chest compressions during direct laryngotracheobronchoscopy. Anaesth Rep 2023; 11:e12268. [PMID: 38144714 PMCID: PMC10746857 DOI: 10.1002/anr3.12268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- N. Wilson‐Baig
- Department of Anaesthesia and Intensive CareWrightington, Wigan and Leigh Teaching Hospitals NHS Foundation TrustWrightingtonUK
- East Anglian Air AmbulanceNorwichUK
- Department of Anaesthesia and Critical CareRoyal Manchester Children's HospitalManchesterUK
| | - R. Walker
- Department of Anaesthesia and Critical CareRoyal Manchester Children's HospitalManchesterUK
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Manouchehrian N, Abbasi R, Jiryaee N, Beigi RM. Comparison of intravenous injection of magnesium sulfate and lidocaine effectiveness on the prevention of laryngospasm and analgesic requirement in tonsillectomy. Eur J Transl Myol 2022; 32:10732. [PMID: 36165596 PMCID: PMC9830401 DOI: 10.4081/ejtm.2022.10732] [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] [Received: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 01/13/2023] Open
Abstract
The aim of the present study is to compare the effect of intravenous (IV)injectionof magnesium sulfate and lidocaine on the prevention of laryngospasm, and analgesic requirement in tonsillectomy surgeries. In this double-blinded clinical trial, 62 children are randomly selected and categorized into two groups. Two minutes after intubation, group A received 15 mg/kg IV magnesium sulfate, while group B received 1 mg/kg IV 2% lidocaine. Laryngospasm frequency, nausea and vomiting, hemodynamic status (in 15 minutes after extubating), sedation score, analgesic requirement, and duration of recovery were compared between the two groups. Data were analyzed using SPSS software version 21 and with a 95% confidence interval. Both groups had no significant difference based on the age and weight means, as well as sex frequency. 10 patients (32.3%) in the lidocaine group and 3 patients in the magnesium group (9.7%) had stridor, and the difference between the two groups was statistically significant (p = 0.026). Laryngospasm only occurred in a patient of the lidocaine group. The frequency of nausea and vomiting, agitation and analgesic requirement in the lidocaine group were higher than the magnesium group (p= 0.001). However, sedation score and recovery time were higher in the magnesium group (p=0.001). No statistically significant difference was seen between the two groups in terms of hemodynamics. Magnesium sulfate and lidocaine had no difference in the incidence of laryngospasm, but magnesium sulfate was associated with a lower rate of stridor, nausea, vomiting, agitation and analgesic requirement in recovery in comparison to lidocaine.
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Affiliation(s)
- Nahid Manouchehrian
- Department of Anesthesia and Critical Care, Besat Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rohollah Abbasi
- Department of Otolaryngology Head and Neck Surgery, Besat Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran,Department of Otolaryngology Head and Neck Surgery, Besat Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran. ORCID iD: 0001-0000-8086-7253
| | - Nasrin Jiryaee
- Department of Community and Family Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Manouchehrian N, Jiryaee N, Moheb FA. Propofol versus lidocaine on prevention of laryngospasm in tonsillectomy: A randomized clinical trial. Eur J Transl Myol 2022; 32. [PMID: 35766592 PMCID: PMC9580534 DOI: 10.4081/ejtm.2022.10581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/15/2022] [Indexed: 12/26/2022] Open
Abstract
Laryngospasm is an important complication of tonsillectomies. This study aimed to compare the effects of propofol versus lidocaine on prevention of laryngospasm in tonsillectomy. This randomized clinical trial included 102 patients who met the inclusion criteria. Patients were randomly divided into two groups treated with 0.5 mg/kg propofol (group P) or 1 mg/kg lidocaine 2% (group L). The frequencies of laryngospasm (within 10 min after extubation), agitation, nausea, vomiting, mean heart rate and mean arterial pressure (MAP) were assessed in both groups. Data were analyzed using SPSS software version 16 at a 95% confidence level. There were no significant differences between the two groups in terms of sex, age or weight. In the P group, the frequency of laryngospasm was significantly lower than L within10 minutes after extubation (4.1% versus 16.3%). Furthermore, the frequencies of agitation (p = 0.003), nausea and vomiting (p = 0.002) and mean heart rate (p = 0.026) were significantly higher in the L group than the P group. However, there were no differences between the two groups in terms of mean systolic and diastolic blood pressure, MAP, SPO2, awakening time, length of stay in recovery and frequency of shivering. Propofol can reduce the incidence of laryngospasm, agitation, nausea and vomiting but it has no effect on the patient's awakening time and length of stay in recovery.
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Affiliation(s)
- Nahid Manouchehrian
- Department of Anesthesia and Critical Care, Besat Medical Center,Hamadan University of Medical Sciences, Hamadan.
| | - Nasrin Jiryaee
- Department of Community and Family Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan.
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Incidence and Associated Factors of Laryngospasm among Pediatric Patients Who Underwent Surgery under General Anesthesia, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: A Cross-Sectional Study. Anesthesiol Res Pract 2020; 2020:3706106. [PMID: 32411216 PMCID: PMC7204258 DOI: 10.1155/2020/3706106] [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: 10/11/2019] [Revised: 12/10/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Laryngospasm is a glottis closure due to reflex constriction of the laryngeal muscles. It can occur at any phase of the anesthetic. Different studies have been done previously with various results and indicative values which initiated us to do this research. This study aimed to assess the incidence and associated factors of laryngospasm among pediatric patients who underwent surgery under general anesthesia (GA). Methods Institution-based, cross-sectional study was conducted on pediatric patients from February to August, 2019, in University of Gondar Comprehensive Specialized Hospital (UOGCSH). Data were entered and analyzed with SPSS version 20. Variables with P value less than <0.2 in bivariate analysis were fitted into the multivariable logistic regression analysis to identify factors associated with laryngospasm. Both crude and adjusted odds ratio with 95% CI were calculated to show strength of association. In multivariable analysis, P value of <0.05 was considered as statistically significant. Results The incidence of laryngospasm among pediatric patients who underwent surgery under GA was 57 (18.4%). Of this, 34 (59.6%), 12 (21.1%), and 11 (19.3%) happened during emergence, maintenance, and induction phases of GA, respectively. In multivariable analysis, airway anomalies (AOR: 14.64, 95% CI: 1.71, 125.04), secretion (AOR: 2.45, 95% CI: 1.19, 5.06), attempts of airway devices (AOR: 2.47, 95% CI: 1.16, 5.22), upper respiratory tract infection (AOR: 2.91, 95% CI: 1.008, 8.41), and inadequate depth of anesthesia (AOR: 7.92, 95% CI: 2.7, 23.22) were significantly associated with incidence of laryngospasm. Conclusions Laryngospasm can occur at any phase of the anesthetic. At UOGCSH, the overall rate of laryngospasm was 18.4%, with the vast majority of episodes occurring on emergence. Inadequate depth of anesthesia, URTI, airway anomalies, multiple attempts of airway devices, and oropharyngeal secretion were predictors of laryngospasm. So, added vigilance is needed in patients with URTI, airway anomalies, or those who require multiple attempts at airway device insertion. Prompt clearing of airway secretions and adequate depth of anesthesia may help to prevent laryngospasm. Since the majority of our patients received an IV induction, endotracheal intubation, and maintenance with halothane, caution must be taken in extrapolating these results to other patient populations.
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Larach MG, Klumpner TT, Brandom BW, Vaughn MT, Belani KG, Herlich A, Kim TW, Limoncelli J, Riazi S, Sivak EL, Capacchione J, Mashman D, Kheterpal S, Kooij F, Wilczak J, Soto R, Berris J, Price Z, Lins S, Coles P, Harris JM, Cummings KC, Berman MF, Nanamori M, Adelman BT, Wedeven C, LaGorio J, McCormick PJ, Tom S, Aziz MF, Coffman T, Ellis TA, Molina S, Peterson W, Mackey SC, van Klei WA, Ginde AA, Biggs DA, Neuman MD, Craft RM, Pace NL, Paganelli WC, Durieux ME, Nair BJ, Wanderer JP, Miller SA, Helsten DL, Turnbull ZA, Schonberger RB. Succinylcholine Use and Dantrolene Availability for Malignant Hyperthermia Treatment: Database Analyses and Systematic Review. Anesthesiology 2019; 130:41-54. [PMID: 30550426 DOI: 10.1097/aln.0000000000002490] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although dantrolene effectively treats malignant hyperthermia (MH), discrepant recommendations exist concerning dantrolene availability. Whereas Malignant Hyperthermia Association of the United States guidelines state dantrolene must be available within 10 min of the decision to treat MH wherever volatile anesthetics or succinylcholine are administered, a Society for Ambulatory Anesthesia protocol permits Class B ambulatory facilities to stock succinylcholine for airway rescue without dantrolene. The authors investigated (1) succinylcholine use rates, including for airway rescue, in anesthetizing/sedating locations; (2) whether succinylcholine without volatile anesthetics triggers MH warranting dantrolene; and (3) the relationship between dantrolene administration and MH morbidity/mortality. METHODS The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given. RESULTS Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities. CONCLUSIONS Providers use succinylcholine commonly, including during difficult mask ventilation. Succinylcholine administered without volatile anesthetics may trigger MH events requiring dantrolene. Delayed dantrolene treatment increases the likelihood of MH complications. The data reported herein support stocking dantrolene wherever succinylcholine or volatile anesthetics may be used.
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Affiliation(s)
- Marilyn Green Larach
- From The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States, University of Pittsburgh Medical Center, Mercy Hospital, Pittsburgh, Pennsylvania (2000 through 2017; M.G.L., B.W.B.) Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida (2018; M.G.L.) Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (T.T.K., M.T.V., S.K.) Department of Nurse Anesthesia, University of Pittsburgh, Pittsburgh, Pennsylvania (2016 through 2018; B.W.B.) Department of Anesthesiology, School of Medicine (K.G.B., T.W.K., J.C.) School of Public Health (K.G.B.), University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, Children's Hospital of Pittsburgh (E.L.S.) Department of Anesthesiology (A.H.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Department of Anesthesiology, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, New York (J.L.) Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Canada (S.R.) Department of Anesthesiology and Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia (D.M.). Current positions: Dr. Larach is now at the Department of Anesthesiology, University of Florida, Gainesville, Florida. Dr. Sivak is now at the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio. Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands Beaumont Health, Dearborn, Michigan Beaumont Health, Royal Oak, Michigan Beaumont Health, Farmington Hills, Michigan Beaumont Health, Grosse Pointe, Michigan Bronson Healthcare, Battle Creek, Michigan Bronson Healthcare, Kalamazoo, Michigan CHOC Children's Hospital, Orange, California Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio Department of Anesthesiology, Columbia University Medical Center, New York, New York Henry Ford Health System, Detroit, Michigan Henry Ford Health System, West Bloomfield, Michigan Holland Hospital, Holland, Michigan Mercy Health, Muskegon, Michigan Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York Department of Anesthesiology, Perioperative Care, and Pain Medicine, New York University Langone Medical Center, New York, New York Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon St. Joseph Mercy, Ann Arbor, Michigan St. Joseph Mercy Oakland, Pontiac, Michigan St. Mary Mercy Hospital, Livonia, Michigan Sparrow Health System, Lansing, Michigan Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands Department of Anesthesiology, University of Colorado, Aurora, Colorado Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania Department of Anesthesiology, University of Tennessee Medical Center, Knoxville, Tennessee Department of Anesthesiology, University of Utah, Salt Lake City, Utah Department of Anesthesiology, University of Vermont, Larner College of Medicine, Burlington, Vermont Department of Anesthesiology, University of Virginia, Charlottesville, Virginia Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee Department of Anesthesiology, Wake Forest Baptist Health, Winston-Salem, North Carolina Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri Department of Anesthesiology, Weill Cornell Medical College, New York, New York Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
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Mokhtar AM, Badawy AA. Low dose propofol vs. lidocaine for relief of resistant post-extubation laryngospasm in the obstetric patient. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28754225 PMCID: PMC9391671 DOI: 10.1016/j.bjane.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Post-extubation laryngospasm is a dangerous complication that should be managed promptly. Standard measures were described for its management. We aimed to compare the efficacy of propofol (0.5 mg.kg−1) vs. lidocaine (1.5 mg.kg−1) for treatment of resistant post-extubation laryngospasm in the obstetric patients, after failure of the standard measures. Method This study was conducted over 2 years on all obstetric patients scheduled for cesarean delivery. Post-extubation laryngospasm was initially managed with a standard protocol (removal of offending stimulus, jaw thrust, positive pressure ventilation with 100% oxygen). When this protocol failed, the tested drug was the second line (lidocaine in the first year and propofol in the second year). Lastly, succinylcholine was used when the tested drug failed. Results In lidocaine group, 5% of parturients developed post-extubation laryngospasm, 31.9% of them were successfully treated via standard protocol, and 68.1% required lidocaine treatment. Among these, 65.6% of patients treated with lidocaine responded successfully and 34.4% required succinylcholine to relieve laryngospasm. In propofol group, 4.7% of parturients developed post-extubation laryngospasm, 30.1% of them were successfully treated via standard protocol, and 69.9% required propofol treatment. Among these, 82.8% of patients treated with propofol responded successfully and 17.2% required succinylcholine to relieve laryngospasm. Conclusion Small dose of propofol (0.5 mg.kg−1) is marginally more effective than lidocaine (1.5 mg.kg−1) for the treatment of resistant post-extubation laryngospasm in obstetric patients, after failure of standard measures and before the use of muscle relaxants.
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Affiliation(s)
- Ali M Mokhtar
- Cairo University, Department of Anesthesia, Cairo, Egypt.
| | - Ahmed A Badawy
- Cairo University, Department of Anesthesia, Cairo, Egypt
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Mokhtar AM, Badawy AA. [Low dose propofol vs. lidocaine for relief of resistant post-extubation laryngospasm in the obstetric patient]. Rev Bras Anestesiol 2017; 68:57-61. [PMID: 28754225 DOI: 10.1016/j.bjan.2017.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/31/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Post-extubation laryngospasm is a dangerous complication that should be managed promptly. Standard measures were described for its management. We aimed to compare the efficacy of propofol (0.5mg.kg-1) vs. lidocaine (1.5mg.kg-1) for treatment of resistant post-extubation laryngospasm in the obstetric patients, after failure of the standard measures. METHOD This study was conducted over 2 years on all obstetric patients scheduled for cesarean delivery. Post-extubation laryngospasm was initially managed with a standard protocol (removal of offending stimulus, jaw thrust, positive pressure ventilation with 100% oxygen). When this protocol failed, the tested drug was the second line (lidocaine in the first year and propofol in the second year). Lastly, succinylcholine was used when the tested drug failed. RESULTS In lidocaine group, 5% of parturients developed post-extubation laryngospasm, 31.9% of them were successfully treated via standard protocol, and 68.1% required lidocaine treatment. 65.6% of patients treated with lidocaine responded successfully and 34.4% required succinylcholine to relieve laryngospasm. In propofol group, 4.7% of parturients developed post-extubation laryngospasm, 30.1% of them were successfully treated via standard protocol, and 69.9% required propofol treatment. 82.8% of patients treated with propofol responded successfully and 17.2% required succinylcholine to relieve laryngospasm. CONCLUSION Small dose of propofol (0.5mg.kg-1) is marginally more effective than lidocaine (1.5mg.kg-1) for the treatment of resistant post-extubation laryngospasm in obstetric patients, after failure of standard measures and before the use of muscle relaxants.
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Affiliation(s)
- Ali M Mokhtar
- Cairo University, Department of Anesthesia, Cairo, Egypt.
| | - Ahmed A Badawy
- Cairo University, Department of Anesthesia, Cairo, Egypt
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Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One 2016; 11:e0158137. [PMID: 27414807 PMCID: PMC4944923 DOI: 10.1371/journal.pone.0158137] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. METHODS A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. RESULTS Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70-4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13-6.18) and RR = 0.95, 95% CI = (0.81-1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27-1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58-14.33)]; aspiration [RR = 0.76, 95% CI = (0.06-8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10-1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15-0.62)]; coughing [RR = 0.28, 95% CI = (0.15-0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26-0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44-11.18)]. CONCLUSION This systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
| | - Ying Lian
- Department of Case Administration, Shandong Provincial Qian Foshan Hospital of Shandong University, Jinan, China
| | - Wen Xian Li
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
- * E-mail:
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Ueno T, Komasawa N, Majima N, Mihara R, Minami T. Tracheal Tube Position Shift During Infant Resuscitation by Chest Compression: A Simulation Comparison by Fixation Method and With or Without Cuff. J Emerg Med 2016; 50:601-6. [PMID: 26823135 DOI: 10.1016/j.jemermed.2015.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/03/2015] [Accepted: 11/20/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tracheal tube placement during infant resuscitation is essential for definite airway protection. Accidental extubation due to tracheal tube displacement is a rare event, but it results in severe complications, especially in infants. OBJECTIVE The present study evaluated how infant tracheal tube displacement is affected by tape vs. tube holder fixation using a manikin. METHODS A tracheal tube with internal diameter of 3.5 mm was placed 10 cm from the gum ridge in an advanced life support (ALS) Baby(®) simulator (Laerdal, Stavanger, Norway). In the first trial, cuff pressure was set at 15, 20, and 25 cmH2O and trials were performed at each setting with no fixation, Durapore(®) (3M, St Paul, MN) tape fixation, Multipore(®) (3M) tape fixation, and Thomas(®) Tube Holder (Laerdal) fixation. After 5 min of chest compression, the tracheal tube shift was measured. In the second trial, we compared the tube shift by chest compression with or without cuff in the same way. RESULTS Relative to no fixation, tracheal tube shift was significantly less in the Durapore, Multipore, and tube holder groups (p < 0.05) at all cuff settings. Of the three fixation methods, the tube holder showed significantly less shift (p < 0.05) relative to tape, regardless of the initial cuff pressure. The positional shift after chest compressions was significantly larger in the trials with cuff than in those without cuff in Durapore or Multipore fixation (p < 0.05), but did not in tube holder fixation. CONCLUSIONS There is less tracheal tube displacement with tube holder fixation than with tape during continuous infant chest compression simulation. The tube cuff can contribute to the positional shift of the tube during infant chest compression.
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Affiliation(s)
- Takeshi Ueno
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | | | - Nozomi Majima
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | - Ryosuke Mihara
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
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Abstract
PURPOSE OF REVIEW Tonsillectomy is a very common procedure, but with risks or challenges, both for the surgeon and anesthesiologist. Many places have considerable experience and expertise with this procedure, and a lot of clinical studies are continuously being presented. RECENT FINDINGS Most preoperative aspects are covered, including indications, preoperative risk assessment, premedication, anesthetic induction and maintenance, as well as recovery function and side-effects; such as bleeding, agitation, pain, nausea and sleep apnea. Controversies exist as to ambulatory versus in-patient care, laryngeal mask airway versus endotracheal intubation, use of local anesthetic infiltration and use of glucocorticoids. SUMMARY Preoperative evaluation should identify increased bleeding risk, potential airway problems, ongoing infection and symptoms of obstructive sleep apnea.Intravenous propofol is most often used for anesthetic induction, although inhalational sevoflurane is a valid alternative. Laryngeal mask airway or endotracheal tube may both be used safely and effectively; the choice will depend upon the routine and experience of the team. Paracetamol and NSAIDs are useful baseline medication for nonopioid multimodal postoperative pain treatment and prophylaxis. Similar with local anesthesia infiltration and dexamethasone medication, although somewhat more disputed. Dexamethasone is also useful for nausea/vomiting prophylaxis, together with ondansetron and also propofol for anesthesia maintenance.
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Orestes MI, Lander L, Verghese S, Shah RK. Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy. Laryngoscope 2012; 122:425-8. [PMID: 22252947 DOI: 10.1002/lary.22423] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/11/2011] [Accepted: 07/21/2011] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate and describe airway complications in pediatric adenotonsillectomy. STUDY DESIGN Retrospective case-control study. METHODS A chart review of patients that underwent adenotonsillectomy between 2006 and 2010 was performed. Perioperative complications, patient characteristics, and surgeon and anesthesia technique were recorded. RESULTS A total of 682 charts were reviewed. Eleven cases (1.6%) of laryngospasm were identified: one was preoperative, seven occurred in the operating room postextubation, and three occurred in the recovery area. Four patients were given succinylcholine, one was reintubated, and the other cases were managed conservatively. Mean age of patients with laryngospasm was 5.87 years (standard deviation [SD], 4.01; 1.9-15.8 years). There were 12 cases (1.8%) of bronchospasm; all were treated with nebulized albuterol. Mean age of patients with bronchospasm was 5.81 years (SD, 4.17; 1.8-14.1 years). Overall, 22 patients required antiemetics (3.3%), 19 required albuterol (2.9%), and five required racemic epinephrine (0.8%). Compared to the children without airway complications, there was no difference in age, weight, American Society of Anesthesiologists status, length of surgery, need for admission, and anesthesia technique in those that had laryngospasm. Patients with bronchospasm, compared to the patients without complications, had faster surgeries (P < .05), were more likely to have underlying asthma (P < .05), and were more likely to be admitted (P < .05). There were no unexpected admissions or other morbidities. CONCLUSIONS The rates of laryngospasm (1.6%) and bronchospasm (1.8%) are significantly lower than reported in the literature, reflecting refinements in modern anesthesia/surgical technique. Knowledge of at-risk patients can facilitate planning to potentially reduce the incidence of perioperative airway complications during adenotonsillectomy.
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Affiliation(s)
- Michael I Orestes
- National Capitol Consortium Otolaryngology Residency Training Program, Walter Reed Army Medical Center, Washington, DC, USA
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