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Zhang X, Wang XD, Cui W, Gao SC, Yang XD, Xia B. Safety of propofol-assisted deep extubation in the dental treatment of children-a retrospective, observational study. BMC Anesthesiol 2024; 24:213. [PMID: 38951786 PMCID: PMC11218232 DOI: 10.1186/s12871-024-02599-2] [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: 03/20/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE Awake extubation and deep extubation are commonly used anesthesia techniques. In this study, the safety of propofol-assisted deep extubation in the dental treatment of children was assessed. MATERIALS AND METHODS Children with severe caries who received dental treatment under general anesthesia and deep extubation between January 2017 and June 2023 were included in this study. Data were collected on the following variables: details and time of anesthesia, perioperative vital signs, and incidence of postoperative complications. The incidence of laryngeal spasm (LS) was considered to be the primary observation indicator. RESULTS The perioperative data obtained from 195 children undergoing dental treatment was reviewed. The median age was 4.2 years (range: 2.3 to 9.6 years), and the average duration of anesthesia was 2.56 h (range 1 to 4.5 h). During intubation with a videoscope, purulent mucus was found in the pharyngeal cavity of seven children (3.6%); LS occurred in five of them (2.6%), and one child developed a fever (T = 37.8 °C) after discharge. Five children (2.6%) experienced emergence agitation (EA) in the recovery room. Also, 13 children (6.7%) experienced epistaxis; 10 had a mild experience and three had a moderate experience. No cases of airway obstruction (AO) and hypoxemia were recorded. The time to open eyes (TOE) was 16.3 ± 7.2 min. The incidence rate of complications was 23/195 (11.8%). Emergency tracheal reintubation was not required. Patients with mild upper respiratory tract infections showed a significantly higher incidence of complications (P < 0.001). CONCLUSIONS Propofol-assisted deep extubation is a suitable technique that can be used for pediatric patients who exhibited non-cooperation in the outpatient setting. Epistaxis represents the most frequently encountered complication. Preoperative upper respiratory tract infection significantly increases the risk of complications. The occurrence of EA was notably lower than reported in other studies.
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Affiliation(s)
- Xiang Zhang
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Xiao-Dong Wang
- Department of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Wei Cui
- Department of Pediatric Dentistry, The No. 2 Hospital of Baoding, Baoding, 071051, China
| | - Shun-Cai Gao
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, 100049, China
| | - Xu-Dong Yang
- Department Head of Anesthesiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Bin Xia
- Department Head of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
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Qiu J, Xie M, Chen J, Chen B, Chen Y, Zhu X, Lin H, Zhu T, Duan G, Huang H. Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:810366. [PMID: 35308520 PMCID: PMC8927763 DOI: 10.3389/fmed.2022.810366] [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: 11/06/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Background Tracheal extubation can be associated with several complications, including desaturation, agitation, hypertension, and tachycardia. We hypothesize that the use of transnasal humidified rapid insufflation ventilator exchange (THRIVE) immediately after extubation under deep anesthesia reduces the incidence of these adverse events. Methods One hundred patients who underwent elective abdominal surgery under general anesthesia were randomly assigned to undergo tracheal extubation under deep anesthesia employing THRIVE (THRIVE group) or awake extubation (CONTROL group). The primary outcome was the incidence of experiencing desaturation (SpO2 < 90%) at any time during emergence from anesthesia. Secondary outcomes included variations in heart rate and blood pressure, comfort level, bucking, and agitation. Results The THRIVE group showed a lower incidence of desaturation than the CONTROL group (12 vs. 54%, OR = 0.22 [95% CI, 0.10-0.49], P < 0.001). Less patients in the THRIVE group experienced a 20% (or more) increase in mean arterial pressure (4 vs. 26%, OR = 0.15 [95% CI, 0.04-0.65], P = 0.002). THRIVE patients did not suffer from agitation or bucking, while in the CONTROL group agitation and bucking occurred in 22 and 58% of the patients, respectively. Additionally, the THRIVE group showed a lower incidence of uncomfortable experience than the CONTROL group (8 vs. 36%, OR = 0.22 [95% CI, 0.08-0.61], P = 0.001). Conclusion Tracheal extubation under deep anesthesia using THRIVE decreases the incidence of desaturation and adverse haemodynamic events and increases patient satisfaction. Extubation under deep anesthesia using THRIVE might be an alternative strategy in selected patient populations.
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Affiliation(s)
- Jin Qiu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Mian Xie
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiwen Zhu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui Lin
- Department of Statistics, Army Medical University, Chongqing, China
| | - Tao Zhu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Macías AA, Finneran JJ. Regional Anesthesia Techniques for Pain Management for Laparoscopic Surgery: a Review of the Current Literature. Curr Pain Headache Rep 2022; 26:33-42. [PMID: 35084655 PMCID: PMC8792136 DOI: 10.1007/s11916-022-01000-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review The field of regional anesthesia has evolved tremendously in the last 15 years. New anesthesia protocols for ambulatory surgery and enhanced recovery after surgery have been developed as well. The focus of these techniques and protocols has centered on patient satisfaction and pain control while minimizing the use of opioids. The field of ambulatory surgery and anesthesia continues to evolve, and regional anesthesia and its plane techniques are at the center of these changes. Recent Findings Recent research has shown that regional techniques contribute to better pain control and patient experience and may decrease patient readmission rates. The safety of these techniques has been validated when performed by experienced practitioners. New techniques such as the erector spinae block (ESP) have been studied in the setting of laparoscopic surgery with promising results. Summary Regional anesthesia techniques for patients presenting for laparoscopic surgery are safe and seem to provide benefits. Those are related to patient experience, pain control, and readmission rates. Different techniques can be applied to a specific type of intervention. Application of these techniques depend on the clinical picture and patient. Future research may help us clarify how these techniques may improve patient satisfaction and operating room efficiency. New regional blocks may also develop based on what we know today.
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Affiliation(s)
- Alvaro Andrés Macías
- Massachusetts Eye and Ear, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Smooth Extubation and Smooth Emergence Techniques: A Narrative Review. Anesthesiol Res Pract 2021; 2021:8883257. [PMID: 33510786 PMCID: PMC7822686 DOI: 10.1155/2021/8883257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022] Open
Abstract
There is a paucity of literature on extubation technique and a lack of consensus regarding the definition of smooth extubation. This narrative review paper defines an ideal extubation, otherwise known as a “smooth extubation,” reviews perioperative criteria for extubation and risks and adverse events related to extubation, and explores various perioperative techniques that can be used to achieve a smooth extubation while caring for an uncomplicated patient without significant risk factors for extubation failure. In light of the evolving practice during the SARS CoV2 (COVID-19) pandemic to minimize aerosol generation and infection transmission, smooth extubation is particularly important.
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Juang J, Cordoba M, Ciaramella A, Xiao M, Goldfarb J, Bayter JE, Macias AA. Incidence of airway complications associated with deep extubation in adults. BMC Anesthesiol 2020; 20:274. [PMID: 33121440 PMCID: PMC7597053 DOI: 10.1186/s12871-020-01191-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022] Open
Abstract
Background Endotracheal extubation is the most crucial step during emergence from general anesthesia and is usually carried out when patients are awake with return of airway reflexes. Alternatively, extubations can also be accomplished while patients are deeply anesthetized, a technique known as “deep extubation”, in order to provide a “smooth” emergence from anesthesia. Deep extubation is seldomly performed in adults, even in appropriate circumstances, likely due to concerns for potential respiratory complications and limited research supporting its safety. It is in this context that we designed our prospective study to understand the factors that contribute to the success or failure of deep extubation in adults. Methods In this prospective observational study, 300 patients, age ≥ 18, American Society of Anesthesiologists Physical Status (ASA PS) Classification I - III, who underwent head-and-neck and ocular surgeries. Patients’ demographic, comorbidity, airway assessment, O2 saturation, end tidal CO2 levels, time to exit OR, time to eye opening, and respiratory complications after deep extubation in the OR were analyzed. Results Forty (13%) out of 300 patients had at least one complication in the OR, as defined by persistent coughing, desaturation SpO2 < 90% for longer than 10s, laryngospasm, stridor, bronchospasm and reintubation. When comparing the complication group to the no complication group, the patients in the complication group had significantly higher BMI (30 vs 26), lower O2 saturation pre and post extubation, and longer time from end of surgery to out of OR (p < 0.05). Conclusions The complication rate during deep extubation in adults was relatively low compared to published reports in the literature and all easily reversible. BMI is possibly an important determinant in the success of deep extubation.
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Affiliation(s)
- Jeremy Juang
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, 20114, USA.
| | - Martha Cordoba
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 20114, USA
| | - Alex Ciaramella
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 20114, USA
| | - Mark Xiao
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 20114, USA
| | - Jeremy Goldfarb
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 20114, USA
| | - Jorge Enrique Bayter
- Clinica El Pinar, Km 2 Anillo vial Floridablanca - Girón, Ecoparque Empresarial Natura Torre 2 piso 1 y 2, Piedecuesta, Colombia
| | - Alvaro Andres Macias
- Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 20114, USA
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Comparison of recovery in pediatric patients: a retrospective study. Clin Oral Investig 2019; 23:3653-3656. [PMID: 31273527 DOI: 10.1007/s00784-019-02993-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The recovery after general anesthesia is influenced by the choice of inhalational agent. Stimulations might make patient's agitate. However, the recovery using no touch technique might be safer. In this study, we compared the recovery time, awakening end-tidal concentration, and respiratory complications among inhalational anesthetics in pediatric patients using no touch technique, retrospectively. MATERIAL AND METHODS The subjects were pediatric patients aged 3 months to 11 years under general anesthesia using sevoflurane, isoflurane, or desflurane. Background, awakening end-tidal concentration, respiratory complications, the time of eye open, body movement, and extubation were recorded. RESULTS A total of 170 patients were included in the study. There were no respiratory complications during emergence. Awakening end-tidal concentration in desflurane was 0.98%, sevoflurane (0.39%), and isoflurane (0.25%). In patients received desflurane, the time of body movement, eye open, and extubation were significantly shorter than patients who received other anesthetics (p < 0.05). CONCLUSIONS The recovery from desflurane was significantly shorter among three inhalational anesthetics with no touch technique. In addition, no airway-related complication occurred. CLINICAL RELEVANCE The recovery from desflurane might be useful to predict emergence by end-tidal inhalational concentration.
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Age-related differences in recovery from inhalational anesthesia: a retrospective study. Aging Clin Exp Res 2018; 30:1523-1527. [PMID: 29500622 DOI: 10.1007/s40520-018-0924-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION It is important to understand the anesthetic requirements of elderly patients. However, little is known about age-related recovery from inhalational anesthetics. In this retrospective study, we compared age-related differences in recovery from three inhalational anesthetics in elderly subjects. METHODS Patients were investigated as three age groups which can be defined as age ranges pediatric (< 15 years), adult (15-64 years), and elderly patients ( > 65 years) under general anesthesia using inhalational anesthetics. Anesthesia and surgery times, drug end-tidal concentrations, the time to first movement, time to eye opening, body movement, extubation, and discharge were recorded. The data were analyzed using a Kruskal-Wallis test and Steel-Dwass multiple comparisons. RESULTS A total of 594 patients were included in the study. In inhalational anesthetics such as sevoflurane, isoflurane, or desflurane, recovery from general anesthesia was not significantly different among age groups (P > 0.05). In inhalational group, recovery was significantly 5-40% faster in desflurane group than in other inhalational anesthetics groups (P < 0.05). There were 20% faster recovery in pediatric and adult groups with desflurane than in elderly with desflurane group. Drug end-tidal inhalational concentrations in pediatric group were significantly higher than that in adult and elderly groups of all inhalational anesthetics, respectively (P < 0.05). CONCLUSION In the current study, we have found that recovery from desflurane was faster in younger patients than in other inhalational anesthetics and aged patients.
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Yin CP, Li YN, Zhao J, Zhang Q, Guo YY, Gao F, Wang XL, Wang QJ. Effect of transcutaneous electrical acupoint stimulation on the EC50 of remifentanil suppressing responses to tracheal extubation in elderly patients. Medicine (Baltimore) 2018; 97:e13814. [PMID: 30593173 PMCID: PMC6314690 DOI: 10.1097/md.0000000000013814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Transcutaneous electrical acupoint stimulation (TEAS) is a emerging treatment which combines transcutaneous electrical nerve stimulation with traditional acupoint therapy. The present study was aimed to evaluate the effect of TEAS on the effective concentration (EC50) of remifentanil suppressing tracheal extubation response in elderly patients.Fifty-three patients undergoing spine surgery were randomly divided into 2 groups: control group (group C, n = 26) and transcutaneous electrical acupoint stimulation group (group TEAS, n = 27). The EC50 values for remifentanil TCI were determined using sequential method and probit analysis.The remifentanil EC50 of that suppressed responses to extubation during anesthetic emergence was 1.20 ng/mL in group TEAS, a value that was significantly lower than the 1.64 ng/mL needed by patients in group C.The TEAS can enhance the efficacy of remifentanil on suppressing responses to tracheal extubation in elderly patients, the EC50 of remifentanil can reduce approximately 27% compared with group C.
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Affiliation(s)
- Chun-Ping Yin
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Ya-Nan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Juan Zhao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Qi Zhang
- Department of Anesthesiology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yang-Yang Guo
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Fang Gao
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Xiu-Li Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
| | - Qiu-Jun Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University
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De Oliveira GS. Optimal analgesic regimen for bariatric surgery: No opioid is rarely the option…. J Clin Anesth 2018; 51:123-124. [PMID: 30142488 DOI: 10.1016/j.jclinane.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Gildasio S De Oliveira
- School of Medicine, Brown University, Providence, USA; Department of Anesthesiology, Rhode Island Hospital, Providence, RI, USA; Department of Surgery, Alpert School of Medicine, Brown University, Providence, RI, USA; Department of Health Services Research, School of Public Health, Providence, RI, USA.
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Kendall MC, Robbins ZM, Cohen A, Minn M, Benzuly SE, Triebwasser AS, McCormick ZL, Gorgone M. Selected highlights in clinical anesthesia research. J Clin Anesth 2017; 43:90-97. [DOI: 10.1016/j.jclinane.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 12/17/2022]
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