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Zhou YY, Yang ST, Duan KM, Bai ZH, Feng YF, Guo QL, Cheng ZG, Wu H, Shangguan WN, Wu XM, Wang CH, Chai XQ, Xu GH, Liu CM, Zhao GF, Chen C, Gao BA, Li LE, Zhang M, Ouyang W, Wang SY. Efficacy and safety of remimazolam besylate in bronchoscopy for adults: A multicenter, randomized, double-blind, positive-controlled clinical study. Front Pharmacol 2022; 13:1005367. [PMID: 36313321 PMCID: PMC9606208 DOI: 10.3389/fphar.2022.1005367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background: With the development of fiberoptic bronchoscopy in the diagnosis and treatment of various pulmonary diseases, the anesthesia/sedation requirements are becoming more demanding, posing great challenges for patient safety while ensuring a smooth examination/surgery process. Remimazolam, a brand-new ultra-short-acting anesthetic, may compensate for the shortcomings of current anesthetic/sedation strategies in bronchoscopy. Methods: This study was a prospective, multicenter, randomized, double-blind, parallel positive controlled phase 3 clinical trial. Subjects were randomized to receive 0.2 mg/kg remimazolam besylate or 2 mg/kg propofol during bronchoscopy to evaluate the efficacy and safety of remimazolam. Results: A total of 154 subjects were successfully sedated in both the remimazolam group and the propofol group, with a success rate of 99.4% (95%CI of the adjusted difference −6.7 × 10%–6% to −5.1 × 10%–6%). The sedative effect of remimazolam was noninferior to that of propofol based on the prespecified noninferiority margin of −5%. Compared with the propofol group, the time of loss of consciousness in the remimazolam group (median 61 vs. 48s, p < 0.001), the time from the end of study drug administration to complete awakening (median 17.60 vs. 12.80 min, p < 0.001), the time from the end of bronchoscopy to complete awakening (median 11.00 vs. 7.00 min, p < 0.001), the time from the end of study drug administration to removal of monitoring (median 19.50 vs. 14.50 min, p < 0.001), and the time from the end of bronchoscopy to removal of monitoring (median 12.70 vs. 8.60 min, p < 0.001) were slightly longer. The incidence of Adverse Events in the remimazolam group and the propofol group (74.8% vs. 77.4%, p = 0.59) was not statistically significant, and none of them had Serious Adverse Events. The incidence of hypotension (13.5% vs. 29.7%, p < 0.001), hypotension requiring treatment (1.9% vs. 7.7%, p = 0.017), and injection pain (0.6% vs. 16.8%, p < 0.001) were significantly lower in the remimazolam group than in the propofol group. Conclusion: Moderate sedation with 0.2 mg/kg remimazolam besylate is effective and safe during bronchoscopy. The incidence of hypotension and injection pain was less than with propofol, but the time to loss of consciousness and recovery were slightly longer. Clinical Trial Registration:clinicaltrials.gov, ChiCTR2000039753
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Affiliation(s)
- Ying-Yong Zhou
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Shu-Ting Yang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Kai-Ming Duan
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhi-Hong Bai
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yun-Fei Feng
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Qu-Lian Guo
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Zhi-Gang Cheng
- Department of Anesthesiology, Xiangya Hospital Central South University, Changsha, China
| | - Hui Wu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wang-Ning Shangguan
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Min Wu
- Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Chun-Hui Wang
- Department of Anesthesiology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao-Qing Chai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Guo-Hai Xu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cun-Ming Liu
- Department of Anesthesiology, Jiangsu Province Hospital, NanJing, China
| | - Gao-Feng Zhao
- Department of Anesthesiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Chun Chen
- Department of Anesthesiology, Yichang Central People’s Hospital, Yichang, China
| | - Bao-An Gao
- Department of Anesthesiology, Yichang Central People’s Hospital, Yichang, China
| | - Li-E Li
- Yichang Humanwell Pharmaceutical Co., Ltd, Yichang, China
| | - Min Zhang
- Yichang Humanwell Pharmaceutical Co., Ltd, Yichang, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Sai-Ying Wang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Sai-Ying Wang,
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Parshin VD, Rusakov MA, Parshin AV, Mirzoyan OS, Vizhigina MA, Simonova MS, Parshin VV, Ursov MA. [Surgery of primary tracheal tumors]. Khirurgiia (Mosk) 2022:12-24. [PMID: 35920218 DOI: 10.17116/hirurgia202208112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the main forms of primary tracheal cancer (PTC), to specify the indications for various surgeries in these patients depending on extent and localization of lesion. MATERIAL AND METHODS There were 263 PTC patients. Benign tumors were diagnosed in 68 (25.9%) patients, malignancies - in 195 (74.1%) cases. Tracheal cancer includes 3 basic morphological variants - adenocystic cancer (49.7%), carcinoid (18.7%) and squamous cell carcinoma (19.0%). Other forms of malignancies were much less common. We applied endoscopic intraluminal and open surgeries. In malignant PTC, open surgeries were performed in 165 (84.6%) out of 195 patients. Baseline palliative endoscopic treatment was performed in 30 patients. They underwent airway recanalization (with subsequent tracheal stenting in 19 patients). Endoscopic resection was preferred for benign tumors. RESULTS Twenty (12.1%) patients died after open surgery, and 1 (3.3%) patient died after endoscopic procedure. Most lethal outcomes occurred in early years of development of tracheal surgery. The causes of mortality were tracheal anastomotic failure in 12 patients, pneumonia in 6 patients, and arterial bleeding in 2 patients. Severe postoperative period was observed in all 3 patients after tracheal replacement with a silicone prosthesis. Long-term treatment outcomes depended on morphological structure of PTC. Favorable results were observed in patients with neuroendocrine tumor (carcinoid), worse outcomes in adenocystic cancer and unfavorable results in squamous cell carcinoma (p<0.0013). Five-year survival rates were 75%, 65.6%, and 13.3%; 10-year survival rates were 75%, 56.2%, and 13.3%, respectively. These outcomes after combined treatment of primary tracheal cancer were significantly better compared to lung cancer (p<0.05 when compared to global data). CONCLUSION Treatment of primary tracheal cancer should be based on classical principles of modern oncology (combined therapy, tumor resection with lymphadenectomy). Open and endoscopic interventions are justified. PTC is characterized by more favorable outcomes compared to lung cancer. It is difficult to analyze long-term results in tracheal cancer depending on various features of tumor process due to small number of observations. Accurate conclusions require multiple-center studies, preferably with international participation, which can convincingly prove certain concept.
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Affiliation(s)
| | - M A Rusakov
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O S Mirzoyan
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - M A Vizhigina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia
| | - M A Ursov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Menna C, Fiorelli S, Massullo D, Ibrahim M, Rocco M, Rendina EA. Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case-control matching analysis and review of the current literature. Interact Cardiovasc Thorac Surg 2021; 33:426-433. [PMID: 33956960 DOI: 10.1093/icvts/ivab092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The endotracheal tube (ETT) and the laryngeal mask airway (LMA) are possible strategies for airway management during tracheal resection and reconstruction for tracheal and laryngotracheal stenosis. The goal of the study was to analyse and compare outcomes in the LMA and ETT groups. METHODS Between 2003 and 2020, a total of 184 patients affected by postintubation, post-tracheostomy and idiopathic stenosis who had tracheal or laryngotracheal resections and reconstructions via a cervicotomy were retrospectively enrolled in this single-centre study. In 29 patients, airway management was achieved through LMA during tracheal surgery, whereas in 155 patients, it was achieved through ETT. A case-control matching analysis was performed with a 1:1 ratio, according to age, gender, body mass index, aetiology and length of stenosis (1-4 cm), resulting in 22 patients managed through LMA (LMA group) matched with 22 patients managed through ETT (ETT group). RESULTS No significant differences were found in the reintubation rate, 30-day mortality and postoperative length of stay. Operative time was shorter in patients with LMA (96.23 ± 34.72 min in the ETT group vs 76.14 ± 26.94 min in the LMA group; P = 0.043). Intensive care unit (ICU) admission rate and stay were lower in the LMA group [18 in the ETT group vs 8 in the LMA group, odds ratio = 10.17, confidence interval (CI) 95% 1.79-57.79; P = 0. 009; 22.77 ± 16.68 h in ETT group vs 9.23 ± 13.51 h in LMA group; P = 0.005]. Dysphonia was more frequent in the ETT group than in the LMA group (20 in the ETT group vs 11 in the LMA group, odds ratio = 13.79, CI 95% 1.86-102; P = 0.010). CONCLUSIONS LMA is a feasible option for airway management in tracheal surgery, with lower operative time, ICU admission rate, ICU length of stay and postoperative dysphonia occurrence.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Fiorelli
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Fiorelli S, Saltelli G, Teodonio L, Massullo D. Airway management by i-gel for open tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach: A case report. Ann Card Anaesth 2021; 24:260-262. [PMID: 33884991 PMCID: PMC8253010 DOI: 10.4103/aca.aca_59_19] [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: 11/04/2022] Open
Abstract
Surgical resection and tracheal reconstruction are the most effective treatment options for airway stenosis. Tracheal surgery is challenging and requires a multidisciplinary approach and a highly specialized team of anesthesiologists and thoracic surgeons that are "sharing the airways". Several airway management tools, different devices, and various approaches can be required to ensure ventilation and gas exchange. We describe the case of a patient affected by tight tracheal stenosis, submitted to tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach. Airway management was successfully performed by i-gel® (Intersurgical, UK) supraglottic device.
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Affiliation(s)
- Silvia Fiorelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Giorgia Saltelli
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Leonardo Teodonio
- Thoracic Surgery, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
| | - Domenico Massullo
- Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Italy
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5
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Smeltz AM, Bhatia M, Arora H, Long J, Kumar PA. Anesthesia for Resection and Reconstruction of the Trachea and Carina. J Cardiothorac Vasc Anesth 2020; 34:1902-1913. [DOI: 10.1053/j.jvca.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022]
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Abstract
The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.
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Affiliation(s)
- Andrey Akopov
- 6/8 L/Tolstoy Street, Saint-Petersburg 197022, Russia.
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Krecmerova M, Schutzner J, Michalek P, Johnson P, Vymazal T. Laryngeal mask for airway management in open tracheal surgery-a retrospective analysis of 54 cases. J Thorac Dis 2018; 10:2567-2572. [PMID: 29997917 DOI: 10.21037/jtd.2018.04.73] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Airway management in tracheal resections presents many challenges. The aim of this retrospective analysis is to report the efficacy and complications associated with the use of the laryngeal mask airway in this procedure. Methods The charts of 54 consecutive patients operated for tracheal stenosis during the period 2009-2016 were reviewed. This cohort included only resections of the trachea. We evaluated total success rate of laryngeal mask insertion (%), insertion success rate on the first attempt, the quality of intraoperative ventilation through the laryngeal mask, the quality of fibre optic view through the device, incidence of bleeding during the first 24 h, signs of dehiscence of the anastomosis within 48 h and 30-day mortality. Results The laryngeal mask airway provided a patent airway throughout the procedure in 52 (96.4%) patients. Insertion of the device failed in 1 (1.8%) patient due to abnormal upper airway anatomy. Another patient (1.8%) developed laryngeal mask malposition during intraoperative neck extension subsequently requiring tracheal intubation. Fibre optic view through the devices including insertion of the flexible bronchoscope was satisfactory in 52 (96.4%) patients. Serious complications, such as pulmonary aspiration, early postoperative bleeding or suture dehiscence were not observed in this cohort. Conclusions Based on this analysis of 54 patients, we would consider the laryngeal mask airway a feasible alternative to the tracheal tube for airway management and ventilation during open tracheal surgery.
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Affiliation(s)
- Martina Krecmerova
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Jan Schutzner
- Department of Surgery, 1st School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Paul Johnson
- Department of Anaesthesia, Antrim Area Hospital, Antrim, UK
| | - Tomas Vymazal
- Department of Anaesthesiology and Intensive Care Medicine, 2nd School of Medicine, Charles University, University Hospital, Motol, Prague, Czech Republic
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Schieren M, Egyed E, Hartmann B, Aleksanyan A, Stoelben E, Wappler F, Defosse JM. Airway Management by Laryngeal Mask Airways for Cervical Tracheal Resection and Reconstruction. Anesth Analg 2018; 126:1257-1261. [DOI: 10.1213/ane.0000000000002753] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schieren M, Böhmer A, Dusse F, Koryllos A, Wappler F, Defosse J. New Approaches to Airway Management in Tracheal Resections-A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2017; 31:1351-1358. [PMID: 28800992 DOI: 10.1053/j.jvca.2017.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although endotracheal intubation, surgical crossfield intubation, and jet ventilation are standard techniques for airway management in tracheal resections, there are also reports of new approaches, ranging from regional anesthesia to extracorporeal support. The objective was to outline the entire spectrum of new airway techniques. DESIGN The literature databases PubMed/Medline and the Cochrane Library were searched systematically for prospective and retrospective trials as well as case reports on tracheal resections. SETTING No restrictions applied to hospital types or settings. PARTICIPANTS Adult patients undergoing surgical resections of noncongenital tracheal stenoses with end-to-end anastomoses. INTERVENTIONS Airway management techniques were divided into conventional and new approaches and analyzed regarding their potential risks and benefits. MEASUREMENTS AND MAIN RESULTS A total of 59 publications (n = 797 patients) were included. The majority of publications (71.2%) describe conventional airway techniques. Endotracheal tube placement after induction of general anesthesia and surgical crossfield intubation after incision of the trachea were used most frequently without major complications. A total of 7 new approaches were identified, including 4 different regional anesthetic techniques (25 cases), supraglottic airways (4 cases), and new forms of extracorporeal support (25 cases). Overall failure rates of new techniques were low (1.8%). Details on patient selection and procedural specifics are provided. CONCLUSIONS New approaches have several theoretical benefits, yet further research is required to establish criteria for patient selection and evaluate procedural safety. Given the low level of evidence, it currently is impossible to compare methods of airway management regarding outcome-related risks and benefits.
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Affiliation(s)
- Mark Schieren
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany.
| | - Andreas Böhmer
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Jerome Defosse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Abstract
The trachea and bronchus surgery is generally performed due to stenosis, traumatic injury, foreign body and tumors. Preoperative evaluation and anesthesia management are very important issues because of higher mortality and morbidity rates. Patients may be asymptomatic, but airway difficulties, hypoxia, stridor, cough, hemoptysis are common conditions in these patient population. The collaboration between the surgeon and the anesthesiologist is very substantial and necessary. Anesthetic techniques include various applications such as one lung ventilation, fiberoptic intubation, jet ventilation, and apneic oxygenation, general anesthesia with or without neuromuscular blockade. In this review, anesthesia management of the trachea and bronchus surgery is evaluated in the light of new knowledge.
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Affiliation(s)
- Zehra Hatipoglu
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mediha Turktan
- Department of Anesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Alper Avci
- Department of Thoracic Surgery, Çukurova University Faculty of Medicine, Adana, Turkey
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12
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Raiten J, Elkassabany N, Gao W, Mandel JE. Medical intelligence article: novel uses of high frequency ventilation outside the operating room. Anesth Analg 2011; 112:1110-3. [PMID: 21372275 DOI: 10.1213/ane.0b013e318212b851] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High frequency jet ventilation (HFJV) is a technique that is most frequently used in the intensive care unit and during tracheal and otorhinolaryngologic surgery. The utility of HFJV for procedures performed outside of the intensive care unit and operating room is currently being explored. The ability of HFJV to provide mechanical ventilation, yet achieve near static conditions of the chest and abdomen, makes it a very appealing technique for procedures such as pulmonary vein isolation and ablation for atrial fibrillation, targeted radiation therapy for lung and liver tumors, and certain diagnostic imaging techniques.
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Affiliation(s)
- Jesse Raiten
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, 3400 Spruce St., Dulles 6, Philadelphia, PA 19104, USA.
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Veres J, Slavei K, Errhalt P, Seyr M, Ihra G. The Veres adapter: clinical experience with a new device for jet ventilation via a laryngeal mask airway during flexible bronchoscopy. Anesth Analg 2011; 112:597-600. [PMID: 21233501 DOI: 10.1213/ane.0b013e3182080407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A new device was developed to deliver high-frequency jet ventilation via a laryngeal mask airway (LMA). We investigated its use during flexible fiberoptic bronchoscopy in anesthetized patients. METHODS Thirty adults were studied during interventional bronchoscopy. After facemask ventilation, the Veres adapter was connected to a size 4 or 5 LMA, and superimposed high-frequency jet ventilation was performed. Oxygen saturation, transcutaneous carbon dioxide, supraglottic airway pressure, and hemodynamic data were recorded and analyzed. RESULTS Procedures were performed under stable hemodynamic conditions. Short procedure times and fast recovery were observed. Mild hypercapnia was the most common minor adverse effect (n = 16). One patient developed a pneumothorax after peripheral biopsy, 1 patient had a stiff chest during bronchoscopy, resulting in high airway pressures, and 1 patient required continuous positive airway pressure mask ventilation in the postoperative care unit. CONCLUSIONS We report the clinical use of the Veres adapter in conjunction with an LMA to achieve rapid surgical access and adequate ventilation during flexible bronchoscopy. As an alternative to the use of an endotracheal tube, the new system may better maintain the airway during interventional and diagnostic bronchoscopy because of the larger diameter conduit.
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Affiliation(s)
- Jan Veres
- Department of Pulmonology, Landesklinikum Krems, Krems an der Donau, Vienna, Austria
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Lohser J, Brodsky JB. Bronchial stenting through a ProSeal laryngeal mask airway. J Cardiothorac Vasc Anesth 2005; 20:227-8. [PMID: 16616665 DOI: 10.1053/j.jvca.2005.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Indexed: 11/11/2022]
Affiliation(s)
- Jens Lohser
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.
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Abstract
PURPOSE OF REVIEW As outpatient anaesthesia increases in volume so does research, especially in ways to reduce morbidity from relatively minor complications such as sore throat and hoarseness, as well as aiming to reduce costs and length of hospital stay. The past year has produced many studies in which newer airway devices have been compared with the laryngeal mask airway and this review evaluates them all. RECENT FINDINGS The relatively recent introduction of the ProSeal laryngeal mask airway shows promise when insertion of a gastric tube is preferred in patients breathing spontaneously, whilst the intubating laryngeal mask airway has demonstrated its usefulness in those situations where the patient prefers to be anaesthetized but intubation may be difficult following classic laryngoscopy. The cuffed oropharyngeal airway and combitube probably only have a place in emergency airway management rather than elective anaesthesia. SUMMARY Despite the introduction of new airway devices, some of which have specific indications for use, the classic laryngeal mask airway remains the 'gold standard' with which newer devices are compared. Whilst some of these new devices show promise in the outpatient setting, further research is required before their universal acceptance.
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Mentzelopoulos SD, Tzoufi MJ. Anesthesia for tracheal and endobronchial interventions. Curr Opin Anaesthesiol 2002; 15:85-94. [PMID: 17019189 DOI: 10.1097/00001503-200202000-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tracheal and endobronchial interventions constitute a wide variety of procedures offering unique challenges in perioperative airway management and ventilatory support. Elective or emergent anesthetic management is individualized according to underlying airway pathology, coexisting disease, and patient age. This review explores recent literature and reports on relevant advances in anesthetic care.
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