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Mancilla-Galindo J, Ortiz-Gomez JE, Pérez-Nieto OR, De Jong A, Escarramán-Martínez D, Kammar-García A, Ramírez Mata LC, Díaz AM, Guerrero-Gutiérrez MA. Preoperative Atelectasis in Patients with Obesity Undergoing Bariatric Surgery: A Cross-Sectional Study. Anesth Analg 2024:00000539-990000000-00918. [PMID: 39178161 DOI: 10.1213/ane.0000000000007166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
BACKGROUND Pulmonary atelectasis is present even before surgery in patients with obesity. We aimed to estimate the prevalence and extension of preoperative atelectasis in patients with obesity undergoing bariatric surgery and to determine if variation in preoperative Spo2 values in the seated position at room air is explained by the extent of atelectasis coverage in the supine position. METHODS This was a cross-sectional study in a single center specialized in laparoscopic bariatric surgery. Preoperative chest computed tomographies were reassessed by a senior radiologist to quantify the extent of atelectasis coverage as a percentage of total lung volume. Patients were classified as having atelectasis when the affection was ≥2.5%, to estimate the prevalence of atelectasis. Crude and adjusted prevalence ratios (aPRs) and odds ratios (aORs) were obtained to assess the relative prevalence of atelectasis and percentage coverage, respectively, with increasing obesity category. Inverse probability weighting was used to assess the total, direct (not mediated), and indirect (mediated through atelectasis) effects of body mass index (BMI) on preoperative Spo2, and to quantify the magnitude of mediation (proportion mediated). E-values were calculated, to represent the minimum magnitude of association that an unmeasured confounder with the same directionality of the effect should have to drive the observed point estimates or lower confidence intervals (CIs) to 1, respectively. RESULTS In 236 patients with a median BMI of 40.3 kg/m2 (interquartile range [IQR], 34.6-46.0, range: 30.0-77.3), the overall prevalence of atelectasis was 32.6% (95% CI, 27.0-38.9) and by BMI category: 30 to 35 kg/m2, 12.7% (95% CI, 6.1-24.4); 35 to 40 kg/m2, 28.3% (95% CI, 17.2-42.6); 40 to 45 kg/m2, 12.3% (95% CI, 5.5-24.3); 45 to 50 kg/m2, 48.4% (95% CI, 30.6-66.6); and ≥50 units, 100% (95% CI, 86.7-100). Compared to the 30 to 35 kg/m2 group, only the categories with BMI ≥45 kg/m2 had significantly higher relative prevalence of atelectasis-45 to 50 kg/m2, aPR = 3.52 (95% CI, 1.63-7.61, E-value lower bound: 2.64) and ≥50 kg/m2, aPR = 8.0 (95% CI, 4.22-15.2, E-value lower bound: 7.91)-and higher odds of greater atelectasis percentage coverage: 45-50 kg/m2, aOR = 7.5 (95% CI, 2.7-20.9) and ≥50 kg/m2, aOR = 91.5 (95% CI, 30.0-279.3). Atelectasis percent alone explained 70.2% of the variation in preoperative Spo2. The proportion of the effect of BMI on preoperative Spo2 values <96% mediated through atelectasis was 81.5% (95% CI, 56.0-100). CONCLUSIONS The prevalence and extension of atelectasis increased with higher BMI, being significantly higher at BMI ≥45 kg/m2. Preoperative atelectasis mediated the effect of BMI on Spo2 at room air in the seated position.
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Affiliation(s)
| | | | | | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | | | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | - Adriana Mendez Díaz
- Department of Bariatric Anesthesia, Baja Hospital and Medical Center, Tijuana, Mexico
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Lee JH, Kang P, Park JB, Ji SH, Jang YE, Kim EH, Kim JT, Kim HS. Determination of optimal positive end-expiratory pressure using electrical impedance tomography in infants under general anesthesia: Comparison between supine and prone positions. Paediatr Anaesth 2024; 34:758-767. [PMID: 38693633 DOI: 10.1111/pan.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
AIMS This study determined the optimal positive end-expiratory pressure levels in infants in supine and prone positions under general anesthesia using electrical impedance tomography (EIT). METHODS This prospective observational single-centre study included infants scheduled for surgery in the prone position. An electrical impedance tomography sensor was applied after inducing general anesthesia. The optimal positive end-expiratory pressure in the supine position was determined in a decremental trial based on EIT and compliance. Subsequently, the patient's position was changed to prone. Electrical impedance tomography parameters, including global inhomogeneity index, regional ventilation delay, opening pressure, the centre of ventilation, and pendelluft volume, were continuously obtained up to 1 h after prone positioning. The optimal positive end-expiratory pressure in the prone position was similarly determined. RESULTS Data from 30 infants were analyzed. The mean value of electrical impedance tomography-based optimal positive end-expiratory pressure in the prone position was significantly higher than that in the supine position [10.9 (1.6) cmH2O and 6.1 (0.9) cmH2O, respectively (p < .001)]. Significant differences were observed between electrical impedance tomography- and compliance-based optimal positive end-expiratory pressure. Peak and mean airway, plateau, and driving pressures increased 1 h after prone positioning compared with those in the supine position. In addition, the centre of ventilation for balance in ventilation between the ventral and dorsal regions improved. CONCLUSION The prone position required higher positive end-expiratory pressure than the supine position in mechanically ventilated infants under general anesthesia. EIT is a promising tool to find the optimal positive end-expiratory pressure, which needs to be individualized.
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Affiliation(s)
- Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Kim EH, Park JB, Kang P, Ji SH, Jang YE, Lee JH, Kim JT, Kim HS. Effect of positive end expiratory pressure on non-hypoxic apnea time and atelectasis during induction of anesthesia in infant: A randomized controlled trial. Paediatr Anaesth 2024. [PMID: 38980197 DOI: 10.1111/pan.14965] [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] [Received: 02/25/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION This study aimed to assess the impact of positive-end-expiratory pressure (PEEP) on the non-hypoxic apnea time in infants during anesthesia induction with an inspired oxygen fraction of 0.8. METHODS This age stratified randomized controlled trial included patients under 1 year of age. Preoxygenation was performed using an inspired oxygen fraction of 0.8 for 2 min. Inspired oxygen fraction of 0.8 was administered via a face mask with volume-controlled ventilation at a tidal volume of 6 mL.kg-1, with or without 7 cmH2O of PEEP. Tracheal intubation was performed after 3 min of ventilation; however, it was disconnected from the breathing circuit. Ventilation was resumed once the pulse oximetry readings reached 95%. The primary outcome was the non-hypoxic apnea time, defined as the time from the cessation of ventilation to achieving a pulse oximeter reading of 95%. The secondary outcome measures included the degree of atelectasis assessed by ultrasonography and the presence of gastric air insufflation. RESULTS Eighty-four patients were included in the final analysis. In the positive end-expiratory pressure group, the atelectasis score decreased (17.0 vs. 31.5, p < .001; mean difference and 95% CI of 11.6, 7.5-15.6), while the non-hypoxic apnea time increased (80.1 s vs. 70.6 s, p = .005; mean difference and 95% CI of -9.4, -16.0 to -2.9), compared to the zero end-expiratory pressure group, among infants who are 6 months old or younger, not in those aged older than 6 months. DISCUSSION The application of positive end-expiratory pressure reduced the incidence of atelectasis and extended the non-hypoxic apnea time in infants who are 6 months old or younger. However, it did not affect the incidence of atelectasis nor the non-hypoxic apnea time in patients aged older than 6 months.
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Affiliation(s)
- Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Bin Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Moscatelli A, Giardina A. The Air-Test, a useful tool for the pediatric anesthesiologist. Minerva Anestesiol 2024; 90:598-600. [PMID: 39021134 DOI: 10.23736/s0375-9393.24.18310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Affiliation(s)
- Andrea Moscatelli
- Neonatal and Pediatric ICU, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy -
| | - Alberto Giardina
- Neonatal and Pediatric ICU, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Min JY, Hyung SW, Jeon JP, Chung MY, Kim CJ, Kim YH. A stepwise lung recruitment maneuver using I-gel can improve respiratory parameters: A prospective observational study. Medicine (Baltimore) 2024; 103:e38718. [PMID: 38941413 DOI: 10.1097/md.0000000000038718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
I-gel has been used in various clinical situations. The study investigated alterations in respiratory parameters following a stepwise lung recruitment maneuver (LRM) using the i-gel. The research involved 60 patients classified as American Society of Anesthesiologists class I-II, aged 30 to 75 years, undergoing elective urologic surgery. Various respiratory parameters, including lung compliance, airway resistance, leak volume, airway pressure, and oxygen reserve index, were recorded at different time points: before LRM, immediately after LRM, and at 5, 15, and 30 minutes after LRM, as well as at the end of the surgery. The primary outcome was to assess an improvement in lung compliance. Dynamic lung compliance (mean ± SD) was significantly increased from 49.2 ± 1.8 to 70.15 ± 3.2 mL/cmH2O (P < .05) after LRM. Static lung compliance (mean ± SD) was increased considerably from 52.4 ± 1.7 to 65.0 ± 2.5 mL/cmH2O (P < .05) after the LRM. Both parameters maintained a statistically significant increased status for a certain period compared to baseline despite a decreased degree of increment. Airway resistance (mean ± SD) was significantly reduced after the LRM from 12.05 ± 0.56 to 10.41 ± 0.64 L/cmH2O/s (P < .05). Stepwise LRM using i-gel may improve lung compliance and airway resistance. Repeated procedures could lead to prolonged improvements in respiratory parameters.
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Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Woo Hyung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Pyo Jeon
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National Hospital, College of Medicine, The Chungnam National University of Korea, Daejeon, Republic of Korea
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Qiu L, Zhao L, Wang B, Yang L, Cao C, Lv M, Xu M, Hou M, Wang X, Wang Y, Gu CP. Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study. BMJ Open 2024; 14:e077183. [PMID: 38749692 PMCID: PMC11097810 DOI: 10.1136/bmjopen-2023-077183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs. METHODS AND ANALYSIS A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively. ETHICS AND DISSEMINATION The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals. TRIAL REGISTRATION NUMBER The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).
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Affiliation(s)
- Lei Qiu
- Weifang Medical University, Weifang, Shandong, China
| | - Liang Zhao
- Shandong University, Jinan, Shandong, China
| | - Bailun Wang
- Shandong First Medical University, Jinan, Shandong, China
| | - Li Yang
- Shandong First Medical University, Jinan, Shandong, China
| | - Cuicui Cao
- Shandong First Medical University, Jinan, Shandong, China
| | - Meng Lv
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mengchao Xu
- Shandong First Medical University, Jinan, Shandong, China
| | - Ming Hou
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Xiaofei Wang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Yuelan Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chang Ping Gu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [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: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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Frassanito L, Grieco DL, Rosà T, Draisci G, Antonelli M. Effect of a pre-emptive 2-hour session of high-flow nasal oxygen on postoperative oxygenation after major gynaecologic surgery. Response to Br J Anaesth 2024; 132: 210-211. Br J Anaesth 2024; 132:619-620. [PMID: 38177004 DOI: 10.1016/j.bja.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Affiliation(s)
- Luciano Frassanito
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico L Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Tommaso Rosà
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Draisci
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Li S, Wang Y, Zhang Y, Zhang H, Wang S, Ma K, Jiang L, Mao Y. Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial. Heliyon 2024; 10:e26594. [PMID: 38420373 PMCID: PMC10901023 DOI: 10.1016/j.heliyon.2024.e26594] [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: 07/04/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Background Atelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methods This study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. Results Anesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019-0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. Conclusion Ultrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.
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Affiliation(s)
- Siyuan Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yunqian Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Hui Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Shenghua Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Ke Ma
- Department of Pain Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
| | - Yanfei Mao
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200092, Shanghai, China
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Camporesi A, Pierucci UM, Paladini G, Gentile A, Buonsenso D, Pelizzo G. Lung ultrasound-guided best positive end-expiratory pressure in neonatal anesthesia: a proposed randomized, controlled study. Pediatr Res 2024; 95:393-396. [PMID: 37648746 DOI: 10.1038/s41390-023-02730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Atelectasis is a common complication in neonatal anesthesia. Lung ultrasound (LUS) can be used intraoperatively to evaluate and recognize atelectatic lung areas. Hypotheses for the study are: (1) The use of LUS to guide choice of best positive end-expiratory pressure (PEEP) can lead to reduction of FiO2 to achieve same saturations of oxygen (SpO2). (2) In a less de-recruited lung, there will be less postoperative pulmonary complications. (3) Static respiratory system compliance could be different. (4) Hemodynamic parameters and amount of fluids infused or need for vasopressors intraoperatively could be different. METHODS We propose a randomized controlled trial that compares standard PEEP settings with LUS-guided PEEP choice in patients under 2 months of age undergoing general anesthesia. RESULTS The primary aim is to determine whether LUS-guided PEEP choice in neonatal anesthesia, compared to standard PEEP choice, can lead to reduction of FiO2 applied to the ventilatory setting in order to maintain same SpO2s. Secondary aims are to determine whether patients treated with LUS-guided PEEP will develop less postoperative pulmonary complications, will have a significant difference in hemodynamic parameters and amount of fluids or vasopressors infused, and in static respiratory system compliance. CONCLUSIONS We expect a significant reduction of FiO2 in LUS-guided ventilation. IMPACT Lung atelectasis is extremely common in neonatal anesthesia, because of the physiology of the neonatal lung and chest wall and leads to hypoxemia, being a lung area with a perfusion/ventilation mismatch. Raising inspired fraction of oxygen can overcome temporarily hypoxemia but oxygen is a toxic compound for newborns. Lung ultrasound (LUS) can detect atelectasis at bedside and be used to optimize ventilator settings including choice of positive end-expiratory pressure (PEEP). This randomized controlled trial (RCT) aims at demonstrating that LUS-guided choice of best PEEP during neonatal anesthesia can lead to reduction of inspired fractions of oxygen to keep same peripheral saturations SpO2.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milan, Italy.
| | | | - Giuseppe Paladini
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milan, Italy
| | - Andrea Gentile
- Department of Medical-Surgical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", Roma, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
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11
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Korman B, Dash RK, Peyton PJ. Effects of N 2 O elimination on the elimination of second gases in a two-step mathematical model of heterogeneous gas exchange. Physiol Rep 2023; 11:e15822. [PMID: 37923389 PMCID: PMC10624564 DOI: 10.14814/phy2.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023] Open
Abstract
We have investigated the elimination of inert gases in the lung during the elimination of nitrous oxide (N2 O) using a two-step mathematical model that allows the contribution from net gas volume expansion, which occurs in Step 2, to be separated from other factors. When a second inert gas is used in addition to N2 O, the effect on that gas appears as an extra volume of the gas eliminated in association with the dilution produced by N2 O washout in Step 2. We first considered the effect of elimination in a single gas-exchanging unit under steady-state conditions and then extended our analysis to a lung having a log-normal distribution of ventilation and perfusion. A further increase in inert gas elimination was demonstrated with gases of low solubility in the presence of the increased ventilation-perfusion mismatch that is known to occur during anesthesia. These effects are transient because N2 O elimination depletes the input of that gas from mixed venous blood to the lung, thereby rapidly reducing the magnitude of the diluting action.
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Affiliation(s)
- Ben Korman
- School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Department of Anaesthesia and Pain MedicineRoyal Perth HospitalPerthWestern AustraliaAustralia
| | - Ranjan K. Dash
- Department of Biomedical EngineeringMedical College of WisconsinMilwaukeeWisconsinUSA
- Department of PhysiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Philip J. Peyton
- Anaesthesia, Perioperative and Pain Medicine Unit, Department of Anaesthesia, Austin Health, Melbourne Medical SchoolUniversity of MelbourneHeidelbergVictoriaAustralia
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12
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Qin YJ, Zhang YQ, Chen Q, Wang Y, Li SY. Effect of high-frequency oscillation on reduction of atelectasis in perioperative patients: a prospective randomized controlled study. Ann Med 2023; 55:2272720. [PMID: 37874665 PMCID: PMC10836273 DOI: 10.1080/07853890.2023.2272720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Atelectasis affects approximately 90% of anaesthetized patients, with laparoscopic surgery and pneumoperitoneum reported to exacerbate this condition. High-frequency oscillation therapy applies continuous positive pressure pulses to oscillate the airway, creating a pressure difference in small airways obstructed by secretions. This process helps reduce peak airway pressure, open small airways, and decrease atelectasis incidence, while also facilitating respiratory tract clearance. This study examines the efficacy of high-frequency oscillation on reduction of atelectasis in laparoscopic cholecystectomy (LC) patients under general anaesthesia, evaluated using lung ultrasound. METHODS Sixty-four patients undergoing laparoscopic cholecystectomy were randomly divided into a control group and a high-frequency oscillation (HFO) group. Both groups underwent total intravenous anaesthesia under invasive arterial monitoring. The HFO group received a 10-minute continuous high-frequency oscillation therapy during surgery, while the control group received no intervention. Lung ultrasound evaluations were performed three times: five minutes post-intubation (T1), at the end of the surgery (T2), and before leaving the Post-Anaesthesia Care Unit (PACU; T3). Blood gas analysis was performed twice: prior to induction with no oxygen supply and before PACU discharge (oxygen supply off). RESULTS The HFO group displayed a significantly lower incidence of atelectasis at T3 (57.5% vs. 90.3%, OR 6.88, 95%CI (1.74 to 27.24)) compared to the control group. Moreover, the HFO group's PaO2 levels remained consistent with baseline levels before PACU discharge, unlike the control group. Although there was no significant difference in LUS scores between the groups at T1 (8.56 ± 0.15 vs. 8.19 ± 0.18, p = 0.1090), the HFO group had considerably lower scores at T2 (13.41 ± 0.17 vs.7.59 ± 0.17, p < 0.01) and T3 (13.72 ± 0.14 vs.7.25 ± 0.21, p < 0.01). CONCLUSION Our study indicates that high-frequency oscillation effectively reduces atelectasis in patients undergoing laparoscopic cholecystectomy. Additionally, it can mitigate the decline in oxygen partial pressure associated with atelectasis.
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Affiliation(s)
- Yuan-jun Qin
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yun-qian Zhang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Qi Chen
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Yan Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Si-yuan Li
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
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13
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Wu L, Yang Y, Yin Y, Yang L, Sun X, Zhang J. Lung ultrasound for evaluating perioperative atelectasis and aeration in the post-anesthesia care unit. J Clin Monit Comput 2023; 37:1295-1302. [PMID: 36961634 DOI: 10.1007/s10877-023-00994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Lung ultrasound is widely accepted as a reliable, noninvasive tool for evaluating lung status at the bedside. We assessed the impact of perioperative variables on atelectasis and lung aeration using lung ultrasound, and their correlation with postoperative oxygenation in patients undergoing general anesthesia. METHODS This prospective observational study evaluated 93 consecutive patients scheduled to undergo elective non-cardiothoracic surgery under general anesthesia. Lung ultrasound was performed 5 min after admission to the post-anesthesia care unit (PACU). Twelve pulmonary quadrants were selected for each ultrasound examination. The lung ultrasound scores and atelectasis status were calculated. The oxygenation assessment was obtained by arterial blood gas analysis before discharge from the PACU. RESULTS Thirty-two patients (34%) had atelectasis in at least one of the 12 evaluated segments, whereas 12 patients (13%) had atelectasis in at least three segments. The proportion of B-lines (≥ 3) and atelectasis in the inferolateral and posterior regions was significantly higher than in other regions. Patients with lung ultrasound scores ≥ 5 had a higher body mass index and lower PaO2 before discharge from the PACU than those with scores < 5. Patients with atelectasis had higher body mass indices and lung ultrasound scores. The presence of ≥ 2 regions of atelectasis was associated with lower PaO2. Using multivariate analysis, body mass index, intraoperative body position, and sex independently correlated with lung ultrasound scores. Age and lung ultrasound scores independently correlated with hypoxemia. CONCLUSION Lung ultrasound enables early postoperative evaluation of atelectasis and lung aeration, which are closely associated with postoperative oxygenation.
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Affiliation(s)
- Lei Wu
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yanyan Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuehao Yin
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Yang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xia Sun
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270, Dong'an Road, 200032, Xuhui, Shanghai, China.
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14
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Frassanito L, Grieco DL, Zanfini BA, Catarci S, Rosà T, Settanni D, Fedele C, Scambia G, Draisci G, Antonelli M. Effect of a pre-emptive 2-hour session of high-flow nasal oxygen on postoperative oxygenation after major gynaecologic surgery: a randomised clinical trial. Br J Anaesth 2023; 131:775-785. [PMID: 37543437 DOI: 10.1016/j.bja.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND We aimed at determining whether a 2-h session of high-flow nasal oxygen (HFNO) immediately after extubation improves oxygen exchange after major gynaecological surgery in the Trendelenburg position in adult female patients. METHODS In this single-centre, open-label, randomised trial, patients who underwent major gynaecological surgery were randomised to HFNO or conventional oxygen treatment with a Venturi mask. The primary outcome was the Pao2/FiO2 ratio after 2 h of treatment. Secondary outcomes included lung ultrasound score, diaphragm thickening fraction, dyspnoea, ventilatory frequency, Paco2, the percentage of patients with impaired gas exchange (Pao2/FiO2 ≤40 kPa) after 2 h of treatment, and postoperative pulmonary complications at 30 days. RESULTS A total of 83 patients were included (42 in the HFNO group and 41 in the conventional treatment group). After 2 h of treatment, median (inter-quartile range) Pao2/FiO2 was 52.9 (47.9-65.2) kPa in the HFNO group and 45.7 (36.4 -55.9) kPa in the conventional treatment group (mean difference 8.7 kPa [95% CI: 3.4 to 13.9], P=0.003). The lung ultrasound score was lower in the HFNO group than in the conventional treatment group (9 [6-10] vs 12 [10-14], P<0.001), mostly because of the difference of the score in dorsal areas (7 [6-8] vs 10 [9-10], P<0.001). The percentage of patients with impaired gas exchange was lower in the HFNO group than in the conventional treatment group (5% vs 37%, P<0.001). All other secondary outcomes were not different between groups. CONCLUSIONS In patients who underwent major gynaecological surgery, a pre-emptive 2-h session of HFNO after extubation improved postoperative oxygen exchange and reduced atelectasis compared with a conventional oxygen treatment strategy. CLINICAL TRIAL REGISTRATION NCT04566419.
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Affiliation(s)
- Luciano Frassanito
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico L Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Bruno A Zanfini
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Catarci
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Rosà
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Donatella Settanni
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Fedele
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy; Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy; Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Draisci
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy; Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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15
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Rispoli M, Nespoli MR, Ferrara M, Rosboch GL, Templeton LB, Templeton TW, Massullo D, Fiorelli S, Granell Gil M, Coccia C, Piccioni F. A Practical Guide for Using the EZ-Blocker Endobronchial Blocker: Tips and Tricks After 10 Years of Experience. J Cardiothorac Vasc Anesth 2023; 37:1884-1893. [PMID: 37481398 DOI: 10.1053/j.jvca.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 07/24/2023]
Abstract
The EZ-Blocker (EZB) is a "Y-shaped," semirigid endobronchial blocker used for lung isolation and one-lung ventilation during thoracic surgery. Like many medical tools, initial efforts to use this endobronchial blocker may prove challenging for the uninitiated. However, some tips and tricks can be applied fairly rapidly to aid the clinician in properly placing the device, and, furthermore, may help the clinician get the most out of this innovative device. This article focuses on some of the technical aspects of its placement that the authors have developed over time. Additionally, other facets and potential pitfalls are discussed that relate to intraprocedural issues that may sometimes arise when using this device. The following aspects of the EZB as a lung-isolation device are discussed: standard positioning techniques, alternative positioning techniques, use in pediatric patients, approaches to achieving exceptional lung isolation, advanced uses, and limitations and potential issues. Although some information was taken from the authors' rather extensive experience with using this endobronchial blocker, some of the relevant literature are also reviewed, with the goal of being to improve the reader's knowledge of the device and improve the likelihood of its successful placement. The underlying design of the EZB remains unique among commercially available bronchial blockers in improving positional stability. The Y-shaped conformation, however, can lead to challenges when positioning the device in some patients. Therefore, some very practical tips and tricks are provided to assist the clinician in correctly positioning the device and other hints to improve the quality of lung isolation and surgical conditions.
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Affiliation(s)
- Marco Rispoli
- Anesthesia and Intensive Care Unit, Department of Critical Care, AO dei Colli-Monaldi Hospital, Naples, Italy.
| | - Moana Rossella Nespoli
- Anesthesia and Intensive Care Unit, Department of Critical Care, AO dei Colli-Monaldi Hospital, Naples, Italy
| | - Maurizio Ferrara
- Anesthesia and Intensive Care Unit, ASL Napoli 1, PO San Paolo Hospital, Naples, Italy
| | - Giulio Luca Rosboch
- Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Domenico Massullo
- Division of Anesthesiology, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Fiorelli
- Anaesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Manuel Granell Gil
- Department of Anesthesiology, Critical Care and Pain Medicine, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Cecilia Coccia
- Istituto di Ricovero e Cura a Carattere Scientifico IFO, Istituto Tumori Regina Elena, Rome, Italy
| | - Federico Piccioni
- Anesthesia Unit 1, Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy
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16
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Li X, Liu H, Wang J, Ni ZL, Liu ZX, Jiao JL, Han Y, Cao JL. Individualized Positive End-expiratory Pressure on Postoperative Atelectasis in Patients with Obesity: A Randomized Controlled Clinical Trial. Anesthesiology 2023; 139:262-273. [PMID: 37440205 DOI: 10.1097/aln.0000000000004603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Individualized positive end-expiratory pressure (PEEP) guided by dynamic compliance improves oxygenation and reduces postoperative atelectasis in nonobese patients. The authors hypothesized that dynamic compliance-guided PEEP could also reduce postoperative atelectasis in patients undergoing bariatric surgery. METHODS Patients scheduled to undergo laparoscopic bariatric surgery were eligible. Dynamic compliance-guided PEEP titration was conducted in all patients using a downward approach. A recruitment maneuver (PEEP from 10 to 25 cm H2O at 5-cm H2O step every 30 s, with 15-cm H2O driving pressure) was conducted both before and after the titration. Patients were then randomized (1:1) to undergo surgery under dynamic compliance-guided PEEP (PEEP with highest dynamic compliance plus 2 cm H2O) or PEEP of 8 cm H2O. The primary outcome was postoperative atelectasis, as assessed with computed tomography at 60 to 90 min after extubation, and expressed as percentage to total lung tissue volume. Secondary outcomes included Pao2/inspiratory oxygen fraction (Fio2) and postoperative pulmonary complications. RESULTS Forty patients (mean ± SD; 28 ± 7 yr of age; 25 females; average body mass index, 41.0 ± 4.7 kg/m2) were enrolled. Median PEEP with highest dynamic compliance during titration was 15 cm H2O (interquartile range, 13 to 17; range, 8 to 19) in the entire sample of 40 patients. The primary outcome of postoperative atelectasis (available in 19 patients in each group) was 13.1 ± 5.3% and 9.5 ± 4.3% in the PEEP of 8 cm H2O and dynamic compliance-guided PEEP groups, respectively (intergroup difference, 3.7%; 95% CI, 0.5 to 6.8%; P = 0.025). Pao2/Fio2 at 1 h after pneumoperitoneum was higher in the dynamic compliance-guided PEEP group (397 vs. 337 mmHg; group difference, 60; 95% CI, 9 to 111; P = 0.017) but did not differ between the two groups 30 min after extubation (359 vs. 375 mmHg; group difference, -17; 95% CI, -53 to 21; P = 0.183). The incidence of postoperative pulmonary complications was 4 of 20 in both groups. CONCLUSIONS Postoperative atelectasis was lower in patients undergoing laparoscopic bariatric surgery under dynamic compliance-guided PEEP versus PEEP of 8 cm H2O. Postoperative Pao2/Fio2 did not differ between the two groups. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Xiang Li
- Department of Anesthesiology, Eye & Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - He Liu
- Department of Anesthesiology, Huzhou Central Hospital, Huzhou, China
| | - Jun Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhi-Lin Ni
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhong-Xiao Liu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jia-Li Jiao
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Han
- Department of Anesthesiology, Eye & Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Jun-Li Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
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17
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Wang YH, Su PC, Huang HC, Au K, Lin FCF, Chen CY, Chou MC, Hsia JY. Pulmonary Recruitment Prior to Intraoperative Multiple Pulmonary Ground-Glass Nodule Localization Increases the Localization Accuracy-A Retrospective Study. J Clin Med 2023; 12:jcm12082998. [PMID: 37109340 PMCID: PMC10141549 DOI: 10.3390/jcm12082998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
The standard treatment for early-stage lung cancer is complete tumor excision by limited resection of the lung. Preoperative localization is used before video-assisted thoracoscopic surgery (VATS) to improve the accuracy of pulmonary nodule excision. However, lung atelectasis and hypoxia resulting from controlling apnea during the localization procedure may affect the localization accuracy. Pre-procedural pulmonary recruitment may improve the respiratory mechanics and oxygenation during localization. In this study, we investigated the potential benefits of pre-localization pulmonary recruitment prior to pulmonary ground-glass nodule localization in a hybrid operating room. We hypothesized that pre-localization pulmonary recruitment would increase the localization accuracy, improve oxygenation, and prevent the need for re-inflation during the localization procedure. We retrospectively enrolled patients with multiple pulmonary nodule localizations before surgical intervention in our hybrid operating room. We compared the localization accuracy between patients who had undergone pre-procedure pulmonary recruitment and patients who had not. Saturation, re-inflation rate, apnea time, procedure-related pneumothorax, and procedure time were also recorded as secondary outcomes. The patients who had undergone pre-procedure recruitment had better saturation, shorter procedure time, and higher localization accuracy. The pre-procedure pulmonary recruitment maneuver was effective in increasing regional lung ventilation, leading to improved oxygenation and localization accuracy.
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Affiliation(s)
- Yu Hsiang Wang
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Pei Chin Su
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Hsu Chih Huang
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Kenneth Au
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Frank Cheau Feng Lin
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Chih Yi Chen
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Ming Chih Chou
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Jiun Yi Hsia
- Division of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
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18
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Electric impedance tomography and protective mechanical ventilation in elective robotic-assisted laparoscopy surgery with steep Trendelenburg position: a randomized controlled study. Sci Rep 2023; 13:2753. [PMID: 36797394 PMCID: PMC9935531 DOI: 10.1038/s41598-023-29860-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/11/2023] [Indexed: 02/18/2023] Open
Abstract
Electrical impedance tomography (EIT) reconstructs functional lung images and evaluates the variations of impedance during the breathing cycle. The aim of this study was to evaluate the effect of protective mechanical ventilation on ventilation distributions recorded by the EIT during elective robotic-assisted laparoscopy surgery with steep Trendelenburg position. This prospective, randomized single center study included patients with healthy lungs undergoing elective robot-assisted laparoscopic urological surgery in general anesthesia. Patients were randomly assigned to either protective lung ventilation or conventional ventilation. In the protective ventilation group, tidal volume (TV) was set at 6 ml/Kg predicted body weight (PBW), with PEEP 6 cmH2O, and recruitment maneuvers (RM) as needed. In the conventional ventilation group, TV was set at 9 ml/Kg PBW, with PEEP 2 cmH2O and RM only as needed. Ventilation distribution was assessed using an EIT device. This study included 40 patients in the functional image analysis. Significant differences were found in ventilation distribution in the region of interest (p < 0.05). Driving pressure was significantly lower in protective ventilation group (p < 0.05). Peak and plateau pressures were not different between the groups while statical significance was found in tidal volume and respiratory rate. EIT may be a valuable tool for monitoring lung function during general anesthesia. During elective robotic-assisted laparoscopy surgery with steep Trendelenburg position, protective mechanical ventilation may have a more homogenous distribution of intraoperative and postoperative ventilation. Larger sample size and long-term evaluation are needed in future studies to assess the benefit of EIT monitoring in operation room.Clinical trial registration ClinicalTrials.gov Identifier: NCT04194177 registered at 11th December 2019.
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19
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Min JY, Chang HJ, Kim SJ, Cha SH, Jeon JP, Kim CJ, Chung MY. Prediction of hypotension during the alveolar recruitment maneuver in spine surgery: a prospective observational study. Eur J Med Res 2023; 28:64. [PMID: 36732838 PMCID: PMC9896773 DOI: 10.1186/s40001-023-01031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Atelectasis can occur in many clinical practices. One way to prevent this complication is through the alveolar recruitment maneuver (ARM). However, hemodynamic compromise can accompany ARM. This study aims to predict ARM-induced hypotension using a non-invasive method. METHODS 94 American Society of Anesthesiologists physical status I-II patients aged 19 to 75 with scheduled spinal surgery were enrolled. After anesthesia, we performed a stepwise ARM. Data on perfusion index, mean arterial pressure, heart rate, pleth variability index, cardiac index, and stroke volume variation was collected before induction of anesthesia (T0), just before ARM (T1), at the start of ARM (T2), 0.5 min (T3), 1 min (T4), 1.5 min (T5, end of ARM), and 2 min after the beginning of ARM (T6). Hypotension was defined as when the mean arterial pressure at T5 decreased by 20% or more compared to the baseline. The primary endpoint is that the perfusion index measuring before induction of anesthesia, which reflects the patients' own vascular tone, was correlated with hypotension during ARM. RESULTS Seventy-five patients (79.8%) patients developed hypotension during ARM. The pre-induction persufion index (Pi) (95% confidence interval) was 1.7(1.4-3.1) in the non-hypotension group and 3.4(2.4-3.9) in the hypotension group. (p < 0.004) The hypotension group showed considerably higher Pi than the non-hypotension group before induction. The decrease of Pi (%) [IQR] in the non-hypotensive group (52.8% [33.3-74.7]) was more significant than in the hypotensive group. (36% [17.6-53.7]) (p < 0.05) The area under the receiver operating characteristic curve of Pi for predicting hypotension during ARM was 0.718 (95% CI 0.615-0.806; p = 0.004), and the threshold value of the Pi was 2.4. CONCLUSION A higher perfusion index value measuring before induction of anesthesia can be used to predict the development of hypotension during ARM. Prophylactic management of the following hypotension during ARM could be considered in high baseline Pi patients.
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Affiliation(s)
- Ji Young Min
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Hyun Jae Chang
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Sung Jun Kim
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Seung Hee Cha
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345 Republic of Korea
| | - Joon Pyo Jeon
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Chang Jae Kim
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Mee Young Chung
- grid.411947.e0000 0004 0470 4224Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
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Gharib A. Effect of continuous positive airway pressure on the respiratory system: a comprehensive review. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2023. [DOI: 10.1186/s43168-022-00175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
CPAP is characterized by the application of a constant and continuous positive pressure into the patient’s airway. By delivering a constant pressure during both inspiration and expiration, CPAP increases functional residual capacity and opens collapsed or under ventilated alveoli, thus decreasing right to left intrapulmonary shunt and improving oxygenation in obese individuals.
Main body of abstract
Obesity is characterized by several alterations in the mechanics of the respiratory system that tend to further exaggerate impairment of gas exchange rendering these patients prone to perioperative complications, such as hypoxemia, hypercapnia, and atelectasis. Interestingly, CPAP has been advocated as an efficacious modality for prevention and treatment of postoperative atelectasis considered to be the most common postoperative respiratory complication. In OSA, the CPAP device works to splint the airway open and prevent the collapse of the upper airway that is the cardinal event of OSA leading improvement of sleep, quality of life and the reduction of the risks of the cardiovascular and neurocognitive side effects associated with the disease. Besides such a beneficial effect, there are other physiological benefits to CPAP: greater end-expiratory lung volume and consequent increase in oxygen stores, increased tracheal traction to improve upper airway patency and decrease in cardiac after load.
Conclusion
Due to various physiological benefits on the respiratory system CPAP therapy is crucial for the prevention postoperative complications particularly related to obesity and the cornerstone for the treatment of moderate to severe obstructive sleep apnea.
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Galmén K, Jakobsson JG, Perchiazzi G, Freedman J, Harbut P. Quantitative assessment of atelectasis formation under high frequency jet ventilation during liver tumour ablation-A computer tomography study. PLoS One 2023; 18:e0282724. [PMID: 37011083 PMCID: PMC10069764 DOI: 10.1371/journal.pone.0282724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND High frequency jet ventilation (HFJV) can be used to minimise sub-diaphragmal organ displacements. Treated patients are in a supine position, under general anaesthesia and fully muscle relaxed. These are factors that are known to contribute to the formation of atelectasis. The HFJV-catheter is inserted freely inside the endotracheal tube and the system is therefore open to atmospheric pressure. AIM The aim of this study was to assess the formation of atelectasis over time during HFJV in patients undergoing liver tumour ablation under general anaesthesia. METHOD In this observational study twenty-five patients were studied. Repeated computed tomography (CT) scans were taken at the start of HFJV and every 15 minutes thereafter up until 45 minutes. From the CT images, four lung compartments were defined: hyperinflated, normoinflated, poorly inflated and atelectatic areas. The extension of each lung compartment was expressed as a percentage of the total lung area. RESULT Atelectasis at 30 minutes, 7.9% (SD 3.5, p = 0.002) and at 45 minutes 8,1% (SD 5.2, p = 0.024), was significantly higher compared to baseline 5.6% (SD 2.5). The amount of normoinflated lung volumes were unchanged over the period studied. Only a few minor perioperative respiratory adverse events were noted. CONCLUSION Atelectasis during HFJV in stereotactic liver tumour ablation increased over the first 45 minutes but tended to stabilise with no impact on normoinflated lung volume. Using HFJV during stereotactic liver ablation is safe regarding formation of atelectasis.
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Affiliation(s)
- Karolina Galmén
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gaetano Perchiazzi
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
- Department of Anaesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Jacob Freedman
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Division of Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
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The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial. PLoS One 2022; 17:e0273410. [PMID: 36084154 PMCID: PMC9462747 DOI: 10.1371/journal.pone.0273410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of atelectasis is high in patients undergoing general anesthesia. This may cause oxygenation impairment and further contribute to postoperative pulmonary complications (PPCs). As important airway management devices for general anesthesia, few studies have compared the effects of laryngeal mask airway (LMA) and endotracheal tube (ETT) on atelectasis. Additionally, lung ultrasound has been increasingly used for bedside atelectasis diagnosis. For the above considerations, this trial is designed to compare the effects of LMA and ETT on atelectasis assessed by lung ultrasound scores, further providing more powerful clinical evidence for perioperative respiratory management of non-laparoscopic elective lower abdominal surgery under general anesthesia. Methods This is a prospective, single-center, single-blind, randomized controlled trial. From July 2021 to July 2022, 180 patients undergoing elective non-laparoscopic lower abdominal surgery under general anesthesia will be recruited and randomly divided into the ETT and LMA groups at a ratio of 1:1. The primary outcome is the total atelectasis LUS of 12 lung regions 15 min after the establishment of the artificial airway. The total atelectasis LUS at the end of surgery and 30 min after extubation, oxygenation index, postoperative airway complications, PPCs, and length of stay will be analyzed as secondary indicators. Trial registration ClinicalTrials.gov identifier: ChiCTR1900020818. Registered on January 20, 2019. Registered with the name of “Laryngeal mask airway versus endotracheal tube for atelectasis.” URL: https://www.chictr.org.cn/showproj.aspx?proj=35143.
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Zhang A, De Gala V, Lementowski PW, Cvetkovic D, Xu JL, Villion A. Veno-Arterial Extracorporeal Membrane Oxygenation Rescue in a Patient With Pulmonary Hypertension Presenting for Revision Total Hip Arthroplasty: A Case Report and Narrative Review. Cureus 2022; 14:e28234. [PMID: 36158355 PMCID: PMC9488858 DOI: 10.7759/cureus.28234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Patients with pulmonary hypertension (PH) are at an increased risk of perioperative morbidity and mortality when undergoing non-cardiac surgery. We present a case of a 57-year-old patient with severe PH, who developed cardiac arrest as the result of right heart failure, undergoing a revision total hip arthroplasty under combined spinal epidural anesthesia. Emergent veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was undertaken as rescue therapy during the pulmonary hypertensive crisis and a temporizing measure to provide circulatory support in an intensive care unit (ICU). We present a narrative review on perioperative management for patients with PH undergoing non-cardiac surgery. The review goes through the updated hemodynamic definition, clinical classification of PH, perioperative morbidity, and mortality associated with PH in non-cardiac surgery. Pre-operative assessment evaluates the type of surgery, the severity of PH, and comorbidities. General anesthesia (GA) is discussed in detail for patients with PH regarding the benefits of and unsubstantiated arguments against GA in non-cardiac surgery. The literature on risks and benefits of regional anesthesia (RA) in terms of neuraxial, deep plexus, and peripheral nerve block with or without sedation in patients with PH undergoing non-cardiac surgery is reviewed. The choice of anesthesia technique depends on the type of surgery, right ventricle (RV) function, pulmonary artery (PA) pressure, and comorbidities. Given the differences in pathophysiology and mechanical circulatory support (MCS) between the RV and left ventricle (LV), the indications, goals, and contraindications of VA-ECMO as a rescue in cardiopulmonary arrest and pulmonary hypertensive crisis in patients with PH are discussed. Given the significant morbidity and mortality associated with PH, multidisciplinary teams including anesthesiologists, surgeons, cardiologists, pulmonologists, and psychological and social worker support should provide perioperative management.
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Li C, Ren Q, Li X, Han H, Peng M, Xie K, Wang Z, Wang G. Effect of sigh in lateral position on postoperative atelectasis in adults assessed by lung ultrasound: a randomized, controlled trial. BMC Anesthesiol 2022; 22:215. [PMID: 35820814 PMCID: PMC9275275 DOI: 10.1186/s12871-022-01748-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Postoperative atelectasis occurs in 90% of patients receiving general anesthesia. Recruitment maneuvers (RMs) are not always effective and frequently associated with barotrauma and hemodynamic instability. It is reported that many natural physiological behaviors interrupted under general anesthesia could prevent atelectasis and restore lung aeration. This study aimed to find out whether a combined physiological recruitment maneuver (CPRM), sigh in lateral position, could reduce postoperative atelectasis using lung ultrasound (LUS). Methods We conducted a prospective, randomized, controlled trial in adults with open abdominal surgery under general anesthesia lasting for 2 h or longer. Subjects were randomly allocated to either control group (C-group) or CPRM-group and received volume-controlled ventilation with the same ventilator settings. Patients in CPRM group was ventilated in sequential lateral position, with the addition of periodic sighs to recruit the lung. LUS scores, dynamic compliance (Cdyn), the partial pressure of arterial oxygen (PaO2) and fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2), and other explanatory variables were acquired from each patient before and after recruitment. Results Seventy patients were included in the analysis. Before recruitment, there was no significant difference in LUS scores, Cdyn and PaO2/FiO2 between CPRM-group and C-group. After recruitment, LUS scores in CPRM-group decreased significantly compared with C-group (6.00 [5.00, 7.00] vs. 8.00 [7.00, 9.00], p = 4.463e-11 < 0.05), while PaO2/FiO2 and Cdyn in CPRM-group increased significantly compared with C-group respectively (377.92 (93.73) vs. 309.19 (92.98), p = 0.008 < 0.05, and 52.00 [47.00, 60.00] vs. 47.70 [41.00, 59.50], p = 6.325e-07 < 0.05). No hemodynamic instability, detectable barotrauma or position-related complications were encountered. Conclusions Sigh in lateral position can effectively reduce postoperative atelectasis even without causing severe side effects. Further large-scale studies are necessary to evaluate it’s long-term effects on pulmonary complications and hospital length of stay. Trial registration ChiCTR1900024379. Registered 8 July 2019, Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01748-9.
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Affiliation(s)
- Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China
| | - Qian Ren
- Advertising Center, Tianjin Daily, Tianjin, China
| | - Xin Li
- Department of Cardiothoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongqiu Han
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Peng
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China
| | - Keliang Xie
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
| | - Zhiqiang Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
| | - Guolin Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, NO.154, Anshan Road, Heping District, Tianjin, China.
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The effect of ultrasound-guided lung recruitment maneuvers on atelectasis in lung-healthy patients undergoing laparoscopic gynecologic surgery: a randomized controlled trial. BMC Anesthesiol 2022; 22:200. [PMID: 35778701 PMCID: PMC9248140 DOI: 10.1186/s12871-022-01742-1] [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: 11/16/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atelectasis is the primary cause of hypoxemia during general anesthesia. This study aimed to evaluate the impact of the combination of recruitment maneuvers (RM) and positive end-expiratory pressure (PEEP) on the incidence of atelectasis in adult women undergoing gynecologic laparoscopic surgery using pulmonary ultrasound. METHODS In this study, 42 patients with healthy lungs undergoing laparoscopic gynecologic surgery were randomly divided into the recruitment maneuver group (RM group; 6 cm H2O PEEP and RM) or the control group (C group; 6 cm H2O PEEP and no RM), 21 patients in each group. Volume-controlled ventilation was used in all selected patients, with a tidal volume of 6-8 mL·kg-1 of ideal body weight. When atelectasis was detected, patients in the RM group received ultrasound-guided RM, while those in the C group received no intervention. The incidence and severity of atelectasis were determined using lung ultrasound scores. RESULTS A total of 41 patients were investigated. The incidence of atelectasis was lower in the RM group (40%) than in the C group (80%) 15 min after arrival in the post-anesthesia care unit (PACU). Meanwhile, lung ultrasound scores (LUSs) were lower in the RM group compared to the C group. In addition, the differences in the LUS between the two groups were mainly due to the differences in lung ultrasound scores in the posterior regions. However, this difference did not persist after 24 h of surgery. CONCLUSIONS In conclusion, the combination of RM and PEEP could reduce the incidence of atelectasis in patients with healthy lungs 15 min after arrival at the PACU; however, it disappeared within 24 h after surgery. TRIAL REGISTRATION (Prospectively registered): ChiCTR2000033529 . Registered on 4/6/2020.
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26
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Patel SK, Bansal S, Puri A, Taneja R, Sood N. Correlation of Perioperative Atelectasis With Duration of Anesthesia, Pneumoperitoneum, and Length of Surgery in Patients Undergoing Laparoscopic Cholecystectomy. Cureus 2022; 14:e24261. [PMID: 35475248 PMCID: PMC9018945 DOI: 10.7759/cureus.24261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/05/2022] Open
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Nair PR, Ramachandran R, Trikha A, Anand RK, Rewari V. Effect of positive end expiratory pressure on atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia: A lung ultrasonography study. J Perioper Pract 2022; 33:99-106. [PMID: 35322693 DOI: 10.1177/17504589211045218] [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: 11/17/2022]
Abstract
Postoperative pulmonary complications vary in major upper abdominal surgery. The objective of this study was to assess the effect of positive end expiratory pressure on the incidence of atelectasis in patients undergoing major upper abdominal surgery under general anaesthesia using lung ultrasound. The patients were randomised into receiving either no positive end expiratory pressure (Group I) or positive end expiratory pressure of 5cm H2O (Group II). Lung ultrasound was performed at various time points - baseline, 10 minutes, 2 hours after induction, during closure of skin and 30 minutes post extubation. The lung aeration as assessed by Total Modified Lung Ultrasound Score was worse in the Group I as compared to the Group II at 2 hours post induction. Driving pressure in Group II was significantly reduced compared to Group I. Application of positive end expiratory pressure, as minimal as 5cm H2O, as a single intervention, helps in significantly reducing the Total Modified Lung Ultrasound Score after a duration of more than 2 hours and also attaining low driving pressures during intraoperative mechanical ventilation.
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Affiliation(s)
- Parvathy Ramachandran Nair
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rahul Kumar Anand
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
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Overview of Lung Ultrasound in Pediatric Cardiology. Diagnostics (Basel) 2022; 12:diagnostics12030763. [PMID: 35328316 PMCID: PMC8946933 DOI: 10.3390/diagnostics12030763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
Lung ultrasound (LUS) is increasing in its popularity for the diagnosis of pulmonary complications in acute pediatric care settings. Despite the high incidence of pulmonary complications for patients with pediatric cardiovascular and congenital heart disease, especially in children undergoing cardiac surgery, the use of LUS remains quite limited in these patients. The aim of this review is to provide a comprehensive overview and list of current potential applications for LUS in children with congenital heart disease, post-surgery. We herein describe protocols for LUS examinations in children, discuss diagnostic criteria, and introduce methods for the diagnosis and classification of pulmonary disease commonly encountered in pediatric cardiology (e.g., pleural effusion, atelectasis, interstitial edema, pneumothorax, pneumonia, and diaphragmatic motion analysis). Furthermore, applications of chest ultrasounds for the evaluation of the retrosternal area, and in particular, systematic search criteria for retrosternal clots, are illustrated. We also discussed the potential applications of LUS, including the guidance of interventional procedures, namely lung recruitment and drainage insertion. Lastly, we analyzed current gaps in knowledge, including the difficulty of the quantification of pleural effusion and atelectasis, and the need to differentiate different etiologies of B-lines. We concluded with future applications of LUS, including strain analysis and advanced analysis of diaphragmatic mechanics. In summary, US is an easy, accurate, fast, cheap, and radiation-free tool for the diagnosis and follow-up of major pulmonary complications in pediatric cardiac surgery, and we strongly encourage its use in routine practice.
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Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Paediatr Anaesth 2022; 32:321-329. [PMID: 34797011 DOI: 10.1111/pan.14335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia. We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
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Affiliation(s)
- Suze Bruins
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Neil Powers
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
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30
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Lee HM, Min JY, Lee JR, Lee MH, Byon HJ. Effects of positive end-expiratory pressure on pulmonary atelectasis after paediatric laparoscopic surgery as assessed by ultrasound: A randomised controlled study. Anaesth Crit Care Pain Med 2022; 41:101034. [DOI: 10.1016/j.accpm.2022.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
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31
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Pulmonary Risk Assessment. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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De Cassai A, Starnari R, Pullano C, Torrano V, Geraldini F, Costa F. This is why you should (not) use spinal anesthesia for laparoscopic surgeries. Saudi J Anaesth 2022; 16:371-373. [DOI: 10.4103/sja.sja_380_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/04/2022] Open
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Ji JY, Chung JH, Kim NS, Seo YH, Jung HS, Chun HR, Gong HY, Kim WJ, Ahn JM, Park YJ. Causes and Treatment of Hypoxia during Total Hip Arthroplasty in Elderly Patients: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412931. [PMID: 34948542 PMCID: PMC8700985 DOI: 10.3390/ijerph182412931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/28/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022]
Abstract
Intraoperative hypoxia occurs in approximately 6.8% of surgeries and requires appropriate management to avoid poor outcomes, such as increased mortality or extended hospitalization. Hypoxia can be caused by a variety of factors, including laryngospasm, inhalational anesthetics, and surgery for abdominal pathology or hip fractures. In particular, elderly patients are more vulnerable to hypoxia due to their existing lung diseases or respiratory muscle weakness. This study presents the cases of two elderly patients who developed hypoxia during total hip arthroplasty under general anesthesia. Positive end expiratory pressure, the recruitment maneuver, and increased fraction of inspired oxygen improved hypoxia only temporarily, and patients’ oxygen saturation level again dropped to 79–80%. We suspected that hypoxia was caused by atelectasis and, therefore, resumed spontaneous respiration. Thereafter, both the patients showed an improvement in hypoxia. Intraoperative hypoxia that is suspected to be caused by atelectasis can be improved by securing sufficient lung volume for respiration through increased muscle tone with spontaneous respiration.
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Affiliation(s)
- Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
- Correspondence: ; Tel.: +82-41-570-2823
| | - Jin Hun Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Nan Seol Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Yong Han Seo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Ho Soon Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Hea Rim Chun
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Hyung Yoon Gong
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Jae Min Ahn
- Department of Neurosurgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Yu Jun Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (J.H.C.); (N.S.K.); (Y.H.S.); (H.S.J.); (H.R.C.); (H.Y.G.); (Y.J.P.)
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Kim HI, Min JY, Lee JR, Kwan Woong C, Cho MR, Byon HJ. The effect of oxygen concentration on atelectasis formation during induction of general anesthesia in children: A prospective randomized controlled trial. Paediatr Anaesth 2021; 31:1276-1281. [PMID: 34614266 DOI: 10.1111/pan.14304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In adults, the use of lower oxygen concentration during induction is associated with less atelectasis formation without an increase in incidence of hypoxia. However, it is unknown whether this remains true in the pediatric patients. METHODS Fifty-four pediatric patients who were scheduled to undergo elective lower abdominal surgery were randomized to one of three oxygenation groups: 100%, 80%, or 60% oxygen (in air). During anesthesia induction, patients were ventilated with sevoflurane in 100%, 80%, or 60% oxygen. Endotracheal intubation and mechanical ventilation were performed. Atelectasis was diagnosed using LUS, which was performed after anesthetic induction and at the end of surgery. RESULTS We assessed atelectasis after anesthetic induction and at the end of surgery. After anesthetic induction, the number of atelectatic lung regions was significantly different among the three groups (median [IQR], 2.0 [1.0-2.5], 2.0 [1.0-2.8], and 3.0 [2.0-3.0] in the 60%, 80%, and 100% oxygen groups, p = .033) and between the 60% and 100% groups (p = .015), but not between 80% and 100% groups (p = .074). However, no differences in the number of atelectatic lung regions were found among the three groups at the end of surgery (2.0 [1.3-3.8], 3.0 [1.8-3.0], and 4.0 [2.0-4.0] in the 60%, 80%, and 100% oxygen groups; p = .169). CONCLUSION Lower oxygen concentration during anesthetic induction is associated with less atelectasis formation immediately after anesthetic induction in children. In addition, applying 80% oxygen instead of 100% oxygen is not enough to prevent atelectasis formation, and 60% oxygen should be applied to prevent atelectasis. However, this effect does not last until the end of surgery.
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Affiliation(s)
- Hyun Il Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Rim Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Choi Kwan Woong
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Il San Hospital, Goyang-si, Korea
| | - Matthew R Cho
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Il San Hospital, Goyang-si, Korea
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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Abstract
ABSTRACT In the last few decades, obesity became one of the world's greatest health challenges reaching a size of global epidemic in virtually all socioeconomic statuses and all age groups. Obesity is a risk factor for many health problems and as its prevalence gradually increases is becoming a significant economic and health burden. In this manuscript we describe how normal respiratory and cardiovascular physiology is altered by obesity. We review past and current literature to describe how obesity affects outcomes of patients facing critical illnesses and discuss some controversies related to this topic.
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Affiliation(s)
- Itay Ayalon
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Department of Pediatric Critical Care, Tel-Aviv, Israel
| | - Lauren Bodilly
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Kaplan
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Hunt TD, Wallack ST. Minimal atelectasis and poorly aerated lung on thoracic CT images of normal dogs acquired under sedation. Vet Radiol Ultrasound 2021; 62:647-656. [PMID: 34672040 DOI: 10.1111/vru.13016] [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: 10/18/2020] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
General anesthesia optimizes image quality of thoracic CT in dogs by providing patient immobilization and respiratory control. However, it also comes with disadvantages that may serve as a detractor to the use of CT in veterinary practice. With the use of multidetector helical CT combined with injectable sedation for restraint, parameters such as atelectasis and poorly aerated lung should not be appreciably different from what has been observed in dogs under general anesthesia. This prospective pilot study aimed to evaluate the mean lung attenuation and the amount of atelectasis and poorly aerated lung on thoracic CT images acquired under injectable sedation in normal dogs. The entire thorax of 10 client-owned dogs was scanned. Attenuation measurements were generated by three-dimensional reconstruction software. Mean ± SD lung attenuation was -707.0 ± 60.0. Atelectasis was not identified on any of the scans. Hypoinflated lung, the percentage of lung parenchyma with attenuation greater than -500 and -250 Hounsfield units (HU), was 10.7 ± 4.7% and 2.4 ± 1.2% (mean ± SD), respectively. There was no significant change in these percentages over time. Compared to previously published data, thoracic CT images obtained under sedation had mean attenuation comparable to normal expiratory lung and a lower percentage of poorly aerated lung compared to that of anesthetized dogs. Using sedation to complete canine thoracic CT does not itself lead to alterations of lung attenuation and may confer less hypoinflation and atelectasis than general anesthesia.
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Affiliation(s)
- Tania D Hunt
- Veterinary Imaging Center of San Diego, San Diego, California, USA
| | - Seth T Wallack
- Veterinary Imaging Center of San Diego, San Diego, California, USA
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Araos J, Lacitignola L, de Monte V, Stabile M, Porter I, Hurtado DE, Perez A, Crovace A, Grasso S, Martin-Flores M, Staffieri F. Evaluation of Lung Aeration and Respiratory System Mechanics in Obese Dogs Ventilated With Tidal Volumes Based on Ideal vs. Current Body Weight. Front Vet Sci 2021; 8:704863. [PMID: 34660755 PMCID: PMC8517180 DOI: 10.3389/fvets.2021.704863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
We describe the respiratory mechanics and lung aeration in anesthetized obese dogs ventilated with tidal volumes (VT) based on ideal (VTi) vs. current (VTc) body weight. Six dogs with body condition scores ≥ 8/9 were included. End-expiratory respiratory mechanics and end-expiratory CT-scan were obtained at baseline for each dog. Thereafter, dogs were ventilated with VT 15 ml kg−1 based on VTi and VTc, applied randomly. Respiratory mechanics and CT-scan were repeated at end-inspiration during VTi and VTc. Data analyzed with linear mixed models and reported as mean ± SD or median [range]. Statistical significance p < 0.05. The elastance of the lung, chest wall and respiratory system indexed by ideal body weight (IBW) were positively correlated with body fat percentage, whereas the functional residual capacity indexed by IBW was negatively correlated with body fat percentage. At end-expiration, aeration (%) was: hyperaeration 0.03 [0.00–3.35], normoaeration 69.7 [44.6–82.2], hypoaeration 29.3 [13.6–49.4] and nonaeration (1.06% [0.37–6.02]). Next to the diaphragm, normoaeration dropped to 12 ± 11% and hypoaeration increased to 90 ± 8%. No differences in aeration between groups were found at end-inspiration. Airway driving pressure (cm H2O) was higher (p = 0.002) during VTc (9.8 ± 0.7) compared with VTi (7.6 ± 0.4). Lung strain was higher (p = 0.014) during VTc (55 ± 21%) than VTi (38 ± 10%). The stress index was higher (p = 0.012) during VTc (SI = 1.07 [0.14]) compared with VTi (SI = 0.93 [0.18]). This study indicates that body fat percentage influences the magnitude of lung, chest wall, and total respiratory system elastance and resistance, as well as functional residual capacity. Further, these results indicate that obese dogs have extensive areas of hypoaerated lungs, especially in caudodorsal regions. Finally, lung strain and airway driving pressure, surrogates of lung deformation, are higher during VTc than during VTi, suggesting that in obese anesthetized dogs, ventilation protocols based on IBW may be advantageous.
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Affiliation(s)
- Joaquin Araos
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Luca Lacitignola
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Valentina de Monte
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Marzia Stabile
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Daniel E Hurtado
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile
| | - Agustín Perez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Antonio Crovace
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Salvatore Grasso
- Section of Anesthesia and Intensive Care, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
| | - Manuel Martin-Flores
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy
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Salter R, Parmar J, Alyward L, McKie MA, Falter F. Association of Passive Lung Insufflation Oxygen Fraction in Adult Patients on Cardiopulmonary Bypass with Postoperative Pulmonary Outcomes: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2021; 36:461-468. [PMID: 34756804 DOI: 10.1053/j.jvca.2021.08.108] [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] [Received: 04/02/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine whether FIO2 of passive lung insufflation during cardiopulmonary bypass correlates with postoperative pulmonary function. DESIGN A retrospective, observational study SETTING: A single-center, university-affiliated, specialist cardiothoracic center in the United Kingdom. PARTICIPANTS Adult patients presenting for nonemergency, nontransplant cardiac surgery requiring cardiopulmonary bypass without the need for deep hypothermic circulatory arrest between January 1, 2018, and December 31, 2018. INTERVENTIONS Passive insufflation of the lungs during cardiopulmonary bypass with fresh gas flow of varying FIO2. Patients were sorted retrospectively into low FIO2 (0.21-0.44), intermediate FIO2 (0.45-0.69), and high FIO2 (0.7-1.0) groups. The primary outcome was the difference between the PaO2:FIO2 on the first postinduction blood gas and on the first blood gas recorded postoperatively in the intensive care unit (ICU) (delta PaO2:FIO2). Secondary outcomes were ICU and hospital lengths of stay, requirement for respiratory support, and 30-day mortality. MEASUREMENTS AND MAIN RESULTS Nine hundred patients were included in the authors' analysis (low FIO2 n = 307, intermediate FIO2 n = 459, high FIO2 n = 134). There was no significant difference in delta PaO2:FIO2 among the groups (low FIO2 = 52.5 [-38.8 to 152.4], intermediate FIO2 = 71.8 [-39.4 to 165.1], high FIO2 = 60.2 [-19.2 to 184.0], p = 0.25). There were no significant differences among groups for any secondary outcomes. CONCLUSION Fresh gas flow with a low FIO2 delivered to the lungs without positive airway pressure during cardiopulmonary bypass was not associated with improved postoperative pulmonary function when compared to higher FIO2 levels.
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Affiliation(s)
- Ryan Salter
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jasvir Parmar
- Transplant Services, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Liam Alyward
- Cambridge Perfusion Services, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Mikel A McKie
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Florian Falter
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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Pollock RD, Gates SD, Radcliffe JJ, Stevenson AT. Indirect Measurements of Acceleration Atelectasis and the Role of Inspired Oxygen Concentrations. Aerosp Med Hum Perform 2021; 92:780-785. [PMID: 34641998 DOI: 10.3357/amhp.5859.2021] [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: 11/24/2022]
Abstract
BACKGROUND: A growing number of symptom reports suggestive of acceleration atelectasis in fast jet aircrew have raised the question as to whether traditional guidelines on inspired gas composition remain valid. The aim of this study was to assess the effects of inspired O₂ concentration on the development of acceleration atelectasis when wearing modern anti-G garments. METHODS: There were 14 nonaircrew subjects who completed 5 centrifuge exposures to +5 Gz lasting 90 s. During exposures subjects breathed a gas mixture containing 21, 35, 45, 60, or 75% O₂. To assess the extent of atelectasis post-Gz, forced inspiratory vital capacity (FIVC), regional FIVC (EITFIVC), shunt, respiratory resistance, reactance, and compliance and peripheral O₂ saturation during a hypoxic exposure were measured. RESULTS: Compared with baseline, FIVC was not statistically significantly altered. EITFIVC was 14.4% lower after the 75% O₂ exposure only with a greater symptom reporting with higher FIO₂ in some individuals. A significantly greater shunt (3>6%) followed the 60 and 75% O₂ exposures. O₂ concentration during Gz had no effect on respiratory resistance, reactance, compliance, or hypoxemia. DISCUSSION: There is evidence of mild acceleration atelectasis present when breathing 60% O₂, particularly in susceptible individuals, with 75% O₂ causing more obvious physiological compromise. An inspired oxygen concentration of <60% will prevent the majority of individuals from developing acceleration atelectasis. Pollock RD, Gates SD, Radcliffe JJ, Stevenson AT. Indirect measurements of acceleration atelectasis and the role of inspired oxygen concentrations. Aerosp Med Hum Perform. 2021; 92(10):780785.
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Effect of positive end-expiratory pressure during anaesthesia induction on non-hypoxic apnoea time in infants: A randomised controlled trial. Eur J Anaesthesiol 2021; 38:1012-1018. [PMID: 33259454 DOI: 10.1097/eja.0000000000001400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypoxaemia occurs frequently in infants during anaesthetic induction. OBJECTIVE We evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants. DESIGN Randomised controlled trial. SETTING Tertiary care children's hospital, single centre, from November 2018 to October 2019. PATIENTS We included patients under 1 year of age receiving general anaesthesia. INTERVENTION We assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg-1 atropine, 5 mg kg-1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg-1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg-1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants' trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%. MAIN OUTCOME MEASURE The primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound. RESULTS Sixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2). CONCLUSION Positive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT03540940.
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Hochhausen N, Kapell T, Dürbaum M, Follmann A, Rossaint R, Czaplik M. Monitoring postoperative lung recovery using electrical impedance tomography in post anesthesia care unit: an observational study. J Clin Monit Comput 2021; 36:1205-1212. [PMID: 34542735 PMCID: PMC9294009 DOI: 10.1007/s10877-021-00754-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 11/26/2022]
Abstract
With electrical impedance tomography (EIT) recruitment and de-recruitment phenomena can be quantified and monitored at bedside. The aim was to examine the feasibility of EIT with respect to monitor atelectasis formation and resolution in the post anesthesia care unit (PACU). In this observational study, 107 postoperative patients were investigated regarding the presence and recovery of atelectasis described by the EIT-derived parameters Global Inhomogeneity Index (GI Index), tidal impedance variation (TIV), and the changes in end-expiratory lung impedance (ΔEELI). We examined whether the presence of obesity (ADP group) has an influence on pulmonary recovery compared to normal weight patients (NWP group). During the stay at PACU, measurements were taken every 15 min. GI Index, TIV, and ΔEELI were calculated for each time point. 107 patients were monitored and EIT-data of 16 patients were excluded for various reasons. EIT-data of 91 patients were analyzed off-line. Their length of stay averaged 80 min (25th and 75th quartile 52–112). The ADP group demonstrated a significantly higher GI Index at PACU arrival (p < 0.001). This finding disappeared during their stay at the PACU. Additionally, the ADP group showed a significant increase in ΔEELI between PACU arrival and discharge (p = 0.025). Furthermore, TIV showed a significantly lower value during the first 90 min of PACU stay as compared to the time period thereafter (p = 0.036). Our findings demonstrate that obesity has an influence on intraoperative atelectasis formation and de-recruitment during PACU stay. The application of EIT in spontaneously breathing PACU patients seems meaningful in monitoring pulmonary recovery.
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Affiliation(s)
- Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
| | - Torsten Kapell
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Martin Dürbaum
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Michael Czaplik
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Hoeberg E, Levionnois O, Andréïs S. Successful management of hypoxaemia in a mule during general anaesthesia. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Emma Hoeberg
- Department for Clinical Veterinary Science Unit of Anaesthesiology and Pain Therapy Universität Bern Vetsuisse Fakultät Bern Switzerland
| | - Olivier Levionnois
- Department for Clinical Veterinary Science Unit of Anaesthesiology and Pain Therapy Universität Bern Vetsuisse Fakultät Bern Switzerland
| | - Sabrina Andréïs
- Department of Clinical Veterinary Science Universität Bern Vetsuisse Fakultät Bern Switzerland
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Kim PH, Park YS, Yoon HM, Jung AY, Joo EY, Choi IC, Song MH. Factors Associated with Occurrence of Atelectasis during Sedation for Imaging in Pediatric Patients: A Retrospective Single Center Cohort Study. J Clin Med 2021; 10:jcm10163598. [PMID: 34441894 PMCID: PMC8397091 DOI: 10.3390/jcm10163598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022] Open
Abstract
Sedation can induce atelectasis which may cause suboptimal image quality. This study aimed to identify factors associated with the occurrence of atelectasis during sedation for imaging in pediatric patients. Patients < 18 years who had undergone whole-body magnetic resonance imaging (MRI) under sedation with propofol or dexmedetomidine were included in this study. The development of atelectasis was visually and quantitatively assessed by coronal short tau inversion recovery images of the thoracic level. Multivariable logistic regression was performed to identify the independent factors associated with the development of atelectasis. Ninety-one patients were included in the analysis. In the multivariable analysis, administration of supplemental oxygen was the only factor significantly associated with the occurrence of atelectasis (adjusted odds ratio, 4.84; 95% confidence interval, 1.48-15.83; p = 0.009). Univariable analysis showed that the use of dexmedetomidine was associated with a lower incidence of atelectasis; however, this could not be verified in the multivariable analysis. Among the pediatric patients who had undergone imaging under sedation, additional oxygen supplementation was the only independent factor associated with atelectasis occurrence. A prospective clinical trial is required to identify the cause-effect relationship between oxygen administration and occurrence of atelectasis during sedation.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Yong-Seok Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - Hee-Mang Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (P.H.K.); (H.-M.Y.); (A.Y.J.)
| | - Eun-Young Joo
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
| | - Myung-Hee Song
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.-S.P.); (E.-Y.J.); (I.-C.C.)
- Correspondence: ; Tel.: +82-2-3010-3992; Fax: +82-2-3010-6790
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Savvas I, Pavlidou K, Braun C, Schauvliege S, Staffieri F, Moens Y. Evaluation of the Effect of the Inspired Oxygen Fraction on Blood Oxygenation during Inhalant Anaesthesia in Horses: A Systematic Review with Meta-Analysis. Animals (Basel) 2021; 11:ani11082245. [PMID: 34438703 PMCID: PMC8388394 DOI: 10.3390/ani11082245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023] Open
Abstract
In anaesthetized horses, pronounced ventilation/perfusion mismatching often occurs. Several authors have investigated the effect of lower inspired oxygen fractions (FiO2) to reduce formation of absorption atelectasis. This systematic review compared the effects of low (<0.6) and high (>0.8) FiO2 on the arterial oxygen tension (PaO2), the alveolar-to-arterial oxygen tension difference (P(A-a)O2), and the PaO2/FiO2 ratio in horses during inhalation anaesthesia. Using the Systematic Review Protocol for Animal Intervention Studies, four experimental and one clinical investigations were deemed suitable for inclusion. A meta-analysis was performed on the four experimental studies. The PaO2 was significantly lower (p = 0.0007, mean difference -23.54 kPa, 95% CI -37.18, -9.90) with a lower FiO2. However, the P(A-a)O2 was also significantly lower (p < 0.00001, mean difference -20.80 kPa, 95% CI -26.28, -15.32) when using a low FiO2. For the PaO2/FiO2 ratio, only one study fitted the inclusion criteria, so no meta-analysis was performed. It is concluded that, while only a limited number of studies are available, the use of a higher FiO2 in horses during inhalation anaesthesia will result in higher levels of PaO2, but also a larger P(A-a)O2 difference. Further studies are needed to increase the level of evidence on this subject.
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Affiliation(s)
- Ioannis Savvas
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, 546 27 Thessaloniki, Greece;
- Correspondence:
| | - Kiriaki Pavlidou
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, 546 27 Thessaloniki, Greece;
| | - Christina Braun
- Anaesthesiology and Perioperative Intensive Care Medicine, University of Veterinary Medicine, 1210 Vienna, Austria; (C.B.); (Y.M.)
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
| | - Francesco Staffieri
- Section of Veterinary Clinics and Animal Production, Department of Emergency and Organs Transplantation, University of Bari Aldo Moro, 70010 Bari, Italy;
| | - Yves Moens
- Anaesthesiology and Perioperative Intensive Care Medicine, University of Veterinary Medicine, 1210 Vienna, Austria; (C.B.); (Y.M.)
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Pritchett MA, Lau K, Skibo S, Phillips KA, Bhadra K. Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy. BMC Pulm Med 2021; 21:240. [PMID: 34273966 PMCID: PMC8286573 DOI: 10.1186/s12890-021-01584-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/05/2021] [Indexed: 12/18/2022] Open
Abstract
Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged in advanced bronchoscopy and interventional pulmonology. While anesthesia-induced atelectasis is common, it is not typically clinically significant. Advanced guided bronchoscopic biopsy is an exception in which anesthesia protocols substantially impact outcomes. Procedure success depends on careful ventilation to avoid excessive motion, reduce distortion causing computed tomography (CT)-to-body-divergence, stabilize dependent areas, and optimize breath-hold maneuvers to prevent atelectasis. Herein are anesthesia recommendations during guided bronchoscopy. An FiO2 of 0.6 to 0.8 is recommended for pre-oxygenation, maintained at the lowest tolerable level for the entire the procedure. Expeditious intubation (not rapid-sequence) with a larger endotracheal tube and non-depolarizing muscle relaxants are preferred. Positive end-expiratory pressure (PEEP) of up to 10-12 cm H2O and increased tidal volumes help to maintain optimal lung inflation, if tolerated by the patient as determined during recruitment. A breath-hold is required to reduce motion artifact during intraprocedural imaging (e.g., cone-beam CT, digital tomosynthesis), timed at the end of a normal tidal breath (peak inspiration) and held until pressures equilibrate and the imaging cycle is complete. Use of the adjustable pressure-limiting valve is critical to maintain the desired PEEP and reduce movement during breath-hold maneuvers. These measures will reduce atelectasis and CT-to-body divergence, minimize motion artifact, and provide clearer, more accurate images during guided bronchoscopy. Following these recommendations will facilitate a successful lung biopsy, potentially accelerating the time to treatment by avoiding additional biopsies. Application of these methods should be at the discretion of the anesthesiologist and the proceduralist; best medical judgement should be used in all cases to ensure the safety of the patient.
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Affiliation(s)
- Michael A Pritchett
- Chest Center of the Carolinas at First Health, President of the Society for Advanced Bronchoscopy, FirstHealth of the Carolinas and Pinehurst Medical Clinic, 205 Page Road, Pinehurst, NC, 28374, USA.
| | - Kelvin Lau
- Thoracic Surgery, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Scott Skibo
- Interventional Thoracic Oncology, Pulmonary Critical Care, Haywood Regional Medical Center (A Duke LifePoint Hospital), 262 Leroy George Drive, Clyde, NC, 28721, USA
| | - Karen A Phillips
- Anesthesiologist and Intensivist, Medtronic, 2101 Faraday Avenue, Carlsbad, CA, 92008, USA
| | - Krish Bhadra
- Interventional Pulmonology, CHI Memorial Rees Skillern Cancer Institute, 725 Glenwood Dr E-500, Chattanooga, TN, 37401, USA
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Klaengkaew A, Sutthigran S, Thammasiri N, Yuwatanakorn K, Thanaboonnipat C, Ponglowhapan S, Choisunirachon N. The evaluation of non-anesthetic computed tomography for detection of pulmonary parenchyma in feline mammary gland carcinoma: a preliminary study. BMC Vet Res 2021; 17:237. [PMID: 34229677 PMCID: PMC8259360 DOI: 10.1186/s12917-021-02950-6] [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: 03/24/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thoracic radiography in awake cats is a common procedure for the evaluation of pulmonary metastasis in feline mammary gland carcinoma (MGC). However, due to poor sensitivity, computed tomography (CT) is progressively taking its place. To perform CT in animals, general anesthesia is normally preferred but can cause lung atelectasis, affecting lung interpretation. Besides, MGC is often found in senile cats that are concurrently affected with other diseases, increasing anesthetic risk. Therefore, this study was aimed at comparing the effect of anesthesia on lung atelectasis observed through CT in clinically healthy cats and comparing the feasibility of non-anesthetic CT with non-anesthetic radiography in the detection of lung lesions in feline MGC. Thoracic CTs from anesthetized, clinically healthy cats and non-anesthetized either clinically healthy cats or MGC-affected cats were reviewed. In clinically healthy cats, motion artifacts and characteristics of lung atelectasis were observed and compared. In MGC-affected cats, motion artifacts were observed and compared to clinically healthy cats, and the number of MGC-affected cats, the number and characteristics of lung lesions were compared between non-anesthetic thoracic CT and radiography. Results Anesthesia significantly increased lung CT attenuation (P = 0.0047) and was significantly correlated with lung atelectasis (OR = 15; CI 2.02–111.18; P = 0.0081), particularly of the cranial lung lobe. Nonetheless, significantly higher motion artifacts in the caudal thoracic area were found in non-anesthetized healthy cats (P = 0.0146), but comparable low motion artifacts were observed in anesthetized healthy and MGC-affected cats. Non-anesthetic CT revealed higher numbers of MGC-affected cats and pulmonary nodules with a significantly lower nodular diameter (P = 0.0041) than those observed on radiographs. The smallest nodular diameters detected on radiographs and CT were 2.5 and 1.0 mm, respectively. Furthermore, CT showed additional information such as intra-thoracic lymphadenopathy, that could not be seen on radiographs. Conclusions Despite the motion artifacts, CT without anesthesia is a sensitive technique as it provides better lung inflation. Furthermore, compared to non-anesthetic radiography, non-anesthetic CT provided more information such as higher number of pulmonary nodules of a smaller size, including more distinct intra-thoracic lesions, such as lymphadenopathy, in MGC-affected cats.
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Affiliation(s)
- Auraiwan Klaengkaew
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Somchin Sutthigran
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Ninlawan Thammasiri
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Kittiporn Yuwatanakorn
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Chutimon Thanaboonnipat
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand
| | - Suppawiwat Ponglowhapan
- Department of Obstetrics, Gynaecology and Reproduction, Research Unit of Obstetrics and Reproduction in Animals, Faculty of Veterinary Science, Chulalongkorn University, 10330, Bangkok, Thailand
| | - Nan Choisunirachon
- Department of Surgery, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri-Dunant Road, Wangmai, Pathumwan, 10330, Bangkok, Thailand.
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Bergmann A, Schilling T. [Intraoperative Ventilation Approaches to One-lung Ventilation]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:329-341. [PMID: 34038972 DOI: 10.1055/a-1189-8031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The management of thoracic surgery patients is challenging to the anesthetist, since one-lung ventilation (OLV) includes at least two major conditions: sufficient oxygenation and lung protection. The first is mainly because the ventilation of one lung is stopped while perfusion to that lung continues; the latter is related to the fact that the whole ventilation is applied to only a single lung. Recommendations for maintaining the oxygenation and methods of lung protection may contradict each other (e. g. high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume, etc.). Therefore, a high degree of pathophysiological understanding and manual skills are required in the management of these patients.In light of recent clinical studies, this review focuses on a current protective strategy for OLV, which includes a possible decrease in FiO2, lowered VT, the application of positive end-expiratory pressure (PEEP) to the dependent and continuous positive airway pressure (CPAP) to the non-dependent lung and alveolar recruitment manoeuvres as well. Other approaches such as the choice of anaesthetics, remote ischemic preconditioning, fluid management and pain therapy can support the success of ventilatory strategy. The present work describes new developments that may change the classical approach in this respect.
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Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants: A prospective randomised controlled trial. Eur J Anaesthesiol 2021; 37:1150-1156. [PMID: 33009186 DOI: 10.1097/eja.0000000000001327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants. OBJECTIVES We hypothesised that maintaining spontaneous ventilation can reduce atelectasis formation during anaesthetic induction in infants. We compared spontaneous ventilation and manual positive-pressure ventilation in terms of atelectasis formation in infants. DESIGN Randomised controlled study. SETTING Single tertiary hospital in Seoul, Republic of Korea, from November 2018 to December 2019. PATIENTS We enrolled 60 children younger than 1 year of age undergoing general anaesthesia, of whom 56 completed the study. Exclusion criteria were history of hypoxaemia during previous general anaesthesia, development of a respiratory tract infection within 1 month, current intubation or tracheostomy cannulation, need for rapid sequence intubation, preterm birth, age within 60 weeks of the postconceptional age and the presence of contraindications for rocuronium or sodium thiopental. INTERVENTION Patients were allocated randomly to either the 'spontaneous' group or 'controlled' group. During preoxygenation, spontaneous ventilation was maintained in the 'spontaneous' group while conventional bag-mask ventilation was provided in the 'controlled' group. After 5 min of preoxygenation, a lung ultrasound examination was performed to compare atelectasis formation in the two groups. RESULTS Atelectasis after preoxygenation was seen in seven (26.9%) of 26 patients in the 'spontaneous' group and 22 (73.3%) of 30 patients in the 'controlled' group (P = 0.001). The relative risk of atelectasis in the 'spontaneous' group was 0.39 (95% CI 0.211 to 0.723). Regarding ultrasound pictures of consolidation, the total score and sum of scores in the dependent regions were significantly lower in the 'spontaneous' group than in the 'controlled' group (P = 0.007 and 0.001, respectively). CONCLUSION Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age, particularly in the dependent portions of the lungs. TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT03739697).
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Ultrasound-guided versus conventional lung recruitment manoeuvres in laparoscopic gynaecological surgery: A randomised controlled trial. Eur J Anaesthesiol 2021; 38:275-284. [PMID: 33399385 DOI: 10.1097/eja.0000000000001435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pneumoperitoneum and steep Trendelenburg position promote the formation of pulmonary atelectasis during laparoscopic gynaecological surgery. OBJECTIVE To determine whether lung ultrasound-guided alveolar recruitment manoeuvres could reduce peri-operative atelectasis compared with conventional recruitment manoeuvres during laparoscopic gynaecological surgery. DESIGN Randomised controlled trial. SETTING Tertiary hospital, Republic of Korea, from August 2018 to January 2019. PATIENTS Adult patients scheduled for laparoscopic gynaecological surgery under general anaesthesia. INTERVENTION Forty patients were randomised to receive either ultrasound-guided recruitment manoeuvres (manual inflation until no visibly collapsed area was seen with lung ultrasonography; intervention group) or conventional recruitment manoeuvres (single manual inflation with 30 cmH2O pressure; control group). Recruitment manoeuvres were performed 5 min after induction and at the end of surgery in both groups. All patients received volume-controlled ventilation with a tidal volume of 8 ml kg-1 and a positive end-expiratory pressure of 5 cmH2O. MAIN OUTCOME MEASURES The primary outcome was the lung ultrasound score at the end of surgery; a higher score indicates worse lung aeration. RESULTS Lung ultrasound scores at the end of surgery were significantly lower in the intervention group compared with control group (median [IQR], 7.5 [6.5 to 8.5] versus 9.5 [8.5 to 13.5]; difference, -2 [95% CI, -4.5 to -1]; P = 0.008). The intergroup difference persisted in the postanaesthesia care unit (7 [5 to 8.8] versus 10 [7.3 to 12.8]; difference, -3 [95% CI, -5.5 to -1.5]; P = 0.005). The incidence of atelectasis was lower in the intervention group compared with control group at the end of surgery (35 versus 80%; P = 0.010) but was comparable in the postanaesthesia care unit (40 versus 55%; P = 0.527). CONCLUSIONS The use of ultrasound-guided recruitment manoeuvres improves peri-operative lung aeration; these effects may persist in the postanaesthesia care unit. However, the long-term effects of ultrasound-guided recruitment manoeuvres on clinical outcomes should be the subject of future trials. TRIAL REGISTRATION ClinicalTrials.gov (NCT03607240).
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50
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Park M, Jung K, Sim WS, Kim DK, Chung IS, Choi JW, Lee EJ, Lee NY, Kim JA. Perioperative high inspired oxygen fraction induces atelectasis in patients undergoing abdominal surgery: A randomized controlled trial. J Clin Anesth 2021; 72:110285. [PMID: 33838534 DOI: 10.1016/j.jclinane.2021.110285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE We evaluated the feasibility of use and effects on postoperative atelectasis and complications of lower inspired oxygen fraction (FIO2) compared to conventional oxygen therapy. DESIGN Single center, randomized clinical trial. SETTING University hospital, operating room and postoperative recovery area. PATIENTS One hundred ninety patients aged ≥50 with an American Society of Anesthesiologists physical status of I-III who underwent abdominal surgery with general anesthesia. INTERVENTIONS Participants were randomly assigned to either the low FIO2 group (intraoperative: FIO2 0.35, during induction and recovery: FIO2 0.7) or the conventional FIO2 group (intraoperative: FIO2 0.6, during induction and recovery: FIO2 1.0). MEASUREMENTS The primary outcome was postoperative atelectasis measured with lung ultrasonography at postoperative 30 min in the post-anesthesia care unit (consolidation score: each region 0-3, 12 region, total score range of 0 to 36, a lower score indicating better aeration). MAIN RESULTS Seven patients in the low FIO2 group were omitted from the study due to changing FIO2 during intervention (7/95 (8.4%) vs. 2/95 (2.1%), p = 0.088; low FIO2 group vs. conventional FIO2 group). Overall, atelectasis was detected in 29.7% (51/172) of patients 30 min after surgery by lung ultrasound and 40.1% (69/172) of patients after 2 days after surgery by chest X-ray. The scores of lung ultrasonography and the incidence of significant atelectasis (consolidation score ≥ 2 at any region) were lower in the low FIO2 group than in the conventional FIO2 group (median [IQR]: 3 [1,6] vs. 7 [3,9], p < 0.001 and 17/85 (20%) vs. 34/87 (39%), RR: 0.512 [95% CI: 0.311-0.843], p = 0.006, respectively). The incidence of surgical site infection and length of hospitalization were not significantly different between the two groups. CONCLUSIONS Based on our findings, decreased inspired oxygen fraction during anesthesia and recovery did not cause hypoxic events, but instead reduced immediate postoperative atelectasis. The use of intraoperative conventional higher inspired oxygen did not afford any clinical advantages for postoperative recovery in abdominal surgery.
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Affiliation(s)
- MiHye Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Kangha Jung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - In Sun Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Eun Jee Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Nam Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, South Korea.
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